EP 87: Summer Sleep Struggles & Solutions with Dr. Olivia Kessel

Please excuse any errors from this autogenerated transcript

Dr Olivia KesselHost

00:06

Welcome to the Send Parenting Podcast. I'm your neurodiverse host, dr Olivia Kessel, and, more importantly, I'm mother to my wonderfully neurodivergent daughter, alexandra, who really inspired this podcast. As a veteran in navigating the world of neurodiversity in a UK education system, I've uncovered a wealth of misinformation alongside many answers and solutions that were never taught to me in medical school or in any of the parenting handbooks. Each week on this podcast I will be bringing the experts to your ears to empower you on your parenting crusade. Welcome back to our Summer Pocket Rocket series on Bite Size Podcast, where we're going to address the real challenges and opportunities for raising neurodiverse kids during the holiday season. I'm Dr Olivia and in this third week we're going to explore the importance of sleep and how exercise can play a role in sleep to keep our wonderfully wired children in balance and better equipped to face any challenges during the long summer days. Speaking from experience, both sleep and exercise can cause kind of fall by the wayside during the holiday season. It's easy for routines to slip and you know, with the long, light-filled summer evenings it's harder to go to bed. Bedtimes can stretch later and later and if your child is like my daughter, she wakes up at the same time, no matter what time she goes to bed, which is early, around 5, 5.30 in the morning, so that usually equals one sleep-deprived little girl. Also, physical activity At school they run around the playground. They have scheduled exercise. This can also come to a grinding halt during the summer holidays, especially if you're juggling working from home and childcare. Sometimes it's just easier they're on the screens and it's hard to motivate them to get up and go and get some exercise. So I know with my daughter if I say go play outside, no, I want to be on Minecraft. So it's something I usually have to do with her. I think all of us would agree, though, that having a good night's sleep and having regular exercise actually play a major role in our children and even for ourselves kind of equilibrium and ability to cope with the day.

02:21

With Alexandra, I mean, I have struggled for years. I wondered if you know what was wrong actually, because you know, I remember people in my baby group saying oh um, my child's sleeping through the night. Well, mine wasn't. And then, year two, she still wasn't. Year three, year four, year five, it wasn't until she was 11 that I understood that, actually the fact that she was finding it so difficult to go to sleep and actually stay asleep was part of her neurodiversity, it was part of her ADHD, and it wasn't until that light bulb moment that I have actually been able to implement solutions that have actually really, really helped now in terms of her getting to sleep and staying asleep. It's not perfect. We still have issues. We had an issue last night. She had a nightmare the night before and she was really anxious about going to bed. It took us about two hours to get to sleep. So none of these solutions are perfect, but we've come a long way and I think the first key in that is understanding that actually being neurodiverse affects our sleep.

03:22

And actually what's interesting is actually around 70% of kids with ADHD have sleep issues and around 40 to 80% of children with autism have sleep issues, and when you look at the research between both autism and ADHD, there's a lot of similarities between why they're having challenges sleeping. So if we look at the kind of key factors one in both autism and ADHD and other neurodiversities I would imagine as well is this difficulty falling asleep really really struggling and huge nighttime routines, huge anxieties. In both cases their brains are more active and making it really hard for them to wind down. At the end of the day they can be restless. They can have thoughts racing through their head. The anxiety can almost get amped up when they're laying in their bed by themselves. Also, sensory sensitivities can really play a role. So noises, lights in the room, how the bedding feels, can all make it very hard for them to relax. And then when they do finally fall asleep, they can have restless sleep. So they might toss and turn, have fragmented sleep, and that all leads to those frequent wakenings. It disrupts the sleep patterns which we're going to discuss in a little bit, and that then makes them not get the right kind of sleep that they need. So they wake up feeling really tired.

04:46

In ADHD they also have what's known as a delayed sleep phase syndrome. So that means kind of that they tend to fall asleep much later than their peers excuse me, not pairs and so they therefore wake up later. It's not true with all kids with ADHD. My daughter's in that way. She, you know I need to put her to bed really early because she wakes up really early. But I know from a lot of clients I talk to and people that I know that their children stay up really late, and that's an issue In both autism and ADHD.

05:15

Waking up frequently during the night is so common. They can wake up multiple times and I know for me this almost killed me, because I need my sleep really badly too, and so constantly be woken up is really difficult. And when they do wake up, they have a heightened level of arousal, physical restlessness, they might've had a nightmare. It disrupts the sleep cycle and then it really makes it hard for them to not only go back to sleep but to get into that deep sleep that they need to reboot and have a good next day, that deep sleep that they need to reboot and have a good next day. Interestingly, in both autism and ADHD they have shorter sleep durations. They tend to sleep less than their neurotypical peers. It's a combination of the trouble falling asleep, staying asleep and waking up early, despite late bedtimes, can result in a total lack in terms of their amount of sleep, and this makes the next day more challenging and it becomes almost a vicious cycle. One of the key thing that's really interesting in both ADHD and autism is the abnormalities in melatonin levels in both, and for those of you who don't know what melatonin is, it's a hormone that regulates that kind of sleep-wake cycle, and irregularities can lead to difficulties falling asleep and maintaining sleep, and studies have shown that these children have a kind of different sleep architecture, which means the structure and stage of their sleep cycles can actually be atypical because of these difference in melatonin levels. So let's take a step back. So hopefully now I've clarified that it's actually part of being a neurodiverse child that sleep can be a real issue for some of the reasons that I've just explained.

06:58

But what does it mean to get a good night's sleep, and how much sleep should our children be getting? Well, if your child is between one and two years old, they're going to sleep a lot. They're going to sleep 11 to 14 hours, including naps, and as they get older that time is going to decrease. So from three to five years old, they're going to get 10 to 13 hours of sleep, and that includes naps as well. And then as children get older again in the bracket between six to 12 years old, they should get around nine to 12 hours sleep. And then teenagers 13 to 18, eight to 10 hours of sleep, which is around what I think adults get. I think adults should get around eight hours sleep. I personally prefer nine, but I'm lucky if I get that. So that's the amount of sleep our children should be getting.

07:44

And then I mentioned earlier about the stages of sleep, and this is really important because we need all the stages of sleep. So we have non-REM sleep and that's for non-rapid eye movement sleep. So and that's broken into three stages. Okay, stage one is light sleep. This is the transition between wakefulness and sleep. It's that light sleep where you know if you make a noise going out of your kid's bedroom, they wake up, startled, you know. So they're really just under the level of consciousness. They then move into stage two, which is still considered a light sleep, but it's characterized by their heart rates dropping, their body temperature dropping and they're starting to prepare to enter into deep sleep.

08:32

And stage three of non-REM sleep is known as deep sleep. Of non-REM sleep is known as deep sleep and it's also known as a slow wave sleep and it's the deepest stage of non-rapid eye movement sleep. This is the most restorative part of sleep. It's where the body repairs, regrows tissues, builds bones and muscles and strengthens the immune system. So this is a really key stage, that stage three of deep sleep. Then we also have rapid eye movement sleep, and you can sometimes see this. Your kids' eyes will move. You can see it on your pets too, when their eyes are moving and it's characterized by rapid eye movement and it's an increase in brain activity. And that's when you have your vivid dreams and, despite having the heightened brain activity, the body itself remains relaxed and doesn't move. And what REM sleep is crucial for is cognitive functioning, so memory, learning and emotional regulation. So we need both our non-REM sleep and our REM sleep.

09:42

So how do we cycle between these different stages? Well, a typical sleep cycle in children lasts about 60 to 90 minutes and it progresses first of all in the non-REM sleep Stage one, that light sleep is a few minutes, then stage two, that slightly deeper light sleep is about 20 to 30 minutes, and then stage three, that really restorative deep sleep is about 20 to 40 minutes, and then they go into the REM sleep for around 10 to 20 minutes and they keep cycling through these stages multiple times during the night, and the proportion of deep sleep is higher in the first half of the night, whereas the REM sleep increases towards the morning. So you're going to have that restorative bone muscle growth in the beginning of half of the evening and then in the second half. That's where you're going to have those dreams of the evening, and then the second half, that's where you're going to have those dreams and that's where you're going to have your cognitive functions, such as memory, learning and emotional regulation, get its kind of needed time. So it's really interesting.

10:48

So what happens in our kids who are waking up multiple times during the night to these kinds of sleep cycles? Well, it can disrupt those sleep cycles in several ways. So you're going to have a reduction in that important deep sleep which is so crucial for physical restoration and growth. You're also going to have interrupted REM sleep, so that's going to affect cognitive functioning, mood regulation the next day and memory consolidation. So you can see how important sleep is. And then finally, waking up frequent times means that they have fragmented sleep. So overall, this can lead to daytime sleepiness, irritability and difficulty concentrating. So I think it's really crucial because understanding the sleep cycles and then we all understand that when our child hasn't had a good night's sleep, or when we haven't had a good night's sleep, that the knock-on effects of that the next day we're more likely to get upset, so are our children. We're grumpy, we're irritable. But understanding that it's actually those sleep cycles and not spending the right time in those sleep cycles kind of makes it really clear and, at least for me, has highlighted how important sleep is it really clear and at least for me, has highlighted how important sleep is. So I mentioned earlier that both in autism and ADHD they can have lower levels of melatonin.

12:05

So how can melatonin help our children with these sleep cycles? Because oftentimes and I know this happened with me and Alexandra we took a lot of advice on sleep routines, on having the same routines, you know, decreasing screen time before going to bed, relaxing before getting to bed. We did everything we possibly could. I reached out to sleep specialists around the world. Actually I tried everything and nothing was really working until I discovered melatonin and it's a naturally occurring hormone.

12:40

Melatonin it's in all of us and it can really help in terms of exploring how we can better help our children to sleep. So it's produced by the pineal gland in the brain and plays a pivotal role in regulating the sleep cycle. For children who struggle with sleep, whether that's due to ADHD, autism or other conditions, melatonin can really help bridge that gap. So in children, the production of melatonin it can be disrupted due to various factors. So the fact that they have irregular sleep schedules, exposure to screen times, delay in terms of melatonin production all of these can lead to problems with sleep.

13:26

So how does melatonin actually work? Well, first of all, it adjusts the sleep-wake cycle so it can help reset a child's internal clock, especially if they have irregular sleep patterns. For children to fall asleep at a conventional time, melatonin can signal to their body that it's time to wind down and prepare for sleep, so it can really help in terms of when they start going to sleep. It can also reduce the time it takes them to fall asleep and help them to stay asleep. And I know, you know, alexandra, when she got diagnosed with her ADHD, she was prescribed melatonin and it really was life-changing. And she's being prescribed a dosage that they start a really low dose and then, if you need to, you can increase it, but it's a fast acting and then it's a slow acting so that it keeps her sleeping throughout the night. It's not like a sleeping pill, it's just helps her reset her own rhythms and sleep cycles. So it's made a dramatic difference in terms of going from like two, three hours taking to go to sleep at night to now she goes to sleep. It usually takes about 10, 15 minutes, if I'm honest. You know there can be if there's other things going on that that can change. But we usually take her melatonin same time every evening 6.30, and by 7.30, 8 o'clock she's going to sleep. So and then she's staying asleep.

14:55

Actually, for the first time in my life actually sleeping through the night, I mean getting a full night's sleep, both of us. It has been. It's changed my world. I mean it really has. It's changed both of our worlds. It's not always perfect. There are things that can come and arise that you know can override it. It's not perfect, but it has made a really, really big difference. So I think it's worth exploring and it's worth learning more about to see if it would work with your child.

15:25

Because of all the reasons sleep is important, using a hormone that is melatonin that can help is really really been key for us. Anyway. Now, in the UK you have to get it by prescription. In Europe and America you don't. Uk, you have to get it by prescription In Europe and America you don't. But I think it's also really important to have that kind of oversight from a clinician as well, and we always make sure to give it at the same time every day. You know it doesn't always, you know, if your child is super anxious about something. Alexandra had a nightmare the other night and last night she was super, super anxious about going to sleep and so it took a couple of hours, but then, when she eventually did get to sleep, she stayed asleep for the whole night. So I think, you know, nothing's perfect, but it's definitely one of the tools in my tool chest which have been most helpful in helping us to get a good night's sleep.

16:22

But another key tool that you can use with sleep and I use this with Alexandra as well is exercise. So why is it important to have exercise? Well, you know, regular physical activity can really really profoundly not only, you know, affect physical health, which of course it does, but it really profoundly impacts mental wellbeing, especially with children with neurodiversity. So I've noticed that the more exercise that I can get Alexandra to engage in, the more she is able to, the more she is able to face her challenges. I've noticed a improved focus and attention, and actually research has shown that it exercises increases the level of neurotransmitters like dopamine and norepinephrine, which are decreased in both autism and ADHD, and these chemicals play a vital role for focus and attention. A study published in the journal of Attention Disorders found that children with ADHD who participate in regular physical activity showed improvements in attention, executive function and behavior, and I would say that that would align also with autism. You can also see a reduction in hyperactivity, because it helps children to channel their energy constructively, and in both autism and ADHD, exercise can really enhance executive functioning, which includes those skills that we've talked about before planning, organizing, impulse control and it can really help enhance these skills and studies have shown. Numerous studies have shown that exercise actually has a significant improvement in executive functioning and academic performance.

18:08

So incorporating regular exercise also is incredibly crucial for sleep quality and the duration of sleep. The scientific evidence really shows this. It shows that exercise can help regulate those sleep patterns we discussed. So just similarly, like how melatonin works, it helps to regulate the body's internal clock, or that circadian rhythm, and that regulation is essential for getting that consistent sleep-wake cycle. According to the National Sleep Foundation, physical activity can help children fall asleep faster and enjoy a deeper sleep, and remember that deeper sleep is the restorative sleep. So you know I've noticed it with my daughter that it really, really plays a huge role as well.

18:50

It also can help reduce anxiety and stress, and those can also be co-factors in why your child isn't able to go to sleep. Physical activity is a natural stress reliever because it releases hormones such as adrenaline and cortisol, and it can. You know there was a study what was it? It was in the Journal of Clinical Child and Adolescent Psychology that found that exercise significantly reduced anxiety levels in children with neurodiversities and therefore contributed to better sleep quality. It also helps to promote relaxation because of those endorphins that are released that are natural mood lifters. These can give you a sense of wellbeing and relaxation and it's easier then for kids to wind down at night.

19:35

And I know, speaking personally as well, I find that, you know it just takes down everything a notch, both for my daughter and for myself. Now, you know it's hard. You know it's one thing to you know. I think we can all agree with the scientific evidence that, yes, exercise is great. It's quite another thing to actually get your child to exercise, especially when they'd much rather be on their screen or hyper-focusing on Minecraft. So it isn't. You know it's not easy. It's not easy in our household, it's just not easy.

20:15

So a couple of strategies that I think are key is one find an enjoyable activity that they really like. So Alexandra likes biking, she likes swimming, you know. She likes dancing, she likes being on the trampoline, you know, whatever it is. Find something that they really engage with. She also really enjoys interacting with me, so if I get involved then she's more likely to get involved. She actually had chicken pox recently and she missed sports day. So we went outside in the garden and we had our own sports day and it was a lot of fun. She taught me how to throw and catch, which I'm absolutely terrible at. So making it something that you guys do together is important.

20:50

And then also back to that consistency thing make sure you do it, even if it's only 20 minutes twice a week. Just do 20 minutes twice a week, and then, when those benefits start ruling out, then it becomes easier to get the children involved, because they start to enjoy it, they start to feel good, they start to want to do it. So start small and then, you know, increase, do what's manageable for you, but be consistent with it. You know, don't do it right before bedtime because it can have a stimulating effect. Do it earlier in the day, you know, or in the early evening, just so that, um, you don't uh, inadvertently, um affect the, uh, the sleep time. So. So sleep is really super important and it's multifactorial. We've discussed melatonin, we've discussed exercise.

21:38

It's also really important to do a couple, three key things as well. One, establish a sleep routine that you do every night, that you do even when you go on holiday or if you're at someone else's house. You do the same routine every night. So we have, we take our melatonin at a certain time, we go upstairs, brush our teeth, we read a story I do tapping on Alexandra, sometimes I light an incense stick and I give her a crystal to sleep with and then she goes to sleep. So, and ensuring that the bedroom is quiet, the right temperature, she has the right blankets on her bed, I leave a meditation on you can use white noise and all of these things make for a good sleep environment. And then it's also important to kind of decrease that screen time before kids go to bed. I don't let her watch her screen for about an hour before bedtime because actually the blue light from the screens can help, can actually interfere with the production of melatonin, but also it's hyper-focusing as well, I think and you know so many parents because I am amazed, actually, because kids text Alexandra sometimes at 9.30 at night and I'm like, why are the kids still on the phone at that time? And I'm not being judgmental, because it's you know. I have, luckily, a really old iPad that she can't do anything on that I play her meditations on. So I take all of her devices out of her room. If I were to leave them in her room she would be on them. So taking away that temptation is a good idea. She would be on them. So taking away that temptation is a good idea. It's not easy, but these are things that you can really do. So three top tips hopefully to take away from this Pocket Rocket series on sleep and the use of exercise is really consistency is the key. Number two is really be mindful of screen time and exposure during bedtime and during the night. And three incorporate exercise, make it fun. So thank you, send Parenting Tribe.

23:46

Next week will be the final Summer Pocket Rocket series, focusing not on our children but on ourselves. I'm going to open up the discussion on self-care and I've had a few guests who've come on the show who said oh, it's just another thing that we have to do. They agree, but they feel like it's another burden. And what I want to talk about next week is that it shouldn't be another burden. It shouldn't be another thing to do on our list of numerous things to do, but really understanding that taking care of yourself is a crucial element for success with your neurodiverse child, because if you don't take care of yourself, you cannot be the parent you need to be for your child. So stay tuned for next week. I think it's going to be an interesting topic to listen to. So thank you for listening to me and joining me today. Remember, maintaining balance with sleep and exercise is essential for our children and ourselves. Until next week, I'm Dr Olivia, wishing you and your family a restful and active summer. Thank you.

09:53