Preventing Sleep Problems and Developing Healthy Sleep Habits in Young Children Maya Garbuz, MSSW, CISW Certified Child Sleep Consultant madisonsleepconsultant.com [e-mail]

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Preventing Sleep Problems and Developing
Healthy Sleep Habits in Young ChildrenMaya
Garbuz, MSSW, CISWCertified Child Sleep
Consultantmadisonsleepconsultant.commaya_at_madison
sleepconsultant.com
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Outline

• Sleep physiology
• Causes and effects of sleep disruptions
• Prevention of sleep disruptions
• Intervention techniques
• Cultural Competence
• Community resources

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Sleep Cycles
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Circadian Rhythms

• More information
• Secrets of Sleep Science From Dreams to
  Disorders Craig Heller. Stanford University
  Lectures

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Melatonin

• Hormone that regulates sleep
• Melatonin production depends on light
• Melatonin manufacturing is not regulated by FDA
• Side effects dont 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.org

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Lights Impact on Sleep

• Research
• 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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Statistics

• 1 in 4 adults struggle with sleep in some way
• 20-30 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 Sleep

• Suppose 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 wont 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 Disruptions
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Obstructive Sleep Apnea

• 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

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Environmental Issues

• 7 Ingredients of healthy sleep environment
• Dark
• Quiet
• Comfortable
• Low-stimuli
• Cool
• Consistent
• Safe
• More information
• National Sleep Foundation sleepfoundation.org/bed
  room/

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Other Causes of Sleep Disruptions

• Other Medical Issues
• Behavioral/Temperament Issues
• Trauma
• Sensory Processing Disorder
• Hunger
• Separation Anxiety
• Overstimulation
• Nutrition Issues
• Unbalanced Internal clock
• Many changes happening
• Travel Effects
• Developmental Milestones
• Lack of Consistent Schedule Bedtime Ritual

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Effects of Sleep Disruptions

• Physical
• 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 Disruptions

• Behavioral
• 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 in Children

• Moodiness and irritability, aggression
• Temper tantrums
• Grogginess when they wake up in the
• morning
• Child falling asleep in the car
• Having 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 DISRUPTIONS
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
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What Do We Need to Prevent Sleep Disruptions

• Consistency!!!
• Bedtime routine
• Sleep environment
• Good-for-sleep foods
• Level of activity during the day
• Light exposure during the day
• Boost melatonin production at night
• Watching sleep cues

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Sleep Cues I am ready for bed

• If being fed sucking slower or weaker
• Yawning
• Turning away from faces
• Decreased activity
• Glazed look
• Babbling less

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Sleep CuesI am close to losing it

• Being disinterested in surroundings
• Laying head down for a second
• Rubbing eyes
• Slower movement
• Nuzzling into your neck
• Seeking contact
• Red circles around eyes

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Sleep CuesNo way I am sleeping now!

• Fussing
• Crying
• Cant nurse
• Arching
• Flailing

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Average Sleep Hours
Age Nighttime sleep Daytime sleep Total Hours
1 month 8.5 hours 7.5 hours/many naps 16
3 months 6-10 5-9 / many naps 15
6 months 10-12 3-4.5 / 2-3 naps 14.5
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
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INTERVENTION TECHNIQUES
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1 Change Parents Expectations

• 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 and 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-Soothe

• Cry-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 Routines

• 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 Routine

• What is a good bed time routine?
• Older children can be a part of developing their
  own routine
• Sleep Aids
• Picture schedules
• Timers
• Pass system
• Loveys (Build-A-Bear)

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Childrens Books About Sleep

• Goodnight, Moon by Margaret W. Brown
• Goodnight, iPad by Ann Droyd
• The Quiet Book by Deborah Underwood
• Dr. Seuss Sleep Book
• The Going To Bed Book by Sandra Boynton
• Just Go To Bed by Mercer Mayer
• Time for Bed by Mem Fox
• The Boy Who Wouldnt Go to Bed by Helen Cooper
• I Love to Sleep In My Own Bed by Shelley Admont
• I Dont Want to Go to Sleep by Chris Francis

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5 Improve Nutrition

• Sleep-inducing foods
• Problem foods
• Iron deficiency
• More information
• National Sleep Foundation
• Sleepfoundation.org/bedroom/taste.php

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6 Dont Neglect Naps

• Research important for development in various
  areas (cognitive, physical, emotional) longer
  attention span
• Support night sleep
• Age

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Naps and Learning

• There is evidence that we are more likely to
  retain what weve 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 Daycare

• Quiet and dark room
• Lullabies or white noise?
• Pre-nap slow-down activity
• Comfortable (shoes off, warm)
• Low-stimuli setting (toys cleaned up)
• Loveys

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Cultural 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 Cont.

• When talking about sleep have to take culture
  into consideration
• African-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. OConnor. Childrens
  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 Awareness

• Factors 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-sharing
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Community Resources

• Medical
• Sleep Clinics
• Chiropractors
• Behavioral
• Sleep Consultants
• Psychologists
• Occupational Therapists

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On-line Resources

• American Academy of Pediatrics
• Aap.org
• National Sleep Foundation
• Sleepfoundation.org
• American Sleep Association
• Sleepassociation.org
• Gwen Dewar, Parenting Science
• Parentingscience.com

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Books on Sleep and Sleep Training Methods

• Good Night, Sleep Tight by Kim West (all ages)
• The No-Cry Sleep Solution by Elizabeth Pantley
  (best for infants)
• Solve Your Childs Sleep Problems by Richard
  Ferber (great info on sleep)
• Sleeping With Your Baby A Parents 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?
No, seriously Tell me more. You are so
interesting