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By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  We know sleep is a critical contributor to our overall state of physical and psychological health. One of the most important functions of sleep involves allowing our bodies and our brains to recover and recharge. Sleep is even more important for children, as it directly impacts mental and physical development The topic of children and sleep can be a challenging one though. Children don’t typically understand the importance of sleep and aren’t intrinsically wired to maintain a sleep schedule and structure without external guidance. So, as a child develops, it’s up to their caregivers to manage their sleep schedule and ensure they’re getting enough sleep. Managing children’s sleep problems can be hard enough but teenagers may be even more challenging. We will also address teenagers’ sleep challenges here.
Children and sleep Sleep patterns and needs change drastically across age ranges. For instance, those who have experienced a newborn know that sleep happens whenever the child feels like it, making the parents’ sleep schedule highly irregular. Fortunately, between the age of 6 months to 2 years, children typically begin to develop more of a regular sleep pattern. Once this happens, it’s possible to start implementing proper sleep hygiene principles. Sleep Hygiene for Children Here are 5 effective sleep tips for children aged 2-13 years that can help children with sleep problems:
Sleep hygiene is always the best place to start when it comes to managing sleep challenges but what if it isn’t enough? What if sleep hygiene doesn't work? Sleep hygiene should always be tried first when it comes to sleep challenges. For children and adults alike, maintaining consistently good sleep hygiene is typically enough to help with sleep problems. It’s important to note that sleep hygiene will likely take a few weeks, or longer, to have a noticeable impact on your child’s sleep. So be patient and consistent with their bedtime routine. If your child still has sleep problems (such as not being able to fall asleep, or waking up in the night) some other home treatment options have been found to be effective. For example, research has found white noise played over the course of the night was able to help children with ADHD get to sleep faster and stay asleep longer. Weighted blankets are also demonstrating some preliminary and promising effects on sleep for children with Autism Spectrum Disorder. Teenagers and Sleep Another age category that tends to have significant sleep challenges is teenagers. Despite the traditional angsty know-it-all attitude and resistance some teens may have to regular sleep, their brains are still developing as well as their bodies changing, so sleep is just as important during these years as it was when they were younger. What impacts teenagers’ sleep? Many of us can remember being a teenager and wanting to stay up excessively late, resisting structure and schedule in terms of sleep. And, as a result, feeling constantly sleep-deprived or irritated and grumpy as a result. This is not just rebellious teenager behaviour. Research has shown in the teen years circadian rhythms change drastically, as do hormones. Teenagers don’t just want to stay up longer, their body is telling them to. All the while their schooling starts just as early, if not earlier than it did when they were younger. The net result is sleep-deprivation, as environmental expectations make getting the required amount of sleep more difficult. So, how can we support our teenagers in getting better sleep?We may think that allowing them to sleep in on the weekends to catch up on sleep is the best thing we can do. It isn’t. Letting them sleep in actually makes things worse, as this disrupts the body’s internal clock even more. Remember – a consistent bedtime and wake up time is an important aspect of sleep hygiene – and as such, keeping a consistent schedule is still the best thing for teenagers. Since their circadian rhythms are changing and impacting the time they want to sleep, it can be helpful to adjust this sleep rhythm. This can be done by adjusting their light exposure, such that light is increased in the mornings and decreased at nighttime. Effectively adjusting light exposure involves (1) exposing oneself to natural light (even it it’s cloudy) shortly upon waking up in the morning, and (2) removing light in the evenings by ensuring lights are dimmed. There are blackout blinds/curtains, and discouraging use of screens like smartphones, TV’s and computers before bed. Final Thoughts If your child or teenager still has significant sleep problems or other contributing health issues (physically or emotionally), it’s recommended you speak to a medical professional. Sleep is a very important and incredibly complex process, so when presented with recurrent issues it should be addressed by a qualified healthcare professional and not self-diagnosed or self-medicated. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth Edgar Watson Howe says, “there is only one thing people like that is good for them; a good night’s sleep.” Sleep plays a vital role in our health. We need it to survive – the same way we need water, oxygen, and food. Yet, about one-third of working adults struggle with chronic sleep difficulties.
Effects of a good (and bad) sleep After a long and restful sleep, we wake up feeling energized. Our mood is positive, we’re focused and attentive, and we’re generally more resilient against day-to-day stressors. But when we are lacking in sleep, we’re more likely to feel irritable, annoyed, experience changes in appetite, and be much more distracted. One of the most common sleep problems is insomnia, which is characterized by difficulty falling asleep, not being able to stay asleep, and/or early-morning awakenings. The most effective treatment for insomnia is cognitive-behavioural therapy (CBT). CBT is an evidence-based treatment approach that focuses on changing behavioural patterns, thoughts, and worries – including worries about sleep. Aside from scheduling an appointment with your therapist or learning a few CBT techniques on your own, what can we do to sleep better? Discover the root cause of poor sleep Before implementing tips to enhance your sleep hygiene, it’s important to consider if there are any confounding variables that may be contributing. 1. Are any physical conditions or factors, including medication side effects, playing a role? If you aren’t sure about underlying health conditions or if your medication is affecting your sleep, book an appointment to speak with your medical doctor. 2. Do you find yourself excessively worrying or ruminating before bed? A certain amount of stress and anxiety is a normal part of life, but also one of the strongest factors that influence sleep. If you find yourself excessively thinking or ruminating at night, and that’s preventing you from sleeping, it can be helpful to keep a worry log. To do this, write down all the potential worries that may keep you up at night. Recording these an hour or two before bed can serve a preventative role. If, once in bed, you still find yourself worrying, get out of bed, write down your concerns, and ask yourself three key questions:
3. Are you unsure of what is keeping you up at night? If you are having trouble identifying the root of your sleep problems, keep a diary for one to two weeks. Track your diet, work, and leisure activities, and level of stress and sleep/wake times. This can help identify patterns and factors that are affecting sleep that you may not otherwise be aware of. 10 ways to improve your sleep hygiene Once you have done the above, it’s time to implement good sleep hygiene principles. Here are 10 tips to help you sleep better, more often.
Editor’s Note: This post was originally published as part of a Globe and Mail “Ask the Psychologist” column authored by Dr. Samra, and has been edited and updated. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
I keep having work dreams. Or should I say, nightmares. How can I make them stop? The answer: Ah, the dreaded workmare. Unfortunately, I have no magic wand to make work-related nightmares stop. The key is to first understand what factors contribute to the types of dreams we all have, as well as the function they serve. The next step is to then work to alleviate the causal factors. Scientific understanding about dreams and their associated meaning is, on the whole, pretty poor. What we do know is that our most vivid and memorable dreams occur during our deepest stage of sleep, known as the REM (rapid eye movement) stage. We also know that there are differences from person to person on how much we dream, or whether we even recall our dreams. The frequency and content of our dreams can be influenced by factors such as what we have eaten on a given day, how much alcohol we have drunk and myriad other physiological factors (for example, nightmares can be a side effect of some medications). We also know – most importantly – that our day to-day life situations have a significant impact on the content and intensity of our dreams. Stressful and, in extreme cases, traumatic life situations are among the most significant psychosocial factors that affect our dreams. Studies that have examined dream content show that we tend to have and recall more negative dreams than positive ones, with the underlying theory being that there is an adaptive function to have threatening dreams. Namely, having nightmares can help us to simulate actual or perceived threatening situations in a safe environment, allowing us to be more psychologically and cognitively prepared for the threats when they come up in life. Pay attention to what stresses you at work but also in your personal life. High levels of stress, as well as perceptions that we are in situations that are unpredictable and over which we have little control, can play a role. Make a list of all the significant stressors in your life. Order these from most stressful to least. Then ask yourself the following questions: Do I have any control over this stressor? What specific action can I realistically take that may help alleviate my stress? Then make an action plan to reduce the stressors over which you have some control. Stress builds when we become passive and immobilized, and taking some action (even if it’s not the “perfect” one) can help tremendously. In addition, having a consistent pre-sleep ritual can help to reduce the intensity and frequency of your nightmares. First, minimize talking or thinking about stressful situations right before bed. Relaxation or meditation strategies can help to slow down both your mind and body. Have a warm bath or listen to soothing music to distract your mind. Avoid reading books or watching TV or movies with upsetting content. If you are woken by a nightmare, get out of bed (staying there will help associate the nightmare with your bed). Do deep, diaphragmatic breathing for five to 10 minutes and then do something relaxing, such as having a warm glass of milk, before you get back into bed. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. The question:
Lately my sleep has been terrible. Sometimes I have trouble falling asleep, and other times I wake up around 4 AM and can’t get back to sleep. What’s going on? The answer: First of all, you’re not the only one struggling with this. Up to one-third of the population has chronic sleep problems, which can include trouble falling asleep, staying asleep, and waking up too early. Here are some tips to help you get a better night’s rest: Schedule “worry time” Worries – about work, relationships, finances – can contribute to difficulty falling asleep, or can wake you up in the middle night. Unfortunately, just trying to force yourself to “stop thinking” does not work very well. It can be helpful to schedule a dedicated time to worry, 15 to 20 minutes, one to two hours before getting into bed. Find a quiet space, out of your bedroom. During your “worry time,” write down all the worries you have that day. Ask yourself “What can I do about this now?” Take a solution-focused approach. If there is something to be done immediately, do it. If not, schedule a time for the next day or later in the week. Set a regular schedule It’s more important to establish a fixed wake-up time than a regular bedtime. We can control what time we wake up, but we can’t make ourselves fall asleep. If you are having sleep problems, eliminate daytime naps as these decrease the restorative value – or quality – of your sleep at night. Reduce sleep-interfering activities In the several hours before bedtime, you should reduce (and ideally eliminate) caffeine, alcohol and tobacco use, and avoid strenuous exercise. Use your bed for two activities only – sleep and sex (no watching TV or working on your laptop in bed!). Make your bedroom sleep-inducing Create a pleasant environment for sleep. Get a comfortable pillow. Use blinds or heavy curtains to create a dark room. Turn off phone ringers. Make “going to bed” a soothing experience Set a pre-sleep routine that you follow each night, as this signals to your brain and body that it’s time to quiet down. This may include some form of meditation or relaxation, a warm bath or herbal tea. Get yourself ready for the next day, dim the lights and then mentally “put away” any ongoing problems or upcoming tasks. Get out of bed if you can’t sleep. Don’t get into bed unless you are sleepy. If you have trouble falling asleep within about 20 minutes (or wake and can not go back to sleep) stay out of bed until you feel sleepy. Remember, don’t do anything stimulating when you get out of bed. Challenge worries about sleep You may be kept awake by worries about not being able to sleep, or about the effect of a poor night’s sleep. Move your clock out of sight so that you are not “clock-watching.” Remind yourself that you can make it through a day even if you have had little sleep. It can be tempting to rely on medications (prescription or over-the-counter) for sleep but these are a short-term solution only and guidelines do not recommend their use for longer than one to two weeks at most. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  Sleep is a core physiological function that impacts many other important areas of functioning (e.g., energy, mood, appetite, motivation, concentration, efficiency). The average adult needs 6-9 hours of sleep. Consistently getting less than 6 hours per night leads to a range of health consequences, and consistently getting more than 9 hours leads to excessive lethargy and fatigue. Unfortunately, many of us struggle with mild to chronic sleep difficulties that impact our daily lives. Understanding our sleep cycle gives us insight into how our sleep patterns work and can help us identify the reasons why our sleep may be disturbed.
Types of Sleep We have 2 main types of sleep: non-REM and REM sleep.
Sleep Cycles We cycle through Stages 1, 2, 3, and REM throughout the night. Each cycle takes approximately 90 minutes and repeats. Also, as the night progresses we increasingly spend a longer period of time in REM (which leads to sleeping becoming more “restorative”, or restful the longer we sleep). So, let’s talk about each stage individually. Stage One - we’re in transition between being awake and asleep. This is a state of very light sleep, and when we are awakened in stage 1 we may claim or feel we weren’t sleeping. Stage Two - is a light stage of sleep. It’s characterized by the slowing down of brain waves. Stage Three - is a stage of deep sleep – when we are woken from this stage, we’re often confused and disoriented. This is the stage during which bedwetting, sleepwalking or night terrors are experienced. Stage Four or REM stage is the last stage in the cycle. In this stage, the eyes usually move fast in different directions and breathing patterns become irregular. Our limbs may also become paralyzed though the feeling is temporary. People who are awoken from this stage may have bizarre tales or wild dreams. Once we leave REM sleep we start the cycle over again. Changes in our Sleep Cycle Sleep patterns are impacted by a range of factors, including stress levels, low mood and depression, worry, physical health conditions, medications, and worry about sleep. Alcohol and many prescription drugs can help facilitate Stage 1 and 2 of sleep, but often have detrimental impacts on our more restorative Stage 3 and REM sleep. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
I am a healthy, active 30-year-old woman. I have not slept through the night in over a year – I always wake up two or three times a night, restless and annoyed and unable to get back to sleep. Do you have tips/mental strategies for falling back to sleep easily? And what can I do to treat this? (I’d prefer not to take sleeping pills). The answer: Chronic sleep problems are very common and impact up to one-third of the population at any point in time. A much higher percentage of people will experience more short-term/transient sleep problems (often tied to particular events that are happening in their life, that resolve when those stressors resolve). The good news is there are very effective cognitive and behavioural strategies that can dramatically improve sleep length and quality. “Insomnia” is a broad term and can include trouble falling asleep, trouble staying asleep and/or early-morning awakening. There are a number of “usual suspects” that reliably and predictably impact our sleep:
You indicate you are healthy and active, which is great (as regular exercise will help improve the quality of sleep). But if you have not had a physical over the last year, I would encourage you to see your family doctor to ensure there is no other medical contribution (anaemia is a very common cause of sleep disruption for women in their menstruating years). If you are taking any prescription medications you may also inquire about whether they have any impact on sleep cycle/quality. Assuming there are no physical causes to your sleep problems, I would do an inventory of current stressors in your life. Worries and anxieties are a huge cause of sleep disruption. Identifying the stressors and taking an active, problem-solving approach to target those stressors would be important. It sounds counter-intuitive, but setting some dedicated “worry time” an hour or more before sleep can be helpful. Set aside 15-20 minutes to sit somewhere quiet (not your bedroom) and spend time thinking about and writing down all the worries that are on your mind that day. Ask yourself “what can I do about this right now”; if there is action to take, take it…usually though there is no immediate action that can be taken, and scheduling a time to deal with the problem can help get it out of your mind temporarily. Engaging in good sleep hygiene behaviours is important (sleep hygiene – like dental hygiene – refers to behaviours that promote good sleep and prevent later sleep problems). Finally, I am glad to hear you say that you are reluctant to take sleeping medications – although they can help with sleep for the short-term, sleep medications are habit-forming, they do not address the core issues that are contributing to sleep problems, and prescribing guidelines only recommend their usage for short, time-limited periods (usually 7-10 days only). The Canadian Sleep Society has some excellent, publicly available brochures on sleep. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth Taking Medications for Sleep – Do They Work?
Do you struggle with sleep difficulties? Too much on your mind or too much on the go? This is a common problem in the fast-paced world we are living in. Many people are plagued with stress and worry thoughts that make it difficult to fall asleep. Have you used or considered using sleep medication to help you sleep? Many of us have because it seems like a simple and easy solution to our challenges. But are medications for sleep really a good solution? Should you take sleeping pills?Sleep medication, both prescription and non-prescription, should only be used in conjunction with making lifestyle changes and should only be used intermittently, for a short duration of approximately 5-10 days. More extended use leads to drug tolerance, dependence, withdrawal effects, side effects, and rebound insomnia (where sleep problems after medication cessation become worse than they were prior to taking medications). When taking sleep medications, it’s important to note that you should never mix them with alcohol, and you should always ensure you have allowed for at least 7-8 hours to sleep after taking medication, as it can affect your ability to function the next day. What about melatonin? I’m sure you’re thinking, ‘what about melatonin? It is natural isn’t it?’ Yes, melatonin is the key hormone that increases sleepiness. About 50% of people with sleep problems can benefit from up to 3mg of melatonin, taken 0.5 to 1.0 hours before bedtime. But, just because melatonin is a natural hormone doesn’t mean it should be used regularly. Melatonin can cause some side effects including:
It can also interact with other medications. So, the answer to the question should you take sleeping pills? It should also be used sparingly and in conjunction with lifestyle changes, good sleep hygiene, and CBT. Cognitive-behavioural treatment (CBT) is the most effective treatment for sleep problems, as well as associated mood and worry or anxiety issues, all of which commonly impact our ability to sleep. It may also be helpful to talk to your family physician to ensure there are no other underlying issues that may be impacting your sleep. If you’re still struggling with sleep difficulties, sign up for a video consultation with a counsellor at the Psychological Health and Safety Clinic. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  Sleep difficulties are increasingly common these days given the fast-paced world we are living in. There can be multiple contributors to sleep difficulties – and determining the cause of sleep challenges is the first step in finding a solution. One of the best ways to do this is by keeping a sleep diary. So, let’s talk about how to keep an effective sleep diary. Why keep a sleep diary? A sleep diary can be a helpful tool in the process of getting better sleep. It allows you to learn about your sleep patterns and habits, keep you proactive about your sleep, as well as potentially help your health care professional diagnose and treat any sleep disorders. It also provides a unique opportunity to track your sleep treatment and improvements over time. So, how do you keep an effective sleep diary? How to Keep a Sleep Diary The sleep diary should be filled out every morning, within approximately an hour of waking, based on the previous night’s sleep. Setting a reminder on your phone can help – and keep the recording simple, such as keeping a notes file on your smartphone. It’s okay if you miss a day but try to be as consistent as possible. If there’s anything irregular that might affect your sleep – like illness or an emergency, just add a note to that day. When recording information in the diary an approximation is okay. Don’t worry too much about getting every detail exactly right – for example, don’t clock-watch while you’re in bed. Excessive worry can have a negative impact on our sleep. What should be recorded in the diary?There are some things you should regularly record for the most effective sleep diary:
Keep it as simple as possible! An effective sleep diary shouldn’t be a make-work project; since our lives are busy, we should do everything we can to make recording these details as easy as possible. There are many templates you can easily find online via a quick google search of ‘sleep diary’. You can also keep notes on your smartphone as an alternative. One way to make the recording as easy as possible is to have these categories laid out ahead of time so all you have to do is fill in the details. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
I keep having violent dreams that wake me up in the middle of the night. What’s going on? The answer: We don’t understand very well why we dream, whether dreams have meaning, and why some people have vivid dreams, while others rarely can remember having a dream at all. We do know from studies that look at dream content that we tend to consistently have and remember more negative dreams than positive ones. Some theories suggest that there is an adaptive function to having threatening dreams – it helps us simulate threatening events and situations (in a safe environment) with the result of helping us be more cognitively prepared for threats when they come up in real life. There are a few reasons you may be having violent dreams. It may be that you are currently under a high level stress or that you are (or feel you may be) in a threatening situation that you need to get out of. Consider the current stressors in your life and think about ways you can get help with these difficulties. Individuals who have experienced traumatic events (abuse, assault, life-threatening situations including accidents or illnesses) are at higher risk for having nightmares. A mental health professional can help you work past traumas. Violent dreams can also be the result of a sleep disorder, known as parasomnia. Speak to your family physician if you are having recurrent violent dreams as an overnight sleep study, called a polysomnography, may be helpful to determine the cause. Finally, side effects of a number of medications can include violent dreams and nightmares (as many medications affect the stage of sleep in which we dream – the REM, or rapid eye movement, stage). Changing medications or dosages may help to solve the problem. Independent of the specific cause, there are a number of pre-sleep rituals that may help minimize the intensity or frequency of your violent dreams. Try to minimize talking or thinking about stressful situations before bed. Relaxation or meditation strategies can help to slow your mind and body down. Have a warm bath, or listen to soothing music to distract your mind. Avoid reading books or watching TV or movies with upsetting content. If you are woken by a violent dream, get out of bed and practice some deep breathing and do something relaxing, such as listening to soothing music or having a warm glass of milk, before you get back into bed. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  The Effects of Chronic Sleep Deprivation: Why We Shouldn’t Run a Sleep Debt
Most of us have probably heard the saying, “I’ll sleep when I’m dead.” This phrase is typically used by those who are living busy lives and are proud of themselves for continuing to hustle. They often prioritize getting ahead in life over the detrimental effects of lack of sleep. Sometimes this phrase is turned into a word of advice, “You can sleep when you’re dead” – but this type of advice could actually be deadly. Here we are going to discuss the effects of chronic sleep deprivation. Many of us think we can get away with less and less sleep – and we certainly can, for a few days or even a few weeks. However, when we go extended periods without catching up on our sleep, there’s a detrimental impact on our physical and emotional health. Sleep is an essential part of our ability to function. During sleep, our body physiologically heals itself and restores its chemical and hormonal balance. Our brain forges new connections and this helps with memory retention. Sleep isn’t a luxury and each time we don’t get enough sleep we are racking up our sleep debt. What is sleep debt? Sleep debt, or chronically running a sleep deficit, is the cumulative effect of not getting enough sleep. People often use the phrase sleep debt to make a comparison to banking. When we don’t get enough sleep, our sleep account becomes overdrawn and we’re required to attempt to make it up. The more sleep debt we accumulate, the more challenging it becomes to repay. According to one study, it can take four days to fully recover from one hour of lost sleep. Making up sleep debt Unfortunately, even though we often refer to it as sleep debt, sleep doesn’t actually work as a bank does. We aren’t able to store up sleep surplus in anticipation of getting less sleep, and we are unable to make up sleep debt indefinitely. https://youtu.be/a-h9Vv5kD0s How to Manage Sleep Debt So, what’s the best way of managing sleep debt? When it comes to our health, prevention is always the best method. So, we should all be aiming for 6 to 9 hours of sleep a night – most nights. We can achieve this by engaging in good sleep hygiene and having a consistent sleep routine. If we’re getting a less-than-ideal number of hours of sleep, we generally shouldn’t go more than a few days without allowing ourselves to ‘catch-up’. What does catching up look like? We allow ourselves a night or two to sleep as much as we need – which should be achieved by getting into bed earlier than usual (rather than excessively sleeping in). One of the important aspects of sleep hygiene is having a consistent sleep schedule in terms of wake and bedtime – and yes, even on the weekends. If we consistently wrack up a small sleep debt over the week and attempt to repay it over the weekend it affects our sleep rhythm. For example, if we work M-F, and sleep in on Saturday and Sunday – this makes it more challenging to go to bed at the appropriate time Sunday. It will also likely affect how we feel when we wake up Monday – and this can lead to a snowball effect in terms of negatively impacting our sleep cycle. The variability in sleep and wake times is less concerning if you aren’t encountering any sleep problems. But, if insomnia or other sleep conditions are at play – being super rigid with sleep schedule is critical as sleep cycle changes can worsen issues. Final Thoughts If you follow the sleep hygiene principles and sleep problems continue, it may be helpful to talk to your doctor. If sleep problems persist, there may be something contributing to your inability to get enough sleep. Cognitive-behavioural treatment (CBT) is one of the most effective treatments for sleep problems. Consider seeing a registered mental health provider to help manage sleep difficulties and support implementing good sleep hygiene principles. Book a consultation with the Psychological Health and Safety Clinic today if you'd like to explore this option. |
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