In the article “How to Help Children and Teens through Anxiety at Bedtime,” author Karen Young denotes that bedtime can be an anxious time for some children and teens. Although sleep helps the brain process the day’s work, it can also enhance anxiety. In detail, the amygdala, the part of the brain that controls one’s fears and emotions, is sensitive when it comes to sleeping. When the brain is tired, it no longer has enough resources to filter anxiety and may misinterpret experiences as threats. This means that the brain will employ the fight or flight response to “protect” the person, even when the threat is not real or present and the child will feel more uncomfortable and nervous. Lack of sleep and lack of internal resources can make anxiety worse, which in turn will make sleep for the next night tougher.

During this time, it is important that you, as a parent, can support your child emotionally and physically. Even the separation from a parent at night can be nerve racking for a child. Fears may also be triggered from the past. Children then turn these fears into monsters under the bed, something that gives the fear a voice. It's crucial to remember that the feelings are always real and always allowed, even when the content or the “story” of the fears are not real. Validating, listening, and providing support are the ideal steps for parents to make in this situation. For example, acknowledging and validating their fear (“It sounds so scary”) and then providing the support by letting them know you are there to keep them safe and you trust that they are safe (“I am here to keep you safe and our house is very safe”).

We as humans like to make up stories to provide meaning for a situation. The same thing happens with fears. In order to make sense of our feelings, we make up a story as to why we are fearful, sometimes they’re accurate, sometimes they are not. Harvard researchers found that “the content of a dream can be changed by [simply] talking about that dream just before bedtime” (Young). Talking about the dreams they would like to have can make all the difference without even knowing it. Talking about their fears and worries are also helpful.

Young also mentioned that sometimes children may just feel nervous and scared, instead of knowing why they feel that way. Anxiety may not present itself as an observable emotion, such as anger or aggression, it may just be a feeling of being unsafe.  Some children may become controlling or demanding at bedtime. In actuality, this isn’t about them trying to be difficult, it’s about trying to control the environment so they can feel safe. They are unaware that being controlling is them being anxious. There are two problems that can arise because of this:

1. It becomes difficult to relax when trying lead and manage their environment that they do not actually have control over. 

2. Children may not be the best leaders, especially when they’re tired.

All children care about is feeling safe. We can help them by:

• Setting boundaries, consistently and lovingly (the lights will be turned off in 5 minutes, when the long hand gets to the 6)

• Validating their feelings (I see that you feel ___, I would feel that way too)

• Providing them with the fantasy-based wants or stories (I really wish we could play all night long together)

• Connect and provide them with a choice they can manage (Do you want 1 story and a song; or 2 stories?)

The first step in re-associating the brain with bedtime is teaching the brain that bedtime is safe. You can have a conversation with them to see if it makes them feel better if you stay with them for a little while before they fall asleep. Reading a book together, talking about your day and the shared experiences, and letting the child have something of yours (a shirt, pillowcase, small and safe toy) can all be helpful in fostering and focusing on the connection. This connection strengthens the feeling of safety. Slowly, you can increase their independence and decrease the time spent at bedtime to the point that you are only in the room for five minutes. It is important to focus on the process of feeling safe rather than the outcome, and know that little by little, the feeling is growing.

Sleep is the necessary for the brain to relax, process the day’s events and store learned information. It is difficult for children to do so if they feel unsafe, simply focusing on the emotion and building on the connection between you and your child can make them feel the more at ease and therefore will sleep better at bedtime. For more information on child or teen anxiety and parenting, please visit Hilber Psychological Services. 

• Written by Lily Schmitt and Tanya L. Hilber, PsyD

Reference

Young, Karen. “How to Help Children and Teens Through Anxiety at Bedtime.” Hey Sigmund. https://www.heysigmund.com/anxiety-at-bedtime/

Author Wes Crenshaw illustrates that poor sleep and attention deficit disorder (ADHD or ADD) are actually related. In detail, Crenshaw notes that “Poor sleep can lead to ADHD-like symptoms and complicate a diagnosis.” In fact, researchers, in the “ADHD Is a Myth” crowd, found that individuals with ADHD are declared to have sleep apnea, narcolepsy, or primary insomnia. It is then suggested that parents should start monitoring their child’s sleep patterns; ”quality of sleep must be considered in making an ADHD diagnosis” (Crenshaw). 

In crenshaw’s experience of working with two dozen teens and young adults for sleep studies, he found that the best solution to poor sleep patterns resulting from ADHD is stimulant medication. Results show that “Some teens will sleep better after beginning stimulants [and] A few will have daytime sleepiness despite taking them” (Crenshaw). Be aware that by treating ADHD with stimulants, sleep patterns will improve for some people while remaining or possibly limiting the effectiveness of the treatment for others, especially those with ADHD-related insomnia. Crenshaw notes that ”we find the Daytrana patch helpful for those with stimulant-induced insomnia, because it’s the only medication that can be shut off early (by removing the patch).” 

For those who have not had sleep problems before and have not overused napping but start to lose sleep after starting a medication, it is recommended that either they stop using stimulants and/or switch to a non-stimulant for ADHD. However, Crenshaw declares that “if the stimulants are working, we prefer to tinker with their timing and release to improve sleep.” This is why it’s important “to assess sleep problems before any medication is prescribed” (Crenshaw).

When trying to help teens develop a consistent sleep-cycle, it is import to remember that the results will not be apparent right away. Children, especially teens and those with ADHD, will first resist having restrictions on when they can sleep. For example, when trying ”to help a client manage stimulants and sleep, [scientists learned] that the client is staying up late and, in extreme cases, reversing the sleep-wake cycle” (Crenshaw). This is why good sleep is critical in treating one‘s poor habits and crucial to understanding the ADHD-sleep conundrum (Crenshaw). Because, if they do start to have a regular cycle, their quality of sleep will improve. 

In efforts to try to help teens with ADHD sleep better, try to 

1. Make time for it. Eight hours are recommended, especially with an hour of prep time. 

2. Turn off screens. They wake up our brains even more with all of the games and light they produce. 

3. Say goodnight to the (artificial) sun. It is important to shut off/block out (using shades) all artificial light in the evening. The body will then signal the brain that the night cycle is coming and that it should start preparing for sleep. 

4. Rise with the light. Progressively increase the brightness of a light in one’s bedroom (by using a timer) like the rise of the sun. 

5. No napping. Although ”many teens compensate for poor sleep by taking naps” (Crenshaw), researchers discovered that naps actually cause unhealthy sleep. In actuality, a 10- to 15-minute nap in mid-afternoon is recommended instead; “These may improve functioning and improve sleep” (Crenshaw).

For more information on therapists at Hilber Psychological Services can help your children and your family with parenting, sleep hygiene, and ADHD symptoms, please visit our website or contact us. 

For more information on how Neurofeedback services can assist your child with ADHD and sleep issues without the use of medications, please contact San Diego Center for Neurofeedback.

- Written by Lily Schmitt and Tanya L. Hilber, PsyD.

Reference

Crenshaw, Wes. “What Comes First: ADHD or Sleep Problems?” ADDitude. 18, June 2019. https://www.additudemag.com/adhd-sleep-problems-solutions/

In the article, “How to Help Teenage Girls Reframe Anxiety and Strengthen Resilience,” author Deborah Farmer Kris recounts how rates of anxiety-related disorders in teenage girls have risen. Furthermore, not only can girls get anxious and stressed out easily, but so can any other teenager or adult. This could be because of the environment they are in, denial of their stress and anxiety, lack of sleep, no validation of their emotions, etc. Damour, a psychologist and author of the new book "Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls," states “some degree of stress and anxiety is not only normal but essential for human growth.”

Through decades of research and working with adolescent girls and their families, Damour observed that “the anxiety that teenagers express is a sign that they are aware of their surroundings, mindful of their growing responsibilities, and frightened of things that are, in fact, scary.” She notes that adults can make a difference by reassuring their child and have an honest conversation with them about their emotions and what is going on in their life that may make them stressed.

Keep in mind that teenagers brains and bodies are still developing and that change can spur stress. Not only physical or emotional change but also the act of continually switching schools, academic workload is increasing, or social relationships are constantly evolving. With this information, parents should continue to support their child but also let them figure it out on their own. “Teenage girls are particularly sensitive to the cues they receive from parents and teachers –  from words to facial expressions. How adults respond to teens’ emotional reactions matters a lot,” said Damour. The growth that they experience on their own will allow them to develop as a person who can withstand these types of stresses in the future and know how to handle them.

It is best not to avoid the anxiety as a whole, but to call it out and realize that one needs help. In this case, parents should stick to the two words that Damour has found helpful: “stinks” and “handle:”

“‘That really stinks’ is a very simple phrase that cuts right through it. It says, ‘I hear you and I’m just going to sit here for a moment and acknowledge that what you are up against isn’t that great.”

Validation and empathy go a long way when it comes to the exact thing that a child wants to hear, that they are being heard and that someone understands what they are going through. If teens realize that some level of stress is inevitable then they can accept it and move on to focus on how they can build in recovery time whether that is by having some downtime or getting more sleep.

Sleep deprivation is one of the simplest explanations for the rise in anxiety-related concerns, Damour said. If your child is getting less than seven or eight hours of sleep then a change needs to be made. Most of the time, teenagers may not be getting enough sleep because they are on their electronics. With the change of turning off social media for the night by putting their device on do not disturb or putting their phone in another room can make all the difference.

Stress and anxiety is part of life. It is not a parents job to get rid of it completely but to help their child get through it by sitting down with them and discussing their feelings. Stress and anxiety do not go away overnight, but with some extra sleep, reflection time, and downtime, teenagers can develop a sense of self on their own and figure it out with some guidance from a parent if needed.

For more information on stress, anxiety, sleep deprivation or how Hilber Psychological Services can help, please contact us and check out Lisa Damour’s book "Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls.”

-Written by Lily Schmitt and Tanya L. Hilber, PsyD

References

Kris, Deborah Farmer. “How to Help Teenage Girls Reframe Anxiety and Strengthen Resilience.” Mindshift. Web. 12 Feb. 2019. https://www.kqed.org/mindshift/52994/how-to-help-teenage-girls-reframe-anxiety-and-strengthen-resilience

Damour, Lisa. Under Pressure Confronting the Epidemic of Stress and Anxiety in Girls. https://www.amazon.com/gp/product/0399180052?pf_rd_p=f3acc539-5d5f-49a3-89ea-768a917d5900&pf_rd_r=R1KSEQT2AT89FSXWG6K1  

As many American teenagers are beginning middle school and high school, more homework is starting to pile up and extracurriculars after school are beginning. Take sports for example, on average they are 2 hours long whether they are right after school or at 6:30 at night. When students get home after practice, there is still homework to do which takes about 30 min. to 2/3 hours depending on the subject. By the time students eat dinner, shower, and begin homework it is around 9 o’clock. This leaves little to no room for the full 8 hours of sleep if students are studying for hours and planning to wake up at 6:30 the next morning.

In the article, “Sleepless No More In Seattle — Later School Start Time Pays Off For Teens,” Patti Neighmond introduces the idea that schools should have a later start time in order for students to get that extra half an hour to an hour more of shut-eye.

For example schools in Seattle recently made the change for middle and high schools to start at 8:45 rather than 7:50 a.m in the 2016-2017 school year. Even though this shift required the rescheduling of extracurricular activities and bus routes, students were now allowed to sleep in and come to school rested and ready to learn. Researchers from the University of Washington conducted a study that found that those students who had the later start time “got 34 minutes more sleep on average” and “boosted their total nightly sleep from 6 hours and 50 minutes to 7 hours and 24 minutes.” Not only did students get more sleep, it was also recognized that students began to get better grades and received fewer tardies along with being absent less because there was no excuse for staying home or being late because one did not get enough sleep.

Similarly, Horacio de la Iglesia, a researcher and a biology professor at the University of Washington, stated that "to ask a teen to be up and alert at 7:30 a.m. is like asking an adult to be active and alert at 5:30 a.m." No one wants to do that.

Many studies were conducted to test the different start times and which one would have the greatest positive effect on a students mental health.

In one study, researchers compared two groups of students at Roosevelt and Franklin high school who took a biology class. "When they started at 7:50 a.m. there would always be stragglers who were having a hard time getting here," says Cindy Jatul, one of the biology teachers at Roosevelt High School. It was seen that students who took the class in the morning were less alert and engaged in the lesson compared to those who took the same class with the same curriculum later on in the day.

In addition, Franklin High School science teacher A.J. Katzaroff says "there was lots of yawning" when school started at 7:50 a.m. It was noticeable that it was harder to focus on class discussions and activities because the student’s brain was not fully awake. After the time switched from a 7:50 to an 8:45 start time, students were more engaged and willing to come to school ready to learn on time.

Neighmond acknowledged that students need time to wake their brain up, so let’s let them. It is understandable that there may be some drawbacks for parents that need to get to work early in the morning, but for those who do get that extra half an hour of sleep will be more engaged and on time to class and all and all get better grades.

Many might think that when school starts later, teens will just stay up later, but instead, students will take advantage of the extra time to sleep. When it comes to sleep every minute counts.

If you have questions about teen development and the effects of later sleep times, please contact us. For more information on therapy, visit FAQ at Hilber Psychological Services.

-Written by Lily Schmitt and Tanya L. Hilber, PsyD

References

Neighmond, Patti. “Sleepless No More In Seattle — Later School Start Time Pays Off For Teens.” NPR News. Your Health. Web. 12 Dec. 2018.
https://www.npr.org/sections/health-shots/2018/12/12/676118782/sleepless-no-more-in-seattle-later-school-start-time-pays-off-for-teens