Imagine this: You fall asleep, cozy and warm, in your own bed. Several hours later, you awake, as you do most nights, but you're sprawled out on the living room floor without a clue as to how you got there. You drag yourself back to bed, only to find yourself in the living room again a few hours later.
Disconcerting? You bet.
This, says a doctor, is similar to how a baby must feel who has fallen asleep safely rocking in his mother's arms only to awaken naturally a few hours later alone in his crib.
"We all learn to fall asleep under a certain set of conditions," says Dr. Richard Ferber, author of "Solve Your Child's Sleep Problems" and director of the Center for Pediatric Sleep Disorders at the Children's Hospital in Boston. "If the routine varies, we may have some difficulty falling asleep."
Sleep associations are at the heart of many children's sleep problems, Dr. Ferber said during a recent lecture here -- the first of two programs for parents sponsored by the Maryland Committee for Children. The second will take place May 28 at Notre Dame College.
Waking up isn't the problem, he said. Not going back to sleep is.
"Sleep is not this single event that you fall into; wakings at night are completely normal," he explained. "The problem is the youngster's ability or lack of ability to go back to sleep."
Children and adults' sleep cycles normally include periods of very deep sleep, periods of lighter sleep with dreams and brief periods of wakefulness.
When babies are 4 or 5 months old, they usually begin to sleep through the night, Dr. Ferber said. After that, "little kids fall into very deep sleep very, very rapidly," and stay there three to four hours. Lighter sleep and dreams occur in the middle of a child's sleep cycle and then deep sleep again before waking.
Often youngsters -- adults, too -- don't notice or remember waking in the middle of the night. But when a child cannot return to the conditions he associates with falling asleep, he stays awake and usually awakens someone to help him.
To prevent this problem, "let the child learn to fall asleep how he will wake up at night. I don't think it's really fair to a child . . . to go to sleep in one setting and wake up and find he's been shifted . . . night after night," said Dr. Ferber.
If the problem exists, it can be corrected -- quickly, he added.
The solution lies in changing a child's going-to-sleep routine, but not in shutting the door and letting him cry himself to sleep. The new routine goes something like this: Put the child to bed, say goodnight, leave the room, Dr. Ferber said.
The first night, if the child cries, a parent may return after five minutes, then if the crying doesn't stop, wait 10 minutes before going back, then 15. On the second night, wait 10 minutes before returning, then 15 and so on.
Under no circumstances, said Dr. Ferber, should a parent pick up the child or resume behavior -- such as rocking or back rubbing -- associated with the old routine. He should stay only a couple of minutes to reassure the child, and himself.
This routine should be repeated when the child wakes in the middle of the night, he explained.
"Your child will begin to see after only a few minutes what you have planned. He finds out quickly that you are still around and responsive to him," Dr. Ferber writes in his book. "Eventually he will learn it is no longer worth it to cry for 15 or 20 minutes just to have you come in briefly. . . . At the same time he is learning how to fall asleep alone and in bed."
Dr. Richard Ferber said there are many reasons children have trouble sleeping. Among the most common are:
* Excessive feeding in the middle of the night.
* Lack of limits set by parents, allowing children to be in control of bedtime.
* Psychosocial problems -- such as alcoholism, financial worries and divorce -- that interfere with proper nurturing during the day, and make setting limits at night inappropriate.
* Medical problems, such as ear diseases and heartburn.
Studies show that 25 to 30 percent of all children experience "significant problems" falling or staying asleep, Dr. Ferber said. He believes most of these problems have solutions.