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August 2018

Helping Our School-Age Children Sleep Better

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BY PERRI KLASS, M.D, NY Times Everyone knows that getting a baby to sleep through the night can be a big challenge for parents. But sleep problems are common among preschool and school-age children, too. As we ask children to function in school, academically and socially, fatigue can affect their achievement and behavior. Australian research on sleep problems in children has included work aimed at the “school transition” year in which children adjust to a school schedule. In a study of 4,460 children, 22.6 percent had sleep problems, according to their parents, at that transition age of 6 to 7 years. “We were surprised, we thought it was all baby sleep” that was the problem, said Dr. Harriet Hiscock, a pediatrician who is a senior research fellow at the Murdoch Childrens Research Institute at the Royal Children’s Hospital in Melbourne who was one of the authors of the study. Those results led to a randomized controlled trial of a brief intervention for children in their first year of school. A group of 108 parents who felt their children had sleep problems was divided into two groups. One group got a consultation at school, with a program of strategies tailored to the child’s sleep issues, and a follow-up phone consultation; the other group got no special intervention and served as controls. Parents in the intervention group were counseled about a range of possible measures to improve sleep, from consistent bedtimes and bedtime routines to relaxation strategies for anxiety that might be contributing to insomnia. The children in the intervention group resolved their varying sleep problems more quickly, though sleep problems got better over time in both groups. The interventions also produced positive effects on the child’s psychosocial function and parents’ mental health. The most common sleep issues for children around the age of school entry, Dr. Hiscock said, definitely include limit-setting issues — that is, some of them need their parents to make the rules and routines clear. But there are also children with what sleep specialists call “sleep onset association disorder,” in which a child has become habituated to falling asleep only in a certain context, requiring the presence of a parent, or needing to have the TV on, to cite two common examples. Very anxious children are also often problem sleepers. And then there are children beset by nightmares, night terrors and early morning waking. Screen use is a major issue in childhood sleep, and more generally in childhood these days. The first recommendation is always to get the screens out of the bedroom, the same recommendation made for improving adolescent sleep, and for adults in the current best-selling book by Ariana Huffington. All of us, old and young, are vulnerable here, but it’s a good place for parents to draw the line for their children, even when they can’t quite manage it for themselves. Reut Gruber, a psychologist who is an associate professor in the department of psychiatry at McGill University, where she is director of the Attention Behavior and Sleep Lab, said that there is a close association between sleep and a wide range of cognitive functions, including attention, executive function and memory. When children go to school, “they need to pay attention and plan and follow instructions, all of which fall under executive function, which is very much affected by sleep,” she said. Many parts of the brain work less well when children are tired. “The prefrontal cortex is very sensitive to sleep deprivation, and it is key to the brain mechanisms which underlie executive function and some of the attentional processes,” she said. “The amygdala is affected by sleep deprivation and is essential for emotional processes.” These different but connected brain pathways led her to be interested in the way that sleep affects many different aspects of academic performance. In an experimental study of a small group of 7- to 11-year-olds who did not have sleep, behavior or academic problems, the children were asked to change their sleep patterns, so that they were sleeping an hour less per night, or an hour more. After five days with less sleep, she said, there was measurable deterioration in alertness and emotional regulation, and after five days with more sleep, there were gains in these areas. For the past several years, Dr. Gruber and her colleagues have worked with a school board in Montreal to develop a school-based sleep promotion program that was piloted in three elementary schools; results were published in May in the journal Sleep Medicine. The intervention involved a six-week sleep curriculum for the children, to teach them about healthy sleep habits, and materials designed to involve parents, teachers, and school principals, who were asked to consider the sleep ramifications of school schedules, extracurricular activities and homework demands. The children in the intervention group extended their sleep by an average of 18.2 minutes a night, and also reduced the length of time it took them to fall asleep by 2.3 minutes. These relatively modest changes correlated with improved report card grades in English and math; the control group children’s sleep duration did not change, and their grades did not improve. The goal of the intervention was to help families make sleep a priority. “How do you make changes in your priorities, find the way as a family, as a school, as an individual, to reshuffle things, no matter how much homework, no matter how many aunts and uncles coming for a visit, that bedtime will still be respected?” Dr. Gruber asked. “We all agree in principle, but how do we actually incorporate it into daily life?” The American Academy of Pediatrics recently endorsed the 2016 guidelines issued by the American Academy of Sleep Medicine, that 3- to 5-year-olds need 10 to 13 hours of sleep per day (including naps), while 6- to 12-year-olds need nine to 12 hours for optimal health and well-being. Dr. Gruber advised that a child should wake up naturally, without requiring energetic parental encouragement. If after nine or 10 hours of sleep, a child still seems very tired, parents might wonder about

Kink in your neck? Here’s what to do.

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For the days when you wake up with a kinked neck because you slept funny, but still have to get to work – Here are a few at-home moves to try that could help you before you get in to see a PT!   Chin Tucks 1. Stand with your back against a wall 2. Move your chin towards your chest, while pushing the back of your head into the wall, and hold for 5 seconds as you feel a comfortable stretch from your neck to the base of your skull. Repeat 10 times.   Cervical Towel Traction 1) Lying on your back, grab the towel and place it behind your head so that the pull comes from the base of your skull. 2) Provide traction by scooting away from the door which puts tension through the rope and will give you a nice stretch through your neck. 🔹Start with 3-5 minutes. 🔹You can keep your legs bent or straighten them for more tension. 🔹When you are done, scoot back towards the door to decrease the tension and slowly take your head out of the towel traction. *Please see a PT at Elevate to get the proper set up for the towel traction device.   Sub-Occipital Stretch 1) Tuck your chin. 2) Place one hand on your chin and provide a gentle pressure to further tuck your chin. 3) Place your other hand on the back of your head and provide a gentle upward pull to provide a stretch at the base of your head.   3 Finger Cervical Flexion Rotation 1) Place your thumb on your sternum. Hold index, middle and ring fingers together. 2) Flex your chin down to your ring finger. Then rotate and look left. 3) Then ‘sweep’ down to fingers with chin, and rotate and look right. Stay in a pain free range of movement. As you progress, work your way to rotating at your index finger.   Upper Trapezius & Levator Scapulae Static Stretches Upper Trap: 1) Maintaining good sitting posture, side bend your head to one side, bringing your ear to your shoulder. 2) Take your arm and reach over and pull the opposite side of your head into further side bend Levator Scapulae: 1) Maintaining good sitting posture, rotate your head towards the angle of your armpit. 2) Take your arm and reach over to the base of your head and pull your head toward your armpit.

Elevate’s Favorite Level 2 Core Exercises

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Now that you’ve mastered how to brace your abdominals and create stability while moving and breathing in level 1, let’s add some more challenges!💪🏻 This series progresses the coordination and stability of core muscles while BOTH arms and legs move, as well as the demand by adding longer lever arms, and load! This Dead-Bug series of core stability exercises is a great way to improve lumbopelvic stability that helps reduce the probability of lower back pain or injury. Here are several progressions to get started.   Dead Bug 90/90 Heel Drops Lie on the ground with your arms extended and packing the shoulders tightly down and back. Bring your knees up to 90-degrees while pressing your lower back into the floor and drawing the belly in. While maintaining your lower back firmly on the ground, slowly lower one leg while maintaining 90-degree knee bend and lowering the opposite arm ear level.    Pause for a 1-2 count and then return to the home position. Alternate back and forth between sides without allowing the lower back to rise. Perform 2 sets of 8 reps per side Dead Bug 90/90 Leg Extensions Lie on the ground with your arms extended and packing the shoulders tightly down and back. Bring your knees up to 90-degrees while pressing your lower back into the floor and drawing the belly in. While maintaining your lower back firmly on the ground, slowly extend one leg forward while lowering the opposite side arm to ear level.   Pause for a 1-2 count and then return to the home position. Alternate back and forth between sides without allowing the lower back to rise. Perform 2 sets of 8 reps per side Dead Bug  – Straight Legs Lie on the ground with your arms extended and packing the shoulders tightly down and back. Extend your legs up toward the ceiling while pulling your toes toward your shins as you press your lower back into the floor and draw the belly in. While maintaining your lower back firmly on the ground, slowly lower one leg toward the floor while lowering the opposite side arm to ear level.   Pause for a 1-2 count and then return to the home position. Alternate back and forth between sides without allowing the lower back to rise. Perform 2 sets of 8 reps per side Alternating Straight Leg Dead Bug with Medicine Ball Lie on the ground with your arms extended and packing the shoulders tightly down and back while holding a medicine ball. Extend your legs up toward the ceiling while pulling your toes toward your shins as you press your lower back into the floor and draw the belly in. While maintaining your lower back firmly on the ground, slowly lower one leg toward the floor and return to home position. Perform the same movement with the opposite leg before returning to the home position. Lastly, lower the ball until the arms are at about cheek level and return to home position.   Rotate between all three moves without allowing the lower back to rise. Perform 2-3 sets of 8 reps each Dead Bug with Overhead Medicine Ball   Lie on the ground with your arms extended and packing the shoulders tightly down and back while holding a medicine ball. Extend your legs up toward the ceiling while pulling your toes toward your shins as you press your lower back into the floor and draw the belly in. While maintaining your lower back firmly on the ground, slowly lower one leg toward the floor as you lower the arms holding the medicine ball to about cheek level. Perform the same movement with the opposite leg and arms before returning to the home position. Perform 2-3 sets of 8 reps each

Elevate’s Favorite Level 1 Core Exercises

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Get your *abs* in gear! Did you know your core includes the joints and muscles of the abdomen, spine, pelvis, and hips? The muscles of the core are like an orchestra of muscles, working together, creating ‘optimal control’ between movement and stiffness depending on the demand.  Strength PLUS coordination and control of the core musculature are a cornerstone of quality movement and performance and are important in preventing pain and injury as well. Here’s one series of exercises to focus on the abdominals section of your “core orchestra.” This series is not easy when done correctly!  It combines core stabilization with movement and breathing (an often forgotten yet critical piece in core stability), helping to lay a foundation in the neuromuscular system to build on with more challenging functional activities and demands. To start, place your fingers on the inside rim of your pelvic bones, gently lower your low back to the floor, feel the space fill up under your fingers as the deep abdominals activate.  Bring your ribs down toward your pelvic bones, creating a bracing of your abdominals.  Remember to relax your shoulders and hold that activation as you BREATHE normally.  Try to do 10 – 20 breaths keeping that contraction.  It’s not easy! Then proceed with maintaining that stability with your abdominals when adding leg movements as shown.  Keep the spine lowered toward the floor and ribs toward the pelvic bones the whole time, trying not to arch, and continue to BREATHE!  Your trunk should look like a cylinder. 1. Supine Marching 2. Up-up, Down-down 3. 90/90 Heel Taps 4. 90/90 Leg Extensions Try each one 30 – 60 seconds, with a short rest in-between exercises.  Can you do it?  If you can, then check out the advanced exercises in “Level 2!”