How much sleep do preschoolers need?

Preschoolers, typically ages 3 to 5, need 10 to 13 hours of sleep each night (including naps). Getting enough sleep improves their overall health and behavior, supports a stronger immune system, helps kids perform better in school, and improves memory and overall mental well-being.

Common pediatric sleep disorders in preschoolers

Understanding the most common pediatric sleep disorders can help parents and caregivers recognize the signs early and seek appropriate support. Here are some of the most common sleep disorders in preschool-aged children:

Insomnia

Insomnia refers to difficulty falling asleep or staying asleep, which results in not getting enough quality rest and feeling tired upon waking. In children, insomnia can be caused by anxiety, poor sleep habits or hygiene, or overstimulation before bedtime (like excessive screen time.)

If your child has insomnia you may notice:

• Excessive fatigue, grogginess, or irritability during the day

• Frequent middle-of-the-night wake ups

• Difficulty falling asleep

• Early wake-ups

• Trouble concentrating or focusing on tasks 

• Behavioral issues 

How to manage insomnia

• Consistent bedtime and wake times on weekdays and weekends.

• Implement a relaxing bedtime routine.

• Avoid screen time at least one hour before bed.

• Prepare a comfortable sleep environment with minimal distractions.

• Put your child to bed drowsy (still awake) to help them learn to fall asleep on their own.

• Address any sources of anxiety like school, social, or family issues).

• Teach your child deep breathing exercises and mindfulness techniques.

• Encourage therapy, if relevant. 

• Identify and manage any underlying conditions such as asthma, eczema, ADHD, or sleep apnea.

• Review medications with your child’s pediatrician to see if they are affecting sleep.

Obstructive sleep apnea

Obstructive sleep apnea (OSA) is a condition where a child’s breathing is paused during sleep. Breathing pauses (apnea) last about 10 to 20 seconds and are caused when a child’s airway becomes partially or completely blocked during sleep, usually due to enlarged tonsils or adenoids. These pauses reduce the body's oxygen levels, which the brain interprets as a threat, which wakes up the child leading to disrupted, low-quality sleep. 

If your child has OSA you may notice:

• Loud breathing 

• Snoring

• Sinus congestion  

• Excessive fatigue, grogginess, or irritability during the day.

• Behavioral issues 

How to manage OSA

OSA often requires medical intervention. If you think your child might be affected, talk to your pediatrician. Common treatment options include removing the tonsils and adenoids (tonsillectomy and adenoidectomy), using a CPAP machine to help with breathing during sleep, or using nasal steroid sprays to reduce airway inflammation.

Sleepwalking

Sleepingwalking occurs when children are in deep sleeps. “This is a type of parasomnia where a child may sit up in bed, walk around, or perform other complex behaviors while still asleep,” explains Ellsworth. “It often occurs in the first third of the night during deep sleep.”

Children who sleepwalk may have a blank or glassy-eyed stare, and while they might respond to others, it can be very difficult to fully wake them. Most sleepwalkers return to bed on their own and typically have no memory of the episode the next morning. Sleepwalking often runs in families and can occur multiple times in a single night. While sleepwalking itself is harmless, it can be dangerous if the environment causes injury (like stairs or tripping) or if the child can leave the bedroom or house. 

How to manage sleepwalking

• Create a secure sleep environment to avoid accidental injuries, like locking doors and windows, using childproof locks, blocking access to stairs, and removing breakable objects. 

• If sleepwalking episodes are frequent and occur around the same time each night try scheduled awakenings. Gently wake your child about 15 to 30 minutes before their usual sleepwalking time. Let them fully wake up, then fall back asleep. This simple routine can help shift their sleep cycle and reduce sleepwalking. 

• Since sleepwalking is more likely to occur when a child is overtired or sleep-deprived, improving overall sleep may prevent sleepwalking. Keep a consistent bedtime and wake-up time every day, and make sure your child is getting the proper amount of sleep for their age.

Night Terrors

Night terrors are sleep issues that cause kicking, screaming, panicking, or crying even though the child is still asleep. Children with night terrors may look awake and usually won’t respond or acknowledge those around them. “Unlike nightmares, night terrors involve sudden arousals from deep sleep with intense fear, screaming, and confusion, and the child usually doesn’t remember the episode the next day,” explains Ellsworth.

If your child has night terrors you may notice:

• Uncontrolled crying

• Breathing fast

• Screaming

• Thrashing and kicking

• Will not respond when spoken to

• Will not acknowledge people around them

• No memory of the night terror in the morning

• Excessive fatigue, grogginess, or irritability during the day

How to manage night terrors

Night terrors can be tough to watch, but the good news is most children grow out of them with time.The goal with night terrors is to keep your child safe, support restful sleep, and reduce possible triggers. Since night terrors happen during deep sleep, a consistent and calming bedtime routine can help regulate their sleep cycles.

Make sure their sleep space is safe—clear away anything they might trip over or bump into if they move around during an episode. Try not to wake your child during a night terror, as it can make them more confused or upset. Instead, stay nearby and gently reassure them until it passes.

If the episodes tend to happen around the same time each night, try waking your child 15–30 minutes beforehand to help reset their sleep cycle. Managing stress, avoiding overtiredness, and making sure they get enough sleep can also help.

Restless leg syndrome

Restless leg syndrome (RLS) is a neurological condition where a child feels an uncontrollable urge to move their legs, usually at bedtime or in the middle of the night. This can make it harder for them to fall or stay asleep and result in poor quality of sleep.

If your child has RLS you may notice:

• Complaints of aching legs 

• Itching or tingling sensations in the legs

• Erratic leg movements 

• Twitching in the legs 

• Tossing and turning in bed 

• Excessive fatigue, grogginess, or irritability during the day.

• Behavioral issues 

How to manage RLS

Treatment focuses on improving sleep quality, reducing discomfort, and addressing underlying causes. Start by making sure they’re getting enough rest and sticking to a regular bedtime routine—being overtired can make symptoms worse. 

Simple bedtime habits like gentle stretching, warm baths, or a quick leg massage can help relax their body before sleep. It’s also a good idea to talk to your pediatrician about possible causes, such as low iron levels, which are commonly linked to RLS. 

To help reduce symptoms, limit screen time and stimulating activities in the evening, and avoid caffeine (even the kind found in chocolate) before bedtime.

Tips for restful sleep

• Create a consistent bedtime routine: A predictable series of calming activities before bed helps signal to the brain that it’s time to wind down. These sleep cues can help children fall asleep more easily.

• Establish a regular sleep schedule: Set a fixed time for lights out. A good bedtime is between 7:00PM and 8:30PM for preschoolers (closer to 7PM for 3 year olds). “Going to bed and waking up at the same time every day, even on weekends, supports healthy circadian rhythms,” says Ellsworth. 

• Limit screen time before bed: Blue light from screens can interfere with melatonin production and make it harder to fall asleep. Limit all types of screen at least one hour before bed, including phones, video games, tablets, and television. 

• Ensure a sleep-conducive environment: A cool, dark, quiet room with minimal distractions can promote better sleep. Consider blackout curtains to keep the room very dark and white noise machines to block out interfering sounds.

• Encourage physical activity during the day: Regular movement during the day helps children fall asleep more easily at night. This could be a walk around the block after dinner, sitting on the porch and reading a book, or having a picnic on the grass. Heavy work (activities that require the use of large muscles like pulling or pushing) can be particularly helpful before bed. “Heavy work activities provide deep pressure stimulation, which can promote the release of calming neurotransmitters like serotonin and reduce arousal in the nervous system,” explains Ellsworth. “This can help kids feel more grounded and relaxed before bedtime, making it easier to fall asleep.” Adding in heavy work like jumping or climbing may help or sensory support like massage. It may take a while to figure out what works best for your child, but trying different options can help if bedtime is a struggle.

• Address anxiety or fears during the day: Children may have difficulty falling asleep because they have anxious feelings leftover from their day or they are rehashing the day’s events in their mind. Talking about their worries during the day can help children feel more secure at night.

• Connect with your toddler during bedtime: It’s a great time to share a special song, talk about their day, and fill their emotional cup. 

• Use visual or verbal cues to prevent meltdowns: Consider using "OK to wake" clocks, visual timers, and picture schedules. Give your preschooler a five- to ten-minute warning before it’s time to wrap up play time and get ready for bed.  

• Let your child participate in the bedtime routine: This can mean offering two pajama choices or asking if they'd prefer to skip or be carried to bed. Offering autonomy at bedtime can minimize power struggles in the evenings.

At what ages are sleep disorders most common?

Sleep disorders can affect individuals of any age, but some types tend to be more prevalent during particular developmental stages. What are developmental stages that occur during preschool years that can affect sleep and cause sleep disorders?

“During the preschool years (ages 3 to 5), children experience rapid brain, emotional, social, and physical development that can significantly affect their sleep,” says Ellsworth. “Cognitive growth leads to vivid dreams and increased imagination, often causing nightmares or night terrors, while emerging independence and awareness of time may result in bedtime resistance and anxiety.” 

As preschoolers begin to drop their daytime naps and sleep more at night, any changes to their routine can throw off their internal clock. Many children also rely on specific sleep cues, like a parent nearby or a favorite toy, to fall asleep. If those cues change, it can lead to bedtime resistance or night wakings.

How are sleep disorders diagnosed?

Diagnosing a sleep disorder usually starts with a look at your child’s medical history and sleep patterns. Your pediatrician can start the evaluation, and a sleep specialist can help pinpoint the cause and create a personalized plan to support your child’s sleep.

• Medical history: Your pediatrician will ask about your child’s sleep habits and daily routines to understand both daytime and nighttime behaviors.

• Sleep history and questionnaires: These tools help identify sleep patterns and behaviors that might indicate a disorder.

• Sleep tracking: Parents may be asked to monitor and record their child’s sleep habits over one or two weeks.

• Sleep study: Your pediatrician may recommend that your child completes a sleep study overnight to monitor breathing, brain activity, and movement. Sleep studies can help diagnose conditions like sleep apnea or RLS..

Are sleep disorders temporary?

Some sleep disorders are temporary and linked to developmental phases, stress, or environmental changes. Others, like OSA or RLS, may require long-term management. However, with early intervention and behavioral support, many sleep problems can be significantly improved or resolved over time.

When to consult your pediatrician 

Consulting your pediatrician about your preschooler’s sleep issues if your child has:

• Persistent difficulty falling or staying asleep, lasting more than a few weeks

• Frequent night wakings that disrupt rest

• Loud or frequent snoring or breathing pauses

• Excessive daytime sleepiness

• Irritability or behavioral problems related to poor sleep

• Signs of RLS like leg discomfort or twitching

• Frequent or dangerous night terrors or sleepwalking

• Severe bedtime anxiety or refusal to go to bed

• Sudden changes in sleep patterns

• Concerns about growth and development linked to sleep problems

FAQs

What is bruxism and how does it interfere with sleep?

Bruxism is the involuntary grinding or clenching of teeth, typically during sleep. In children, it can lead to disrupted sleep, jaw pain, headaches, and tooth damage. “It may be related to stress, misaligned teeth, or certain medical conditions,” explains Ellsworth. “Because it disrupts restorative sleep, children may appear tired or irritable during the day.”

What is delayed sleep phase disorder and how does it disrupt sleep?

Delayed sleep phase disorder is a circadian rhythm disorder where a child's internal clock is shifted later than usual, and they naturally feel tired later in the evening compared to most other children. This can result in difficulty waking up in the morning and disrupts daily functioning. 

How do you mix heavy work with calming activities before bed? Isn’t heavy work overstimulating?

“While heavy work involves active movement and muscle engagement, it actually provides deep pressure input that can have a calming and organizing effect on the nervous system, not overstimulation,” explains Ellsworht. When done thoughtfully, heavy work can help children feel grounded and relaxed, making it easier to transition into calming activities before bedtime.

To mix heavy work with calming routines, you can start with short, structured heavy work activities like carrying a laundry basket, pushing a weighted object, or doing animal walks for about 5 to 10 minutes. This helps provide that calming sensory input. Then, smoothly transition into more quiet, soothing activities such as reading a story, gentle stretches, or deep breathing exercises. 

What’s examples of a bedtime routine for a preschooler?

1. Calming heavy work activities (like carrying a small laundry basket)

2. Brushing teeth

3. Putting on pajamas

4. Spend 10 to 15 minutes reading books in a quiet, dimly lit space

5. Cuddle in bed doing deep breathing exercises or practice gentle stretching before getting in bed

6. Tuck your child in with their favorite stuffed animal or blanket

7. Turn on the white noise machine and turn off the lights 

8. Sing lullabies 

9. Goodnight 

If you have questions about pediatric sleep disorders, reach out to your local or Summer Health pediatrician for support. Summer Health is a pediatric telehealth platform offering 24/7 care, providing answers for everything from urgent concerns to everyday questions about your child’s health.