Is it a mental health disorder, a physical disorder or simply a lack of SLEEP?

February 19, 2020

Happy Wednesday! Today I wanted to share with you an article I read inΒ Pediatric News written by Tara Haelle. The Title isΒ A Good Night’s Sleep.Β 

In the article, Tara quotes Dr. Spinks-Franklin, a pediatrician in Texas Children’s Hospital Β in Houston as explaining that “social media and electronics are not the only barriers to a good night’s sleep for teens.”

Lets review what is the recommended hours of sleep for children:

infants – 12-16 hours (Oh to be a baby!) including naps (for those ages 4-12 months). Β  Β Β Kids 1-2 years old need 11-14 hours and kids ages 3-5 years old need 10-13 hours Β including naps. By the ages of 6-12 years the amount drops to 9-12 hours/night.

Most of us can control how many hours of sleep our little ones get (there are exceptions!), however, the teen years can sometimes pose a challenge when it comes to sleep! Many parents fall asleep before their teens do! Did you know that teens actually need 8-10 hours of sleep? Yet, statistics show that 75 % of seniors get less than 8 hours of sleep!

It’s true that social media, TV and computers contribute to this lack of sleep but a rigorous academic load with extracurricular activities can also play a large role. Some teens work after school and this too feeds into their hours of homework and other responsibilities. Another factor is drinking caffeine in the afternoons. Many teens quickly learn that drinking caffeinated drinks will help keep them up to study but what they don’t realize is how it affects them the following day!

I will also note that sleep apnea can also result in the symptoms discussed below. If you notice that your teen is snoring loudly or has pauses in their breathing during sleep discuss this with your doctor and consider a referral to an ENT (Ears, Nose and Throat specialist). This is a treatable disorder than can truly change a child’s life.

I for one believe in later start times for teens. Enforcing early start times in schools leads to a decrease in sleep overall and as a result increases the levels of irritability and other problems as I will explain.

According the Dr. Spinks-Franklin, there are 2 kinds of sleep problems in teens: insomnia and delayed sleep phase syndrome. Both are very important since they can lead to short Β and long term physical and mental health issues.

In the short term, a lack of sleep leads to poor judgment, poor executive functioning and even depression.

The interesting part of the article addresses the similarity in symptoms between ADHD and a lack of sleep:

  1. Depression, feeling sad, or emotional hypersensitivity.
  2. Mood swings, crankiness (this happens to parents too!)
  3. Difficulty concentrating, fidgeting in one’s seat or daydreaming
  4. Unable to complete tasks or stay on task. Problems with memory
  5. Difficulty in social situations, such as with others in school or friends
  6. Daytime sleepiness
  7. Behavioral issues like impulsivity, aggression or hyperactivity
  8. Frequent careless mistakes
  9. Feeling lethargic or lack of motivation
  10. Easily distracted

The problem with insomnia is that once it starts it is difficult to break the cycle as anxiety and school or social stressors seem worse with the lack of sleep. What can be small hills can feel like mountains impossible to climb.

The second issue mentioned is that of delayed sleep phase syndrome. This is when someone has a delay in the secretion of melatonin and just can’t seem to fall asleep when they want to. In teens this is made worse by sleeping in on the weekends (to catch up on sleep) since this interferes with the body’s circadian rhythm (our body’s physical, mental and behavioral daily cycles) making the problem worse!

So what can we do???

  1. No screen time 1 hour before bed! I try to tell patients to leave reading or project based learning for right before bed and encourage them to do their computer work as soon as they get home from school or activities
  2. No caffeine at least 5 hours before bedtime.
  3. Consistent schedule for sleep (including weekends!)

While all of these can seem difficult to implement, if you are noticing any of the above symptoms with your teen, sit them down and have a discussion about it. If your teen is struggling they may consider your advice. It is worth a try!

Making small changes can have big impacts. Instead of treating the symptoms, let’s try to focus on the why of how we feel instead.

I hope you’re having a wonderful week!

Happy zzzzzzz’s πŸ™‚

Elizabeth Vainder, M.D.

“Good Night:Common Problems seen in teens are insomnia and Delayed Sleep Phase Syndrome.”Β Pediatric News Volume 54, No.2 February 2020., Tara Haelle, expert analysis from AAP 2019.

** If you suspect that insomnia is affecting your child’s ability to function in school or their day to day life, speak to your pediatrician. Consider cognitive behavioral therapy which can also help with insomnia.

10 Strategies for getting babies to sleep through the night

 

January 22, 2020

Good morning! If you just had a baby and you’re wondering how you are ever going to make it through this parenting thing on such little sleep, you are not alone! Having a baby can bring with it so much joy but as the initial stage of bliss begins to wear off, the extreme lack of sleep really starts to break you down. Before you start thinking that you will never sleep again, I am writing 10 strategies to help you get your baby sleeping through the night when he/she is ready.

I will add that newborns need to eat small amounts frequently. It is not appropriate to think that your baby will be sleeping through the night from Day 1, and if they are then something is wrong. So the strategies I am listing below are to help you approach sleep with your baby from Day 1, keeping in mind that you and your baby will change along the way and you need to be willing. Just when you think you found the best way, the baby will do something different. As baby’s grow, their needs change and as they become more and more aware of their surroundings, so do their reactions to what we do in response. This is especially important to understand as it related to sleep.

1. Less is more. When you are setting up a bedtime routine, remember less is more. I know there are many gadgets, sound machines, lullabies, etc out there to get your baby to fall asleep but you need to make it simple. You may not have that gadget when you travel or as your baby grows so remember less is more

2. Establish routines from Day 1. Babies thrive in routines and sleep is no different. Although it is difficult with a newborn it is not impossible. Try to create a pattern that the baby can recognize. For example: Bath, Story, Bed.

3.Β  Create a quiet time 1 hour before bed. Studies show that it is more difficult to fall asleep and stay asleep when you use computers or electronics before going to bed. Establish this as a rule in your house from Day 1. This is the perfect time for reading and engaging your baby. (This means YOUR phone too…put it down)

4. Help your baby to fall asleep but do not put them to sleep. In other words, you can help your baby relax if he/she is upset but once they appear relaxed, just lay them down. Let them learn from the beginning how to fall asleep without you.

5. Once a baby is between 3-4 months old try to separate feeding from sleeping. You do not want your baby to associate falling asleep with breast feeding or even bottle feeding. Not only does this create a bad habit, but once a baby has teeth, you increase their risk of cavities if they fall asleep drinking milk.

Β 6. Try to create a clear difference between day and night in your home. Daytime is when we speak freely, sing, dance and our lights are on. In the middle of the night we do not sing and dance! (at least not with a newborn).

7. Do your best to not run to your baby with every little sound. Newborns make lots of sounds and even a slight cry when they are settling in or trying to fall asleep. Let them try to get to sleep without your help after you have checked all your boxes: a.full tummy b. clean diaper. (you will begin to recognize your baby’s cries as you get to know them).

Β 8. It’s never to early to introduce a “lovey” or a special blanket. While newborns can not sleep with blankets in their crib, older kids can. However, you can place a lovey or special blanket near your baby while you are helping them transition from day to night with your bedtime routine. Just don’t put it in the crib.

9. Say goodnight. Sneaking away from a baby will create anxiety. The earlier a baby learns that he/she is going to sleep alone the less anxious they will be about going to sleep. (imagine if you’re a baby and you fall asleep in your mother’s arms, thinking you are there all night, only to find yourself alone in your crib at 2 am!-ANXIETY!)

10. Setbacks will happen when a baby is sick or you travel. It is totally fine! Somedays you just have to do what you have to do to make it through. Just try to get back into your original routine as soon as you and your baby are ready!

Sleep is one of the most overlooked aspects of health that many of us take for granted. Our bodies need to sleep. Being proactive in creating healthy sleeping habits will not only help your baby but it will also help you. You will be a better parent with a good night’s sleep and it’s never too early to begin preparing for it with your new baby!

Happy zzz’s!

Elizabeth Vainder, M.D.

Pediatrician

DRVCARES