Sleep Well. Live Well.

Sleep Well. Live Well.

The Q&A For The Sleep-Deprived Family

Tired of being awakened at night, by crying babies and your toddler's foot in your face? Does your child refuse to sleep by bedtime? We've got the tips and tricks to help you deal with sleep disorders affecting you and your children. Our CEO, Kristina Lindhe, hosted a webinar with sleep experts Liv Svirsky, and Kristoffer Bothelius, authors of "Godnatt! Om små och stora barns sömn” (which translates to Good night! On small and big children’s sleep). They're both licensed psychologists with extensive experience in working with sleep disorder. Liv is also a specialist in the field of clinical psychology and has worked with children and young adults affected by sleep disorders. Besides holding a Ph.D., in psychology, Kristoffer is also a psychotherapist who researches sleep and sleep disorders.

Here’s a condensed version of the interview for you to glean interesting facts about sleep from. Trust us when we say that this reading will change your perspective on and approach to sleep.

*Please note that the Q&A has been edited for clarity and brevity.

Kristina Lindhe: I’ve read the book, and I have gained a lot from it even though I don’t have young children now. It’s a great book for everyone to read, but it’s especially helpful to parents of young children or teenagers. I can’t recommend it enough.
We notice the importance of sleep especially when we can’t sleep. Kristoffer, why is sleep important?

Kristoffer Bothelius: That’s a great question. All organisms that have a nervous system sleep. Even the smallest roundworms that you find in the compost have a sleep-like behavior. So, sleep seems to be really important. We know certain things happen while we’re asleep that don’t happen when we’re awake; making wakefulness a time for disintegration while sleep one for recovery. It’s also a fact that most of the growth hormones released in a day mostly occur during the first stage of our sleep cycle; the first stage of deep sleep. So, sleep is vital for us adults as it allows us to repair our bodies and cells. It’s also important for children as it enables normal growth and development.

Besides the aforementioned benefits of sleep, there’s a widely known tidbit about sleep’s effect on our immune system. If we’ve been sleep deprived for some time, we can, for instance, easily catch a cold.
There are also things that happen during sleep to transport residual products from the central nervous system. Waste products from the brain are transported away during sleep. So, there are many different parts that are vital to us that happen during sleep.

Kristina: So, if I were to summarize it, you’re saying sleep has a physical and biological function. It’s almost chemical? Is that right?

Kristoffer: Yes. It plays a very important biological role. But it also plays a significant role in us feeling well psychologically. It helps us maintain concentration, consolidate memories and store them in a good way. Sleep helps us become more flexible in our thinking. One of the things that happen when we’re sleep-deprived is that we become more rigid in how we think. We have difficulties thinking outside the box.
Sleep also helps us manage our emotions. It helps us handle difficult things and have a harmonious mood. The phase when dreams occur seems to help us handle troublesome emotions during the day. So, there’s a biological and a psychological aspect to sleep.
Kristina: It’s interesting that we don’t think about this until we’re not functioning. It’s like breathing. We’re not aware of our breathing, but it takes center stage when we can’t breathe. So, what is normal when it comes to children? How much sleep should children of different ages get?

Liv Svirsky: What’s considered to be the normal duration is wide. It’s, for instance, normal for newborn babies between the age of 0-2 months to sleep between 9-20 hours a day. It’s a wide range, but anything within it is OK. The range does get narrower as we grow older. It’s normal for teenagers to sleep between 8-10 hours a day. And adults can sleep between 6-10 hours a day. A lot is considered normal.

Kristina: This is probably an important question for first-time parents. “Should my baby sleep this much? Is it normal? Should we wake the baby up?” Are these questions you come across? Do people ask them?

Liv: Yes. These questions, regarding infants, pop up at pediatric health centers mostly. It’s common to be concerned about whether the baby is getting enough sleep. And I think it’s comforting to know that a lot of different scenarios fall within the norm. Simply put, our sleep needs vary.
Your starting point when making your assessment has to be the child you are dealing with. Consider if the child seems to be feeling well. Is it awake when it needs to be, and is it doing other things adequately? If so, sleep is probably not an issue. So, start there, and don’t compare with people who say “our child sleeps at 7 p.m. and is up at 7 a.m. without waking up once” Don’t buy into that even though that’s also considered to be the norm. Children are different. We’re individual beings.
Teenagers experience fear of missing out which can disrupt their sleep. Parents can combat that by coming together with other parents to establish a common phone policy for the teens at school or the community. For example, everyone should log off at the same time in the evening so that none of the teens feel that they’re missing out on their social life.

Teenagers experience fear of missing out which can disrupt their sleep. Parents can combat that by coming together with other parents to establish a common phone policy for the teens at school or the community. For example, everyone should log off at the same time in the evening so that none of the teens feel that they’re missing out on their social life.

Kristina: But what happens when a child doesn’t get enough sleep?

Liv: You notice when children aren’t getting enough sleep if they’re tired, clingy (if they’re young toddlers), if they’re emotionally unstable or if they start crying easily. As they get older, it gets easier to read them and know when they’re not getting enough sleep. Their behavior can resemble one of a child who hasn’t eaten. Their mood kind of dips. That’s when you should consider if sleep deprivation is the problem.

Kristina: That is also accurate for adults. If we haven’t gotten enough sleep, we become unstable, we can cry or get angry, but we might not relate to a child the same way.

Liv: Exactly. Especially when they’re so young and can’t tell us. That’s when we start guessing.

Kristina: Do you think we should adjust our children’s sleep or should we let it be?

Liv: We’re clear on that in our book. If it’s not a problem, you shouldn’t fix it. If you have a child that seems to be feeling well despite being on the lower side of the normal sleep spectrum and even sleeping less than same-aged children around him/her, you don’t have to do anything about it. Don’t rely on the numbers and think that your child should be on the higher end of the spectrum. But if there’s an issue, if the child is tired, if it’s drowsy during the day, falls asleep at school and so on, that’s when you consider whether you should take action.

Kristina: Do you have anything you’d like to add, Kristoffer?

Kristoffer: I agree with Liv. As she said, you don’t have to worry as long as the baby is feeling well. I do want to note, however, that tired children aren’t always drowsy. Some are hyperactive. People sometimes mistake sleep disorder with ADHD because the child can act in the same manner.
When it comes to sleep disorders, it’s those such as snoring and sleep apnea that you should try to fix. That’s when you need to contact a health care provider. As Liv said, base your judgement on your child’s wellbeing and activity during the day. That’s our best advice.
Other than that, a lot is considered normal, and it really comes down to the parents having to accept that it is what it is. The first years are a period of irregular sleep for the children and parents. That’s something you simply have to accept for what it is.
Your baby's and your bedtime routine should include calming activities such as taking a bath a few hours before, reading a book or listening to soothing music. Any activities you choose to engage in before slumber time shouldn't stimulate your brain too much and should preferably aid in lowering your body temperature.

Your baby's and your bedtime routine should include calming activities such as taking a bath a few hours before, reading a book or listening to soothing music. Any activities you choose to engage in before slumber time shouldn't stimulate your brain too much and should preferably aid in lowering your body temperature.

Kristina: What can parents who still feel the need to help their child get a good night’s sleep do?

Liv: I’d say that step 1A is to establish fixed routines from an early age. Go to bed at a fixed time. Emphasize nighttime by having the children change into pajamas, turning off the lights and closing the curtains. Such activities indicate that it’s nighttime. For older children, you might want to read a bedtime story or sing a lullaby. Establishing fixed routines during daytime is also a good idea. Getting some morning daylight is especially good. Be mindful of folding back the sunshade for infants in strollers so that they’re exposed to enough daylight. Basically, help your children understand that when it’s time for bed, you need to turn off the light, keep the rooms cold and quite when you’re getting ready to sleep.

Kristina: What about children who don’t want to sleep or don’t want to sleep in their own bed? Those are evidently two different problems that many parents recognize in their own children or other parents’ children. What do you believe should be done in those cases?

Liv: Just like Kristoffer said earlier, sometimes you simply have to accept the situation and just bear with them. Especially when it comes to younger children… accept that this is a time in your life when you all sleep together, when you’ll be awakened at night, you won’t sleep in separate bedrooms or beds, and you’ll wake up with a tiny foot in your face.
A lot of people, will, in retrospect, say it was a cozy time. So, try to think about that future perspective today, and realize now that it actually is cozy to sleep together.
However, if you do want to establish those boundaries of separate bedrooms and beds for the child, then you need to be consistent. You just have to decide that you’re going to do it. The methods aren’t really difficult. If the child is supposed to sleep in its own bed, then put it down in its own bed. Make sure it stays there through the night even if the child wakes you up to drink water multiple times at night, go to the bathroom, wants you to sing a lullaby again or cries for you. That will all eventually subside.

Kristina: Don’t try to cheat your way out of the bedtime story.

Liv: And don’t say “I don’t have the energy for this today, so let’s allow David to sleep in our bed.” You should be committed to the decision. You will have a few difficult 24-hour days during this time.
Kristina: Kristoffer, when you mention children who can’t sleep, it naturally brings us to “sleep windows,” a subject you cover in your book. They’re something a lot of parents ponder. I know that you have opinions about sleep window, what are they?

Kristoffer: There are a lot of myths about sleep windows, how to sleep and when to sleep. One myth a lot of adults hear is that the sleep we get before midnight is most critical. That can be a stressful myth if you haven’t fallen asleep before midnight. There’s no evidence supporting that myth. There’s no such thing as sleep windows. However, it can be stressful when you think about it and believe you’ve missed or are about to miss your or your child’s sleep window. So, these myths are not as helpful as they are stressful.
You made a pretty good comparison earlier between sleeping and breathing. Just like breathing, sleep doesn’t require action. There is a biological control system that signals to us if and when we should sleep. The problem lies in the need to regulate or overdo it when it comes to sleep. We can’t really manage sleep performance, and we can’t force our children to sleep. We can optimize their sleeping condition, but we can’t do anything to actually make them fall asleep.
That means having a fixed bedtime for your children. Make your judgment based on the time rather than the behavior the child is displaying. For most children, the best bedtime is between 7 p.m. and 8:30 p.m. So, choose a time and stick to it.

Kristina: I’d like to talk about teenagers. Teenagers are kind of like babies in that they want to sleep a lot. What do you do about that? It usually frustrates the family, but at the same time family members want to respect their teenagers’ boundaries. What should parents do about teenage sleep issues?

Liv: In adolescence you have a delayed sleep cycle. You get tired later in the evening and want to sleep longer in the morning. American sleep researchers recommend starting later in the morning, so teens are more alert in school.
Another reason teenagers will stay up is simply for social reasons. They want to hang out late at night which, of course, results in them getting tired in the morning. So, there are both biological and environmental factors that come into play here.
Many teenagers tend to feel that they’re missing something if they log off. One piece of advice we usually offer is that the parents, in a school or community, come together and establish common curfews. For example, everyone should log off at the same time so that none of the teens feel "everyone has a social life now, and here I am lying in bed and trying to fall asleep." Instead, it’ll be easier for them to relax since everyone has logged and they won’t miss anything.
Kristina: Kristoffer, do we have questions from the viewers?

Kristoffer: Yes, there was a question about physical activity during the day. “Can more physical activity during the day help make children more tired? And that question applies mostly to older children.”
You might want to see sleep from a 24-hour perspective. What happens during the day will also affect how you sleep at night. One such clear factor is the level of activity. A higher activity level during the day, both physically and mentally, helps us sleep better at night. There is something called local sleep— i.e. different parts of the brain sleep at different depths simultaneously. The parts of the brain that have been more active during the day will actually be able to sleep deeper during the night than the other parts. So, yes physical activity during the day seems to be very, very good in enabling us to sleep well.
However, what you should keep in mind is that it should not be too late in the evening. Late-night physical activity tends to make it difficult for us to fall asleep. So, preferably in the morning, preferably outdoors or in the early afternoon. But yes, it's just good.

Kristina: I would say that applies to us adults as well. Physical activity is good for us.
Well, I think it's time to round up here. I want to thank Kristoffer and Liv for joining us. This subject is very interesting and close to many people’s hearts, that’s why more knowledge is needed in this area. I would like to take the opportunity to urge you to read this book if you have any questions because you’ll find a lot of answers in it. Thank you very much for wanting to come and for joining us and thank you from us here at Lexington