Many thanks to the students at the Pediatric Pulmonary Center (PPC) Training Program at the University of Florida for providing Suwannee River with this blog post on best sleep practices. PPC offers CE courses through StellarEd Solutions. Please visit their StellarEd page to see what educational opportunities are available for your CE needs.
With Daylight Savings coming up on March 13th, here are some tips to consider in regards to good sleep hygiene:
According to the National Sleep Foundation
- Sleep hygiene is a variety of different practices that are necessary to have normal, quality nighttime sleep and full daytime alertness.
- Examples of good sleep hygiene include (Michael Thorpy, MD):
- Maintain a regluar wake and sleep pattern seven days a week.
- Spend an appropriate amount of time in bed, not too little or too excessive.
- Avoid napping during the day, as it can disturb the normal pattern of sleep and wakefulness.
- Avoid stimulants, such as caffeine, nicotine and alcohol close to bedtime. While alcohol is well known to speed the onset of sleep, it disrupts sleep in the second half as the body begins to metabolize the alcohol, causing arousal.
- Exercise can promote good sleep. Vigorous exercise should be taken in the morning or late afternoon. A relaxing exercise, like yoga, before bedtime can initiate a restful night’s sleep.
- Food can be disruptive right before sleep. Stay away from large meals close to bedtime. Also, dietary changes can cause sleep problems. If someone is struggling with a sleep problem, it’s not a good time to start experimenting with spicy dishes.
- Ensure adequate natural light. This is particularly important for older people who may not venture outside as frequently as children and adults. Light exposure helps to maintain a healthy sleep-wake cycle.
- Establish a regular, relaxing bedtime routine. Try to avoid emotionally upsetting conversations and activities before trying to go to sleep. Don’t dwell on or bring problems up in bed.
- Associate your bed with sleep. It’s not good to use your bed to watch TV, listen to the radio or read.
- Make sure the environment is pleasant and relaxing. The bed should be comfortable and the room should not be too hot, too cold or too bright.
According to the American Sleep Association
Most of the same points as the National Sleep Foundation, in addition to:
- Maintain a regular sleep routine
- Avoid naps if possible
- Don’t stay in bed awake for more than 5-10 minutes
- Don’t watch TV or read in bed
- Don’t drink caffeine inappropriately
- Avoid inappropriate substances
- Exercise regularly
- Have a quiet, comfortable room
- If you are a clock watcher at night, hide the clock
- Have a comfortable pre-bedtime routine
Good Sleep Hygiene for Children
According to Seattle Children’s Hospital (Robert Hilt, MD):
- Keep a consistent bedtime and wake time every day of the week. Late weekend nights or sleeping in can throw off a sleep schedule for days.
- Avoid spending lots of non-sleep time in bed. Spending hours lying on a bed doing other activities before bedtime keeps our brains from associating the bed with sleep time.
- A child’s bedroom should be cool, quiet and comfortable.
- Those children who stare at clocks should have their clocks turned away from them.
- Bedtime should follow a predictable sequence of events, such as brushing teeth and reading a story.
- Avoid high stimulation activities just before bed, such as watching TV, playing video games or exercise. Do not do these things during a nighttime awakening either. It is best to not have video games, TVs or telephones in a child’s bedroom.
- Having physical exercise as part of the day often helps with sleep time many hours later.
- Relaxation techniques — such as performing deep, slow abdominal breaths or imagining positive scenes like being on a beach — can help relax a child.
- Avoid caffeine (sodas, chocolate, tea, coffee) in the afternoon/evenings. Even if caffeine doesn’t prevent falling asleep, it can still lead to shallow sleep or frequent awakenings.
- If a child is awake in bed tossing and turning, it is better for them to get out of bed to do a low stimulation activity (e.g. reading), then return to bed later. This keeps the bed from becoming associated with sleeplessness. If still awake after 20-30 minutes, spend another 20 minutes out of bed before lying down again.
- Worry time should not be at bedtime. Children with this problem can try having a “worry time” scheduled eaerlier when they are encouraged to think about and discuss their worries with a parent.
- Children should be put to bed drowsy, but still awake. Letting them fall asleep in other places forms habits that are difficult to break.
- Security objects at bedtime are often helpful for children who need a transition to feel safe and secure when their parent is not present. Try to include a doll, toy or blanket when you cuddle or comfort your child, which may help them adopt the object.
- When checking in on a child at night, checks should be “brief and boring”. The purpose is to reassure the child you are present and that they are okay.
- If your child is never drowsy at the planned bedtime, you can try a temporary delay of bedtime by 30-minute increments until the child appears sleepy so they can experience falling asleep more quickly once they go to bed. The bedtime should be gradually advanced earlier until the desired bedtime is reached.
- Keep a sleep diary to keep track of naps, sleep times and activities to find patterns and target problem areas when things are not working.