In this week’s post, I’m talking a little bit about creating a successful bedtime. Specifically, creating a bedtime that is predictable, linear, goal directed, and brief (e.g. less than 30–40 minutes). I would also love to hear what has worked for you and what has not? What are the rituals at night which you hate to miss? What has not worked for bedtime in your home?
I was interviewed last month at Wellocracy about way your body clock can work for you or against you. For most people, their schedule is working against their natural inclinations. If you are wondering how well your sleep schedule is meeting your needs, it is very easy to figure this out. On a typical day (work day or school day) do you need an alarm clock to wake up? If the answer is “no”, congratulations! You are in the minority.
If you are like me, you may hit the sleep button a few times before you blearily make your way down to the coffee maker. If you are a teenager, you are likely frantically trying to get up and out the door in time to catch the school bus or a ride to school because of the structural factors curtailing your sleep.
A German researcher, Till Roennenberg, coined the phrase “social jet lag” to describe the state of persistent sleep deprivation which results from having your external sleep schedule (e.g. when you need to get up for school or work) out of phase from your natural schedule. He actually has a survey you can take to determine your chronotype here. Brain Pickings has a great summary of his work, and he wrote a fascinating book for lay people called Internal Time: Chronotypes, Social Jet Lag, and Why You’re So Tired.
As a rough rule of thumb, your degree of social jet lag is the difference between the time you need to wake up on work or school days and on free days. This can be a bit more difficult to figure out than it seems. Many teens (and adults without small children) will be sleep deprived during the week and then make up some of the sleep on the weekends. Therefore, a better comparison is between work/school days and vacation days where the teen has been allowed to sleep on his or her own schedule for several days.
Let’s take the example of a teenager who needs to get up for school at 6 AM with difficulty but arises, feeling refreshed, a month into her school vacation at 9 AM. This implies three hours of social jet lag on every school day, equivalent to the jet lag of flying from San Francisco to New York five days a week. However, unlike travelling, there is no real habituation. Being jet-lagged every day sounds pretty awful, and it is the state the majority of our teens spend every day in.
So what can be done about this:
- Going to bed earlier. You are unlikely to be able to go to sleep three hours earlier, no matter how tired you are. However, every little bit helps, and a bedtime 30 minutes earlier every night translates to 3.5 hours of extra sleep a week– almost half a night of sleep for an adult.
- Light exposures in the morning can shift your body clock earlier. Light box therapy has been proven to be helpful, and newer devices like this one from Phillips have lower light intensities than prior models
- Advocating for later school start times is critical. If you want to get involved, head to Start School Later and find out how you can advocate in your community for this issue.
For what it is worth, I took the chronotype questionnaire and found that I was actually a “slight early type” to my great surprise. I have always thought of myself as a night owl; I will say that I have become much more of a morning person by necessity since I am the parent of two small boys.
So: do you think that you have “social jet lag”? Do your children? If you took the sleep quiz, is your chronotype different than you expected?
I do not remember who recommended a sound machine for us as we were planning on the birth of our first child; we registered for and received our beloved Marpac Sound Conditioner (affiliate link) which we have run nightly in the room of our older son. When my second son came along, we purchased another one and have been happily using it ever since. The devices seem to be unbreakable and provide uniform sound output. They are a bit bulky but the sound has less of the tinny quality of an electronic device . I have found it very useful when traveling as our older son especially is a light sleeper.
The principle behind the use of sound machines is the idea that constant sound prevents intermittent sounds (doors closing, siblings crying, etc) from interrupting sleep. For newborns, Dr. Harvey Karp popularized the idea that white noise louder than a baby’s crying replicated the sound in the womb and thus recommended white noise from a vacuum or loud “shushing” would help soothe a fussy baby (with my older son, this did seem to be true. You don’t know how loud you need to shush until you watch the video).
A recent study, however, has made me question the ongoing use of sound machines in our home. A group in Canada studied the amount of ambient noise generated by 14 infant sound machines (which were not identified by name). They used sophisticated techniques to measure sound levels; specifically, they used a sound booth and a device to simulate the size of an infant’s ear canal. They also corrected for the properties of the hearing of a six month old (thus, findings in the study are reported as A-weighted decibels, or dBA). They measured at three distances: 30 cm/ 11.8″ (as on a crib rail), 100 cm/ 39.4″ (as on a table next to the crib), and 200 cm/ 78.7″ (as if across the room). They found that:
1. All sound machines exceeded the maximum recommended sound exposures when placed on the crib rail.
2. Three machines produced volumes exceeding safe sound levels recommended for ADULTs (85 dBA) at the crib rail distance.
3. Although the sound levels were lower at the maximum distance, 13/14 machines generated levels greater than recommended volume (50 dBA) when at the loudest volume.
To put these findings in perspective, it is important to note that the recommend sound levels for infants in the hospital is quite low (50 dBA is quieter than normal conversation (60 dB) by about a factor of ten).
After reading this study, I wanted to measure the sound output from our sound machines to see how they compared. I used Cateater’s Sound Pressure Meter because I am powerless before a good looking app, but you can get a free app like Decibel 10th which will do the same thing for free.
The best number to use is the average as the max number is very sensitive to throat clearing, doors closing, or the laughter of your children “trying to be quiet while Daddy works”.The second and third distances represent the distances from the machines to the approximate head position of my sleeping 3 and 6 year olds.
I found that the sound levels were within safe limits for both of my boys (less than normal conversation), but they did exceed the very conservative limit for infants on the higher settings.
To give some perspective: normal conversation is 60 dB. For more on safe sound levels, the CDC has a good information page on safe sound levels and hearing loss in children.
So what should you do if you have been using a sound machine?
- Don’t panic! You likely have not done your child any harm. If you are worried about his or her hearing, your pediatrician can arrange screening. First off, moving your sound machine out of your child’s crib or bed is probably a good idea.
- It is probably a good idea to move your child’s sound machine out of their crib or bed and to the other side of the room.
- You can get a rough idea of how loud your device is by downloading a sound pressure meter application from your phone.
- You can also turn off your sound machine after your child goes to sleep. This is what we have started doing. Another option is to use a timer like this one which is what one of my colleagues who works in ENT does with his son.
- Don’t use the loudest volume settings if you can help it.
We have changed our practice by turning off the sound machines when we go to bed, although my six-year-old tends to get up and turn his back on. Did we do any permanent damage to our sons’ hearing when they were little? It is unclear, but I do not think so. (They don’t listen, but I don’t think that is due to their hearing).
Do you use sound machines for your children? If so, does this make you change your practice?
Like all parents, we have learned what works in our home through trial and error with our little boys, who are now almost three and almost six years of age respectively. There are many rules which are bent, stretched, or shattered depending on the circumstances. One rule, however, that we have learned to respect is the fact that our kids NEED TO BE IN BED BY 8 PM. The reason is that, unscientifically, my kids start to spazz out after this time and that their resistance to being told what to do increases exponentially after this hour.
There was some recent research on bedtime in early childhood which suggests that being strict about your kid’s bedtime has benefits other than the short-term (your sanity). This research has received a lot of press. A group in England examined the relationship between bedtime regularity and timing (at ages 3, 5, and 7), and measures of scholastic ability at age 7 in over 10,000 children as part of the Millenium Cohort Study. Parents were asked about the timing of their child’s bedtime. Was it regular on weeknights? When did it typically occur? Irregular bedtimes and typical bedtimes later than 9 PM were both associated with decreased reading, math, and spatial abilities both at the time of measurement and at follow up measurements. In simpler language, irregular or late bedtimes seemed to be related to lower markers of future scholastic achievement. This study does have some important limitations. First off, the authors did not track sleep duration, so I suspect that later bedtimes are a marker of sleep deprivation. The other significant factor is that irregular bedtimes corresponded to some level of socioeconomic disadvantage for the child. It is easy to imagine how a single parent working two jobs may struggle to get his or her child into bed regularly.
However, these findings makes a lot of sense. More consistent rules and more sleep help children to thrive. In my experience, bedtime needs to be goal directed, linear, and consistent. It should happen at the same time most nights and allow your child to get between 10-11 hours of sleep at night, which is appropriate for most school age kids. Many children wake at the same time independent of how late they go to bed; this is why the timing of bedtime is so important. Bedtime can be challenging: I have on how to address bedtime here and especially here. I also think that it is important, however, to be flexible for occasions that are meaningful– if your kids really wanted to see those fireworks on the 4th of July, I think you likely have not damaged their chances of getting into college.
The studied noted above was entitled “Time for bed: associations with cognitive performance in 7-year-old children: a longitudinal population-based study”; you can get the full article in the link above. This study also received quite a bit of press, some of which was a little hyperbolic:
Late nights ‘sap children’s brain power from the BBC
Irregular bedtimes may affect children’s brains from the Guardian.
Parents: what has worked for you at bedtime? Do you enjoy bedtime with your children, or is it a struggle?
This past weekend, an article entitled, “Diagnosing the Wrong Deficit,” , a psychiatrist named Vatsal Thakkar writes about the relationship between sleep disorders and attention deficit hyperactivity disorder in both children and adults. This is a great article and I would recommend that you read the whole thing. I especially appreciate his sharing his own diagnosis of atypical narcolepsy as an adult.
I’ve written previously on the connections between ADHD and sleep disorders in children. To summarize, both inadequate and disrupted sleep (for example, in obstructive sleep apnea) can cause problems with attentiveness and behavior similar to that of attention deficit hyperactivity disorder. Dr. Thakkar opens his article with the story of a patient presenting at age 31 with “the classic symptoms: procrastination, forgetfulness, a propensity to lose things and, of course, the inability to pay attention consistently.” However, this patient’s symptoms began at age 31, which does not fit the classic profile of ADHD:
It turned out he first started having these problems the month he began his most recent job, one that required him to rise at 5 a.m., despite the fact that he was a night owl.
The patient didn’t have A.D.H.D., I realized, but a chronic sleep deficit. I suggested some techniques to help him fall asleep at night, like relaxing for 90 minutes before getting in bed at 10 p.m. If necessary, he could take a small amount of melatonin. When he returned to see me two weeks later, his symptoms were almost gone.
To me, this is the key point of the piece. So many children, teens, and adults are not getting enough sleep, and suffering as a result. In my practice, this is especially common in teenagers in whom high academic workloads and early school start times contribute to chronic structural sleep deprivation, which leads to (again) attentional problems, depression, lower test scores, and an increased risk of car accidents.
Clearly, children (and adults) with problems paying attention or performing at work or school should have a sleep evaluation. Some people will need a sleep study or evaluation by a specialist. However, EVERYONE will benefit from getting enough sleep at night. There’s a great article on the National Sleep Foundation website about how much sleep people need at various ages. Some rough rules of thumb for sleep at night:
- Preschoolers (age 3-5) need 11-13 hours of sleep
- Elementary school age children (5-10 years of age) need 10-11 hours of sleep
- Teenagers (age 11-17 years) need 8.25-9.5 hours of sleep
- Adults need 7-9 hours of sleep at night.
Very few of my patients (or their parents) would not benefit from more sleep. I think that small incremental changes are a good place to start. When I’m negotiating with teenagers around sleep schedules, I start with an extra 30 minutes of sleep a night. That is almost an extra half night of sleep/week. Chronic sleep deprivation adds up, but so do improvements in habit and routine. Lately, I’ve been trying to go to bed earlier and have noticed a lot of improvement in my mood and productivity.
Does your child get this much sleep at night? Do you? If not, how can you make this better?