Preventing Sleep Problems Preventing Sleep Problems and Developing Healthy Sleep and Developing Healthy Sleep

Habits Habits in Young Childrenin Young Children

Maya Garbuz, MSSW, CISWMaya Garbuz, MSSW, CISWCertified Child Sleep ConsultantCertified Child Sleep Consultant

madisonsleepconsultant.commadisonsleepconsultant.commaya@madisonsleepconsultant.commaya@madisonsleepconsultant.com

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OutlineOutlineSleep physiologyCauses and effects of sleep

disruptionsPrevention of sleep disruptionsIntervention techniquesCultural CompetenceCommunity resources

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Sleep CyclesSleep Cycles

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Circadian RhythmsCircadian Rhythms

More information: Secrets of Sleep Science: From Dreams to Disorders; Craig Heller.

Stanford University Lectures

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MelatoninMelatoninHormone that regulates sleepMelatonin production depends on lightMelatonin manufacturing is not

regulated by FDA: Side effects don’t have to be listed Dosage may not be accurate

Not enough studies to test safety of melatonin use on children

More information: National Sleep Foundation:

sleepfoundation.org5

Light’s Impact on SleepLight’s Impact on SleepResearch:

◦ Exposing eyes to lots of light during the day increases melatonin production at night

◦ Exposing eyes to light in the evening decreases melatonin production at night

Blue Light is the biggest melatonin suppressant

More information: ◦ Lowbluelights.com◦ Richard Hansler, Ph.D. Pregnant? New Baby? Need

Sleep!

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StatisticsStatistics1 in 4 adults struggle with sleep in some

way20-30% of young children experience

some kind of sleep disorder at some point in their childhood

Up to 80% in children with special needs and chronic illnesses

80% of children with Autism (20% being severe sleep issues)

About 50% of all children with sleep issues having this being an “every night” occurrence

More information: American Academy of Sleep Medicine: aasmnet.org

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The Bizarre Phenomena of The Bizarre Phenomena of SleepSleepSuppose you have a new baby and your obstetrician is telling you of the neonatal exam: he says you have a beautiful, healthy baby, but there are a few things you should be aware of as new parents: frequently, your baby will go unconscious and be unresponsive to normal stimulation; the frequency of these attacks will gradually decrease to one a day by the time she goes to school, but they will last throughout life. Periodically, when unconscious, she will be paralyzed, except for spastic muscle twitches; her eyes will dart back and forth and her heart and breathing rate will get irregular. As she gets older, she will have hallucinations during these episodes; she will hear voices and see things that are not there. Some of these things will be very strange, and may be even terrifying, causing her to sit up and utter screams of fright; but not a problem, because this condition is also characterized by total amnesia: she won’t remember any of these terrifying experiences.

Loss of consciousness, paralysis, spastic muscle contractions, cardiac and respiratory arrhythmia, hallucinations, terror, amnesia, my word! You are upset, anxious, but the doctor tells you: nothing to worry about it; this is completely normal. It is sleep! (From Secrets of Sleep Science: From Dreams to Disorders, Craig Heller; Stanford University Lectures )

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Causes of Sleep Causes of Sleep DisruptionsDisruptions

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Obstructive Sleep ApneaObstructive Sleep Apnea

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Night Symptoms:◦ Snoring◦ Gasping and pausing for breath◦ Restlessness◦ Sweating◦ Bedwetting (leaking diaper)

Day Symptoms◦ Sleepiness◦ Difficulty awakening in the morning◦ Irritability◦ Long naps◦ Falling asleep in the car

Environmental IssuesEnvironmental Issues7 Ingredients of healthy sleep environment:

◦ Dark◦ Quiet◦ Comfortable◦ Low-stimuli◦ Cool ◦ Consistent ◦ Safe◦ More information:

National Sleep Foundation: sleepfoundation.org/bedroom/

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Other Causes of Sleep Other Causes of Sleep DisruptionsDisruptionsOther Medical Issues Behavioral/Temperament IssuesTraumaSensory Processing DisorderHungerSeparation AnxietyOverstimulationNutrition Issues Unbalanced Internal clockMany changes happeningTravel EffectsDevelopmental MilestonesLack of Consistent Schedule & Bedtime Ritual

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Effects of Sleep Effects of Sleep DisruptionsDisruptionsPhysical:

◦ Lack of energy, fatigue◦ Compromised immune system◦ Weight gain◦ Slow and impaired reaction

Emotional: ◦ Bad mood◦ Impaired social interactions

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Effects of Sleep Effects of Sleep DisruptionsDisruptionsBehavioral:

◦ Hitting◦ Moving all the time or not at all

Cognitive:◦ Difficulty learning new concepts◦ Short attention span◦ Impaired abstract thinking◦ Lack of desire to play, especially with new and

challenging toys

Delays in all areas of development

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Symptoms of Sleep Deprivation Symptoms of Sleep Deprivation in Childrenin Children

Moodiness and irritability, aggressionTemper tantrumsGrogginess when they wake up in the morningChild falling asleep in the carHaving to wake child up almost every morning Child has trouble thinking during the day On some nights, child “crashes” much earlier than their usual bedtime

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PREVENTIONS OF SLEEP PREVENTIONS OF SLEEP DISRUPTIONSDISRUPTIONS

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Stop singing Rock A Bye Baby to put me to sleep… A song about a baby in a

cradle that comes crashing down does not exactly make me want to close my

eyes

What Do We Need to Prevent What Do We Need to Prevent Sleep Disruptions: Sleep Disruptions:

Consistency!!!Bedtime routine Sleep environmentGood-for-sleep foods Level of activity during the dayLight exposure during the dayBoost melatonin production at nightWatching sleep cues

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Sleep Cues: Sleep Cues: “I am ready for bed”“I am ready for bed”

If being fed – sucking slower or weaker

YawningTurning away from facesDecreased activity Glazed lookBabbling less

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Sleep Cues:Sleep Cues:“I am close to losing it” “I am close to losing it”

Being disinterested in surroundings

Laying head down for a secondRubbing eyesSlower movementNuzzling into your neck Seeking contactRed circles around eyes

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Sleep Cues:Sleep Cues:“No way I am sleeping now!”“No way I am sleeping now!”

FussingCryingCan’t nurseArchingFlailing

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Average Sleep HoursAverage Sleep HoursAge Nighttime

sleepDaytime sleep

Total Hours

1 month 8.5 hours 7.5 hours/many naps

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3 months 6-10 5-9 / many naps

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6 months 10-12 3-4.5 / 2-3 naps

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9 months 11 3 / 2-3 naps 14

12 months 11 2.5 / 2 naps 13.5

18 months 11 2.5 / 1-2 naps 13.5

2 years 11 2 / 1 nap 13

3 years 10.5 1.5 / 1 nap 12

4 years 11.5 Optional nap 11.5

5 years 11 Optional nap 11 21

INTERVENTION INTERVENTION TECHNIQUESTECHNIQUES

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# 1: Change Parents’ # 1: Change Parents’ ExpectationsExpectations

What is “sleeping through the night?” (American Academy of Pediatrics vs. public awareness)

When is my child should be sleeping through the night?

Differences between child and adult sleep

More information: Parentingscience.com (Gwen Dewar, Ph.D.)

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Differences Between Child Differences Between Child and Adult Sleepand Adult Sleep

Adult Child

90-110 min. cycles 45-60 min cycles;Adult-length cycles by age 3

4 phases 2 phases

Regular circadian rhythm

Circadian Rhythm is not fully established until about 4-6 months

Regular Melatonin production

Melatonin is produced in low and consistent (same during day and night) quantities the first 4-6 months of life

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#2: Teach Child to Self-#2: Teach Child to Self-SootheSootheCry-It-Out is not the only option:

Extinction (Weissbluth) Gradual Extinction or Controlled Crying (Ferber) Extinction with parental presence (West) No-cry (Pantley)

Research shows that consistency, not the method delivers results

More info:Timothy Morgenthaler, etc. Practice Parameters for Behavioral Treatment of Bedtime Problems and Night Wakings in Infants and Young Children. An American Academy of Sleep Medicine Report

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# 3: Introduce Consistent # 3: Introduce Consistent RoutinesRoutines

Sense of Control:◦Knowing when something happens

creates a sense of control and safety◦Reduce bed time struggles (blame

the clock)Physical Cues

◦“My body feels sleepy”

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# 4: Improve Bed Time # 4: Improve Bed Time RoutineRoutine

What is a good bed time routine? Older children can be a part of

developing their own routineSleep Aids

Picture schedules Timers Pass system Loveys (Build-A-Bear)

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Children’s Books About Children’s Books About SleepSleep

Goodnight, Moon by Margaret W. BrownGoodnight, iPad by Ann DroydThe Quiet Book by Deborah Underwood*Dr. Seuss’ Sleep BookThe Going To Bed Book by Sandra Boynton Just Go To Bed by Mercer MayerTime for Bed by Mem FoxThe Boy Who Wouldn’t Go to Bed by Helen

Cooper I Love to Sleep In My Own Bed by Shelley

Admont I Don’t Want to Go to Sleep by Chris Francis*

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# 5 Improve Nutrition# 5 Improve NutritionSleep-inducing foodsProblem foodsIron deficiency

More information:National Sleep Foundation:Sleepfoundation.org/bedroom/taste.php

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# 6: Don’t Neglect Naps# 6: Don’t Neglect NapsResearch: important for development

in various areas (cognitive, physical, emotional) & longer attention span

Support night sleepAge

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Naps and LearningNaps and LearningThere is evidence that we are

more likely to retain what we’ve learned if we go to sleep shortly after our studies (G. Dewar)

Naps are as effective as night sleep for learning

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How to Promote Naps at How to Promote Naps at DaycareDaycare

Quiet and dark roomLullabies or white noise?Pre-nap slow-down activityComfortable (shoes off, warm)Low-stimuli setting (toys cleaned up)Loveys

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Cultural CompetenceCultural Competence

Cultural differences affect where, when, and how children sleep

No difference in the total amount of sleep within 24-hour period between white and ethnic minority children

Differences in timing and distribution of sleep

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Cultural competence – Cultural competence – Cont.Cont.When talking about sleep have to take

culture into considerationAfrican-American infants have higher

incidence of SIDS and are more likely to be placed in prone for sleep – prevention!

More info:◦ Oskar G Jenni, Bonnie B. O’Connor. Children’s Sleep:

An Interplay Between Culture and Biology. Pediatrics. Vol. 115

◦ Julie Boergers, Daphne Koinis-Mitchell. Sleep and Culture in Children with Medical Conditions. Journal of Pediatric Psychology. Vol. 35(9)

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SIDS AwarenessSIDS AwarenessFactors that may contribute to

SIDS: Prematurity Smoking during and after pregnancy Bed-sharing* Sleeping alone in the room Having “fluff” in the crib Prone to sleep Trying to sleep-train too early

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Co-sleeping vs. Bed-Co-sleeping vs. Bed-sharingsharing

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Community ResourcesCommunity Resources◦Medical

Sleep Clinics Chiropractors

◦Behavioral: Sleep Consultants Psychologists Occupational Therapists

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On-line ResourcesOn-line ResourcesAmerican Academy of Pediatrics

◦Aap.orgNational Sleep Foundation

◦Sleepfoundation.orgAmerican Sleep Association◦ Sleepassociation.orgGwen Dewar, Parenting Science◦ Parentingscience.com

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Books on Sleep and Books on Sleep and Sleep Training MethodsSleep Training MethodsGood Night, Sleep Tight by Kim West (all

ages)The No-Cry Sleep Solution by Elizabeth

Pantley (best for infants)Solve Your Child’s Sleep Problems by Richard

Ferber (great info on sleep)Sleeping With Your Baby: A Parent’s Guide to

Co-sleeping by James McKenna (information on safe bed sharing and co-sleeping)

Sleep Better! A Guide to Improving Sleep for Children with Special Needs by Mark Durand

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Questions?Questions?

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No, seriously… Tell me more. You are so interesting…