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New Classes

Learn about sleep - It's more important than you think!

Monthly at
Cooley Dickinson Hospital
Center for Midwifery Care
in Northampton, MA

Sleep for Expectant Parents
April 18, 2015 (1 - 3 p.m.)
Sleep in the First Year
April 11, 2015 (10 a.m. - Noon)

Contact me at 413.348.6273 or beth@sleepandparenting.com to register.

Beth's Blog

Wednesday
Oct072015

Q and A About Sleep, Daylight, and Time Changes Too!

1. What is the connection between daylight and sleep? Why is it important to put young children to sleep shortly after dark?

 Most folks are not aware that sleep is governed by biological processes in our brains, just like our respiratory, cardiovascular, and hormonal systems.  One of those processes is our circadian rhythms, also known as our biological clock.  This “clock” follows the natural rhythms of the day, which were easy to recognize before electric light because, as diurnal creatures, we simply went to sleep when it got dark and woke up when it got light. 

The hormone melatonin has much to do with this process.  The brain is programmed to secrete melatonin as daylight decreases to bring on sleep.  During the day, sunlight suppresses the release of melatonin.  Unfortunately, room light and, even more, so the blue light from electronic devices) also suppress it. Having a regular sleep schedule goes a long ways toward helping the brain know to release melatonin just before your bedtime.

 For young children, whose need for sleep is great, it is essential that parents help them get in sync with their natural circadian rhythms.  Darkness is a true asset.  Staying up later after dark isn’t wrong per se, if a child would just sleep late in the morning.  But generally our biological clocks (and this is more true for children) do still run on our natural rhythms (responding to light and dark), so when daylight arrives, children typically wake up.  Not until circadian rhythms shift in adolescence do children start sleeping later in the morning.  As a result, bedtime routines and regular bedtimes in conjunction with the arrival of night are very important to “cue” the brain to release melatonin to bring on sleep.  In other words, going to bed when darkness comes gives children the best opportunity to get the amount of sleep they need. 

2. Should parents shift bed time and nap time back an hour to reflect the time change? What happens if they don't shift bed time with the time change?

In the fall, shifting daily schedules can help a baby or child adjust to the time change.  There are a number of ways to approach this:      

   a) One technique is to start naps ½ hour earlier.  Because naps will probably end earlier, you can make bedtime ½ hour earlier as well.  A young baby who naps twice a day may even need a 5 p.m. bedtime in the transition.  For children who don’t nap, simply adjust the bedtime earlier (perhaps by ¼ or ½ hour increments during the transition).

   b) Another strategy is to be proactive: begin moving the bedtime earlier by 15 minutes a night for the 3 or 4 nights prior to the time change.

  c) Yet another approach is to just go with the new time and don’t put your child to sleep earlier.  In this case, you may have to stretch her to the normal naptime and bedtime.  You can do this by giving her a bath or playing active games such as “The Hokey Pokey.”  For older children, you may need to bear with the crankiness as you try to stretch them to the new bedtime (which is actually, by the hours of the clock an hour after their usual bedtime).

Remember, however, that no matter how you approach it, everyone will adjust within a week or two!

3. Which age groups are most affected by the time change? 

 Everyone is affected, adults and children alike.  Yet the younger you are, the more sleep you need (newborns: 16 to 18 hours in 24 hours; infants and toddlers: 11 to 15 hours in 24 hours), and the more you will be affected by lack of sleep associated with the time change.

4. What are 5 tips for helping children adjust to the schedule changes?

   1)   If the child is very sensitive to changes and doesn’t “roll” easily with lack of sleep, adjust her schedule earlier to help her with the transition.

  2)   If the child generally does well with change and isn’t much affected by a little sleep loss, try to keep her involved and entertained to make it to the “new” nap and bedtimes.

  3)   Early waking as a result of the time change can be hard, so be sure to darken, darken the room!

  4)   Expect behavior to be affected.  Make your life and theirs easier by not overscheduling the days around the transition.  Give lots of down time!

  5)   Remember it will take a little while, but not forever!  For older children, it can take about a week.  For younger, it can take a week and a half or two.  So parents need to go to bed earlier too.  Best advice is to relax; this too shall pass!

5. How would you explain to a child who's old enough to know that 8 p.m. means bed time that they now have to go to sleep at 7 p.m.?

Using ¼ or ½ hour increments to make bedtime earlier may not seem as harsh in the transition.  Be proactive and let them know your plan.  Giving a little information about sleep and the brain can be wonderful too!  Contact me for handouts that give basic information about sleep for children.  Let them know that getting enough sleep means they are able to learn better, think more clearly and do better at sports and other activities.

6. Is there anything else about daylight savings and sleep schedule changes that is important to know?

The spring time change is easier and no real adjustments need to be made.  It does, however, provide some great opportunities.  If you were looking to set bedtime earlier, this is a perfect time to make that change.  And if you are dealing with an early riser, they most likely will begin to sleep later naturally.  Hurrah!

Friday
Mar272015

Sleep Training at 8 Weeks? Absolutely Not! Why This Recommendation is Wrong and Other Myths About Infant Sleep

When human infants are born, in essence they are still gestating.  Their nervous systems are immature, their brains minimally developed, and they are completely dependent on their parents for survival.  Their neurological development continues at an almost exponential rate, yet it takes until 3 months before these infants are truly “born to the world.”  At last parents see those smiles, as their little ones begin to respond to their environment and to their parents who have survived a world of sleep deprivation caring for them during all that time!

This reality came to mind as I read a New York Times blog post today about the recommendation by Tribeca Pediatrics to sleep train 8 week old infants by leaving them at 7 p.m., only returning to them at 7 a.m. the following morning.  As a family sleep consultant, I was stunned when I first heard about this advice from clients who receive their pediatric care from Tribeca.  Stunned because it implies that infants do not need care and soothing from their parents during the night. 

Leaving an infant alone for that length of time runs counter to everything experts in human development know about the critical connection between infants and their parents.  An infant’s developing brain is significantly influenced by the back and forth interaction between her and her parents or caregivers, and parental response to her cries is the earliest such interaction.1  From birth to 3 months, infants must grow to feel loved, cared for, and secure in their world.  Without this bond, healthy development does not occur. 2 

Recommending sleep training at such an early age also implies the mistaken belief that an infant’s cries are intentional.  Research makes a clear distinction between cries in the first three months of life and cries after the major developmental changes that occur between 3 and 4 months of age.3, 4

Moreover, this recommendation propagates another myth: that a young infant can regularly sleep for 12 hours a night.  “Is your baby sleeping through the night?” generally is the first question asked of new parents in the United States.  It is a cruel question, given the lack of sleep these parents are experiencing and their newborns’ total lack of mature circadian rhythms.  Without an internal biological clock, infants’ brains do not distinguish between day and night and they cannot be expected to sleep a prolonged period of time at night.

Prior to 3 months of age, a baby’s sleep patterns are primarily influenced by biological factors and are not under her or her parents’ control.  In other words, parents must take their cues from and follow their baby’s schedule.5, 6 But not for long, because once a baby is 3 months old, parents can begin to introduce strategies that will “nudge” their little one toward becoming more independent with sleep.

An important piece of sleep knowledge is that both going to sleep and staying asleep are learned behaviors.  Most babies and children will need their parents to help them learn this skill.  And by 4 months of age, parents can embark on some gentle sleep coaching methods. 

Parents are generally averse to leaving an 8 week old baby (and very often even older babies) to cry unattended for hours at a time.  What feels so wrong to many parents is in fact wrong.  Yet eventually, it is important to help a baby learn to sustain sleep.  Parents cannot go on for much longer than three or four months without good sleep.  Babies will be able to sleep better with sustained sleep.  Families and relationships will all benefit from everyone getting better sleep.  And there are ways to help a baby learn to sustain sleep without leaving her alone to cry. 

Unfortunately, recommendations such as those given out by Tribeca Pediatrics ignore the clear evidence from the literature and are often based on the pediatrician’s own cultural beliefs and values.7, 8 I am deeply sympathetic to parents who have to navigate the many contradictory points of view found in the media and often in their own pediatric practices!

Citations:

1 “The cultural study of infant development and parenting might be beneficially understood in a framework of necessary versus desirable demands. A necessary demand is that infants and parents communicate with one another. Normal interaction and children’s healthy mental and socioemotional development depend on it.” Bornstein, M. H. (2002). Parenting infants. In M. H. Bornstein (Ed.), Handbook of parenting (2nd ed., pp. 3–43). Mahwah, NJ: Erlbaum

2“Babies' brains expect that they will experience nearly constant physical touch, rocking and cuddling: without it, they just don't grow.”  www.zerotothree.org

3“…excessive crying is primarily an honest signal of need, namely, to elicit additional parental resources and attention to modulate the behavioral state.”   Oskar Jenni. 2004.

4“Sleep-wake processes play a key role in early infant crying,” Behavioral and Brain Sciences, 27, 464-465.

5“From 0 to 3 months of age, it is difficult to separate sleep and excessive cry/fuss problems because the architecture of sleep at this age is less established and the two behaviors are so closely linked.”  Jordana Bayer et al. 2007. “Sleep problems in young infants and maternal mental and physical health,” Journal of Paediatrics and Child Health, 43, 66-73.

6“The decrease in crying with increasing age is due to the development of controlling mechanisms in the nervous system that permit inhibition of excessive arousal as well as… sustained sleep…  Responding to the babies’ crying with soothing efforts during this period seems to be helpful to both parents and their babies…and does not seem to cause more crying, unless it is intrusive, but, in fact, may result in less crying in subsequent months.”  Remarks by Arthur Parmelee, M.D. on receiving the 1975 C. Anderson Aldrich Child Development Award from the American Academy of Pediatrics

7“Differences in sleep patterns as a function of development add to the complexity of understanding sleep biology in children.”  Oskar Jenni and Bonnie O’Connor. 2005. “Children’s Sleep: An Interplay Between Culture and Biology,” Pediatrics, S115, 204-216

8“Many pediatricians…lack sound training in developmental and behavioral pediatrics, and thus their advice is largely based on their own cultural values and beliefs (many of which may be operating out of their own direct awareness) in interaction with their personal and clinical experience.”  Oskar Jenni and Bonnie O’Connor. 2005. “Children’s Sleep: An Interplay Between Culture and Biology,” Pediatrics, S115, 204-216

Wednesday
Sep032014

Later school start times for teens! Yes!

A new school year has begun and teens across the country are dragging themselves (or being dragged by parents…) out of bed long before they’ve gotten the 9 to 10 hours of sleep they need.  It is little comfort for them that the long-awaited recommendation from the American Academy of Pediatrics for middle and high school start times to be no earlier than 8:30 a.m. has just been published.

As someone who studies and speaks about sleep locally and around the country, I am aware of the widespread sleep deprivation among babies, children, teenagers, and adults in our culture today.  Economic pressures on families that result in two parents working outside of the home, social pressures for children to be involved in activities late in the day, and the 24/7 use of electronic devices have created a world in which we either struggle to get the rest we need or devalue sleep altogether. 

Researchers in the field of adolescent sleep have been advocating for later high school start times for more than a decade.  The research of Mary Carskadon (Brown University) documents changes in the adolescent brain that cause a shift in circadian rhythms.  This shift means that teens, in comparison to younger children, do not get sleepy or fall asleep until much later in the evening compared to younger children.  Teens, however, still require 9 to 10 hours of sleep a night.  This phenomenon and the added activities and responsibilities taken on in the teen years (such as after school jobs, more homework and athletic practices) lead to what Dr. Carskadon describes as a “perfect storm” in the lives of teenagers.

This “perfect storm” is causing an epidemic of sleep-deprived adolescents, right at the time when they are being asked to perform at their very best levels, both in academic and extra-curricular activities in preparation for college, athletic pursuits, and adulthood.  Because sleep deprivation greatly impairs our nervous systems, it hampers teens’ abilities to be alert, pay attention, solve problems, retain information and cope with stress.  Not a recipe for success, to be sure!

When school systems delay their start times, there are immediate results.  Students are more alert in classes, improve their grades, perform better in sports, have better attendance rates, have less depression and, as noted by parents, are friendlier, happier, and more relaxed.  In addition, 1) teens gained one hour of sleep each night because their bedtimes didn’t change despite school starting later and 2) they were able to complete more of their homework during school hours because they were more alert and able to be more efficient with their time.

Communities generally have a complex reaction to this recommendation.  The seriousness of the situation can become lost in the discussion about changing bus schedules and family routines.  Change is hard, but it may be helpful to remember that before communities began to bus children to school, schools began around the time recommended. 

It is essential to help communities better understand the need for this change. The general public needs to know how critical sleep is for development (from infancy to adolescence), how much it impacts our overall health and ability to successfully manage the “ups and downs” of daily life, and its significant role in memory and learning.   I urge you to join me in supporting later school start times for our teens!

Friday
Jun212013

"Sleeping Through the Night"

One of the most difficult sleep issues facing young parents is babies and children waking in the night.  For most of the first 4 months of life, babies have not developed the mature sleep rhythms which allow them to sustain sleep for a long period at night.  After six months of age, however, it is reasonable for parents to expect that their babies would be able to stay asleep for most of the night.   Unfortunately, sustaining sleep at night is a learned behavior, and most babies need their parents’ help to develop this skill.  Let’s look closer at this very common but trying dilemma.   

Why do babies and children wake in the night?  Babies and children usually awaken as they come out of deep sleep into an “arousal.”  All human beings (adults and children) have arousals during sleep.  They occur as we cycle through stages of sleep and can happen every hour and a half to two hours or more frequently. 

When you are in deep sleep or if you are a very good sleeper, you may not even be aware of these arousals.  However, if you are a light sleeper (and almost all new moms fall into this category), you may awaken during these arousals, especially in the second half of the night.  All who struggle with sleep must learn to go back to sleep when this happens.  Babies or children usually need their parents help to do so.

Why are there babies and children who wake in the night and those who don’t wake or wake less often?  The answer generally lies in two realms.  The first is that of a child’s individual style.   Sensitive or “intense” children more often need their parents’ help in settling or soothing to sleep.  The second is related to sleep associations.  Everyone has these associations: they are the things or behaviors present when we fall asleep. 

Adults have routines which include sleep associations.  Examples of such routines are: 1) change into pajamas/brush teeth/read in bed/close the bedroom door halfway/sleep on back or 2) take a shower/change into pajamas/turn off light/sleep on stomach.

Sleep associations for children usually fall into two categories: 1) something that a baby or child does or needs to do to fall asleep on her own or 2) something that a parent or another adult does or provides to help a baby or child to fall asleep. 

Associations that depend on an adult are essential and appropriate in the first months of life, but become less helpful as babies mature.  Sensitive or “intense” children are more likely to develop sleep associations involving a parent to bring about sleep. 

The following are examples of common sleep associations. 

ASSOCIATIONS THAT HELP BABIES/CHILDREN FALL ASLEEP ON THEIR OWN:

·        Sleeping in a certain position (once they can find those positions on their own)

·        Sleeping with a favorite object

·        Sleeping with lights off

·        Sleeping with door closed

·        Sleeping with a fan or sound machine

ASSOCIATIONS THAT REQUIRE A PARENT’S OR ANOTHER ADULT’S HELP:

·        Nursing or drinking from a bottle to fall deeply asleep

·        Being rocked until deeply asleep

·        Being sung to or cuddled until deeply asleep

·        Having music playing until deeply asleep

Studies consistently find that babies and children who learn to soothe themselves to sleep because they are put to sleep awake or drowsy, sleep better than those who are put to bed already asleep.  Sleeping “better” refers to being able to sustain sleep through arousals and thus, reaping the benefits of healthy sleep. Growth hormone is released during sleep, stimulating tissue growth and repair.  Sleep is also crucial for brain development, for the consolidation of knowledge, and for overall good health.

How does one help a baby or child learn to self-soothe? Research supports both the “camping out” method (in which the parent remains in the room until the child falls asleep) and the “checking in” method (in which the parent puts a child to bed awake and returns at regular intervals for reassurance and comfort) as effective and safe for teaching a baby or a child to fall asleep and stay asleep on her own. 

Both methods are based on a baby or child developing self-soothing abilities.  With these new skills, she will no longer need the sleep associations that require her parent’s or another adult’s assistance to fall asleep.  The associations that allow her to fall asleep and stay asleep on her own will enable her to sustain her sleep throughout the night.  She will no longer need a parent’s or another adult’s help to go back to sleep during the normal arousals in the night. 

Every parent approaches the work of helping a baby or child learn self-soothing skills in an individual manner.  Every baby or child and parent will respond differently to the process.  There are many variations of the methods described above.  Developing a plan that honors these differences and “feels” right to a parent is the basis of my work.

Monday
Jan282013

New Moms and Sleep

Caring for a new baby is one of the most challenging experiences adults can face, yet it is also an experience that most parents say they wouldn't trade for anything in the world.  It can be awe-inspiring, but it also can be overwhelming.  Every month at the sleep classes I teach for new parents, I am impressed by both the fortitude of these new moms and dads as well as their level of exhaustion.

When preparing for the arrival of a new baby, family and friends help with the gathering of necessary supplies such as clothing, diapers, cribs, carseats, swings, blankets, and more.  Parents focus on being prepared for the birth experience, but very few think to prepare for how to manage caring for the baby at home when sleep deprivation will make everything about this new venture even more daunting. 

So what can new parents do?  How can those around them help?   Some suggestions follow:

#1 Make sleep a priority both for mom and for her baby.

Caring for a newborn implies sleep deprivation. The tiny size of infants means they must be fed around the clock. Babies are born without mature sleep patterns (which can take until 4 to 6 months to develop) and, as a result, do not know day from night. So it is essential that moms sleep when their infants are sleeping.

This is often difficult because a tendency is to try to get household chores done, make phone calls or catch up with email. The best advice is to let the chores go and ask for help if you just can't stand a messy house or dirty dishes. If there is an older child try to get sleep when the child is at school, or when he/she takes a nap. Ask for help from relatives, neighbors, and friends.

Another reason to make sleep a priority is that sleep deprivation is a major factor in the development of post-partum depression. Hormonal changes responsible for disrupting sleep during pregnancy continue in the first weeks after birth. So even the "new baby blues" may be simply the result of lack of sleep.

#2  Begin to establish healthy sleep habits for your baby

Even though an infant can't be expected to follow a schedule or sleep through the night, moms can help babies develop healthy sleep habits by making sure their baby doesn't get overtired. Babies up to 2 months of age should go back to sleep after only 1½ to 2 hours of waking.

#3 Help babies develop self-soothing skills

Ignore baby's normal sounds during sleep (babies are not consistently quiet sleepers). Babies move about or rustle, whimper, and may even briefly cry during sleep. When parents rush in to get their babies, babies don't have the opportunity to experience going back to sleep following the normal arousals that interrupt sleep for us all.

Practice putting babies down to sleep drowsy in the early weeks. For moms this offers the opportunity for her partner to put the baby down. (As with all strategies, some babies will respond well; others will continue to need mom or to need to be asleep before being put down.)

The good news is that all babies can learn to sleep. The first step involves helping new moms hold back the influences of the busy world around them so that they get the rest they need. Friends and family must work with them to create a haven in which they can nurture the elements of healthy sleep: regularity, consistency and a slower pace. We will all benefit from joining them in this important effort.