[E245] The Science and Heart of Bedtime with Allison Ezell

[00:00:00] Speaker A: Foreign. [00:00:04] Speaker B: Welcome to the Empowered to Connect podcast where we come together to discuss a healing centered approach to engagement and well being for ourselves, our families and our communities. Hey everyone, this is Jesse Farris and I'm here with a special guest. Her name is Allison Ezell and I'm so excited to meet her. She's a new friend to me and she is. Tell me if I'm right about this. Allison, a sleep specialist? [00:00:32] Speaker A: Specialist, Yes. I am a pediatric sleep consultant. [00:00:35] Speaker B: Pediatric sleep consultant. And so we are going to be diving into everything sleep today in this episode and I can't wait to get into it. Why don't you tell us a little bit about what brought you to that work, Allison, and tell us a little bit about yourself. [00:00:51] Speaker A: Yeah, absolutely. So I am a wife and a mom of four. I live about an hour north of Dallas, Texas, out in the middle of nowhere. And I have four kids. My first two are biologically teenagers. And then I have two children who joined our family through adoption. My almost 11 year old son was adopted internationally as a toddler from China and my youngest was a foster care adoption who also came to us as a toddler and was adopted a couple years later after a couple years in the foster care system. And I found myself about two years after coming home from China with my son and in a really hard season of sleeplessness and not understanding how to help this precious little boy that I had. And he was the sweetest, happiest, most full of energy boy all day long. And then something would happen when the sun went down and it was like a completely different child that I was dealing with overnight. And, and I remember going to his pediatrician and being like, okay, you know, and they ask all the usual questions and saying, you know, hey, well, do you have a good bedtime routine? Yes, I have a bedtime routine. Do you have, you know, have you considered melatonin? No, I don't want to give him melatonin, you know, those types of things. And kind of going through that checklist with him. And I remember at one point we kind of went round and round with him for about a year, trying to be like, what's, what's going on? I think we need some, some more help here. And at one point he looked at me and he said, have you tried a sticker chart? And I just remember wanting to scream into the void, this is not a sticker chart situation. This is a little boy who is legitimately terrified in the middle of the night. And I don't know how to help him. Fast forward about another year. And at this point, we had found ourselves in the office of a sleep medicine doct doctor and a TBRI counselor. And I was stuck between the middle of two worlds who were telling me to do two completely different things. I was being told by this doctor to sleep train and to try these medications and things like that. And in the meantime, I was having this TBRI therapist affirm the trauma informed parenting that I wanted to maintain in my home for him, that I knew was best for him. And, and I desperately was searching for somebody to bridge those two, to say, hey, here's yes, this is the basis of sleep science. This is what you need to understand. This is the basis of trauma informed parenting and attachment. And how in the world do we make these two things come into alignment to get you back on track? And I couldn't find anyone to do it. And I remember I was sitting there venting to my husband one night, like, I just don't understand. I don't know how to. And he said, you know, and I was like, there needs to be somebody out there who can help parents stuck like I am. And he goes, well, you're pretty passionate about it. What? Oh, you go, you know, are there programs? Can you become a sleep consultant? Like, what could you do? And I was up for a challenge. And so I kind of did what Scrappy Moms do. And I said, hey, here's a hole. I'm resourceful. I think I, you know, could figure it out. So I went, I went back to school and I got certified as a pediatric sleep consultant. And so I now do what I needed so desperately for someone to help me do several years ago. [00:04:29] Speaker B: I love that. I think, welcome to the Scrappy Moms Club. Or maybe you'll welcome me to it. This is what we do, right? If, if we are looking for a solution and we cannot find it or it's not resonating in the way it needs to, then you, that's what you do. You go out and find the way to make it work and then you share that wisdom with others. So absolutely. I'm so excited that you get to share your wisdom with us today. [00:04:54] Speaker A: And here we are. All these years later, here we are. [00:04:58] Speaker B: Well, maybe I'm. I'm very curious. As you're working with parents, what would you say are maybe the most frequent kind of problems that you see that people bring to you? And I'm going to guess it's probably similar to what you were experiencing. [00:05:17] Speaker A: Yeah, absolutely. I see. You know, there's kind of two big Boxes that people come to me and it's either I can't get my child to fall asleep or I can't get my child to stay asleep. More often it's that I can't get my child to stay asleep. I would say for a lot of people falling asleep, I wouldn't say it's easy, but it's the easier of the two. And then middle of the night wake ups are probably the biggest thing. And it doesn't matter if they are a 2 month old or a 12 [00:05:48] Speaker B: year old or a 46 year old. I mean, I literally. Allison just saw my doctor this morning and was talking about sleep with her. [00:05:56] Speaker A: Absolutely, absolutely. It's brutal. It doesn't matter what age the child is. If you have that broken sleep and you're not able to get those long stretches and those good sleep cycles like you need, it is absolutely debilitating. So I would say the vast majority of parents come to me in that I need help getting my child to fall asleep easier and quicker or I need help getting them to stay asleep and stop the brokenness and the fractured sleep that's happening where they're up. And that was our situation. In hindsight, I see how he didn't necessarily fall asleep fine. At the time I thought he did. I was like, getting him to go to sleep is easy. However, what I realized is that I was the one doing all the work of him falling asleep. And this was something that we'll probably get to in a minute. I'm jumping ahead a little bit, but I thought in my head, well, I can get him to fall asleep easy. That's not the problem. The problem is that he's awake and having these absolute terror panic attacks every two to three hours all night long. And this was going on for years and years and years. And so we were both just on the floor in the middle of the night crying to each other. I mean, and so I would say those are the two biggest. There are some outliers, some night terrors, what are called parasomnias, which are sleep disturbances, things like that. But those are the two biggest camps is how do I get my child to fall asleep better or stay asleep better. And age is fairly irrelevant. I'm going to guess. [00:07:22] Speaker B: Yes, for sure. I'm going to guess for those listening, they are thinking of the buckets they fall into, if not both, actually. So. And I'm excited that we get to talk about some of that stuff. [00:07:35] Speaker A: Yes. [00:07:35] Speaker B: I'll just say, you know, as a mom of two daughters, I've Got like a little smorgasbord of our own things going on in our family. You know, kids who had trouble falling asleep, a kid who had trouble staying asleep. We have a little parasomnia happening in our house that has all kinds of funny and not so funny stories attached to it. So. Right, so. So I have a feeling I'm going to be nodding my head a lot as you're sharing. I wonder, would it be helpful to our listeners to kind of just tell us a little bit of sleep science to give us kind of a foundation that helps us build from. [00:08:15] Speaker A: Yeah, absolutely. I think there are two really primary sleep science components. Cause here's the reality. The reality when you're talking about kids that have experienced trauma, foster kids, adopted, you know, kids in the foster system, adopted children, things like that, you have to consider the duality of sleep for those kids. Right. Because yes, there is a science to sleep. Absolutely. And we can't overlook that. And I will give you a few kind of basics there. But I think the other side of that coin, and this is where ultimately we landed with my son, is that sleep for him was a two sided equation. He had some sciency medical things going on, but he also had trauma and fear and he didn't feel safe in the dark, alone at night, those types of things. And so for most kids and almost all the families I work with, it is that we have to address both. And so it's the intersection of those two things which is ultimately putting them on the right path. But in terms of science, let's start there. If you understand nothing else about sleep, the two big overarching things that are the game changers for sleep, in my professional opinion, are sleep associations and sleep pressure. So sleep associations. The easiest way I can explain that to you is if you can think about your pillow. So when I lay down at night to go to sleep, I lay down on my pillow, I cover up with my blanket. I live in Texas, so I have multiple fans on in my room because it's hot, hot and because I like the white noise of it, you know, it's dark, those types of things. So the conditions around my, around me that are happening at the moment I fall asleep, right? Those are my sleep associations. So, you know, being on my pillow, under my covers in the dark, white noise on, fan going, right. Those are kind of my criteria that I need. Well, for some kids it's different. It's rocking, it's feeding, it's a parent laying beside them. It's, you know, a lullaby that plays and then stops. It's, you know, just a parent sitting in the room. Right? Whatever it looks like for them, that's their criteria for how they're going to fall asleep. Now, the tricky thing is we don't fall into a deep sleep at the beginning of the night and stay there. And where a lot of parents fall into trouble is when how the child falls asleep at the beginning of the night is not the same as what's going to happen later. And so coming back to the pillow, if I fell asleep on my pillow and a couple hours later I woke up, because that's just the way the human brain works. We cycle through sleep cycles about every two and a half to three hours all night long. If I woke up two and a half to three hours later and someone had taken it, number one, I would wake up, I'd be very confused and uncomfortable and I wouldn't be able to go back to sleep until I got my pillow back, right? I would immediately sit up, I'd be confused, I'd be like, what the heck? Where's my pillow? Who took it? I'd go look for it. And then as soon as I had it back, I could go back to sleep. Well, for a lot of parents, they are the pillow. And this was the situation that was happening with my son. For the longest time. I was literally laying next to him, arm across, rubbing his back, all those types of things. I was putting him to sleep rather than putting him to bed. There's a difference. When he would wake up a couple hours later, I was gone. No one was touching him, no one was laying next to him anymore. He felt the same as if my pillow was gone. And he couldn't return to sleep until we recreated the conditions from the beginning of the night. That's sleep associations. Understanding that concept alone solves 70% of the sleep issues that I see. It's huge. So when you understand that piece of it, that's when I see. When I'm in conferences and all sorts of things, it's like light bulbs, light bulbs, light bulbs, light bulbs. So if you can really evaluate what is changing from the child's perspective, what is changing after they fall asleep? So is the song going off? Are they falling asleep with lights on and then they go off? Are you leaving? Are they being rocked to sleep and now they're not moving anymore? Are you holding them to sleep, whatever that looks like for you? Evaluate that and start to shift toward more consistency at the time they fall asleep. Because when they wake a few hours later, they will no Longer have that moment of panic if everything has remained the same. And the hard part is, the hard part to marry that with is okay, I hear you. But I want to make my child feel safe. Right. And that's the predicament that so many people get into is. And I was in this same situation for years. [00:13:15] Speaker B: Yeah, I hear that. When you were trying to figure out how to get them to fall asleep. But you were working with that TBRi practitioner and you knew that the safety, the felt safety was so important, 100%. [00:13:26] Speaker A: And so what we really had to do. And this is not an overnight fix. This is not on Amazon. This is not something that can be delivered to your door. [00:13:33] Speaker B: Oh, man. Everybody stopped listening just now. [00:13:35] Speaker A: I mean, I'm sorry I don't have an affiliate link for you. I'm so sorry. But what eventually is the game changer is understanding how can I help build confidence in my child in separation? So how. What tools do they have to tolerate brief periods of being alone? And so how can I equip my child to see me walk out of the room without fear and terror? And so that starts with just. It's repetition. I wish there was a seat. There's no secret. It is time. It is repetition. It is praise. It is empowerment. Lather, rinse, repeat, over and over and over and over and over again. And I think what was a huge game changer for me, because I thought in my brain, the most loving thing I can do for him is be right there when he falls asleep. Be there, Be all, you know, be all over him, holding him, rubbing his back, all those things. Because I knew that was hard for him. But what I didn't understand, and it took me years to wrap my head, wrap my head around this, and my own therapist actually helped me with this. We should all be in therapy. But my own therapist helped me. I mean, help me resolve it. But what I. And I was like, but it feels so wrong to not be right on top of him. And she looked at me and she said, okay, but you have to understand, you have to start in the way you intend to go. Because from his perspective, unless you're going to stay there all night, it's actually not the most loving thing you can do to be there with him. Because what happens is he gets really attached to that and he loves it so much that when he wakes up every couple hours and you're not there, it's. I won't say re. Traumatizing. That sounds extreme, but it's just that reminder of people leave me and she, and she, I remember she looked at me and she was like, it sounds unloving to remove yourself from the, from that. But when you think about it from his perspective, you're not going to stay. So to, to help him understand and to give him that consistency and the predictability of starting the night in the way we intend to go is actually the more loving thing that we can do. Because we're not reigniting any sort of abandonment. We're not re. Triggering anything in him where he wakes up and his, you know, his most important safe person was there and now they're not. And he doesn't have to keep reliving that feeling over and over and over again all night. And that for me was a big like, oh. Because I never really thought about it that way. I never really thought about, from his perspective. I'm there and he feels completely safe. And then he wakes up and I'm not. And it's like fear, panic, you know, and I didn't, I didn't put the two together. And so stepping out of that and really considering his perspective of how would that feel to fall asleep, for example, for me next to my husband and then to wake up later and he's gone, that would be hard for me to reconcile over and over and over again. And especially for kids that have that hyper vigilance, it's extra spidey sense. Right? Their spidey sense is huge. [00:16:54] Speaker B: I was thinking about that just in terms of. There are some kids, and I would even say, I mean, this varies even with kids who have experienced trauma, where some kids can, you know, fall asleep with their parent next to them and the lights on and wake up with the lights off and the parents gone and they'll fall back asleep, they're okay. And some kids cannot. [00:17:20] Speaker A: What would you say? [00:17:21] Speaker B: I mean, I think from my experience it would be just. Why does anything affect any child more, more intensely than other children? It's just unique to their own personality and experience and the way that trauma has impacted them and the way they're, you know, their sensitivity and all of that. What would you say? [00:17:42] Speaker A: And I think, I think so much of it is temperament. Yes, I think temperament is a highly under considered aspect of sleep because I, you know, my husband is one, he can fall asleep, the lights are on, the TV's on, I'll come in, I'll turn everything off, I'll go to sleep. He doesn't wake up until morning. He, he's out of it. I mean, he's oblivious. You know, my oldest Child, he can sleep through tornado sirens. I mean, he just does not care. My two middle kids are, I mean, they're super light sleepers. They're super high anxiety. They are. I mean their antennas are on all day, all the time. They're the first to notice any change anywhere, ever. And I think so much of it is temper, temperament and wiring. I think too, you have to consider, I think history matters. I think a child's history really, really matters. Because when you have a child who comes from a background of maybe neglect or abandonment or something like that, something where they were on their own for appear for at an inappropriate time, where they really needed that secure, safe caregiver and they didn't have it, that they are going to be extra on the alert for danger because they've experienced it. They didn't always get that safe attachment loop of I have a need and a safe adult meets it. They develop that mistrust. And so that mistrust therefore lights up that spidey sense. Right, right. And so I think so much of it too is looking at their history, looking at their temperament and saying, okay, outside of sleep during the day, are they your dtc? Everything has to be structured and ordered and you know, are they that type A kid? Are they very regular? Are they very, you know, how, how adaptable are they to change? And that can give you some good clues into what things are going to be like at night and how they're going to handle those types of changes. Because I do, I mean, and just like I said, two of my kids highly sensitive to sleep associations. Two completely not. [00:19:56] Speaker B: I mean, I'm even just thinking about myself. And the story I was told about myself as a baby was that my parents couldn't check on me because they would crack open the door. This is before all the videos and all the whatever. They would crack open the door and I would wake up. So they, they were like, it was so terrible because you were our first child. We just had to believe you were still asleep if we didn't hear you, you know, and still in adulthood, I'm a, I'm a little bit, I'm easy to wake, like, and if I wake, then I'm awake. Like I have a hard time falling back asleep. So, yeah, whatever that means about me, you can infer about my personality. But I mean, I, I'm just guessing. Our listeners listening to this, thinking of their own profiles of like, oh, well, I'm like this, this or that. [00:20:43] Speaker A: Yes. [00:20:43] Speaker B: Or thinking of the person they know who could sleep through all the Alarms and all of the. Yes, yeah, yeah. [00:20:51] Speaker A: And then I think the other big, big piece of sleep science that can't be ignored is sleep pressure. And that's the piece that, that has to do more with circadian rhythms and timing and things like that. And so, you know, overall sleep needs are primarily genetic in nature. If you've ever met a kid who like, you know, their parents would be like, well, they're just low sleep needs, that might be valid. That's actually a valid thing. You know, there is an average range for an age group in terms of how much sleep they need. So for example, school age kids need somewhere between 9 and 11 and 11 hours of sleep overnight. I've got one kid who could go eight and a half and she's completely fine. Another kid who if he doesn't get at least 10, he's a nightmare. So, you know, there's such a range in there. So I think understanding sleep pressure and the drive to sleep kind of, especially if you've got toddlers that are in nap ages, that's a huge one. Because really, sleep needs, think of it almost like a pizza, right? So if they need 11 hours of sleep in a day, if they take a two hour nap in the middle of the day, that's going to severely cut into what they need overnight, right? So a lot of times I have families that come to me and say it takes my daughter two hours to go to sleep at night. And so then we'll, we'll look at her day holistically and she's taking a nap from 2 to 4 in the afternoon and then they want her to go to bed at seven and I'm like, that's not her fault, that's sleep pressure. Of course she's not, you know, this is a three year old, let's say hypothetically, she's snapping from two to four and they want a seven o' clock bedtime. That's not her fault, that's a sleep pressure issue. She's undertired, she's legitimately not tired enough. Or you've got people insisting that their 6 and 7 year olds need naps. I'm not going to say there's no six or seven year old in the world that needs a nap. The vast majority don't. Right. And so you've got these kids. So if you are going to take a piece of that piece out of the equation in the day, you have to understand the impact that it's going to have on night. You can't have your cake and eat it too, if you're wanting to give your kid a three hour nap. [00:23:04] Speaker B: I remember this thing about toddlers and babies. Our kids came home to us at the age of one, somewhere in that range between 12 and 24 months. And it was such a new idea to me that sleep begets sleep, that a well rested child will then be. Will. Will rest well the next day. But a child who had gotten poor sleep might have trouble sleeping the next day. And just kind of that cyclical nature of it. I think about it when you talk about naps too, like, oh, to break the pattern or habit of a nap is so rough because it requires like writing it out. Yeah, that's tough. And when you think, when you talk about sleep pressure, just so I'm clear, why do they call it pressure? You're needing to build up the pressure, the need for sleep. [00:24:02] Speaker A: Yeah, yeah. So it's actually a hormone. So there's literally a hormone building inside your body all day long that is giving you the need to sleep. So it's actually a chemical thing that's happening inside you all day long. I won't bore you with the sciency terms, but it's actually, if you think about it literally building, it's almost like filling up a glass and then if you take a nap, some of it pours out. Right. And so then you've got to refill it and then you pour some out and then you got to refill it and then you've got to pour some out. So it's such that delicate balance. Because overtired kids sleep like junk, right? Yes, I don't have to tell anybody that. But on the flip side of that, you also sometimes have parents who have wildly unrealistic, probably because of social media expectations for what their kids should be doing. So they've got, you got a four year old taking a two and a half hour nap at daycare and then not wanting to go to bed until 9 or 10 at night. Well, that's their, that's their, that's their physiology. They need five or six hours after that nap to get tired enough again because they poured their whole cup out and they don't have enough pressure built up in there to need it again. So that's the tricky balance. It's a little bit of a tightrope. And so I am always encouraging parents to kind of play with timing and find that sweet spot of where is my child? Because I don't want exhausted kids, obviously. But you also want the child to have exerted enough energy and have had Enough time to build that up. So, you know, if you think about, you know, adults, right. If we fall asleep at 6 o' clock on the couch for any length of time, the vast majority of us are going to struggle, going to sleep at 9, 9:30 later on because we messed up our sleep pressure. Right. So we'd have. So it kind of becomes a cycle. Right. And this, I see this a lot with toddlers who are accidentally dozing on the way home from school at like 5. [00:26:00] Speaker B: Yeah. Oh, there's nothing worse than the drive home. And you're like, no, no, don't fall asleep. [00:26:05] Speaker A: And it'll be four minutes. And to them it might as well have been four hours. And you're like, come on. But it does. It's. I mean, I almost think about it like a balloon. You have to build up enough pressure without it popping. Right. And then. So every time they sleep, they take a little bit out and then we have to rebuild it and then a little bit out and then we have to rebuild it. And that's sleep pressure. [00:26:27] Speaker B: I'm curious. [00:26:28] Speaker A: But it's all happening chemically in the brain. [00:26:30] Speaker B: So how would you recommend recognizing when a child's sleep pressure has built to the point where they need to sleep or they're ready to sleep? [00:26:40] Speaker A: Yeah, yeah, I'd say it's a combination because some kids are really sneaky. Some kids will not give you signs. [00:26:45] Speaker B: No. My oldest daughter was like that. She would speed up when she got tired. So you would think, oh, she's got a second wind. She did not. She was showing you she was tired, but a totally different way than I was expecting. [00:26:57] Speaker A: It's like a pinball machine. Yep. And they're just like off the walls, so they're really easy to miss, I will tell you that. So I think one thing that I always encourage foster, especially foster parents, if they're open to receiving a wide range of ages, especially if you're getting like under five. Like when we were open as foster parents, we were zero to four. So a really great thing for me to have just like printed out and had as a cheat sheet or saved on my phone would have been awake Windows chart. And essentially what that is is kind of giving you like a range of approximately how long is this child going to be able to be awake comfortably between slee periods without flipping out. Right. And understanding that those early weeks are a completely different ballgame. And they will absolutely fight or flight. [00:27:46] Speaker B: Right. [00:27:46] Speaker A: They will, they will sleep too much, too little, not at all as a trauma response. But once you Find your groove kind of understanding, like, okay, I was placed at three in the morning with this nine month old. How many naps do they take? How long, relatively speaking should I be aiming? Throw in the dart in the middle for how long they're going to be awake between naps. So understanding that and having a general awareness of wake windows, especially for young ones, and then also just watching their cues, watching the child right in front of you because like I said, those early weeks, it's so much for them to process that they are going to either fight it and stay awake for hours and hours and hours on end because it's so scary to fall asleep in that situation because sleep is so vulnerable for them, or they are going to sleep as an escape. It is going to be their method of flight and they are going to sleep to just, just get, make the world go away. And you see both. You see both. I will never forget being in China, adopting my son. And there was this sweet girl who was probably, I want to say maybe 11, you know, early tween age. And I don't believe her orphanage prepared her for what was about to happen. And these precious parents came in and I legitimately think she thought she was being kidnapped. And we saw them, you know, obviously at the meeting and then the next day when we went back to finalize things and she had not slept in that entire 24 hours. [00:29:17] Speaker B: Oh wow. [00:29:18] Speaker A: She had not even really been willing to sit down for the last 24 hours because her system was in such a state, state of panic and shock and they were obviously just bleary eyed and delirious and, you know, all of that. But that was her control. That was her, that was her trauma. That was her trauma response. She was controlling it like, I might have to be here, but you can't make me, right? And so that's a very real thing too. And so looking at the child right in front of you and saying, hey, has this been a lot? I noticed a lot of times after visits with my foster son, he would come home from those and just crash for hours. And I just let it, you know, even as a toddler, even if it was a second nap of the day, which messed up his sleep pressure, but that's another story. But you know, I just, you know, looking at the child right in front of you, right, understanding kind of a general guideline and then watching for the cues and just kind of seeing if you can kind of gauge that. But a lot of times, especially with kids that get labeled as bad behavior at bedtime, it's not that. It's not. It's that we're not respecting their biology and giving them a proper schedule and expectation for their age. [00:30:29] Speaker B: Let's untangle some of this a little bit. Just if we've got someone who's listening, that's like, okay, but I hope she ends up talking about how to fall asleep, because that's my thing. So maybe let's start there. What. What is involved in falling asleep and what advice do you have for our listeners? [00:30:49] Speaker A: Yeah, so let's go science first. [00:30:53] Speaker B: I'm thinking you mentioned something about avoiding melatonin when you were finding your solution. And I'm like, okay, so she ha. Like she knows how to do it for real, not just, you know, the fake way that a lot of us use. [00:31:06] Speaker A: We could record a whole episode on melatonin. [00:31:09] Speaker B: Sure we could. [00:31:09] Speaker A: I'm not going to, but we could. We really could. I mean, I've seen good, bad, and everything in between, but. Okay, so let's start with science, right? Let's start just. Just basics. Forgive the dog shake in the background. Let's start with science. Okay? Two things have to happen inside a person's body to fall asleep. Heart rate has to slow. Body temperature, core body temperature specifically has to drop. Those are two prerequisites that have to physiologically happen. Okay? Now, knowing that a lot of people are like, but how come my kid right before bed is bouncing off the walls and playing like ping pong ball? And I literally had a kid who we used to have this hallway, we called it the catwalk in our old house. And he would run down and slam himself into one wall and then run the other way and slam himself into the other wall. And he would do this as long as I would let him. Right? Now here's the tricky part. How quickly can that child make those two things happen? Right? He was one that he had two speeds. I think some of them related to this. He was that or he was out cold. There was legitimately no in between. And he still kind of is that way. He's six. It's fun, but he's. That's just him. He's just that way. And so we would have to have some level of transition, some level of transition. So I recommend it for kids that are like that. What I've come to realize six years into doing this is kids are going to. Kids are going to get their needs met one way or the other. We as parents can proactively look at our bedtimes, look at our evenings and say, okay, what are the bad things? What are the hard things that we're dealing with, let's say, after tuck in, and what are the needs behind them? Right? So for a kid who just can't be still and is running all over the place, that tells me that kid needs sensory input, right? That kid needs some heavy sensory input. Heavy work. Okay? So I can either deal with that on the back end of things as a bad behavior, or I can proactively make that part of our routine. [00:33:18] Speaker B: Right? [00:33:18] Speaker A: But I gotta do it strategically because I don't want that to be the thing that happens right before I tuck him into bed, because I know his heart rate has to be down and his temp has to be down. That is going to put both of those things up. So I'm going to put that at the beginning of the routine. I'm going to put that at the beginning. We're going to do some heavy sensory stuff. We're going to do some heavy work. We're going to get some energy out. I have families that have like a swing inside. They do some swinging before bed. I have some with, like, indoor jungle gyms, they like to do that kind of thing. For others, it's as simple as, like burrito rolls with a blanket. Whatever it is, let's get some deep sensory work going on there, right? And then that's the thing that we have to have a. And then. So how are we going to move from all wound up and working to sleep? Right? So we have to have a transition at that point. I personally am a huge advocate of some sort of water exposure, bath, shower, something like that every single night. And the reason for that is because it does that for us. It takes all of that heat from our core, it puts it into our extremities, and it's like a Kickstarter for falling asleep. Now everybody's like, but what about eczema? But what about this? I don't have time. But okay, different situations, I've got a severe eczema kid, we use soap twice a week, he gets in water every night. There are ways that you can make this part of your routine, but I would encourage you to at least consider it because there are proven scientific benefits. And also, if you actually, like, keep a log of what it does, there's all sorts of data. It reduces what's called sleep onset latency, which is the stupid word for how long it takes a kid to fall asleep. It reduces that statistically almost every single time. So I would encourage you to at least try it. It's Literally five minutes. I stick him in a shower for five minutes. He uses soap twice a week, and we move on with our night. It doesn't have to be super long. It doesn't have to be fancy. It just. It's just done. [00:35:17] Speaker B: Is it okay if it's a bath or a shower? Do you. Would you recommend one over the other? [00:35:22] Speaker A: Total personal preference. [00:35:23] Speaker B: Okay. [00:35:24] Speaker A: Doesn't matter. [00:35:24] Speaker B: It's just helping body temperature and maybe like kind of sensory regulation. [00:35:31] Speaker A: Exactly. Warm water exposure, sensory input, calming. And most of the time, especially with younger kids, you're sitting right there next to them. [00:35:39] Speaker B: Right. [00:35:40] Speaker A: So it's also giving you connection. Right. And most of the time, because there's water, you don't have your phone on you. So you're not doing this while they're there. You're giving them eye contact. I love to sit on the side of the bathtub with my boys and they'll see me sitting up there like this 80% of the time. And we're just chatting. We did trivia. We asked. Would you rather. It's such an easy connection point and it checks so many boxes. Right. I also love to include a bedtime snack or milk, especially for kids with food insecurity, because it gives you one less variable. Right. I mean, in the middle of the night, we all have that checklist. When they're up at 2:00am, like, well, are they hungry? Are they cold? Are they this? Are they this? Right. If we can remove one thing from it and know that we proactively. Again, how do we get on offense proactively as part of the routine. They didn't even ask for it. It's just there, it's one less thing that they have to request. They get a cup of water and they get peanut butter crackers. Right. It doesn't have to be rocket science, but putting that into the routine as a given, every single night, something with a little bit of protein and fat, low sugar, some hydration, easy learned. [00:36:51] Speaker B: That also helps if your blood sugar is, what is it dropping or spiking in the middle of the night. Yeah. Because some people have blood sugar that will drop in the middle of the night and it causes them to wake up. [00:37:06] Speaker A: Exactly. [00:37:06] Speaker B: Okay. [00:37:06] Speaker A: Exactly. So that's a huge one. So I. When I'm working through a bedtime routine with someone, I'm thinking through needs. Right. Have we met their physiological needs? Have we met their connection needs? That's a big underrated one. Because a lot of times when you ask a family what's your bedtime routine, they're just going to tick off hygiene. [00:37:24] Speaker B: Right. [00:37:25] Speaker A: We take a bath, we put pajamas and lotion on, and we brush our teeth. And then I put them in bed. Yep. And then on the back end. Right on the back end. They have all of these difficult behaviors that are just their kids asking for connection. [00:37:40] Speaker B: I want to add something here too, because I think a lot of us. I want to talk about this more later, but parental expectations are huge at every step in this. Right. And so if we're expecting to kind of get home from sports practice, have them jump in the shower, and 15 minutes later fall asleep in their bed, like, that may not happen for that kid. And if you literally write down the amount of time each of these things is going to take in order for your child to feel sleepy at the end, it might add up to a lot more than you were expecting. So especially when you put in the connection piece, I think a lot of times we can expect that we'll rush a kid through their bedtime routine. We checked all the hygiene boxes and done. But if we're. If we're rushing through the connection piece, they can tell the difference. And it doesn't. Doesn't check that box. I'm also thinking about how we often used reading bedtime stories as our connection point of contact. And my husband and I loved to read books with the silly voices and be dramatic. And it would be the last thing we would do before we wanted our girls to fall asleep. And we would be revving them up without realizing because we were just wanting to connect in that way with the dramatic stories. So I learned that I had to have like, a different bedtime story voice when I was using that time to connect with them than I did at other times during the day. It was like I needed to sound like Alexa or Siri or like kind of the most boring voice soothing ever. [00:39:27] Speaker A: Yes. [00:39:29] Speaker B: So it was checking the connection box and we were, you know, cuddled in close, but it was. Was not exciting them to the point that it's now raised their heart rate and body temperature. [00:39:40] Speaker A: Yeah, exactly. And I love including some level of play and silliness as an aspect of bedtime. It's. It just has to be the order sprinkled in with, you know, and it's so funny because people send me all the time these, you know, tiktoks and things that are like the bedtime routine with mom and it's like yoga music and bedtime routine with dad, and it's wwe and, you know, how do you get the dad on board, you know, Those types of things. And every kid's going to adapt differently, every kid's going to respond differently to different things. And you know, and again, it kind of comes back to that temperament thing. You know, I have that one that's either a pinball or asleep. And he truly can, you know, very, very quickly go from, you know, now we don't have that catwalk anymore. So he stands up on his bed and he just like jumps up and he slams himself down. He's just wild and he can be doing that and two minutes later if I can just get him to be right. Right. And so much of it is going to be that temperament, but he's also one that is very easygoing and he's not real sensitive and he doesn't take a lot to adjust and you know, so it's so kid specific. Yes, but, but we do know physiologically that those two things are required to kind of throw. Cross that threshold to sleep. [00:41:02] Speaker B: Sure. [00:41:02] Speaker A: And so if we can kind of. Because I really see our role as the parents at bedtime as teeing them up. Right. We don't. And I think a lot of parents put way too much pressure on themselves to do all of it. It is not on you to make your kid go to sleep. It is on you to meet their needs and tee them up for success so that they can cross the finish line on their own. And that shift alone changes a lot because we put so much pressure on ourselves to be all of it. Well, who's going to put the two year old to sleep tonight? Well, you know what, the two year old can put himself to sleep. You need to give him the tools and set him up to be able to do that for himself. Right. With some strategy. Right. With some strategic tools. [00:41:50] Speaker B: Let's talk about some of that strategy, especially in terms of fear. I'm thinking about in our house, it looked different ways for each of our different children, but there was fear at bedtime. And so especially if you have someone with a younger child or someone whose placement is within the first two to three years of being placed in the family, like what would you recommend in terms of creating that felt safety without holding the responsibility that you have to quote, unquote, put them to sleep. [00:42:25] Speaker A: Yeah, yeah. A couple of things. One, spend time in their room. Spend time in their sleep space at non sleep times. That is one of the biggest things that is, I think, overlooked. And this can go for teenagers, especially if you have a newer teenage placement. That space. Your house is like being in a foreign country. If you can Help them, you know, because so much of it is exposure and repetition, exposure and repetition, exposure and repetition. So a lot of times we think, okay, my kid has a fear of fill in the blank. So I'm just never going to expose them to that. That's our thought, is that. But that's not reality, that's not life. That's not actually equipping them, that's just avoiding. [00:43:10] Speaker B: Well, I think what people are showing us is it actually makes the fear increase. Right. If you avoid the, the thing that they're afraid of. Yeah. [00:43:19] Speaker A: Because what that tells the child is I can't handle you when you're afraid. I. You. It says you should be afraid of this, right? It says you're right to be afraid of this. So let's just avoid it entirely. So whether that's separation, whether that's the dark, whatever it is, we need repeated exposures and we need repetition. And so taking the time to go into that space with them. Because I will tell you, my son, when he was at kind of the height of those sleep problems at 3 to 4 years old, simply moving towards his room at night, his entire countenance changed. He didn't want to go in there. He was terrified of his room. Come to find out, he was terrified of his closet. That took me years to uncover. Didn't know he was terrified of his closet. And so we started. This was a TBR therapy suggestion, actually. We started just going in there right after school. 4:30 in the afternoon, blazing sun, not even dark, and just playing. And again, don't overthink it. We just went in there, we took a box of Magna tiles, or we took some stuffed animals or we took whatever, we took Uno cards, whatever, and we just sat down on the floor, or we sat down on his bed and we just spent time there. And slowly. What would happen over time is that he became less and less afraid of the same space itself from those repeated exposures. And in those moments right where he was playing with something, I would sprinkle in. Hey, I'm going to go walk out into the hallway and grab my bottle of water. I'll be right back. And so he would be in his room, he would watch me walk out into the hallway. I would come right back every time and I would say, thank you so much for waiting calmly for me. And what that taught him slowly over time is that I can be here, she can go and I'm okay. But we had to start that during non sleep times so that it became normal for him at other times. So when you start in those low pressure moments, they are equipped with that confidence. And I paired it with praise and I paired it with tasks. I paired it with a lot of redirection. So I'd say, hey, will you add three more blocks to our tower while I go grab my bottle of water in the hallway? I'll be right back. And then I would come back in and say, what three blocks did you add? And he would build it's confidence. So much of it is a lack of confidence. Other things in terms of fears, I would say for older kids, giving them some voice and some shared power over the space itself. Sometimes it's as simple as, I don't want to be looking at my closet. Can we turn my bed a different direction? Sometimes it's I want a nightlight. And saying, okay. Sometimes it's giving them some sort of remote or something that controls the light switch. Right. Like my kids have fans with a light in it and they have it remote so they can turn the light on at any point that they want it. And having, having that security. Also equipping them with what to do when they're scared. I think a lot of times we get fixated on the fear itself rather than the feeling of fear. And so equipping them because one week it's going to be I'm scared of ants. The next week it's going to be, I'm scared of monsters. The week after that I'm scared of ghosts. The week after that I watched Frozen and now I'm scared of snowmen. Right. I've heard all of it. And if we can equip our kids not so much to like, let's go fight the monsters, but to say, okay, okay, you're scared. There's a monster under there. What do we do when we're scared? And equipping them with tools to cope with that, whether that's breathing, whether that's using a security object, whatever it is that works for them. But putting tools in that toolbox to deal with the feeling rather than the object can be really, really powerful as well. For all of that. [00:47:08] Speaker B: That's good. All right. I want to also get to this other side for the listener that has been patiently waiting for what to do with their kids waking up in the middle of the night. What recommendations do you have when that's happening? Frequently? [00:47:27] Speaker A: Yeah, yeah, yeah. First and foremost, always go back to the beginning. How are they falling asleep? What is changing and evaluating it. I won't harp on that for long. So we already have. But really evaluate that. Because that is going to be the catalyst to everything else. Once I changed that for my son. And again, that was not an overnight Amazon delivery. That was months and months and months of work. But it's not built today. [00:47:51] Speaker B: What, out of curiosity, did it look like once you had shifted it, instead of laying next to him with your arm on his back, what did it look like when you were getting ready to leave that room and he was going to fall asleep on his own? [00:48:06] Speaker A: Yeah, it was not like we went from here to Negan. It was very much a gradual progression. And this is what I got a lot of. A lot of families through is kind of that gradual. Okay. Well, yes, she's used to you laying, you know, right next to her. Could you sit on the. Sit on the floor beside her and put your hand on her back for a few minutes? Well, could you eventually move to sitting on the floor and not touching? Can you gradually pull your position back? Can you do a little bit more? Can you eventually be sitting by the door? Can you eventually be sitting outside the door with the door cracked where they can see your feet? You know, that type of thing? And so it was a very gradual process that was met with a lot of praise and a lot of confidence building. And so we did a lot of work during the daytime, like I talked about, and then at night, after kind of teeing him up, like we've talked about, teeing him up with that. It was a gradual pullback. And I recommend gradual pullbacks to, you know, those unsustainable sleep associations for probably every parent that's listening, because really just ripping band aids off and going, it's a new day. We're just gonna start right now. And it's day one. That's not. I've rarely found a child that handles that well. It's very jarring, especially for kids with histories like the ones most of us probably listening have. So I would always encourage you to do almost like quarter turns. Can we sit beside them and touch their back? Can we intermittently touch their back? Can we sit beside them and just put a hand every now and then? Right. Can we just sit beside them and not touch? Then can we move, Right, and just very gradually pulling that back with lots and pray, lots of praise and lots of confidence building on the way. So that's number one. Beginning of the night is always going to be. Once that domino falls, a lot of the rest of it shakes out completely on its own. To be honest, if that's not the case, if your child falls asleep completely and Totally on their own. And they're still waking up multiple times a night. I would say a couple things. One, look at your response. Make sure that you have a very consistent, predictable response to that. Because from the child's perspective, a lot of times I'll ask families, like, what are you doing when they wake up in the middle of the night? And they'll start the answer with, well, sometimes that is at best a game to that kid. At worse, you're creating anxiety because if that kid doesn't know exactly what's going to happen every time they wake up in the middle of the night. And sometimes you're happy and you respond quickly and with love and other times you're mad and you make them wait 10 minutes and they have to scream forever before you come. And sometimes you bring milk and sometimes you refuse it and sometimes it's. At worst they're disorganized. Yeah, right. That's creating disorganization, confusion, anxiety, fear. That's like going to work and not knowing what boss you're getting every day, what version of your boss you're going to get. So get on the same page. You and your partner get on this. If you have one, get on the same page. Make sure you're both responding the same way every time. Right. Take the novelty out of it. Take the game away. Because that's like spinning wheel of fortune and going, where are they going to land? So, and that's for the, and that's for, you know, less anxious prone kids. The anxious prone kids, the fear kids, the anxiety kids. It's just feeding it. It's just feeding it and making it scarier. [00:51:30] Speaker B: No predictability. [00:51:31] Speaker A: Yeah, no. And the consistency a lot of times goes out of the window in the middle. And I'm, I was guilty of this. I'll be the first one to call myself out. [00:51:39] Speaker B: Yeah, same. I'm terrible. I am terrible when I am woken up. Yes. [00:51:45] Speaker A: Horrible. It's human nature. We all are. We all are. But I think that's why if you can sit down and you know, rather than just reacting to it constantly. [00:51:55] Speaker B: Right. [00:51:55] Speaker A: But in so much of. If you. Is there, you've probably seen a theme proactive. But to get on the same page with them and say, okay, when the child wakes up tonight, because we know they will when they wake up, we are going to follow the exact same protocol. So you don't even have to think because that's the last thing you want to do in the middle of the night. So when they wake up, we're going to look at the clock. And we're going to wait three minutes. Assuming they're not like level 10 hysteria, panicking, we're going to wait three or four minutes and see if they can settle it on their own. Because sometimes they're just transitioning sleep cycles and they just need to readjust and they'll go back to sleep on their own, right? Sometimes they're just kind of talking, right? Listening for that and saying, okay, is this a low level rumble or is this, oh my God, Mom, I need you. Right? And if it's a low level, giving them a second pause, a second, they're still awake after four or five minutes, we're gonna go in and honestly, I've scripted this with families and we've said the same two sentences over and over and over and over again. I'm here, you're safe, it's bedtime. Doesn't have to be long. Actually, fewer words in the middle of the night is actually better because we don't want them to get all I, then they're wait for hours, right? Right. I'm here, you're safe, it's bedtime. Getting that heavy hand on their back and saying, I'm here, you're safe, it's bedtime. Right? And then leaving before they're, before they're fully asleep. That's the other key. Because when we are responsible for putting them all the way back to sleep in the middle of the night, guess what's going to happen in two or three hours? You're going to be right back on that answer wheel, right? Reassuring and say, and then leaving again, coming back. I would much rather see a family be doing frequent checks than taking on that full responsibility because you're never going to get rid of it. You're never going to get rid of it when it's all on you to get them fully asleep and fully back to sleep all night long. So I would much rather see a family doing that than taking all that responsibility on so having that consistent response with it. And then two. And the third thing I would say about it is if it's a real extreme case, I mean, if you've got a kid who's literally, I mean, and I've seen these families every 27 minutes all night long, and you're just telling yourself it's normal. It's not. It's not. Do not be afraid of sleep studies. Sleep disorders are incredibly common in this population because we know trauma affects the brain and sleep is neurological. Do not be afraid to bring it up to your pediatrician tell them it's bigger than sleep Chart. My son was diagnosed with a sleep disorder. On top of, you know, there being behavioral and confidence things, he actually had a sleep disorder. He had a physical issue that was causing him to wake so often at night, and then the trauma and the panic side would take over. So we had to address the physical and the emotional and behavioral. Right. [00:54:46] Speaker B: You can't, you can't ignore one or the other. You have to consider both. And I'm so glad that you addressed that, because that was going to be one of my last questions to you, Allison, was, you know, at what point do you start seeking outside help? Do you have any red flags? You know, you're saying if you're up 20 every 27 minutes all night long, what else would you throw into that ring? [00:55:10] Speaker A: Yeah, couple things to really, really pay attention to. One, obviously, any, I say obviously may not be obvious to everyone, but one would be any sort of like coughing, choking, gasping for breath overnight. If your kid's waking up like, that's not normal, definitely get it evaluated. I would say frequent waking that is happening at least every hour or more. If you're literally awake every 45 minutes, every 27 minutes, every 55 minutes, that's not normal. It definitely should be evaluated. Thrashing. Really, really restless sleeping. Now, there are some people that are truly just active sleepers, but there are also, especially with legs, legs that constantly thrash that can be indicative of something that is similar to restless leg. It's actually what my son has. It's called plnd and it looks like restless leg, but their arms and legs are literally moving hundreds of times every single minute. And it is physically impossible to not do something about that. To help their brains and bodies relax. That's another big one, I would say, if it's separate from sleep pressure issues, if you've got like an older kid or a teenager and they are truly taking over an hour and a half to two hours to fall asleep every single night, that's a red flag for insomnia. Definitely, definitely discuss that with somebody. The other big one, for the older kids, there is something called delayed circadian rhythms disorder. And that is if you've got a kid who's like up until 2 o' clock in the morning and then wanting to sleep every morning till 11 or noon, that's their circadian rhythms have gotten pushed. And that's actually a sleep disorder that you can pass the normal teenager that [00:56:58] Speaker B: just sleeps till noon. [00:56:59] Speaker A: Yeah, no, not that this is truly somebody whose brain, you know, and not. And I don't mean scrolling a phone until 2am we're talking like they really. [00:57:10] Speaker B: Yeah, they could lay there and they would still be awake. [00:57:13] Speaker A: Yeah, exactly. You could take everything out of their room except a book and they would still be awake until 2 or 3 in the morning. That's a common one with teens. So those are the big ones. Excessive daytime sleepiness is another one. And I'm not talking about like the toddler who skipped a nap and falls asleep on the high chair. Like, I'm talking about like an 8 year old who can't stay awake for the whole school day. That's indicative of a sleep quality issue. [00:57:38] Speaker B: I'll throw one in there too because I know someone that can push through like not falling asleep during the day, but looks very hyperactive or has trouble with forgetting things. Very forgetful, very disorganized, very. Some of that could be sleep quality too. [00:57:59] Speaker A: Absolutely. Executive functioning processes. Mental health. There's a lot of mental health stuff tied to sleep deprivation. It is like you said in the very, very beginning, it is so important for so many reasons. But mental health, anxiety, I mean, all those things go up with sleep deprivation. [00:58:19] Speaker B: Yeah. It's just so crucial to the way that we operate. We need it every single day. [00:58:28] Speaker A: And it's not selfish to want to fix your family's sleep. I get so many parents who are like, I know they just need me all night, but I can't do this anymore. And it is not selfish because you cannot parent. You cannot parent the way you want to parent when you are operating from 90 minute sleep chunks. You can't, you can't. And I know a lot of parents carry a lot of guilt about asking for help with this and they shouldn't. And they shouldn't. Because a better, healthier, more rested, more regulated parent is good for everybody. [00:59:05] Speaker B: Good for everybody. I think that is the perfect line to end on, actually. I think you've given us so much great practical advice. I'm thinking through just so many things of my own daughter's sleep. My own sleep. Yeah. And thank you for reminding us that it's not selfish. It's something that we all need. [00:59:27] Speaker A: Absolutely. [00:59:28] Speaker B: Anything else as a parting wish or thought for our listeners as we wrap up? [00:59:35] Speaker A: No, I don't think so. I do just want to say to the foster and adoptive parents who are sleep deprived, maybe you have a brand new placement or something like that. I just want to say that you are seen and known and you are doing really hard things. And yes, sleep is really, really hard. And it is really tricky. It is complicated, it is nuanced. But you're not alone. Because I think for so many years, in my own struggle, I thought it was my fault. I thought I was doing something wrong. And I thought I was a terrible mom for not being able to fix it. And if that's you, I just want you to know that you are seen and you are not alone. And this is an incredibly common struggle. And that it won't be this hard forever. [01:00:15] Speaker B: Thank you so much. We will put in our show notes if people want to be able to find you. Do you have a blog, a website, you know, social media? [01:00:25] Speaker A: Absolutely. I am Dwell Pediatric Sleep. D W E L L Dwell Pediatric Sleep. Across all the platforms. I'm probably most active on Instagram. That's my favorite platform. But I am on Facebook, Instagram. I'm technically on TikTok. I'm never on it, but I technically have one. I wouldn't recommend following more than I [01:00:45] Speaker B: can say for myself these days. [01:00:47] Speaker A: Yeah, I mean, but Facebook, Instagram and then dwellpediatricsleep.com is my website where you can. There's all sorts of guides, resources there, consultation services. If anybody needs more one to one help, I'm always happy to do that as well. [01:01:01] Speaker B: Awesome. Well, we're grateful for your advice and thanks so much for spending time with us today. [01:01:07] Speaker A: Absolutely. Thank you for having me. [01:01:13] Speaker B: We hope you enjoyed the episode. If you're interested in learning more, head to empoweredtoconnect.org for our library of resources. Thank you to Kyle Wright, who edits and engineers all of our audio, and Tad Jewett, the creator of our music. On behalf of everyone at. Etc, thanks for listening and we'll see you next time on the Empowered to Connect podcast. In the meantime, let's hold on to hope together.