Sleep…


So, as I mentioned in my last post, S has been having some major problems sleeping lately.

At first I thought it was a random one-off thing. There was a night back in June when she couldn’t sleep and woke me up around 11.30pm to say she couldn’t sleep. I thought maybe it was anxiety about a sleepover she was having the next day, but then she started getting really upset and anxious and asking me if all the doors and windows were locked.

It was a really odd thing to say out of the blue, and I immediately started to wonder if something had happened to trigger a bad memory or something. Kids with trauma in their early years often have repressed memories and sometimes they can pop up out of the blue, or they might feel scared but not be able to really articulate why. I tried to ask gently if there was any particular reason why she was feeling scared and I went to check all the locks etc again for her to reassure her. She said she was worried someone was going to break in. She got more and more distressed and although I tried to reassure her and offered to let her read for a bit until she felt sleepy she was working herself up into a state and frankly by this point it was 1am and I needed to get to bed myself. So I asked if she wanted to go to sleep in my bed, which she did, but she tossed and turned for a couple of hours before finally nodding off around 3.30am.

She was pretty embarrassed about it in the morning, though I reassured her that it’s ok for kids to climb into their parents’s bed whenever they feel scared no matter how old they are.

Over the next month I noticed she was doing a lot of pissing about in her room after she was supposed to go to bed. I initially put it down to her being 11 and taking the piss so we had words a few times about lights out and going to sleep etc. She had done a bit of this in the early months of living here but I hadn’t called her on it so much in the beginning as we were all getting to know each other and settling in. It hadn’t occurred to me that she might genuinely be having trouble sleeping I just thought she was taking the piss!

However we had a few more tough nights a few weeks later, where she would wake me up around 12.30am and struggle to get back to sleep. I suggested she read for a while until she felt tired, but she woke me up again at 2am in floods of tears as she was so exhausted and just couldn’t sleep. She came into my bed again but once again tossed and turned until at least 4am.

It happened a few times when she seemed to wake up around midnight and be unable to go back to sleep until 4am or so. She also seemed to be really struggling with falling asleep in general, and it occurred to me that rather than pissing about at bedtime because she’s 11 it was actually because she genuinely can’t sleep.

Now, there are lots of theories about trauma, abuse and neglect in children and the physiological impacts on the body. (I can picture my sceptical friend rolling his eyes as I type this so I will try to paraphrase the scientific elements as best I can without drifting into hokum….). I am a member of a number of adopter networks and groups and I know first hand that many, many traumatised children struggle with sleep and bedtimes. Some people think it is simply an issue of not being able to relax enough to switch off and sleep, as many traumatised children are in a constant state of fight or flight, or hypervigilance, and their brains struggle to allow them to relax into a state of safety in order to fall asleep. We are at our most vulnerable when asleep or falling asleep so if you have grown up around lots of sudden and unexpected violence, (often at nighttime) and you never know when the next loud bang or crash might come from, your brain stays vigilant and it can be very hard to allow yourself to be vulnerable enough to fall asleep.

There is also some evidence, (although I have struggled to understand the science in detail as the peer-reviewed papers tend not to be written in plain enough english for me to grasp), that shows that when children are in a constant state of fear during early years development, their brain produces cortisol during the fight or flight response, and if it is prolonged over months or years, the over-production of cortisol can cause physiological damage within the brain and can interrupt other key developmental processes. This can have knock-on effects such as reduced seratonin, oxytocin and melatonin levels in the brain, which can remain into adulthood, and these chemical and hormone imbalances in the brain can lead to other problems. Most commonly it leads to issues such as PTSD/PTSS, depression, anxiety, and sensory processing disorders (SPD), where the brain cannot correctly interpret signals from the body and nerves. Children with SPD cannot process certain senses properly, such as an under-developed sense of heat, touch, smell, taste etc, or over-developed senses and struggle with the feeling of fabric on their skin, tastes, textures etc.

(Apologies to any scientists out there who feel I have butchered the science here – this is a simplified version of what I have understood from the journal articles I read but I am willing to be proven wrong!).

Now as my very sceptical friend would point out, you can’t go assuming your child has a serious medical problem or developmental delay just because they are pissing about at bedtime like most kids do at that age (I certainly did!). And to be fair on at least one occassion we discovered that she had accidentally watched a scary video on YouTube and it had freaked her out at bedtime. But on the other hand sitting helpless on the bed night after night as your kid weeps with exhaustion because they can’t sleep for hours and hours is certainly an indication that something is really wrong.

I know many adopters who have had these kinds of issues and problems, and many of them swear that being prescribed melatonin has saved their life (a hormone that helps to induce sleep). However it needs to be prescribed by a specialist paedeatrician and cannot by issued by a GP so it’s not a solution we can easily try (I assume it would be months just to get a referral appointment to try and discuss it).

And so in the meantime I took to the internet to investigate alternative options. Despite not being so flush with cash these days I dropped about £250 on various gadgets and gizmos – a weighted blanket, a fancy nightlight that emits a specific red light approved by NASA to help encourage melatonin production, a diffuser to emit sleep-enhancing essential oils, an app to read sleepy bedtime stories to her if she is awake at 2am, etc. We have done lots of reading on Sleep Hygiene and already have a reasonably stable bedtime routine involving no screens 30 mins before bed, quiet reading time in bed to wind down, regular and predictable bedtimes, and a Lumie sun clock to simulate sunset as she goes to sleep to improve melatonin production.

And while all this was happening another piece of the puzzle fell into place.

Back in winter S wouldn’t wear a coat most of the time, claiming not to feel the cold, yet back in May/June we had quite a few arguments about her wanting to wear her hoodie to school when it was over 30 degrees. At home she loves to be snuggled under a fuzzy blanket on the sofa, no matter what temperature it is, and she refused to give up her massive big duvet even when it was baking hot and I tried to get her to use a sheet at nighttime instead. It had occurred to me a few times that it was clearly more a sensory-seeking issue of liking the feel of being safely snuggled under a blanket than being cold, but I hadn’t quite pieced everything together.

Then she had a day out at a local charity where they were out in the sun all day, and it was during the heatwave so it was super hot. She insisted on wearing her hoodie in the morning, but when I picked her up in the afternoon she was still wearing it, and as she got into the car her face was bright red and dripping with sweat. I told her to take her hoodie off at once as she was clearly overheating badly, but she just looked at me in confusion and said “I’m not hot though”. She genuinely didn’t feel hot at all, (although her skin was incredibly hot to touch) and she was so confused when I ordered her to take it off (I was seriously worried she might have heatstroke if she had worn it all day in that weather).

It occurred to me that if she genuinely doesn’t know her body is too hot then all those nights she lay awake unable to sleep may have been her body overheating under an enormous duvet and she was not able to recognise the signals coming into her brain. So I confiscated her duvet, despite massive protestations, and once the weighted blanket arrived I think it really helped to meet her sensory needs without overheating.

A few times since then myself (and others) have noticed her radiating heat and feeling incredibly hot to the touch and she literally has no idea. So I think I might need to support her in managing and regulating her body temperature to help her learn how to do it for herself. And I am desperately trying to find more articles on thermo-dysregulation and trauma in children but there seems to be a lot less research on this specific area. Anecdotally I know many adopters who say their kids have similar issues (eg kids that will happily get into a bath that’s way too hot and not notice even as their skin turns bright red etc). However I haven’t been able to find enough peer-reviewed scientific evidence to support linkages with thermo-regulation and trauma so that will have to remain a theory for now.

I’ve called the doctor and asked for a paediatric referral to discuss an assessment for SPD and/or prescription for melatonin, and in the meantime I am waiting to see if all the other sleep hygiene measures we have put in place (night light, essential oils, weighted blanket, no duvet, sunset clock to slowly dim the lights as she reads in bed etc) help at all. It’s hard to know, as we’ve been away on holiday, and are heading off camping soon, so we can’t regulate sleep patterns all that easily at the moment, and as we get closer to the start of term the anxiety of starting a new school will no doubt kick in as well.

But hopefully if we throw enough mud at the wall some of it will stick!

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