SLEEP 401: What Parents need to Understand about Sleep after Trauma ~ The time I advised a parent not to take their child to the doctor.
Children not sleeping well is an issue. It is an issue for them and often quickly becomes an issue for others in the family home too – especially if the ‘sleep challenge’ is seeming to be an ongoing issue rather than just a blip.
Many of the children who I have worked with struggled with sleep. Some of them REALLY struggled with it, to the point of long-term not sleeping for more than an hour or two at a time for weeks or months on end.
When one Dad brought his daughter for her third play therapy session, he announced to me he wanted to take her to the doctors. She was not sleeping and she needed some tablets and could I ‘have a word’. As I never speak about important things with parents in front of their children, I waited until we were safely in my play therapy room and well into the session before mentioning it to her.
She knew she was doing all sorts of things to put off closing her eyes.
She had a reason.
She didn’t want to go to sleep.
Sleep meant not being in control of her thoughts.
Sleep meant NIGHTMARES.
She described one of the nightmares to me.
I could fully understand why she would not want to go to sleep.
Sleep means being out of control.
Many, many children (and adults) who have experienced trauma in their life (particularly those who have experienced physical, sexual or emotional abuse) often find that they have nightmares that feel extra horrible. They are a way of the subconscious brain ‘re-experiencing‘ the trauma in order to process it in the hope of making sense of it. The moment(s) of trauma was very likely a moment when the child was totally out of control (dis-empowered) and sleep is now another traumatic experience for them when they feel out of control, and something bad (nightmares) happens.
Going to the doctor for not sleeping, would put a child in a room with 2 adults and depending on the particular doctor, this is often an overwhelming and dis-empowering experience in itself. If the child was given sleeping tablets, then they now have drugs to dis-empower them again and make them sleep, the very thing the child is trying to avoid.
I spoke to the Dad on the phone and made these 3 suggestions:-
- I was only just starting to work with her. Let’s give it some time and see how things go with the play therapy, before turning to any additional interventions. These type of nightmares don’t go away with a simple ‘there’s nothing to worry about’, lava lamp or ‘sleep buddy’. The child who has experienced trauma will likely need safe and effective non-directive creative therapy to process what happened (even if they were too young and don’t remember it). With a qualified and experienced practitioner this is exactly what Play Therapy does.
- It was really important at this stage for the girl to have her voice heard. For this reason alone it would be important to hear her when she says she doesn’t want to go to the doctor and she doesn’t want sleeping tablets. Hearing her is a simple way to empower her.
- She had started doing many regressive behaviours at bedtime, needing a blanket, wanting a story and drink, wanting old teddy bears, wanting cuddles and sucking her thumb. I helped her dad understand this is very normal in these circumstances, and helped him see how these behaviours related to the age she was abused. Although she was actually in double figures, I gave him ideas to help him respond to her as if she was 3 again – to give her the 3 year old support and nurturing she (still) needed.
As our therapeutic relationship developed, and when she was ready, over time she was able to reprocess her traumatic experiences. The theme and subject of the nightmares were played out in her sessions and resolved. And with continued guidance on how best to parent her through the process (particularly around bed time) her sleeping got better too.
I totally understand that parents (who often become sleep deprived themselves when a child is persistently not sleeping), just want a quick fix, and if the child is keen to go to sleep then maybe a trip to the doctors might help for a time (although don’t go until you have already properly tried the suggestions in the other Sleep Series articles – listed below in case you missed them!). HOWEVER, if your child is not wanting sleep, and rejecting any real help to get to sleep, it may well be because of trauma-related nightmares.
If so, what they need is understanding, empowerment and the chance to heal at their own pace.
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The other posts in the SLEEP SERIES are here:-
Sleep 101 – 3 Essential Foundations for a Better Bedtime