Today we’re featuring a guest post from blogger Aby League. Aby League is a passionate writer and researcher. She owns About Possibilities blog and writes mostly about health, psychology and technology. Get in touch with her via @abyleague
According to the estimates of 40 accredited pediatric sleep centers in the US, about 20 to 30 percent of children older than six months suffer from sleeping problems such as insomnia. The lack of sleep or not getting enough of it can be detrimental to an adult’s health—so what more for children?
A quality, restful sleep is required to heal and repair the body, and encourage healthy growth in children. Without it, your child may show crankiness and other behavioral problems during the day. Studies have also shown that bad sleep is also linked to poor grades in subjects like math, writing, and reading. They may also show symptoms of depression and anxiety disorders.
Fortunately, there are ways to make your child sleep earlier and better such as telling stories and creating bedroom rituals. Furthermore, the bedroom plays a major role in the quality of sleep a child gets every night—from the color of the walls to the type of bed mattress. Everything inside the room must be designed to make it ideal for sleep.
However, every child is unique so coming up with the right design may be a bit harder than it would seem. At times, it can get a bit frustrating especially when you’re still trying to find out how to design your bedroom conducive to sleep. You may need to try different designs or mix and match them to find the perfect one for your child. Here are 11 fascinating bedroom designs to help your kids sleep better.
1. Starry, starry night
Photo via Pinterest
You can play a bit with bedroom lighting depending on your child’s preference, but it is recommended to use dimmable lights. Although studies show that light, or the lack thereof, is a key factor in getting a good night’s sleep, many children actually find it a bit difficult to sleep in a completely dark room. A good way to find out how much light the child needs to sleep comfortably is to use a dimmable light.
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2. Fluffy clouds for a mattress
Photo via Pinterest
Your child’s bed should be comfortable enough to keep them settled and well rested. In general, a kid’s mattress should be full-sized, with the bed a bit lower for younger children. Full-size mattresses allow the child to move freely and find the best sleeping position. The size should also allow for company when the child needs one. In terms of comfort, your child should be the decision maker, but firm mattresses would be best for younger children, especially infants.
3. Make it “cool”
Photo via Pinterest
Image is important to children. They find much more comfort in bedrooms that they consider “cool” rather than those that need to match the design of the home. The bedroom is their place of comfort so it will be best if they have a say on its design. However, you’ll still need to provide a bit of guidance to ensure that the room is free from clutter or things that could divert their attention from sleeping.
4. Electronics: Keep off
Photo via Pinterest
Electronic items, such as laptops, computers, and tablets, are best left outside the bedroom. These items stimulate a child’s interest instead of inducing sleep. Encourage the child to read a book inside the bedroom instead of browsing the Internet or chatting with their friends.
Another reason why electronics should be avoided is that children often forget to unplug devices, thus, creating a fire hazard. There are countless stories of exploding cellphone batteries or overheating devices causing fires, so ask your children to use these devices in the living room or study room where you can monitor them.
5. The rainbow connection
Photo via Pinterest
The traditional blue for boys and pink for girls may seem like the best colors for children, but it isn’t always the case. Keep in mind that children are unique and will sooner or later have preferred colors as they grow older.
6. Keep it open and fresh
Photo via Pinterest
A child’s room should always smell clean and fresh, but without the aid of an air freshener. The room should be well ventilated and the best way to do this is to open a window or two for a few hours during the day. This may not be advisable if the home is in the city because of pollution, but there are other ways to ensure that the room is airy.
7. Not too warm, not too cold
Photo via Pinterest
Keep in mind that your ideal room temperature may not be the same for your child. If possible, let the child choose the temperature setting. However, if you or your child is unsure of the right settings, try to aim for anywhere between 16 and18 degrees Celsius and start from there. You might also want to consider installing a ceiling fan for evenings that are comfortable enough to turn off the AC.
8. Keep the outdoors out
Photo via Pinterest
The environment outside the home can also affect a child’s sleeping patterns. Noise, light, and temperature are usually the culprits so try to reduce them as much as possible. If the home is located in a busy area, particularly during the night, then try to reduce noise by closing the windows and playing soft music inside the room. It will divert the child’s attention from exterior noise. However, it’s best to play tunes instead of music with lyrics to avoid additional distractions. Moreover, use curtains and drapes to reduce visual distractions at night.
9. Get rid of clutter
Photo via Pinterest
In a child’s room, storage can never be enough. Children and “stuff” are synonymous, so try to squeeze in extra storage spaces when you can. Doing so will reduce distracting clutter and even help the child learn about organization. If you have limited space, look for a bed design that can give you more storage space.
10. Decorate, decorate, decorate
Photo via Pinterest
Some of us were fortunate as kids to have decorated rooms, but others had the misfortune of being stuck in an adult room. All parents want their children to have a clean and tidy room, but this doesn’t mean that the room should be bare and unappealing for children. Kids will be kids. They’ll find ways to decorate their own rooms, which usually doesn’t turn out too good, so it’s best to teach children how to decorate their rooms properly.
11. Creating a theme
Photo via Pinterest
Themed rooms such as this personal teepee room are a good place to start, especially when the child is still young. These types of rooms encourage a child’s creativity and make the room entertaining However, keep in mind that as the child grows older, the theme may become a bit out of date. It’s best to come up with a design that you can easily change as needed rather than themes that can be a bit costly to replace.
Additionally, avoid themes that turn the room into a play area. Don’t over-design your child’s room. Always remember that the bedroom needs to be ideal for sleeping. There are other areas in the home where a child can play and have fun, study or do other things. Over-decorating the room can actually divert the child’s attention and lead to poor sleeping habits that can affect the child’s health.
Indeed, imagining how your child’s bedroom would look like can be exciting and fun. However, always remember that comfort and how the bedroom will help induce sleep on your child are more important than aesthetics. Hopefully, these kids’ bedroom ideas for better sleep can help you create the perfect room for your child
Bright light therapy for sleep problems?
It doesn’t sound logical: how can bright light help you sleep? Doesn’t light keep you awake?
Well yes, light does keep you awake. That is precisely why light is a useful tool to help correct certain sleep problems in which the sufferer’s night-day cycle is out of sync with the rest of the world. The most common sleep problem of this type is Delayed Sleep Phase Disorder.
What is Delayed Sleep Phase Disorder?
Delayed Sleep Phase Disorder (DSPD) is a problem with the body’s internal clock, or circadian rhythm. This is the cycling of our sleep and metabolic functions that normally fluctuates in sync with night and day. For example, for most people, body temperature decreases at night and increases during the day. We tend to get sleepy around 10 p.m., and wake up around 6 a.m. (I said “tend to”!)
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But for some people, the day seems to run on a totally different clock. For people with DSPD, the day is shifted 3-6 hours later. They do not become sleepy until 1 a.m. and do not want to wake up until 10 a.m. It’s a problem if they need to wake up at 6 a.m. to go to school or to work. So they tend to feel tired and sluggish throughout the day. Then night comes but they can’t fall asleep! For all appearances, the person with DSPD is suffering from insomnia, or some other sleep problem.
DSPD generally starts in adolescence or young adulthood. According to the International Classification of Sleep Disorders, DSPD occurs in 7-16 percent of young people. About 10 percent of my teen sleep coaching clients who complain of insomnia actually have DSPD. These teenagers often describe themselves as “night owls”.
Paying attention only to panel B of this figure, notice that the sleep time for a person with DSPD is four hours later than normal.
Bright light therapy works like this. For the patient with DSPD in this figure, they sit in front of a bright light box starting at around noon. They stay there for 1-2 hours. They repeat this pattern for 2 days. Then the hour that they sit in front of the box is advanced (moved earlier) by an hour for another two days.
Bright light therapy re-sets the internal body clock earlier and earlier until the patient is waking up at the “normal time”, say 6 a.m.
Bright Light Therapy TOO Bright?
These light boxes are very intense. Some people complain that the lights are too bright and they quit the therapy because the experience is too unpleasant.
It turns out that when bright light therapy is combined with other therapies such as cognitive behavior therapy, a less intense light box may be adequate to treat the problem.
The color of the light also turns out to be important. Light at the blue-green end of the spectrum is more effective at achieving the desired result. This type of light may not feel as harsh as intense white light.
Light during the day, dark at night
Light therapy alone will not treat DSPD. The patient may also need to break some bad habits. For example, electronic devices with screens need to be turned off in the evening, ideally two hours or more before bed. This change in behavior may be easier said than done for some young people. The problem is that exposure to the blue-spectrum light at night can undo the effects of the light training in the morning.
Cup of Joe? No.
People with DSPD also need to be careful about caffeine consumption. Coffee and other caffeinated beverages should be avoided during the four hours prior to bed time. Energy-dense foods, especially ones high in sugar, are stimulating and should be avoided in the evening. This may pose a problem for teenagers who are fond of dessert.
What about exercise?
It’s absolutely essential for health, but not in the evening! Especially with intense exercise, people find it much more difficult to “wind down” when they’ve exercised too close to bedtime. I recommend adjusting the schedule to get exercise done in the morning.
Treat other conditions
Many teenagers also suffer from anxiety and depression. The relationship between sleep problems and psychic distress are complex. It’s difficult to know sometimes which came first, the sleep problem or the distress. One thing is for certain: sleep problems make psychic distress worse and vice versa! I recommend getting help for anxiety and depression if possible. As I mentioned before, cognitive behavioral therapy combined with light therapy is effective. If the patient has the time and the motivation, talking therapy can help solve both sleep and mood problems.
- Bright light therapy is an effective treatment for Delayed Sleep Phase Disorder
- Avoid screen time at night!
- Exercise regularly, but do it early in the day
- Avoid caffeine and energy-dense foods at night
- Pay attention to anxiety and mood problems
Kids with ADHD sleep less well than other kids. Why is this?
Before we address this question, let’s back up and ask some preliminary questions:
- Is it true that kids with ADHD sleep less? Yes, the evidence suggests this is true.
- Is ADHD a real disorder? Some experts claim there is no such thing as ADHD. They argue that what we call “ADHD” is causing the sleep problems we see.
A study published in the June issue of the Journal of Sleep Research presents some evidence that might help answer these questions.
These Danish investigators found that there is something funny about the way kids diagnosed with ADHD sleep. There are some notable and very important features of this study. The first has to do with the way researchers recruited families to participate.
Parents and pediatricians referred children to a clinic because of problems with attention. None of them had a diagnosis of ADHD. They filled out questionnaires and agreed to let their children have sleep studies. They did all of this before they had a diagnosis. In other words, the subjects were “blinded” to their placement in the study. This type of blinding helps remove any unconscious bias the parents may have had when answering the questions. By the end of the study, investigators had data from 76 children, average age nine. That’s not a huge study, but it is the largest study of ADHD sleep patterns to date.
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Parents kept a 1-week sleep diary, logging hours of sleep and various other data points. Then investigators fitted children with take-home sleep study (polysomnography) machines. Though not the most comfortable devices, most children tolerate them well. The machines measure brain wave activity, breathing and oxygen levels, among other things. Finally, researchers invited the children to a sleep lab to perform a Multiple Sleep Latency Test (MSLT). It’s a long name for a test that simply measures how long it takes you to fall asleep when you take naps during the day.
The investigators also diagnostic tests for other disorders, such as autism, anxiety, and depression. They also performed intelligence tests and excluded children who scored an IQ less than 70. Investigators did not explain why they excluded mentally retarded children from the study. No part of the exams required any cognitive ability on the part of the child at all.
It turned out that 55 percent of the children with ADHD had some other diagnosis as well, called a “co-morbidity.” Before the study started, the investigators had guessed that children with multiple diagnoses would have more trouble sleeping.
To their surprise, investigators found that children with multiple diagnoses had the same sleeping patterns as children with only an ADHD diagnosis.
Children with ADHD did not sleep as long as children in the control group. On average the 76 children with ADHD slept 501.9 minutes (about 8 hours and 20 minutes). Control children slept an average of 543.6 minutes (just over 9 hours).
Children in the ADHD had more sleep cycles (6.2) than the controls (4.4). In other words, the rise and fall of sleep, also called “sleep architecture” was significantly different.
It takes 10 minutes longer for children with ADHD to fall asleep at night, compared with control children.
By contrast, when taking the MSLT test, children with ADHD fell asleep faster, suggesting they are sleepier during the day despite being reported as more hyperactive and restless.
Taken together, these results suggest that the sleep of children with a diagnosis of ADHD may sleep differently than other children. What does this mean?
Is ADHD a problem with the part of the brain that controls attention and alertness? This has been the theory for decades. This theory is the basis of ADHD treatment with stimulants.
Sleep is more complex than this. Many parts of the brain are involved. Could it be that the symptoms of ADHD are caused by some other oddity in the way the brains of ADHD kids work?
The results of this study are interesting, but raise more questions than they answer. At the end of the paper, investigators admitted that “it remains unclear whether sleep disturbances in ADHD are an aetiological (causal) factor, a co-morbid disorder or the result of an overlapping neurodevelopmental disorder of the brain.” In other words, the investigators cannot say whether kids with ADHD sleep poorly, or whether kids who sleep poorly have symptoms of ADHD.
This study provides another nail in the coffin of the “chemical imbalance theory“. This theory stated stated that ADHD was caused by too little stimulatory neurotransmitter in the brain.
Investigators also avoided making an obvious point: If symptoms of ADHD correlates with a sleep disorder, then giving amphetamine-based medications to children probably will not correct the underlying problem. The opposite is more likely. Indeed, insomnia is a well-known side effect of Ritalin and other ADHD drugs.
And lack of sleep never helped a distractible child.
In 1995 I won a musical head banging contest at my niece’s bat mitzvah. As I recall the DJ played “Smells Like Teen Spirit” by Nirvana. I did what any student of 70’s hair band culture would have done. I planted my feet firmly in place, raised my right arm, saying “I Love You” in American Sign Language (cuz rock n’ roll is all about the love, dontcha know?) Then I proceeded to make like I was hammering finishing nails into a two-by-four. With my forehead. Brother Beavis will demonstrate.
I was so naive. That was NOT musical head banging.
Apparently, musical head banging has something to do with your baby’s sleep. It is claimed by some “experts” that if you play music to your baby as she falls asleep in the crib, she may develop musical head banging. And this is bad.
I learned this from illinoishomepage.net in an article entitled “Sleep Problems”
CHAMPAIGN COUNTY, Ill.
You might think letting your baby fall asleep to music is a good thing, but old habits sleep hard. It could actually negative affect their sleep.
It sounds harmless, but letting baby drift off listening to music might have a few consequences. Studies show constantly relying on certain sounds to go to sleep can create a need to listen to music.
So, if they’re away from home and don’t have access to that music, baby might not be able to sleep without listening to it first.
This could lead to musical head-banging. Music could make your child more likely to bang their head against solid objects.
If you think music isn’t the right choice for your child, experts suggest a white noise machine. It will drown out household sounds and provide a quiet environment for them to sleep in.
You can even find some apps for them on your smartphone.
A graphic in the accompanying video suggests that livestrong.com is the source of this information. I followed the lead and found this article from s2015. It states, in part,
[H]eadbanging (sic) is the habit some children have of banging their heads against solid objects. If you have a child who bangs his head, you may notice it’s more prevalent when falling asleep or when listening to music, notes the University of Michigan Health System. That means headbanging could be exacerbated when your little one listens to music to fall asleep.
I was floored. I’ve been a sleep consultant for a long time and I’ve never heard of this phenomenon before. According to her bio, the author of the piece, whom I will not name, “specializes in health, fitness and lifestyle topics. She is a support worker in the neonatal intensive care and antepartum units of her local hospital and recently became a certified group fitness instructor.” I wonder if she’s ever had a baby?
Not finished with my search, I checked the references at the bottom of the article. There was one piece that did indeed come from the University of Michigan Health System web site. The subject of the article was “Bad Habits/Annoying Behavior“. Here is what this piece had to say about head banging:
Body rocking is when (sic) a child rhythmically rocks while either sitting or resting on their knees or elbows. This behavior usually starts around age six months and disappears by age two. Most children rock for 15 minutes or less. Like head banging, it occurs while listening to music or falling asleep.
That’s it. How did we get from here to “Music could make your child more likely to bang their head against solid objects”?
I’m afraid what happened here is the internet version of a game of telephone. The message got so garbled by the last call that this television station in Illinois ended up giving some pretty dumb advice to parents.
What is Musical Head Banging, Really?
It’s one of two things. Babies rock and bang their heads sometimes when they are tired. It is a sort of self-soothing technique. It usually lasts no more than 15 minutes. Other babies bang their heads as a kind of what I call “Stupid Baby Trick”. Bonking her head makes the baby hear this hollow ‘thud’ sound that she didn’t expect. Any unexpected sensation is interesting to a baby. She’ll keep doing it because, well, it’s interesting. The same thing happens when she pulls her own hair (it HURTS!) or gags herself with her own fist.
Eventually the child gets bored and the behavior stops. But sometimes the baby keeps the behavior going if it gets a big reaction from a caregiver. It is as if the baby says to herself “I’m getting bored with this head banging thing, but look what a reaction I get from mom! I’m gonna keep this going!”
Can music become a negative sleep association?
Something else the Illinois article said caught my attention. It was the suggestion that that music at bedtime might interfere with sleep: “Studies show constantly relying on certain sounds to go to sleep can create a need to listen to music (emphasis added).” What were these studies?
I went to the online National Library of Medicine/National Institutes of Health, affectionately known as “PubMed“. I performed every search I could think of combining “music” and “sleep disturbance” or “sleep associations”. I could find none. There are no such studies. Playing music in the nursery does not interfere with the process of a baby falling asleep or staying asleep. In fact, one of the sources cited at the livestrong article actively recommended music to help a baby fall asleep.
Unless of course you decide to blast “Smells Like Teen Spirit” in the nursery.
Is there any relationship between sleep and happiness?
It is known that depressed people often sleep too much. Other depressed people have a hard time sleeping. We also know that, on the whole, happy sleep better. Or maybe it is that people who sleep better are happier. We’ll return to this question later. For now, we report the results of a study out of South Korea that asked over 72,000 teenagers about their lives. The survey asked the teens about their lifestyles, especially diet, exercise, and sleep.
Happiness in Korean Teens
The Korea Youth Risk Behavior Web-based Survey (KYRBWS) has been administered to middle- and high-school students every year beginning in 2005. The results of the happiness study were based on the 9th study, administered in June-July 2013.
Students were asked at random to participate in the study. They were given the option to decline, including at the beginning of the survey.
A single question was asked about the teen’s happiness: ‘In general, how would you describe your happiness?’ Predefined responses were ‘very happy’, ‘a little happy’, ‘neutral’, ‘a little unhappy’, and ‘very unhappy’.
The investigators note that this single question is good enough to assess the truth of the teen’s overall happiness. Nevertheless, one can ask whether the question could be interpreted as “are you happy today?” as opposed to “are you in general a happy person or not?” It’s a little like asking someone what the whether is like where they live. If it happens to be a beautiful day, I suspect the subject’s feelings about the weather would be more positive than if there were a thunderstorm that day.
Nevertheless, the investigators went ahead, and asked a number of demographic and lifestyle questions.
The survey then asked a number of questions about diet, exercise and health habits. For example, the teens were asked whether they had consumed alcohol or smoked a cigarette in the previous 30 days. If they answered yes, they were classified as a current drinker or smoker. Specific questions were asked about physical activity and fruit consumption.
The students were also asked about screen time, including television watching and video game playing.
Sleep and Happiness
Students were asked about their sleep on both weekdays and weekends. The investigators divided the answers into two groups: students who slept fewer than 8 hours per night, and those that slept more than 8 hours.
The data were analyzed by a statistical device called “adjusted odds ratio”. This is simply the association between an exposure and an outcome. The investigators compared “exposures” such as hours of sleep, to the outcome “happiness”. They took the group of teens who described themselves as “very unhappy” and assigned them the value of 1. If more sleep meant the teen rated herself as happier, the odds ratio would be greater than one. If the correlation ran in the other direction, the odds ratio might be less than one.
Korean Teens are not very happy
There were a couple of interesting observations coming out of this study. The proportion of teens in the study who reported that they were very happy or a little happy with their lives was only 58.2%. In comparison, 94.8% of American adults say they are very or a little happy. That’s a fairly stunning difference. The investigators believe the happiness gap can be explained by the cultural difference between “collectivist” societies like Korea’s, and an “individualistic” society such as in the US. The truth is probably more complex than this.
Korean Teens don’t sleep a lot
The survey revealed that Korean teens spend a lot less time asleep than do American Teens. Overall, 21.8% report getting more than 8 hours of sleep on weekdays, and 66.3% sleep more than 8 hours on weekends. By contrast about half of American teens get 8 hours or more of sleep on weekdays, with substantially larger percentages on weekends. Again, the reasons for the disparity are probably complex.
More sleep, more happiness
The investigators found that the more Korean teens slept, the more likely they were to rate themselves as happy. If a girl reported more than 8 hours of sleep on weeknights, the odds ratio was 3.00 that she’d rate herself “very happy”. In other words, she was statistically three-times more likely to call herself “very happy” as opposed to “very unhappy”. For a boy, the odds ratio was 2.32. It’s worth mentioning here that odds ratios of more than 2.00 are thought of as meaningful. Even though lower odds ratios may be real and statistically significant, anything the difference might not be “clinically significant”. In other words, lower odds ratios make you say “so what? In real life you can’t really see much difference!”
On weekends, the odds ratios were smaller. Girls who slept more than 8 hours had an odds ratio of 1.63 for self-rating “very happy”. For boys the odds ratio was 1.72. This result suggests that more “unhappy” Korean teens were sleeping >8 hours on weekends, possibly in an attempt to make up their sleep debt.
Sleep and Happiness; Chicken and Egg
A big weakness of this study is that it shows only associations. It cannot show causes. So at the end of the day we cannot really know why Korean teens who sleep more rate themselves happier. Are they happier because they sleep more? Or do they sleep more because they are happier?
Looking at the study as a whole, however, we can begin to unravel the “which came first?” problem. It turns out that other positive health habits correlate with happiness as well, such as healthy eating and exercise. And negative health habits such as smoking and drinking tend to correlate with unhappiness. Again, we can’t really be sure which came first, but the results as a whole are compelling.
- Sleep and Happiness in Korean teens are associated with one another.
- Less sleep is associated with smoking, drinking and less happiness.
- More sleep may help teens feel better about themselves.
Case Study: A mother of a 17-year old high-school senior contacted me . She was concerned that the young man wasn’t getting enough sleep. He played a sport every season, and got decent grades. He had friends and did not demonstrate any evidence of behavior or mood changes. The problem was that he appeared to sleep until the afternoon every Saturday. How many hours of sleep should a 17-year old get?
How many hours of sleep should a 17-year old get?
The answer to the question is fairly easy: it is 9 1/2 hours, according to most sleep experts. When I told this to the high schooler who is the subject of this case study, he gave a fairly typical reply:
“Ha. Ha-ha. Ha-HA-ha.”
I get that a lot.
The sarcasm, not meant to be rude, was his way of expressing that there was not a chance in hell he’d be able to get that much sleep. There simply were not enough hours in the day for him to get everything done and to sleep 9 1/2 hours!
Let’s call him “Nate”. A typical weekday ran as follows: Nate’s alarm would go off at 7:30 am. He’d take approximately 10 minutes to get out of bed and stumble to the bathroom. Breakfast for Nate consisted of a protein smoothie. He told me this had been his breakfast of choice for as long as he could remember. Nate never had been much of a big breakfast eater.
The most important meal of the day
That wasn’t a bad choice. I was glad to hear he got some protein in before school. Nate is 5 feet, 8 inches, 140 lbs. He’s a long-distance track athlete. Nate probably wouldn’t have made it to lunch block without something in his system.
Good diet is one of the three legs upon which all of health stands. The others are exercise and sleep(!). Some experts add stress reduction as a fourth leg.
Nate’s school is 1.1 miles from his home. He almost never walked or rode his bike. His mother drove him. This gave Nate a time cushion to help him get out of the house. Nate is lucky in this regard. Teenagers who need to catch a bus have tighter time constraints. If they miss the bus, they are sore out of luck, so they have to work harder at going out of the house.
If the teenager is old enough to drive, I hope they got enough sleep the night prior. It is well known that teen sleepiness is associated with accidents during the morning drive.
First block in Nate’s day starts at 8:30 am, one hour after he wakes up.
Nate Hits the Road
School lets out at 2:20 pm. Nate changes into running shorts and runs with his friends to track practice. He will not be home until 6:00 pm. Noah eats before showering, much to the chagrin of his mother and his younger brother. This particular issue is beyond the scope of our consult!
By the time Nate has eaten and showered, it is 7:oo pm and time for homework. The average high school student has 3.5 hours of homework per night. Nate is no different.
At 10:30 pm, homework done, Nate is finally able to text his girlfriend, which he will do for about one hour (or at least, that is how time he will admit to!)
Nate’s home is one where phones are permitted in the bedroom. Both Nate, his brother, and his mother, all keep their phones by the bedside. Here’s a possible area where I can intervene. Technology in the bedroom is associated with reduced sleep and increased daytime sleepiness in teens.
By my calculation, the maximum amount of sleep Nate would get in a typical night would be 8 hours, 1 1/2 hours less than the recommended amount. My suspicion is that the real number is probably closer to 7 1/2, given that Nate likes to watch YouTube videos and spends a fair amount of time on Facebook.
By the weekend, Nate has accumulated a sleep debt. Naturally, if he does not need to wake up for school, he will stay in bed. It is not unusual for Nate to wake up between 11:30 am and noon.
How many hours of sleep should a 17-year old get? The Fix
I had a number of suggestions for Nate.
For the average sleepy teenager, there are factors that cannot be changed, and a few that can. The start time for school should be later, but for now, 8:30 am remains too early for the average teen.
Sports are important to Nate, and I certainly would not recommend that he cut out track from his life. I have clients who play sports and participate in other after school activities as well. In these cases I recommend cutting out some activities. I call this “simplifying” the life of the teenager. Simplification is sometimes easier said than done.
Do homework during school hours
I asked Nate if he had a free block, formerly known as “study hall”. When I was in high school, very little studying got done in study hall. These days, over-scheduled students are taking advantage of study hall to get their homework done. It’s not possible for Nate to do all 3.5 hours of his homework during the 50 minute block, but it’s better than nothing. Nate admitted that it would be painful, but he could do the writing-intensive part of his homework during free block.
Bedrooms are for beds, not for phones
I also suggested that Nate’s family make a rule about technology in bedrooms. No intervention like this will work unless everyone else in the home is on board as well. There were no televisions in the bedrooms. This alone was a terrific start. The next step was to get everyone to agree to leave their devices in the kitchen, plugged in.
I left it to Nate and his mother to negotiate the time for plugging in the phone. I was a high school boy once. I know what this is like. I didn’t speak to my girlfriend nearly as often as kids these days do (I had to share the one land line we had with three sisters and my parents). But I probably would be texting her if I had a smart phone back then.
Get Back to Basics
It never hurts to make sure that you are eating well and getting plenty of exercise. By eating well, I mean something fairly specific:
- Meat and vegetables
- Nuts and seeds
- Some fruit
- Starches rarely
- Sugar NEVER
Easier said than done, right? A growing body of evidence is supporting these basic guidelines.
Nate has already gotten the vigorous exercise part covered. If your child is not doing any exercise, I recommend they get out and move. It doesn’t really matter what they do as long as they do something regularly.
Now that you know how many hours of sleep should a 17-year old get, the last piece is convincing the school system. Later start times have been shown to show benefits and few down sides. If an effort to start school later is not underway in your district, I recommend getting one started!
And if you need a sleep coach, I can help!
In the age of the Fitbit, it is only a matter of time before devices designed for babies appear on the market. There are a whole bunch available now. There is a pacifier that doubles as a thermometer. You can buy a device to prevent heat stroke in your baby. There is even a GPS tracking devices for babies. The particular segment of the infant wearables market that concerns us here are the devices that measure infant blood oxygen levels. The unstated reason for buying such devices is the prevention of death by SIDS, or other sleep-related infant deaths.
Infant Wearables in the Age of Back-to-Sleep
These devices are based on a well-tested technology from the world of medicine called pulse oximetry. The “pulse ox” works by shining a red light onto the skin and simultaneously measuring the wave-length of the light that bounces back. The device then calculates the amount of oxygen in the bloodstream. Such devices have been used in even tiny babies for many years. Now, several companies are marketing these devices for parents worried about SIDS.
Do they work? Do infant wearables really prevent SIDS?
These are obviously two separate questions. We’ll tackle them one at a time.
To address the question of whether home pulse oximeters work, a few studies have been published. The study that best answers the question was published the the UK in 1991.
The British investigators focused on a group of babies that recently had been discharged from hospitals with apparent life-threatening events. Translated into English, the babies had turned blue at home, either because of choking or lung disease related to prematurity. This was a good population to study. The chance that these babies would actually need the alarm was greater than the general population of babies. Most of these babies had some kind of medical problem that made them more vulnerable to dropping their oxygen levels. This means the investigators were not measuring rare events and it would be unlikely that the number of events measured would be too small to give meaningful results.
The investigators also gave monitors to parents who had already lost a baby to SIDS.
The study looked at the number of events that the wearable devices picked up. Importantly, they also looked at false alarms, and measured side-effects of the devices, such as blisters and other skin burns.
A total of 201 babies were monitored for 30 months. Only 19 families withdrew from the study before it ended.
The pulse oximeters recorded 81 events, of which 52 were true episodes of blueness. No episodes were missed. In other words, the sensitivity of the device was 100%. Any time a test shows a 100% sensitivity (no true positives missed), there is going to be a substantial false positive rate. For these parents, that means an alarm going off for no reason. Sometimes the sensor would move out of position or fall off, activating the alarm. Sometimes it was a true false alarm. The device would go off when nothing was wrong. In the UK study, false alarms happened about once every 4 days.
Very few of the babies got skin redness from the red light source and none were burned.
Four babies actually died during the study. One sibling of a SIDS victim died while the infant wearables were in calibration mode. That is to say they were not turned on correctly. The cause of death was ruled SIDS as well. The other three babies died of the severe congenital heart and lung problems that got them included in the study.
There are two important take-aways from this study. Pulse oximeters work well. They will catch every dip in a baby’s blood oxygen level. But the devices cannot prevent death in severely ill babies. As was demonstrated catastrophically in this study, the devices won’t work if they are not turned on.
Infant Wearables and SIDS
The second question we asked was whether these devices can prevent your baby from dying of SIDS. The honest answer is “nobody knows”. In the UK study, the only baby to die of SIDS was not wearing an alarm. One other sibling of a SIDS victim in the study had a substantial dip in her oxygen and was later found to have meningitis. The answer remains open. We simply do not know if infant wearables prevent SIDS.
But wait! Didn’t this study show that the alarm always goes off when the baby’s oxygen dips too low? If so, won’t any baby in danger of SIDS set off the alarm?
It’s a reasonable question. The answer is “yes, you are probably right”. And yet, we simply do not know because the studies have not proven the point to a degree of scientific certainty.
The Question You Didn’t Ask
It’s clear that pulse oximeters for use at home are very sensitive. They catch every event. This also means they “catch” events that are not events. Imagine how unbelievably frightening it must be to be awakened in the middle of the night by such an alarm. You cannot be sure if you are answering a false alarm or if you will be dialing 911. The question we didn’t ask at the outset was “do you think infant wearables make you more relaxed, or more anxious?”
The American Academy of Pediatrics has not taken a position on these devices for healthy infants. The organization’s silence probably reflects the absence of scientific evidence on SIDS prevention. Pediatricians disagree as to whether or not it’s a good idea for parents to buy such a device. My recommendation would be to discuss it with your pediatrician before buying.
And if you have any issues or (non-medical) concerns about your baby’s sleep, I’m a sleep consultant.
The two age groups most at risk for getting into car accidents are teenagers and the elderly. The reasons for the high accident rate in each group are obviously different. Elderly people’s faculties tend not to be as sharp as they once were. Reaction time slows. Eyesight and hearing decline. The causes of teen car accidents are completely different. Besides lack of experience, there is risk-taking behavior and poor judgment. But one factor in the high rate of teen car accidents is getting more attention in recent years: sleepiness. It is well known that early high school start times make for sleepier teenagers. Now there is a growing body of scientific literature that is suggesting a link between school start time and car accidents.
What Does School Start Time Have to Do With Teen Car Accidents?
In 1998, University of Kentucky researchers Fred Danner and Barbara Phillips got word that a single county in their state planned to increase high school start time. In 1998, schools in the county started at 7:30 am. In 1999 start time was moved to 8:30 am. The remainder of the state kept the same start time. Danner and Phillips seized on this opportunity to test whether the change in start time would have any effect effect on the rate of teen car accidents.
Danner and Phillips found that high schoolers in all four years got substantially more sleep in 1999 than in 1998. The number of students getting the recommended amount of sleep, 9+ hours, increased from 6.3% to 10.8%. The number of students getting at least 8 hours increased from about one-third to over 50%.
But the most interesting finding was the drop in the rate in teen car accidents.
Despite rapid population growth, with many more cars on the road, the rate of crashes in the study county dropped after the change in school start time. The average crash rates in the 2 years after the change in school start times dropped 16.5% in the study county. At the same time, the car accident rate increased 7.8% in the rest of the state.
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Danner and Phillips were careful not to conclude that the school start time directly caused fewer accidents. The study hampered by the unforeseen circumstance that the student ID numbering system changed between 1998 and 1999. As a result, the investigators could not go back and find out if particular teens involved in accidents were sleeping more or less.
The Virginia High School Start Time Study
One study alone cannot answer a question. This is especially so when the study only shows a correlation (as opposed to a causal relationship) between teen sleep and car accidents. Any scientific question is best answered by several studies looking at the same problem. In 2011, a group of researchers at Eastern Virginia Medical School published a study similar to the 2008 Danner and Phillips study.
The Virginia investigators compared teen driver accident rates in two neighboring counties with different high school start times. The Virginia Beach district started high school 75-80 minutes earlier than the neighboring Chesapeake district. The investigators guessed that the rate of teen car accidents would be higher in Virginia Beach than in Chesapeake.
This is indeed what they found.
For Virginia Beach and Chesapeake, teen drivers’ crash rates in 2008 were 65.8/1000 and 46.6/1000, respectively. In 2007 were 71.2/1000 and 55.6/1000. Teen drivers accident peaks in the morning occurred one hour earlier in Virginia Beach than in Chesapeake, consistent with school commute time. Congestion data for the two towns did not explain the different accident rates.
The Australian Teen Car Accidents Study
This study, published in 2013, was the first study of teen car accidents that was prospective as opposed to retrospective. That is, a large group of young people (over 19,000!) was signed up to participate. They were then followed over a number of years, while carefully documenting hours of sleep and other important contributing factors.
Here’s what they found: On average, teens who reported sleeping 6 or fewer hours per night had an increased risk for accidents compared with those who slept more than 6 hours. If the teen slept less on weekends, they were more likely to be involved in “run-off-road” accidents. Peak hours for these accidents occurred between 8 pm and 6 am.
Whereas the study did not address school start times as such, it offers some very strong data to the body of literature. First, it was a very large study. It also controlled for various factors that could skew the results of a smaller studies. As the evidence grows stronger that sleepiness leads to car crashes, the case for later school start times becomes stronger as well.
Back to Virginia
Finally we look at a second study published in 2014 by the Eastern Virginia Medical School group. This time, the investigators compared data for teen car accidents in two neighboring counties in central Virginia. Henrico County schools began at 8:45 am and Chesterfield County schools began at 7:20 am. This time, investigators not only compared the rate of teen car accidents in each county, they also compared the rates of adult accidents as a comparison group.
For 2009-2010, Chesterfield teens had a higher accident rate than the later starting Henrico teens. There was no such difference in adult crash rates for either year in Henrico County and Chesterfield County, making it less likely that a systemic (not teen-specific) difference between the two counties was to blame for the difference.
Investigators also found two peak hours for teen car accidents, one in the morning when teens drive to school, and another in the afternoon when sleep deprivation begins to kick in.
Putting It All Together
One study never answers an important scientific question. The more studies that look at a question, the more likely we are to come up with an answer that approaches the truth. As the body of evidence grows, we are beginning to see a picture emerging that describes the dangers of early school start time for high schoolers. It seems that teens who must get up earlier than they should are more dangerous on the road.
There is an easy fix for this one. Start school later. There are a number of objections to this concept that deserve attention. Indeed attention has been paid to these objections. We will address them in future posts.
I have argued before that no modern sleep expert recommends pure “cry-it-out” (CIO) sleep training. Here I want to explain in more depth where CIO stands currently. In order to simplify the discussion, I’ll call it by its more technical name, extinction. Some versions of this method are widely recommended today. One kind, unmodified extinction, has all but disappeared, or become extinct. That’s a shame, because it is highly effective, as I’ll explain below.
When it comes to any kind of human or animal behavior, “extinction” refers to the disappearance of a behavior in the presence of a stimulus. Pavlov famously could make his dogs salivate when he rang a bell (the stimulus). The dogs had learned that the bell meant Dr. Pavlov was about to feed them. That was only the first part of the experiment. In the second part, the dogs stopped salivating after a while. In other words, the salivating behavior “extinguished” with time.
Extinction in Sleep Training
When it comes to sleep training, the behavior we are trying to extinguish is crying. In sleep training, there are now three versions: Extinction with parental presence, graduated extinction, and unmodified extinction.
Extinction with parental presence is a version of CIO where the parent stays in the baby’s room, but does not respond to cries. With time, the caregiver moves farther away from the crib. Finally, the baby sleeps alone. This method has been championed by Kim West. She renamed the method “The Sleep Lady Shuffle”. The terms get even more confusing because West’s followers refer to her method as “bedtime fading”. This is very different from true fading techniques.
The graduated variety is today better known as “Ferberization“. The method involves answering the baby’s cries, but doing so at longer intervals every night until the baby goes to sleep on her own.
Finally, we come to the true dinosaur, the unmodified CIO technique, sometimes called “cold turkey”. The villain of the CIO story is a late-19th century pediatrician named Luther Emmett Holt. The first time we see the words “cry it out”, they appear in Holt’s 1894 catechism “The Care and Feeding of Children.”
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Holt’s book is not a “sleep book”. In fact, there is no section on bedtime routines such as the kind we’ve grown used to. There is, however, a section on the types of infant cries and what to do about them. The section that follows is really about “problem crying”.
What should be done if a baby cries at night?
One should get up and see that the child is comfortable—the clothing smooth under the body, the hands and feet warm, and the napkin [diaper] not wet or soiled. If all these matters are properly adjusted and the child simply crying to be taken up, it should not be further interfered with. If the night cry is habitual some other cause should be sought.
How is an infant to be managed that cries from temper, habit, or to be indulged?
It should simply be allowed to “cry it out.” This often requires an hour, and in extreme cases, two or three hours. A second struggle will seldom last more than ten or fifteen minutes, and a third will rarely be necessary. Such discipline is not to be carried out unless one is sure as to the cause of the habitual crying.
Holt is describing a particular kind of crying here. This is crying born of habit. These are babies who have learned that crying can draw her parents’ attention. I suspect he is referring to babies who’ve acquired “object permanence“. That is, the baby knows that mom or dad is still there when they leave the room, and she can induce them to come back.
Dr. Holt is not describing a way to get a baby to fall asleep. He is describing a solution to a problem. That sleep problem is “bad sleep associations“. For example, the baby won’t sleep unless she has physical contact with a parent, or if she has a binky in her mouth. Likewise, sleep books that discuss “cold turkey” or any other CIO technique are aimed at families that already have developed bad sleep associations and want to reverse them.
The Moa is Extinct. So is the Cold Turkey
Of the three types of extinction methods, only unmodified extinction, or cold turkey, has disappeared. It has ceased to be (see video below). And yet, cold turkey has been tested experimentally and found to be extremely effective. Several arguments agains cold turkey have been raised, not least that the method stresses the baby and caregivers. These objections have also been tested and so far have proven to be false. Even the most-cited article arguing for the negative effects of CIO failed to show that the stress hormone cortisol goes up in crying babies!
The main reason cold turkey has gone extinct is that it is really difficult to listen to a child cry. Most parents can’t handle it. I know I couldn’t (the boys’ mother was the stronger partner). Listening to crying becomes even more difficult because of a thing called the “extinction burst”. This is an increase in crying as the sleep training process proceeds. Sometimes the burst happens after it appears that you’ve succeeded and the baby is sleeping through the night. In either case, the stress for parents becomes too much.
A second reason, perhaps more important, is that many parents believe cold turkey CIO will psychologically damage the baby. There is absolutely no evidence for this. To the contrary, the evidence suggests that babies sleep trained with unmodified extinction get good quality sleep. Parents report better sleep for themselves and their children. Overall there are only positive results for the family.
One more cultural factor deserves mention: consistency. Probably the number one reason why any of the extinction methods fails is that parents cannot or will not stick to the plan consistently. Consistency is the number one most important feature of any sleep training method, whether you are doing scheduled awakenings, bedtime fading, or the “Sleep Lady Shuffle” (which is, to repeat, extinction with parental presence).
To Extinguish This Line of Argument
- The bottom line is that extinction methods are effective.
- Extinction methods do not harm your baby or your bonding with her
- Consistency, consistency, consistency. This is the essential piece of solving any sleep problem
Finally, let us explore the true meaning of
life extinction with the help of our panel of experts, John Cleese and Michael Palin.