- Hi, I'm Betty Lin-Fisher, consumer columnist
and medical reporter with the Akron Beacon Journal.
I'm here at Akron Children's Hospital
in the Considine Building, and I'm here
with Dr. Jamie Travis, a pediatric psychologist.
We partnered together this past Saturday
for the latest Healthy Actions column,
which was talking about healthy sleep habits,
and we actually covered a lot of ground.
We talked about healthy sleep habits,
and tips for anywhere from infants to teenagers.
So I won't re-hash the whole thing,
you can read it at www.beaconjournal.com/topics/linfisher.
And then you can also revisit this video,
which after we're done will be posted on the column.
I'll do one more housekeeping thing before we get started.
We do encourage comments on the Facebook Live here,
and we've been taking some questions today
by Twitter and Instagram.
Dr. Travis does have some patients
right after this and all throughout the day,
but she will try, we will try to connect later,
and try to answer some of those questions
if you have other questions that we haven't covered.
So first of all, thank you very much for joining me.
Can you tell me a little bit about what you do here?
- Yeah, absolutely.
So I'm the pediatric psychologist
who works in behavioral sleep medicine,
so I coordinate with families
and our sleep medicine physicians
to help children who are having difficulty sleeping.
- Okay, great.
So we got a couple questions this morning by Instagram,
some of them are ones that we covered in the column,
so we'll touch on them a little bit,
but maybe you want to go read the column
to see some more of the details of it.
But one of the first ones was from Tricia Ball:
Is it normal that my two-and-a-half-year-old
still doesn't sleep through the night?
- Right, so that's a great question.
We all need as much sleep as possible,
and we know that we want our kids
to get as much sleep as possible.
And sleeping through the night is a big milestone for kids.
When a child is two-and-a-half years old,
they should certainly be able to sleep through the night.
So a lot of times...
The question leads to other questions
in terms of, like, what might be supporting your kiddo,
or encouraging them to have a difficult time
sleeping through the night.
Sometimes we inadvertently reinforce behaviors
that kids get used to, and then it's hard
for them to break those habits.
So a two-and-a-half-year-old should be able
to sleep through the night, so it might just be a matter
of us figuring out what exactly is causing them to wake up.
- Okay, it was a little unclear, too,
about whether this meant, is this two-and-a-half-year-old
getting up and ending up in mom and dad's bed,
and we'll talk about that in a little bit.
You also mentioned that it's pretty normal
for two-and-a-half-year-olds to rouse themselves...
Or I think you said, to wake up,
but then go back to sleep, right?
- Yeah, so as a part of our normal sleep cycles,
our brain wakes up, arouses, four to six times a night.
So every time our brain reaches that aroused state,
it's possible for us to have a true waking,
where we're awake, and maybe we're looking for something
that makes us comfortable to fall asleep.
So for example, I fell asleep with my mom lying next to me,
or in the room with me, and then I wake up
in the middle of the night and she's no longer there,
then I might become more fully awake and go seek her out
in order to help me get back to sleep.
- Okay, and we'll...
You have a couple tips to what to do
in that situation in a second.
Can we also talk about what's normal
in terms of when someone says "sleeping through the night,"
that it really depends upon whether you're talking
about an infant versus a teenager.
- Right, yeah, so sleeping through the night
when kids are brand new, itty-bitty newborns,
really means a stretch of four hours or so
is considered sleeping through the night.
And then as they get older, the stretches get longer,
and that really has a lot to do with our biology,
in terms of how we're developing our circadian rhythm,
and then the things that we need to sustain life,
like hunger, primarily.
When we're younger, we need to eat more frequently,
and as we get older, up to even six months of age,
we don't need to eat as frequently.
So we can therefore sleep for longer stretches of time,
because we're not having to meet other needs.
- Sure.
My kids are 19 and 16, I wish I knew that,
that it was only four hours, because I used to be
always jealous of people who said, (laughs)
kid slept through the night.
And I did know people who literally put their kid down,
and you know, early in the morning, they were still asleep.
I guess my kids slept through the night. (laughs)
Four hours. - Yeah, four to six hours
is great when they're little, yeah.
- Okay, okay.
Two more questions that are kind of similar,
and that we touched on in the column,
but we'll touch on them here, ECoen216 says:
How do I keep my toddler in his bed?
He wakes frequently and comes to find mom and dad.
And FrancPartyofFive: Best sleep training
for a one-and-a-half-year-old
that's still refusing to sleep through the night?
- Yeah, so, (laughs) absolutely,
kids are always keeping us on our toes
in terms of how to help them get their best rest.
So I would say probably we would start considering
what's happening at the beginning of the night.
Again, are they able to self-soothe,
and put themselves to sleep alone, independently,
at the beginning of the night?
If they are, then they're gonna be much better able
to re-initiate sleep after a normal night waking,
or an abnormal night waking, like if something
in their environment wakes them up.
If a child isn't yet able to put themselves to sleep
on their own at the beginning of the night,
then we're gonna have much more parental involvement
through the night in terms of them coming to seek you out,
looking for additional support,
trying to get whatever they had at the beginning
of the night when they were falling asleep.
So take it into consideration kind of what is happening
at that time when your child is falling asleep is step one
to helping them learn to sleep through the night,
or get back to sleep without you.
- Okay, and you gave some great tips in the column
about using the sleep fairy, giving some incentives,
if you can stay a certain amount of time,
coming back every minute instead of them coming,
sleeping bags, we'll just...
I'm giving you a little bit of teasers,
but you can go read some more details there in the column.
So you gave some good tips there as well.
Can we move on to maybe perhaps some self-soothing ideas
to help kids fall asleep on their own?
- Yeah, so as kids get a little bit older,
even toddlers, preschoolers, we can start
to teach them ways to self-soothe
where they can be actively involved in relaxing their body.
So since our body does need to be relaxed
while we're sleeping, if we're able to
intentionally do actions to relax our body,
it will help us fall asleep.
So examples that we typically teach kids
are things like deep breathing, or belly breathing,
the idea where we're taking in slow, deep breaths
in through our nose, and then out through our mouth.
So a lot of times I'll imagine with kids,
if I'm trying to teach them, kind of that pattern
of breathing in through their nose
and out through their mouth.
I'll have them think about their favorite warm food,
like a slice of pizza, or macaroni and cheese,
and imagine that they're smelling the food, (inhales)
and then they're blowing on it to cool it down
so they can take a bite. (exhales)
So that kind of helps them develop that rhythm
of smell, (inhales) blow, (exhales)
and that type of breathing really helps
to fully relax our body, helps us to pull air
from our stomach rather than our lungs,
so that our body gets into a more relaxed state,
and mimics how we breathe when we are asleep.
So that's one good strategy.
- Okay, so it's not necessarily just about counting sheep.
- No, not just about counting sheep,
but the idea of counting sheep could be helpful
in the sense that it provides a mental distraction,
like if they are having to adjust to something new,
like falling asleep with less parental support,
and having their brain busy,
so that they're not thinking so much about like,
I want mom here, or why my dad isn't here right now,
and instead they can think about a story for example.
So a lot of times I'll recommend that families
try adding some environmental distractions
like a noise machine that plays them soothing sounds,
or lullabies, bedtime stories being read,
or even an audiobook, so that kids have something
that they can listen to to distract them.
Or we'll teach kids ways to distract themselves
by going on imagination vacation,
which is sometimes called guided imagery.
But the idea there is that kids would think
about a place that's fun, relaxing, a place they wanna be,
and really fully imagine themselves being there
by thinking about what am I gonna see there,
what am I gonna hear, what am I gonna taste,
smell, and touch, and kind of walking through them.
So if they really like going to the pool,
we're at the swimming pool, and I can feel the warm sun
on my face, and the wind is in my hair,
and it's got warm concrete under my feet,
and then I jump into the water, and it's cool,
and there's a big splash, and it's fun,
I laugh, and my family laughs,
so they can just really imagine themselves actually there.
- But you want this all in their head, right?
Not them talking, 'cause I can imagine
that some kids could get really excited by that,
and then not be sleepy. (laughs)
- Right, yeah, so with the imagination vacations,
and with the deep breathing, any type of relaxation strategy
that we're trying to teach a kid,
we encourage daytime, like awake practice of that skill,
so that it's like anything, practice makes perfect,
they're going to be able to use these skills much better
to help themselves fall asleep or fall back to sleep
if they've practiced it regularly,
and it's not like a game time.
Like, right now I'm distraught, and I want my mom here,
but you're telling me to do imagination vacation.
So doing some daytime practices
can then make it so that at nighttime,
they can go to those places on their own.
And yes, mentally, without talking out loud
in the middle of the night.
- We mentioned in the column that you really do try
to discourage the electronic usage
because of that blue light, you mentioned it a little bit,
the idea of using audio instead.
We've all got smartphones, and you had the idea
of, you know, record yourself reading a book
and put it on a loop, or there's YouTube reading lists,
and perhaps...
And again, I'm assuming you're not reading
a really exciting chapter book
that the kids don't wanna go to sleep
and wanna keep listening to.
- Yeah, that's a great point.
When we're using outside environmental distractors,
then having it be something that the child's familiar with,
especially if it's an audiobook, and not something new
that they're wanting to stay awake to hear,
but something that's familiar to them
that will keep their brain busy,
but not encourage them to stay awake.
- Okay, another question we got this morning,
which I thought was a great one,
and my son, when he was young, had these too,
which is night terrors.
And can you talk a little bit about what night terrors are,
how they're different from nightmares,
I'm gonna throw a couple questions at you,
what ages are these at, and what do you do?
- Sure, so let me start with nightmares,
and that will help I think kind of explain night terrors.
So nightmares are dreams that happen that children remember,
they can recall, they'll describe to you in detail
what was scary, or at least that they were scared,
they might seek out parental support.
Normally nightmares happen in the last part of the night,
so more in the last two-thirds of the night.
That's because that's the time
when our brain is actually dreaming,
we're going between light sleep and dreaming
towards the later part, half of the night.
So if a child comes to you, and they say,
"I'm scared, I had a bad dream about this monster,"
and they're telling you details about it,
probably a nightmare, something like we talked about before,
like an imagination vacation or deep breathing,
should help them to settle, get themselves back to sleep.
And doing an imagination vacation before bedtime
actually helps to reduce nightmares,
because there's research that says
we're more likely to dream about whatever we think about
within the hour before falling asleep.
So doing that can also reduce nightmares
if you have a child who's having frequent nightmares.
If, however, your child is waking up,
or appearing to be awake, in the night,
they're screaming, they're crying,
they're saying, "Mama, Mama,"
they might be coming towards you,
but when they're interacting with you,
they're just not fully there,
they're not really connecting, they're not responding
like they would to you during the day
if they fell and hurt something--
- And their eyes are open sometimes!
- Their eyes are open, yeah,
they can look very, very awake.
But if a child is seeming very terrified like that,
they might say things that make some sense,
but not total sense, or they're just not responding
to your soothing like you would expect,
like they might push you away, or leave, or still protest,
then this is possibly a night terror, or sleep terror,
because it can happen during the day during naps as well.
This happens when a child is in deep sleep,
and deep sleep typically happens
within the first third of the night.
So if your child has a terrified-seeming event
early in the night, maybe before you've fallen asleep,
it could be that it's more likely
to be a sleep terror than a nightmare.
And when this does happen, it's important to know
the best thing that you can do
is to interact with them very minimally.
If you recognize like, okay, I think they're still asleep,
because when they're having a sleep terror,
they are literally in their deepest sleep,
so the worst thing that we could possibly do
is wake the child up.
Which is really heartbreaking for a parent,
because they look so terrified, but if you wake them up,
you're pulling them from deep sleep
back up to awake, which really disrupts their sleep quality,
makes them hard to soothe.
So you wanna interact minimally,
guide them back to bed, not say a whole lot,
maybe say it's okay, and then just have them lay back down.
If they stay in bed, that's probably another good indicator
that it was a night terror, or sleep terror,
versus a nightmare.
- Okay, okay.
I messed up on those, and--
- It's easy.
- Well, and I think you also have to make sure,
I mean my son was, like, flailing around on the floor.
So I guess you also have to make sure
that they're-- - Safe, exactly.
- In a safe environment, and if they're doing that,
you probably don't necessarily want them back in the bed.
How long can they...
They can last a while.
- They can last a while.
Most night terrors, sleep terrors, will be shorter
if you don't interact with them.
- Okay.
- Interacting with them will actually prolong them.
They should typically resolve in about 15, 20 minutes,
sometimes shorter, but they can go on for a while,
which again, can be distressing.
Sometimes parents will tell me too that they're concerned
that they're gonna wake up a sibling,
and they'll say, oh, I have to wake them up,
because if I don't wake them up
it's going to be problematic,
it's gonna wake up their brother or sister
who they share a room with, but the truth is,
if both kids went to bed around the same time,
they're probably both in their deep sleep,
and other sibling is not actually that likely to wake.
That's when I have families just, you know,
monitor for safety, get them back to bed.
I often don't hear those concerns about--
- Did you say what age?
You said about ages four to six generally, right?
- Right, so night terrors are developmentally appropriate
between the ages of four and seven,
so if you have a child who's having them,
that is developmentally appropriate.
But they can also be a sign that you child
either isn't getting enough sleep,
or the quality of sleep that they're getting isn't good.
So for example, their breathing gets disrupted
during their sleep, so if you have a child who snores,
or you hear them pause, or gasp,
or choke when they're sleeping, that's not normal,
it's not normal for kids to snore.
I don't think a lot of parents know that.
But if you have a child who's snoring,
I would definitely recommend talking to your pediatrician,
and seeing if it might be useful to consult
with one of our sleep medicine physicians,
and having an overnight sleep study done to find out
how their body is working while they're sleeping.
- Does that early, like when you're about four,
can that sometimes coincide with when you're starting
to end naps, and so, you know, they're sleepy,
if you're waiting too long?
- That's a good hypothesis, four is the age
where naps do kind of decrease a little bit.
I don't know the exact science
of why they would start around four and end at seven.
- Okay, so you might just, sometimes you might just...
You were saying, there's no exact science,
but it might mean they don't have good enough sleep,
so perhaps try to move their bedtime up a little bit,
or if you're seeing it...
- It might be worth checking into,
like is my child getting an age-appropriate amount of sleep.
Sometimes we think that they're getting a good amount
of sleep, like, oh, they're getting eight hours,
but the truth is kids that age
need more like 11 or 12 hours of sleep,
kids up to age 10 need 10 hours of sleep,
and adolescents even need nine.
So it might be worth checking, you know,
is my child getting an age-appropriate amount of sleep,
and if not, what can I do to increase that,
or increase it consistently.
Because sometimes it's that they can get
an age-appropriate amount some nights,
but then other nights they're missing,
and the truth is we really can't catch up on sleep
more than about two hours a week,
so if they have some nights where they're at a sleep loss
or in sleep debt, they just may not be able to catch up,
and that might be causing them to have
more parasomnia behaviors like sleep terrors.
- Okay, so on the same kind of vein,
but what advice do you have for children
who are afraid of the dark?
So we're talking about kids who don't even wanna go to bed,
because they're afraid of the dark.
You had some really good ideas of things
to help them with that.
- Yeah, so for nighttime fears, the main thing is...
Well, first, prevention, like if you have a child
who's afraid of the dark, or afraid of certain things,
then you want to try to avoid them watching scary content,
being exposed to maybe material that older kids,
older siblings, cousins, neighborhood friends might watch,
because that's gonna be more likely
to increase their nighttime fears.
But then the main thing is that you want to help them
get used to being in the dark,
and seeing that being in the dark is actually not that bad,
that there aren't scary things in the dark
like they imagine that there will be.
So one of the main strategies that we use
to help kids overcome the fear of the dark,
which is totally developmentally appropriate,
especially during those preschool,
early elementary school years,
is to do what's called a flashlight treasure hunt.
So this would be parents going into a kiddo's room,
taking an item, like okay, I'm gonna hide this in your room,
taking it into their room
while the kid's out in the hallway,
hiding it somewhere, really obvious at first,
so maybe on the middle of the table,
the parent leaving, making sure it's dark in the room,
all the lights are off, no nightlight or anything like that,
ideally you do it at nighttime, so that, you know,
environmentally it's dark by the windows.
You give them a flashlight, you send your kiddo
into the room to find the item that you hid,
and then once they find it with their flashlight,
they come back out, and they get a prize.
As nights go on, you start to hide items
in more difficult places.
So first you hide really easy, so maybe they're in there
for like, five seconds, then you hide it
so maybe they're in there 10 seconds,
think about maybe this will take them 20 seconds to find,
and then as they get better and better,
you want them in there searching
for as long as you think it might take them
to fall asleep, which should be,
a normal amount of time to fall asleep is 15, 20 minutes.
So if you can get them comfortably in the dark
with a flashlight searching for things--
- And you're outside the room.
- You're outside the room.
- Giving them cues, or, okay...
- You're primarily waiting.
If they feel like they can't find something,
and you feel like they have been searching hard for a while,
you could give a hint or a clue to help them find it,
but you want them to spend time in the dark
doing something that's kind of fun and distracting,
and helping them to realize nothing bad is going to happen
just because it's dark.
- Okay, in the column, we talked a lot
about healthy sleep habits, having bedtime routine,
consistency, and agreement between parents,
especially that crying it out period, or just patterns.
What advice do you have for parents
in two parent households, which we have a lot of
in today's society, where the kids are sleeping
in different places at different times,
and what do you do if perhaps the two sets of parents
don't have the same philosophies?
- Yeah, so that's of course very common
for caregivers to have different philosophies around sleep,
or different routines, or patterns,
or schedules that require a child's sleep
to be different in different settings.
So as much as possible, I recommend open communication,
try to have caregivers be on the same page
as much as possible, even if it's just,
if our timing can't be quite the same,
then let's do a similar bedtime routine,
so that the child has that consistency of knowing
these are the steps that lead me
to be tired and fall asleep.
If they can keep a similar sleep/wake schedule,
then that's gonna be ideal for a child to fall asleep
at the same time and wake up at the same time.
All of us as humans benefit from that consistency.
But the truth is, if one caregiver does sleep one way,
and another caregiver does sleep another way,
kids will adapt.
So even if you aren't able
to maintain consistency across households,
you can have consistent routines in your household
that will support your child's getting good sleep.
- Okay, good to know.
I think we covered a lot of ground,
thank you so much for this.
We also talked about how, you know,
if you are having issues, you can always go
to your pediatrician, and then you can come
to Akron Children's self-refer.
Do you wanna put in a plug, what the phone number,
or how people can find you?
- Sure, if you try some of these strategies at home
and you're having a hard time just getting them to work,
I'm happy to problem-solve,
and just kind of tweak and tailor strategies.
A lot of times, parents are doing great things,
it's just a matter of tweaking them to make it so that
the child's motivated to make some change.
So if you feel like you'd like some support
around your child's sleep, you can call
our sleep medicine clinic here at Akron Children's
at 330-543-8885.
- Okay, great, thank you so much.
- Thank you.