Sleep tips for families and young people

Part 1: Stimulus Control

Dr Chandrika K Gedara, Clinical Psychologist, UCLH

The COVID-19 pandemic has led to significant changes to our lifestyles. Young people and families are finding it hard to stick to a routine of school and work which are important for good quality sleep. Poor sleep can impact our daytime functioning, cognitive abilities, emotional regulation and physical health, including our immune system. When dealing with stressful situations having the right amount and quality of sleep means you are more likely to handle stressful situations better.

Over the next 3 weeks, there will be a series of blogs with some brief tips to help get a better night’s sleep. Here is the first part:

Ideal sleep environment. 

• Avoid bright light before bedtime. Melatonin is the natural hormone produced in our bodies to regulate our sleep-wake cycle. Darkness aids the production of melatonin signalling the body to prepare to sleep. Bright light inhibits the production of melatonin.
• Ensure the bedroom is not too cold or warm – ideal temperature between 18°- 22°C.
• Switch off lights when you go to bed.
• Use blackout blinds or curtains to make the room dark.
• Ensure the mattress, pillows and duvet are comfortable.
• Where possible, reduce noises, use earplugs if required.
• Keep ‘sleep stealers’, such as reading, watching screens, using the phone, outside of the bed. Use the bedroom for sleep only. 

Regular Exercise

• When we exercise endorphins are released into our blood and can improve our mood and sleep quality. 
• Try and engage in 20 minutes of regular daily exercise (e.g. cycling, swimming, dancing, walking).
• Avoid exercising in the three hours before going to bed to minimise body overstimulation.

Diet

• Avoid a heavy meal close to bedtime and aim to finish your dinner meal at least 2-3 hours before bedtime.
• Limit your caffeine intake and avoid its consumption at least 5 hours before bed time. Caffeine can be typically found in coffee, tea, cocoa, fizzy drinks. 

Napping

• Avoid napping if possible. Napping can steal valuable time from your night time sleep. 
• Napping during the day can tell your body that you can sleep at anytime and not just at night.
• Napping anywhere (e.g. on a chair, sofa) also tells your body that you can sleep anywhere and not just in your bed. 

Vicious Cycle Of Sleep – Thoughts, Emotions, Behaviours

Thoughts

• Negative beliefs about sleep e.g. ‘I am the only one that cannot sleep’ ‘I need 8 hours of sleep to function’.
• Negative automatic thoughts on the impact of not sleeping well e.g. ‘If I do not sleep tonight, I will have a bad day tomorrow’ ‘If I do not sleep tonight, I will fail at my exam tomorrow’.

Emotions

• Worrying about not falling asleep may lead to physical symptoms of increased heart rate, muscle tension, rapid breathing/shortness of breath, butterflies in stomach, etc. This can trigger our fight or flight response making us feel hyper aroused and alert.
• Feeling low may lead us to experience increased fatigue, low energy levels and lack of motivation to engage in activities.

Behaviours

• Lying awake in bed tossing and turning.
• Forcing yourself to go to bed early, even when we are not sleepy-tired.
• Clock-watching the time when are awake at night.

Breaking the Vicious Cycle

• Challenging our thoughts and beliefs about sleep with factual evidence e.g. Research shows that not everyone needs 8 hours of sleep every day to function well and that people can vary needing between 6-10 hours a night. Each individual varies in the amount of sleep they require. 
• Try and leave any worries outside the bedroom. Try scheduling a ‘worry time’ earlier in the day and if you have worries in the middle of the night write them down and address them the next morning.
• 15 minute rule – If you are awake after 15minutes then get up from your bed and go into another room and engage in non-stressful activities (e.g. listening to gentle music, playing Sudoku, etc) and return to bed only when you feel sleepy tired. This will help to not spend time in bed tossing and turning. 
• Create a Buffer Zone 1-2 hours before bedtime to help you put the day to rest. In the buffer zone you can engage in relaxing activities, such as having a bath, reading, reflecting on your day. The buffer zone can help you to wind down and gradually move from an active state to a more relaxed one. 

Anchoring the Day

• Wake up in the morning at the same time every day, even during weekends. 
• Develop a daily family timetable and schedule regular day time routines, chores and fun activities. 
• Try and expose to bright light in the morning. Together as a family try and go for a morning walk or light exercise. This can help regulate your sleep-wake cycle. 

Relaxation strategies

• Relaxation can help relax our muscles and calm our mind promoting sleep. It is important to find the relaxation strategy that works for us and practice it regularly during the day too. Get creative and find the one you can do together as family such as, Progressive Muscle Relaxation, Breathing and Visualisation exercises, and Mindfulness activities.

Anxiety and Worry

• Acknowledge and normalise your child’s feelings and set up a time during the day to talk about these emotions. Get creative and use pens/papers to draw out the family’s feelings about the current situation to facilitate discussions.
• Alternatively, if the worries are happening closer to bedtime then try and write/draw worries and put them inside a Worry Monster box or soft toy to be looked at the next day.
• Practise children’s relaxation strategies such as the ‘Bumble Bee Breathing’. Together with your child take a deep, slow breath in before breathing out through the mouth. As you are exhaling say ‘buzzzzzzzzzz’, ‘hmmmmmmm’ or ‘ohhhhhhhhhh’. Try and repeat 5 times.

Additional resources and information can be found here:

• https://www.thechildrenssleepcharity.org.uk/
• https://raisingchildren.net.au/search?query=sleep
• https://www.nhs.uk/LIVE-WELL/SLEEP