This blog is my place to vent and share resources with other parents of children of trauma. I try to be open and honest about my feelings in order to help others know they are not alone. Therapeutic parenting of adopted teenagers with RAD and other severe mental illnesses and issues (plus "neurotypical" teens) , is not easy, and there are time when I say what I feel... at the moment. We're all human!

Thursday, May 7, 2015

How to get some sleep


Image by photosforyou from Pixabay
Some common causes of issues with sleeping:
  • Mental illness - Bipolar disorderADHD...
  • Trauma - PTSDNight Terrors - Sleep terrors differ from nightmares. The dreamer of a nightmare wakes up from the dream and may remember details, but a person who has a sleep terror episode remains asleep. Children usually don't remember anything about their sleep terrors in the morning. Adults may recall a dream fragment they had during the sleep terrors. Also, nightmares generally occur in the last half of the night, while sleep terrors occur in the first half of the night. 
  • Sexual Abuse - if a child was abused/ molested in bed, the bed and bedtime can become a trigger.
  • Sleep Disorders -
    Circadian Rhythm Sleep Disorder - a family of sleep disorders affecting, among other things, the timing of sleep. People with circadian rhythm sleep disorders are unable to sleep and wake at the times required for normal work, school, and social needs.
    Restless Leg Syndrome (RLS) - a disorder of the part of the nervous system that causes an urge to move the legs. People with restless legs syndrome have uncomfortable sensations in their legs (and sometimes arms or other parts of the body) and an irresistible urge to move their legs to relieve the sensations. The condition causes an uncomfortable, "itchy," "pins and needles," or "creepy-crawly" feeling in the legs. The sensations are usually worse at rest, especially when lying or sitting.
    {I have also had these sensations when I'm having a mild allergic reaction.}
ADHD and Sleep
ADHD is linked with a variety of sleep problems. For example, one recent study found that children with ADHD had higher rates of daytime sleepiness than children without ADHD. Another study found that 50% of children with ADHD had signs of sleep disordered breathing, compared to only 22% of children without ADHD. Research also suggests that restless legs syndrome and periodic leg movement syndrome are also common in children with ADHD.
In general, sleep deprivation is a problem among children in America. According to NSF's 2004 Sleep in America poll, more than two-thirds of children experience one or more sleep problems at least a few nights a week.
For children with ADHD, poor sleep (too little sleep or symptoms of sleep disorders) may profoundly impact ADHD symptoms. In fact, one study found that treating sleep problems may be enough to eliminate attention and hyperactivity issues for some children.
Children and adults behave differently as a result of sleepiness. Adults usually become sluggish when tired while children tend to overcompensate and speed up. For this reason, sleep deprivation is sometimes confused with ADHD in children. Children may also be moody, emotionally explosive, and/or aggressive as a result of sleepiness.
In a study involving 2,463 children aged 6-15, children with sleep problems were more likely to be inattentive, hyperactive, impulsive, and display oppositional behaviors.
 Bipolar Disorder and Sleep 
Bipolar disorder may affect sleep in many ways. For example, it can lead to:

  • Insomnia, the inability to fall asleep or remain asleep long enough to feel rested (resulting in feeling tired the next day).
  • Hypersomnia, or over-sleeping, which is sometimes even more common than insomnia during periods of depression in bipolar disorder.
  • Decreased need for sleep, in which (unlike insomnia) someone can get by with little or no sleep and not feel tired as a result the next day.
  • Delayed sleep phase syndrome, a circadian-rhythm sleep disorder resulting in insomnia and daytime sleepiness.
  • REM (rapid eye movement) sleep abnormalities, which may make dreams very vivid or bizarre.
  • Irregular sleep-wake schedules, which sometimes result from a lifestyle that involves excessive activity at night.
  • Co-occurring drug addictions, which may disrupt sleep and intensify pre-existing symptoms of bipolar disorder.
  • Co-occurring sleep apnea, which may affect up to a third of people with bipolar disorder, which can cause excessive daytime sleepiness and fatigue.
During the highs of bipolar disorder (periods of mania), you may be so aroused that you can go for days without sleep without feeling tired the next day. For three out of four people with bipolar disorder, sleep problems are the most common signal that a period of mania is about to occur. Sleep deprivation, as well as jet lag, can also trigger manic or hypomanic episodes for some people with bipolar disorder.

Some techniques for getting sleep:
  • BEDTIME ROUTINE. Have a set bedtime routine and stick to it. (Bath, brush teeth, "room time," quiet activity in a dimly lit room, parent reading a book or telling a story*, singing a song or rubbing the child's back...).
  • Room Time. This was for both the kids and the parents. Room time was 1/2 hour before bed or 9pm whichever was earlier. Even my older kids had room time. Especially as teens most of my kids didn't really go to sleep at 8 or 9pm anymore, but if they were up running around, the kids who needed more sleep would want to be up too. Plus, Hubby and I wanted some adult time (Get your mind out of the gutter! We just wanted to watch non-Disney TV shows and talk about our day!). 
  • Avoid stimulating activities between dinner and bedtime. This is not the time for a rousing game of tag or scary movies/ stories.
  • Establish a regular exercise routine (do avoid exercising too late in the day).
  • Eating and drinking. Avoid eating a heavy evening meal and caffeinated beverages.
  • Avoid overstimulation - bedrooms should not be playrooms. Our therapist suggests bedrooms should have a bed, a dresser (even this can be too much for some kids!), a stuffed animal or two, a book or two and a quiet activity if the child doesn't read independently. No TV or other electronics with screens belong in a bedroom.
  • Decrease distractions - White noise can help. Use fans, heaters, blinds, earplugs, or sleep masks, as needed.
  • Give your child tools to overcome his worries. These can include a flashlight, a spray bottle filled with "monster spray," or a large stuffed animal to "protect" him.
  • Screen time ending 2 hours before bedtime - Screens – found on computers, cellphones, and TVs – emit blue light that is found in the light spectrum present during daytime hours. Acting as artificial sunlight, blue light decreases your production of melatonin.
  • No electronics in the bedroom - nothing with a blue light - no tv, no computer, no mobile devices (had to be charging in parent's room overnight)... My older teens were allowed to have their laptop in their room if they could be trusted, didn't have sleep issues, and needed them for homework and such. 
  • Melatonin - a mild herbal supplement available over the counter that helps regulate your sleep and wake cycle. A small dose is usually given near dark to signal the body that nighttime is coming (this is why it does not really work during the day). 
  • Essential oils - I don't claim to know anything about these, but a lot of parents swear by them. 
  • Sleep meds - children taking sleep meds should do so only under a doctor's care. If an adult requires sleep meds more than a few days in a row, it's probably a good idea to discuss it with a doctor.
  • Medications - Certain bipolar medications may also affect sleep as a side effect. For example, they may disrupt the sleep-wake cycle. Discuss this with your child's doctor.
  • Consistent bedtime and wake time. No matter what time I went to sleep the night before, I get up every day (even weekends) at the same time. This helps force my body to keep my circadian rhythms more regular. For children past the age of napping. Avoid naps during the day.
  • Bright lights in the morning. Getting the child active and moving in the morning. 
  • Sleep time. People generally need 8 hours of sleep a day. Kids and teens usually need closer to 10. Especially when my kids are dysregulated, I move their bedtime earlier.
  • Daylight Savings time and school holidays. Changing your body's sleep schedule takes time. I usually start getting the kids back on schedule 2 weeks prior to school starting again after winter and summer vacations, and avoid letting the kids stay up too late or sleep in too much on weekends and holidays.
  • Sleep Study - Having a professional sleep study done can rule out things like Restless Leg Syndrome and Sleep Apnea.
  • Keep a Sleep Diary
  • How long it takes to go to sleep
  • How many times you wake up during the night
  • How long you sleep all night
  • When you take medication or use caffeine, alcohol, or nicotine
  • When you exercise and for how long
  • Events and Stressors from the day
  • See a professional sleep doctor (somnologist).
  • Biofeedback - Practice biofeedback and other calming techniques at other times of the day. Then you can use them at bedtime.
  • Counting to 100. I use this one a lot. I get comfy, close my eyes, breathe slowly and deeply, and count to 100 in my head - each breath in and out is a count of 1 (deep breath in, deep breath out - "1", deep breath in, deep breath out - "2"... If I move for any reason then I have to start over with 1. If I reach 100 and I'm still awake, then I roll over and try a new position - and restart the count.
  • 4-7-8 Breath. I use this quick and simple breathing every night. It works!
  • Progressive Muscle Relaxation - The link gives a good tutorial, but basically PMR teaches you how to relax your muscles through a two-step process. First, you systematically tense particular muscle groups in your body, such as your neck and shoulders. Next, you release the tension and notice how your muscles feel when you relax them. This exercise will help you to lower your overall tension and stress levels, and help you relax when you are feeling anxious. 
  • Sleep Phase Chronotherapy (SPC), which progressively advances sleep time by 1–2 hours per week until you've gone all the way around the clock to your preferred bedtime. The idea is that it's almost impossible to make yourself get sleepy and go to sleep early, but it is possible to stay up a little later every night until you move your bedtime all the way around the clock to the right time. Yes, this is as difficult to do as it sounds. This post has info on how this went when I did SPC with Kitty.
  • Weighted Blankets - You can even make these yourself. How to Make a Weighted Blanket
  • Nightmares - One thing my mother taught me is that we can take control of our dreams and nightmares. When I have a recurring nightmare (such as being chased). I try to think of what's going on in my life that might be making me feel this way. Then I rewrite the dream in my head (might be right when I wake up, might be later in the day). I imagine every detail of what I want to have happen instead. (Turn and confront the person chasing me. Have the ability to fly. Whatever.) Think of defeating a bogart in a Harry Potter movie.
  • Visualization - How to have good dreams. My "secret trick."
    Kitty wanted to have a good dream, and I told her I knew a secret trick.

    I asked her what she wanted to dream about - "getting married and having kids with Jesse McCartney" (Blech!). But I decided to ignore the gross factor, so we both could get some sleep seeing as she'd had a tough day.

    So to have a good dream you tell yourself a story or write a play in your head while you're laying comfy in your bed. Your story is about what you want to dream about, but you have to imagine EVERY detail. Where are you? What does your house look like, is it a two-story or a one-story, are you in the living room? Where is Jesse? Is he at work? Do you go with him? Do you work? What do you do? Picture it in your head. What are you wearing when you go to work with Jesse? Are you wearing an evening gown? What color is it? Do your heels hurt your feet? Are you in a crowded club or a private limo? What color are the seats in the limo? Is it moving or are you stopped? Does Jesse take your hand as you get out? What does his cologne smell like? Can you feel his hand in yours?

    All of this was done in a quiet, calm, monotonous voice, and I didn't usually wait for answers for most of the questions. I just wanted her to visualize the picture. I did biofeedback when I was her age so I tried to mimic the method of painting imagery.

    In the morning, she said it worked!
**Storytime - At our house, to keep kids interested in listening to stories long after they'd passed the stage of Goodnight Moon, I made up stories unique to them. Because I had kids of varying attention spans, emotional age, and intelligence in the same room, reading a chapter in a book, just wouldn't work.

So I created a Choose Your Own Adventure type story. Each child got to pick 3-5 things (depending on how many kids were listening) to put in the story. This could be themselves, a place, an activity, an animal (lots of flying unicorns in the girls' stories), a favorite toy, a friend...

Then came the "fun" part. I had to tell a story that incorporated all of the things they'd chosen. Often the story had a secret moral to the story (when someone had been stealing, it was amazing how often the characters in the story dealt with that particular issue!). Sometimes, I drew on fairy tales (Hansel and Gretel) or Narnia type stories (went through a secret door in a tree). The story was always different, although sometimes we might travel to the same place (they really liked the secret door in the tree!).

I always told the story in a quiet, calm, monotonous voice, usually while laying on the kid's bed with them (gently patting their back or stroking their hair), or sitting on the floor next to the child's bed if that kid couldn't handle having someone on the bed with them (sexual abuse issues). If I was telling the story to more than one child, I usually sat on the floor or in a chair nearby to avoid jealousy issues.

The best part was, the story could be as long or as short as I wanted, so if I was tired...

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