Sleep issues 4 year old

[Itsalljustapuzzle]

Hi. I am currently sat up watching my nearly 5 year old sleep because he is always exhausted despite sleeping seemingly well (cannot cope with school, 30 mins swim and nothing else in the morning = 2 hour nap, this type of exhausted). Doctor isn't sure if it's some sort of parasomnia or sleep related seizures disrupting his quality of sleep, or something completely different. There are no known nutrient deficiencies, he has had numerous blood tests to rule these out. For context, I suspect he has some sensory issues and there are definitely some fixations with interests, he is very sensitive to stimulation but not diagnosed as ND.

Please, could anyone tell me:

Has anyone experienced either of these?
Is it common for children to be rubbing the mattress/sheets/their own body with their hands and feet in their sleep?
Is it common for children of this age to sit up / eyes open / look around and go back to sleep but have no recollection?

I'm not sure what I'm supposed to even be looking for or how to help him. It's been going on years but I've always been told he's just a tired child and I've kept pursuing it (and been laughed at by professionals more than once, sadly).

Thank you.

You posted this at 2.05am

are you in the uk?

Could you ask to have his mitochondria tested? I would also ask for a blood test to see if your DS has had any viruses recently. Ask about Epstein Barre/ glandular fever. Ive had a lifetime of being told its all in my head only to finally have that test in my 40s.
Does he have any other symptoms of Fibromyalgia or ME? As someone who had fatigue issues that started in late childhood I would recommend as much rest as possible. Don't listen to ANYONE if they recommend pushing through it or more exercise.

Conserve energy and recognise that after an event like a birthday party or something thr effects might be felt immediately, or a few days later.

@Haveyounotnoticedyes I am, I was up watching him sleep.

@OhMaria2thank you for these ideas, I’ll raise these with his doctors and I will look into it more. You’re right about fatigue and needing days of rest after, it’s hard for other parents around me to understand but I have to enforce it or he just suffers. It’s so tricky for him.

I’d hope he was fast asleep and exhausted at 2.05am!

He’s asleep but sitting up and looking round, feeling the bed with his hands, rubbing his feet together, pushing his feet against a wall. He doesn’t remember any of it. I’m trying to figure out if this is low quality sleep or if it’s normal and there’s a bigger issue at play.

Gets up around 6:30/7, chill out morning with a couple of books / breakfast / pottering about, absolutely exhausted and can’t concentrate on a thing by 9.

He attends school… he’s managing the day? Not falling asleep at his desk?

@Fridgemicro no he doesn’t go, after 5 hours of preschool last year he spent the next day (sometimes plus another day) laid around saying he was too tired to get up, wouldn’t play, too tired to eat at tea time. His dr said understandable to start him later as he isn’t CSA until Sept 2026. 90 mins play date with or without me there and he’s done in, starts laying around and can’t join in properly, we leave and he sleeps! Never come across it before.

So what does he do all day if no pre school or school?

Does he snore/have trouble breathing at all? My LO had obstructive sleep apnea and was very unsettled at night and exhausted in day, although not to this degree.

Could the sitting-up thing be night terrors (or something similar, but not ‘terrors’ obviously)?

Could he have sleep apnea? Have you seen his chest dip down when sleeping, does he snore, are there pauses, then small gasps in breathing?

Have you got anything that can monitor sleep, like a Fitbit, which may give you more information on what is happening?

@Atorwavejust as if he’s home educated, we do short bursts of maths, phonics, learning about the world, trips out to see friends either to clubs or the park or home ed groups etc. Just has to sleep once or twice for several hours in between what we are doing and nothing can last long.

@BrbreezeOccasionally snores, but it’s not consistent, not even every night. Does sleep apnea cause snoring all night?

@SundayMondayMyDayI have never noticed his chest dip or pauses in breathing, but I’ve been watching him sleep loads and videoing him if I’ve managed to catch him doing something and he’s just frequently ‘doing’ something like sitting up or tickling his own face or trying to get some sort of sensation to his feet. I’ve got a fitness watch, it never entered my head but what a great idea, he could wear it for bed and I could try get some data that way?

Thank you all for replying, I’ve been down so many rabbit holes and it’s so hard to figure it out without other input (which sadly has been lacking, but please know I’ve been trying like mad and it’s just such a puzzle everyone sort of shrugs and moves on!).

Good luck with it - my 4 year old (many years ago) was always hugely grumpy / screaming / refusing to eat at breakfast (major meltdowns)… it turned out he had enormous tonsils and adenoids and had really bad sleep apnoea. We caught it in a video - he had surgery, and it massively improved.

Could you put a detailed list of symptoms and things that happen into ChatGPT, and see if it can come up with any other ideas for what might be the cause, or of things you could try?

I would invest in cameras and film him sleeping rather than sitting up all night. There's the added benefit of being able to replay stuff and watch it in more detail and also show medical professionals. And obviously you can sleep too!

Sleep apnoea can cause snoring, but it can just be episodes of snoring, doesn’t need to be all night.

If you could give him extra pillows to sleep with, so he is more propped up, that may alleviate things (if it is a sleep-breathing / apnea issue)..

so he will be starting school after the Christmas break? Does he have any siblings?

@Atorwaveno, next September is when he is CSA. School isn’t really the issue though, he struggles enough with staying awake when he’s not there. He wouldn’t last the full day in school at the moment without either falling asleep or completely exploding with dysregulated, exhausted behaviour and that would just be after one day. While it’s hard, although he’s doing great with how things are at the moment.

Thank you very much for the tips @SundayMondayMyDayand @NuffSaidSam. Funnily enough I’ve bought a camera this morning to save my sleep! Then I might catch more happening too, which I suspect is in the earlier hours when I’m in a deeper sleep. The apnea thing definitely is another avenue to explore.

He is still very young. At that age mine was still having a 2 hour nap in the afternoon.

rather than sporadic naps, I’d formalise a proper daytime nap routine. So get him up, dressed and doing something every day at same time, hearty food, lots of fresh air, proper nap during the afternoon etc etc.

Does he have a bro or sister?

Interestingly, some of my dc were very early to give up naps (before / around the age of 2), and there was an awkward phase of being too tired to cope, but not able to nap - which passed in time.

I wonder whether a contributing factor might be that he is now ‘established’ in a ‘routine’ where he is getting a significant portion of his sleep requirements from a couple of naps, which are maybe 2-3 hours long, each? Is this what you mentioned upthread?

I am not sure how much sleep a child needs at the age of 4, but it may well be only around 9-10 hours, and if he is consistently used to getting up to six hours of that during the day (via a couple of long naps), then that means he has very little ‘sleep pressure’ left to help him get to (and stay) asleep at night. If he is getting 6 hours during the day, maybe he only needs another 3 hours (overnight), but you are expecting him to sleep for a full night.

If it was me, I would aim to re-structure his sleep, so that he is just getting it at night-time. This will probably need to be a gradual shift, done by gradually reducing and cutting out the naps he has, and trying to get consistency in routines for bed-time, and adopting good ‘sleep hygiene’ measures. I think various sleep experts I have read say that you can adjust things by 15 mins at a time, and do that for a few days, then shift it again by 15 mins. But I suppose you can see how it goes, and so it as quickly or slowly as dc needs. I would try to reduce the naps in time, and definitely address / remove the later / afternoon nap first, as that is probably making it impossible for him to sleep at night.

A sleep book I read a few years ago (for adults) said that during the day, ‘sleep pressure’ builds up, which is the brain’s need to sleep, and that it is this mounting sleep pressure that helps us fall asleep and stay asleep at night. The book suggested that if an adult has (even a short one) a nap too late in the day, then it can dissipate the sleep pressure and cause problems getting / staying in sleep.

Have you put the fitness tracker on him? Does that tell you anything? Mine says what level of sleep I am in so deep, light, REM and how much I am awake. I have a Fitbit.

Ds used to have night terrors so would always wake himself up yelling but have absolutely no recollection the next day despite appearing to be awake and bolt upright and sometimes getting out of bed. When he was a teen he installed an app on his phone to record his sleep and then he heard himself yelling which he found both funny and unsettling. He finds it very hard to drift off to sleep, he is now 22 and still does the yelling but less frequent.

Your son is clearly getting some kind of feedback from the feet rubbing. Maybe a weighted blanket might help make him feel secure.

But he definitely needs to be referred to a sleep specialist as this is not a typical sleep issue.

@Lilaclove1Yes he has a 2 year old brother (who ironically, doesn’t need that much sleep and doesn’t really nap!). So currently we are up at 7, nap 11-1, sleep at 7 again and that is an exhausted ‘sleep as his head hits the pillow’ sleep at 4.5 year old! If we ever drive anywhere, he’s asleep by 9am and has another hour or so around 2pm, I could still transfer him to a pram!

@SundayMondayMyDayyou’re definitely onto something with him being too tired to cope. While I can’t see his sleep being unhealthily high (although I wish I slept for 14 hours a day!), he certainly struggles to stay awake even within a couple of hours of waking. He either has a 2 hour sleep in the middle of the day or 2 shorter naps either side if we go somewhere further afield, that is max once per week. I can completely see him being wakeful if he’s slept too much in the day, especially because then he wouldn’t be able to stay asleep quite as well would he, but I don’t think he’s actually waking up (I thought he was, but the doctor is saying he’s asleep during these periods that I think he’s alert, although they haven’t actually seen him sleep so I don’t think they know either). I’ve requested a sleep study but I can see their point, he likely wouldn’t sleep well away from home at 4yo.

@LaneCaneCandyI’ve put mine on him, he woke and took it off last night so I’m giving it another go tonight! If it doesn’t work, I think you can get other sleep-tracking devices that I may look for. That’s interesting about your son, isn’t it odd that they don’t remember at all. Thank you for sharing. Weighted blanket also a great idea, the pressure may help with the feet issue.

Thank you everyone- these are all things I have been struggling to make sense of by myself and it really is helping having ideas bounced around.

@LaneCaneCandygot the full night’s sleep with watch on, 59 mins of deep sleep recorded, 24 mins awake, the rest was light/rem sleep. Unsure of accuracy but definitely no wonder he woke tired!

I tend to use it as a guideline so sometimes it says you slept great, actual data - 8hrs 12 mins which was 2 hr awake, 1 hr 40 REM, 3hr 37 light sleep, 1hr 19 deep sleep but then says your daily readiness is low and 15!

Mine is a fitbit so shows the "benchmark" graph and whether I am within the normal guidelines for my age so there is a target box and it shows if I have reached it or not and how far into it I got.

Sleep clinics offer sleep studies at home where a monitor is attached to their foot or big toe so don't let that put you off going forward. They might also want to see the footage of your son if you record him on a camera. Something is not right and he needs to be able to function so it is always worth pushing forward and asking to be referred to a clinic.

My 4yo is on waitlist for autism and definitely has sensory issues. Horrendous sleeper since day 1. He also sits up and looks around and needs to be laid back down to bed , this happens maybe ever 60-90 minutes every single night. One desperate night recently bought him a £120 weighted blanket (!) which maybe helps a little

How long did he attend nursery for before you pulled him out?

@clinellwipethis is very interesting. I’ll have a look for the blanket.

I tried the watch thing again and it said out of 11.5 hours sleep, only 34 mins was deep. While I think it is surely inaccurate, I wonder if it’s comparable to the day before as they are both his data. Tried no nap yesterday (was really tough from about 1pm ish) and he went to bed early and his sleep was far worse, but could be because it was a one off try. Can’t believe I’m still thinking about / trying to solve sleep nearly 5 years in!!

@Conthin12he went for a year, initially mornings, then alternate full days, then nursery recommended back to mornings as he was struggling to cope with the stimulation and exhaustion, but it wasn’t hugely better because he was already shattered before he’d even got there.