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Sleep. Everyone knows they should sleep, but why is everyone so bad at sleeping? It is not surprising that in our high-stress world that there is a large market of weighted blankets for the general public. There are a few factors that go into sleeping, but the three big ones that impact sleep are diet, stress/routine, and screen time.

It seems unrealistic to have different expectations for how children behave with a decreased amount of sleep. Why are adults able to complain about poor sleep habits and then expect children to deal with their sleep issues without realistic assistance? There is some underlying expectation that children can deal with poor sleep; we make them go to school, participate in all of their daily activities and responsibilities, and hold them to the same behavioral expectations. For children who have growing brains, this seems unfair for obvious reasons.

We know of a few factors that impact sleep quality. The two things we focus on as occupational therapists are the neurochemicals that are available in the brain and the prominent type of brain waves that occur before and during the bedtime hours. When we sleep, our brain makes changes; we know this. During this time, the neurochemicals are busy carving new and efficient neural pathways.

So why are we as parents and clinicians not spending the majority of our time getting our children to sleep well? In the field of occupational therapy, sleep is not widely viewed as an activity of daily living that is necessarily measurable. Further, many therapists do not know how to improve sleep quality in their clients because they are focused on top-down strategies. Pediatricians often prescribe melatonin, which does help children fall asleep, but the brain has not changed in this situation. The goal for us at The Collective is for children to fall asleep and stay asleep by themselves, without additional medications or supplements. And, it is possible!

To fall asleep, we need a lot the calming chemicals dopamine and serotonin and fewer stress-induced neurochemicals, such as adrenaline and cortisol. Think of going to get a massage; after your appointment, you feel relaxed and sleepy because there is a lot of dopamine and serotonin floating around in your brain (unless you are me, who does not like even the thought of being massaged). Similarly, think of starting a new job and the quality of sleep you get the night before; you are anxious, excited, worried, and the adrenaline and cortisol in your brain prevents you from falling asleep quickly and getting into a deep sleep.

In addition to needing specific neurochemicals, we need our brain to produce Theta waves to fall asleep and then Delta waves to enter deep sleep. Many children who experience stress or anxiety, whether it is constant or periodic, have brains that are in Beta or high Beta states. A high Beta state is a state of anxiety and stress. Trying to fall asleep in this state (almost a fight or flight state) is nearly impossible. Everyone has experience this: you are anxious and you cannot fall asleep; once you do fall asleep, you often do not fall into a deep sleep and wake up repeatedly. Think about when you have to wake up early for a flight; you might be up every few hours or less anticipating an early wake up.

Think about what the brain has to do for children to fall asleep it is sending high Beta waves: the brain waves have to change from high Beta to Beta to Alpha to Theta so start to fall asleep and then finally to Delta to get into a deep sleep. That is a big jump to go from a high Beta state to a Theta state and then into a deep sleep Delta state, which is why (at least one of the big reasons) so many children with modulation and self-regulation disorders struggle to fall asleep and stay asleep through the night. As a result, these children never or rarely enter a Delta state and are chronically tired. I can tell you that as a sleep deprived mother, chronic lack or sleep is terrible for myself and for those around me. The negative behavioral outcome of chronic sleep deprivation makes sense: irritable, emotionally reactive, inattentive, unmotivated. Sounds a bit like oppositional defiant disorder, ADHD, SPD, ASP, etc. doesn’t it? Well, no sh*t. These children aren’t sleeping. Everyone is oppositional, defiant, and more or less sensitive to their environment when they are tired.

We address sleep as one of our first priorities along with diet/nutrition and a healthy nervous system. Our sleep protocol focuses on getting deep pressure and touch input to the child so that those calming neurochemicals are released. Further, we suggested music that helps to entrain Theta waves and then Delta waves in the brain to promote a faster fall asleep time and a deeper sleep.

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