Dreaming of Regulation: The Importance of a Good Night’s Sleep

That list feels kind of familiar doesn’t it? Perhaps because of how well these factors fit into the Regulation Rocket! When we think about sleep as a component of the fuel that propels the Rocket (along with other basic needs), it’s easy to see why the Rocket wouldn’t fly as well if it’s missing, or low quality. Not only is the fuel tainted, but other components of the Rocket (executive functioning, social abilities, emotional understanding, biology, motivation) are damaged because of it.

One of the reasons that I think we can miss sleep as an important factor in regulation, is the fact it’s not always obvious if an individual has had a poor night’s sleep. If an individual has experienced sleep deprivation (lack of sleep) or sleep restriction (considerably less sleep than normal), caregivers are usually well aware of this, and make concessions in their expectations of their child that day. If it’s an ongoing issue, additional support from a psychologist, occupational therapist or sleep therapist is normally sought. Likewise, some caregivers are more than aware if their child hasn’t slept well, because they didn’t either! However sleep fragmentation (briefly waking up multiple times throughout the night, and staying in wakefulness even after going back to sleep) can be less overt, especially if the child doesn’t seek caregiver support to return to sleep.

Similarly, sleep disordered breathing (such as sleep apnea, “benign” snoring, breathing complications due to asthma) or periodic limb movement disorder may not be attributed to difficulties regulating arousal, attention, emotions, and behaviour, even though sleep studies indicate they impact neurobehavioural functioning. This may be due to a lack of awareness/observation of the conditions, or a dismissal/lack of knowledge of the impact they have on the list above.

On top of sleep fragmentation, sleep disordered breathing or other sleep disorders (such as periodic limb movement) sleep inertia has a huge impact on factors needed for regulation. Sleep inertia is the name given to the phenomenon that occures after waking, resulting in decreased performance and increased disorientation. Studies have shown this can last up to 4 hours after waking, which for most children is a time the highest expectations can be placed on them, due to the belief that this is when they will be the “most energetic and attentive”. While energy levels may be higher than usual depending on the child (perhaps in an effort to wake themselves up or get out of sleep inertia), attention levels are often not due to disorientation. This mismatch between current performance level and occuaptional expectation can result in “regulation difficulties” as the child struggles to fly their Rocket where it’s expected to go.

Due to disordered sleep in children being a relatively new field of research, it’s unclear what percentage of the general population experiences sleep disturbances, or how regularly. One study of school aged children who hadn’t been referred for any sleep or behavior issues identified 25% of the 135 children as poor sleepers. The prevalence of disorganised or disturbed sleep is higher in populations of individuals with ADHD, autism, Pervasive Developmental Disorder, learning or neurobehavioral disorders.

What can you do if you suspect sleep is impacting on your child’s regulation?

Firstly, I would definitely have a chat with your GP about it. They may recommend you to a sleep testing clinic, or provide you with some resources to monitor your child’s sleep at home. Also chat to any other caregiver in your child’s life, such as educators. Ask about how your child goes throughout the day, are they better after late morning after shaking off the sleep inertia? What is challenging for them? What is easy/manageable? These conversations can stimulate solutions to support your child and increase understanding about what may be going on for them.

Some general sleep related tips:

• Promote good sleep hygiene: this includes a regular bedtime routine, switching off electronics at least half an hour before bed, creating a comfortable sleeping environment for your child, keeping the bed for sleeping on only (not for playing or lounging around on!)
• Have consistent sleep schedules for weekdays and weekends (avoid the temptation to allow your child late Saturday nights or oversleeping on Sunday mornings!)
• Reasonable bedtimes. Avoid letting your child stay up until they want to, and enforce bedtimes that allow your child the quantity of sleep recommended for their age.
• Consistent environment from sleep to wake. When you fall asleep with one stimulus (eg music, TV, a blanket) and that stimulus is removed, or a new one added, your brain is alerted to the fact that something is different and wakes you up to ensure it’s not dangerous. Keep your child’s bedroom environment as consistent as possible throughout the night to minimise nighttime wakenings.
• Talk with your child about what to do if they do wake up at night, and practice using strategies with them (drinking water next to their bed rather than getting up, walking to the toilet by themselves, accessing comforts such as a preferred toy if it falls to the floor).