Cortisol and Sleep Disruption

Laura Markham's picture

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Most little ones between 12 and 24 months need 10-12 hours of sleep per night, plus a nap. But many parents find themselves faced with a baby or toddler who becomes increasingly resistant to bedtime and goes through a period of waking earlier and earlier in the morning. How to cope?

The first assessment to be made is how much sleep your child actually needs. Is she waking at 5am (after sleeping since 7pm) because she only needs ten hours of sleep? You can answer that question by evaluating the crankiness factor. Does she seem rested and cheerful when she awakens, and throughout the morning? Or does she seem tired?

Also, has she been happily sleeping for twelve hours in the previous months, but suddenly begins waking after ten hours? That's a clue that she still needs twelve hours, but something is preventing her from sleeping. Of course, all kids' sleep needs change over time, but those changes are generally very gradual

So why does he resist going to sleep at 8pm, even when he hasn't had a nap and is very tired? And what's more, why is he waking up at 5:30am after only 10 hours of sleep, when he's obviously not fully rested?

Almost certainly, he is over-tired. When little ones miss naps or experience stress of any kind, they have to work hard to function. Their bodies go on alert and pump them full of stress hormones like cortisol. Cortisol makes them cranky and hyper-alert, so they have a harder time falling asleep. They stay more tense at night, so when they experience the normal slight awakenings that happen for all of us as we cycle through the phases of night-time sleep, they pop awake, instead of putting themselves back to sleep. For the same reason, they also awaken earlier in the morning.

So what can you do?

  1. Try putting her to bed earlier, at 7pm. It defies logic but if she actually needs the sleep, this will help her catch up, and could solve the problem within a couple of days.

  2. Figure out what's stressing him. Is it separation anxiety? Did you start a new job? Does he need more cuddle time with you? You might want to make sure you're showering him with attention during the time he's awake.

  3. Kids in daycare often have elevated cortisol levels in the afternoon. Those who go to daycare in the morning but are home in the afternoon have normal cortisol levels; the cozy afternoon at home seems to give them time to recover before bedtime. If she is in daycare, you might want to think through other alternatives that would leave her in her own home in the afternoons.

  4. To get past the cortisol build-up in his system and let him catch up on his sleep, you could try a small dose of melatonin an hour before bedtime for a night or two. Even though all indications are that melatonin is completely safe, I would definitely not use it for a baby for longer than a couple of nights, simply because we don't have any research showing what the long-term effect is on babies.

  5. Don't let him watch TV. TV suppresses melatonin production and makes it harder for kids to fall asleep and stay asleep at night.

  6. Invest in blackout curtains so her body will be fooled into sleeping longer. A bright room will lure anyone to wakefulness.

  7. Teach him to put herself back to sleep. Sometimes babies benefit from tools that help them. For instance, you could tape record yourself singing to him. Show him the tape and play it for him during the day. Get a tape player that he can turn on and off by himself and set it up accessible to his crib or bed so he can turn it on when he awakens.

  8. I am not a fan of CIO, but it may be that your child can easily learn to keep herself asleep longer in the morning. Get a CD alarm clock and put her favorite music in it. Start by setting the alarm for 6am. Tell your daughter that she needs to sleep all night. In the morning, the clock will play her music and you will come and get her. If she wakes up before 6am, go in and hug her and tell her that it is still night and she has to wait until the music comes on, and then you will get her. When the alarm goes off at 6am and the music plays, get her up.

    Once she is routinely sleeping till 6am, start adjusting the time by 5 minute increments until she is sleeping until 7 am. I realize that it will seem crazy to let the music wake her on a day when it seems she will actually sleep past 6am, so if you can get one that has a remote, and turn it off if your daughter is still asleep, that is of course the best scenario. Little ones love the reassurance that when the alarm goes off, mom appears, and many seem to regulate themselves to wake with the alarm.

    I need to add that if your child resists this by crying, she is unlikely to put herself back to sleep. I've spoken to many parents who say their kids were easily "sleep trained" who found those methods ineffective in the early morning hours once the child was fairly rested. This method works best once a child can understand what you are telling her.

  9. If you can't find an alarm clock with a remote that you can adjust from outside the room, you could try a visual cue, like a bunny rabbit alarm clock whose eyes open at the time you set. It won't wake him, of course, if he's still asleep, but he can check to see if it's time. These are available at: . Another, less expensive option, is to get a plug-in timer and a night light, and set it to go on at your target time. Tell him that if the light is on, it's morning and time to get up.

  10. Make sure he naps, so he isn't over-tired at night. If you can see he's tired but resists napping, schedule your days for awhile so that he naps in the car while you run errands.

  11. Simply take her into your bed when she awakens at 5:30 or 6am. If you don't want her to get used to your bed, you could go back to sleep with her on the couch. If she is actually tired, she will probably go to sleep with you for another hour. If this works, I regard it as the easiest solution for everyone involved. Early waking is the hardest sleep problem to solve, because kids are somewhat rested and usually just work themselves into a frenzy and can't fall asleep. So if napping on the couch with her gets you an extra hour of sleep, that might be the best you can do for now. This phase will pass.

  12. Don't feed him until what you would consider wake up time (7am?)

  13. For some kids this age, teething is an issue. If you suspect this, from her behavior during the day, you could try some tylenol to see if it helps.

  14. Try reading Elizabeth Pantley's No Cry Sleep Solution for Toddlers and Preschoolers, which is full of helpful ideas.

Wishing you and your little waker a good night's sleep -- Sweet dreams!

Dr. Laura Markham