Busting Sleep Myths: From Wake Windows to Sleepy Teens (Ep. 4)

4 sleep myths audio only
[00:00:00] Craig Canapari MD: Welcome to the Sleep Edit, a podcast devoted to helping tired kids and parents sleep better. We focus on actionable evidence-based sleep advice, so everyone in your home can sleep through the night. Now, a quick disclaimer, this podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice.
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[00:01:09] Arielle Greenleaf: Welcome back to the Sleep Edit our podcast where we talk about all things sleep in children. I am Dr. Craig Canapari. I’m a pediatric sleep doctor,
[00:01:19]
[00:01:19] and I’m Ariel Greenleaf, certified pediatric sleep consultant.
[00:01:23] Craig Canapari MD: Okay, So we thought it would be fun today to talk about, sleep myths, sleep pet peeves things that I think are in common circulation in the world of pediatric sleep and the information that parents get that we don’t think are either particularly useful or accurate.
[00:01:41] Ariel, I think on our list here, you put one of the things we’ve talked about at length wake windows
[00:01:47] Arielle Greenleaf: Yes
[00:01:47] Craig Canapari MD: wake windows are not a thing that are discussed in pediatric sleep doctor school, and we’ll get into the reasons for that. I had not even heard about these before a few years ago.
[00:01:56] And then I started researching and I saw that this was all over [00:02:00] the internet. And I don’t know if you want to take a pass at explaining what weak windows are Exactly.
[00:02:05] Arielle Greenleaf: Yeah.
[00:02:06] Wake windows are essentially age-based windows of time during which your child should be awake before they go back to sleep. So time between sleep periods during the day. Basically, it’s a system to determine when your baby or child is ready to go to sleep for a nap.
[00:02:27] Craig Canapari MD: Yeah, and it was interesting I think the idea behind wake windows is not a bad one, right? For lots of different reasons, parents struggle, especially in infants about the timing of naps. So any system that purports to tell you the ideal formula for when your child should nap seems like a great idea, but I would say the problem is. there’s really not a lot of evidence that these things are particularly predictable.
[00:02:57] Arielle Greenleaf: Sure, and I’m glad to [00:03:00] hear that on your end. It’s basically the same as what I experience, at least with the people that come to me even though there may not be a science, there’s no scientific background to it or there’s no medical background to it for easier babies or go with the flow babies, these formulas can work.
[00:03:18] But those aren’t the people that I’m seeing. Those aren’t the people that come to me and say, I’ve looked these up, I’ve tried them, it’s not working. Is my baby broken? Am I doing something wrong? And that’s where I have a problem with the idea of wake windows. the majority of the people who come to me and are struggling have found these wake windows by Googling or looking on social media and it’s just not working for them.
[00:03:41] And they feel like something’s wrong. And that’s where I start to get frustrated because it is wake windows are literally everywhere. You look as a parent, and you say, how do I get my baby to nap? Just use these wake windows And it can be very confusing and frustrating when it doesn’t work.
[00:03:58] Craig Canapari MD: Yeah. And I think [00:04:00] this is my main problem with it, right? There are parents will say, oh, wake windows really help me with my baby’s naps. I think the problem is if you look online, you’re gonna see all these different formulas about, okay, your child is four months old, here’s how long they should be going for naps.
[00:04:19] And people are just making these numbers up.
[00:04:21] Arielle Greenleaf: yeah,
[00:04:22] Craig Canapari MD: I and what bothers me is when a parent will say Wake windows didn’t help my baby nap. What am I doing wrong? And the problem is not the parent or the child, it’s just it’s tends to be a rigid system.
[00:04:37] we always say the kids don’t read the textbooks, right? So things don’t always fit. there are a couple of things that are constant. One is the number of naps that babies take as they get older is gonna change. We’re gonna talk about this a little bit later too.
[00:04:53] The other is and the reason for this is that is kids get older, their sleep drive [00:05:00] matures. Drive is the phenomenon where the longer you’re awake, the more likely you are to fall asleep. So for a healthy adult who’s sleeping normally at night, you can be awake all day and not take a nap.
[00:05:13] So you accumulate sleep drive throughout the day from when you get up in the morning, say at six or seven till nine or 10 o’clock at night, and that’s normal. Babies ac, accumulate sleep drive much more quickly, and that’s why young babies are gonna nap multiple times per day. a two or 3-year-old might just nap once during the day.
[00:05:33] And an older child or a grownup won’t nap at all is because the rate of sleep drive accumulation changes over time It’s so individual about how quickly the sleep drive accumulates. there are many factors that determine nap timing as well. How long you slept the night before, what your baby’s particular sleep biology is some [00:06:00] kids need 12 hours of sleep. some need 18. those kids are gonna have different intervals between the naps, different nap duration. And there’s also just this underlying thing ofwhen your first kid, you may have the luxury of having them on a schedule they want, but then your second or third kid, guess what?
[00:06:19] You’re getting your kid up. You have to go get the other kid at preschool. many people have to put their kids in daycare and then often they’re trying to fit their kids’ nap into a schedule that may not be particularly natural for them.
[00:06:33] Arielle Greenleaf: Absolutely. I think it’s interesting because I feel as though on my end I. One of my biggest jobs is to determine specific, a specific formula for a baby or child’s day. What can they handle? Handle what is that window of time that tends to be the child has built up an up enough [00:07:00] sleep drive to take a decent nap, but not hasn’t been kept up so long that they’re, overtired or struggling to fall asleep.
[00:07:07] And sometimes for some children it’s crazy. There’s literally like a five minute window. If we miss it, then naps gonna be short or skipped. It’s it’s wild. But I would say, a lot of people that come to me have babies that are a little bit more on the sensitive side. That’s why they’ve come to me.
[00:07:21] They’re not one of those easygoing babies that, you can go with the flow. But it’s. It’s very clear. One thing that came very clear to me within the first year of doing this was how different every child really is from the next. And I do think it’s fine to start with the basics that are out there.
[00:07:43] You can look at what might work for a five month old or a six month old and start there, but then we need to look at how is the baby or the child reacting? Are you keeping, are they starting to get cranky before that nap? And are they getting really [00:08:00] cranky? And then you put them down and they don’t fall asleep easily.
[00:08:02] But we find that before you put them, before they get cranky, if we catch ’em before that time, then they do sleep well. And that is super individualized. I get really frustrated with the wake window idea because every baby or child is going to have a very different. I call it a formula.
[00:08:20] when I sit down and I’m analyzing the data, the patterns start to show themselves pretty quickly. Some children just really do need less sleep than others, and others are just, once you get them sleeping while you’re like, wow, this child was cranky because they were so crazy tired and needed way more sleep than we thought they did.
[00:08:38] So that’s, wake windows are something very individualized. They’re not, in my experience.
[00:08:48] Craig Canapari MD: Yeah, no, if you find an online calculator or something and it helps you, that’s great. It may be a good place to start working, but It’s not really magic here. And if you’re struggling, the problem is [00:09:00] not you or your inability to execute on it. It’s just that your baby’s needs are a little bit different.
[00:09:05] And I’m always leery of these kind of concepts that get very popular, that make a subset of parents feel inadequate. The fact is this stuff is hard. It’s difficult.
[00:09:17] Arielle Greenleaf: absolutely
[00:09:19] Craig Canapari MD: Yeah. Kids are not just like little robots, right? you put in a certain input, you expect a certain output.
[00:09:24] Arielle Greenleaf: And that’s what I always say to them too. you can get a child sleeping well and they’re going to have a rough night or a few rough nights, and it’s, they start to freak out and it’s these, this is gonna happen.
[00:09:35] They’re not robots. They’re going to be times and days where they’re gonna be a little off. But I think that is important to understand that you can’t just look at this formula and assume that every single day the child is gonna consistently follow that formula because they’re, they are individuals.
[00:09:53] Craig Canapari MD: I think I wanna move on to our next kind of myth here, or I guess pet peeve. [00:10:00] And that is the idea of the specific sleep regression. So what a sleep regression is, it’s a term that’s not really used in the medical literature, but it is when a child that’s been sleeping well all of a sudden their sleep gets worse.
[00:10:13] And this is something that we all have observed as parents, as sleep professionals. I guess where I get where I struggle with this is where it’s like, it’s the seven month sleep regression. It’s the 359 day sleep regression. It’s the, my team didn’t make the playoff sleep regression.
[00:10:29] It’s the moon is rising in Scorpio, sleep regression. There seemed to be 1,000,001 of these if you put in Google that’ll fill in all of these, sleep regressions. And that really isn’t based on anything.
[00:10:42] Arielle Greenleaf: And I think it ties nicely with the wake window idea because oftentimes you’ll see, your baby is now six months, and that means they’re going to hit X regression. Similarly, they’re six months, so they should be able to stay awake for this amount of time.
[00:10:59] [00:11:00] The idea and the understanding that these babies are individuals and they’re going to, develop on their own timeline. for instance, my baby didn’t crawl till she was 10 and a half months, and I started panicking because everywhere you look, it’s like uhoh, if they’re not crawling by X time, watch out, there could be something wrong with your baby.
[00:11:19] And my daycare even said something to me, so I was panicking. But sure enough, she crawled, she just did it on her own timeline. It’s almost like setting parents up for failure and or fear it, it’s a little disconcerting because parents are worried. Some children don’t even hit major regressions. Some children sail through every little thing and maybe have one bump in the road. Whereas others, like I said about that, you know that five minute window of time for when you can put them down for an app, same thing.
[00:11:49] They start to get an inkling that they’re going to crawl and their sleep goes haywire for a couple weeks. And that’s where I get tripped up with this idea oh gosh, they’re eight months. Watch [00:12:00] out. Warning, sign ahead.
[00:12:02] Craig Canapari MD: Yeah. I feel like a lot of times the kid wakes up once or twice a night when things have been going well, and then the parents start Googling, and they’re like, oh yeah, it’s the it’s the nine months, three days, and 57 minutes sleep progression.
[00:12:16] And then they just panicked that it’s something that they’ve done. There’s a, there are some somewhat predictable disruptions in sleep, kids learning to walk, kids potty training, et cetera. I know Jodi Mindell, who’s at The Children’s Hospital of Philadelphia did an informal analysis on some data that she had and unfortunately never published this.
[00:12:36] But she was looking at sleep data she’d collected over years in children and just seeing if there was any pattern of these periods of nighttime awakenings. And she was looking specifically to see if they corresponded with this book called The Wonder Weeks. this kind of came up with the idea of these very specific sleep regressions.
[00:12:53] And in a nutshell, there didn’t seem to be any predictability to these patterns of disruption or [00:13:00] growth. It seemed to be very individual in child per child. So there isn’t a lot of evidence that These are predictable things. That being said, I would say to a parent if they’re like, oh, my kid’s, sleep is good.
[00:13:09] Now it’s not good. What can I do? Have you changed something in your behavior around sleep? Have you started laying down with your child till they fall asleep When you used to have them fall asleep independently? Has bedtime slipped a little bit,
[00:13:23] Like the things that got you to success, often you need to revisit them when things start to go sideways on you. Or sometimes in a day or two, your kid’s just gonna come down with the cold,
[00:13:34] Arielle Greenleaf: yeah, exactly.
[00:13:36] Craig Canapari MD: A ear infection, they’re teething.
[00:13:37] Arielle Greenleaf: I think
[00:13:38] Craig Canapari MD: But sometimes I feel like we blame teething for everything that goes awry.
[00:13:42] Arielle Greenleaf: Yeah.
[00:13:42] And I’ve looked at studies about that, the studies show that teething really doesn’t cause as much trouble as it gets blamed for.
[00:13:50] So whenever someone says my baby’s sleep has been crap for six months, they’ve been teething for six months. And that’s the [00:14:00] reason why I like to tell them babies, pretty much teeth until their, two year molars come in. So if you want to wait two years and blame everything at all on bad sleep on two years of teething, then go for it.
[00:14:14] But in general, teething might hurt as the tooth is starting to pop out. A little bit of Motrin or Tylenol can probably help with that kind of pain. It’s not like they’re getting kicked in the mouth with like by a horse or something like that.
[00:14:28] Craig Canapari MD: the reason they’re not sleeping well.
[00:14:29] Arielle Greenleaf: Similarly, there is evidence, around gross motor developments, learning to crawl, learning to walk
[00:14:35] Also language development, you may have a child waking early and singing in their bed or speaking sentences all of a sudden in their bed. And that generally is around that 20, 21, 22, 23 month mark.
[00:14:47] But again, like that’s a wide range. there are going to be sleep disruptions throughout childhood. Do I agree that they’re going to happen at the same time for every child? No.
[00:14:57] Craig Canapari MD: Yeah, and going [00:15:00] back to the teething thing honestly I would say that us pediatricians are maybe a little bit to blame for this. imagine your primary care doctor. Someone comes in and be like, oh, my kid hasn’t been sleeping for a couple of days. They see a tooth buttdr something.
[00:15:11] They’re like, ah, it’s the teething. sleep is a mysterious process, right? And sometimes it’s just not great for a few nights, we just wanna understand why things are going on.
[00:15:20] So the pediatrician wants to know too, and the pediatrician wants to give the parents something to hang their hat on. But we don’t really get to do that with the 15 or 16 year olds who come in who’ve never slept well.
[00:15:31] Arielle Greenleaf: It’s
[00:15:31] interesting that you say that because even the idea of wake windows and regressions we have such little control as parents, especially in nonverbal children we’re trying to decode what’s going on, it’s like we want some sort of an answer or some sort of a pattern or a routine that’s going to work or, make us feel more comfortable that our child is not sleeping well.
[00:15:54] Because we’ve ultimately, we don’t really know. We, we sure there are certain things, like we said, you move to a [00:16:00] new house, the child isn’t sleeping well, of course they’re not sleeping well. They need to adjust, but, not having those answers can feel really stressful.
[00:16:09] It can cause anxiety. and doctors don’t have a lot of time with their patients, so it’s oh, the gum is red. They’re teething. That’s why, they gotta give some sort of an answer so the parent doesn’t leave thinking, then, you said nothing’s wrong, but why is this happening?
[00:16:23] they need a reason why I see what you’re saying.
[00:16:26] Craig Canapari MD: Yeah, if your kid’s been sleeping well, then there’s a couple of nighttime awakenings. give it a couple of days up to a week before you really worry or have to recalibrate things, especially if something has changed, you got back from vacation or something, it’s not gonna be perfect.
[00:16:43] Arielle Greenleaf: And but if it’s multiple times per night or it’s not getting better after about a week, it’s worth starting with your pediatrician. Agreed. I think that’s the first course of action. And the other thing I like to think about is the child completely inconsolable? if you go in and you take the [00:17:00] child outta their crib or their bed and you, and they’re like perfectly fine, once you go in there, then it’s probably more just like they want you in there or something.
[00:17:08] They need a little soothing. But if they’re completely inconsolable, there could be something medical going on so it doesn’t hurt. To have that be the first course of action, especially again, one night is one thing, but if it’s going on for a few nights, child is inconsolable, sleep is not happening for anyone of course that should be your first line of action.
[00:17:28] And then if it comes back that everything is a okay from a medical perspectivethink about what’s been going on. Is there, a new teacher, a new classroom? And then if you’ve slipped back into bad habits of going in every time and rocking or sleeping in bed or on the floor with the child, it’s time to recalibrate and get back to basics and rebuild those boundaries.
[00:17:53] Craig Canapari MD: Passing out with your hand inside the crib, like that sort of thing. parents accidentally amplify these feedback [00:18:00] loops to say, your kids learn to walk or like learning some new words You hear them on your monitor, they’re talking at night, and then you feel like you need to go in and do something.
[00:18:10] Honestly, they’re not upset. You don’t need to do anything, I would give it a little minute, even if they cry out Don’t rush in because otherwise your kid’s gonna have those natural awakenings at night and then they’re gonna start expecting you, and then that’s when things go off the rails.
[00:18:23] Arielle Greenleaf: A hundred percent.
[00:18:25] Craig Canapari MD: let’s talk about a specific flavor of sleep regression called nap strikes. a nap strike is when a kid has been taking a nap at a certain time and then they start refusing to take that nap. So what are the different things a parent might think about if all of a sudden the a nap that was dependable is not happening anymore?
[00:18:45] Arielle Greenleaf: Of course the first thing they think is, oh, this child doesn’t need this nap anymore. babies dropping a nap that’s super common and expected, they’re going to move from newborn five, four or five naps down to three naps, then to two naps, and then they get into the [00:19:00] toddler ears and they’re on the one nap, and then they’re on no naps.
[00:19:04] That’s when it becomes a little hairy, because a lot of times there is a lot going on developmentally as they move into, toddlerhood. So that two to one nap transition is often rushed because one of the naps is shorter, skipped for a little bit.
[00:19:19] Parents think, okay it’s time and they move to one nap and it’s a disaster. the child maybe just turned two and having a nap strike, and the parent’s oh, it’s time to be done with naps. But then nighttime falls apart, and in reality, the child still needs the nap. I think when we’re talking about infants, it’s different than when we’re talking about older toddlers and preschoolers.
[00:19:44] Craig Canapari MD: Yeah, and we were back and forth about when naps can tend to get dropped. For example, babies that are taking the third nap give it up between six and 15 months, and I got this data from Iglowstein, which is the big paper on pediatric sleep patterns.
[00:19:59] And I’ll talk about some [00:20:00] limitations of that in a moment. And I know you say that usually it’s younger in your hands with your patient populations, like around nine months.
[00:20:07] Arielle Greenleaf: Yeah, and I would say even nine months is pretty late. Once we see those first two naps consolidating more like an hour and a half, two hours each. That third nap almost kind of messes with nighttimeSo when I’m working with people, I’ve even had six month olds just drop.
[00:20:28] You said six to 15 months but, six month olds that are taking, two hour naps during the day and they no longer need that third nap, they just go down again. That’s a higher sleep need baby, to be fair. And so they’re going to bed earlier and sleeping 12 to 13 hours overnight.
[00:20:44] But usually in my experience, no later than nine months, are they going down to two naps.
[00:20:52] Craig Canapari MD: And the limitation of the Iglowstein paper as well is that these were Swiss children. This is a pretty homogeneous group of [00:21:00] kids. And for example, we know that in African American children, they tend to nap later than Caucasian children.
[00:21:10] Arielle Greenleaf: Later in the day.
[00:21:11] Craig Canapari MD: just no. They like, as they get older, kids going from a morning and afternoon nap to an afternoon only nap.
[00:21:19] I think the Iglowstein stuff says 18 to 24 months. And you said younger than that, 13 to 18 months. Iglowstein talked about kids giving up, napping entirely between ages two to four years. And I know you’re saying a little bit later, ages three to five. We have, sometimes pathologized kids who are going to kindergarten and still napping, but that is actually fairly common in African American children.
[00:21:45] So it’s important to recognize with any of these dataset that who are the population of kids that were studied? There are healthy children that nap after school in kindergarten, and we don’t wanna overly pathologize this. We don’t want to get too much in the [00:22:00] weeds here, but the idea that there is a huge range of times in which children may give up their afternoon nap.
[00:22:08] And I think there was a study that came out four or five years ago. It was fairly controversial, saying that in this large dataset, they were showing that a lot of kids, their nighttime sleep improved if they stopped napping after age two. So they actually suggested that If you have a child with either going to bed really late or having disrupted sleep, getting rid of that nap, that single nap after age two may be helpful.
[00:22:32] Now, to me, that’s a nuclear option, right? Because parents really depend on naps for sanity if they’re home with the children. Also in daycare, children of these age groups are expected to nap, and if the child is incapable of napping, it actually can lead to children being asked to believe the daycare.
[00:22:51] Ariel, just ’cause kids don’t wanna nap, it doesn’t always mean that they don’t need to nap.
[00:22:55] Arielle Greenleaf: yeah, there’s a lot there that I have to say [00:23:00] because I get very frustrated. I understand as a parent it’s very frustrating to see the way naps are handled. But at the same time, if you have a room of 12 children and they all have different mapping needs, how do you handle that?
[00:23:14] So what I often see is children that are pushed to one nap far too soon. And then the baby is struggling so badly just to get from that one nap in the middle of the day to a normal bedtime. And in those situations what I do is I have the parent offer the two naps on the weekend back up bedtime, if they can put them down earlier when they pick them up from daycare, which isn’t always possible.
[00:23:43] But those are some mitigating factors that we can, ways around it until the child is ready for that. On the other side of things, like you’re saying I do, I have seen many times naps interfere with bedtime and [00:24:00] overnight sleep. someone will come to me with a two and a half year old, or a three-year-old.
[00:24:04] She naps great. She sleeps two and a half hours during the day, but then she won’t fall asleep till 10 o’clock at night and then she’s up at six in the morning. ​
[00:24:14] And in those cases I say can we first start by capping the nap or changing the time of the nap?
[00:24:19] sometimes if they’re able to, I find out that the nap isn’t ending till 5:00 PM or something like that. If we can back the nap up and have it starting at noon and they’re up by two, playing around with those things can work. But I’ve definitely seen and understand why that study would say that.
[00:24:36] I’ve seen sometimes dropping the nap entirely. This child is taking a two hour nap and sleeping eight hours overnight. You drop the nap and then suddenly they’re sleeping 10, 11 hours overnight. And things have improved drastically.
[00:24:49] Craig Canapari MD: The classic presentation to me of a kid who’s ready to give a get rid of the nap is a kid that’s in daycare. They take the nap ’cause every other kid in the school is taking the nap.
[00:24:58] But when they nap in [00:25:00] daycare, they’re up to 10 o’clock at night and then the weekends they don’t wanna nap because they like to hang out with their parents and they go to bed at a normal time. And that’s usually a little bit of an older kid, like a three or 4-year-old. But and those situations, I feel like I’m a little bit more successful in getting the preschool or the daycare to offer some alternative activities because, a 3-year-old can, self-regulate a little bit better than a 2-year-old.
[00:25:24] They’re less to be disruptive.
[00:25:26] Arielle Greenleaf: Yeah. In some states, I know in Massachusetts, There’s you can provide a nap time bag if you are asking the daycare to keep the child awake, you provide some quiet activities for them to do on their own when everybody else is napping.
[00:25:44] like a tambourine and a whistle and stuff like that.
[00:25:46] some drums, play drums, a whistle all of that stuff. ’cause a lot of times children just follow the group and the room gets dark and they might put on some soft music or some white noise [00:26:00] and it’s hard not to fall asleep at that time.
[00:26:03] And then it can get in this weird cycle too, because they fall asleep because their nighttime sleep has become shortened. So they’re tired from their shortened nighttime sleep by the time nap time comes around. But then you have to undo that cycle ’cause it just keeps going forward.
[00:26:20] sometimes I can have the parent speak to the daycare provider and they do make accommodations to keep the child up. Not every daycare is gonna be able to do that. Sometimes I will speak to, have them speak to their pediatrician and get a note if it’s really causing some problems.
[00:26:36] A lot of times staff is taking lunch, they switch on and off. So it does become tricky when daycare comes into play.
[00:26:45] Craig Canapari MD: Here’s another one on your lists of myths. Putting a baby to bed later will make him sleep in later.
[00:26:52] Arielle Greenleaf: I know, Many babies and children are going to bed way later than they should, which is then having negative [00:27:00] impacts on their sleep. it often results in a much earlier waking than a later waking.
[00:27:04] But I know that you recommend, bedtime fading where you’re putting them to bed a little bit later and helping them fall asleep faster, and then perhaps, falling asleep or staying asleep longer. I think this goes into the idea of the next thing I put down, which is desired wake time.
[00:27:25] So of course every, every I, and I don’t know where that. That ca that phrase has to have come from sleep. Consultants like that can’t possibly be something from medical literature desired wake time. I would love for my child’s desired wake time to be, 8:30 AM on the weekends and 6:30 AM so she’s up for the bus on the weekdays.
[00:27:50] But we can’t, these children are not robots and we have to look at what is age appropriate. And I think that’s where I get hung up to [00:28:00] with putting them to bed later, help ’em sleep later. It’s not necessarily because you’ve even shared that age appropriate wake time is much earlier than you might think.
[00:28:09] And so if you want the child to get enough sleep overnight, they’re probably gonna have to go to bed a little bit earlier because they’re programmed to wake earlier.
[00:28:19] Craig Canapari MD: Oh yeah. No I would agree. the bedtime fading, a sleep training technique for a child having a lot of difficulty with sleep wi with sleep onset, sometimes temporarily moving bedtime later can help, if people are having like two, they’re taking two hours for their kid to fall asleep, it can be helpful, but usually then we’ll ratchet back.
[00:28:40] The time that the child is falling asleep, just incrementally. And I think if parents have to have reasonable expectations about when their kids are gonna wake up because Yeah, sure. I really didn’t want my 13-year-old when he was seven months old to get up at four 30 every morning.
[00:28:57] And that was a little bit out of range, but [00:29:00] getting him to five 30 or six was where we wanted to go. And we did find that slowly moving his bedtime a little bit later did help us get there. I think in retrospect, he just didn’t need that much sleep. you put in input X you’re gonna get output y, right?
[00:29:16] Oh, my kid’s getting up at four. I move their bedtime two hours later, they’re gonna wake up two hours later. It does not work that way at all. I think with careful attention to sleep diaries and Sleep duration, you can tweak this, but you have to recognize that little kids are, most of them are morning larks.
[00:29:32] Now have I seen kids who are not like this? I have families where the parent works an evening shift, the child waits up to see them, and the whole family gets up at 10 in the morning and the kids really adapted to that, It can happen and that works. There’s nothing inherently wrong with that.
[00:29:48] It works well for the family, it’s gonna work less well when that kid starts kindergarten, unless the family makes some accommodations. And I think, desired wake time, I’d say that’s something that maybe you would see more in the [00:30:00] adult literature on cognitive behavioral therapy for insomniaLike I do this all the time with college students, right? Because high schoolers, they all have to get up a little bit too early for their natural biology. For the desired wake time for a college student, I might say when’s your earliest class to nine?
[00:30:16] You, your desired work wait time should be 8:00 AM most days, right? That’s what we’re shooting for and we’re shooting for a bedtime that will allow you to get a sufficient amount of sleep. But I agree that like it’s a little bit of a pipe dream for young kids. This idea that you have a lot of control over when they wake up.
[00:30:32] We could probably have a full session on early morning awakenings ’cause they really are so painful. But I would agree that parents, you might have, you might be able to adjust this a little bit, but if your kid is waking up anytime between five 30 and or seven, that is very typical for an infant and a toddler
[00:30:50] with your first kid, it’s a rude awakening with your second kid, honestly, you’ve probably become by hook or by cook. You become a morning person anyway. So, I wasn’t a morning [00:31:00] person and now I am. Now my kids sleep in and I can’t, so thanks fatherhood.
[00:31:04] they’ve ruined it for me.
[00:31:05] Arielle Greenleaf: I recently had someone say instead of 6:30 to 6:30, which I don’t know where that came from because I would never say we’re going to get your child sleeping from 6:30 to 6:30 again. it’s just so individualized.
[00:31:19] Craig Canapari MD: You’re not hundred percent guaranteeing that your yeah, like every day, six 30 to six 30, just put it and then yeah.
[00:31:25] Arielle Greenleaf: Okay. I, they said how about 8:30 to 8:30? And I’m like, my 9-year-old was always like a 5:30, 6,, sometimes 6:30 sleeper. And only recently did I get her to seven because I basically was like, if you wake up before seven, I am not getting up
[00:31:45] you’re
[00:31:45] not getting your iPad.
[00:31:46] And so strangely, now she’s sleeping until seven or later. But if I could have had her sleeping until seven back in those early days when I wasn’t used to waking up so early, oh, it would’ve been a dream.
[00:31:59] But [00:32:00] it’s, five 30, like you said, and I like to say six to seven because that’s a pipe dream. But five 30 I see a lot. So anywhere between five 30 and six is usually the earliest, Because some kids just really like some adults, they’re early birds.
[00:32:13] They’re going to wake early no matter what. Yeah, the desired wake time thing as well as oh, if I put my baby to bed at 8:30, then she’ll automatically sleep till 8:30, sort of thing. I think that’s just a pipe dream.
[00:32:25] Craig Canapari MD: Yes. And that, that is the nature of parenthood, right? when I was in pediatric residency, did I ever think that I would microwave a plate of pepperoni and serve it to my child for dinner? No, I did not set out to do that.
[00:32:36] But that’s a thing that I had to do because I was a parent. So is your child’s sleep going to be perfect or exactly what you want? Absolutely not. you can expect it to be within a certain realm of quality but it’s not gonna be perfect. And I think a lot of what I do is calibrating people’s expectation about what’s actually realistic?
[00:32:57] Your two year old’s not gonna sleep till 10 on the [00:33:00] weekends. And if they do, honestly, it’d be weird.
[00:33:02] Arielle Greenleaf: Yeah. Agreed. the expectations thing isone of the most important things in my work because There are so many unrealistic expectations all over the internet, all over social media. even going back to the wake windows, I can provide this plan and I can show the data.
[00:33:21] And parents still just like they have it programmed those wake windows and I’m like, just forget you’ve ever seen those wake windows. let’s look at the data from your child. Look what works well for them and it can be very hard to undo all of that.
[00:33:37] Craig Canapari MD: Yeah. And I think it’s as a parent, it’s a real trap sometimes that you have a certain, and look, we see it all. ’cause I work with children with a lot of. Pretty severe medical issues is like a parent has a certain amount of they’ve imagined how things are always gonna be. And it might be something really simple that unfortunately they don’t get to have a child that’s developmentally normal or a child that doesn’t have some significant health problem.
[00:33:59] But [00:34:00] it can also be a sort of be set of behaviors or expectation and, you can maybe nudge your child into a certain direction, but they are who they are.
[00:34:07] Arielle Greenleaf: I think that’s sometimes a rude awakening for people. you see your friends and maybe you have two friends whose babies can come to brunch and sleep through the whole brunch and then go for a lovely walk And then you try to bring your baby to brunch and the baby’s screaming the whole time what is going on?
[00:34:24] And it, it’s just like you said, or we discussed earlier, I think, you just, parenthood is an, is like a real eye opener to like. The fact that you only have so much control this person is an individual we can provide certain guardrails and boundaries, but they are who they are and we have to, adjust to them because they probably aren’t going to naturally adjust to our lifestyle.
[00:34:54] Craig Canapari MD: Look, here’s my hot take. Parents brunch is over when you have a baby. I don’t think [00:35:00] I’ve been a brunch honestly, since my kids were born. Maybe once or twice. Even when they’re older, they have no interest in a leisurely meal that’s sometimes between breakfast and lunch. It is a concept that is totally unappealing to children.
[00:35:12] I think I went to brunch once for one of my birthdays. We went out in Brooklyn and my kids were older. It was fine. It was weird. They were showing one of the alien movies on the TV screens there, my kids thought that was pretty cool. People ripping out of people’s chest and stuff. Yeah, new York’s weird.
[00:35:28] let’s hit our last thing because so we keep on time here. Never wake us sleeping, baby or child.
[00:35:34] Arielle Greenleaf: Okay.
[00:35:35] Craig Canapari MD: Is this something that parents should never do? Is this a third rail of parenting?
[00:35:41] Arielle Greenleaf: Okay, so if you’ve got that child who is say there, three years old and they take, they wanna take a three hour nap, but then that means bedtime isn’t until 11:00 PM or something.
[00:35:54] If they do that, you’ve gotta start looking at it. correct me if I’m wrong, but overnight sleep is [00:36:00] more restorative than daytime sleep. Is that accurate?
[00:36:02] Craig Canapari MD: So I think that in general, for your average healthy adult, that’s the case. you get to deeper stages of sleep and the longer you sleep, the longer you get through the different cycles of sleep, like REM sleep, slow wave sleep, et cetera. In kids, it’s a little bit different.
[00:36:18] They might actually pass those deeper stages of sleep. But I would agree with you, if it’s mucking with the bedtime sleep. And the classic example of this is a kid that gets picked up at daycare, they fall asleep in the car at five o’clock, the parents take 30 minutes to drive home and then
[00:36:33] The kid’s gotten into a deep stage of sleep, the parents have trouble waking them up and then bedtime’s a disaster ’cause the kid just isn’t tired. So I would say that. If you are really struggling with bedtime, especially in a toddler or preschooler, you gotta look at limiting that nap. And especially late in the day.
[00:36:50] Arielle Greenleaf: I don’t think most kids after 18 months of age should be napping after 5:00 PM yeah, I would back that up. Usually I [00:37:00] say 5:00 PM for like the infants, because even with infants after 5:00 PM can really start to cause issues. When it comes to those toddlers, if they nap after 3:00 PM
[00:37:10] sometimes it’s a disaster.
[00:37:12] most of the children that I’m working with past 18 months need to be woken. Certainly no 3, 3 30 at the very latest. And I guess it also depends are they on one nap or two? Because if they’re on two naps, you definitely need that.
[00:37:32] you have to look at the sleep needs and the later than NAP gets, like you said, it’s harder at bedtime. And if a child is older, then they’re going to have, they’re going to need more time to build up that sleep drive than a baby that falls asleep at five, from five to five 30.
[00:37:48] Like maybe they can stay awake for another two hours or something and then go to bed. But if you have a two and a half year old that’s waking up at five they may need another four or five hours before they can fall back to sleep [00:38:00] normally. And that’s when you start to look at the timing and then the length, the duration,
[00:38:05] So that’s, never wake a sleeping baby. in the newborn stages many babies have day and night confusion. It’s very common for a new baby to not have any idea, they don’t have, their goal is to eat, gain weight sleep and poop,
[00:38:23] Honestly, those are on my list of goals as well
[00:38:25] yeah, I guess those are pretty basic needs.
[00:38:27] but with newborns. Sometimes you find that they are wanting to sleep long stretches during the day. So during the day, they want to take four or five hour naps, and then during the night they wanna wake up every two hours to eat.
[00:38:43] so one of the things that I recommend is waking your newborn about every two hours during the day to feed them, get them out in the sunlight. We know that sunshine that light and dark play a big role in the development of melatonin and circadian rhythms. [00:39:00] So if you’re able to just get them up, feed them, it can start to change, things around so that daytime becomes more like waking every two hours and nighttime there are longer stretches.
[00:39:11] It can take some time. But it is something that I recommend at that age as well.
[00:39:16] Craig Canapari MD: Yeah, no, I think that’s really good advice. Baby’s natural circadian drive is not gonna emerge till four to six weeks of age, but you still have some control over this, right? They can still learn.
[00:39:26] Arielle Greenleaf: Yeah, totally.
[00:39:27] Craig Canapari MD: so I just wanna hit our last two and actually, we’ll finish with the teenagers, but let’s talk about this one.
[00:39:31] This one is I don’t know if I, you still, I don’t live as much unlike the sort of mom social media as I did when my kids were younger and I was blogging more regularly. But this idea of sleep training being selfish. Used to have a lot of currency. I feel like I don’t DI mean, does it still,
[00:39:47] Arielle Greenleaf: Yes.
[00:39:49] Craig Canapari MD: we could talk about this all day, but I would say that, moms and dads if you are, absolutely miserable and it’s appropriate for you to sleep, train your child.
[00:39:58] There’s lots of good reasons why you should do [00:40:00] it. you’ll be a better parent to your child. You’re gonna enjoy them more. You’re gonna have less of a short fuse. this is such an interesting study that somebody shared online actually looking at. Mothers driving with babies with insomnia and babies without, and they found that the mothers of infants with insomnia, they had on a standardized driving test, they had greater lane deviation, higher maximum speed, and poor self ready driving behavior.
[00:40:27] The fact is, this is really a safety issue, not just for you, but also for your children. And if you are so sleep deprived, you can’t drive safely. Not only should you not feel bad about doing something about that, it’s actually urgent that you do. Again, there’s lots of different reasons. We know also that poor sleep in infants is associated with maternal depression in the first year of life. I authorize you to meet with your pediatrician and get started on this issue. It really is very important.
[00:40:58] Arielle Greenleaf: I think you [00:41:00] understand that. I see it almost every day. And sometimes it’s babies and other times it’s my 3-year-old, I’m sleeping on the floor of my three-year-old’s room because that’s the only way that that anybody can get any sleep.
[00:41:12] But I’m not really sleeping well He’s waking up multiple times a night just to make sure I’m there. you’d be shocked at the number of replies that simply say, oh yeah, my 6-year-old, my 10-year-old still sleeps with me because that’s the only way anybody can get any sleep.
[00:41:30] That’s a choice for people to make. But the undertone there is that drawing boundaries, which is essentially what we’re doing when we’re sleep training a three-year-old. We’re teaching them the rules with love and care involved and they learn really fast. the undertone is that, oh, you’re going to basically damage your child.
[00:41:54] Or your child needs you so badly, they need you overnight. And they’re only little for so [00:42:00] long. And I think this can cause people to feel guilty and second guess themselves.
[00:42:06] Craig Canapari MD: When is it going to change? Do I just need to give up and realize that parenting is this hard and unmanageable. I honestly think parents deserve not to be miserable. there’s gonna be bad days, right? But if your life is structured, if your child’s behavior is making you miserable, get some help it doesn’t have to be that way.
[00:42:26] It’s hard being a parent, sometimes people that are tired have so little energy to make positive changes they want things to be better, but they, it’s hard for them to actually overcome inertia to get things going.
[00:42:38] But I encourage you, if you are struggling, get some help. Everybody needs help sometimes.
[00:42:44] Arielle Greenleaf: Absolutely. there’s another study that was interesting that I saw. It was a recent study about how. Moms groups actually increase cortisol levels of mothers that are in these moms groups, these [00:43:00] Facebook
[00:43:00] Craig Canapari MD: Oh my God, really
[00:43:01] Arielle Greenleaf: Yes. And I was like that’s really interesting because they are
[00:43:05] Craig Canapari MD: Oh my God. Yeah. This is what we can start to say. Yeah, I’ve had people tell me that my profession is abusive to children and I should be, someone should call CPS on me. Or Child Protective. Yeah. Child Protective Services or department of Child and Families. we have to look at the bigger picture here because there’s so many studies about the importance of sleep in all ages of children, and of course, adults.
[00:43:33] Arielle Greenleaf: So why do we continue to look at it as a selfish thing when we know it’s essential for our overall health, physical and mental? I don’t understand why it becomes this controversial thing.
[00:43:48] Craig Canapari MD: Let me close with one of my hobby horses. we’ve only talked about little kids here, but really there’s a lot of sleep challenges throughout childhood. And I work a lot with teenagers with sleep [00:44:00] issues. And specifically there’s this myth that there’s been a lot of research that your average American teenager is sleep deprived.
[00:44:08] We’re talking 60, 80% of American teens are getting less than eight hours of sleep on school nights, if we said that, 80% of teenagers didn’t have. Access to adequate food or clean water it would be a national emergency. The driver of this structural sleep deprivation is the average start time for high schools in the US is early, especially true in the Northeast, where I think in Connecticut, our average start time is like seven 20 or seven 30.
[00:44:40] Arielle Greenleaf: Yeah, that sounds right.
[00:44:42] Craig Canapari MD: When people move into adolescence, they, their sleep schedule shifts two or three hours n na, naturally later. And this predates smartphones, Xboxes, Fortnite, what have you. This was demonstrated in the nineties by Mary Carskaddon. And in spite of this, [00:45:00] if you look at most school districts, school gets earlier for high schools versus elementary schools.
[00:45:06] So the result of this is you have a population of teenagers who have no control over their schedule, who naturally are going to sleep later and their school is getting up earlier and they’re getting squeezed into chronic sleep deprivation. I’m involved with a national organization called Start School Later that has actually made a lot of headway.
[00:45:27] some states now have start time laws. California passed one a couple of years ago High schools and middle schools shouldn’t start before 8:30. I think Alabama actually just passed a law. There’s a ton of evidence for this. I’ve advocated a lot of places and I hear from parents, teenagers can just go to bed earlier.
[00:45:43] And the fact is they really can’t. If you have a teenager, say in my district, there are some kids that have to get on the bus by six in the morning to get to the high school on time. So they have to get up at five 30 in the morning. For them to get a sufficient amount of sleep, [00:46:00] they need to be a, not in bed, but asleep by nine or nine 30 at night, which is just not happening between homework and their natural biologic drive.
[00:46:09] It doesn’t mean that teenagers shouldn’t be responsible stewards of their own sleep. Like they shouldn’t, my kids don’t have their smartphones in their rooms. They’ll tell you as a, it’s not a picnic being the teenage child, of a sleep doctor, I’m tough with sleep structure and stuff on them.
[00:46:25] But we also have to create a more sleep friendly society for teenagers. We used to do that for a lot of parents either too, right? If you’ve got, if you’ve got moms having to go back to school when their kids are six weeks of age, they’re gonna be sleep deprived too. So that’s it for what we’ve got today.
[00:46:42] to wrap this up, this has been the sleep edit. You can find me at Dr. Craig Canapari.com and at Dr. Canapari
[00:46:49] on most social media.
[00:46:50] Ariel, where can people find you?
[00:46:51] Arielle Greenleaf: people can email me at ariel@arielgreenleaf.com or find me on Instagram at Ariel [00:47:00] Greenleaf.
[00:47:00] Craig Canapari MD: Okay and if you found this useful, please share this with your friends. We’re just getting this started and really appreciate your listening.
[00:47:09] Arielle Greenleaf: Thanks so much for listening to the Sleep edit. You can find transcripts at the web address Sleeped show. You can also find video of the episodes at that address as well as in my YouTube channel. You can find me at Dr. Craig canna perry.com and on all social media at D-R-C-A-N-A-P-A-R-I. You can find Ariel at Instagram at Ariel Greenleaf.
[00:47:40] That’s A-R-I-E-L-L-E-G-R-E-E-N-L-E-A. If you like the flavor of the advice here. Please check out my book. It’s Never Too Late to Sleep. Train the Low Stress Way to high Quality Sleep for babies, kids, and parents. It’s available wherever fine books are sold. [00:48:00] If you found this useful, please subscribe at Spotify or Apple Podcast and share it with your friends.
[00:48:06] It really helps as we’re trying to get the show off the ground. Thanks.
[00:48:11]