Get Your Sleep On

Above all else, they must sleep. They have to sleep. The theories for why we need to sleep are varied, but they all converge on the brutal necessity that we need consistent sleep routines.

According to the Gospel written by St. Matthew, Christ fasted for forty days in the wilderness before being tempted by the devil. But lo, nowhere does it say that Christ went without sleep during these forty days. So then, even God in the Incarnate Form seems to have needed sleep.

The Sleeping Gypsy by Henri Rousseau, 1897, on display at MoMA

There is a lot of controversy and debate about how to help babies sleep, so I will steer clear of this topic and direct folks to consider this resource for infant sleep guidance and references.

The things I would be willing to do to help my children sleep are too endless to count. Sleep is so incredibly important and necessary for adaptive daily functioning that I often do everything I can in my personal and professional life to steer others toward the best possible sleep time.

I want to share with you a blog I stumbled upon a few months ago that does a fantastic job synthesizing and distilling the clinical research related to the importance of sleep routines. This website by Craig Canapari, MD from Yale is a quick, personable, and approachable read.

I appreciate his website for a variety of reasons, but here are the main ones:

• He's able to take and integrate multiple perspectives in his writing and recommendations.

• It's pretty transparent that he is open to diverse parenting-styles and family dynamics.

• He writes with an eye for the research and ear for what parents might use in their homes.

I loved his post on harnessing sleep rhythms for better sleep routines.

I also strongly recommend this post as we creep up on daylight saving time (November 4).

Some quick thought nuggets regarding sleep for children and adults alike:

• Knowing thyself and your daily rhythms. Do you know when you generally become most tired or drowsy? Do you know the same for your child? Track it!

• Viewing technology prior to sleep onset is prohibitive for a variety of reasons. I strongly encourage families, if and where they can, to set clear limits on when technology goes away for the evening and where this technology is stored/kept safe over night.

• Finding a routine that works for you/your kids is key. Rather than trying to make your family or child conform to other people's presentation of their own perfection, look for what works for you and your family and then find a way to stick to it most of the time. Consistency is the critical part.

If it were not already obvious, I am pretty passionate about this topic. One of my first blog posts provided advice and tips about "Bedtime Routines". The following post was "Product Review: Teach Me Time Clock," which we use in our house to help manage our children's nightly slumber times [Bonus: the price has come down since we first purchased it in 2014]. As I shared in my last post “Third Time’s The Charm” our youngest has needed our help throughout his whole life (all 17 months and counting) to achieve consistent, sleep-through-the-night sleep. I use these resources and suggestions in my personal life every evening, along with a prayer for a good night’s sleep.  

Third Time's the Charm

What counts as luck depends on what you're looking for…

My Better Half gave birth to our third child in May of 2017, so he's coming up on a year and a half on this earth as we roll through fall. He's about as close to perfectly adorable as one baby could ever be. He's generally happy and adored by his siblings; he loves social gatherings and being held by lots of friends. He goes by a lot of different nicknames based on his behaviors.

But he loves to wake up more often than our previous children and has less variety in his diet. He has not hit his speech and motor milestones at the same time and rate as our first two kids. So in many ways, our third child has held the mirror up to my face when it comes to my work. 

I work with a lot of people who work hard at improving their sleep or that of their loved ones.

I work with a lot of people who work hard at increasing the types of foods their loved ones eat.

I dispense a lot of advice and guidance around eating and sleep routines in my work, and the process of parenting our third child has been quite humbling and eye-opening. Put simply:

Sometimes the evidence does not work so well.

I have read (and re-read) the literature on sleep hygiene, and we consulted with our providers to put in place a well-organized evidence-based approach to increasing the variety in his diet.

And still every day feels the same.

This is all not to say to heck with science/medicine and to go rouge on reality because of it. But this is me acknowledging as a human who happens to be a psychologist that sometimes the ideas and the plans that derive from the scientific method don't apply equally well to all.

That is a sobering thought to hold. 

Our third child has given me a different type of appreciation for those who face these issues and deepened my empathy (and my resolve) for how stressful, challenging, and rewarding these things can be.

When I became a parent, I did not know that love could come in so many forms. The way I feel and I respond to each of our children is so different and implicit it defies the words I have here.

Our youngest is his own unique person - challenges, successes, personality, and all. The big kids often call him “Boss Baby” because he has a huge head on a small frame. And, because he wants what he wants when he wants it and he lets us all know it. So as luck would have it, his smile and his laughter are so infectious that our joy clearly continues to outweigh our work.

Product Review: Teach Me Time Clock

Last week I posted about Bedtime Routines. I wanted to share an accompanying product review of something I have and use daily in my home, along with some ideas on how I use it to improve my kid's sleep. 

Sleep can be challenging at different stages of development for a variety of reasons. Sleep can also be a sensitive subject for caregivers and healthcare providers alike when it comes to improving the onset (how long does it take to fall asleep) and increasing the duration (how long do they stay in bed asleep). At the end of the day, we all need sleep to function, so I’ve talked about it often with my friends and with families I have worked with over the years.

So...my cherubic first born child learned to sleep through the night at a young age. This is something we took relatively for granted until our second child arrived 22 months later. Just about the time our 2.5 year old transitioned to her big girl bed, she started developing the fabulous habits of A) getting in and out of her bed repeatedly and B) waking up too early. By my math, she was losing anywhere from 60 to 120 minutes of sleep on the front and back ends.

We needed to shore this issue up in a hurry since it was ratcheting up the household stress.

Like most things in my life, my Better Half deserves a lot of the credit. She read about this product, we purchased it, and had it all set to go atop the dresser in our daughter’s bedroom:

Teach Me Time Clock can be purchased on Amazon. This is the nightlight ("stay in bed") mode.

Here’s what the Teach Me Time Clock can do:

• Tell time
• Work as a traditional alarm
• Provide touch-button voice-over to speak actual time
• Serve as a nightlight
• Change colors at different times (this is the key ingredient).
• Here are our current settings:
  • 7:30pm - soft yellow light comes on (serving as a nightlight)
  • 8:00pm - soft yellow light continues on (time for bed)
  • 6:45am - soft green light comes on (indicating time to get up)
  • 8:00am - soft green light turns off (nobody is asleep at this time...)

So our daughter used to wake up around 6:30am, but was now waking up at 5:30am. She used to go to bed around 8pm with little fuss, but now was getting up and down until close to 9pm.

This is what we needed to do:

• Talk about the clock to her, the colors, and what she could earn for following the rules
• Identify a strong motivator soon after the light changes (morning tv show)
• Tell her what she would get for staying in bed until the light turned green (tv show)

The careful reader will likely notice that I have said nothing about getting her to stay in bed in the evening without getting up and down a bunch. I believe the the venerable Sun Tzu put it best when he said, in different words, “never fight a war on two fronts.” Sage advice here.

It would’ve been amazing if this took only one evening to do the trick. Of course, it did not.

What we needed to do was set the clock to 5:45am (close to her new 5:30am awake routine) and then gradually move the time toward our 6:30am goal in 10-15 minute increments over a few weeks. In addition, she would often wake at 5:30am, come get one of us, and then want to go watch her tv show. I would take her back to her room, lay her back in bed, and then lay with her until it turned green. I praised her to holy heck, got her dressed, and took her to tv time.

Then we worked on having her lay by herself until the light turned green. Then once this new behavior of laying in bed on her own until the light turn green appeared firmly established, we moved the time forward. This would often reset the level of support back to her needing to be taken back to bed, me laying beside her, then fading my physical presence, and her staying in her bed on her own. Then we’d move the clock forward another increment toward our goal.

Green light means time to get out of bed. "I slept until the light turned green" - parenting win!

What happened if she refused to stay in bed until the light turned green? This is where we would "ride the lightning."

She just didn’t get tv time that morning. And yep, it was not fun for either party.

But she got the hint relatively quickly because we also were not doing tv time in the evening, so this increased the reinforcement value of tv time.

This is one of those parenting battles where I feel like we fought the good fight and won. It wasn’t a one week or even a one month slam dunk, silver bullet sort of deal for us or her. But I do think this alarm clock provided a nice level of cuing and support that we still use with her.

Now we are preparing to transition our son to a big boy bed and will be ordering a second Teach Me Time Clock soon.

Bedtime Routines

I believe our souls call out for consistency in the form of predictable, daily routines. I am sure that life would be boring for most of us if everything was predictable and routine, but when learning something new and potentially challenging (like how to eat or sleep or drive a car), a consistent order and flow gives a comfort that enables new things to come more readily to us.

Bedtime is a ritual that rewards parent and child alike.

For the child, having a bedtime routine signals what to expect as they transition away from the wakeful part of their day where they acquire new skills and encounter new situations at a ferocious pace.  The order in which the routine unfolds matters a great deal, but can vary depending on what you know about your child. For example, certain children become animated during bath time (or don't even like getting their hair wet), while others begin to quiet down and doze. If your child becomes more animated or upset during the bath time routine, starting bath time sooner or only bathing every other night might be an easy place to modify things.

For the parent, having a bedtime routine gives you a chance to gently guide your child toward a restful state that readies them for falling asleep. It also provides an opportunity to lay the foundation for the next day (picking out clothes after looking at the weather on your phone). 

For the parent and child, the bedtime routine provides an opportunity for bonding and more attentively observing the subtle ways in which your child responds to their world and others.

Recommendations to consider with the bedtime routine:

Provide your child with a clear indication of when the bedtime routine will begin. For example, you could say, “In ten more minutes” or “at 7:30, we will get ready for bed." For some children, setting an alarm (fun song) on your smartphone could be a creative support.

Pay attention to how you announce the bedtime routine. For some children, saying, “Time for bed” is the equivalent of saying, “the fun thing you are doing right now (e.g., playing with toys) will have to end soon because I said so.” Instead, try changing the way you state this by using a preferred activity or item as part of the announcement. For example, you could say, “Time for bubble bath!” or “silly story time is soon!” This reminds children of the fun parts of bedtime.

Start the bath early enough that you don’t have to rush your child through it. If your child likes to play in the tub, build in extra time by starting earlier so that they can have more time to play in the bathtub.

A lot of kids have a hard time transitioning from the bathtub to getting dressed and brushing their teeth. In these situations, I'd recommended leading with a clear contingency that gives them something to work for and look forward to. Something like, "Once you hop out of the tub and have your pajamas on, you can pick an extra book!" Help them get dressed and praise them for using nice hands. With tooth brushing, I think having your child pick out a favorite toothbrush from the store and/or a preferred tooth paste container can help make this part of the routine fun.

I really like background sounds or some for of white noise when I sleep, and both of my little ones have a white noise machine in their room. It's also served as a discriminative stimulus for my kids -- sleep machine turned on signals little butts into bed in order to have story time.

Since starting my private practice, I have had the opportunity to work with more than one family to improve their bedtime and sleep routines. I really enjoy this type of work, besides who doesn't enjoy a good night's sleep?