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Coffee and Chat: The ABC’s of Sleep with Jan Jenner

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Top Tips for Sleep

In a Children’s Occupational Therapy practice, many parents tell OTs that they feel they could cope better if they just got more sleep. When I heard about Matthew Walker’s “Why We Sleep” book from a colleague on a course, I bought it and read it cover to cover. I then shared it with everyone in my life struggling with sleep because this book links sleep with mental health, physical health and sleep through the lifespan.

Here are “Why We Sleep” top tips for sleep hygiene from the appendix- is you want more information about why for any of these tips, go back to the book and dig deeper:

1)    Stick to a sleep schedule: go to bed and wake up at the same time each day as people have a hard time adjusting to changes.  Sleeping in on weekends can’t repay our sleep debt.

TOP TIP: set and alarm for bedtime

2)    Don’t exercise too late in the day: try to exercise 30 minutes on most days but no later than 2 or 3 hours before your bedtime

3)    Avoid caffeine: Coffee, cola, certain tea and chocolate contain stimulant caffeine and can take 8 hours to fully wear off.  Older teens may benefit from being cautioned that nicotine and alcohol also worsen sleep.

4)    Avoid large meals before bed: these can cause indigestion and having too many fluids might mean you need to get up to use the toilet

5)    If possible avoid medications that disrupt or affect sleep: over the counter and herbal remedies for cough, cold or allergies can disrupt sleep.  If you are worried, talk to a pharmacist or health care professional to see if any drugs you take might contribute to insomnia

6)    Don’t take naps past 3pm: Naps can help you catch up on lost sleep but if you nap too late in the day, it can be harder to fall asleep at night

7)    Relax before bed: don’t overschedule your day so you have no time to unwind.  Reading or listening to music could be part of your bedtime ritual

8)    Take a hot bath before bed:  Your body temperature will drop after getting out of the bath and this may help you feel sleepy and relaxed so you are more ready to sleep

9)    Have a dark, cool, gadget free bedroom:  Noises, bright light, an uncomfortable bed or warm temperatures can distract you from sleep.

10) Have the right sunlight exposure: Try to get outside in natural sunlight for 30 minutes a day.

11) Don’t lie in bed awake if you are still awake after 20 minutes or starting to feel anxious or worried get up and do some relaxing activity until you feel sleepy.  The anxiety of not being able to sleep can make it harder to fall asleep

 

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Neuroscience and Sleep

Submitted by guest blogger Ruth OT

Before I trained to be an occupational therapist, I studied neuroscience to masters by research level. It is so helpful in my work to have that underpinning knowledge of some of the things going on in the brain and how these affect behaviour. However, I don’t miss growing neurons in petri dishes and counting them.
Our kids are not great sleepers, to understate it considerably. We have had more sleep advice than anyone has any business accessing. It’s been variably effective. In the UK, there are several charities who offer sleep advice for children with special needs (Cerebra and Scope to name but 2), alongside advice from our children’s centres and child and adolescent mental health services (CAMHS). They’ve all been helpful, they’ve all prioritised the importance of a good consistent bedtime routine, on minimising distractions from sleep and on knowing your child’s sleep patterns. We have filled in more sleep diaries that you can shake a stick at (incidentally, this is the most effective way to make sure your child actually sleeps I have found! It’s amazing how well they sleep when you’re filling in a sleep diary to prove they never sleep).
I have promised myself I will stop reading sleep advice because I only get frustrated when we still don’t sleep, but here are some things we have found helpful (some nights at least!) and a little bit of the neuroscience of why.

Melatonin
One of our children along with many autistic people I know is taking melatonin at bedtime. The doctor tells us frequently that this is expensive, and we’d prefer to avoid medication as much as we can on general principle, so it’s worth knowing a bit about what melatonin does and how to boost it without medication.
Melatonin is a substance which the brain makes from the neurotransmitter serotonin, mostly in the pineal gland. The pineal gland is a tiny gland right in the middle of the brain and close to the visual centres of the brain. It starts making serotonin into melatonin when the light reduces, stimulating sleep onset. I don’t know whether my kids’ pineal glands are less efficient converters of serotonin to melatonin or whether their brains are less sensitive to the melatonin produced, but I just need some sleep so here are some ways we try to boost melatonin production.

Light and Screens
If melatonin is made when the light dims, it stands to reason that emphasising that light change is important, so we make sure they get lots and lots of daylight when we want them to be awake, and none when we want them to be asleep. This is not always easy in Northern England and involves a lot of getting wet and muddiness. We play outside every day we possibly can. When we can’t, we are lucky enough to have a big conservatory which we use as a playroom, and we have daylight effect lightbulbs in key rooms of the house which we use in daytime then switch to lamps in the evening. We have found that physical activity in the day can help with sleep, but if it’s all indoors such as soft play centres and swimming pools, it’s nothing like as effective as a walk outside no matter how wet the walk may be!
We have a no screens after the evening meal rule when sleep is particularly tough. Focusing visually on an (often bluish) glowing screen will inhibit melatonin production if you’re struggling to sleep, turn the technology off, it really does help.
We have blackout blinds behind blackout curtains and we close the doors of all the rooms that don’t have that every night (actually in our child who takes melatonin’s bedroom, we’ve made wooden boards which fit exactly into the window area over the Velcro blackout blind. Yes, I am serious…).

Serotonin
If melatonin is made from serotonin, it also stands to reason that it’s a good plan to have a lot of serotonin available to be converted. A large proportion of the antidepressants available have their effect by increasing the amount of free serotonin in the brain, this may explain some of why depression can affect sleep patterns. If you think mental health difficulties may be influencing sleep patterns, please talk to your doctor about this. It can be a vicious cycle that poor sleep exacerbates depression and depression then makes sleep more difficult, it is important to break that cycle.

Food
There are certain foods which contain tryptophan which the brain then makes into serotonin. I know some parents who swear by these in evenings, these include cherries, nuts, seeds, tofu, cheese, red meat, chicken, turkey (you know how we all fall asleep after Christmas dinner?), fish, oats, beans, lentils, and eggs. Just be aware that strong flavours and smells can be very alerting and so be less helpful than you’d think. Also, many of these can be allergens.

Movement
It’s also good to know that serotonin and melatonin levels rise with proprioceptive activity (movement against resistance, which helps the person to understand their own body more clearly), so including (not too vigorous) movement against resistance as part of the bedtime routine can really help- moving against the water in a warm bath, followed by squeezing yourself in a soft towel would be one example, or carrying a good sized box of bedtime stories up the stairs to bed. Movement of the head can also stimulate serotonin release in the brain and help sleep, just avoid spinning and sudden changes in speed or direction as these will counteract the effects.
Doing all of this does not mean you will get a good night’s sleep (I think we got about 2 hours last night!), but it might just improve your chances.