Kids' Wellness Matters Podcast Ep. 20: Building Better Bedtime Habits

Sleep is just as important to your child's development and well-being as a balanced diet and exercise. Yet, establishing healthy sleep habits can be a challenge at every age and stage of childhood. In this episode, two experts from the Sleep Medicine Center at Lurie Children's, Irina Trosman, MD, and Allison Clarke, PhD, talk about common sleep-related issues and also bust myths about good sleep practices, from the use of melatonin in kids to the usefulness of power naps. Listen in for steps you can take to help everyone in your home get a good night's sleep. 

“Making sure that the parents are good (sleep) role models … setting good examples from early on, and also making sure that the parents have consistency. We do not want mom to give one message and dad use a different one, and that's frequent, right? You would hear from one parent, ‘I am a good cop, and my husband has a soft spot that wants to cuddle and wants to co-sleep.’ And so making sure they're on the same page, trying to reach a compromise, having consistency among caregivers is also very important."

- Dr. Irina Trosman

“Kids are going to feed off of whatever parents are feeling at bedtime, and it can be really stressful. I will admit, myself, that I'm not always my best self at bedtime. But, the more that parents can think about the goal of the bedtime routine being to help their kid feel calm and relaxed in bed versus getting them to sleep at all costs, can really help the kid to learn and associate bedtime with relaxation and rest.”

- Dr. Allison Clarke

Episode Highlights

• Trosman talks about the mystery of sleep and its elusive but essential role in our brains’ and bodies' ability to function. Despite its mysteries, Clarke says when kids aren’t getting sufficient sleep or good quality sleep, it often shows up in behaviors such as  hyperactivity, impulsivity, and struggling with academics.
• Sleep is crucial for growth and development in all ages of childhood. The teenage years are especially important because, due to hormonal changes, their circadian rhythm may change and they start preferring to go to bed later.
• They discuss many habits parents can implement to better manage bedtime activities and help kids calm down to prepare for sleep.
• Children are usually seen at Sleep Medicine Center, after parents have tried certain approaches recommended by primary care and basic interventions fail. In relatively healthy children, common diagnosis at the center include sleep apnea and restless leg syndrome. In children with more significant medical conditions that impact their sleep, Tosman works with other specialists such as with neurologists, ear, nose, and throat doctors, psychologists, psychiatrists, to give a multi-layer approach to caring for patients. 
• The experts also bust myths about “catching up on sleep,” giving children melatonin and more! 

Transcript 

[00:00:00] Dr. Nina Alfieri: Welcome to Kids Wellness Matters. I'm Dr. Nina Alfieri.

[00:00:07] Dr. Rob Sanchez: And I'm Dr. Rob Sanchez. We are both parents and pediatricians at the world renowned Ann and Robert H. Lurie Children's Hospital of Chicago.

[00:00:15] Dr. Nina Alfieri: On this show, we'll chat with a wide range of experts about caring for children from newborn to young adult. Because Kids Wellness Matters.

[00:00:29] Dr. Rob Sanchez: You're getting good sleep these days, Nina? How's it going for you?u

[00:00:31] Dr. Nina Alfieri: Is anyone? No, sleep is so important. I feel like it's that gold at the end of the pot that we're always looking for. But all too often. I'm going to paint a picture that maybe one or two other listeners might identify with.,You get home after a long day, right? You drove in your car. You're so excited to get home. You're thinking about the bubble bath. You put on your lavender sleep mask after dinner, and you are ready to go to bed. And you look at your kids and they have that look in their eyes and they're like, chase me, let's run. Let's do arts and crafts. 10 more bookies. Has that ever happened to you?

[00:01:03] Dr. Rob Sanchez: The bedtime zoomies are always a thing. Got the bags under my eyes, too. Sleep is hard to come by. And certainly, just the ideal routines can oftentimes get interrupted. My kids wanted to stay awake, wanted to keep the party going, but we all need to get good sleep. And it's one of the things that we talked about with some of our wonderful sleep specialists at Lurie Children's in this episode about so many things, everything from some of the behavioral aspects of stuff, but also like some of the significant medical diagnoses that go into it, that they help treat. And especially dispelling some of the myths that there are about sleep. Have you heard about some of these? What are some of the things that you hear?

[00:01:36] Dr. Nina Alfieri: There's so many myths about sleep and it's so interesting because we spend such a large part of our life sleeping and it's something you need to do every single day, but there's no shortcut for it, right? Let's see a myth I've heard about sleep. The catch up sleep myth is a real thing. I mean, in residency, you would work 30 hours straight and think you can catch up. It's true. You never feel quite the same as if you just slept regularly. And I think we're starting to learn about that more in medicine too.

[00:02:01] Dr. Rob Sanchez: I gotta tell you, I really learned a lot, especially in this conversation about someone who really focuses on the behaviors. They offer some really nice tips I thought as a parent about how we can try and model some good sleep practices. Whether that does include a nice sleep mask and time to wind down or whatever that may be. Or, one of our favorite things is reading a good book and doing that with your kids and finding those opportunities. But I also like that they acknowledge that there are some significant sleep difficulties, right? There's things like obstructive sleep apnea and significant conditions that can affect sleep. And what's great that they talked about is, in their sleep center, they have all different types of providers that work together. You have medical specialists, different collaborators, folks who are going to approach it from a behavioral side of things. And they work with the family and the child in a really nice way. It's really nice to know that we have great colleagues who are focusing on this.

[00:02:46] Dr. Nina Alfieri: That's awesome. I've been dreaming about this episode and I will definitely not be snoozing during it.

[00:03:01] Dr. Rob Sanchez: Sleep is just as important to your child's development and well being as a balanced diet and exercise. Yet, establishing healthy sleep habits can be a challenge at every age and stage of childhood. Today, we are talking with two experts from the Sleep Medicine Center at Lurie Children's about common sleep related issues and steps that you can take to help everyone in your home get a good night's sleep.We welcome Dr. Irina Trostman, an attending physician in pulmonary and sleep medicine, and Allison Clark, a pediatric psychologist in sleep medicine and the Pritzker Department of Psychiatry and Behavioral Health. Irina, Ali, thanks so much for being here.

[00:03:35] Dr. Irina Trosman: Good morning, Rob. Thank you.

[00:03:37] Dr. Allison Clarke: Thanks so much for having us.

[00:03:38] Dr. Rob Sanchez: I first want to talk about the Sleep Medicine Center at Lurie Children's. Can you tell us what makes it a premier destination for children and families struggling with sleep related problems?

[00:03:48] Dr. Irina Trosman: Sure, we'll brag a little bit,

[00:03:50] Dr. Rob Sanchez: Yeah, please do.

[00:03:51] Dr. Irina Trosman: We're very proud of our center and we recently were reaccredited by American Academy of Sleep Medicine. It's the highest honor testifying that we're a state of the art facility fully focused on pediatric patients. We don't do adult sleep studies. Our technologists are fully trained and focused, comfortable, taking care of from the youngest to the oldest, from the healthiest to the most complex children. We have individual rooms with all appropriate equipment to be able to take care of kids who have special needs, wheelchairs, require two care givers at times , or G tube feedings to just the youngsters who come and visit us for a sleepover. All the studies are read by Pediatric sleep specialists who are board certified or board eligible. And we have state of the art technology. And we have two centers, actually. One is at the main hospital and one in the suburbs. We're able to accommodate patients from various geographic areas. And we have private facilities , which are very important in every room. That is not necessarily true for other sleep centers. So, everything is focused on the child. Our goal is to get the best out of this. A little bit of a challenging night. We actually try to make sure that the child is well prepared.  We have a wonderful help from our sleep psychologist, Dr. Clark, who is here today. And Allie helps kids to get used to sleep study equipment and helps them get more comfortable, especially we know ahead of time that the child may need special accommodations and needs to have some sensory issues. So, we're willing to work of time. to make the night successful. Ellie. Anything I forgot?

[00:05:19] Dr. Allison Clarke: No, I would just say I think we have a unique team and that we are made up of physicians, nurse practitioners sleep technologists, and then, as far as I know, I think we're the only pediatric program in the Illinois area that has a behavioral sleep medicine specialist. I work with kids as young as a few months old through 18 and sometimes older.Just helping them with more of the cognitive behavioral aspects of sleep helping both kids and their parents with what are the strategies we can try in a more structured way to help make sleep a little bit easier.

[00:05:51] Dr. Rob Sanchez: What is happening to our bodies and our brains at night when we get good sleep?

[00:05:56] Dr. Irina Trosman: We wish we could give you an exact answer, but it's still somewhat an enigma. Sleep is still so elusive. There is still a lot of unknown. First of all, there are multiple theories regarding what sleep does to our bodies and our brain.And we know there's a developmental component to that where there's a significant amount of development happening, especially brain cells among connections and what we call pruning. During the first year of life, that's why infants sleep so much. They have little periods of wakefulness, but they process a lot of this information.during sleep. We also know there are a lot of significant changes that occur during sleep architecture. For instance, REM sleep that is notoriously famous, and gradually the amount of REM sleep recedes. So why is that? Is it because a little bit of a mature stage as opposed to what people think a lot of times REM is actually more mature?We don't know. There are theories that it's energy preservation state, which is true . Even though the brain is working very actively during sleep, the rest of the body's metabolism slowing down. Perhaps we're preserving energy because we can't keep going 24 There is also a theory of toxin removal. We think that's a clean up process that is going on, that the toxins accumulated during daytime are being removed at night. There is a theory of grow and we know for sure that growth hormone gets released, so kids do truly grow, during sleep.

[00:07:10] Dr. Allison Clarke: I guess I would just add that when kids aren't getting sufficient sleep or good quality sleep is that we often, especially in the immediate term, we see hyperactivity, impulsivity, struggling with academics and school. We know that sleep is important for that behavior and executive functioning skills that kids need to function their best day to day.

[00:07:30] Dr. Rob Sanchez: Clearly it's complex. There's a lot that we do know, as you mentioned, but there's still multiple theories that are out there that we're working through and seeing more evidence to support in terms of all the different functions that's happening. For me, and I imagine for parents, it's hard to really grasp that.  I think a lot of people don't think about sleep until it becomes an issue, take it for granted.

[00:07:48] Dr. Irina Trosman: All right. We take it for granted. Even though we spend a third of our time in sleep during our lives. I think our job as pediatricians is to be proactive and make people think about sleep in terms of good sleep. We try to be proactive and prevent things from happening rather than be retroactive because it's so much harder to fix the broken sleep.

[00:08:07] Dr. Rob Sanchez: To delve a little bit more deeper into that. I wanted to talk about things from the medical perspective, but also the psychological perspective, Irina, I wanted to start with you. So, from a medical perspective, you mentioned, folks don't think about sleep until it is an issue. How can sleep issues impact a child's day to day functioning and overall development?

[00:08:24] Dr. Irina Trosman: I would say that not only do sleep issues impact children, they also impact the whole family. We think about a child in the context of the family and we always try to gather information, how much a child's sleep behavior impacts the rest. Because it's important in the parents' home, primary caregivers, they also need to be rested. Sometimes surprisingly, disturbances don't seem to have a significant impact on the family, but that's more an exception. In immediate aftermath, so to speak, as Allie mentioned. Children do have the same probably behavioral representation of sleep deprivation that we do, maybe it's slightly different. As opposed to being frankly sleepy, they could be a little more hyperactive and attentive, just on the way a little bit more emotional. And in the long term we think that it probably, and of course, nobody did prospective studies in deprived kids and decided to test them and see how much impairment, cognitive impairment, memory impairment they will have. You have to take this with a grain of salt. But we do anticipate that kids who are chronically sleep deprived probably will have long lasting impact as far as their academic performance, emotional needs, their ability to have good peer relationship behavioral and academic struggles, as well as possibly having, especially in adolescents, depression and anxiety, and it sometimes sprawls out of control when kids can't sleep.

[00:09:38] Dr. Rob Sanchez: Certainly, the clinical aspect is there but Allie, I'm sure you also focus on the psychological how, do those behavioral challenges intersect where a child is having these sleep issues?

[00:09:47] Dr. Allison Clarke: Yeah, I think Irina made good points about just what we're seeing. The impacts are certainly on the kid and teenager, but also parents and their frustration and being unable to sleep. We actually do have some data. I was thinking through how in California and some other places where they made changes to school start times and they actually delayed it. There's a lot of evidence that shows that kids had better academic functioning. Better functioning just day to day, but also like fewer car accidents. There are serious implications for Total quantity of sleep when kids are getting better sleep. I think the biggest challenge that we see is kids and teens don't necessarily maybe grasp all this complex what's actually happening in our brain for sleep. In their immediate, they're thinking, I want to play more games or more video games or see my friends or stay on my phone. And so it sometimes is difficult to think through that aspect of like the teen brain and what might motivate them. So sometimes it is. Not necessarily for them grasping, what does the sleep mean for me? But like, alright, let's think through some things that do have value for these kids and the teenagers.

[00:10:56] Dr. Rob Sanchez: Yeah. No, I can imagine that could be a tough conversation, but I imagine you have some tricks of engaging them and talking to them like, Oh, hey, this is why you want good sleep. You might run faster. You might do better on this thing. Is that kind of what you're talking bout?

[00:11:09] Dr. Allison Clarke: Yeah, for sure. I think it's figuring out what motivates them. And it is, you're right, that for kids who are athletes, it's, Oh, have you ever thought through how your performance might be driven by getting better sleep? And sometimes we do experiments where we say, like, you don't have to do this forever, but will you give me to try for two weeks and just see how you're feeling by the end of that time? Sometimes it's figuring out, is there an external motivator? Like, getting your driver's license or some new video game, right? The things that are the focus of their motivation then can be driver's these are things you're earning if you're following the rules around bedtime and sleep. There also are the American Academy of Sleep Medicine puts out a video contest for teenagers where they actually speak to sleep. And so it's kind of nice. I often will share those videos with kids because it's. Kids speaking to kids um, sometimes gives a little more buy in.

[00:12:01] Dr. Rob Sanchez: What we frequently see in teenagers in particular is this night owl sleep pattern, where they tend to stay up late and want to sleep in, and it's not necessarily truly abnormal because as we, you may have heard, in puberty there are changes that occur In the sleep pattern, so to speak, and teenagers, especially when they are going through the sexual development truly become a little bit more night owls.

[00:12:23] Dr. Irina Trosman: They are, their melatonin production doesn't kick in until a little bit later, there's changes in the amount of melatonin that they produce, there's actually a significant reduction in melatonin oral production. melatonin amount that they produce, and they do prefer to go to bed later and wake up later, which is unfortunately not what is accounted for by our high school start time. So when we talk about sleep requirements, we're trying to emphasize it's not just the amount of sleep, it's the timing of sleep and of course quality of sleep. If they wake up at times to check social media and go back to sleep, it's interrupted sleep. It doesn't matter if they get nine or ten hours of required sleep cumulatively. But the conversation is always a challenge with teenagers. Very rarely do we find teenagers who have a very good understanding of how important sleep is. And even if they do consciously, the temptations were working against the tide of social media. Netflix and Netflix like, and then the fact that most teenagers now have multiple screen devices in their bedrooms. And parents at times are so hesitant to reinforce screen time because they choose their battles. And I sympathize. I understand it's not easy having two young men in my own family. I can tell how difficult it is.

[00:13:31] Dr. Rob Sanchez: Curious, what about younger children? I'd imagine that they need more sleep. Are there differences in terms of, school age children, preschoolers, and more infants or newborns?

[00:13:39] Dr. Irina Trosman: We understand that the youngsters who are growing, whose brains are growing the fast need more sleep. And we expect initially them to have a big chunk of sleep at night and then nap. And the majority of American kids probably stop napping by age four or five. Sometimes it's a challenge, especially when they start first grade, because some kindergartners get used to napping, and transition to a school makes it a little bit harder. We understand that, too. But in general, yes, younger kids need it. more. They also have a tendency to wake up early and it doesn't always agree with parental expectations. There are frequently early risers. Waking up at 5:30 sometimes is perceived as an issue by parents who prefer to sleep a little bit longer, but we try to reassure them that this is just normal and you have to just have a little bit more realistic expectations. We also have some parents who expect their kids to fall asleep at 7 o'clock by age 9 or 10. And again, we just need to reset a little bit of expectations, but in general, we expect kids of younger age to get more sleep and hopefully uninterrupted sleep.

[00:14:36] Dr. Allison Clarke: Yeah, I would agree. And certainly if kids aren't getting that, 9 to 14 hours when they're much younger, I think that we want to think through is there something else that's contributing to sleep challenges? But what we're looking at is oftentimes how is the kid functioning during the day as an indicator How is their attention during the day? Are they seeming tired? If they're in a long car ride, are they falling asleep? And those can help us to figure out, are we timing things well in order to get the kid to sleep? Rested. What are some strategies to implement effective sleep routines for kids? We often hear the term sleep hygiene, which is a vague term and overarching and everyone feels like maybe overwhelmed by what that actually means. But I think the big thing is trying to set up the environment for success, right? I think the first thing is really just establishing what is our bedtime routine. Falling asleep as a skill, just like anything else that we learn, learning how to ride a bike. And it doesn't just happen, you don't lay down and immediately fall asleep, but rather the goal of our bedtime routine is that we have three or four simple steps. Um, maybe a 20 minute process where we are gradually winding down and doing activities that are more and more geared toward relaxation and rest. So that might be things like, going to the bathroom and brushing your teeth or laying with a parent and reading a story or reading independently if they're older, maybe singing a few songs, and then, ideally, lights off and we go to bed.  It's definitely up to parent preference in terms of what they want to do. Where kids sleep and whether or not they prefer for their kids to sleep independently. But I think one of the things that's really important is if parents are wanting kids to sleep on their own or in their own rooms, one of the keys really is making sure that the environment where they fall asleep is the same that they're in if and when they wake up in the middle of the night. And so oftentimes we'll see parents say, Oh, my kid falls asleep really well at bedtime, but they still are waking up in the middle of the night. And then once we talk with them, we're learning that they may require a parent to be there at bedtime or drinking milk at bedtime. One of the things we know is that we all actually wake up in the middle of the night, it's sort of part of the natural transition from one sleep cycle to the next, and so it's really important that kids learn how to put themselves to sleep on their own at bedtime so that then when they do wake up overnight, they're able to resume sleep on their own as well.

[00:16:58] Dr. Irina Trosman: Allie is absolutely correct. This is a great advice for any family. We also need to take into account the background. One of the probably most important things is to make sure that the parents themselves follow the good sleep hygiene practices. After all, parents are the role models and if they tend to watch movies and fall asleep with TV on what are the odds that their child wants setting good example from early on and also making sure that the parents have consistency. We do not want, mom give one message and dad uses different. And that's frequent, right? If you hear from one parent, I am a good cop and my husband has a soft spot that wants to cuddle and wants to go to sleep. Making sure they're on the same page, trying to reach a compromise, having consistency among caregivers is also very important.

[00:17:40] Dr. Rob Sanchez: You emphasize some of the healthy parts to routine, right? Brushing teeth, books in some cases, and sometimes calming music can be helpful. A conversation I've had with some families and also with colleagues is the bedtime zoomies, where there just seems to be an increase in activity for some kids in the hour leading up to bedtime. It can be sometimes common that, hey, maybe that's part of the routine, but you can establish some boundaries around that. Is that a common thing that comes up, or how do you address some of those types of behaviors too?

[00:18:05] Dr. Allison Clarke: Our hope and our guidance is trying to figure out if there are potential ways that we could tweak even sometimes the timing of bedtime to better match when kids are actually naturally winding down. And sometimes the zoomies can't be a sign that kind of we're a little past that time of point of no return. Oftentimes in kids with ADHD and other neurodevelopmental conditions, it can be really hard to calm your body at bedtime. , I think sometimes parents are like, okay, yeah, let's get out, pull the energy, and maybe you'll go to sleep. What we try to do is ideally Move that rough and tumble play and active play a little earlier in the day, meet some of those sensory needs, and then ideally trying, if we can, to limit engagement and interaction in those activities as part of bedtime. And, guide kids towards, again, they might not have the skill set, but like, these are the three or four behaviors we can engage in if our body is feeling antsy. So it might be, grabbing a really heavy blanket or snuggling a stuffed animal or listening to something relaxing or doing yoga so that they can get that physical interaction, but in a way that gears them down rather than impinging them up.

[00:19:14] Dr. Rob Sanchez: With these sleep challenges that need more medical expertise to diagnose and treat, that's where the work that you do in the Sleep Medicine Center can really play an important role. Can you tell me about the conditions that the team treats and focuses on?

[00:19:27] Dr. Irina Trosman: By the time kids come to us, usually the parents already tried certain approaches recommended by primary care, so we probably see a little bit more extreme cases, the ones that don't respond to basic interventions And if we talk about relatively healthy children, not children with very significant, considerable comorbid or other impairments. Medical conditions that certainly can impact sleep. In general, what we see are probably difficulty falling or staying asleep, which you call it insomnia. We see kids who have, on the contrary, excessive sleepiness, whether or not because they're not getting enough sleep or getting sleep at the wrong time, or their sleep is broken, or maybe they're getting enough sleep and yet sleepy. We see kids who have difficulty breathing. Whether or not they have pauses from gasping or snoring or just quiet pauses, but any issues during sleep that are related to breathing, we see those kids. And then we also see a smaller fraction of children who have restless leg syndrome, complaints of leg discomfort and urge to move. We also see more preemies making it too and more kids with significant medical conditions that are now making it to their childhood and that's wonderful but I think the challenges that their families are facing are unprecedented. We barely have experience with certain genetic conditions because there may be a handful of them in the whole world and we sympathize with these families and we try to help them but it's not uncommon for us to see unique patients or patients who, again, have significant considerable medical conditions that impact their sleep and we try to work with other specialists trying to maximize our collaboration, trying to make it more of a team effort to help us. We frequently collaborate with neurologists, ear, nose, and throat doctors, psychologists, psychiatrists, trying to make it more of a multi-layer approach.

[00:21:02] Dr. Rob Sanchez: So what could a first visit to the center look like for a family? And how do you make it a child friendly environment?

[00:21:07] Dr. Irina Trosman: One of the advantages that we have almost an hour allocated for the first visit. There are so many dimensions that can impact sleep, and we try to take a very comprehensive history and do a good exam.We do have questionnaires that parents have a chance to fill in ahead of time, and if we find any red flags, we at least attempt to cater to this. If the child has sensory needs, we may end up waiting for the very end to do a physical exam or try to adapt to that. The best strategies that parents at a past notice work for their child, for instance, some kids prefer to be examined specifically while the parents are holding them, or maybe defer ear exam because they've been traumatized by previous ear exams. So definitely those things could be taken into account, especially if parents don't give us a heads up. We appreciate other caregivers' feedback. The other day, I had a family that put the phone the daytime care provider from daycare who gave me a little bit of a rundown on how this child takes naps in daycare in a different setting. It's super helpful if parents bring the little video clips. Sometimes we can diagnose sleep apnea just basically looking at the video. And so it's like a mini sleep test. So we try to be understanding and of course if there are any cultural preferences we certainly try to accommodate. As far as being family friendly, I think all Lurie Children's Clinics are very child friendly.if kids are really nervous we can meet with them and I will walk them through what to expect and sort of build in social stories around the sleep study and even mail them some of the equipment so that they can practice with the stickers and the wires ahead of time.

[00:22:33] Dr. Rob Sanchez: What are some of the innovative treatments or technologies in sleep medicine that kids are benefiting from these days, especially at your site of work?

[00:22:41] Dr. Allison Clarke: One of the things we're really excited about is myself and Maria Gonzalez, one of our nurse practitioners, who started a multidisciplinary pap clinic. So for kids with CPAP and BiPAP, which is basically a machine, a mask and a machine that kids with sleep apnea who can't be treated with other surgeries and other strategies may recommend that they use a mask for sleep. And these masks I mean, some people liken it to, like, having a window down on the highway while you're driving. The air is really rushing at your face and it's difficult for even grown ups or adults to get used to the masks and equipment. But one of the things that we've done is we've established monthly clinics where myself and Maria Gonzalez and then Tiffany St. James, another provider, meet with each of the families. And really practice using the devices together and establish what we refer to as graduated desensitization. They're really gradually getting used to the equipment and then practicing on a day to day basis so that we can help them get used to the equipment in a way that's really reaffirming. We do a lot, we've got stickers and little trophies and mass logs that they can earn, which I think families have been really receptive to. And then we've actually developed a one to three month follow up phase. And then as they're doing better, we phase it out. So I think this has been a really nice way to capture those families. Most struggle with the device and now we have a little more of a structured way to support them.

[00:24:05] Dr. Irina Trosman: I think another unique feature is that Allie and I sometimes team together and do combined visits via telemedicine. So, If I see a child who probably will benefit from behavioral interventions and cognitive behavioral therapy, and Allie sees this patient, then we regroup three to four months later for this follow up together, so we can minimized amount of time, parents brainstorm together with the family and also minimize amount of time the families are seeing different providers because it could be quite cumbersome. And another unique feature of our program is that our ear, nose, and throat doctors are qualified to implant a device for children with Down syndrome that allows them to breathe. It's an alternative to pap therapy and it's called Inspire. Very few centers in the city do it and the Down syndrome patient population is unique and very dear to us, and sometimes it's very difficult for these kids, despite our best efforts to tolerate pap therapy, they have sleep apnea, and this device is a nice alternative. I'm very proud of our ear, nose, and throat colleagues that they're now skilled to do that, and we work very closely, and again, do this kind of combined visits where ear, nose, and throat doctor, myself, and the inspired representative are all in the same room, helping the family along this process.

[00:25:13] Dr. Rob Sanchez: That's tremendous. And it's great that you mentioned that because I know that in our division, we had a presentation from them talking about referring our families of children with Down syndrome and making sure they take advantage of this. it's a wonderful innovation, but it also speaks to the, all the great aspects of the care that you provide in the sleep center,

[00:25:29] Dr. Irina Trosman: Absolutely, one of the best parts, not only working with these amazing families, but also working with amazing colleagues and being able to collaborate and help families together and respecting their time and needs and it's very gratifying.

[00:25:43] Dr. Rob Sanchez: Thank you so much for the work that you're doing in that area. We've talked about some of the complex stuff. We talked about some of the other aspects to sleep but there's a lot of truths and myths about kids and sleep that are out there. So I wanted to take a little bit of time during the episode to talk about it a little bit. So we'll throw some truths or myths out there and then we'll get your take. all right, so the first one I have, all right, truth or myth, you can quote unquote catch up on sleep. What do you say?

[00:26:08] Dr. Irina Trosman: Partially

[00:26:09] Dr. Rob Sanchez: Okay. Okay.

[00:26:10] Dr. Allison Clarke: Was going to go with myth, so we'll see if we agree. Yeah,

[00:26:14] Dr. Irina Trosman: You can catch up on a little bit of sleep, but it takes time to recover and you cannot pay the debt in one, like right away. Probably one of the most amazing experiments that was done in the 60s where there was a competition among 17 year olds how long they can stay awake. And one of them engaged his two friends into this and remained awake for almost I believe 10 days. And then he was hospitalized with almost like dementia like symptoms and slept for 3 days. in a row. So clearly didn't stay asleep for 10 days to recover sleep debt.And that was probably the most extreme case. And that's where he was hospitalized at Stanford and the father of sleep medicine, Dr. William DeMint, documented findings. But what we see that chronically deprived patients take time to recover from sleep debt.. You can't just compensate with one nap. The reason I said it's partially true or partially false is because there is some recovery.

[00:27:01] Dr. Allison Clarke: Right. You could miss one night of sleep. That's

[00:27:04] Dr. Irina Trosman: Right, or right. And the truth is it is a coping mechanism for many parents who take care of sleep deprived kids. So to say that it's not true, probably not the case.That's what allows them to survive. But is it optimal? No.

[00:27:15] Dr. Rob Sanchez: Yeah, Allie, is that kind of your

[00:27:16] Dr. Allison Clarke: Yeah, I was just going to add one or two bad nights of sleep with finals. Not gonna ruin you, although often it can result in illness and other things suggesting that there is some impact, but it's more the prolonged sleep loss that's hard to recover from.

[00:27:30] Dr. Rob Sanchez: That makes total sense. Okay. Next truth or myth. Naps are bad for older kids and teens. What do you think?

[00:27:36] Dr. Irina Trosman: Probably because very frequently they impact their ability to fall asleep in the evening and that resets the whole clock as we spoke early and discussed it. It makes it harder. Again, it's true for our culture, it's probably not true for many Mediterranean cultures where siesta is acceptable

[00:27:52] Dr. Allison Clarke: Right, I've seen in Spain, I think the school structure allows for it. It's hard just in our culture where there's a very early school start time and that's not part of our kind of day to day timing.

[00:28:04] Dr. Irina Trosman: And if they have to take a nap, try to limit it to a very short nap, like a cat nap, not to descend to deep sleep. where they will have hard time waking up from, they will feel groggy, what we call sleep inertia, this grogging is waking up from deep sleep and it certainly will reset their time, the evening bedtime or in most cases

[00:28:19] Dr. Allison Clarke: Yeah. So that's like 15 minutes, which is really hard to do. Aim for that 15 to 20 minutes.

[00:28:24] Dr. Rob Sanchez: Next truth or myth. All right. It's okay to have different sleep schedules during summer break versus during the school year. What do you think?

[00:28:31] Dr. Allison Clarke: I will start by saying sort of truth to that. I think that oftentimes teens especially will feel like they're sleeping more of on their natural circadian rhythm where they prefer to go to bed late and to wake up later over summer. And if their schedule allows, that's not necessarily a bad thing. But the important part about it is not just suddenly waiting until the day before school to reset your sleep schedule. It's really thinking through, maybe even depending on how distinct it is from your kind of academic schedule, like even a month prior, really starting to slowly shift the schedule back closer to that school start time so that they're not in a shock state when they get back to school.

[00:29:10] Dr. Irina Trosman: Yeah, I'm trying to be pragmatic. If I were to say that this is super important to have a consistent schedule, it's probably true, but nobody's going to follow that. And then with the long daylights, especially in the summer, it's probably not realistic. We compromise. We say, don't go too extreme and then transition back to the school stage. Schedule a little bit ahead of time to allow time to transition and so start gradually kinda shifting schedule.

[00:29:32] Dr. Rob Sanchez: As you're shifting the schedule as a common approach, just set an alarm to wake up a little earlier, try and avoid those naps during the day, and then try and get back to a little bit earlier bedtime.

[00:29:40] Dr. Irina Trosman: Yes. And um, Summertime is also travel time and a lot of times that interferes with this. But assuming they have about two weeks, I usually say be gentle and. gradually 15 20 minutes increments, start waking up early, not so much trying to put them to bed a little early because that kind of naturally should follow, but rather waking up a little bit early, exposing to a lot of lights, getting them out of bed, and then starting that time routine a little bit early, hoping that they will get sleepy a little bit early, but not forcing, not super focused on like fall asleep because that can set the opposite effect,

[00:30:10] Dr. Rob Sanchez: Truth or myth, sleep problems are common in youth with asthma.

[00:30:13] Dr. Irina Trosman: Absolutely. Especially if asthma is not well controlled. So I think two major aspects, a, just sleep disruption from cough and difficulty breathing and need for nebulizer treatments or inhalers, especially albuterol and steroid medications or admissions to the hospital, emergency room visits, all of that could be very disruptive to sleep. And the second aspect is inflammation. There have been very good studies showing that inflammation from asthma extends all the way to upper airways. So children with asthma are at high risk of having sleep apnea, and not to forget that asthma frequently coexists with allergies and nasal congestion, and so if that's untreated, all of that increases the chances of having difficulties breathing through the nasal passages. Notes I'm creating a setup for sleep apnea, so two conditions frequently coexist, but we're not talking about well controlled asthma, that's probably a different story.

[00:30:59] Dr. Rob Sanchez: Last truth or myth. This one might be a little bit of a hot topic. And it's about melatonin. So, Truth or myth, a nightly melatonin gummy is okay for children. What do you think?

[00:31:08] Dr. Irina Trosman: The short answer is no. So just very briefly to give you an overview, melatonin is widely available in various preparations that are loosely DA regulated. So we have to remember that what is on the label is not necessarily reflecting the accurate amount of melatonin placed in the preparation. And different countries have different melatonin use the truth is there are still a lot of unknowns about melatonin and there's definitely a place for melatonin to be used in patients who travel across time zones, for those who work shifts, or for certain kids populations who have, children population that have significant struggle with sleeping, but we prefer to use melatonin. Either because these kids have low melatonin levels or at least based on some limited studies like kids with autism or kids who struggle with sleep so much that melatonin seems to be least of an evil if we tried all the behavioral interventions and now thinking about medications versus melatonin. It's not true that we don't use it and I find that there is a place and time for it but we need to be careful, and if you are considering giving your child melatonin, you better ask your pediatrician and make sure that there is a thorough evaluation. Why does your child need melatonin? Could it be something else going on? Could it be addressed with non melatonin?And if there is a need for melatonin, how much is relatively safe to use and how frequently?

[00:32:19] Dr. Allison Clarke: Yeah. The only thing I would add is that I also see it sometimes not being, it's what parents view as maybe the safer option for, like, a medication for sleep. I've seen families come in with kids who are waking up in the middle of the night who are taking melatonin, and the way we understand it, it usually helps more with kind of that initial sleep inertia versus more sustained sleep. So just thinking through, I agree with Dr. Trostman to definitely talk with the pediatrician before initiating it because there might be things that are more effective or more helpful for sleep.

[00:32:50] Dr. Rob Sanchez: Absolutely. No. And that's really helpful to know, to be mindful of these things, to know that, yes, it could be something that's considered, but there might be other interventions that you could be doing that might be more helpful too. Thank you for your thoughts on those. Thank you for your thoughts on all of those truths and myths, but especially that one. It's always helpful to get, better understanding of something as complex as sleep and how we approach it. wanted to see if you had one piece of advice for our listeners, for parents who might be listening to this and thinking about how they can improve their child's sleep even later this evening. So what might be one piece of advice that you have for parents, to improve their child's sleep, starting tonight?

[00:33:25] Dr. Irina Trosman: Be good sleep models. Follow through yourself good sleep hygiene and good practices and the kids will mostly follow that.

[00:33:32] Dr. Rob Sanchez: That's huge,

[00:33:33] Dr. Allison Clarke: I think in a similar vein, kids are gonna feed off of whatever parents are feeling at bedtime and it can be really stressful. I will admit myself that I'm not always my best. Self at bedtime. But um, the more that parents can think about the goal of the bedtime routine being to help their kid feel calm and relaxed in bed, versus getting them to sleep at all costs um, can really help the kid to learn and associate bedtime with relaxation and rest.

[00:34:00] Dr. Rob Sanchez: Definitely really important stuff to keep in mind and how we approach it for our kids, but also how we take care of it ourselves . Irina, Ali, thank you so much for taking the time and for sharing such great advice for our listeners and for parents.Thank you so much.

[00:34:12] Dr. Irina Trosman: Thank you for having us. We appreciate

[00:34:14] Dr. Allison Clarke: Thanks so much for having us.

[00:34:15] Dr. Rob Sanchez: Thanks for listening to Kids Wellness Matters.

[00:34:19] Dr. Nina Alfieri: For more information on this episode and all things kids wellness, please visit LurieChildrens.org