The Value Of Sleep

All Articles in the Category ‘The Value Of Sleep’

New Data And 10 Ways To Reduce SIDS And Suffocation Risk In Babies

Mommy-copy-e1273260009105Any parent to a newborn worries about Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected Infant Death (SUID) and what they can do to prevent it. SIDS deaths are unexplained while SUID deaths in infants are secondary to things like suffocation, entrapment, infections, or trauma. The new recommendations take research on all of these risks into account and are specific to guide parents to reduce risks for SIDS and sleep-related suffocation, asphyxia, and entrapment among infants in the general population.

I’ve been interviewed a lot lately about all the fancy new baby trackers, monitors and even smart cribs available to the public being marketed as SIDS reducers. These are not the answer to safer sleep — no data to prove it. I’m a digital enthusiast but it doesn’t change my concern that these devices are entering the market out of the place of fear, not science for improved safety. I think we have to acknowledge that these trackers might amp and rev up anxiety more than they will decrease it in some parents.

What we CAN do to decrease risk of SIDS is follow new research-based guidelines published this month from the American Academy of Pediatrics (AAP) to reduce the likelihood of SIDS and suffocation. This new set of guidelines are updates to the 2011 recommendations, some being similar, and others a bit different. Big changes from my perspective are the stronger recommendations for pacifier use in infants, the strong recommendation against feeding babies in the nursing chair at night, and the ongoing urging to have your babies in BARE, BORING, BASIC sleeping environments in a parents room. Pillows, blankets, bumpers, and stuffed animals are cute but not safe for infants under 1 year of age. Where we feed our hungry babies in the middle of the night matters, too. The recs out this month help define ways to do this with more confidence you’re reducing risk.

“Parents should never place the baby on a sofa, couch, or cushioned chair, either alone or sleeping with another person. We know that these surfaces are extremely hazardous.” ~Rachel Moon, the lead author of the new guidelines and professor of pediatrics at University of Virginia School of Medicine

10 Ways To Reduce Risk Of SIDS And Suffocation

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Parent Sleep Matters

Podcast also available in:

Sleep is tied to our outlook, our mood, our performance, our safety, and our sense of stress/anxiety. We’re nicer people after we sleep and I often say that after a good night of sleep I get to be more of the mom & parent I earnestly want to be. Sleep is magical that way.

Thing is, sleep has a profound effect on our perspectives and attitudes about life. In fact research has found that sleep loss causes bias in our memory — the less sleep we have the more we focus on negative events and the more our memory builds space for memories of the negative details in our life. In addition, the less we sleep, the less we think our children do. Huge opportunity to improve things when we not only prioritize our children’s sleep but our own.

For more listen to the podcast and read this and this where I talk with sleep expert, Dr. Maida Chen and discuss 5 ways to improve our own sleep and our family’s wellbeing.

Each Hour Matters: How Much Children Should Sleep

The American Academy of Pediatrics (AAP) has issued a Statement of Endorsement supporting the American Academy of Sleep Medicine (AASM) guidelines outlining recommended sleep duration for children from infants to teens. Not exactly “news” but great reminders because of their import. The statement is pretty clear about it’s importance and perhaps this is why it will make headlines:

Sleeping the number of recommended hours on a regular basis is associated with better health outcomes
including: improved attention, behavior, learning, memory, emotional regulation, quality of life, and
mental and physical health. ~Journal of Clinical Sleep Medicine

Melatonin Boy SleepingHard to beat the benefit. Nothing quite as powerful as this besides, in my mind, a feeling of belonging and getting outside and moving/exercising every day! I’m in full support of the guidelines. Bottom line, even with the phase shifting we’re doing with summer because of the glorious evening light we get, and with release of the noose of tight schedules during the school year, there’s no question each night of sleep is something worth preserving and protecting. If we think about sleep like we think about what we feed our families and how much we move and exercise, we’ll be keeping our wellness in check.

Little deficiencies in sleep matter. Sure, if you’re a great sleeper and get the recommended amounts of sleep nearly every night, one night here and there with a bit less sleep is tolerable. But children who consistently don’t get recommended sleep accumulate sleep deficiencies into an earnest sleep DEBT. That sleep debt has consequences like decreased attention, increased risk for challenges with weight, dangerous driving, bad mood (YUCK!), injuries, hypertension, diabetes and decreased performance at school. In teens insufficient sleep is associated with increased risk of suicidal thoughts, suicide attempts and self-harm. This is all real deal, powerful and important stuff. The National Sleep Foundation has found that 85% of teens don’t get adequate sleep leading researchers to call this The Great Sleep Recession. Badness for all of us. Knowing bad sleep habits can start early, we can address this actively and consistently.

Sleep Recommendations For Children, Even In Summer

For optimal health, children should keep a consistent bedtime — helps with school days, attention and actually getting the sleep they need! Even if you shift bedtimes to later times this summer (Yeah!) keep thinking on these goals in hours.

sleep needed by age

In addition to these recommendations, the American Academy of Pediatrics suggests that all screens be turned off somewhere between 30 minutes and 1 to 2 hours before bedtime so as not to interfere with falling asleep. Data has found small screens (smartphones) are more disruptive to sleep that even TVs. And another thing pediatricians recommend (because we have the data to back it up) is that parents make sure no TV, computers, tablets or other screens be allowed in children’s bedrooms.

For infants and young children, establishing a bedtime routine is important to ensuring children get adequate sleep each night. Even if it’s about to shift, keeping it consistent from one night to the next can be the magic stuff of good dreams.

Self-care And Parenting, Sleep And Loneliness

My passion in work and the focus of my career is centered around improving the health and well-being of children. It always will be. I can get SO wrapped up in the opportunities to leverage every tool I’ve got to clarify, learn, relieve suffering, and contribute to pediatric health. I feel lucky to have the tools I do to translate/partner with patients and families and I feel humbled by the ongoing challenges in reducing pediatric illness and injury…earnestly it can leave me feeling very obliged to do more and more and more. There is just so much we can do to leave this planet better than how we found it. Most of us feel this way, of course. One of the thrills in working in a clinic and a hospital, a TV news station, and online with all of you is that I am bolstered and surrounded by cohorts of people who invest huge amounts of time in improving the lives of others.

Engagement In Parenting, Work, And Self Care

Many of us feel deeply engaged in raising our children while also feeling wholly committed to improving our community as we slide into these years where we’re really ready. We have completed our education, we’re more senior in our roles at work, and we’re now trusted by others to contribute. In this privilege of simply being engaged in these ways we can sometimes over-focus on being productive, vigilant  and present in our work while also being loyal friends, parents and partners. We do this to the point that we earnestly de-prioritize ourselves. Some people can juggle all of these investments elegantly. Most of us are still a work in progress.

There’s a lot out there telling us how to do this being alive thing better; the self-help sections of the internet are pretty heavy up there in the clouds. I don’t hold a singular, gold nugget of data in my mind that says when we care for ourselves data proves our children are healthier, happier. But I know it like I know the hue of blue in the sky.

I like this Atlantic piece, The Internet Wants To Help You Take Care of Yourself and if you’re looking for content on self-care, check out these TED talks, too (if you haven’t yet seen Brown’s talk on the power of vulnerability cancel the rest of your day if need be to find the 20 minutes to watch it). When thinking about self-care I don’t just think about vitamin D and exercise, sleep and vegetables. I think about the foundations of our belonging and our connection to others. Amid all the people we’re supporting, all the work, all the love of our children and families and all of our activities, do we feel we belong? Is it possible amid all these people, these tasks and responsibilities, and all this love that we might feel a bit alone?

The first TED talk in that self-care list up there grabs my attention like an alarm when Guy Winch speaks on loneliness:

Loneliness creates a deep psychological wound, one that distorts our perceptions and scrambles our thinking. It makes us believe that those around us care much less than they actually do. It makes us really afraid to reach out because why set yourself up for rejection and heartache when your heart is already aching more than you can stand.

Of course one thing that seems to ALWAYS help when overwhelmed is sleep. I often say that I’m a better parent and simply more the person I want to be everywhere when I’ve prioritized sleep for myself and for my babies. Data shows we simply are more level and more positive in our perspectives when we’ve slept. We’re safer drivers, we’re more focused at work or school. We all hear this and we all know this on some level…..that caring for ourselves is the prerequisite to caring for others. We make less mistakes. But in the midst of all of our hectic sandwich generation schedules, it’s easy to pay lip service to self-care and continue to motor on, focusing on delivering care for others. And THIS: self-care can sound fluffy and self-centered. People throw around the word “deserve” a lot. As I get older I see self-care as elemental to a meaningful and connected life. And I certainly see it as a huge challenge. When babies come into our heart it’s hard make sense of all of the marriages we have (to our families, to our work and advocacy, and to ourselves). Read full post »

Cry-It-Out Improves Sleep And Reduces Mom Stress

Parents debating sleep training can rest (literally and figuratively) easy. New data out today in Pediatrics found that letting babies cry-it-out (CIO) or self-soothe does not increase signs of stress compared with babies who don’t. The study out of Australia tested two sleep training methods: “graduated extinction” (parents leave and return at increasing intervals of time, AKA one version of CIO) and “bedtime fading” where parents shifted bedtimes based on how long it took babies and young toddlers to fall asleep. The groups of babies and their moms were compared to those in a control group of babies and moms/dads who received only sleep education. The group in total was small, some 43 infants spanning 6 months to 16 months randomized into the three groups. I was fortunate to be able to discuss the study and what it means for parents on The TODAY Show this morning. In addition, I chatted about the study design, findings, and implications with Dr. Maida Chen, the Director of the Seattle Children’s Sleep Center. We were both excited as the study evaluated baby’s sleep, tracked their sleep with actigraphs (movement monitors), evaluated sleep by parental sleep diaries, measured morning and afternoon cortisol levels (a stress hormone) and tracked time to fall asleep, number of nighttime awakenings, total sleep time, mom’s stress, mom’s mood and long-term bonding. Even though the study may have some limitations (very small sample size and parents self-selected to the study with sleep concerns therefore it may be non-representative of parents at large who AREN’T worried about sleep) the randomization to the three groups and the measures studied boost the exciting results.

6 Take-Aways From The Baby Sleep Study

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Your Children Not Sleeping? It Might Be YOU

parent sleep

No question sleep — the good and restorative kind of sleep — changes our day. Sleep is tied to our outlook, our mood, our performance, our safety, and our sense of stress/anxiety. We’re nicer people after we sleep. I often say that after a good night of sleep I get to be more of the mom I earnestly want to be. Sleep is magical that way.

Thing is, sleep has a profound effect on our perspectives and attitudes about life. In fact research has found that sleep loss causes bias in our memory — the less sleep we have the more we focus on negative events and the more our memory builds space for memories of the negative details in our life. Yikes.

You know how it is…we all do. You start the day exhausted or you head into work tired, clutching your coffee, trying to rev up for the day. Your child didn’t sleep well through the night and therefore neither did you. Happens all the time, of course and to some parents more than others. You’re wondering (and likely doing some research online) what you can do to improve their sleep. What tricks haven’t you tried? What schedule should you be following? The hidden answer might be the last thing you’d think of …your own sleep.

Thing is, if we didn’t sleep well last night we may be misrepresenting the facts of the night.

A new sleep study published in Pediatrics showed that parents who don’t sleep well may mistakenly believe their children didn’t either. The researchers studied the sleep of 100 2- to 6-year-olds in Finland and their parents. Children wore bracelets (devices called actigraphs that track movement and quantify sleep) for a week to estimate sleep duration and quality while parents kept a sleep diary for their children and filled out a sleep questionnaire. Parents’ age and education were included as relevant variables in a the study as well as the child’s age, gender, chronic illnesses, medications, and number of siblings.

People who sleep poorly overestimate their children’s sleep problems.” ~Marko Elovainio, author of Pediatrics study

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Using Melatonin To Help Children Fall Asleep

When I recently shared this article on my Mama Doc Facebook about a “magic” children’s bedtime story promising to make the going-to-sleep process easier, many parents inquired about melatonin.

No question that supplemental melatonin has a role in children’s sleep dysfunction but also no question that parents are turning to melatonin out of a need for convenience. I’ve had COUNTLESS curbside consults from parents asking me if melatonin is safe to use in the short-term but also for years on end. The short answer is we don’t entirely know because studies just haven’t been done. Often when I get the story of how families are using melatonin, I end up advising changes in the sleep schedule more than a need for meds. What we do know: melatonin can help children fall asleep with sleep dysfunction, sleep dysfunction and inadequate sleep have serious health consequences, and although melatonin only helps with sleep initiation (falling asleep) it can be hugely beneficial for children who lie awake at night for hours at bedtime. The other thing we know: melatonin is not regulated like medicines (it’s overseen as a food supplement) that has been studied in very few pediatric populations so it’s difficult to generalize safety for children everywhere. Lots of definitions, dosing info, and pediatric sleep expertise below.

If your child can fall asleep in about 30 minutes after the lights are out (especially when you have made sure no screen time for 1-2 hours prior, no caffeine in afternoon) then melatonin is unnecessary.

If it were my child I’d use melatonin if sleep dysfunction at bedtime was getting in the way of necessary sleep, but I’d also do everything I could to get them off of it as soon as I could. Many children respond to the hypnotic effect of higher doses of melatonin, but many children are also given it for family convenience, too. In my experience, sometimes families use it to treat anxiety (those kids whose mind spins and spins and spins and worries) at bedtime. Although sometimes melatonin helps kids fall asleep, it’s just a band-aid.

Children are sleeping less than ever before and there are mounting impediments to a good night’s sleep (screens, early school start times, stimulants in the food source, busy school days and activities keeping kids up late). However inconvenient, I think sleep hygiene (routine bed time, no screens before bed, bed used only for sleeping) and consistency with what we do as parents may be the only magic wand to wave for sleep throughout childhood. Awakenings typically rise from all sorts of developmental milestones and changes as children grow. Overnight awakenings will always be normal although how our children get back to sleep on their own changes our night of sleep dramatically. When it comes to challenges falling asleep, sometimes melatonin can really help, especially in children with underlying autism spectrum disorder, attention deficit disorders, or children with shifted sleep schedules.

Only a few long-term studies have looked at prolonged use and associated effects, but most sleep specialists consider melatonin safe, particularly for occasional short-term use. The bigger question is why parents feel the need to give their child melatonin.  –Dr. Maida Chen

What is Melatonin?

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What About You? The Value Of Sleep

The minute we become parents we immediately start to hone in on the value of our children’s sleep. Their growth, their feeding, their development and their sometimes labile temperament quickly illustrate the import of real rest in our lives. Many parents advertise their commitment to their child’s sleep as a huge parenting win. Those of us who struggle with it, we often admit defeat. It’s clear, pretty early in infancy, that sleep transforms who we are, how we think and how we live from day one. Our babies are savvy professors in this regard.

Modern parenting conversations are teasing out the value of child sleep versus the value of adult sleep in multiple ways. In some cases, it’s the tug-o-war and battle-of-minds while discussing data and beliefs around when to let a baby cry-it-out. Working parents often report on their inability to sleep in the early working/baby years. In the U.S. we constantly revere those who don’t sleep a lot  — productivity seems to trump wellness in the hierarchy: there are politicians, profressional athletes and successful business people who brag about their capacity and earnest commitment to their craft via the lens of accomplishing greatness on minimum sleep. All this, despite the mounds of research that find health and performance benefit from a good night’s rest. Read full post »

Sleep Debt And “The Great Sleep Recession”

2-13 teen sleep photoTeens in the U.S. aren’t getting enough sleep and it’s not getting better as time unfolds. After days of too little sleep we accrue a “debt” of sleep. An article out earlier this month details the long-term effects of chronically tired teens, “The Great Sleep Recession” the reality that as teens progress from middle school and into high school, the majority don’t get the sleep they need. National Sleep Foundation has found that over 85% of teens lack adequate sleep. Sleep matters: deprivation and tiredness affect schoolwork, attention, mood, interactions, unhealthy weight risk and lifelong health habits. Teens need between 8 – 10 hours of sleep each night (imagine — that means if in bed at 10:30 a teen shouldn’t hear an alarm prior to 6:30am!) but the data out this month shows a growing number of teens from all ethnicities and backgrounds are getting less than 7 hours of sleep, 2 hours less than what is recommended. This has big effects on the culture we’re rearing. Typically teens won’t naturally get tired and drift off to sleep prior 10 pm, so one way to combat this sleep deficit is to push school start times to a later hour.

Why Teens Need Sleep

Sleep deprivation changes the experience of life. There an increase in risk for anxiety and for depression in young adulthood in those who don’t get adequate sleep and it’s harder to focus, pay attention, perform at school and make decisions when we’re tired.

  • Less sleep leads to more car accidents and poor judgment. Changing the time teens start school can improve safety:
    • Delayed start time lowered one county’s teen crash rates during study, while statewide teen crash rates (that reflected schools that stayed on the same schedule) rose 7.8% over same time period.
    • In a two county comparison in Virginia, the one with an earlier start time had a crash rate of 48.8/1,000 drivers vs the county with later start times 37.9/1,000 drivers.
  • Sleep deprivation can lead to substance abuse later in life and is tied to more use of caffeine and other stimulants.
  • Caffeine in the morning and afternoon, naps throughout the day and evening and/or sleeping in on the weekend help teens cope with fatigue but these band-aids and catch-ups will not restore brain alertness like sufficient sleep does.

“Sleep Recession”: Trends From 1991-2012

Graph data adapted from: http://pediatrics.aappublications.org/content/early/2015/02/10/peds.2014-2707.full.pdf+html

Graph data adapted from: http://bit.ly/1Gm8HbQ

The recession is here, teens are more tired than they were in the 1990’s.

  • Sleep recession trending
    • Teens who get more than 7 hours of sleep in decline
    • Largest decrease in sleep in 15 year-olds.
      • In 1991 72% got >7 hours of sleep
      • In 2012 only 63% got >7 hours of sleep
  • Gender gap in adequate sleep widening as girls getting less sleep than boys

How Later School Start Times Can Help

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Sleeping With A Smartphone

460297347Turns out small screens in the bedroom may be worse for sleep than a TV. Little screens enter the room without much effort, stealing away in a pocket or backpack without notice; smartphones also grab our attention in novel ways. The light emanating from small screens is really close to our face (potentially interfering with that lovely melatonin spike before bed in ways a TV across the room cannot) and small screens are often interactive, requiring us respond or type back, provoking alertness. The first study evaluating effects of smartphones and tablets on sleep in US children is out. While the news isn’t surprising it isn’t good either.

We may be raising a really tired generation of children.

I’ve been chatting for years about trying to keep TVs out of childrens’ bedrooms. Simply put, television adds little to a child’s life when viewed right before bed. In fact ,Seattle Children’s experts Dr Michelle Garrison and Dr Dimitri Christakis have shown consuming television just before bed can cause children to have more trouble falling asleep, more nightmares, and more awakenings during the night [here’s more info–> why no TV before bed is better]. Recently though, we learned what we all likely suspected: interactive, small screens may be even worse for a child’s sleep than the TV. Tablets, TVs, iPads, and smartphones are for most adults and kids a normal part of everyday life, even during infancy and toddlerhood. 2013 Common Sense Media data finds 45% of 5 to 8 year-olds have a TV in their bedroom and 72% of children from birth to 8 report using mobile devices during the day.

A study out this past week in Pediatrics shows small screens in the bedroom have a troubling effect on children’s sleep. Read full post »