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By Dr. Melody Hawkins, Pediatric & Adolescent Sleep Center
The fall season is looming, and the only certain thing is that it will be very different than last school year.
These changes may have a negative influence on an overall feeling of well-being for you and your child. The influence on your emotions from these changes should not be overlooked as increased levels of chronic stress can profoundly impact your mental and physical health.
From a sleep perspective, increased stress can lead to problems, including falling asleep at night, waking up more frequently at night, and increased reports of restless sleep and remembering bad dreams. Issues also include early morning awakenings, sleepwalking, sleep terrors, and regression in sleep training for younger children.
One concept in sleep medicine regarding insomnia (problems falling asleep and/or staying asleep) is called the 3P behavioral model or Spielman model. The three components are 1) predisposing factors, 2) precipitating factors, and 3) perpetuating factors.
The idea describes how a sudden onset stressor can cause acute insomnia, but then maladaptive habits can start as a coping mechanism to deal with insomnia, perpetuating the behavior and causing insomnia to become chronic. Sometimes insomnia will persist even after the acute stressor has passed because of the habits that were adopted.
This school year will mean very different things for many families. It may include a new working situation for parents, in-person school, virtual learning, or a combination of the two. The reality of the pandemic also means many uncertainties and increased fear of illness. For some people and most children, decisions are made by other people; new rules and regulations may cause even more stress, anxiety, and feelings of frustration.
A good starting point is to eliminate stressors to our body that you do have control over, including keeping a simple strategy of maintaining normal sleep, activity, and eating schedule. Although this sounds simple, it takes work and willpower to maintain these good habits. Having your body’s circadian rhythm disrupted can cause profound effects on mental sharpness, energy levels, hormone secretion, appetite, insulin resistance, and can make your sleep less restorative.
Here are some tips for how to maintain your body’s circadian rhythm.
MAINTAIN A CONSISTENT SLEEP & WAKE SCHEDULE
Children who don’t have any trouble falling asleep at a normal bedtime may be able to enjoy sleeping in an hour or two on the weekends without problems. However, if you or your child have problems falling asleep at your normal bedtime, then sticking close to your normal wake time, especially on Sunday mornings, is very important to prevent “social jet lag.”
This “social jet lag” is a common situation of sleeping late on Sunday mornings, leading to trouble falling asleep on Sunday nights, leading to difficulty waking up on Monday mornings. If you allow your sleep schedule to drift back three hours on the weekends (a very common practice), on Mondays, your body will feel like you had just traveled from the east coast to the west coast and back in one weekend.
OBTAIN MORNING LIGHT EXPOSURE & DIM LIGHTS 1- TO 3-HOURS BEFORE BED
Morning light exposure is the most important factor in setting your circadian rhythm. Light therapy can alter the circadian rhythm for delayed sleep phase syndrome by exposure to bright light in the morning.
This can be as simple as opening all the blinds and turning on the lights. Sunlight is best; try not to wear sunglasses on the way to school or work if you struggle to fall asleep on time at night. Also, avoid exposure to electronics 1- to 2-hours before bed. Not only does this promote falling asleep more easily, but it also may help your sleep be more restorative.
Blue light exposure has been shown to impair the secretion of melatonin. Having an electronic device present in the bedroom isn’t recommended at night.
BE ACTIVE DURING THE DAY
If virtual learning from home, one idea to keep active would be to replace your morning commute with a short morning walk. This combines morning light exposure with morning activity. Morning exercise may also help promote optimal levels of deep sleep at night. However, avoid strenuous activity 2- to 3-hours before bed. Intense workout sessions can cause hormonal changes that can last a few hours.
DON’T SPEND TOO MUCH TIME IN BED WHEN NOT SLEEPING
Spending too much time awake in bed can promote insomnia as the brain starts to associate the bed with being awake. It isn’t recommended to study or do schoolwork in bed, as well.
MAINTAIN A NORMAL EATING SCHEDULE
Eating regular meals will help keep your circadian rhythm and digestive system on track. Eating is a daytime activity and a signal to your body to be awake. Eating at night during desired sleeping hours isn’t recommended for healthy children over 6-months-old as it promotes nocturnal awakenings.
Many children and parents have a challenging year ahead. Optimizing your family’s sleep will help provide them with energy and mental focus to meet these challenges. Poor sleep often exacerbates behavioral problems, especially in children.
Please reach out to the Pediatric & Adolescent Sleep Center if these strategies are not effective or if you are having challenges implementing them. Sometimes frequent nocturnal awakenings are a sign of a medical problem. If there are concerns for poor quality sleep, an evaluation to rule out medical causes is recommended. A pediatric sleep specialist can give insight into the risk factors for medical sleep problems and indications for further evaluation.
As the only American Academy of Sleep Medicine accredited sleep center in Northern Virginia, the specialists at Fairfax Neonatal Associates’ Pediatric & Adolescent Sleep Center evaluate and treat sleep-related problems specific to pediatrics and adolescents. Patients, ages 20 and younger, are seen by board-certified Pediatric Pulmonologists who are dedicated to fully treating a wide range of sleep disorders, including Restless Leg Syndrome, Narcolepsy, Sudden Infant Death Syndrome, and more.
Learn more about Dr. Melody Hawkins, this post’s author here, and all of Fairfax Neonatal Associates’ providers here. Connect with their Pediatric & Adolescent Sleep Center online or by calling (703) 226-2290.