Sleep tricks

I preach about sleep to kids all the time, both at the office and at home. It is one of my three most important things for overall health along with eating nutritious foods and exercise. Most of us don't get enough sleep. Here are some tricks to get in a few extra minutes each day... they all add up!

photo source: Shutterstock

Most of these tips are appropriate not only for kids and teens, but also for their parents!

Know how much sleep is typical for every age group. A great infographic of this is found at the Sleep Foundation. Warning: It shows generalizations. For example: when tweens and teens go through a growth spurt many need 10-11 hours of sleep per night, which is more than the graph shows. Just remember that individuals are just that: individual.

Think of sleep as a currency. We can go into sleep debt when we don't get enough. If it's just a little loss of sleep, it is easy to catch up and pay back the debt. The further into debt you go, the harder it is to get out of debt. Don't let the bank come after you in terms of health problems!

• Listen to your body. If you're tired, you need more sleep. The longer you stay up, the harder it will be to fall asleep. It is ironic, but sleep deprivation leads to insomnia. If you suffer, try to get extra zzz's on a weekend to fill the deficit. But don't allow yourself to sleep so late that you can't go to bed on time that night. (Note: many kids get hyper when they're tired, so don't be fooled if they have lots of energy in the evening. If they don't wake easily in the morning, they are tired!)
• Routines. Go to bed and get up at the same times every night. If you stay up later on a weekend, be sure it isn't more than 2 hours past your ideal bedtime.
• If you have a hard time getting up, try to get natural sunlight as soon as possible in the morning. It helps set your circadian rhythm. If you can't get natural sunlight, turn on lights in your home.
• Conversely, start turning down lights a few hours before bedtime. Avoid screens (tv, computers, smart phones). Lights keep you from feeling tired. Don't let them keep you up!
• Journal before bed if thoughts keep you awake. People who spend bedtime thinking about everything can't sleep. Jot a few things down to give yourself permission to not think anymore. Sounds weird, but this "worry list" works for many people!
• Be active during the day. Lounging around makes you feel more tired during the day, but it is then harder to fall to sleep at night. Experts recommend avoiding exercise for a few hours before bedtime, but I know that is really hard for kids in sports. I don't have a great fix for that, unfortunately.
• Set the alarm for the last possible minute. Kids and their parents who hit snooze several times miss out on all that sleep that they are in a half awake zone. If you really don't need to get up until the 3rd snooze time, set the alarm for that time. You will be more well rested so it will be easier to get up immediately. Train your body (or your kids) to get up at that time. After several days of an extra few minutes of sleep, you'll notice the difference!
• Learn meditation or biofeedback. Some insurance plans might pay for this. There are apps available for smartphones and tablets, just do a search. Here's one review of apps to release tension. I have used the StressEraser, but it can be pricey. Searching Amazon or eBay will have less expensive options, allow you to browse several brands, and read customer reviews.
• Set the mood in the room: darken the room, get the temperature "just right", and find the number of blankets that helps you sleep. Setting up a fan or other white noise maker helps many people sleep. For more tips on setting up the perfect room for sleeping, see Bedroom.
• Keep kids out of the parent bed so everyone gets the best sleep. Snoring, different bedtime, and other body movements makes it hard to sleep together. No one sleeps well, which makes everyone grumpy the next day. 
• Reading at bedtime can be a great relaxing thing, but if you have a page turner, be careful to not get caught up in the book for hours. I find that stopping at a lull mid-chapter is better than waiting until the end of a chapter. A good author leaves you hanging at the end of a chapter and begging for more! Set a time limit and stop reading when time's up! That's what bookmarks are for.
• Avoid caffeine, especially hidden sources. I have occasionally gotten ice cream with coffee for a family bedtime treat, only to find out upon tasting it that it had coffee. Caffeine is often added to drinks, so read labels. But be careful! It might not say caffeine directly. Some are labeled as "guarana" -- a plant with caffeine. Pretty much anything that is labeled as an energy drink (or food) is a likely culprit.  Even decaf coffee has a small amount. Chocolate naturally has caffeine... the darker the chocolate the higher the caffeine content. Some pain relievers and other medicines have caffeine. Especially for those not accustomed to caffeine, it will disrupt sleep even if taken several hours before bedtime.
• Take a warm bath. This can help relax you for a good night's rest.
• Ask a family member to give you a massage or back rub. Again, a great way to relax!
• Warm milk or herbal teas might help some sleep.

Spring Forward... Lose sleep...

As we move our clocks forward to increase the number of daylight hours, we all lose one hour of sleep.  In the whole scheme of things, this isn't much. Most people (kids and adults) lose needed sleep every night.  Only 8% of teens get the recommended amount of sleep.  Eight percent!  No wonder they have increasing rates of so many problems.

Last night I watched "Race to Nowhere" a documentary of the pressures placed on our kids today.  Kids feel pressure to do well in school (many while taking an overload of AP classes), leading to many hours of homework each night.  They participate in sports, which takes up valuable time after school away from homework, but does help them exercise and do something they enjoy (until they burn out and don't like it anymore). They feel the need to do community service and join clubs to build their portfolio to get into a great college.

While I think the film was developed with an agenda and not every kid is suffering from overload, I certainly see enough teens (and preteens) who seem to suffer from sleep deprivation, depression, anxiety, stress, and more.  Are these kids simply not using time efficiently?  Even the documentary showed one of the troubled teens doing homework with her cell phone right there and texting interrupting her thought.

Maybe a quick break after school to play outside for 30 minutes will help release energy and allow the brain focus to study.  Then turn off the tv and put the phone in another room and get to work.  My question: Are these kids spending 6 hours doing 1 hour worth of work?  

Interesting point made in the film though: Studies show that as the amount of homework assigned decreases, test scores increase.

Are we setting our kids up for failure from the beginning? Research shows that kids under 3 years who watch tv have higher incidences of ADHD and aggression along with lower cognitive development.  Kids with ADHD take longer to do tasks because they do not focus and concentrate until the task is complete.  They often need to re-read or re-do work because they miss concepts.  They can suffer from poor self esteem and increased rates of depression because they feel like failures.  In the short video below Dr. Dimitri Christakis explains how researchers are learning about the influences of stimulations (too little and too much) on learning and development.  Take 16 minutes to watch it!

Past growth and development cannot be changed, but we can improve current growth and development.  Maximizing nutrition, healthy exercise, and sleep can help the body and brain be its best.

Kids and teens are staying up too late (sometimes all night) to finish homework.  They are tired during class so take caffeine or other stimulants (such as those used to treat ADHD without a prescription) to stay awake.  They are too tired to focus in class, so they perform below their knowledge on tests.  Between 7-12 years old, kids need 10-11 hours of sleep every night.  Teens need 8-9 hours, sometimes more during rapid growth spurts.

Kids who once enjoyed a favorite sport feel the pressure from coach to train more, but the demands of school put the kids in a quandry: they need to make grades to play, but they don't have time after practice to do the homework.  Often practice and game times are late in the evening, making it hard for kids to fall to sleep at a normal bedtime, since the body needs about 2 hours after exercise to fall to sleep.  I have blogged on this before here.

I see many kids and teens who have chronic headaches or other symptoms that are likely due to sleep deprivation, but they insist it is something else and they want the million dollar workup to find a cause and expensive medications to treat the symptoms.  Once symptoms have started, they might need more treatments, but beginning with healthy nutrition, exercise, and sleep might prevent many of these problems!

The fear of failure and pressure to succeed is leading to kids trying anything to succeed, not just staying up late and drinking too much caffeine.  Cheating in schools, such as copying homework, plagiarizing, or cheating on a test is becoming commonplace. The large majority of high school students admit to cheating.  What does this mean for our future society if kids learn to cheat the system to succeed?

Kids who are chronically sleep deprived are at risk of physically hurting themselves due to slowed reaction times, concentration and focus failures, and difficulty processing information (much like being under the influence of drugs or alcohol).  They are more likely to be injured while playing their sport. Drivers are more likely to be in a car accident.  Drivers 16-24 years of age are the most likely to report falling to sleep at the wheel in the past year according to a study by the AAA Foundation for Traffic Safety.  Also in this study, people who sleep 6-7 hours a night are twice as likely to be in an accident as those sleeping 8 hours or more.  People sleeping less than 5 hours increase their risk 4-5 times!

How can we all wake up rested and still get everything done each day?  What can we cut back on with our families?  There are initiatives to get schools to enforce less homework and to start later, but until then, what can YOU do to help your kids get the sleep they need?

Play it Safe!

As the Spring sport season approaches, it is a good time to review the importance of playing safe to prevent injuries.  Parents want their children to grow up to be well rounded academically and physically.  A great way to be physically fit is to participate in sports, but often kids do too much too soon or play with an injury- which can lead to worsening the injury and removal from the game.  Unfortunately by 13 years of age many kids leave sports due to feelings of inadequacy or burnout.  They lose the many benefits of athletics, including physical exercise, mental well being, drug abuse prevention, and more.  Most young kids should not play at an elite level.  Not all will be natural athletes, but all can and should participate in life long sports to varying degrees.  Emphasizing having fun while improving performance can help kids feel less pressure to win and be the star athlete, but even the star should emphasize fun at younger ages!

In general there are two types of injuries: acute and overuse.  Overtraining syndrome is a mental as well as physical issue that can lead to decreased performance and sports burnout. Acute injuries are commonly recognized, and include things such as sprained ankle, wrist fracture, or concussion.  Overuse injuries are less often identified and are more difficult to diagnose.  They occur subtly over time from repetitive trauma to the bones, joints, and tendons.  Examples include little league elbow, gymnast wrist, or stress fractures.

Acute Injuries:  Although not all injuries can be prevented, you can decrease the risk of acute injuries  by adhering to the rules of the sport and the sport-specific safety measures recommended.  If injury is suspected, removal from the sport until injury is healed is important to prevent further injury.

Overuse Injuries:  In the child and adolescent, overuse is the cause of up to half of all pediatric sports injuries.  It is bone, muscle or tendon microtrauma caused by repetitive stress without adequate healing time.  It begins with pain after activity, then pain during activity without affecting performance, followed by pain during activity that affects performance, and finally pain even at rest.  Children are at increased risk because of their growing bones and inability to recognize or describe symptoms.



Overtraining Syndrome (“burnout”) is the psychologic, physiologic and hormonal changes that lead to decreased performance.  Symptoms include chronic muscle or joint pain, personality changes, increased heart rate at rest, decreased sports performance, fatigue, lack of enthusiasm, and inability to complete usual routines.  Prevention includes encouraging a variety of sports throughout the year, making workouts interesting and fun and having athletes take 1-2 days off per week, plus 2-3 months off per year for other activities.  Overtraining can lead to burnout in the early years, which can cause a child to end participation in sports altogether, which may cause inactivity and contribute to the obesity epidemic in our country.

In general, injury prevention begins with making sure your child is playing in a safe environment with a knowledgeable coach and well fitted safety gear.  My favorite tips:

• Remember that many coaches are volunteers with little (or no) specific training.  Don't assume the coach knows how to prevent or treat injuries... you should ask what their experience is!  Be sure there are always at least 2 adults around (this is abuse prevention... another topic entirely, but important!) 
• Encourage athletes to take the time to warm up and cool down.  
• Make sure athletes drink plenty of water, especially in warm weather. 
• Be sure they are playing at a level that meets their skills. 
• Let them know that they should enjoy playing for the fun of the game, not to win.  
• Be sure to remind them that you enjoy watching them play ~ not watching them win!  
• Have kids take time off a favorite sport to try something different for a season.  This not only keeps the game fun, but it works different muscle groups and improves overall fitness.  
• I am also a firm believer in sleep for kids of all ages! Sports practices and games can interfere with an appropriate bedtime and adequate sleep, so make sure your child doesn't suffer from sleep deprivation. 

American Academy of Pediatrics Guidelines and Recommendations Include:

• Athletes should take 1-2 days off per week from competitive athletics and competitive practice to allow physical and psychological recovery.
• Athletes should be a member of only one sport per season.
• Athletes should take at least 2-3 months away from a specific sport during the year.  During this time another fun activity can be done to prevent loss of skills or conditioning.
• The focus of participation should be fun, skill acquisition, safety, and sportsmanship.
• Weekly training time, number of repetitions or total distance should not increase by more than 10% per week.
• Watch for possible burnout if the athlete complains of nonspecific muscle or joint problems, fatigue or poor academic performance.  Consider time off at that time to allow physical and psychological recovery.
• Use caution for younger athletes who participate in multiple games during a short time period.
• Children should participate in a sport at a level consistent with their ability and interest.
• Single sport specialization should be avoided before puberty.  Young athletes who participate in different sports at various seasons have less burnout and fewer overuse injuries.
• Parents should be aware of the coach’s knowledge of proper training techniques, equipment and training of a particular age group.  Parents should encourage organizations to mandate coach training in these areas.
• Never allow an injured athlete to participate in activities until completely healed or cleared by a physician.
• Children are more at risk for heat injury.  Proper hydration should be encouraged.  Avoidance of prolonged activity in moderate temperatures or any activity in extreme temperatures should be enforced.  
• Ensure proper nutrition:         

Proper caloric intake is based on body size and growth rate in addition to calories burned.  Monitor for signs that the athlete is trying to lose weight to benefit performance (to the detriment of overall growth).

Balance nutritional elements based on the Food Guide Pyramid.

Adequate iron is needed.  The amount of iron needed in the diet is highest during the growing years and sports may contribute to iron losses.  Athletes need adequate iron to bring oxygen to tissues in the body.

Calcium intake is important for normal bone growth and possibly to help prevent and heal stress fractures.

Resources and References:


PEDIATRICS Vol. 106 No. 1 July 2000, pp. 154-157, AMERICAN ACADEMY OF PEDIATRICS:  “Intensive Training and Sports Specialization in Young Athletes.”  Committee on Sports Medicine and Fitness.


PEDIATRICS Vol. 119 No. 6 June 2007, pp. 1242-1245, “Overuse Injuries, Overtraining and Burnout in Child and Adolescent Athletes.”  Joel S. Brenner, MD, MPH and the Council on Sports Medicine and Fitness.

Stop Sports Injuries

New Year's Reflection

I was fortunate to be able to spend New Years with my extended family in the St Louis area.  Conversation led to my mother remembering old family videos in the basement. After a little digging around, my brother found the never before seen footage!

We had a blast watching videos of past holidays and vacations.

Some things were fun to compare. My daughter is better at ballet than I was at her age.

Other things were simply laughable.  Although I was impressed at my grandmother looking fit and trim in short shorts, most clothing choices of the 70s should never be repeated.  What will they think of our current clothes in 30 years?

One thing that struck me sadly was the average weight of people at all ages in the 70s seemed to be less than the average weight of people the same age today.  I'm not saying my friends and family have gained weight ~ I would get into trouble for that!  It was simply noticeable that people of today are heavier when comparing large groups.

I've read the statistics before...

Self Reported Weight up Nearly 20 Pounds Since 1990
Mean Body Weight, Height, and Body Mass Index, US 1960-2002

... but it was interesting to see large groups of people from my past vacations and comparing to what I see daily when out and about.  It made it real.

If the US is such a great nation, how have our individuals as a group gained weight in this unhealthy manner?

Is it the convenience of pre-packaged foods, many of which are processed and/or high in fat?   More women work now than previously. Does this contribute to less home-cooking and more fast foods?

Is it that the meal size increasing?  Large sodas of my childhood are now the smallest size available.  Who needs 64 ounces of acidic bubbly sugar?  We eat larger servings both at home and at restaurants. 

Are we less active than we used to be?  I can easily see how today's kids are tempted with tv, video games, and other sedentary activities.  As a child, I only had one tv channel, and most often it had adult programming. (There were no recordings available!) I had many other things to do both in the house and outside.  We didn't have many structured activities, so we just made it up as we went along.  And we had a blast!   What about adults? Are they less active? Do we work more hours than our parents?  Do we spend more free time in front of the tv/computer than our parent's generation? What did they do for fun?  Was it out of a chair?

Do we sleep enough? With many tasks to do and distractions, such as tv programming and internet available all night, do people stay up too late to get a good night's rest?  More and more research supports that sleep is needed for concentration, endurance, immune functions, as well as weight control and more.  How often do we feel tired?

I suspect that there are many reasons for our generalized weight gain, which means that there are many potential fixes, and not one alone will help.  I have tried to limit processed foods at home, but they are convenient and easy, so I sometimes splurge.  We try to eat as a family at home most nights, though activities sometimes interfere.  Portion control is relatively easy for my kids: they eat minimally by nature.  My husband and I need to check ourselves.  My kids are much better at exercise than I am, mostly because they have time and they love to move!  I don't want to forego sleep to fit in exercise. No one gave me time for Christmas... but I'm working on finding some free time!

What do you find helps keep your family healthy?

  

Too Little Sleep in Athletes

I am very concerned on many levels about late nights required for local sport programs from a parent perspective and as a pediatrician.

Many physical and emotional problems have been linked to sleep deprivation.  I see many kids who struggle in school and at home with behavior and learning problems that are directly related to loss of adequate sleep.  Poor sleep is also related to obesity, poor growth, depression, anxiety, poor school performance, and so many other issues.  Sleep is needed for release of growth hormone, which is needed for bone and muscle growth, muscle repair, fat burning, and learning.  Sleep loss leads to poor attention spans, inconsistent performance, decreased aerobic endurance, delayed response times, and increased illness, and will therefore affect their game!  There is increased risk of injury in these tired athletes.

You can argue that one late night a week will not have devastating consequences, but I disagree. We have all heard that consistent bedtimes are important for sound sleep.  Ironically sleep deprivation often leads to insomnia and more sleep problems. You cannot sleep "extra" to bank sleep hours.  Kids will often sleep in on weekends to attempt to catch up on the sleep hours missed during the week, but that means a week of struggles emotionally and physically.  It also gets their sleep routine off balance, which again contributes to poor sleep.

It is recommended to exercise at least 2-3 hours before bedtime because exercise is stimulating, making it difficult to fall asleep after exercise until the body temperature and metabolism return to normal.  Yet I find that many school aged kids have practices and games in the late evening into night hours.

School aged kids up to 12 years of age need 9-11 hrs of sleep per night to function adequately.  Practices and games late in the evening shortchange their night's rest by far too many hours.  Don't forget to consider that the time to settle down after the game is up to 3 hours. The following day they are likely to have problems at school.  An overtired child often has MORE problems getting to sleep, which affects the rest of the week.  These younger kids tend to have a lot of noticeable behavior and learning problems. Many are misdiagnosed with ADHD and treated with medication, when all they really need is better sleep. It is simply not acceptable to set them up for this failure.

As kids enter middle school they often need extra sleep due to puberty.  (Growth hormone is released during sleep.)  Unfortunately, school tends to start earlier and their game/practice times are often later, meaning they might be getting up just a few hours after they are falling to sleep.  Do we really want to affect their growth during these important years? 

No wonder many middle and high schoolers fall to sleep in class and struggle with falling grades, irritability, depression, and more.

Kids shouldn't have a hard time getting up in the morning.  If they are, it's a sign of not enough sleep!

I should also include coaches and parents in this, since we will be required to teach and transport these kids. Adults will fall short of their recommended 7-9 hrs of sleep, which affects mood, weight gain, and attentiveness.  This affects not only health, but also home and office life.  Can you wake up before your alarm?  If not, can you get to bed earlier?  That is a healthier choice than adding an extra cup of coffee or energy drink to your day.

We as parents and coaches want our kids to succeed in all areas of life. We want to give them the tools they need for this, which must include proper sleep.  Practice and game times on school nights must take into consideration the sleep requirements of these kids.  I do not want to be responsible for allowing  my child to be out late on school nights, therefore contributing to increased risk of poor school performance, behavior issues, immune deficiencies, depression, growth and obesity, and all the other known consequences of poor sleep. Once these issues surface it is too late to prevent them and the snowball effect begins!

The question: What can parents do?????