Monthly Archives: May 2010

A Consistent Bedtime Routine Helps Baby Sleep

A consistent bedtime routine is a powerful tool to help infants consolidate their sleep into longer periods at night.  And when baby sleeps, parents can too!

Researchers had parents implement a 3-step bedtime routine.  The steps were a bath, a massage, and a quiet activity like cuddling or singing a lullaby, in that order.  Lights out was within 30 minutes of finishing the bath.  Nothing else was changed, the parents continued to put their child to bed they way they had been.

After just two weeks of this bedtime routine, the babies woke up fewer times in the night, and were awake for shorter periods.  Their mothers were less likely to perceive the babies sleep as a problem.  Not only that, but the mothers’ mood improved, so they were less tense, less depressed and less angry.

This gives hope to new parents, that they can help their child sleep better in just a few weeks, and that this improves the well-being of the family too!

Dr. Darley will be speaking on ‘Help your baby ‘Sleep Like a Baby'” on Tues, June 1st, in Mukilteo Wa.  This program is sponsored by Program for Early Parenting Support.

Teaching Babies to Sleep

There’s lots of discussion of what is the best way to help babies learn to sleep through the night. Use the ‘cry it out’ method, or use the ‘no cry’ method?

Sleep researchers have compared these methods, and here’s what they concluded:

1) The strongest support is for ‘Unmodified Extinction’ and ‘Preventive Parental Education.’
2) Research also supports the use of ‘Graduated Extinction,’ ‘Bedtime fading / positive routines,’ and ‘Scheduled awakenings’
3) Most children respond well to these behavioral techniques, and there is an improvement in the child’s daytime behavior, and parent’s wellbeing.

Here are those techniques briefly defined:
Unmodified Extinction: Parents put the child to bed at bedtime, and leave the child to sleep until the morning. Parents only monitor the child for safety and illness.
Preventive Parent Education: Parent ed aimed at preventing the development of sleep problems, and includes these behavioral interventions.
Graduated Extinction: Parents put child to bed at bedtime, and briefly check on the child on a pre-determined schedule.
Bedtime fading / positive routines: Parents establish an enjoyable bedtime routine, and put the child to bed when they usually fall asleep. Then the bedtime is gradually moved earlier once the child is able to fall asleep easily.
Scheduled awakenings: Parents first track when their child usually wakes up, then wake the child before that time, doing the same back to sleep routine as when the child wakes on his own.

Choose which method fits with your parenting values and your child, then stick with it and be consistent. In most studies only a few weeks were needed to help infants sleep through more of the night, and for parents to feel better.

Dr. Darley will be speaking on this topic for PEPS in Mukilteo, Wa. on June 1st. Please join us!

Primer of Useful Sleep Terms

Using standard sleep terms can help clarify what is really going on with your sleep.  Here are some terms that we use in the field, and which are sometimes confusing to people or misunderstood.   Having clarity will help diagnose any sleep problems you’re having.

Bedtime – This is the time that you get into bed with the intention of sleeping.  This should be the same time as ‘Lights Out.’  This should not be the time you got into bed to read, watch TV, or talk with your bedpartner.

Waketime – This is the time you awaken for the day, as distinct from the time you get out of bed, which may be later.

Sleep Onset – The number of minutes it took to fall asleep after Lights Out. 

Wakenings after sleep onset – The number of times you awoke between Lights Out and your Wake Time.  You can also record the amount of Wake Time After Sleep Onset.

Total Sleep Time – The amount of time between Bedtime and Waketime, minus Sleep Onset and Wake Time After Sleep Onset.

Time in Bed – The amount of time between Bedtime and Waketime.

Sleep Efficiency:  The Total Sleep Time divided by Time in Bed.  Should be > 90%.

Here’s an example:  Last night Alice read in bed starting at 9:30pm.  At 10pm she turned off the light, and was asleep in 15 minutes.  She woke up once to use the bathroom and was back asleep in 15 minutes.  At 7:30am her alarm went off.  She lay awake in bed for another 30 minutes doing her meditation before getting up at 8am.

Bedtime =10pm,  Waketime =7:30am,  Sleep Onset =15 minutes, Wakenings after sleep onset =1, Wake time after sleep onset =15minutes, Total sleep time =9 hours (10pm to 7:30am minus 15 minutes sleep onset and minus 15 minutes wake time after sleep onset), Time in Bed = 9.5 hours, Sleep Efficiency = 94% (9/9.5)

Sleep and Trauma

In my office, it is not unusual to learn that a person’s sleep difficulties started with a trauma or bad experience.  For many people, the trauma they experienced was years (or decades) ago, and still affects their sleep.   These sleep difficulties can take the form of insomnia, nightmares or excessive daytime sleepiness.   Although this can be a hard topic to discuss, it is something to be aware of.

It is thought that brain chemistry can be altered, creating a hyperalert state.  People can also become very vigilant, staying on-guard even during sleep time.

As a naturopathic physician, here are some of my thoughts when working with someone who has sleep changes after a trauma:

  • Biochemically, I think about the 24 hour cortisol rhythm.  Cortisol should be high in the morning, and decrease over the day. (For more complete discussion, see my blogpost on cortisol). 
  • I also think about changes in neurotransmitter levels that may have occurred. 
  • Current safety, creating a sleep space that feels (and is) secure.
  • Stress reduction throughout the day to reduce sympathetic activation.  This can be in the form of a 2-3 minute break every 2 hours to do some deep breathing.
  • Unravel negative sleep associations with the bed, bedroom and bedtime.
  • And the use of other Cognitive-Behavioral techniques for insomnia.
  • Referral to a mental health professional to address trauma.

This blogpost just scratches the surface of this important topic.  You can learn more about sleep and trauma on The National Sleep Foundation website http://www.sleepfoundation.org/article/sleep-topics/trauma-and-sleep.   They include tips for people who are suffering from temporary sleep disturbance.

A Mother’s Sleep Dilemma

Unfortunately, being a sleep expert doesn’t make one immune to sleep difficulties. Having been a life-long good sleeper, all my sleep difficulties began with motherhood.

Many mothers in my naturopathic sleep medicine practice tell me that they stay up late so they can have some time to take care of tasks, talk to their partner and relax. Then they get up early with their child, which leaves them burning the candle on both ends. Nationally, 62% of parents report that they get less sleep than they need. As we’ve talked about in other posts, insufficient sleep can negatively affect mood, physical health and ability to function in many ways.

This is something I’ve struggled with myself. So this week, in the spirit of Mother’s Day, I’ve tried a new routine in order to give myself the gift of being well-rested. Shortly after my young daughter goes to sleep, I also go to sleep. The payoff has been waking up 1-2 hours earlier, and having some time all to myself. At that time of day I’m mentally sharp and full of energy, a great trade-off for those evening hours when I was so tired.  The focused time is a wonderful way to start the day, whether it be spent on organizing the day, catching up email, yoga or meditation.

Though it seems like there just aren’t enough hours in the day for mothers, getting enough sleep makes the hours we do have so much better. Would this strategy work for you?

More information about Naturopathic Sleep Medicine can be found at www.naturalsleepmedicine.net

Sleep in the Elderly

You may hear people tell how their sleep has worsened as they age. They describe lower quality night time sleep, and more need to nap during the day. Recently I had the privilege of working with a person age 101 on sleep health. This was a good experience, which brought elder sleep issues to the front of my mind. This week, an important study about sleep in the elderly was published in the medical journal Sleep.

Sleep Characteristics of the Elderly
Over 15,000 interviews were conducted in China with people 65 years old and older, including almost 2,800 people age 100 or more. China has an estimated 40.5 million people who are 75 years old and older. The US has more than 18 million people in this age group.

Looking at this population, 65% of the people reported their sleep is “good or very good.” Total sleep time was 7.5 hours, which included naps. Men were more likely to sleep well than women.

An interesting finding was that the oldest (age 100+) were 70% more likely to sleep well than those ages 65 to 79. They were also 3 times more likely to sleep 10 or more hours each night, and less likely to get only 5 hours of sleep.

Access to healthcare and economic status also made a difference – people were 84% more likely to sleep well if they had adequate healthcare. The people with poor health overall were less likely to sleep well, as were those with a chronic disease, anxiety, or difficulty doing the tasks of daily living. Those with good economic stability were more likely to sleep well.

How Can We Use this Information?
Although this study gives us valuable information about sleep in the elderly, it does not give information on cause. We are still left wondering “How long did these elderly people sleep in their middle age?” “Did their sleep habits earlier in life allow them to live into their hundreds?”

What was clear is that those with the best overall health were more likely to sleep well. So taking good care of yourself, addressing health concerns, and getting help from a medical professional when needed will help your sleep in the long run.

This Chinese study is ongoing, so we’ll be able to learn more about this in another couple years – stay tuned!