How Sleep Affects Behavior In Children And Teens – With Dr. Breus “The Sleep Doctor”

Episode Transcript

Dr. Nicole Beurkens:

Hi everybody. I’m Dr. Nicole Beurkens and welcome to the show. Today’s episode is all about the connection between sleep and behavior. It’s one of my favorite topics to talk about with parents and families at the clinic. I’m super excited to have as my guest Dr. Michael Breus, known as, The Sleep Doctor.

He knows more about sleep than just about anybody else that I know and he’s got super credentials. He’s a double board certified clinical psychologist and clinical sleep specialist – one of only 168 psychologists in the world with those credentials. He’s the author of three books, with the newest book, “The Power of When”, which is a groundbreaking biohacking book proving there is a perfect time to do everything, including, things like talk to your kids and actually get them to respond to you. He’s an expert resource for major publications and TV doing more than 200 interviews a year and he’s been in private practice for over 18 years. And I’m really, really excited to have you on the show. Welcome!

Dr. Michael Breus:

Thanks I appreciate it, Nicole. I’m excited to be here and I’m excited to share some wisdom and some knowledge and hopefully, we’ll get there with everybody. So let’s rock and roll!

Dr. Nicole Beurkens:

Absolutely. You know, I want to start by having you talk about on a very basic level the connection between sleep, the quality of sleep and the amount of sleep that kids get and their behavior. Because I find in working with families a lot of parents really don’t understand or appreciate the connection between those two things. So, can you start out by talking a bit about that?

Dr. Michael Breus:

Absolutely. So when we’re looking at sleep. So first of all, let’s be super duper clear. It’s going to vary based on the age of the child. So when we’ve got younger kids sleep can actually have an even larger effect or really a different effect versus, for example, a teenager who might require a little bit less sleep. But, as we all know, teenagers like to stay up late and sleep late, which is kind of crazy. So we have to kind of factor those things in.

So first of all, it’s going to depend upon the age of the child, generally speaking. But there are some things that I want people to kind of know and understand as we kind of move forward. So one thing, this is a crazy statistic, but 25 percent of children who’ve been diagnosed with ADD or ADHD actually have an underlying sleep disorder. And that disorder can be apnea, or it can be something called restless leg syndrome, or periodic limb movements.

Here’s what’s interesting is tired kids oftentimes don’t act tired. Unless they’re teenagers, right?

Let’s think about it.

So I’ve got a 16-year-old and now a 15-year-old. And here’s what I can tell you is when they were 5 and 6 and they got tired, they didn’t say, mom, I want to take a nap. You know what they did was they got rambunctious and that can sometimes really look like some of that behavior that we have a tendency to see with ADD or ADHD children. And so there’s a misdiagnosis that happens.

Here’s where it gets even worse is in many cases some of those children are being placed on medication that’s a stimulant medication. Which of course, affects their sleep cycle at night and can make restless legs even worse. So all of a sudden, we’ve got this super crazy cycle that we really have a hard time getting these kids out of. So the very first thing I like to let parents know is, just because your child has a diagnosis, I’m not thinking that it’s a sleep disorder. There are different cases where actually that could occur. And we see that come out in their behavior.

Generally speaking, cranky kids are just not fun. And that’s really where we’re at a lot of times with sleep and many children don’t even realize it is sleep that they need. Because they think, you know parents would think, oh, well you’re just a little low on energy so here, have a snack. Even if it’s a healthy snack you know, not necessarily a sugar snack, it’s still not going to replace sleep. Right? There’s no replacement for sleep and so thinking about that it’s probably worthwhile maybe going over some of the ideas behind how much sleep children need at different ages so that we can avoid some of these problem behaviors as they come out. Make sense?

Dr. Nicole Beurkens:

Yeah, I think that’s a great idea and I appreciate you raising the point about the percentage of kids diagnosed with ADD or ADHD who actually have underlying sleep issues because I see that a lot in practice. Where kids will come in and they’ve been diagnosed with one of those conditions or a related type of condition. And, you know, I always am asking about sleep and it’s because so many of these kids aren’t sleeping well or maybe they’re in bed long enough but the quality of sleep isn’t there. And parents will say, oh my gosh, we’ve done every medication. We’ve done everything and my kid is still really symptomatic having all these symptoms. And it’s amazing when we can address the underlying sleep issues those behaviors during the day just improve dramatically.

I’m glad that you raised that. Yeah, let’s talk about the amounts of sleep that kids should be getting. Because I think a lot of parents are surprised to hear, especially when we think about teenagers, so yeah, let’s cover that.

Dr. Michael Breus:

Absolutely so, I’m going to work my way backward from kind of teenagers going back right. And so when we look at teenagers it would be fantastic. I know it’s not realistic but it would be fantastic if they could get 10 hours a night. Right? That would be the ultimate kind of number that we’re looking for. Especially in the earlier teen years when we’ve got puberty hitting when we’ve got all those developmental changes going on. The more sleep, the better.

Remember something.

Sleep is healing and sleep is growing. And that’s what sleep is, especially at these ages. So when we’ve got teenagers who’ve got busy schedules, they’re on their devices late at night, they’re chatting with their friends, they’re watching YouTube, all of these things. They’re not getting the rest that they need.

I just want to briefly talk for just a second about some of the devices and the use of devices that night because that can be a big one as well. Many parents might not realize it but there’s a specific kind of light that comes from your laptop from your phone iPad, what have you. It’s called blue light. Now, let’s be honest it actually isn’t blue by color, but it’s blue in the spectrum of white. 450 to 480 nanometers is the frequency that’s coming out of these things. Now, I don’t mean to get too technical but it gets really interesting really quick. This frequency when it hits your eyeball, it actually tells your brain to turn “off” the melatonin faucet in your head.

That’s not so great for adults but that’s really bad for teenagers for two reasons.

Number one, is they have a tendency to use these devices much longer than adults do.

Number two, their internal biological clocks are already shifted later no matter what.

This is a biological function, if you remember back when you were a teenager, again, you like to stay up until 12 and sleep until 12. That’s exactly what these kids are like biologically. Then they get these lights in front of them and it can push them even later. And, oh, by the way, you still got to wake up for school at 6:30 in the morning. And that just stinks. Not only for the kid but especially for the parents. Right?

I can’t count the number of parents who have been like, Michael, what do I do with my kid? I can’t wake him up! And I mean I’ve heard some horror stories you know, like ice water being thrown on these kids, you know, pulling the sheets out from under them. I mean, you know, the morning warfare that occurs with trying to wake up a teenage child it’s no fun for anyone. Right?

And so, step one is usually education with these kids because a lot of times they don’t know what’s going on I mean just because it’s their body doesn’t mean they’ve figured all this stuff out. So a lot of times when I educate kids about it they’re like, oh, well that makes more sense to me. And we give them solutions. And so, a solution that’s actually a very kid friendly solution.

My initial solution in my house was I’m going to turn off the router at night. There was almost a mutiny at my house when I tried to do that. It just didn’t go over very well. But we now have these glasses called blue blocker glasses and these are very good. Both of my children wear them starting at 8 o’clock at night.

Now yes, they look a little goofy but you can have fun with it. My kids actually post on Instagram like look what my dad is making me wear, I can’t believe I’m the Sleep Doctor’s kid. You know, all kinds of fun funky stuff.

What’s great about it is it blocks this blue light and when it does that it actually reduces eye strain. Because we know lots of children are going to have eye strain kids they’re looking at computers. But when we block that blue light, we’re allowing that melatonin to be produced. And that’s really something that’s going to be important for our teenagers.

And when we go a little step backwards to our younger kids. So we’re talking now 12 to about 8, the number actually increases in terms of the amount of sleep that we would love for them to get. We’re thinking more like 12 hours in this age range especially towards the back end or the lower end of the age range. We really want these kids in bed earlier and then because they’re going to get up fairly early anyway. Right?

Allowing them to get 10, 11, 12 hours is really going to be great for them. Again, this is a super big developmental time for them. We really want to make sure that they’re getting the opportunity to grow. But also from a cognitive standpoint, this is where all the information is coming in. This is where they’re learning how to learn. It’s really hard to learn with a sleepy brain. OK.

When you’ve got a child who’s got different types of behavioral issues, different types of things going on in their lives, sleepiness is just a factor you don’t want complicating the whole thing. If you can get them to that you know 10 to 12-hour range, closer to the 12-hour range, you’re going to be a lot better.

When you get down to the to the smaller kids, not the itty-bitty’s. But the smaller kids, then you’re really looking at 12 to 14 hours and usually, there’s a nap in there somewhere and that can count towards that 12 or 14 hours. Those are the kind of things that parents should be shooting for. Now, look. I get it. Especially, having teenagers sometimes it’s impossible to even get eight hours much less 10 hours.

So here’s the thing that you’re going to hear from me that you don’t usually hear from most sleep specialists, which is, yes they can take a nap when they come home from school. Especially if they’re teenagers because nothing is going to stop them from sleeping when they want.

Dr. Nicole Beurkens:

Right.

Dr. Michael Breus:

But don’t worry about that. And by the way, my son comes home he could take a two and a half to three-hour nap and all of a sudden I got to wake him up for dinner. And then he’ll eat, do his work, and then go back to sleep. So don’t worry about that. The second thing is, it’s OK to let them sleep in on the weekends. Saturday it’s perfectly fine. I mean honestly, nobody gets up in this house until noon. I mean I do. But other than that. Right? So that’s OK. Be careful with letting them sleep too late on Sundays in particular.

And here’s why…

Because if they sleep in on Saturday, if they sleep in on Sunday as well, their brain, especially the teenagers, is going to want to sleep in on Monday. So get them up within two hours of their normal wake up time on Sundays but on Saturdays let them sleep in.

Dr. Nicole Beurkens:

Yeah. And I think that that’s really helpful for people to understand how important sleep is at that age. You know, I often say to parents that if you look at it both from a growth, a physical growth standpoint and a brain development standpoint, the fastest period of growth in life obviously during infancy but the second fastest is really during the adolescent years. They’re undergoing so much physical growth and cognitive and brain growth and the sleep needs are tremendous. And unfortunately, a lot of kids at those ages get really shortchanged. Whether it’s because of devices and things interfering in their sleep or just the fact that school starts so darn early. And that’s such a frustration. Especially, you know, there’s so much talk in the world of education about using evidence-based educational approaches. And yet, the evidence really shows that we have our start times completely reversed, right? Are younger kids or elementary kids should be starting earlier because that works for them. And our older kids, are teenagers, shouldn’t be starting high school, middle school until 8:00 o’clock, 9:00 o’clock. And instead, we’re getting them up at the crack of dawn, and I think that really does create a lot of challenges. Especially when we think about them, you know, trying to get homework done in the evening or participate in sports, things like that. I talk to families about shooting for eight hours. That needs to be the minimum goal and if they can get more, great, but what can we put in place to make sure they’re at least getting eight. Because I see what a huge difference it makes in their mood and their anxiety level and their irritability. You know, their overall behavior.

Dr. Michael Breus:

I was also going to say, including their academic performance.

Dr. Nicole Beurkens:

Yes!

Dr. Michael Breus:

Right? So you know the parents are out there who are big on academics. Look, the data is super clear. Right? Is sleepy kids get bad grades. It’s just the bottom line. Right? And and so if you’ve got a child who on top of behavioral issues, you’ve also got academic issues. You’ve got to look at their sleep. I can almost guarantee you there’s something in there that’s not going the way it should be. And you know there’s a lot of different things out there that you can use, resources, that you can use to help you learn how to sleep better, deal with sleep issues and sleep problems.

And there are some sleep problems, by the way, that are very characteristic based on age. Right? And so, as an example, one of the things that we see in the younger kids in that earlier developmental stages. Right so, we’re talking now ages 4 to about age 8.

One of the big things we see there are these things called night terrors.

Okay. Now I don’t know if anybody out there has experienced them. My daughter had nightmares and they scared the crap out of me. OK. Because here’s what it is, if you don’t know. Is your child is lying there and then they just sit up and they just scream bloody murder and then you come. I mean I’m running across the house. I’m thinking you know, I’m going, there’s an intruder or my daughter fell or something, and she looked at me and then boom she just fell back asleep. Right. And you know my heart is beating out of my chest. I’m reasonably certain I would have had a heart attack at this point. And she’s perfectly fine the next morning. I said, hey Carson, what was all that screaming about? And she was like, what are you talking about dad? Because they’re completely amnestic to it they have no idea that it occurred. So there’s actually some very very good treatments for stuff like that. One of them and I will gladly share it here.

Dr. Nicole Beurkens:

Yeah, please.

Dr. Michael Breus:

After they fall asleep if you wait about 45 minutes when they’re into their deeper sleep cycle. Go in and gently wake them up and ask them two or three questions. Like, what day is it? Did you do your homework? What’s your middle name? They can be the same three questions every night by the way. Just enough for them to think and then put them back to sleep. For some reason and we don’t know why that seems to be kind of the reset button for night terrors and they just magically go away. I did that with my daughter it worked like a charm. I can’t explain exactly why it worked from a neurochemistry standpoint but I can tell you it works a bunch. And it’s very very helpful.

Dr. Nicole Beurkens:

That’s great. You know, I had never heard that before. And that’s awesome because you know, I’m convinced they are called “night terrors” because they’re terrorizing for us as the parents.

Dr. Michael Breus:

Right!

Dr. Nicole Beurkens:

The kids are fine but for us it’s horrible. And I know that those tend to run in families like often, you know I see a couple kids in the same family, you know there would be a couple kids with those issues but I hadn’t heard that before. That’s a really helpful tip for parents who are listening who have that issue with their child. Because certainly, I mean, while they’re not, you know, alert and cognizant of what’s going on. And that is still quite disruptive to their sleep. Right? Especially kids who are having several of those in a night.

Dr. Michael Breus:

Absolutely. And during this particular age range, another big problem that we see is called enuresis or bedwetting. Right? That’s a very common issue. And it was surprising to me how many parents have come to me with children who have bedwetting issues. I was actually kind of surprised at that. And believe it or not, there are some very, very, simple techniques out there. So if you go to Google and you type in, Bell and Pad. B-E-L-L and pad. This is a little device and it’s really quite interesting. It’s got a little sensor that goes on the internal part of their underwear and it can sense moisture. And then there’s a little cord that goes to a little alarm or a vibrating disc that goes in their pillow. And it just gently wakes them up when it senses this level of moisture. The child knows, oh I need to get up. Gets up, takes themselves to the bath and comes back. Usually, in seven or ten days the issue is gone. Right?

There is well documented, you know, protocols for a lot of these issues. Unfortunately, parents don’t know about them or pediatricians may not know about them. So, you know, we’ve got to make sure that parents are getting well educated and understanding some of these things for sure.

Dr. Nicole Beurkens:

You know speaking about younger kids and you know night terrors and bedwetting. You talked about the amount of sleep that kids should be getting in different ages. This makes me think that I want you to talk about quality of sleep and sleep interruption. Because I think, you know, sometimes parents will say, well, gosh my kid is you know sleeping for 12 hours in a stretch. The amount of time that they’re sleeping seems to be fine. And yet, when we dig into it more it turns out that they’re having poor quality sleep or restless sleep. So can you speak to that a bit?

Dr. Michael Breus:

Absolutely. So the number one culprit for restless sleep, especially when you start to get into the like 10, 11, and up is caffeine. Lots and lots of people are allowing their children to drink sodas, diet sodas, anything, you know energy drinks Monster what have you. These are not appropriate for children at all. OK. Bottom line. Caffeine has absolutely zero nutritional value. There is no reason it should be introduced into a child’s regimen. So that’s number one is. And by the way, if your child is drinking caffeine do not cold turkey them off of it. OK. That’s a nightmare. You need to slowly taper them off a bit, especially if they’re drinking more than one or two in a day. That’s really not good. If they are only drinking one or two in a day you can definitely get rid of that. And you’ll be better off with it. Water is the best thing that they could be drinking. They don’t need juice. They don’t need Gatorade. They need water. That’s it.

Dr. Nicole Beurkens:

Absolutely.

Dr. Michael Breus:

Well filtered water, I’m with you, but water is really where they need to go. But caffeine is a big one. Another big one that I found more so with itty bitty kids than larger kids, is what is the bedtime routine? Sometimes that bedtime routine can be different and that can throw the child off from a quality perspective. So, I’ll give you a great example. I had a parent who the father had a very difficult job and wouldn’t get home, oftentimes, until literally 10 minutes before the children were going to bed. But he planned it so that he could get home so he could put the children to bed because he wanted to be part of that. And so I thought that was great until I found out that part of what he likes to do. He had two boys was the roughhouse for bed. Because it’s fun and your wrestling and all that. Worst idea ever. OK. What you don’t want is a lot of physical activity right before bed. Remember everybody sleep is not an on/off switch. It’s more light slowly pulling your foot off the gas and slowly putting your foot on the brake. There’s a process that needs to occur there.

Roughly one hour before your child’s bedtime, which you should know now based on kind of what time they wake up and how many hours they’re going to need. One hour before, do yourself a favor and create what I call a power down hour. Twenty minutes for things that just got to get done before the next day. So that could be getting their sports equipment together, finding out what they want for lunch. You know, finishing up last minute homework details, something like that. 20 minutes for hygiene. Right? So brush teeth, wash face. Bath if you’ve got young kids. And then 20 minutes of some type of relaxing type of thing. So that could be story time, song, prayer. It could be reading. It could be if you have an older child teaching them meditation techniques.

There’s a lot of different things that you can do to help ease your child into sleep. That has a tendency the data is interesting when children are doing positive things before bed they actually get deeper sleep and their dreams are more positive. Which is kind of cool, right? And it’s a pretty easy thing to do.

One simple trick that I do with a lot of my kids is I have them create a gratitude list right before bed every night. Like just list five things that you’re grateful for. Sometimes it could just be, I’m grateful that I liked dinner tonight. Or sometimes it can be something you know that’s big that’s going on in the household. Like, I’m grateful that Mommy’s chemotherapy treatment went well. Because there are so many different issues that can affect a child especially while they’re thinking before bed. And if you’ve got something going on in your household that’s pretty stressful like a divorce, or an illness, or death of a loved one. You need to expect that your child’s sleep will definitely be affected by this.

Even a purely emotional traumatic event can certainly have major side effects on the quality of their sleep. The final thing is their environment, right? And so, I know many kids will share a room with their brother or their sister. But if their brother or sister has night terrors, that’s going to stink. You know, or if they snore, or if they like to play loud music, or if they get up at a different time.

Really looking at that environment can also be critical for getting children to have a better sleep environment, which then leads to better quality sleep.

The final way to increase quality sleep for kids I would argue is exercise. The data is super consistent. Children who exercise sleep better. Period. End of story. So for you folks out there who got kids who were on a bunch of sports teams, that’s awesome. I don’t have kids that are very sporty and so we find other exercises. Walk the dog, go out for walks after dinner. You know, whatever we can do to kind of promote that, especially in younger kids to make it habitual. It’s always going to be better for the quality, not just quantity of their sleep.

Dr. Nicole Beurkens:

That’s some super helpful things for parents to think about. And that’s also something that you just commented made me want to ask you about specific signs or symptoms that might indicate to a parent that there is some sort of actual sleep disorder, you know, going on. There are kids who you just kind of are restless and don’t sleep well and may be hard to settle down. Using good routines at night and not doing caffeine and getting exercise like those things do wonders for kids. And then we’ve got kids who are experiencing a level of restless sleep, or inability to fall asleep, or stay asleep, or who are super, super tough to get up in the morning. Like there are things that can indicate that there’s something there that should be medically looked at, right?

Dr. Michael Breus:

Absolutely.

Dr. Nicole Beurkens:

Can you talk to us about what some of those things might be that parents should look for?

Dr. Michael Breus:

Sure. First of all, no child should snore. Okay? So let’s just talk through that idea for a second. Now I get it. If your child has allergies, if your child has asthma things like that. But, generally speaking, children shouldn’t snore. When they’re snoring that means that their airway is becoming compromised and that they’re not breathing very well and they could have something called sleep apnea.

One of the first things that we look at in kids, especially kids with behavioral issues, is sometimes it makes a lot of sense to bring them in for a pediatric sleep study so we can learn if they’ve got apnea. Apnea is not just an adult disorder, it’s definitely in kids. And as a matter of fact, in adults, the cut off for apnea is five times an hour or greater. Alright, stopping breathing. For children, it’s one time an hour or greater. So it’s very different. These studies are run differently. They’re scored differently. You have very specialized sleep doctors and pediatricians who run these studies. So that’s one thing I look for is the potential for sleep apnea.

Snoring, difficulty waking up, falling asleep in school, those types of behavior, lethargy, not wanting to do their favorite things anymore. And then also a tendency for them to eat high sugar, high-fat foods is also these are all potential signs of sleep apnea. Sleep apnea also, by the way, can be confused with narcolepsy sometimes. The good news here is narcolepsy almost never shows up before age like 13, 14, 15.

If you’ve got a sleepy young kid the chances of it being narcolepsy are very very small I wouldn’t necessarily worry about that. Another thing that you can do is go into their room while they’re sleeping at night and watch them for about 15 minutes. Are the covers flying? Are their legs moving? Or you hear vocalizations, are they talking? What’s going on?

By the way, 25 percent of all children are sleepwalkers and sleep talkers. It’s perfectly normal. It’s only a safety issue. Right? And so, if you’ve got a child that’s a sleep talker, you’re fine they just might be a little bit noisy. But if they’re next to their brother then that could be an issue. But have you got a child that is a sleepwalker, the big thing to make sure you do is put baby gates up at the top of the stairs and the bottom of the stairs. The reason I do it in both places is because a lot of times parents will only put it in one place. And what ends up happening is for some reason a gate gets moved and something goes wrong. So and children fall asleep on the couch, blah, blah, blah. So just be careful with that.

Also if you have a child that has a tendency to be very mobile, like they can walk across the house, down the stairs, and out the front door. Which happens more frequently than you’d imagine. Instead of having a bolt lock change it to key lock from the inside. Key lock it and then take the key and put it above where the child can reach for it. Make it obvious for the adult. I mean it can be on a tac right there, but while they’re sleeping it would be almost impossible to go through that complex of a behavior for that but that’s something. But by the way, sleepwalking and sleep talking are usually a sign of sleep deprivation. So the child is not getting the quality and quantity of sleep that they need. And that can be an issue as well.

Dr. Nicole Beurkens:

That’s interesting. That’s helpful to know. I didn’t know that increased sleepwalking and sleep talking could be, you know, an indication of sleep deprivation. That’s really good to know.

Dr. Michael Breus:

Absolutely, it can be. And then on the scarier side of things which is incredibly rare, are seizure disorders. Right?

Dr. Nicole Beurkens:

Right. Dr. Michael Breus: And so if you have a child who has known seizures, which many parents who are watching this could have that as a situation. Then you also want to be careful to see if they’re having seizures while sleeping. Because that can be incredibly disruptive and the seizures might be different. They could have grand mals during the day and petites at night and it would be hard to see.

Again, if you have any suspicion it’s going to be good to get a sleep study done. Only because if you’ve got a child, again, with daytime seizure you really want to be careful about something like that. So those are kind of the bigger things that you would want to be looking for that could be sleep disorders.

Now, there’s also, refusal to go to bed. Right? Which is a biggie. Right? And I don’t want to go to bed, one more glass of water, or you know that kind of stuff. And so, look,  that is nine times out of ten that is not a child issue. That is a parent issue. Right? So I have to reach through the children and strangle the parents. Right? It’s all about consistency. You’ve got to put your small kids down at the same time every night. I don’t care if grandma and grandpa are in town. And their flight was delayed and they get into your house at 9 o’clock and Johnny’s bedtime is 8:30. Johnny needs to be asleep. OK. Like Johnny’s not going to be great if he stays up until 9:30, then hangs out with grandma and grandpa till 10:30. The next day it’s going to be a disaster. Right? And that doesn’t do anybody any good.

Consistency, consistency, consistency, is really the best. And you can use behavioral charts and things like that. So in our house, we use hot wheels cars. So my son loved to get up. You know one more glass of water, one more this. And so what we did was, I said, Cooper, let’s go to the store. And he was all excited. We went to the toy store and I said, there’s a big wall of Hot Wheels. I said, pick out ten cars. He went crazy. He was having so much fun. We put them all in the bag and I held him up in the front seat while he was in the back and we got home. He was like, hot wheels! Hot wheels! Hot wheels! And I said, oh no, no, no, no. You don’t get any hot wheels. You got to pick out the hot wheels. But here’s what’s going to happen. If you can keep your butt in your room all night long for one full night. You get a hot wheels car.  And guess what? Magically, my son was able to do that. Now I will tell you the first night he peeked his little head in and I knew it was going to happen. I had the car that he wanted the most sitting right next to me and I raised it and I showed it to him. I said, you ain’t going to get it if you walk through that door. He’s spun around and went back.

So it is really about just being fun and getting them involved if you noticed I had him choose the prizes because that was an important thing. And it gets them involved. And I explained to him why sleep was important and why I needed him to stay in his bed until the clock in his room said 6-3-0. That was our deal. You did that. You could walk over to the basket and grab a hot wheel. And literally in ten days, we were done. So it’s very very possible to train your children, but when you are inconsistent with schedules it’s just going to make your life much more difficult.

Dr. Nicole Beurkens:

Yeah, that’s so important. It’s something that I talk with families, about all the time. Often those types of issues are more the parent’s issues. And our issue with not wanting our kids to be upset with us, or us being tired at night and not wanting to, you know, hold kids accountable. You know, and I will say the same type of consistency goes for older kids too. I mean, right now my four kids are 12 to 18. And I’m just as rigid with them about the importance of sleep and maintaining consistent routines. Obviously, they’re doing more of that now because they’re of an age where they can do more of that. But, but I think it’s important for parents to recognize the huge role that we play in not only educating our kids about why sleep is important but also holding them accountable to learn how to sleep well. And to learn how to manage those evening routines, and how to soothe themselves when they wake up in the night. That’s part of our job to help them learn to do that. And sometimes there can be challenges around that. Especially if parents have had their own sleep issues, you know, parents who don’t sleep well, I think, struggle to help, you know, maintain routines with their kids.

That consistency is so important and recognizing that our kids aren’t always going to like it, especially as they get older. You know? And little kids don’t want to go to bed because they want to play and you know they’re convinced that everything fun in the world happens while they’re in their bed. And then when they get older, it’s like they don’t want to go to bed because they want to talk to their friends. Everybody else’s Mom and Dad let them stay up until you know 2 AM texting or whatever it is, but I think being able to hold firm with that and say that this is such a huge part of your health and your wellness. And for parents to feel empowered to kind of set those expectations and hold kids accountable to that I think is super important.

Dr. Michael Breus:

I do too. And I’m not trying to give parents a hard time. I’m just saying, be consistent, you know.

Dr. Nicole Beurkens:

Yes. Yes.

Dr. Michael Breus:

Your body needs that level of consistency and your children’s bodies will develop faster and better with consistent sleep. It’s just healthier. It’s probably the easiest thing that you can do for the health of your child is to keep them on a consistent sleep schedule. You don’t have to… I’m not saying you have to feed them spinach every day. You know I’m not, I’m not saying that they have to run a marathon. I’m just saying, go to bed at the same time to wake up at the same time. That’s all I’m asking. And I promise you, they and you, as parents, will reap the rewards.

Dr. Nicole Beurkens:

Yeah, I love that. And I often say to parents that while just addressing sleep by itself may not be the only thing that’s needed to massively, you know, shift especially more severe behavior problems in kids. If you aren’t addressing the sleep stuff, you’re not going to get very far with anything else.

Dr. Michael Breus:

Exactly.

Dr. Nicole Beurkens:

To me, it’s one of the really underappreciated components of behavioral disorders, behavioral challenges in kids. And I think we need to be talking about it more and helping parents understand just how critical it is and that you can do all the behavior training in the world. You can bring your kids to all the therapy. You can be you know on all these medications doing all these different things. And if your kids not getting the right amount of good quality sleep at night, you’re not going to get very far. And I’ve just seen that, you know, in 20 years of practice.

Dr. Michael Breus:

No question about it. And I know we’re running a little short on time. But I did want to include one more thing if I can.

Dr. Nicole Beurkens:

Yes, please do.

Dr. Michael Breus:

So I have lots and lots of parents who say to me. Okay. Dr. Breus, I’ve tried all those things but my kid just doesn’t sleep and I want to give them a pill. What do I do?

First of all, sleeping pills for children are only in the most extreme cases, you could imagine. We’re talking about things like schizophrenia, bipolar, you know, those types like severe, severe autism like those cases. Absolutely. It makes sense, you would absolutely need to get this done with a pediatric psychiatrist who is on board with your psychologist and the therapy that’s going on there because they have to coincide. You can’t just give the kid a pill and think that they’re going to sleep. Alright, that’s number one.

Getting out of the pharmaceutical induced sleep and looking at, for example, over the counter stuff. Right. Lots and lots of pediatricians tell parents just give them Benadryl, it’s all fine. Okay, it’s really not fine.

Dr. Nicole Beurkens:

Right. It’s not fine.

Dr. Michael Breus:

Let’s just be super clear about that. It’s not fine. Okay, and there’s a lot of reasons why it’s not fine. But the biggest reason that it’s not fine is what you’re educating your child to do… is to think that they require a pill for this natural sleep-related process and that is not true. You are giving that to them because you don’t want to deal with them up or being consistent or things like that and so it’s an easier solution. This easy solution is not going to pay off long term. I promise you.

Now, if you’ve got a child and you have a 17-hour flight to Europe or something like that, absolutely, I get it. Okay. Weird environment. Sure, you know, or God forbid, that they’re sick or something like that all bets are off there but if you’re dosing your child with Benadryl nightly, bad idea. If you’re doing it even once a week. Honestly, that’s not really where you need to be here. This is a bigger issue and then you need to find a pediatric sleep specialist.

Either way, that’s a good point. If you don’t know where to find a pediatric sleep specialist, every major children’s hospital has a pediatric sleep lab and a pediatric behavioral sleep specialist associated with that lab. So, if you’re looking and you’re like, oh my gosh, I don’t know where to go. Whatever the closest pediatric hospital is or children’s hospital is, that’s the place to start. If they don’t have a one, which would be kind of amazing, they’ll know somebody who does in the community and be able to help you out with that. Also, we should talk about supplementation.

Dr. Nicole Beurkens:

Sure!

Dr. Michael Breus:

I think that’s an important aspect for people to understand as well. So, my favorite supplement for children for sleep is the recipe that I call banana tea.

Dr. Nicole Beurkens: Nice!

Dr. Michael Breus: Right. And so it’s all about magnesium. So it turns out that most of us, even kids, have magnesium deficiencies. Because you can eat a bushel of kale a day and it’s not going to give you the right amount of magnesium.

Number one, our soil doesn’t have a lot of magnesium in it any longer. So we at the end, by the way, our bodies don’t produce it so we have to ingest it. It turns out that bananas are loaded with magnesium, but the peel actually has three times the amount of magnesium as the fruit itself. So simple recipe. Okay. It’s called banana tea but it actually doesn’t have any tea in it. So, you take an organically grown banana cut off the tip and the stem. Cut it in half. Leave the peel on and the fruit in it. Okay, then put it into about three cups of boiling water. I’m going to move this because the sunlight is… by the way, we are in my kitchen which is perfect because we can make banana tea!

Dr. Nicole Beurkens:

That’s right!

Dr. Michael Breus:

And you take the banana, wash it off and then you put it into three cups of boiling water and you boil it until it turns brown. Then you drink the water. You don’t have to eat the banana or the peel. Although plenty of people do. It’s actually nice because it’s mushy and it’s not too bad -or- use it for banana bread or something like that.

Dr. Nicole Beurkens:

Yeah!

Dr. Michael Breus:

But the banana tea is great! And I have a lot of moms were take this mixture, they make it during the daytime and instead of presenting a hot liquid they put it in molds and make popsicles.

Dr. Nicole Beurkens:

Yeah, nice.

Dr. Michael Breus:

And so it’s a great little treat for the little ones. They got to like bananas, because it’s very banana-y as my daughter likes to say. But it works really really well and it’s a great form of supplementation because you’re also getting a lot of the natural constituents from the banana which help you absorb the magnesium. So you’re not just popping up pill and hoping for the best. Right?

Dr. Nicole Beurkens:

Awesome.

Dr. Michael Breus:

That’s definitely one thing and then we really would be doing a disservice if we didn’t bring up the idea of melatonin. And are parents using it? Should parents be using it? What should they do.

Dr. Nicole Beurkens:

Yeah.

Dr. Michael Breus:

So let’s talk about it a little bit right now. So first of all, the appropriate dosage of melatonin is low, low, low. We’re talking a half a milligram here for kids, right. For adults, it shouldn’t be over one and a half milligrams. By the way, 95% of it is sold in over-dosage format. Okay. The only place I’ve found melatonin in half a milligram dose is actually at Trader Joe’s. Their house brand and I’ve checked it out, so the quality is good. So if you’re going go out and grab something that’s the one to grab but remember something. Almost all children make enough of melatonin. Okay?

Melatonin is not a sleep initiator. It’s asleep regulator. So melatonin doesn’t make children fall asleep it changes their circadian rhythms. So, as an example. Let’s say you’ve got a teenager whose circadian rhythm is shifted late. They want to stay up late and sleep late, but they’ve got to get up at five o’clock in the morning for some event. Melatonin the night before might not be a bad idea there. But again, generally speaking, giving a pill to a child every single night is probably unnecessary. However, there’s a big caveat here.

Dr. Nicole Beurkens:

Right.

Dr. Michael Breus: Children on the spectrum, there’s a lot of really good data to show not only is melatonin very effective and should be used nightly, but the dosage is high. We’re talking 3, 4, 5 milligrams at times can be very effective for kids who are on the spectrum. So if you don’t have a child on the spectrum, I’d prefer if you can do things that were more behavioral… banana tea, stuff like that. Really, you don’t want to head towards the pill right away but for kids, but if you’ve got a child is on the spectrum. Don’t hesitate, because it can be very, very helpful in those particular situations.

Dr. Nicole Beurkens: Awesome. Super helpful. So many great tips that people can take away from this and so much helpful information for parents to start thinking about how their child is sleeping and simple things they can do to improve that. If people want to find you online and get more information where can they go?

Dr. Michael Breus: Sure. So head on over to my website it’s thesleepdoctor.com – it’s pretty easy to remember, once I say it hopefully you’ll never forget it. But also if you go to thesleepdoctor.com, I would suggest that you go to the section called, the Blog. And click on my blog. In the search bar, type in teens or children – I’ve probably written close to 20-25 blogs about this stuff and I go into the details on it. So you can really get some great information there. And we’ll also make some stuff available in the show notes and links in the show notes for people as well.

Dr. Nicole Beurkens:

Awesome. Super. Thank you so so much. It’s been great having you. I appreciate you being a guest.

Dr. Michael Breus:

Sure. It’s my pleasure. I just want to wish everybody out there, Sweet dreams!