Showing posts with label sleep. Show all posts
Showing posts with label sleep. Show all posts

Friday, 6 January 2023

What’s really going on when a child is ‘overtired’ – and how to help them have a silent night in the New Year

Posted by Helen Ball, Professor of Anthropology, Director of the Durham Infancy & Sleep Centre (DISC), and Fuse Associate at Durham University

Anyone who’s cared for a young child will recognise the signs. They’ve had too little sleep or missed a nap, they’re cranky, tearful, and stroppy, and they can’t or won’t fall asleep. They are “overtired”. But is such a thing really possible – to be more tired than tired?

What we tend to call overtiredness happens when an emotional state, such as anxiety, distress or fear, blocks our ability to go to sleep even when we’re really tired. This is a survival response that helps us to stay awake when in danger, no matter how tired we are. It suggests overtiredness can be reframed to help us better respond to our child’s needs when it happens.

At the end of the day, the feeling we have of needing to sleep is called sleep pressure. The longer we stay awake the more sleep pressure rises. Typically, the higher it gets, the easier it is to fall asleep. If we stay awake for long enough, eventually we’ll fall asleep even if we are trying not to.

The sensation of sleep pressure is caused by the build-up of chemicals (called adenosines) in the brain. These are proteins that are removed from our brains while we sleep, and build up again while we are awake.

For adults, this process takes about 14-16 hours. When we delay sleep past this point the build-up of adenosines cannot go on unchecked. At some point, eventually, we must sleep.

Babies’ sleep pressure builds up more quickly than adults. Young babies often fall asleep after being awake for an hour or two. As children get older, sleep pressure builds more slowly. But it takes several years until a child is able to stay awake all day.

What stops us sleeping?

To fall asleep we must be calm, relaxed and able to switch off our brains so that the build up of sleep pressure can tip us into sleep. When something blocks the action of sleep pressure, such as fear, pain or racing thoughts, we may struggle with sleeplessness.

In the same way, sleep happens more easily for a baby or child when sleep pressure is high, they are in a calm relaxed state, and nothing is preventing sleep onset. But sometimes babies and children need help to become calm before sleep pressure can kick in and they can nod off.

When a baby or young child’s sleep pressure is high and the need to sleep is strong, but they are emotionally unable to calm themselves, or they are in a situation where they cannot relax – where there is noise, lights, or activity – we may label them as overtired. Emotional exhaustion, which is a form of stress, prevents both children and adults from sleeping and makes them cranky.

Some responses to overtiredness are heavy-handed. Ordering a child to their room, putting them to bed in the face of distress or punishing them for not falling asleep when told to do so will dial up the child further and push sleep further from reach. After all, none of us can fall asleep on command.

Helping babies to sleep

In this situation, we must remember that babies and young children need our help to manage their emotions. It is our job as parents to help them become calm, dial down, and relax in preparation for sleep.

We can do this in many ways. Physical contact such as cuddling, rocking, stroking or patting works for most children, although it must be remembered that some neurodivergent children can find touch irritating rather than calming.

Non-contact methods also work. The presence of a relaxed slow breathing adult can calm a child, as can listening to gentle talking, singing and humming. In the Czech Republic, there is a specific word for lying with and helping a child to relax so they can fall asleep: uspávání.

There is no name in English for the process of helping a child relax so that sleep pressure can tip them into slumber, so we often don’t discuss or acknowledge it. We can use it, though. And we can understand that what we have named “overtiredness” is the conflict between sleep pressure being high and something blocking the effect of that sleep pressure.

In this situation actively removing the blockage – fear, pain, anxiety – by helping babies and children to become calm is the quickest way to help them fall asleep.

Next time your baby is having a meltdown at bedtime, or your child is throwing a tantrum at the end of the day, hug them, cuddle them, talk gently to them and calm them. Let sleep pressure do its thing, and they’ll be snoozing in no time.


The Durham Infancy & Sleep Centre (formerly the Parent-Infant Sleep Lab) is a research centre of the Department of Anthropology. It is the home for a group of researchers examining various aspects of infant and child sleep and parenting behaviour since 1995. Its work with more than 5,000 parents and babies during the last 20+ years has substantially increased parents' understanding of babies' sleep, how best to care for babies during the night, and how best to keep them safe when asleep. 


This article is republished from The Conversation under a Creative Commons license. Read the original article.

Friday, 1 May 2020

Jerry-rigging, day chunking and comfy slippers: Coping with working from home

Posted by Jack Nicholls, Graduate Tutor, Northumbria University

I am a huge fan of Firefly. For the uninitiated, it’s a TV series centred on a rag-tag quasi-criminal crew, working for themselves on a tired but solid cargo spaceship, taking jobs as they can. It has a phenomenal amount to recommend it, and is rich and complex in terms of plot, dialogue and morality. Given that the ship serves as home, workspace, transport and social space, no-one discusses work-life balance. Maybe it’s not such an issue in sci-fi.

In the real world, most of our homes have over the last couple of months been 'jerry-rigged'* into offices, studio, workshops and lecture podiums. Some of us are sharing our new occupational spaces with family or flatmates with their own needs and pressures. Some of us are completely on our own, missing our colleagues. All possible permutations come with challenges and difficulties, and the one commonality is that there aren’t necessarily that many commonalities.

As the diversity of experiences became apparent, I decided to seek and compile a range of different coping strategies from colleagues in my department. What follows is the thematised synthesis of those colleagues’ input and ideas.


Getting writing (or anything else) done
My 'jerry-rigged' free-form workstation
  • Short bursts of focused concentration throughout the day - Pomodoro technique is a variant of this.
  • Daily goal of one substantial work task and one admin task
    • ....or a day given over wholly to one or the other
    • ....or a few small achievable goals.
  • Shutting emails / twitter/ phone off for allotted time periods.
  • Ending the day mid-sentence or with the next idea ready.
  • Content drafting or form/language editing when writing, but never both at the same time 


Structure and timing
  • Choose a daily time to start and definitely finish work, with regular breaks and small treats.
  • Differentiate between the working week and the evenings/weekends/(bank) holidays.
  • Alternatively......giving up on the 9-5... some are working in short bursts when able. 
  • Use your best available thinking time for the more complex/academic/difficult/thinky work (generally morning for me).
  • A ‘panic to do list’ - dump everything out of your head onto paper (work and otherwise) – then prioritise.
  • To-do-list for the next day – 3 things max.
  • Forcing yourself to do the worst job first - (known in some circles as ‘eat the frog’ – I can’t advise taking this literally ☹). 
  • Split tasks up to reduce boredom/weariness. 
  • If able, work early in the day on internet-reliant tasks (internet speed can slow in the afternoon).
  • Spread the admin tasks throughout the week.
  • Open the curtains in the morning, turn the lights on in the evening and then off before going to sleep - good for psychological rhythm.
  • Agree to morning video calls - it forces you to get dressed.
  • Clean and tidy up, either first or last thing - you will feel a sense of accomplishment and peace. 

Habits
  • Get dressed for work – not necessarily what you’d wear to the office/library/placement – but something that is different to your ‘comfy’ wear. When you're finished working get changed.
  • Alternatively...some find it freeing and comfortable to work in their pyjamas if they don’t have a Skype call.
  • Comfy slippers, but smart/casual wear for torso (just in case anyone Zooms, FaceTimes or Teams you).
  • Exercise at some point in the day – that could be anything – online pilates, weights, a stroll.
  • Don’t work excessive hours and be realistic about expectations (it will never all be done).
  • Get some fresh air – if you or one of your household are among the shielded, an open window will do.
  • Give yourself a bedtime and try observing some sleep hygiene.
  • Sing (or even dance) when you have a break and interact with pets if you have them.
  • Keep in regular contact with colleagues and friends, but also be prepared to turn off contact devices when you need to concentrate.
  • Keep your work space organised if possible – if space is limited, some people find it helpful to put all their work things on a tray, then it can be moved to wherever there is space, and quickly out of the away. 
  • Some find working in the same place suits them, others move around for variety, or depending on the task.
  • Switch the background on your Word document to something other than bright white – less strain on the eyes. Any pastel shade is good. 

Pickle & Missy failing to follow social distancing rules
These tips are diverse, and some contradict one another. This is neither a surprise nor a bad thing – academic staff, like anyone else, vary in their personal circumstances, geography, family situation, preferences and strengths. I don’t have caring responsibilities (rabbits aside) but am in a risky health category, so my time is possibly more flexible, but my ability to leave the house extra-limited. The way to look at this list is as a broad range of suggestions, and to take or try things that you think might work for you and your situation. It may be that some things work better under some circumstances than others, and there will be things here that just don’t work in your personal situation. Customise, reverse-engineer, and fit to your needs.


I’ll end where I started – with Firefly. The following exchange takes place after a tumultuous, dangerous escapade.
"We're still flying." 
"That's not much." 
"It's enough" 
Stay as safe as you can, and good luck.

*for those of a less nautical persuasion, 'jerry-rigged' or 'jury-rigged' means having temporary makeshift rigging. In this case my improvised workstation!


Contributors:
Melanie Gibson, Sarah Lonbay, Katie Haighton, Tim Rapley, Monique Lhussier, Natalie Foster, Sonia Dalkin, David Nichol, Julie-Anne Lowe, Kay Heslop, Peter Kruithof, Donna Carlyle

Image:
  1. "Firefly boxset cover" by Tom Mulrooney via Flickr.com, copyright © 2006: https://www.flickr.com/photos/mullers/232714398. Attribution-NonCommercial-ShareAlike 2.0 Generic (CC BY-NC-SA 2.0)

Friday, 21 April 2017

Sleepless in the slammer

Charlotte Randall, Higher Assistant Psychologist and MSc student, Northumbria University

The current prison population is 85,641 and around 50% of this population suffers from symptoms of insomnia. While this is similar to the general population there are a limited amount of resources to help treat this disorder in prisons.

Having worked in prisons for seven years, I am all too familiar with the problems that a lack of sleep can have on an offender's ability to engage with the prison regime, and the impact this has on their mental health. Due to the high prevalence of mental health problems, substance misuse and personality disorders in the prison population, the issue of sleep is often side-stepped and the importance of obtaining and having a healthy sleep practice can be forgotten about.

I am part of the Mental Health In-reach team in a prison in the North East, and have witnessed first-hand the effect poor sleep can have on an offender’s mental health. As this is an under-researched area, I decided it would be interesting and beneficial to conduct research on insomnia in the custodial setting. The aim of the study was to see whether a 60-70 minute session of Cognitive-Behavioural-Therapy for Insomnia (CBT-I) with an accompanying self-help pamphlet was an effective treatment in reducing the symptoms of insomnia in male prisoners.

As I work in the prison Mental Health Team full time, I thought this would be a simple project to undertake, however there were several hurdles along the way. Firstly I was required to gain ethical approval from several different organisations; NHS; National Offender Management (NOMS); and the University. Offenders are classed as a vulnerable population for research purposes, and therefore there is heightened scrutiny from ethic boards as a result of this. This process was lengthy; I had to complete three separate documents explaining the project’s benefits for each organisation. Once submitted, I was required to attend a full Research Ethics Committee (REC) where the research protocol and IRAS (Integrated Research Application System) form were discussed and additional questions were asked. It was then a waiting game to see whether the study had been granted ethical approval. As with any research project there was a deadline of September 2016, in which my dissertation needed to be submitted. Ethical approval was granted in June 2016, after recommendations had been made by the NHS and NOMS ethic boards and an amendment report was submitted.

On the other hand, recruitment for the study was relatively easy, which surprised me! Although it also identified the need for insomnia interventions in the custodial setting and confirmed that this research was important. The offenders were keen to engage, due to the lack of pharmacological (drug related) and psychological interventions for insomnia they were eager to find something that helped them sleep.

Results from this research were positive and highlighted that there was a significant reduction in insomnia related symptoms after completing the 60-70 minute session of CBT-I, with the accompanying self-help pamphlet with category C adult male prisoners. This research is the first of its kind to assess whether an adapted versions of CBT-I is effective in the prison population, where there are limited interventions and resources to help aid sleep disturbances. Although the results were positive, they have to be taken with caution as the prison where this research was undertaken has a unique regime and all prisoners are in single-cells which allowed them to complete certain aspects of CBT-I e.g. sleep restriction.

My experience of completing this research was positive; I enjoyed the prospect of analysing an undiscovered area and hopefully informing academia and practice within a public health setting. I did however find it hard in the early stages of this project, specifically going through the ethics process and length of time this took. A written report has been disseminated to NOMS highlighting the findings of this research. It also identifies how this research could be taken forward and inform future research opportunities. The single session of CBT-I is being delivered in the prison where the research was completed, more data is being gathered and will hopefully be published in 2017.


Photo attribution:
  1. “sans horizon” by poirpom via Flickr.com, copyright © 2015: https://www.flickr.com/photos/poirpom/16479845789/
  2. “prison” by erin via Flickr.com, copyright © 2007: https://www.flickr.com/photos/insunlight/1037277952
  3. “Insomnia” by Ben Harrison via Flickr.com, copyright © 2011: https://www.flickr.com/photos/48755144@N02/5564362009

Thursday, 10 September 2015

Energy drinks: Don't believe the hype

Guest post by Shelina Visram, Lecturer in the Centre for Public Policy and Health, Durham University

When asked where the idea for our study on energy drinks came from, I usually say it was through discussions with colleagues as part of another project I’m leading on in County Durham. But that's not strictly true. The original spark came from my experience a few years ago of lecturing at Northumbria University in the dreaded Tuesday 9am slot (student night in Newcastle is on a Monday), where I noticed some students regularly downing a couple of energy drinks throughout the lecture. This was my first encounter with these drinks being consumed during daylight hours and I was fascinated by the idea that some people might have them for breakfast. So this got me wondering - why would young, seemingly healthy students feel the need to use an artificial source of energy to get them through the day? Or was it just my lectures sending them back to sleep? (That is if they had even been to sleep).


Over the years I noticed more and more of these drinks appearing in shops, on TV shows, in adverts and as litter on the streets, and assumed that they were used primarily by adults to stay awake. Most cans and bottles state that these products are not recommended for children, given that they contain high levels of caffeine which children are advised to consume in ‘moderation’ [1]. But then I overheard a couple of external partners discussing energy drinks in the context of them being seen as a growing 'problem' in primary and secondary schools in County Durham. They were looking for support in scoping the evidence base and exploring what types of interventions or educational materials could be developed locally. Around the same time, a call was circulated via Fuse for research proposals to The Children’s Foundation [2]. Colleagues from Fuse and the Wolfson Research Institute for Health and Wellbeing at Durham University [3] were keen to collaborate on an application. We developed our proposal, were awarded funding, and the HYPER! (Hearing Young People’s views on Energy drinks: Research) study was born [4]. 

Since June 2014, the HYPER! study team has been busy: reviewing the published literature on children and young people’s use of energy drinks; conducting a series of focus groups and interviews with students, parents and staff from four local schools; and involving young people in a mapping exercise, drawing on their knowledge of the area around their school to identify local energy drink vendors. Here are some of the things we’ve learned:

  • If you come across a paper that says ‘energy drinks are good for you’, check to see if the work has been funded by Red Bull or conducted by someone with shares in PepsiCo.
  • Most papers that say ‘energy drinks are bad for you’ are based on expert opinion, rather than robust research.
  • Young people in the UK drink more energy drinks than those in other European countries, yet there are no published studies from the UK.
  • Sales restrictions might seem like a sensible option; they would help to send a clear message but our study participants had concerns that they would be difficult to enforce.
  • The strong influence of the marketing activities of energy drink companies should not be underestimated.
  • Any interventions should ideally involve children and young people, as well as parents, schools, retailers and the industry.
  • There is a lot of confusion around whether energy drinks are safe for children, and parents, teachers and young people need help to make more informed choices.  At least one young person in all but one of our focus groups thought that energy drinks contained bull or horse sperm [5]. They don’t.
There are still lots of unanswered questions. For example, if the government requires energy drinks to carry warnings stating that they are not recommended for children, why are manufacturers allowed to market them so obviously towards young people? What are the long-term health and other effects? Is there a link to health inequalities? And why would anyone knowingly drink something that they thought contained bull sperm? We’re hoping to answer some of these questions by conducting further research so please get in touch if you’d like to collaborate with us or if you’re already involved in work on energy drinks. We would love to hear from you.

You can find out more about this study by reading the new Fuse Brief here.

Shelina spoke about the HYPER! study at the CPPH/Wolfson Seminar - Sweetness, social norms and schools: factors influencing children and young people’s food and drink practices (9 September)


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