Reflect

The event was attended by over 100 like-minded individuals including family sleep practitioners, consultant sleep doctors and parents struggling with sleep problems at home. I was reminded (again) of the critical importance of sleep for mental health and family wellbeing, and came away from the conference with renewed interest in this topic.

If you have ever attended one of my parent talks, I will likely have shared a couple of slides about the importance of sleep to children’s mental health and wellbeing; emphasising the fact that research consistently shows that too little sleep can affect children in multiple ways. For example, we know that lack of sleep can affect their ability to memorise, concentrate, learn, get along with their friends and regulate their emotions.

In a recent interview with Professor Michael Thomas and Dr Simon Green, authors of How the Brain Works, we discussed the study of sleep. They told me that sleep was initially studied in the early years of the 20th century, when it was considered a restorative process that had evolved to keep animals safe when it was too dark to do anything else. This belief has since transformed. Scientists now know that sleep is a hugely complex and active process involving multiple stages that oscillate during the night, and numerous control systems within the brain. During sleep, different parts of the brain important for memory and learning communicate with each other, and memories are transferred from short-term to long-term storage, freeing up space for more learning the next day.

For teens, short sleep duration can heavily impact on their mental health and levels of anxiety. More and more research shows that sleep is a crucial factor for wellbeing and one which needs to be looked after, as sleep problems can lead to other problems. In fact, in a large treatment study which evaluated the symptoms experienced by teens with depression, problems with sleep were actually more common than low mood. Dr Faith Orchard, a leading sleep expert, has also examined links between sleep, anxiety and depression. She found reliable evidence that various aspects of sleep predicted anxiety and depression, including total sleep time on school nights, daytime sleepiness, night waking and the participants' perception of sleep quality.

Professor Thomas and Dr Green told me that when we are sleep deprived, some brain systems suffer more than others. In particular, a lack of sleep impacts on the prefrontal cortex, the part of the brain which is involved in cognitive control and decision making. When we haven’t had enough sleep, these skills suffer. Our moods and emotions are also sensitive to the neurochemistry of the brain, and when we are in a sleep-deprived state, this delicate balance can be disrupted, affecting our mood.

Research consistently shows that many teens don't get recommended levels of sleep, and that they are particularly vulnerable to poor sleep. Without fail, every single evening, my teens hover near the fridge at around 10.30pm, seeking out snacks. Every single evening, I remind them to go to bed. We all know how tricky it can be to get a teen to bed at a reasonable time, but it really is worth refocusing our efforts to model and promote good sleep habits as our children approach middle and late adolescence. Even with older teens, gentle reminders that phones are not needed in the middle of the night are important. I am always emboldened to insist phones remain out of the bedroom when considering Professor Michael Gradisar’s research, which suggests that by remaining authoritative we can help reduce the risks of things like suicidal ideation!

One colleague that I bumped into at the conference, the brilliant sleep consultant, Polly Revaliente, from The Sleep Project, refers to sleep as a ‘magic pill’ for just about everything. As she says, if we knew and understood the importance of sleep for children’s outcomes across the board, wouldn’t we give it to them?

Motivate

One of the speakers at the Sleep Conference was Alice Gregory. Alice is Professor of Psychology at Goldsmiths, University of London, and the author of Nodding Off: The Science of Sleep from Cradle to Grave and The Sleepy Pebble: Calming Tales to Read at Bedtime. So, what advice does Alice want to pass on to the legions of parents with a child who won’t (or can’t) go to bed at night, stay in their bed, or has difficulties falling and staying asleep?

Alice told us why children might find it hard to sleep, even if they are tired. She explained that, “If a child is struggling to fall asleep, they might be tired, but in a state of 'arousal'. In other words, their physical and mental state may not be conducive to nodding off. Perhaps, for example, they have racing thoughts which make it difficult for them to fall asleep.”

How, then, can parents help children come out of that ‘alert’ state? Alice told us that, “There are a number of ways parents and carers can help children to relax and unwind at bedtime. One way is to think about the sleep environment. For example, you might want to dim the lights in the bedroom. When it is dark, our bodies release the ‘darkness hormone’ melatonin, which gives us a cue that it is time to go to sleep. Another way is to keep their room comfortably cool. Our core body temperature naturally drops before bedtime and a cool environment is conducive for good sleep.

Routine is important in trying to cultivate good sleep habits and we should ideally keep bedtime and wake time consistent. Many variables, including our body temperature, melatonin secretion and alertness levels naturally change throughout the day and night, which means that at certain times of the day, we are more suited to falling asleep than at others. By ensuring that bedtime and wake times are consistent, this helps us know when sleep is coming and to prepare accordingly.”

Work by Dr Serena Bauducco, one of our former Tooled Up ‘researchers of the month’, has shown that parents' routines and rules around bedtime and sleep are one of the most powerful protective factors for children's sleep, even into the teen years. As children become teens and start to assert their independence, rules around bedtime often relax. The evidence shows that parents should respect this growing autonomy, but also seek to remain authoritative, keeping a bit of control over bedtime into the teenage years. The teens in Dr Bauducco's study actively welcomed advice and guidance from their parents on how to get enough sleep and better manage all of the things they need to fit in each day. She told us that, "You should really keep your routines and keep a little bit of control over bedtimes for teenagers because they actually need some help in that, and we see that it really works”. A new Australian study showed that adolescents whose parents set bedtimes have at least 20 minutes more sleep on average than those who don't. The researchers say that this "can make 'all the difference' to next-day performance – including reaching the recommended 8-10 hours of sleep a night".

So, how should we know what time those bedtimes and wake times should be? Alice notes that, “Certain guidelines suggest that most children aged between 3 and 5 years will need between 10 and 13 hours of sleep per 24 hours, whereas those between 6 and 13 should get between 9 and 11 hours, and teens between 8 and 10.” In terms of when bedtime should be, “We should acknowledge environmental constraints (such as the time we need to wake up the next day) and the amount of sleep required, but ideally we should only go to bed when we are tired and ready to fall asleep.” We do know that if children or young people lie awake in bed for too long, this can lead to worries and unhelpful thoughts surfacing about their day that make them even less likely to sleep.

It’s important to point out to children that sleep doesn’t only keep us alert. It actually serves a very important function in keeping our brains healthy. As parents, we can attempt to persuade teens that the brain needs to slow and calm down in the hours before bed, so they shouldn’t be too stimulated (by digital devices, for example) late into the evening. For younger children, one of Alice’s books The Sleepy Pebble and Other Stories: Calming Tales to Read at Bedtime, which she co-authored with children’s writer Christy Kirkpatrick, contains five stories that might help them to feel more ready for sleep. “The stories contain techniques that might help children to unwind at bedtime,” Christy told me that “imagery, muscle relaxation and mindfulness can help children to relax, and these techniques are embedded in calm, peaceful stories that are based in the natural world.” Children can choose one of the tales in the book each night, to be read as their last story at bedtime, and parents and carers are encouraged to read it slowly, quietly, and in a calm and soothing voice. This can help bedtime to become a time of day to look forward to. For adults, going to bed is often a treat”, Alice points out. “It would be wonderful if children felt the same.”

Support

We highly recommend that anyone wanting to learn more should read Professor Alice Gregory’s book, Nodding Off: The Science of Sleep from Cradle to Grave. In it, she shares real-life stories and interviews with other sleep experts to find the answers to questions, such as: Why do so many adolescents enjoy lying in at the weekend? Why do children experiencing anxiety, behavioural problems or attention deficit hyperactivity disorder so often have co-occurring sleep problems? And, why are scientists turning to sleep disorders such as sleep paralysis to try to understand paranormal experiences?

You could also ensure that you are following evidence-based approaches by subscribing to Professor Gradisar’s YouTube channel, following the blog on his website WinkSleep and reading Dr Rachel Hiller and Professor Gradisar’s book on sleep problems in school-aged children. For practical support, chat to someone like nurse and sleep expert Joanna Kippax, or Polly Revaliente, who have seen it all. For help with infants’ or toddlers’ sleep, the Paediatric Sleep Council website provides accurate and up-to-date information on sleep in young children for parents and the Association for Child and Adolescent Mental Health has a useful section of advice about sleep issues in older children and teens.

If your child struggles to get to sleep due to concerns about their day, scheduling fifteen minutes of 'worry time' earlier in the evening can help to stop all of these thoughts from arriving when they are trying to sleep. If you’d like to try it, at some point in the evening, significantly before they intend to go to bed, tweens and teens can jot down their top three worries from the day and consider some solutions, leaving bedtime calmer and more relaxed. They might also find the Worrytree app useful.

What about tech at night? Well, we now know that the blue light emitted from phone and tablet screens has almost no negative impact on sleep. For some children, watching something at bedtime or using a calming app may actually be relaxing. However, depending on the character of your child and what they are using their device for, access to screens later in the evening or at night could cause overstimulation. It’s crucial to consider what they are doing online. For teens, it can be tempting to scroll endlessly on social media late at night, especially if they are unable to sleep because of their changing biological clock. It’s important to set boundaries and limitations with technology and that we encourage them to associate bed with sleep. Younger children may find it harder to manage their own routines, so having family guidelines around technology use at night may be helpful. Removing technology from the bedroom is likely to be the ideal in most situations.

If you, or your child, are having sleep issues, or would like some further advice, the National Sleep Helpline is staffed by trained sleep advisors who are available to talk through your issues, offer you some practical strategies and recommend services that could help. Call them on 03303 530 541. Lines are open between 7pm and 9pm, Sunday to Tuesday and Thursday and on Wednesday mornings between 9am – 11am. Sometimes, underlying medical issues can cause sleep issues. If your child has good sleep hygiene habits, but still has problems falling asleep or waking during the night, then make sure you seek help from your GP.

Whatever the sleep problem is in your home, approach it like a researcher. Jot down all observations, look for emerging patterns in your ‘data’, try some of Alice’s tips and evaluate their success.