Technological sleep sabotage

We’re all becoming increasingly reliant on technology for communication, reading and entertainment.  But the screens that we use in everyday life (computer monitors, televisions, tablets, smartphones etc. …) have a particularly negative impact on sleep, especially when used in the evening (ie: when most of us are probably using them).

Using tech is a one-two punch of sleep sabotage.  Both the content and the devices (yes, the media and the message) themselves can be detrimental to sleep.

The Content

A stressful email from a colleague or boss. The latest news from a war torn country. One last game of Candy Crush Saga. We’re often building stimulation, stress and anxiety when we should be settling, creating calm and relaxing.

The Devices

Here’s what you need to know about light. Pay special attention to blue light. Blue light is present in the spectrum of natural light. It corresponds to the part of the spectrum between 430nm and 500nm.

LightSpectrumWhile any light can inhibit melatonin secretion, blue light does it bigger and badder than it’s other rainbow friends. A study out of Harvard compared the effects of exposure to blue light to exposure to green light. The blue light suppressed melatonin for twice as long as the green light and shifted circadian rhythms by twice as much (3 hours vs. 1.5 hours).[1] Blue light meant later and less restful sleep.

So what does composition of light does a screen typically contain?:

BlueLight_ScreensYes, the majority of the light we get from our screen IS blue light. Today, 90% of flat screens are made with LEDs.  A high proportion of the light those very screens are emitting is blue.  And in the case of e-readers, tablets, smartphones and computer screens, you’ve probably got that screen within about 15 inches of your face.

So, what does that mean for sleep?  Less melatonin (which means a less quality of sleep) and more difficulty falling asleep (which means less quantity of sleep).  Generally, if you’re lucky enough to fall asleep, you wake up feeling like you haven’t slept, or at least not well.

The following diagram compares melatonin levels with a print book versus and E-reader.[2] You can see the melatonin levels are lower AND they clear away later; meaning it’s hard to fall asleep, sleep is not a high quality and it’s hard to wake up.
BlueLight

So what can we do?  How can we protect ourselves, and especially our older older children (teens) who are the most vulnerable?

How to protect your sleep

1) Do not use tech before bed.
This is easier for the young kiddos (avoid television, tablet or computer time for a period of at least 2 hours before bedtime).  For the older children (teens) and adults, let’s be serious.  This probably isn’t possible.  A “do not do” approach isn’t sustainable for the majority of us.

2) Invert Black and White on your device
Macs, iOS and some e-Readers have this function built in.  There are some apps which can be downloaded to do this in your selected web browser.  It’s not a perfect solution, but can help, simply by decreasing the quantity of light you’re staring at.

3) Blue light shields
I’m not sure how well these work, but companies like BlueLight Shield and Ocushield offer screen protectors that claim to block or limit blue light from their devices.

4) Orange Glasses
Not exactly fashionable, but blue light blocking glasses can be helpful. I ordered something similar from Amazon.  Stay tuned for my evaluation.BlueLightBlockingGlassesAnyone with a high amount of technology in their lives is susceptible. But you don’t have to lose sleep over it.  Be sensible, take some precautions and you can balance your screen time AND a healthy sleep.

1 J. J. Gooley, S. M. Rajaratnam, G. C. Brainard, R. E. Kronauer, C. A. Czeisler, S. W. Lockley, Spectral Responses of the Human Circadian System Depend on the Irradiance and Duration of Exposure to Light. Sci. Transl. Med. 2, 31ra33 (2010). (available here)

2 A.Chang, D. Aeschbach, J. F. Duffy, C. A. Czeisler, Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. PNAS 2015 112 (4) 1232-1237; published ahead of print December 22, 2014, doi:10.1073/pnas.1418490112 (available here)

 

GERD and your baby’s sleep

GERD (GastroEsophageal Reflux Disease) is a chronic digestive disease. GERD occurs when stomach acid or sometimes, stomach content, flows back into the esophagus. This acid laden reflux irritates the lining of the esophagus and causes GERD.  It looks a lot like this:
GERD and Sleep

Whenever there is discomfort, that can be a significant barrier to sleep. If a family suspects their child is uncomfortable, or their GERD is not well managed, we work with that child’s physician to ensure they are comfortable before proceeding with any sleep training.

From a personal perspective, I can tell you it’s no fun to parent through GERD. From a professional perspective, I can tell you that these are the families most in need of support, sleep is clearly impacted, and in my anecdotal observations in working with families; GERD diagnosis seems to be increasing.

In the past week I’ve attended several continuing educations events, with one physician indicating that GERD is likely overdiagnosed[1] (notable pediatric gastroenterologist Warren Shapiro, MD), while the other indicated that it was underdiagnosed[2] (notable pediatric sleep expert, Judy Owens, MD). The jury is out and it’s difficult to know if the instances of GERD are increasing or if more of these cases are being caught and diagnosed.

Some symptoms of GERD include[1]:

• Recurrent vomiting

• Poor weight gain or even more extreme, a failure to thrive

• Irritability

• Poor sleep

• Bad breath

• Respiratory concerns including coughing, asthma, Apnea

• Recurrent pneumonia

• Esophagitis (inflammation that may damage tissues of the esophagus)

• Dysphagia (difficulty swallowing) or feeding refusal

• Upper airway symptoms (ear infections, throat infections, vocal issues, tooth enamel/dental issues)

Severity of reflux in infants is often focused on weight gain, respiratory issues and pain. If a baby is gaining well, reflux is still a significant matter, but the baby who is not gaining well is obviously a more serious concern.  If your baby is exhibiting a combination of the symptoms above, please discuss the possibility of GERD with your child’s physician or pediatrician.

There are some easy things parents can do to mitigate some of these symptoms[1]:

• Ensure baby is not over eating (easier for bottle fed babies than breast fed… small volumes more frequently is more desirable than larger volume less frequently)

• Consider non-prone sleeping position (elevated mattress; only for non-rolling babies. ALWAYS place an infant on their back to sleep unless you have discussed GERD with your physician and an alternative position is medically indicated)

• Consider trial of hypoallergenic formula

• Consider thickened formula (medically supervised)

There are a number of different pharmacological approaches to treating GERD[1]:

1. Antacids – effectively neutralizing the acids.

2. Pro-kinetics – which can encourage the esophogael sphincter to close, and have the stomach empty more rapidly and frequently, so the acid can’t get to where it’s a problem.

3. Surface Agents – coating the lining of the esophagus so it’s protected.

If medication is unhelpful, or the severity indicates further treatment, surgical intervention is also an option.

I encourage families to consider chiropractic treatment as well. There doesn’t seem to be a body of scientific evidence that would indicate chiropractic manipulations would be helpful in preventing GERD. However, I can tell you in my professional experience and in an isolated case study, chiropractic manipulations have been helpful to improve symptoms of GERD.

The good news is that most babies will outgrow GERD as their digestive system matures.  Until then, there are treatment options worth exploring to help make your baby more comfortable. When GERD is well managed, we can then go about addressing better sleep.

[1] Warren Shapiro, MD, The Incidence , Pathophysiology and Treatment GERD During Infancy, Presentation

[2] Judith A. Owens, MD, The Assessment and Management of Common Behavioral Sleep Problems in Children, Presentation at The Hospital for Sick Children Pediatric Sleep Symposium 2015, Toronto.

For further information:

Mayo Clinic

National Sleep Fountation

How to use your GroClock

GroClock OktoWake
KidSleep Zazoo

Using Child Alarm Clocks – Advice from an Expert


Also known as behavioural clocks, these are helpful tools for communicating time to children who aren’t quite ready to tell time with conventional digital or analog clock. Most often, behavioural clocks function by using a light or image to communicate a time for sleep and a time for waking.

I use behavioural clocks most frequently for early morning wakings, but also for children who are having night wakings or even families experiencing bedtime battles. There are MANY behavioural clocks on the market, they’re all good (although none are great… if anyone is looking into designing one and would like some kick a$$ features from the thoughts of someone who lives and breathes pediatric sleep, please call me) and they will all be effective if parents can implement them correctly and consistently.  It’s less about which clock you use, and more about HOW you use it.

I’m not a product pusher. I think we can all make due with less. If you’re interested in re-purposing things you may already have around your home, consider an old radio alarm clock (set to a quiet, classical station or children’s CD) or those Christmas light timers to turn on a lamp or nightlight in your child’s room.  Just make sure they’re out of reach because I have yet to find a preschooler or toddler who won’t press buttons, flick switches or turn dials.

Whatever you decide to use, make sure to lay the groundwork.  These are some guidelines specifically for use of the GroClock.  It’s probably the behavioural clock I encounter and recommend the most often because it’s fairly inexpensive, simple and usually easily available from some good online vendors (what busy, tired parent has time to go out and shop?).

6 Simple Steps

1) Ensure your child is 3+ years OR you’re 100% convinced they would be able to understand a behavioural clock. Remember that children under the age of 3 tend to be very impulsive. If you’re questioning whether or not your child would be able to comprehend it and follow it’s message, don’t use it. What we do here is set children up for success… ensure they could be successful with this clock before you make the decision to introduce it.
2) Follow the instructions. Make sure you’re proficient in using the device before you show it to your munchkin.
3) Explain how your child is to use it. “Until the yellow light comes on, we need to stay quietly in bed and try to go back to sleep.”
4) Also explain that it’s very grown up and your child is not to touch it (even though you know they will). Use the “locking” mechanism as well. Kids love to press buttons. Make sure they aren’t going to reset it or change the time on you.
5) Turn off the backlight. It’s backlit and yes, I’m asking you to turn it completely off. At night, there’s a blue backlight with a star, at the wake up time, there’s a yellow backlight with a sun. You can dim the night time backlight, all the way to off. Use this clock with the backlight off!
We know blue light can have a melatonin inhibiting effect, which is counter productive to circadian rhythms. Our bodies (especially our children’s bodies) need to produce that melatonin to get the maximum benefits from a long, restful sleep. The yellow light will still turn on and sun will still come up when the night time backlight is off.
6) Celebrate your successes, but don’t dwell on failures.  “I am so happy that you were able to stay in your room until the sun came up. You must be so proud of yourself!”  If it didn’t work out, be kind, but firm in encouraging your child to follow their sleep manners and stay in bed quietly until their sun comes up.  If aren’t able to follow all their sleep manners, a simple “it was hard to stay in your room this morning, but we can try again tomorrow.”  Move along, there’s no need to discuss it further.

If you find you’ve followed all of the above and are STILL having trouble with your child going to sleep and stay asleep until morning, don’t hesitate to contact me.  Sleeplessness and early mornings do not have to be your normal.

Currently Well.ca is offering GroClocks for $10 off, until March 1, 2015 or while supplies last.  As a special for Sleeperific followers and first time buyers from Well.ca, use the code “sleeperific2″ for an extra $10 off your purchase over $40.

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