November 4, 2022
Cindy Lopez:
Welcome. My name is Cindy Lopez, the host of this CHC podcast, Voices of Compassion. We hope you find a little courage, feel connected and experience compassion every time you listen. Today’s episode is proudly sponsored by Adobe and we’re so thankful for their support. Today, we’re talking about sleep. We all need it, and it seems that most of us don’t get enough of it. Sleep affects not only our physical health, but also our mental health. Did you know that the American Academy of Pediatrics recommends 9 to 12 hours of sleep a night for younger kids? We know it’s difficult to get adequate sleep when there’s always so much to be done. From schoolwork to sports to clubs and even screens. In this episode, we talk with CHC experts, Eric Loughhead, Licensed Marriage and Family Therapist, and Jensi Gise, Doctoral Psychology Intern, who both worked with teens in our Rise Intensive Outpatient Program. Listen as they share their expertise and insights on this important topic. Welcome Eric and Jensi.
Jensi Gise, MA:
Thank you.
Eric Loughhead, LMFT:
Yeah, Thank you. I’m Eric Loughhead, I’m a marriage and family therapist. Worked at CHC for quite some time. I’ve worked with the Esther B. Clark School and currently with the Rise IOP Program. Sleep is a significant part of work in both the school and the IOP setting, and particularly for me right now, and I have a almost three month old child. So, seeing more of these signs of lack of sleep in myself and the benefits of sleep in my little one.
Jensi Gise, MA:
Hi, I’m Jensi Gise. I am a psychology doctoral intern who’s been working at Children’s Health Council, and I’m actually coming from Atlanta, Georgia where I’ve been doing my PhD in clinical psychology at Georgia State University. I really enjoy working with kids and teens and their families with a variety of different concerns, including depression, anxiety, OCD, attention difficulties and sleep is often a common problem that we deal with. I have the opportunity now to actually work with Eric a little bit, and we certainly see how sleep impacts the teens that we work with here but thanks for having me.
Cindy Lopez:
Thank you both Jensi and Eric. So let’s talk about sleep. How does sleep affect children’s mental health?
Eric Loughhead, LMFT:
So a lot of what we’ve noticed or what the research that has shown specific to children is the impact that it has on memory consolidation. So, the hippocampus is part of the brain that is pretty important for consolidating the memories throughout the day and lack of sleep can make it so it’s very difficult to do that, essentially leaving a lot of the byproducts of synaptic responses in the brain. So it’s kind of essentially like a street that’s too dirty to drive down or maybe has too many cracks or crevices in it and when you sleep it kind of cleans that up so you can go faster down that street. It can do other things outside of what we might see as academically important. It regulates hormone chemicals that impact hunger so that when you’re really tired and you’re not sleeping, you’re eating things that maybe you wouldn’t otherwise or maybe weren’t the healthiest of choices and can most significantly I think for us impact mood. So if we are not sleeping very much, something negative happens, we would attribute it much more to that negative side, then we would otherwise. So kind of the tolerance for some things gets significantly lower.
Jensi Gise, MA:
Yeah and I think I’ll jump in here too and just say, sleep problems, especially in adolescents they tend to be associated with worse school performance. So like Eric mentioned definitely worse mood, obesity, and I think as well, like being at greater risk for traffic accidents and even sometimes substance use or alcohol use in teens. And so sleep is a problem that tends to be pretty prevalent across a variety of different mental health conditions, and so we know that it could underlie those conditions or at least contribute to worsening them. So anxiety, depression, concentrating in school, these are all consequences that could result from poor sleep in teens and kids.
Cindy Lopez:
So let’s flip that conversation around and talk about the benefits of sleep for mental health.
Eric Loughhead, LMFT:
So to focus on memory consolidation, when you sleep there’s two different parts:
there’s the REM and the non REM versions. And so one version of that is that it can kind of sweep out all the byproducts of your brain activity throughout the day. You know, your brain’s working really hard, working on whatever you’re doing, calculus or addition or English, whatnot, or even playing sports and the byproducts kind of get built up, and you’re not able to clean that while you’rethinking all those real hard thoughts and so then when you go to sleep, your brain is able to send out the cleaning crew and sweep all that stuff away that you don’t really need. So it makes it so that the synapses can fire a little faster, and also when you sleep it’s kind of like if you think about electrical cords. So you have the copper inside and you have the black on the outside, and your brains have that too. It’s called a myelin sheath that goes around the outside of the neurons, and when you sleep it helps to form that so that essentially you can fire those thoughts or whatever you’re doing at that time a lot quicker than previously.
Jensi Gise, MA:
Yeah, and I think, you know, if you’re a parent who has a child who is having difficulty sleeping or a teen who’s maybe resistant to getting a little less sleep, just sort of pointing out that some of the benefits of sleeping enough, not just sleep in general, but getting enough sleep is gonna be improved mood and improved ability to concentrate in school and function and really do well in these aspects of life that I think adolescents and kids are really motivated to want to succeed in.
Cindy Lopez:
So if a child or teen has same anxiety or depression or mood disorders, can lack of sleep cause those kinds of things or does lack of sleep just exacerbate them?
Jensi Gise, MA:
I think that one’s a little blurry. I think there’s some research that would suggest that there might be an underlying sleep problem or disorder that could certainly precede the onset of mental health conditions like anxiety, depression. Certainly though, not getting enough sleep or good sleep can worsen those mental health conditions. So I think it can be a little bit difficult to tease apart, but what we know is that it tends to be kind of interactive, especially in my work with kids and teens, sleep and other mental health problems tend to interact and so definitely getting more sleep, better sleep is going to contribute to having better mental health.
Eric Loughhead, LMFT:
Yeah I think just our biology in general sets us up for these difficult interactions because, you know, as we hit that early teen development our brains naturally push teens to want to go to sleep later. And so what parents are seeing is if a child who has been going to sleep just fine at a certain hour all of a sudden they’re not going to sleep at that same time and they’re trying to go to sleep much later, it often looks as though it’s an angsty teen who just wants to stay up and chat with friends. It may be that, it’s also the biology that’s pushing them to do these things. And so it creates that difficult interaction that I’m sure a lot of our listeners are going to acknowledge between you know, teen and parent and going to bed and going to bed on time. And it feels like there’s a lot of setup here. In Silicon Valley one of the kiddos that I work with labeled it a grind culture wherethere’s this push to get these really high GPAs and study all the time and have all these academics and other areas that they’re looking at, you know, clubs or sports, and the only time that they can take out is sleep because it starts cutting into these other activities that they want to do. So there’s, you know, the pressure from academics and drive to succeed in this area, as well as the biology that’s pushing them to go to sleep later. And the schoolsthat start earlier and earlier, it’s no longer like first period, now we’re going into zero period. So it’s all these things that are working against the teens and, you know, we’re here telling them you need to sleep in order to make these things functional. So, it is like Jensi is saying, it’s this transactional piece where it’s a very delicate balance of enough sleep and trying to fit in all these other activities and things that the families and the teens want or children want to have going for them.
Cindy Lopez:
So what would parents or caregivers be seeing as signs of lack of sleep in a child?
Jensi Gise, MA:
So it’s possible that certain types of mood problems like irritability or even seeming depressed could actually be attributed to lack of sleep. As well if your child is having difficulty in school maybe with concentration or just their school performance overall, their academic performance is declining, it could be a sign of attention difficulties or learning problems. It could also be a sign of lack of sleep. So I think that it can be kind of hard to know, but just for the parents out there who are listening, if you are noticing some changes in your child related to mood or school performance or concentration, I think it’s definitely helpful to consider how much sleep is my child getting? And so asking that question first to try to figure out might be going on.
Eric Loughhead, LMFT:
Yeah, I think ADHD is one of the diagnoses that gets thrown around a lot with this age specifically and so the things that you notice from lack of sleep are also some of the things that you would notice with potential ADHD diagnosis. So like Jensi’s saying, you know, checking on sleep is definitely one of the first steps. I would say it’s probably one of the easier steps than going down the road of ADHD diagnosis.
Cindy Lopez:
So let’s talk about how much sleep a child really needs.
Eric Loughhead, LMFT:
Yeah. that’s gonna be a spicy one cause I’m sure you know, won’t make sense given the number of hours within a day, but the recommendation for the population that we’re talking about adolescents, younger kids, is gonna be around 9 to 11 hours of sleep. There have been a lot of people who have talked about it being something that’s very significant, the lack of sleep that kids are getting or the amount that kids are able to get is nowhere near that, and I think a lot of what we’re looking at now is how to help the kids, you know, with the school start times and things like that, and there’s been research into having a later start time, a significant push to 8:30 being the earliest. And there’s been a lot of positive things that go along with that. I know there’s complications in scheduling and, you know, won’t they go to bed later and what has been seen in some of the test cases is that the kids are able to maintain that bedtime and get a significantly larger amount of sleep across the board.
Jensi Gise, MA:
What we know from more recent research is that many kids and teens say that they’re sleeping less than 8 hours a night, especially on school nights. Many of them are reporting that it takes them greater than 30 minutes to fall asleep at night. I think about half say they need more sleep and then often don’t wake up feeling refreshed like multiple days a week. So this is just kind of what we know that teens are saying across the country about sleep in general. So if you are a parent listening to this know that it’s not uncommon. It’s actually becoming more common that kids are struggling with sleep even though we know that there are consequences and such great benefits to sleeping that 9 to 11 hours per night.
Mike:
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Cindy Lopez:
So we’ve talked about sleep and the problems with sleep and the lack of sleep that kids are getting, and parents are probably sitting there listening to this and saying, “you’re preaching to the choir here, we know that our kids are not getting enough sleep.” So how can parents create an environment for their child that is conducive to adequate sleep? What does that look like?
Eric Loughhead, LMFT:
You know, we’ve had a lot of families and teens they come up with these potentially genius strategies to handle this, and they seem like they’re working for a while until they really, really don’t. And so, you know, some of the things are like taking naps or not getting sleep during the week and then trying to make up for it on the weekend and mathematically, right, it seems like it works. If I’m not sleeping at night, but then I’m getting, you know, an hour here, 30 minutes there, doesn’t that add up to the full amount? And unfortunately it does not. Your body has to go through these specific cycles in one chunk. There’s four different stages of sleep, and it has to go through those at night. You have these other chemicals like melatonin and adenosine that help you enter into those phases at the correct time. And if you’re trying to get a nap during the day, then it can throw off your circadian rhythm, which is kind of what helps you regulate those things so that your body’s thinking, okay, now I’m gonna go to sleep for eight hours, and it only gets like 30 minutes or so, or you know, an hour, two hours and so it’s not that restorative sleep that you would hope for and the weekend portion I will say sounds great. I mean, who doesn’t love, you know, sleeping in on the weekends? The only thing is that then that really throws off your Monday morning, and it creates that sleep debt, which isn’t really something you can make up. So unfortunately it is the consistent sleep schedule, andfor teens, it’s maintaining that sleep schedule through the weekend. So going to bed within a similar time period and waking up around a similar time period.
Jensi Gise, MA:
Yeah and I’ll just hop onto that cause like Eric mentioned, one of the first things that you can do is have a consistent bedtime and also a consistent wake time, and I think it’s recommended within an hour. So if your bedtime’s gonna be around 10, going to bed between 10 and 11, that one hour timeframe every night, even on the weekends is gonna be helpful for promoting that like consistently good sleep and then waking up around the same time every morning, even on the weekends. I think some other things that parents and teens can do to help themselves with sleep are having like a wind down routine that does not include screen time. So no TVs, no phones for about 30 minutes before you’re going to try to sleep and instead includes relaxing activities. So this could be like reading something that is calming or listening to soothing music or taking a bath or doing meditation. And then in terms of the actual environment that teens are sleeping in, it’s recommended that it be kind of a cooler temperature wise environment, a dark room and a quiet room. And so this can be kind of tricky I think especially living in a home with other people or animals. And so some teens or kids might need to use like a white noise machine to help buffer some of the noises that are going on, but that certainly can help.
Eric Loughhead, LMFT:
I think one of the ways to look at it is trying to use as many strategies as possible and see it as not like a perfect thing that you can achieve, but just trying these various things to see what can work because you know, like we’re saying, sleep is a very difficult thing to get that 9 to 11 hours for this particular age range. So doing what you can and not seeing it as like if I don’t do this, I’m a horrible person. With that being said, I’m gonna go into the things that we try not to do. So the bed, I know it’s very enticing to you know, if you’re reading or if you’re doing your schoolwork to hop on the bed and do it there, there’s no more comfortable space in the room, most likely than that bed and that then impacts the sleep because it’s associated with these other activities, and the bed is most ideally associated with sleep. So if possible, doing those other activities at a desk or at another room so that the bed can be, you know, this holy shrine to sleep.
Jensi Gise, MA:
Absolutely. I’m gonna just jump in there real quick ccause I completely agree. Avoid like worrying on your bed, avoid playing on your bed, studying, working, social interactions on your bed, all of those things. We know that then your bed becomes associated with those things that you do when you’re awake and we want it to become associated with sleeping.
Cindy Lopez:
Mm-hmm. Yeah. So some of our listeners are probably thinking, well, what you’re talking about sounds doable for a lot of other kids, but maybe not my kid, especially if a child or a teen is fairly dysregulated. So can you talk about that a little bit? Would there be different kinds of strategies or what advice would you have for parents whose child is more dysregulated and really struggling with sleep?
Jensi Gise, MA:
Eric kind of already mentioned this a little bit, I think there are a lot of strategies to help your child get better sleep, and it can seem really overwhelming to try to do them all at once. So I think the first thing is to Eric’s point, you know, maybe try one or two and incorporate one or two strategies into your and your kids’ routine over time, rather than trying to change everything about the daily routine and the bedtime routine all at once cause that’s gonna feel really difficult. Some other things as a parent you can really model bedtime behavior and good sleep behavior by going to bed yourself at a consistent time which is hard, right? Like I’m not saying that I do this at all, but you know, also reducing your work and your screen time before bed, having a wind down routine yourself. And then for really dysregulated kids, I think some of the other strategies, getting daily exercise can be really important when it comes to getting good sleep at night, especially for kids who have a lot of energy, excess energy, anxiety, etc. So focusing on how do you get your kid out of the house outside and exercising for, you know, half an hour a day. And then diet is also important as well that can also contribute to better sleep.
There are programs for younger children that have been helpful for sleep. So there’s the Bedtime Pass Program if you’re a parent listening, you can Google that. It’s for younger children, but it helps them to go to sleep on their own and kind of reduce the struggle around bedtime. Dawn Huebner also wrote a book that’s called What to Do When You Dread Your Bed, and it has really practical tips for reducing bedtime fears or dread in a way that’s fun and engaging for kids. So those are just a couple of resources that are available out in the internet world that can be helpful.
Eric Loughhead, LMFT:
Yeah. I think one of the key parts there is making some minor adjustments. If you think that there’s something that needs to be changed, making a significant shift right away is going to feel like it’s not maintainable, and that’s gonna mess up a lot of things, you know, we wanna build on that success. So, if you want to change the time period that they go to sleep, making small shifts that eventually move towards that goal time period or if they’re having access to electronics well into the night, then making small shifts over time so that it doesn’t feel as drastic and it doesn’t turn into, you know, a battle in the evening, which is gonna really impact sleep. I also think electronics right now are probably one of thebiggest contributors to lack of sleep that I see. And like Jensi said, modeling as a parent can be really helpful. So having, you know, like a charging station that isn’t in anyone’s room, that everyone puts their phone or electronics on that. So that it’s not like, okay, kids put yours there, mom and dad or parents are gonna go in the other room and play on our phones, making sure everyone’s doing the same thing so that sleep is important for everyone and not just something mom and dad talk about, but don’t do. So yeah, I think modeling is very helpful and specific to diet, I know this is probably more applicable to our teen populations and parents as well is caffeine.
Caffeine is a hell of a drug and it is one that I know is probably heavily used for the teens, and it has a really long half life. So essentially you’re not seeing it clear the brain and that’s only by 50% for five to seven hours. So if you’re having caffeine in the morning, sure, that’ll be well out of your system by the time that you’re going to bed at a reasonable hour. However, if you’re, you know, more into the afternoon caffeine, that five to seven hours is gonna be pretty late by the time it’s 50% out so thinking about that, and also some people are more impacted by other dietary things like sugar. If we maybe noticed that they’re not getting to sleep after having a nice big dessert then maybe thinking about shifting that a little bit.
Cindy Lopez:
So I’m wondering if you have any thoughts or tips for parents about how they can have a conversation with their child or their teen about sleep. What would that sound like ?
Eric Loughhead, LMFT:
I mean I think about maybe it’s just more my style in working with teens, but there’s a lot of research, there’s a lot of studies that show the negative impacts, and I think if you start reading them, it can get a little more depressing. So if you want to go down that road, there’s a lot of information there to kind of do the shock in awe. However, I think finding something that they enjoy, something that they would see the benefit of is gonna be more helpful. You know, if they really like playing soccer, talking about how much it can benefit them in their development and growth and in that sport, if they get more sleep. You know, finding those ways that might be applicable to them, I think is gonna be helpful.
Jensi Gise, MA:
Absolutely. I would go the same route of figure out what’s motivating to your child and start there. So if they’re motivated to, for example, feel happier because they’re struggling with mood symptoms or depression, go that route. If they’re motivated to do really well in school, we definitely know that more sleep, better sleep improves school performance, that’s where I would start the conversation, what’s motivating to your kid and acknowledging that there might be some losses too, right? Like, because there’s only so many hours in the day, you might be losing certain things, if you do sleep more. And so how can you find other times and ways to still do those things that you enjoy, like texting with your friends or using social media, but not to the point where it’s gonna interfere with getting enough good sleep.
Cindy Lopez:
Yeah, this has been a great conversation and I’m listening to the conversation saying, “oh yeah, I should do that too,” right? As we wrap up our conversation,Eric and Jensi, what are your top tips for our listeners about the most effective ways to ensure their children really get the sleep they need?
Eric Loughhead, LMFT:
I think the first one is consistency. Making sure that you have the same routine, and it’s happening every day of the week.
Jensi Gise, MA:
I think the other thing is as part of that wind down routine making sure that you’re helping your kid find ways that they won’t get really activated, like emotionally activated or cognitively activated right before they’re going to sleep. And this might be you know taking measures to reduce phone time or screen time, not working on homework right up until they’re about to go to sleep so that’s still on their mind and really stressful when they’re trying to fall asleep. Thinking about the types of interactions you’re having at home, like not having heated conversations or conversations about things that cause a lot of stress and pressure for your kid right before they’re gonna be going to bed. And also kind of thinking about, you know, TV shows, video games, like how do you push back those kind of more activating ones to earlier in the day so that your child can really take advantage of that wind down period in their day where they’re spending time relaxing and getting ready to have good sleep.
Eric Loughhead, LMFT:
I think one of the other things and it’s more culture I understand, but the perception of sleep. You know, if you put so many hours into working or so many hours into homework and you stayed up until one or two in the morning doing X, Y and Z, that’s viewed as a, a positive thing. You know, kind of like a badge and so creating more communication around the importance of sleep within the home. You know, having it be a conversation in the morning about how you slept and validating how that can feel when you don’t sleep and then making sure that we’re not reinforcing the idea of lack of sleep is a good thing, but more trying to change that perception at least in the home environment too, showing that sleep is very important and we’re not trying to limit that amount of time.
Cindy Lopez:
Thank you so much Eric and Jensi for being with us today and talking about this important topic of sleep. I think it’s something that children, teens, even all of us, right, struggle with sleep. It’s something that happens across the board, so it’s really an important conversation to have. To our listeners if you’re concerned about your child or your teen, please reach out. We have resources at CHC that can help. You can reach us at chconline.org. You can call 650.688.3625 and connect with our care team and find out more about the resources that we have that can help you or you can email careteam@chconline.org. Thank you to our listeners, and we hope you’ll tune in again next week.
Eric Loughhead, LMFT:
Yeah. Hopefully we put you to sleep.
Jensi Gise, MA:
Thanks, Cindy. Thanks Eric.
Cindy Lopez:
Thank you.
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