sleep | Dr. David Palmiter's Blog for Hectic Parents

Helping Your Kid Get a Good Night’s Sleep

It’s back-to-school and many parents are working on sleep with their kids. In previous entries I reviewed evidence that most teens do not get sufficient sleep, shared authoritative guidelines for how much sleep kids should get and summarized the most common ways kids suffer when they do not get enough sleep. Here I offer guidelines for how you can promote a good night’s sleep in your kid.

• Try to encourage a consistent bedtime ritual that starts about an hour prior to the time you’d like your to fall asleep. In this hour try to avoid activities that promote an active or a fretful mind. For younger children reading them a book as they lay in bed can be effective. A shower or bath in this hour can also be relaxing.

• Baring unusual circumstances, consider not allowing your kid to keep a cell phone in her bedroom.

•Try to avoid allowing your kid to watch TV as he falls asleep. However, if you do, make sure it is not on for long and that it is turned off shortly after he falls asleep.

• If your kid is waking up soar or stiff or if her mattress is showing signs of wear or tear, consider replacing it.

• If your kid reports being too cold or too hot when trying to fall sleep, adjust accordingly.

• Try to avoid laying with your child until she falls asleep. If her anxiety level seems to mandate such, see a qualified mental health professional for help.

• Dim night lights are fine to use if such makes your child more comfortable.

• Of course, try to ensure that your child’s environment is quiet. If you live in a busy area and outside noise is interfering, consider purchasing a noise cancelling machine.

• If your kid consistently fights you in getting to bed on time, consider making her earn access to a desired activity or object the next day by getting into bed on time (e.g., cell phone access the next day is earned by having gotten into bed on time with the lights out). This is not punishment. (“I’m taking your cell phone away because you did not get to bed on time.”) This is reward. (“You earn your cell phone each day by having gotten to bed on time the night before.”) So, your kid either earns or doesn’t earn the desired activity or access while you remain an empathic bystander.

• If your kid reports that he cannot fall asleep because his mind is too busy, try one or more of the following strategies:

At a soft volume, play an audio recording of a story with which your child is familiar. Try to avoid plots that are action packed. Also, make sure to turn it off shortly after your kid falls asleep.
Encourage your kid to imagine that it is the next day and he is in a boring class. In the class he is extremely tired, but he MUST stay awake. Encourage your kid to imagine what each of her senses experience as he does this mental exercise.
Encourage your kid to imagine a repetitive pleasurable activity (e.g., fishing, cheerleading, pitching a ball game, dancing, etc.). Again, encourage her to engage all of her senses when imagining this activity.
Play sounds from nature (e.g., the beach, a rainforest, etc.) or other soothing music (e.g., insomnia tracks available on iTunes). If your child has a device like an iPod, he may enjoy using one of the compatible pillows that are available.
Some people report that the aroma of lavender can have a sedating effect. So, consider this as well.

Insomnia is like a fever as it is a symptom that has many possible causes (e.g., sleep apnea, mood disorders, anxiety disorders, etc.). If your child suffers from persistent insomnia consult with your child’s pediatrician regarding possible medical causes. If medical interventions do not resolve the problem, are contraindicated or will take a while to implement, consider seeking out the services of a qualified mental health professional.

Comments (6)

Combating Insomnia

Jul 19, 14 11:57 AM

There are numerous causes of insomnia in youth. Stress, anxiety disorders and mood disorders can each cause this problem. However, if the problem is addressed early, or if it is mild, self-help remedies may be helpful.

A good starting point is to review the amount of sleep that kids need. Sleep is even more important to youth than it is to adults. Just one hour of deprived sleep a night can have negative impacts on cognitive, emotional and behavioral functioning the next day. Moreover, sustained problems with sleep have been shown to contribute to numerous psychological and medical problems, including obesity. These are commonly promulgated guidelines:

1-3 years old: 12-14 hours

3-5 years old: 11-13 hours

5-12 years old: 10-11 hours

Teens: 8.5-9.25 hours

(As you look at these numbers it wouldn’t be uncommon for you, especially if you’re the parent of a teen during the school year, to think “Geez, my kid doesn’t get that much sleep.”)

What follows are behavioral, cognitive and environmental tips for combating insomnia.

Behavioral Strategies

• Try to encourage a consistent bedtime ritual that starts about an hour prior to bedtime. In this hour try to avoid activities that promote an active or a fretful mind. For younger children reading them a book can be effective. A shower or bath in this hour can also be relaxing.

• Baring unusual circumstances, consider not allowing your child to keep a cell phone in her bedroom. Likewise, try to avoid allowing your child to watch TV as s/he falls asleep. However, if you do, make sure it is not on for long and that it is turned off shortly after s/he falls asleep.

• Dim night lights are fine to use if such makes your child more comfortable, but I would try to avoid treating anxiety by laying with your child as s/he falls asleep (enter the word “anxiety” in the search bar above to find alternative approaches).

• If your child consistently fights you in getting to bed on time, consider making him or her earn access to a desired activity or object the next day by getting into bed on time (e.g., cell phone access the next day is earned by having gotten into bed on time with the lights out). This is not punishment. (i.e., “I’m taking your cell phone away because you did not get to bed on time.”) This is reward. (i.e, “You earn your cell phone each day by having gotten to bed on time the night before.”) So, your child either earns or doesn’t earn the desired activity or access while you remain an empathic bystander.

• Try to avoid caffeinated beverages and food (you might be surprised at how common caffeine is) and limit your child’s intake of sugar. (The World Health Organization’s 2014 draft guidelines recommend that no more than 5% of the daily calorie intake occur from sugar, which can be challenging given how prolific the substance is. For example, there can be a teaspoon of it in a tablespoon of ketchup.) Moreover, Ask your child’s pediatrician if natural supplements such as Omega-3 fish oil and melatonin SR might be helpful.

Cognitive Strategies

These strategies are useful when your child can’t fall asleep because his or her mind is too busy. These strategies involve redirecting his or her mind to content that promote sleep instead of interfering with it.

• At a soft volume, play an audio recording of a story with which your child is familiar. Try to avoid plots that are action packed. Also, make sure to turn it of shortly after your child falls asleep.

• Play sounds from nature (e.g., the beach, a rainforest) or other soothing music (e.g., tracks from Michael Bruce’s Insomnia Treatment that is available on iTunes). If your child has a device like an iPod, he may enjoy using one of the compatible pillows that are available.

• Encourage your child to imagine that it is the next day and s/he is in a boring class. In the class s/he is extremely tired, but s/he MUST stay awake. Encourage your child to imagine what each of her senses experience as s/he does this mental exercise.

• Encourage your child to imagine a repetitive pleasurable activity (e.g., fishing, cheerleading, pitching a ball game, dancing, etc.). Again, encourage him or her to engage all of his or her senses when imagining this activity.

Environmental Strategies

• If your child is waking up soar or stiff or if her mattress is showing signs of wear or tear, consider replacing it.

• If your child reports being too cold or too hot when trying to fall sleep, adjust accordingly.

• Of course, try to ensure that your child’s environment is quiet. If you live in a busy area and outside noise is interfering, consider purchasing a noise cancelling machine.

• Some people report that the aroma of lavender can have a sedating effect. So, consider this as well.

If these strategies don’t work, and assuming physical causes have been ruled out, seriously consider seeking out the services of a qualified child mental health professional. For a referral, click here.

Comments (1)

How do I get my kid to sleep in his or her own bed?!

Jan 19, 13 6:21 PM

First I should state that co-sleeping, or kids sleeping in the same bed as their parents, is a culture bound phenomenon that is inherently neither healthy or dysfunctional. So, if you’re from a culture where this is common, and none of the caveats I describe below are in play, no worries. However, there are instances when co-sleeping is symptomatic of an underlying problem. In my experience, the most common of these are marital disturbance, adult loneliness, anxiety–in the child and/or the parent(s)–or some combination of the three. The purpose of this post is to suggest strategies for dealing with situations when you wish for your child to sleep in his/her own room but s/he is freaked out about that (the other problems could be addressed in counseling; you may also find articles pertaining to those topics within this blog site).

Avoidance is rarely an effective strategy for coping with fears that your child has regarding developmentally appropriate activities or situations. As none of we engaged parents are happier than our least happy child, it’s natural for us to support avoiding those (developmentally appropriate activities or situations) that distress our child. But, avoidance is a jealous strategy; the more it is used the more it pulls to be used. Plus, avoidance doesn’t deal with the underlying problem. Keeping in mind that you may need professional and tailored consultation, here are some strategies to try on your own (some of these are merely strategies for promoting sleep hygiene).

• Set up an incentive program for sleeping alone. If your child is younger, or the problem is a mild one, a star chart may suffice (i.e., each successful night earns a star on a chart). Make it so that that your child earns something s/he desires after so many stars are on the chart. If your child is older, or the problem is more significant, it may be more effective to establish a daily incentive program (i.e., sleeping alone earns the privilege of watching TV the next day). There are multiple possible permutations of this that I review in Chapter Five of my parenting book. However, the bottom line idea is to make it in your child’s best interest, as s/he perceives such, to sleep alone.

• If your child is showing a lot of distress about this, you could use the technique of shaping. With your incentive program in place, let the first phase be a reward for something that is a small step forward from where you are at now (e.g., you lay with your child helping her/him to fall asleep in her/his bed, then leave, for a week; then progress to being in a chair in her room as s/he sleeps; then you are in the hallway, etc.).

• Install a nightlight if that comforts your child.

• Allow your child to fall asleep to soothing music or to an audio book of familiar material (you don’t want him/her trying to stay up to hear the next development in the plot line); just make sure it shuts off after a designated time. Alternatively, you could read your child a book. (You could also use shaping for both of these strategies).

• Your child may find a lavender aroma in the room to be soothing.

• A bath or shower before bed can be relaxing and prepare your child for sleep.

• Try to keep your child from consuming caffeinated beverages in the afternoon and evening. A balanced diet is also something that can make a positive contribution to most behavioral problems that kids display.

• Try to ritualize the hour before bedtime (i.e., usually the same procedures followed in the same order).

• Having had at least an hour a day of physical activity (i.e., sweating and breathing hard) can facilitate a good night’s sleep.

• Try to avoid intellectually demanding or exciting activities the hour before bedtime.

If these strategies don’t resolve the problem in a short period of time, and in consultation with your child’s pediatrician, it would usually be advisable to seek out the services of a qualified mental health professional. Click here for a referral.

Eight Tips For When Your Child Freaks Out About Sleeping Alone

Apr 28, 12 7:40 AM

Research suggests that attitudes about sleeping in the parental bed, or co-sleeping, vary across cultures. If a given culture finds this to be acceptable, and the family enjoys it, then there doesn’t seem to be any problems affiliated with it. So, this blog entry is not for those situations. This entry regards situations in which a kid expresses distress at sleeping in his or her own room, the most common cause of which is anxiety.

Tip #1: Consider whether you or your family’s dynamic is facilitating your child’s distress. Sometimes it is a parent who feels anxious about a kid sleeping in his or her own room (e.g., “what if a burglar breaks in and I’m not there to help?!”). Or, it may be that the kid sleeping in the bed averts dealing with a problem in the primary adult relationship (e.g., one parent wants to avoid conflict over sex). Dealing effectively with such underlying issues sometimes can make the surface problem go away on its own.

Tip #2: Avoid avoidance. This is good counsel across all domains of a kid’s life. Anxiety is fed when a kid avoids developmentally appropriate and safe situations because of fear.

Tip #3: Approach the situation with a calm, kind and firm manner. In regards to we parent-lunatics: when our kid hurts we hurt worse. Because of how our kid’s distress makes us feel, we sometimes react without considering whether the distress is good for our kid to experience (e.g., we remove the distress, we get agitated at our kid, we cave in).

Tip #4: Avoid excessive reassurance. A reassurance indicates that there is something potentially dangerous at hand. When explaining this principal to parents I’ll say “imagine I told you not to worry about the roof of this office collapsing on us. Can you sense the discomfort you’d start to feel about the security of the roof?”

Tip #5: Figure out the pacing of the “exposure.” Exposure means allowing (or sometimes forcing) a child to face a developmentally appropriate and safe situation that distresses him or her. If the amount of distress is manageable, the strategy may simply be to insist that he or she sleep in his or her own bed. If the amount of distress is more severe, you can introduce a schedule (e.g., at first you sleeps in your child’s room for a week or so, then you transition to sleeping there only until your child falls asleep, then only for a few minutes as your child settles in and then not at all).

Tip #6: Consider reasonable steps for promoting your child’s comfort. You might decorate the room in a motif pleasing to your child, allow him or her to sleep in special pajamas, leave on a night light, leave your child’s bedroom door open or allow him or her to fall asleep to music or an audio recording of a familiar story. (You don’t story to be so novel and interesting so as to keep your child up. You also want to be sure to turn it off after your child falls asleep as the quality of his or her sleep will not be as good if it remains on. The same goes for music.)

Tip #7: Many kids don’t need this, but you could always set up a reward program. For milder instances this could be as simple as putting stars on a calendar and offering a treat when 7-10 stars are earned (e.g., having a sleep over, purchasing a desired video game). For more entrenched and difficult situations you can set up a daily reward (e.g., TV is earned the next day by having gone to bed properly the night before) as well as a bonus (e.g., a trip to a local water park is earned after 14 nights of sleeping in the bed). (If you set up a program where X number of days earns a reward, it typically would not be required that the days be consecutive.)

Tip #8: If the above self-help interventions do not work, seriously consider consulting with a child psychologist. There may be other complexities at play or your child may need treatment for an anxiety disorder (most of the time anxiety disorders can be treated efficiently and effectively through cognitive-behavioral therapy). To find a provider near you, click here. Below are some related blog posts that you might also find to be of interest and don’t forget to follow me at my Twitter feed: @HelpingParents):

My Child Gets Afraid A Lot. What Can I Do?

Mom Arrested For Giving Her Daughter Xanax: CBT Can Help to Avoid Such Sad Stories.

Signs That a Kid Needs Mental Health Services

Seven Common Myths About Counseling

Affording Mental Health Care

A Chronic Health Problem in Teens: a Lack of Sleep

Mar 9, 11 10:03 AM

The National Sleep Foundation does an annual Sleep in America Poll. Their 2011 edition, which has the theme of “Communication Technology in the Bedroom” was just published. In this blog I’m going to summarize the findings as they regard teenagers, which the poll refers to as Generation Z’ers.

Almost three out of four teens report bringing their cell phones into their bedrooms at night, with 56% texting every night/almost every night in the hour before bedtime. This is concerning as those who text in this hour are less likely to say they got a good night’s sleep, less likely to wake up feeling rested, more likely to be characterized as sleepy the next day and more likely to drive drowsy. Moreover, 28% percent of teens leave their cell phone ringers on at night and 18 percent report being awakened by incoming transmissions. Finally, when they wake up at night 35% of teens report that they will text.

The poll also found, as has been the case with previous editions of this survey, that our teens are not getting enough sleep. This year 4 out of 10 teens reported getting less than the minimal recommended dose of sleep each night with 60% stating that they wake up feeling like they had not gotten enough sleep (46% indicated that they rarely/never get a good night’s sleep on weekdays and only 6% endorsed getting a good night’s sleep every school night). Moreover, among those that drive, 40% indicated that they have driven drowsy. In total 77% of teenagers reported having sleep problems at least a few nights/days a week (e.g., 34% of teens report taking more than 30 minutes to fall asleep at night). Despite these problems teens seem to be aware of how many hours a night they need to be rested (i.e., 61% indicated that they need 8-9 hours, or more, to be rested).

The poll also asked the teens what areas are negatively affected the next day when they are tired. These are the areas they indicated become problematic (the percentage endorsing the problem is in parentheses): mood (87%), schoolwork (84%), family life or home responsibilities (73%), and social life or leisure activities (68%). (Please see my previous blog entry that reviews both the negative next-day consequences, for youth, of being deprived of just one hour of sleep as well as the National Sleep Foundation’s recommendations for how much sleep kids should get each night.)

Other findings:

√ More than three out of four teens use their laptops in their bedrooms in the hour before going to sleep. Most of the poor sleep outcomes that are associated with texting in this hour are also associated with this kind of activity.

√ Sixty percent of teens drink caffeinated beverages each day, with one out of four drinking four or more.

√One percent of teens report using an e-book reader in the hour before bedtime.

To review strategies for promoting a good night’s sleep in your child click here. For now the obvious thing to say is that we parents do well to be mindful of how much sleep our teens need as well as what the likely consequences will be if they are deprived of such.

Comments (3)

Is your kid getting enough sleep?

Oct 16, 10 9:15 AM

For many of us, a typical school night resembles a circus with the clowns’ hair on fire. There is way too much to do and not enough time to do it all. Because of this it may be tempting to try to make more time by pushing our kids’ bedtime back. After all, there has to be give somewhere and, while we might not like seeing our kid tired the next day, we know he or she can always catch up later. Right?

Well, unfortunately, research suggests that even one hour of lost sleep can have a dramatic and negative impact on a child’s or a teen’s functioning the very next day. Before summarizing some of this research, let me share the nightly doses of sleep recommended by the National Sleep Foundation:

1-3 years old: 12-14 hours

3-5 years old: 11-13 hours

5-12 years old: 10-11 hours

Teens: 8.5-9.25 hours

One of the best parenting books I’ve ever read is Nurture Shock (read my blog entry on my top three favorite books for parents by clicking here). According to the authors, the following number among the consequences when our children do not get enough sleep:

• For every hour of lost sleep, a child loses seven IQ points the next day.

• When kids get less sleep, their bodies respond in a manner that maximizes the production of fat and minimizes its breakdown.

• Sleepy kids are more lethargic and less active the next day.

• A complete night’s sleep is needed in order to properly remember newly learned academic material.

• Children with deprived sleep are more likely to remember negative rather than positive events.

• Children who are tired have a more difficult time thinking flexibly the next day.

To review related findings from the National Sleep Foundation click here.

I realize that messages like this are difficult to hear as it is so challenging to fit it all in. Moreover, our children often resist our efforts to get them to bed on time, adult leaders of extracurricular activities often seem unaware of these issues when they schedule late night events and kids sometimes find it difficult to fall and stay asleep. (To review strategies for promoting a good night’s sleep in your child click here.) But, for now, I believe we all do well to realize the importance of our kids getting a good night’s sleep.

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