Bedtime help.

[Bedtimeanxiety]

DS(9) has additional needs, including anxiety about being left. Since his anxiety became severe he has slept in our bed - fine we'll deal with that later. He also can't fall asleep without me or DH laying with him. I really need to tackle this. He sees CAMHS but they aren't helpful on this matter.

Please don't say leave him and he will eventually fall asleep. He gets himself in such a state it's not safe to.

Do you feel you need to tackle it because of what other people think or because you think he should be able to fall asleep by himself?

I need to tackle it because it takes a long time for DS1 to fall asleep and he wakes in the night and needs help to settle then too. It's not healthy for DS to be so dependent on me (it is mostly me, he doesn't always settle with DH). Getting DS to sleep eats into time DH and I could be using to do things around the house/getting everything ready for the next day. As it is now they need doing afterwards and DH is exhausted.

The situation that prompted me to raise it with CAMHS was DH was away with work and I needed to help DS3 who was being sick but DS1 was exhausted and couldn't sleep because I couldn't lay next to him. DS1 ended up hitting his head against the floor crying. I felt DS3 suffered because I couldn't give him the attention he needed, DS1 suffered because he was so distressed and the whole night left me feeling down.

I don't care what others think, we do plenty of things others raise their eyebrows at in order to reduce DS1's anxiety.

That sounds really tough, do you have any way you could think of to reduce his anxiety about getting to sleep on his own? I don't have any ideas other than TV which is probably a bad idea in reality. I hope you can sort it out as it sounds really stressful.

We have a really good routine and always have had. To help with his sleep issues in general we have tried:

• A night light, leaving the main light on, leaving the hallway light on. None make any difference.
• A 2 way monitor so he can talk to us. He talks to us and cries/self harms until we go to him or he comes to us.
• Giving him a teddy of mine. Absolutely no difference.
• A doodle/worry book and doodle pillowcase. Not specifically for getting to sleep, but he spends all night drawing/writing even when we are with him.
• White noise and dream pad pillow. He hated both.
• Music. He hates it but it was suggested and worth a try.
• Ear plugs. During the day ear defenders help but he couldn't tolerate the ear plugs.
• Relaxation, meditation, brushing. First doesn't help with his sleep issues. Second he isn't keen on and doesn't engage brilliantly. Last he can't tolerate.
• Medication - which has improved the quality and quantity of sleep he, and consequently everyone else, is getting but I feel it could still be better.
• Talking to him during the day about night time. He has very poor insight into his difficulties and struggles to put things into practice.

I tried a version of gradual retreat (in that I didn't not respond to him because that would distress him but told him I loved him and it was bedtime) but couldn't carry on with it because DS's anxiety shot through the roof when I didn't hold his hand or let him lay on my arm.

Bumping in the hope someone has a suggestion we can try.

Please don't say leave him
You must surely realise that at some point that is going to be the only option. The fact is this is about control, your 9yo has complete monopoly of you at bedtime to the detriment of the you and the rest of your family. You need to tackle this all at once don't drag it out. Has he his own room or does he share with a sibling? If you can afford to, let him pick some bedding or decor for his room. Tell him that this is where he is going to sleep now because he is too old to sleep with you. Keep it simple and factual. Put him to bed, stay with him but not on the bed. Sit at the bottom of the bed with your back to him. This way he can feel safe that you are there but you aren't interacting with him. The next night sit a bit further away. Continue to move further away every night until you no longer are in his room. If he gets out of bed put him back and resume your seat, don't talk to him at all.

DS does have a bedroom of his own, with decor and bedding of his choosing. But it really isn't as simple as that. He has complex needs including mental health problems and has significant CAMHS involvement. He is emotionally delayed and fragile.

Sitting with my back to him and ignoring him would result in his anxiety levels rocketing. It would enhance his feelings of rejection and people leaving him. I defy any parent to sit and listen to their child become so distressed they vomit and display self injurious behaviour whilst ignoring them. He wouldn't cry and then self settle he would end up seriously hurting himself.

I wasn't suggesting that any of it would be simple. I also have a child with complex needs and most things are rarely simple. But it is our job as their parents and carers to ensure the best for them. Will you continue to co sleep when he is 13 or 15 or 18 or 21? At some point you will need to tackle it head on and it won't be easy in fact it will probably be very upsetting but for his own good it must be done.

If co sleeping is what it takes to get DS to 13/15/18/21 then so be it.

I can not ignore him when he is hitting his head against the wall or floor. I can not ignore him when he is hitting himself. How would I explain how I ignored him while he injured himself to the point of needing medical attention. I can not let him get himself so distressed he e.g. tries to throw himself down the stairs as he has tried previously. It would be neglectful. So how would you ignore him?

You wouldn't make a child walk on a broken leg because it would make the physical condition worse. Ignoring DS would increase his anxiety which in turn has knock on negative effects on other physical and psychological health conditions.

Sorry mumunderthemoon that was harsh of me. You touched a nerve. We will do everything possible to get DS to 13/15/18/21 because many with a medical condition he has die before then.

Not sure how I'm meant to respond really. You didn't previously mention that his condition was life limiting and you wanted advice on changing your situation. I'm sorry I struck a nerve. Perhaps you should discuss this with a medical professional who has all the info.

Again, I apologise for how I responded.

As I said in my OP I have spoken to CAMHS who weren't of much help only suggesting things we had already tried. I didn't mention it other than to say DS is complex and has additional needs because DS's sleep issues aren't related to his physical conditions and his medical teams would pass back to CAMHS on this. DS is relatively healthy now from a physical POV and will hopefully continue to be but we are acutely aware that some with his condition die young.

I do want advice on how I can get DS to fall to sleep his own, but as I said just leaving him when distressed isn't safe - how could I ignore his self injurious behaviour? How would I explain that?

That's why you need medical support. Surely he has realised that if he self injures you come running. Has he ever really hurt himself doing this? I mean broken bones,bruises or bleeding? One of the mums at dds school was told to allow her child to vomit. Then go in clean him up without talking and put him back to bed.

Unfortunately yes, he has. He almost always has bruising from self harming. He has required stitches &/or glue to close wounds a few times, not to mention the cuts that don't need this. As well as 2 broken teeth (baby ones luckily), his arm and chipped a bone in his ankle on separate occasions. For a long time he needed 1:1 24/7, narrowly escaping a CAMHS inpatient admission, if he had been older he would have been, as it were we coped with him doing day visits some days. We are in a better place now, but there are times he reverts to the psychological position he was in a few years ago. Would ignoring with when distressed undo all the hard work?

Where do I go for medical support when specialist CAMHS teams (we've seen more than 1 as DS has been passed along) do not have more suggestions? Is there a sleep team that accepts complex patients because the sleep clinic refused a referral?

When DS is at the point of self harming then he is not capable of thinking if I do X, Y will happen. At that point he is in such a state he is not capable of rational thought. He acts on instincts as part of his fight or freeze responses to stress (he doesn't show a flight response and rarely a fawn response). Though maybe unconsciously, yes.

With the vomiting alone I can try that, yes.

Sorry, I know I'm not coming across well. I am at a total loss which I know doesn't help anyone.

How do you respond when he self injures? Could you or have you been taught how to restrain him? Then you could walk in calmly and restrain him silently until he calms down and repeat as necessary.

Yes, we have been taught restraint and use it where appropriate when de-escalation isn't working. However, restraint should never be used alone, constant communication should happen while ever someone is being restrained. We use it alongside constant reassurance, acknowledgement of DS1's feelings, distraction if possible and reducing the stressor if possible. We do breathing exercises, which we practice with DS1 when calm, in the hope he can regulate his breathing and relax. For very, very occasional use we have Lorazepam for a severe crisis.