Sleep routines for children can change a great deal over the long summer holidays. Later nights, sleeping in, more variability and sleep-wake schedules, more screen time, less focus on a pre-bed wind down routine are some of the common changes.
While many kids and teens adjust easily to the school sleep routine, others may benefit from some structured adjustments to create a great routine around sleep.
The week before school starts is a perfect time to bring some routine and normality back in preparation for the school year starting. Here's some suggestions:
1. Gradually shift the sleep routine. If your child needs to get up earlier and go to bed earlier during the school term, start by having them up out of bed earlier by 15-30 minutes each day this week. Parents are often tempted to get their kids into bed earlier as a first step. However, we find that advancing the morning rising time can be the best way to go initially, rather than enforcing an early bed time. Think of rising time as an anchor for the body clock; if you gradually advance the rising time, you will be able to time the bedtime earlier within a couple of days and the child will more easily be able to fall asleep. It is often the case that an enforced earlier bedtime straight away will be met with resistance and can make falling asleep difficult as the body clock is not used to sleeping at this early time straight away.
2. Morning sunlight is a great way to advance the body clock (ie to make falling asleep and getting up happen at earlier times). In combination with tip 1, if you and the kids can have breakfast outside in sunlight or go for some morning exercise, this can really assist the process. Sunlight turns off melatonin production in the brain and helps us to wake up. The opposite applies in the evening- limit close screen time (tablets, phones) to less than an hour if possible.
3. Consistency. Once the correct bed time and rising time has been reached, keep it consistent even on the weekend. This will encourage the new timings to stick and to become more natural.
4. Wind Down to create a buffer between the day and the night. Help your child to establish a wind down routine that encourages relaxation and sends a cue to the body and brain that sleep time is approaching. Reading to your child, or them engaging in silent reading is a great wind down. Colouring-in or quiet play may also be relaxing for your child. Gentle music, or an audio book are other options.
5. Create a helpful sleep space. Make sure your child's bedroom is cool, quiet, and dark. Ideally, no screens in the bedroom.
6. Get the day right. Recipe for good sleep = active, happy, balanced days with good food and time outside.
If you've implemented the above but have a child that is still not sleeping well, or if implementing the above has been challenging, give Sleep Matters a call. Also see our other blogs on child and teen sleep.
We know that sleep is essential for health and wellbeing. Sleep supports the immune system, assists physical growth and repair, strengthens memory, and improves mood and wellbeing. Lack of sleep can contribute to feeling irritable, stressed and overwhelmed which are common experiences in our busy modern Christmases.
It’s common for sleep to deteriorate during the festive period due to increased busyness and stress associated preparing food, buying presents, end of year work functions, completing work tasks before going on leave, kids being on holidays (while you’re still working), travel, entertaining guests, & increased financial pressure. Phew, it’s an exhausting list.
Add in a large measure of alcohol and an increase in indulgent treats – and you have a time of year that isn’t the kindest on our bodies.
One recent survey suggested that stress related to Christmas is one of the biggest causes of lack of sleep at this time of year – and this is especially the case for women, with a third of women losing sleep because of festive stress.
So how can we respond to festive sleep-stressors in a helpful way? Read on......
Also see our tip-sheet for setting up a healthy sleep routine
When stressed, we produce cortisol and adrenaline, hormones that provide energy and help us function through stress. These hormones keep us alert so if they are around in great quantities, are not conducive to a good night’s sleep.
Especially when busy during the day, we’re prone to take our busyness to bed with us. We can feel fatigued before bed, but when the head hits the pillow, worrying thoughts, deadlines, and to-do lists pop up, and then cortisol and adrenaline floods in.
Daytime (not nighttime) is the time for thinking, planning, & worrying. It's possible to train the mind to do it's thinking/planning, & worrying during the day and get it out of the bedroom. Try using a notebook or your phone during the day so that you can write down reminders and worries as they come up. Create 15 minutes a day to quietly sit, reflect, plan and problem solve. Or talk about what is on your mind with a friend or family member. Revisit your notebook/phone list at this time.
At Sleep Matters, we find this 'thinking time' a helpful strategy for our clients. ‘Bottling up’ stress tends to lead to poor sleep. If you are able to process worries during waking hours they are less likely to pop up whilst in bed at night. What’s more, if they do pop up at night, it can be easier to let go of them if you know you will come back to them during your thinking time the following day.
Stimulus control If overthinking and stress does get the better of you overnight and you feel there’s no way you’ll be able to get back to sleep, we advise to get out of bed. This is an insomnia treatment technique called Stimulus Control. Get up out of bed and ask ‘what will help me wind down?’ It might be listening to a relaxation app, practicing some slow breathing, adding items to your list to organise the next day, reading a book, or doing a crossword. Once you notice that sleepiness has returned or that you are feeling calmer, return to bed.
Alcohol Many of us enjoy a tipple or two at Christmas time, but alcohol can negatively impact our sleep. It changes the structure of sleep, so even if you get enough sleep hours, you won’t feel as refreshed when you wake up the next day. Further, getting up to the loo, or feeling dehydrated can be causes of sleep disruption. See our earlier blog post on the impact of alcohol on sleep.
‘Knit one, pearl one’ when it comes to Christmas alcohol consumption. This means, have a glass of water in between every drink. And drink plenty of water before retiring to bed.
Avoid drinking on an empty stomach, Even an energy bar, nuts & fruit to help fill your stomach is better than no food at all.
Set a time for your last alcoholic drink. Ideally with a space between this drink and when you retire to bed. Tis will allow for a little more processing of alcohol before sleep.
Travel The festive season is a time for travel for many.
Jet lag can be an issue for those traveling across time-zones. While there is no way to completely avoid jet lag, there are ways to overcome it faster, for example by moving your sleep schedule towards the new time zone before you travel. I love to tell people about Jetlag Rooster – a great resource complete with calculators which can help people plan for traveling across time zones. Taking short acting melatonin for a few days can also be very effective.
Sleep is of course essential for people travelling long distances by car. If you feel sleepy whilst driving, it’s crucial to stop and have a rest or short nap, or swap the driving with another passenger.
If you’ve travelled, are stressed, or have had a few late nights you may benefit from a short daytime nap to keep you going.
However, the guidelines around napping may surprise you. Keep naps short and early. We recommend naps to be less than 30 minutes and 7+ hours before the night-time sleep period. Most people find surprisingly good benefit from even a short nap like this. Check our our earlier blog post for more on naps.
Finally, do your best to avoid over worrying about sleep
Remember that disturbed sleep for a night or two, or even a week won’t cause long-term harm – your body is resilient in the face of short term sleep loss.
Make sensible decisions about sleep but don’t 'over-worry' about it. Worry about sleep tends to make sleep much worse.
This year, researchers won a Nobel prize for their work on understanding the role of the body clock, aka circadian rhythm. We have a master clock deep in the brain (the suprachiasmatic nuecleus to be exact) which controls the timing several bodily features such as body temperature, hunger, and sleepiness. Melatonin is an important hormone controlled by our body clock and it has a strong influence on when we feel sleepy and when we feel awake. Exposure to light is a strong factor that influences melatonin production and hence the timing of the body clock.
Knowing whether you are a night owl or an early bird can help you to plan for when to sleep, and when you are likely to function at your best. Click through for more on this here.
Night Owls - late to bed, late to rise Night owls find it easy to stay up late (often well beyond midnight) and often like to sleep in late the next day (beyond 10am).This is because melatonin is timed to increase later in the evening in these people, and the brain continues to produce melatonin later in to the morning, making rising early very difficult. These are not morning people and will describe feeling groggy on waking. They will lie awake in bed tossing and turning if they go to bed too early for their body clock. Teenagers often fit this pattern, so don't be too hard on them when they struggle out of bed in the morning. See an earlier blog post and management tips for this here.
The extreme form of being a night owl is called Delayed Sleep Phase and occurs when the person's body clock is timed too late to fit with their daily obligations - they might often be waking too late for school, university, work, or getting kids off to school.
Early Birds - early to bed, early to rise Early birds are just the opposite. They fall asleep very easily in the evening (often before 10pm) and wake up easily in the morning (before 6am, but sometimes as early as 3 or 4am). It is common for the human body clock to advance earlier through the lifespan, with more over 60's fitting the advanced sleep phase pattern than their younger counterparts.
The extreme for of being an early bird is called Advanced Sleep Phase and occurs when the person's body clock is timed too early to fit with their daily obligations. These people often don't feel they are getting enough sleep due to their early wakings. Further it can be difficult for them to work or socialise in the vening due to feeling sleepy.
Are Circadian Rhythm Disorders harmful? In themselves, circadian rhythm disorders are not necessarily dangerous or unhealthy. Some sufferers are able to achieve the correct amount of sleep if their family and work routines allow them to go to bed and get up at times that fit their body clocks. If however, the circadian rhythm regularly prevents the person from achieving a healthy amount of sleep, unwanted consequences can occur.
Is it possible to shift the body clock? Yes, for most people it is possible. If you need to wake earlier or stay up later, the body can usually be trained. Recovering from jet-lag is a good example of shifting the body clock - training it to match a new time zone. Bright light therapy and careful timing of bed times, rising times, and daily activities such as meals and exercise can be effective in altering the timing of the body clock and treating circadian rhythm disruptions. Please feel free to call Sleep Matters to discuss.
Are you a night owl or an early bird? Follow this link for a quiz that will tell you if you're a night owl or early bird.
This year, the first Nobel Prize in the area of sleep science was won. The prize was based on important research that improves understanding of how the body clock (circadian rhythm) influences our body & mind - including why we feel so awful when we are jet lagged.
At Sleep Matters, the body clock is one of the three factors we assist people with to get their sleep on track. Read our earlier blog for more on this.
Regular rising time and morning sunlight looks after the body clock and can make a really positive difference to sleep and energy levels.
The University of Western Australia, in collaboration with The Australia Alzheimer’s Research Foundation, is offering a scientifically-supported sleep training program to adults aged 60 and over. This program is part of a research project looking at the relationship between sleep and thinking skills. It provides training in coping skills to improve sleep quality and quantity over 7 individual and group meetings between November and February. In addition, you will be provided with a comprehensive evaluation of thinking skills, and of your sleep in the sleep lab at UWA. There is a minimal cost to participants (less than $20 per session) for the training session to defray expenses. However, for the testing of thinking skills sessions we provide $15.00 to cover your travel costs. If interested please contact us at 6457 0264 to see if you are eligible.
This study is approved by the University of Western Australia Human Research Ethics Committee (Ref: RA/4/1/7799)
Dr Melissa Ree from Sleep Matters is part of a team from the University of Western Australia who have implemented a sleep clinic within the north metro mental health service. We're delighted to announce that this service has recently been awarded a high commendation from the Australian Council of Healthcare Standards (ACHS).
So many people with mental health problems also suffer with poor sleep which often remains untreated. We know that poor sleep has a negative impact on wellbeing and mental health symptoms (depression, anxiety, psychosis). The clinic provides access to a brief (3 session) sleep therapy intervention for sleep problems occurring in the context of mental illness (insomnia, nightmares, hypersomnia). Cognitive Behavioural principles were the basis of the therapy intervention.
Results showed that the program improved sleep, depression, anxiety, psychotic symptoms and well-being.
Perth's Sunday Times newspaper yesterday contained an article on Insomnia, with the suggestion that its best cure is to ignore it. This is an eye-catching title and I hope it caught people's attention.
Of course the article contains a mixed message, as on the one hand we know that sleep is so important for health and wellbeing, but on the other, we know that worrying too much about sleep is one of the worst things we can do for our slumber. Worry is most definitely the wrong tool for the job when it comes to treating insomnia.
“When you pull fear out of the process and adopt the idea of skipping a few hours’ sleep as not a huge problem, it changes your perspective.” This is so true. When we are able to reduce worry about sleep, we can relax, stop all the tossing and turning, reduce arousal, and trust that sleep will come if we let it. Telling yourself to 'stop worrying' is unlikely to help, and the more you try to not worry, the more frustrated you may become. We find that mindfulness techniques can help (as noted in the article), corrective evidence to challenge the worry, and lots of science-backed information that ensures our clients understand how sleep works, and what gets in the way.
The article also discusses one of the most effective, evidence-based CBT strategies for treating insomnia - bedtime restriction. This is where people reduce the amount of time spent in bed for a number of weeks in order to increase the biological pressure to sleep. It sounds tough, and indeed can be, but armed with a good plan, understanding the rationale for the strategy and good support, we find that most clients see improvement within 1-2 weeks. This is a huge relief to those who have been sleeping poorly for years.
Well done to the Sunday Times for publishing an article that isn't full of scary information about sleep deprivation, and rather, promoting an evidence-based, effective, common sense approach.
If you would like assistance with poor sleep, get in touch with Sleep Matters today.
Paul Jeffery from Sleep Matters presented a seminar to parents at Queensgate Medical Centre last month. He discussed aspects of childhood sleep and provided tips for improving sleep in little ones. Here is a summary of his talk.
From the age of 3 up until the end of primary school its estimated that children spend around 40-50% of their lives asleep. Sleep is crucial for growing, healing, learning / brain development and emotional balance (see here for research link). For most children and families, getting to sleep and getting enough sleep works smoothly enough. For some youngsters, however, poor sleep can be a headache both for them and for their families. Why does it go wrong?
Developmental stage Sleep can be disrupted at different developmental stages, such as transitioning out of day-time sleeps, or when undergoing a stage of rapid cognitive or emotional development, or when children start to experience typical developmental fears of the dark and being alone at night.
Sleep Need Some children just need less sleep than other children their age, there is a range in hours of sleep needed as you can see in the image below (See sleep need recommendations). For example one preschool age child may sleep 8 hours our of 24 and another may sleep 14 hours. If your child is at the lower end of the recommended range but is happy and functioning OK, it may well be that they just don’t need as much sleep as other kids.
Anxiety A number of kids worry about having nightmares and become avoidant of going to bed. These worries tend to settle down over time. Some children are more prone to strong anxiety or worry that can either be to do with daytime or night-time worries. If the anxiety and reluctance to sleep alone is really impacting the child and or the family, seeking professional support is certainly an option. Childhood anxiety often responds very well to psychological/behavioural treatments.
Body Clock Some children have a body clock that is naturally be set later (a night owl) and so they are not tired at 7pm. There reverse can also be true when kids are early birds who fall asleep well quite early in the evening but are bright eyed and bushy tailed before 5am.
Physical Health Kids can have trouble sleeping in relation to physical health problems such as obstructed breathing and pain syndromes.
Stressors In terms of external circumstances, children’s sleep can be disrupted when the family is going through stress and / or periods of change or indeed when the child is having problems with school or friends. Parents might have struggled to implement predictable and effective bedtime routines, or accidently fostered a routine where their child has become reliant on parents being close to fall asleep. When parents are not united or are having mixed feelings about how to manage their child’s sleep, this can also contribute to problems.
What Can I Do About It? - General Pointers Given there are so many reasons why children might be struggling with their sleep, it’s beyond this post to highlight all the options. Stay tuned for further articles for particular issues, but in the mean-time here are some general tips.
Take Care of the Basics – good day and night-time routines revolving around healthy eating, a balance of activities both for achievement/productivity and time to play, regular wake-up and bed-time, and a clear wind down to bed-time are crucial for helping to regulate children emotionally, behaviourally and physiologically.
Think about What is Contributing to My Child’s Poor Sleep – have you considered the individual, developmental and environmental factors? Is this something that will blow over with time and patience? Are there things that we as parents need to be addressing?
Have a Plan and Stick to It – Make sure I / We are clear about how we want to proceed, and stick to it. Being uncertain and half-hearted will lead you into murky territory!
Rewards and Enthusiasm – you are more likely to succeed in making changes if your child is on board. You are trying to do this “with” not “to” your child so that you are all on the same team.
Harm Minimisation or Change? – For everyone’s sanity, sometimes it is best to take the fight out of things and allow a period of settling before you tackle the issue. For example, allowing children to camp in with you happily rather than arguing about it every night then giving in anyway! Tackle one thing at a time, try to create opportunities for success for you all, but once you decide on change you need to commit.
A common advice on self-help, health, and fitness blogs is to sleep on the left side. Of the variety of reasons provided, not many appear logically sound or scientifically accurate. As a result, it is advice usually dismissed as just another irrelevant urban legend.
Science, however, has been out verifying the claims. Several studies support the benefits of sleeping on one’s left side (ie, with the right side up).
Gastroenterological benefits of Left side sleeping position
Sleeping on the left side is sometimes advised as a preventative measure against acid reflux while sleeping, and even as a symptomatic remedy for GERD (Gastroesophageal reflux disease).
Gastroesophageal Reflux (GER) occurs when stomach juices escape from the sphincter (the sphincter keeps the stomach sealed and separate from the oesophagus). When functioning well, the sphincter opens for a small amount of time after swallowing to allow food/liquid inside, and occasionally to regurgitate the contents of the stomach when we’re unwell. Higher incidence of GER can cause inflammation of the food pipe and other uncomfortable symptoms.
Research cited by The Jama Network, (case controlled studies) shows an improvement in GERD related to sleeping on the left side, elevation in HOB (Head of Bed) and weight loss.
The relaxations of the lower esophagal sphincter are kept a track of through LES manometry. A study on NCBI details higher incidence of GER episodes with sleeping on the right side as compared to the right side, noting more TLESRs or relaxation in the sphincter as well as more number of reflux episodes.
It is thus easy to establish that sleeping on the right side does cause higher incidence of stomach reflux, and the converse is true as well.
Benefits to Brain from Lateral Decubitus Position in Sleep
The Journal of Neuroscience published a study in August 2015 found an improvement in the Glymphatic system (the system that clears waste from the brain) when rats slept on their side or back compared to in an upright position.[MJR1] The study even goes on to propose that sleeping on the side evolved to optimise removal on waste while sleeping. While this study isn’t suggesting that sleeping on the left is better than sleeping on the right, it does suggest side sleeping is better than sleeping on our backs.
Other benefits of sleeping on the side
Other benefits commonly attributed to sleeping on the side include helping people with obstructive sleep apnea, snoring and neck pain. It is proposed that sleeping on the side helps keep the air pathway clear while sleeping, which can otherwise be at risk of the tongue sliding back while sleeping. This also helps reduce snoring. Sleeping on the side can also be helpful in keeping the spine in proper alignment, commonly attributed to a better sleep.
Our infographic contains important tips for improving sleep and setting up a healthy sleep routine. This isn't an exhaustive list, but is a carefully considered selection of change that can have a large impact. Are there some challenges you could set for yourself from these? Try any change for 2 weeks and then evaluate how much it has helped. The points below are ingredients for a healthy sleep routine. These tips can really improve sleep but are not in themselves a treatment for insomnia which involves several other strategies. If you feel you require further assistance, contact us or speak with your GP.
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