Sleep Well, Bee Well – A Focus on Early Childhood Sleep to Promote Parent-Child Relationships and Reduce Health Disparities

Transcript

• 00:00Good afternoon, everyone.
• 00:02Welcome to Grand Rounds.
• 00:04Thank you so much for you all adjusting
• 00:06to this slight change to virtual format.
• 00:09We really appreciate you
• 00:11accommodating this change.
• 00:12It's a brief return to a virtual
• 00:13format and well worth it.
• 00:15So that we can hear from Doctor Ordway today.
• 00:17And we will be back in person next week
• 00:19for Grand Rounds in the Cohen Auditorium,
• 00:22where we'll have our Viola Bernard
• 00:24lecturer from John Pachanka.
• 00:27He'll talk about LGBTQ
• 00:29affirmative healthcare.
• 00:30Please do join us in person
• 00:32for that if you can.
• 00:33And to today's speaker,
• 00:35someone who needs no introduction
• 00:37for our community And Doctor Monica
• 00:40Ordway after 10 years working
• 00:42as a nurse practitioner and Dr.
• 00:44already returned to the Child
• 00:46Study Centre to complete her PhD
• 00:48and her postdoctoral fellowship
• 00:49working with Lil Sadler, Linda Mays,
• 00:52Nancy Suckman,
• 00:52working on Mothering from the inside
• 00:54out and Minding the Baby program and
• 00:57since then joined the School of Nursing,
• 00:59now an associate professor and Co
• 01:01director of Yale Byway Behavioral
• 01:03and Translational Research programme.
• 01:05Really leading an impressive clinical
• 01:07research programme that seeks to
• 01:09address parenting and also sleep as a
• 01:12modifiable risk factor that can help
• 01:14address health inequities very early in life.
• 01:17Doctor Ordway has been funded by the
• 01:19National Institutes of Health and
• 01:21the National Institute of Nursing
• 01:22Research as well as various foundations
• 01:24and has fellow the American Academy
• 01:26of Nursing as well as a board
• 01:28member of the International Sleep
• 01:30Association and sits on the Nanos
• 01:33Scientific and Medical Advisory Board.
• 01:36Doctor,
• 01:36we're so pleased that you can join
• 01:38us for grand rounds today and I
• 01:40can't wait to learn from you.
• 01:41And I'm welcome you back to the
• 01:43Child Study Centre.
• 01:45Thank you. That's very generous.
• 01:46I'm very happy to be here.
• 01:48Sorry to do it via Zoom today but I was
• 01:51telling them I am at the APSS big sleep
• 01:54conference annual sleep conference.
• 01:56So it's AI was happy to to fill in
• 01:59but I did have to do it remotely.
• 02:02So thank you for having me.
• 02:03Just one small correction is that
• 02:05I my PhD was at the School of
• 02:09Nursing but I did but I had a A31
• 02:12that Linda Mays was a Co sponsor on
• 02:15with me in addition to Melissabbas.
• 02:18So I will share my slides and
• 02:20we'll get started.
• 02:28Thank you, Tara, for putting
• 02:30in the CEU information.
• 02:31We'll get the CME code into
• 02:32the chat shortly as well.
• 02:36OK. So hopefully this OK,
• 02:48All right. So today I'm going to
• 02:49talk to you about sleep Well be well,
• 02:51that's not a typo.
• 02:53That is an intervention that I've
• 02:56developed for early intervention and
• 02:58sort of have this this be theme going.
• 03:01It's I want to focus on early childhood
• 03:04sleep to promote parent child relationships
• 03:07and reduce health disparities.
• 03:10Today we'll talk about understanding
• 03:11the importance of sleep and
• 03:13early child development.
• 03:15Can I want to ask two, can you hear me OK?
• 03:16I've never used my ear buds
• 03:18for with my laptop before,
• 03:20so I just want to make sure, OK.
• 03:23And then secondly,
• 03:24to identify barriers to healthy sleep and
• 03:26historically marginalized populations.
• 03:28And then to describe the potential of
• 03:30sleep health promotion interventions
• 03:32in clinical and community settings in
• 03:35order to improve sleep outcomes and
• 03:37strengthen parents child relationships.
• 03:39So to kind of put this in context,
• 03:40I know you briefly mentioned that my
• 03:43pre doctoral work was in with minding
• 03:46the baby and I participated with
• 03:48them and my dissertation study was
• 03:50following up with the families that
• 03:53participated one to three years earlier.
• 03:56So the children were three to
• 03:57five years of age and I and I re
• 04:00recruited them and followed them.
• 04:02And it really,
• 04:04I love my work with minding the baby,
• 04:07not just because it's a phenomenal team
• 04:09and you're very lucky to have Krista
• 04:11there at the Child Study Center now,
• 04:14but because it really helped me.
• 04:18So many questions that I have for
• 04:20my clinical work as a pediatric
• 04:22nurse practitioner in a primary
• 04:23care Center for 10 years really came
• 04:27to be understood when I thought
• 04:29about reflective functioning and
• 04:31the parent child relationship and
• 04:33thinking about the mental state
• 04:35that underlies children's behavior.
• 04:37And I sort of wish I had understood
• 04:40that concept better when I
• 04:41was working with families.
• 04:42It would have really helped me understand,
• 04:45particularly as a lactation consultant,
• 04:46the family that I was working with early
• 04:48on who would struggle with parenting.
• 04:50So I just saw such a great connection
• 04:53between this concept and and primary care.
• 04:56So I had written a paper,
• 04:58one of my papers on how to implement
• 05:01parental reflective functioning
• 05:03in a primary care setting.
• 05:05I then was still at the end of my,
• 05:09I was struggling with how am I going to
• 05:12get this concept into pediatric primary
• 05:14care where we see patients every 15 minutes.
• 05:17And so it's very difficult to fit in talking
• 05:20about attachment theory and parenting.
• 05:23And so I then went on to work as a
• 05:26postdoc with doctor Nancy Bookman and
• 05:29who has unfortunately passed away,
• 05:32but was a phenomenal mentor and
• 05:36working with me to in a in a
• 05:40shorter short term mentalization
• 05:42based intervention program.
• 05:43So I helped lead the meeting,
• 05:47engaged sort of translation of her
• 05:49mothering from the inside out to
• 05:52the West Haven Mental Health clinic.
• 05:54But again, once I became onto faculty
• 05:58in 2013 at the School of Nursing,
• 06:00what I was struggling with was still,
• 06:03how do I get this back to primary care?
• 06:05And at the same time,
• 06:06just the year prior,
• 06:09eco bio developmental framework that
• 06:11I'm sure you're all familiar with
• 06:13was published this the year before.
• 06:15And it's one of those things that when
• 06:16you're going through your doctoral
• 06:18studies and then something changes
• 06:20in a new theory or new approach.
• 06:23And it's sort of, oh,
• 06:23I wish that was there when I
• 06:25was doing my dissertation work.
• 06:27And so this made a lot of sense to me.
• 06:29But I what I think finally clicked for me
• 06:35and in my first year or two and faculty
• 06:37was it something was missing here.
• 06:39So as we know that we have ecology
• 06:41mixing with biology influencing
• 06:43health and development.
• 06:45But I really thought about these
• 06:48foundations of healthy development and
• 06:50how much they the work I was doing my
• 06:53being post doc was related to this.
• 06:54But what was seemed to be missing
• 06:56was sleep as a foundation of health.
• 06:58And once I sort of came to that
• 07:01conclusion and realizing, you know,
• 07:03sleep is a pillar of health and early
• 07:05childhood and it gets a very little
• 07:08attention and I think emphasized by
• 07:10the fact that it was missing as a
• 07:13foundation of health in this model
• 07:15as well as I will let you know that
• 07:18the first definition of pediatric
• 07:20sleep health was published in 2021.
• 07:22So that's really I think a statement
• 07:25about a sort of our under recognition
• 07:29of sleep health and more of a focus
• 07:32on sleep disorders.
• 07:33So most of what's been focused
• 07:34on in the field of sleep has been
• 07:35in sleep disorders.
• 07:36And I think this is a great sleep
• 07:39is a topic that in your work
• 07:42when child development work,
• 07:43parenting work has a has a great place.
• 07:48Obviously today was a pioneer in
• 07:51pediatric sleep research and he
• 07:53published this transactional model of
• 07:56infant sleep and you can see that the
• 08:00most proximal relationship here was in
• 08:03this model is around that the parent.
• 08:06Let me just see if I can get my
• 08:08pointer here is this, you know,
• 08:10parent child interactive context.
• 08:14And so this again was just a perfect
• 08:16way of me bridging the work I was
• 08:19doing in my pre and post doc.
• 08:21And I have using sleep as a back doorway
• 08:26of talking to primary care providers
• 08:29about how to introduce concepts about
• 08:32parenting into their routine practice.
• 08:35So I just like a little bit of background on
• 08:37how I got to the point of studying sleep.
• 08:39And it's a little unusual,
• 08:40I think that I have been doing all
• 08:44this work now and something that
• 08:46I did not get my PhD in.
• 08:47And sleep is a topic,
• 08:48but it's,
• 08:49it's been a really fun experience and I've
• 08:52had some great mentors along the way.
• 08:54So the importance of sleep
• 08:56and early childhood.
• 08:56We know that adequate sleep is essential
• 08:59for cognitive, physical and emotional
• 09:01development in young children.
• 09:03It, it, the brain is undergoing
• 09:05rapid growth and development,
• 09:06as we know in this early childhood period.
• 09:09And sleep actually plays a really critical
• 09:12role in facilitating this process.
• 09:14And it's interesting to note also
• 09:16that Sleep Medicine in general is a
• 09:19fairly young specialty in Pediatrics
• 09:22or in in health medicine in general.
• 09:26It's the first sort of Sleep
• 09:28Medicine as a as a separate,
• 09:30the focus was in 1972.
• 09:32So it's, it's something that's
• 09:35continuing to grow as I can say that I,
• 09:38I Co chaired the IPSA international
• 09:40sleep conference last month and
• 09:42we had four times the number of
• 09:45submissions in our abstracts and five
• 09:47times the number of applications to
• 09:50our pediatric sleep research award.
• 09:53There's definitely a a growing feel that
• 09:55I'm glad to see that sufficient sleep
• 09:58really helps children to consolidate
• 10:00their memories to improve salts
• 10:03problem solving skills and enhance
• 10:05their overall cognitive abilities.
• 10:07So the benefits include things we I
• 10:10just mentioned memory, attention.
• 10:14I often wonder in with all the patients
• 10:16that saw in primary care with ADHD.
• 10:19One of my sort of future hopes is
• 10:23that we include screening for sleep
• 10:26disorders before we prescribe stimulants.
• 10:29Oh, is that Nancy close?
• 10:30Did I see you there? So nice to know Nancy.
• 10:34I was on my dissertation committee and
• 10:35it's been a while since I've seen her.
• 10:37So sorry.
• 10:37I just got a little distracted
• 10:39by the by her lovely face.
• 10:42Sleep also effects the behavior
• 10:45and we can think about this for
• 10:47ourselves as well as children,
• 10:49learning and overall health.
• 10:51It's all a factor of adequate sleep.
• 10:56There are four stages of sleep REM
• 10:59sleep during REM sleep we have
• 11:01the brain is actually very active.
• 11:03They're moving back and forth and this
• 11:05stage is the stage that we're learning
• 11:08is really essential for memory consolidation,
• 11:10positive development and emotional
• 11:13regulation in young children.
• 11:15And then our non REM sleep those.
• 11:17There are three stages of non REM
• 11:19sleep and this is light to deeper
• 11:21sleep where the brain activity
• 11:22and eye movements are,
• 11:24they're less pronounced,
• 11:25but it's it's still important for growth,
• 11:28immune function and restoration
• 11:30of the body's energy,
• 11:31particularly in stage 3,
• 11:33which we refer to as slow wave sleep.
• 11:35That's the portion of sleep where
• 11:38growth hormone is released and
• 11:40where it's very restorative.
• 11:42So I spent,
• 11:43I in my first grant as at age 23 and,
• 11:47and back up to,
• 11:48I was studying sleep,
• 11:49which I'll talk about a little bit,
• 11:51but I started,
• 11:52I was offered an opportunity to
• 11:53work as a nurse practitioner in our
• 11:55pediatric sleep clinic here at Yale.
• 11:57And so I did that for five years.
• 11:59And when I would look at polythenography,
• 12:01I'm really interested in,
• 12:03you would see sometimes patients
• 12:06that would tell you that they have,
• 12:08you know, 8/10/12 hours of
• 12:10sleep depending on their age,
• 12:12but the percentage of their slow wave
• 12:14sleep and REM sleep would be very low.
• 12:17So we typically want to see 25% in each of
• 12:20those stages and 50% in stage one and two.
• 12:23And this often maybe helped me to explain
• 12:26that even though you're sleeping for,
• 12:29you know, the recommended amount of time,
• 12:30if you don't feel rested,
• 12:31it's likely that you're not getting
• 12:34enough low wave in REM sleep.
• 12:36So these stages are important for
• 12:39the overall brain development and
• 12:41their well-being and a balanced sleep
• 12:43schedule that includes both R.E.M.
• 12:44and non R.E.M.
• 12:46is crucial for children's
• 12:47overall development.
• 12:49And where this,
• 12:50what is important is I think
• 12:52a question we're going to talk
• 12:55up today about sleep health
• 12:57disparities and inequities.
• 13:01The literature suggests that
• 13:02sleep health and equities in
• 13:04early childhood that they're very,
• 13:06they're highly significant if you're just
• 13:09looking at night time sleep duration.
• 13:11But if you include 24 hour sleep,
• 13:14they include the nap, the inequity
• 13:17actually becomes less significant.
• 13:19And so the the thinking is that for
• 13:24minoritized race and ethnic groups
• 13:26that children are having longer and
• 13:30more naps and sleeping less at night.
• 13:33And so I think the question remains, what is,
• 13:37what does that mean for health?
• 13:39Are we, is it the 24 hours sleep
• 13:41that's most associated with positive
• 13:43health outcomes or the night time
• 13:46sleep duration that's most important?
• 13:48And I personally hypothesize that it's
• 13:50the night time sleep duration because
• 13:52of the multiple sleep cycles that we
• 13:55have to go that we go through at night.
• 13:57And if we're, if we have a shorter
• 13:59period of sleep at night time,
• 14:01I, I wonder if some of the health
• 14:04inequities we're seeing could be
• 14:06somewhat explained, you know,
• 14:08partially explained by having fewer
• 14:10cycles and therefore less opportunity
• 14:12to get to slow weight and REM sleep,
• 14:15which by the way,
• 14:16don't happen until later in the
• 14:18night time period.
• 14:19So I hope that makes sense that,
• 14:21you know, quicker or shorter,
• 14:23even a longer nap during the day is
• 14:25not going to give you multiple cycles
• 14:27of slow wave sleep and REM sleep.
• 14:29And in fact,
• 14:31we diagnosed narcolepsy by looking
• 14:33whether or not somebody would
• 14:35get into REM sleep and,
• 14:38and a short 20 minute nap period.
• 14:41You should not get to REM in a short nap.
• 14:47So there are multiple factors
• 14:49that would affect sleep and early
• 14:51childhood screen time is one of them.
• 14:54I there was a recent call for
• 14:56children and screen foundation for
• 14:59looking at screen use and infancy.
• 15:01And when somebody sent me
• 15:02the call for proposals,
• 15:04I thought that's ridiculous,
• 15:06you know, under one years of age.
• 15:08But actually when I submitted and
• 15:11that proposal did end up submitting
• 15:13a proposal and on that 35% of infants
• 15:17actually have their own moving device.
• 15:21So it's being used quite often
• 15:24even in early childhood.
• 15:26Bedtime routines are extremely important,
• 15:29but often this not well described
• 15:34not just in terms of the content
• 15:37of the bedtime routine,
• 15:39but also how to structure them and
• 15:43the importance of routines in general.
• 15:45But how is that a recommended
• 15:47sleep bedtime routine would be,
• 15:48you know,
• 15:492020 minutes or so with the same thing
• 15:53being done consistently each night.
• 15:56Routines we're finding are
• 15:58incredibly helpful for for young
• 16:02children sleep environment.
• 16:03So having a dark,
• 16:05quiet,
• 16:05comfortable sleep environment
• 16:07with comfortable temperatures
• 16:08and middle distract distractions
• 16:10can promote better sleep.
• 16:12I had what was an older,
• 16:15I had a case in a clinic.
• 16:18Want to say, let me preface this to say
• 16:21that when we're working with families and
• 16:24asking them about the sleep environment,
• 16:27really being thoughtful about asking
• 16:29questions about where children sleep.
• 16:31Families are bringing their children
• 16:33into the back of the house.
• 16:35So they're further away from gun violence,
• 16:38further away from the front,
• 16:40from the door, quieter.
• 16:43They are often crowded homes.
• 16:46I've done home visits where where
• 16:49the space was for sleeping and,
• 16:52and the space that the family had in
• 16:54the in a friend's house was a bed and
• 16:56a dresser and there wasn't even room
• 16:57for me to sit to do the home visit.
• 17:00So I was standing during that time.
• 17:02And so when we're asking about Co sleeping,
• 17:04we're really we need to understand,
• 17:06is it intentional reactional,
• 17:08or is there something, you know,
• 17:11socio economically that's going on
• 17:13that maybe they weren't able to either
• 17:15afford a a separate space or they
• 17:18physically don't have a separate space.
• 17:20Caffeine intake is an interrupter in sleep,
• 17:26stress and anxiety and also
• 17:28physical activity.
• 17:29As we know,
• 17:30many kids are not getting adequate
• 17:32physical activity activity.
• 17:33And so there's quite a connection
• 17:35there with with sleep.
• 17:38So we all know that early brain
• 17:40development that genes are the blueprint,
• 17:42but that what really kind of
• 17:45shapes the brain development is
• 17:47are there are our experiences.
• 17:49So whether or not a solid brain
• 17:51will provide a weak or strong
• 17:53foundation for future learning is
• 17:56is the experiences are very key.
• 17:57And I would say sleep and at
• 17:59bedtime routine is one of those
• 18:01opportunities for experiences to
• 18:03help to build a stronger connection.
• 18:07As William Dement,
• 18:08who is a sleep expert, has said,
• 18:11adequate sleep is essential for the
• 18:14proper development and maturation
• 18:15of the brain and to facilitate
• 18:17the consolidation of memories and
• 18:19processing of information and overall
• 18:22optimization of cognitive functions.
• 18:25This is just a timeline associated
• 18:28with where sleep plays a role here.
• 18:31So at two to three months there's
• 18:33the emergence of sleep wake
• 18:35cycles before two to three months
• 18:37sleep in children is 50% R.E.M.
• 18:40and 50% non R.E.M.,
• 18:41only two stages and they are
• 18:45not regulated by the by light.
• 18:48So when we talk about not doing any
• 18:51sleep training before six months,
• 18:53this early age group particularly it,
• 18:57it would be futile to try to change
• 18:59any of the sleep patterns at this
• 19:02early age because they're not,
• 19:04they're not even into the sleep cycles yet.
• 19:06At around six months,
• 19:08we start to see an increase in
• 19:10consolidation of night time sleep,
• 19:12so more regular nap and the majority of
• 19:16that period of sleep happening at night,
• 19:20as well as the development
• 19:21of the sleep stages.
• 19:22So the earliest we would even
• 19:23really talk about sleep training,
• 19:25if that's something that the family wanted,
• 19:27would be 6 months.
• 19:28And then around 12 months,
• 19:30we see the maturation of the sleep cycles
• 19:33to be more similar to an adult pattern,
• 19:37but there's still recommendation
• 19:40of sleep recommendation.
• 19:42Duration recommendation is
• 19:44about half the time sleeping,
• 19:46half the time awake and
• 19:47and build this young age,
• 19:49which I think speaks to their the
• 19:53need of sleep for their development.
• 19:55And then at 24 months,
• 19:57there's a continued refinement
• 19:58of their sleep architecture
• 20:00and typically more scheduled.
• 20:04Nap around 18 months,
• 20:06they would likely go from 2:00 to to one nap.
• 20:11This is one of my favorite slides
• 20:13to highlight the role of sleep.
• 20:16And so you've probably seen this
• 20:17type of slide before where there
• 20:19are these sensitive periods of
• 20:21brain development and at the
• 20:22bottom the year years of age.
• 20:25And what I think is something to
• 20:27highlight is that this is the
• 20:29period where sleep consolidation
• 20:30is happening and whether all of
• 20:32what I just described is happening.
• 20:34And so it's it's happening these
• 20:38very sensitive periods.
• 20:40So I see sleep as an opportunity
• 20:43again to intervene.
• 20:44One of the things that I would
• 20:48like to add is that sleep is a
• 20:50potential buffer to toxic stress.
• 20:52And I think we haven't studied that enough.
• 20:54I had the privilege of Co authoring a
• 20:58chapter with Doctor Judy Owens at Harvard,
• 21:00who's like the pediatric sleep
• 21:04mother pediatric sleep, I would say.
• 21:06And it was in the first social textbook
• 21:08on social epidemiology of sleep.
• 21:11And in this chapter we just tried to
• 21:14highlight a lot of the things that of the
• 21:18so the how's sleep and look and among
• 21:23children with socioeconomic adversity.
• 21:26We've already talked about
• 21:27how important it is.
• 21:29What we haven't talked about is
• 21:31how young children often do not
• 21:33obtain sufficient sleep and this can
• 21:35really lead to poor health risks.
• 21:38Specifically,
• 21:3825 to 40% of children before the
• 21:42age of four are sleep deficient.
• 21:45And this continues on across and to
• 21:48throughout childhood, adolescence.
• 21:49The goal of Healthy People 20-30
• 21:52now is to get 1/3 of adolescents
• 21:56to have adequate sleep.
• 21:59So more than 2/3 of adolescents
• 22:01are not getting adequate sleep,
• 22:03and even more than that by
• 22:05the time they're four.
• 22:06There's also been emerging research
• 22:09suggesting that sleep disparities
• 22:10occur as early as one year of age.
• 22:12This is happening very early.
• 22:15And they as we know that race
• 22:17and ethnicity as these are all
• 22:19social constructs should not be,
• 22:21you know,
• 22:22biologically explained why we're seeing
• 22:26these sleep disparities and we need
• 22:29to have more behavioral sleep interventions.
• 22:32But BFIS behavioral sleep
• 22:34interventions and tested with diverse
• 22:36multi ethnic low income children,
• 22:39most of the we have found that behavioral
• 22:41sleep interventions are highly effective,
• 22:43but they have been predominantly tested
• 22:46with a white middle class population.
• 22:52So as I mentioned about sleep as a
• 22:55potential buffer to toxic stress and I
• 22:58started to my first study was looking
• 23:01at the emerging link between allsthetic
• 23:04load on the body from prolonged stress
• 23:07response and sleep disturbances.
• 23:09And I want to look at multiple biomarkers
• 23:15and some of the Lyrica suggested that
• 23:17shorter sleep duration was associated
• 23:18with some of the biomarkers like CRP,
• 23:20cortisol and BMI.
• 23:24So in my case, I studied the extent
• 23:28to which socioeconomic adversity was
• 23:30associated with sleep characteristics.
• 23:32And my hypothesis and specific
• 23:36aims were really to to describe
• 23:39sleep health and early childhood,
• 23:4112 to 15 months of age and to
• 23:44examine the extent to which the sleep
• 23:47characteristics were associated with
• 23:48stress biomarkers and identify some buffers,
• 23:53moderators to adversity and stress.
• 23:57So the longitudinal cross-sectional
• 24:00study for home research visits that I
• 24:02did in their home if they allowed me to
• 24:05or in a place that was convenient to them,
• 24:07included paper and pencil questionnaires,
• 24:10ethnography to give us a objective
• 24:12measure of sleep. That's something else.
• 24:14It's been largely missing a lot
• 24:16of self report of sleep,
• 24:17but I wanted the objective markers and then
• 24:21collected salivary and hair biomarkers.
• 24:24This sample was 113 healthy
• 24:28toddlers from 12 to 15 months,
• 24:30English or Spanish speaking.
• 24:32I recruited them primarily
• 24:33through the primary care center.
• 24:35I looked at adversity, sleep,
• 24:38rest response, and then for outcomes,
• 24:39looked at behavioral health outcomes,
• 24:42looking at the using the,
• 24:45the brief and the other social
• 24:47and emotional assessments.
• 24:51I've faced many challenges.
• 24:52One of the things that I want I
• 24:55would highlight as if you haven't
• 24:56had the opportunity to work with
• 24:59the cultural ambassadors at YCCI.
• 25:01They're amazing and they really helped me to
• 25:06both frame the study to the community,
• 25:10but also helped me to address any
• 25:12of the challenges that I that I
• 25:14came up with and I had. This is
• 25:19it's a separate story but
• 25:20and not for this talk,
• 25:22but I was 10 participants into this
• 25:27when I had a pediatrician in New
• 25:31Haven right to the chief medical
• 25:34officer of Yellow Haven and accused
• 25:36me of scientific misconduct and
• 25:38insisted my study be stopped because
• 25:41I was collecting activity using like
• 25:45a Fitbit type of device which is
• 25:48put on the ankle of the toddlers.
• 25:49And he had said that that was akin
• 25:52to I was traumatizing that toddlers
• 25:54and so it was a very stressful time
• 25:57and the cultural ambassadors were
• 26:00really helpful in navigating that.
• 26:04Obviously I'm still here.
• 26:06So I fortunately,
• 26:07my protocol was was scrutinized
• 26:10and and found to be appropriate,
• 26:13but it also, you know,
• 26:16really does highlight the importance
• 26:18of working when you're working in
• 26:20the community to talk with with
• 26:22those people like the community
• 26:24ambassadors to help you or navigate
• 26:26and and address concerns.
• 26:32This was one of the things people
• 26:35have heard the whole story about what
• 26:37happened when I was 10 participants in.
• 26:39I usually they say I,
• 26:40I can't believe you stayed in.
• 26:42I was a new assistant professor
• 26:43and we had a new Dean that was
• 26:46only here for about 6 weeks.
• 26:47And I said, you know,
• 26:49if it hadn't been for the 1st 10
• 26:51participants and the positive feedback
• 26:53I was getting from the families
• 26:55that wanted me to do this study,
• 26:57I probably would have quit.
• 26:59And examples of how committed
• 27:02these participants were.
• 27:04I wanted to share with you here that,
• 27:08you know,
• 27:08a text message that I got that the family
• 27:11was concerned because they had put their,
• 27:13their child put their foot in a,
• 27:15a mop bucket.
• 27:16And so they were worried.
• 27:18I got A at 6:00 PM from a father
• 27:20who told me that he was sorry he
• 27:23had he's been at the hospital
• 27:25all day because his child was at
• 27:27the daycare center and had pulled
• 27:30off the fire extinguisher off the
• 27:33wall and it landed on his toe and
• 27:36amputated a portion of his toe.
• 27:39And he wanted to let me know that,
• 27:41you know,
• 27:42that they that he went back to
• 27:45the daycare and retrieved the
• 27:46lot for me to act a lot.
• 27:48I was just overwhelmed that he
• 27:51thought to call me and he clearly was
• 27:53dealing with a trauma with his child.
• 27:55But they were just so everyone,
• 27:57the participants were so wonderful
• 27:59to work with and it kept validating
• 28:01this is an area that they want to
• 28:04investigate and they want help with.
• 28:08I talked about the study design already.
• 28:10This is a picture of the actor
• 28:11graph on the right hand side
• 28:13that I said was like a Fitbit.
• 28:15And you'll notice that it had now I covered
• 28:18it with a colorful duct tape when I,
• 28:20I had not done that before the
• 28:23complaint had come in and I 'cause
• 28:25I had thought I would just keep
• 28:27it sort of neutral and, and,
• 28:29you know, not call attention to it.
• 28:32But then I thought, well,
• 28:33maybe it's better for me to make it
• 28:36look more playful and more childlike.
• 28:38So one of the things I did was to
• 28:41try and come up with an idea was to
• 28:44cover in this powerful duct tape.
• 28:46Another concern that came up was around this,
• 28:49which is a light meter.
• 28:51But I had participants asked me
• 28:53if it was a camera.
• 28:55So some other community gave little
• 29:01comments to to that you wouldn't necessarily,
• 29:04you know, have thought about without
• 29:06really engaging with the community.
• 29:09So in our results, we had 44 black,
• 29:1228% Hispanic, 22% non Hispanic
• 29:16white on the mean age of the IT was
• 29:19primarily mothers 29 1/2 years old.
• 29:21More than half of them
• 29:23were unemployed and single.
• 29:25All of the families were at an income
• 29:28to need average income to needs of .9.
• 29:32So they were predominantly
• 29:33living in poverty, below poverty,
• 29:36most of them with a high school or less
• 29:39in high school education and we had
• 29:45most of that 77% was rent
• 29:48view owned their homes.
• 29:50The children were on average 13.8
• 29:53months of age and 25% of them had been
• 29:58involved in Child Protective Services.
• 30:00At some point there we saw that children
• 30:04were not getting enough night time sleep.
• 30:06We would like to see at this age that
• 30:11children were getting closer to 10-11
• 30:13hours of night time sleep and then
• 30:16about two hours of daytime sleep.
• 30:18So they were shy of that.
• 30:21We the MSFC is the means where
• 30:25mean successful square differences
• 30:27of total 24 hours sleep.
• 30:29So the night to night sleep
• 30:32variability was over three hours.
• 30:34Their average bedtime,
• 30:35which we would recommend to be
• 30:37about 8:00 PM for this age group was
• 30:42close to 10:00 and their variability
• 30:45at bedtime was over 2 1/2 hours
• 30:48from one night to the next.
• 30:50This is an example of the output
• 30:53of sleep activity that you can get.
• 30:55And just to Orient you,
• 30:57the light blue is a sleep period.
• 31:00The yellow wiggly lines are
• 31:03light from the light meter.
• 31:05The black lines are activity.
• 31:09These blue bars at the top I manually
• 31:12code to indicate daytime nap.
• 31:15This is midnight,
• 31:17so you can see this child on this 12
• 31:21month old had a very late bedtime.
• 31:26This would be 9:00 bedtime.
• 31:28So they're quite far from that.
• 31:31This would the average and the
• 31:35and the yellow is showing a
• 31:38variability in their night time bed,
• 31:41their bedtime.
• 31:44I did not intend to look at race
• 31:46and ethnicity differences in my came
• 31:48because I was looking at 12 months old.
• 31:50So I, I again, this was before birth
• 31:54report of the early berries was public.
• 31:58And so when we did look at racing as to
• 32:01see what we found was that white children
• 32:04were typically going to bed before 9:00.
• 32:07Black children, fathers were going to
• 32:11bed at 10:16 PM and Hispanic at ten O 8.
• 32:16And more concerning than that to
• 32:18me was what I saw in their night
• 32:21to night bedtime variability.
• 32:23And so I used this map of time
• 32:25zones to sort of highlight what I,
• 32:27what this would be like.
• 32:28What I'm saying here is that we found
• 32:31that white children were had on night
• 32:33to night variability of one hour.
• 32:34So sleeping in New Haven one night and
• 32:36you know, Minnesota the next night,
• 32:38while black and Hispanic children
• 32:40were sleeping in New Haven one night
• 32:42and then close to California the next
• 32:44night and then back to New Haven.
• 32:46And so when,
• 32:47if you think about that as an adult,
• 32:49think that's sort of a powerful message.
• 32:51And and while sleep health has
• 32:55not been studied well,
• 32:57definitely variability,
• 32:58sleep variability is just beginning
• 33:00to be understood as a,
• 33:02an important health variable.
• 33:07So I'm going to just skip over the,
• 33:09the models and what we what we did.
• 33:13But I will say that one thing that
• 33:15we looked at was I was showing
• 33:17you the between group differences.
• 33:19And what we did was then look at
• 33:23the within group differences,
• 33:24which I think is important when
• 33:26you're talking about race,
• 33:27ethnicity differences.
• 33:29And what we found was that employment
• 33:34was significant and housing in
• 33:37the between group differences.
• 33:38But when we looked at within
• 33:41group differences,
• 33:41an example would be
• 33:46single parent parents and what we
• 33:48found was black and white single
• 33:51parents had the bedtime variability
• 33:55was there was a high effect size there.
• 33:58But in the opposite direction where we
• 34:01found that black single mothers had
• 34:03children with lower bedtime variability,
• 34:06some more consistent bedtime,
• 34:09while single white mothers had a more
• 34:12variable bedtime or their their children did.
• 34:16Regarding the biomarker,
• 34:17this has been a bit more challenging because
• 34:20of that young age group in which I collected.
• 34:23It's quite unusual to see that.
• 34:26And so it kind of begs the question of
• 34:28just because it can measure something
• 34:30since sort of struggling with what
• 34:32to do with some of the results.
• 34:34We had a lot of extreme values.
• 34:36I've been working with telemetrics and and
• 34:43a lab at University of California
• 34:45Irvine to help me understand that.
• 34:47That led to a systematic review
• 34:49of looking at sleep health across
• 34:52all stress biomarkers in children.
• 34:54What our results, what we did
• 34:56find was that from our baseline,
• 34:58we followed up with these
• 34:59children a year later.
• 35:00We did see a bit of a significant
• 35:05difference with cortisol.
• 35:08And I'm sorry, not with cortisol.
• 35:10We did not see with cortisol.
• 35:11But I will say that that was
• 35:13really tough to get because I
• 35:15was asking the parents to do it.
• 35:17I used the MEMS tab to try to
• 35:19capture the time, but it wasn't,
• 35:21it didn't work out so well.
• 35:22And so I didn't have timing to really
• 35:25do anything with my cortisol data.
• 35:27But that said,
• 35:28Alpha Emily,
• 35:28we did find to increase over
• 35:31the course of the year and then
• 35:33trends for Aisle 6 and some of
• 35:36the side of clients to decrease.
• 35:41So just sort of summarizes here.
• 35:45So some trends as well as
• 35:48one significant finding.
• 35:50All this has led to the this
• 35:52and an R21 that I did with
• 35:55Doctor Sadler and and Reddicker.
• 35:57I use that information to develop
• 36:00a intervention plus sleep well,
• 36:02be well specifically to address and
• 36:07help families with young children
• 36:10to promote sleep health rather than
• 36:12address sleep problems that exist.
• 36:16We did a the R21 was a mixed method study,
• 36:20so we did interview caregivers
• 36:22and health care providers and
• 36:25pediatricians as well as families.
• 36:30What this is my little logo and the materials
• 36:34are available in English and in Spanish.
• 36:37I worked with two Early Head Start partners
• 36:41at LULAC and at the West Haven Child
• 36:44Development Center and they were both
• 36:47very interested in in studying sleep.
• 36:50What I found or including sleep in
• 36:53their education materials and 170
• 36:56something pages of the Head Start
• 36:58performance standards that are federally,
• 37:01you know, required of the centers.
• 37:04There is many mention of things
• 37:07like dental care, nutrition,
• 37:09safety, exercise,
• 37:11sleep is mentioned 10 times in the 170
• 37:16pages and only in the context of safe sleep.
• 37:19There's nothing in their health promotion
• 37:22regulations that suggests including sleep and
• 37:25their required health promotion materials.
• 37:28And yet the early childcare providers
• 37:31are telling us about how exhausted
• 37:34children are coming in to into daycare.
• 37:38They're coming in late
• 37:42sometimes, you know, 9/10,
• 37:4411:00 which makes it very challenging
• 37:48for the early childcare teachers.
• 37:52We piloted it. So we had,
• 37:54we had it's a three-week intervention
• 37:56that starts with a bedtime routine fit.
• 37:58And something that we start with
• 38:00is we have 14 different bedtime
• 38:03activities that nighttime activities.
• 38:06And these are all magnets that then I,
• 38:08I made, I used a cricket machine
• 38:11to make all of these magnets.
• 38:13And then they can apply to a
• 38:14door hanger that I created.
• 38:16So the families pick what's
• 38:18important to them.
• 38:19So they family that pray,
• 38:21they're family that sing,
• 38:22they can choose the activities
• 38:24they want to do at bedtime.
• 38:25I ask them to choose four to five.
• 38:27And then every week for three weeks,
• 38:30every day for three weeks,
• 38:31the childcare teacher,
• 38:33there's a different handout that they,
• 38:35they give to the family.
• 38:37And then they talk to the
• 38:40family about topics that are,
• 38:41that are around the theme of BED,
• 38:44bedtime, environment and motion,
• 38:46regulation and duration
• 38:48and disruptors of sleep.
• 38:50So they week one we talk about bedtime,
• 38:53bedtime routines.
• 38:54Week two we talk about environment
• 38:56and emotion regulation and
• 38:57week 31 duration and disorders.
• 39:00What we found from the families was that
• 39:04they reported really great feedback.
• 39:06They, they said things like that.
• 39:09They felt more connected to their children.
• 39:12They felt like their child slept better.
• 39:15They were very happy with the,
• 39:17with each of them, with all of the materials.
• 39:22In the pilot, I spoke with a family,
• 39:25a mother. I didn't.
• 39:26He came up to me, a single mom of four,
• 39:29and said to me that she learned so much
• 39:32from the intervention and that she had.
• 39:35It was tough in the beginning.
• 39:37He turned off the television 15 minutes
• 39:39before he started the bedtime routine.
• 39:41And at first the children complained,
• 39:44but then they start to look
• 39:46forward to reading with her.
• 39:47And she said that her two year old
• 39:49who wasn't involved in the study,
• 39:51she said she,
• 39:52the two year old started talking
• 39:53more and that she was attributing
• 39:55that to her reading the books that I
• 39:57provided to them and the bedtime kit.
• 39:59And as she was saying this,
• 40:00I thought if I never work or do another
• 40:04research study in my life again.
• 40:06I've made a difference in this one
• 40:08family's life and was thrilled.
• 40:09But at the same time,
• 40:10I was looking at a box of reach out
• 40:12and read books inside the the daycare.
• 40:15And I thought,
• 40:15I'm not the first person to tell her
• 40:17that to read to her child that this
• 40:19is this has such an impact to her.
• 40:21And she said to me,
• 40:23just as I was thinking it,
• 40:24she said, you know,
• 40:25people have always told
• 40:26me to read to my children,
• 40:27but I never thought that I had time.
• 40:29But reading to them at night
• 40:31really make has made a difference.
• 40:33And I thought,
• 40:34wow,
• 40:35one thing we just need to do better about is
• 40:37talking about reading to each
• 40:38other and actually giving them,
• 40:39talking to them about when to read
• 40:41and when and finding out when they
• 40:43might have opportunity to do that.
• 40:45And then we did have some,
• 40:47I know small to medium effect
• 40:50size of in terms of sleeping.
• 40:52So this is just sort of a highlight of,
• 40:56of what we did.
• 40:59The BED mantra that I was telling
• 41:02you about what form it is,
• 41:03that is the prescription
• 41:07and this pilot was just looking at the
• 41:10feasibility in the pilot data and I've
• 41:12now turned have an R1 that will be
• 41:15reviewed June 10th as a second submission
• 41:18for this study to continue in multiple
• 41:21New England Head Start association.
• 41:23I'm sorry multiple head start
• 41:25centers across New England.
• 41:27So everyone keep their fingers
• 41:28crossed for a good conversation.
• 41:30June 10th.
• 41:31And this is just a little highlight
• 41:34of the teacher training.
• 41:36So I told you about what the families get,
• 41:39what the teachers get a training and sleep.
• 41:42So before they start the intervention,
• 41:44there's a 6th module training that
• 41:48developed that is available online.
• 41:51So they they're 15 minute modules
• 41:53and my goal is to actually develop
• 41:56those into CMD credit so that we
• 41:59can use this also in primary care
• 42:02because in addition to the RO one,
• 42:04it's being discussed next week.
• 42:07Recently with Karen ESA Koi submitted a
• 42:12Pakori for a comparative effectiveness
• 42:14trial looking at sleep well be
• 42:17well will where if we're funded,
• 42:19we will collaborate with a large
• 42:22practice based network of primary care
• 42:25clinics across the country who are
• 42:28who trained PBS pediatric residents.
• 42:30And so we will be very excited to
• 42:32see if we can translate this right to
• 42:35primary care and come full circle and
• 42:37and help me get some of these concepts
• 42:39of parent interaction in into primary care.
• 42:44And then as I mentioned,
• 42:45I did submit a grant.
• 42:47I and I put the title there 'cause
• 42:49I was just really thrilled with
• 42:50my cleverness of my title here,
• 42:52the sleep obesity risk and screen
• 42:54to children and screens.
• 42:56I came in second for that grant.
• 42:58So I did not get funded,
• 42:59but they gave me public feedback and
• 43:01I hope to submit that in October.
• 43:04So I just want to thank my mentors,
• 43:07Nancy Medicare,
• 43:08Lois Sandler and John Dion and take
• 43:11care parties that director of the
• 43:13sleep clinic and Megan O'Connell
• 43:15for for their health and these
• 43:17studies and of course a few doctoral
• 43:20work both and then amaze.
• 43:23And Lois Sandler,
• 43:26thank you.
• 43:32People have questions or if
• 43:33we have time for questions or
• 43:36yes, yes, I think we've got
• 43:37plenty of time for for questions,
• 43:38Questions for for Monica.
• 43:42I want to start out from Sarah
• 43:44Fitzpatrick too, although minding the
• 43:46baby like old friends. Thank you.
• 43:53You know, I would love to
• 43:55collaborate with anyone too that's
• 43:56thinking about adding sleep.
• 43:58Sarah, if anyone's thinking about adding
• 44:01sleep to their studies or you know,
• 44:04please contact me. Happy to do help.
• 44:09Maybe Monica just well,
• 44:10people are collecting their thoughts.
• 44:12I, you know, I was wondering if
• 44:14any of your interventions or if
• 44:16you've thought about incorporating
• 44:18grandparents or alternative
• 44:19caregivers into your interventions.
• 44:21You know, I'm trying to think,
• 44:22I'm thinking as someone who
• 44:23has a nine month at home,
• 44:24I'm thinking about all the
• 44:26recommendations and advice that
• 44:27you get as someone with a new,
• 44:29with a new baby,
• 44:30Obviously sleep recommendations
• 44:31and how you put the child to bed.
• 44:33They've changed across generations.
• 44:35And sometimes there is a bit of
• 44:37a battle of kind of fighting
• 44:38back against advice that you're
• 44:39getting from people that may not,
• 44:41you know, be up to date with
• 44:43the current best practices.
• 44:44So I'm just wondering,
• 44:45is that something that you
• 44:46thought about or is that something
• 44:47that's ongoing in the field?
• 44:50Absolutely. And you know, I should have
• 44:52said that when in the intervention,
• 44:54we provide the materials to any
• 44:56caregiver that has the child overnight
• 44:58or is involved in night time.
• 45:00So we always, we ask that and we offer
• 45:02the materials so that if they're multiple
• 45:04parents or grandparents involved,
• 45:06that they're all getting sort
• 45:08of similar materials.
• 45:10You know, something clinically that
• 45:12I do that I think is important
• 45:14as when I work and sleep,
• 45:15when I was working at a sleep clinic,
• 45:17I were giving advice.
• 45:18I, I listened to what the families,
• 45:20you know, what they,
• 45:22what they described to me in a
• 45:24sleep concern and then have an
• 45:26idea of what would work and then
• 45:28would present that to the family.
• 45:29But I always say to them that
• 45:32this is one idea.
• 45:33Do you think this is something
• 45:35that would work for your family?
• 45:37Because if not,
• 45:37pretend like I have a little bag of
• 45:40tricks next to me and I'll just reach
• 45:42into my bag and I'll pull out another trick.
• 45:44I said that because the worst thing
• 45:46you can do is give you advice that
• 45:48you will walk out with and be like,
• 45:50that woman doesn't know what
• 45:51she's talking about.
• 45:52That's not going to be helpful
• 45:54to you and or your child.
• 45:55So there I,
• 45:56I don't think it's A1 size fits all.
• 45:59And I think that some of it is, you know,
• 46:01we can develop these introversions.
• 46:03I'll tell you what's evidence based,
• 46:04but we have to do a better job
• 46:06of hearing from the families.
• 46:07What are the limitations or the
• 46:10cultural beliefs or backgrounds?
• 46:12Like I said,
• 46:13we don't have a good questionnaire that
• 46:16asks about why families are Co sleeping,
• 46:20because if they're Co sleeping for
• 46:23reaction as a reactional Co sleeping
• 46:25or intentional or cultural or SDS,
• 46:28those are those are different.
• 46:30You know that the background is
• 46:32important before we understand it.
• 46:34And so these studies that
• 46:36talk about closely things,
• 46:37but they haven't really asked why.
• 46:40I think it's it's not really
• 46:42appropriate to make any judgments,
• 46:45you know, or that we can really
• 46:47determine what's what's healthy or not.
• 46:50So I don't know if that didn't,
• 46:52I would just say that got
• 46:53to answer your question,
• 46:54very open to that.
• 46:55But I think a lot of it's going
• 46:57to come in training that putting
• 46:58that into the training materials
• 47:00for whether it's the teachers
• 47:01that are delivering the materials
• 47:03or the healthcare providers that
• 47:05are delivering the materials.
• 47:06And even though I used a little
• 47:08prescription pad not being so
• 47:09prescriptive in our advice.
• 47:12Yeah, makes good sense.
• 47:14And have you noticed something
• 47:15I've been very surprised about
• 47:17is seeing advertisements for
• 47:19sleep aids for children.
• 47:21And so melatonin based sleep aids.
• 47:23It is something that you're
• 47:24seeing an increase in.
• 47:25Is this something that you're
• 47:27assessing and what's your advice
• 47:28and feedback on on these aids?
• 47:31Oh, melatonin right now is a huge
• 47:34topic of of I know, you know,
• 47:35very unregulated, very commonly
• 47:39used in any to send to a pharmacy.
• 47:42And it's always like at the end cap
• 47:44of all these sleep aids and they
• 47:47market them to you know quality sleep.
• 47:49And I think we we definitely
• 47:51don't know enough.
• 47:52We are coming out the IPSA that I
• 47:55mentioned International Pediatric
• 47:56Sleep Association on the board there.
• 47:59We're coming out with a statement
• 48:01about melatonin use,
• 48:02but the statement is not going
• 48:04to include we don't have good
• 48:07evidence about the use of them.
• 48:09I think they are very useful
• 48:11and we commonly use them and
• 48:14neurodiverse patient, but I,
• 48:16I think that we want to move
• 48:19away from just sort of a blanket
• 48:21recommendation as a Band-Aid and not as
• 48:26really picking up and following up.
• 48:28Was that effective?
• 48:28So if you're talking about
• 48:30melatonin in particular,
• 48:31that's, that's one that,
• 48:34and then there's the, you know,
• 48:36$1800 new bassinet that, you know,
• 48:43these are great and if you
• 48:44can afford them, but it's,
• 48:45I don't think that's the only answer.
• 48:47And I think we have some work to do on
• 48:50avoiding shaming families on social media.
• 48:54I, I've had many conversations with
• 48:58families who are parents that talk
• 49:00to me about how awful it is to,
• 49:03to do a cried out method and
• 49:06how babies could not cry.
• 49:08I recently had someone tell
• 49:09me that they shouldn't,
• 49:11babies shouldn't cry for even a minute,
• 49:12but it does brain damage to them.
• 49:15It increases their cortisol levels.
• 49:17And he writes books on this and that.
• 49:21It's all about attachment.
• 49:23And I'm breaking attachment.
• 49:25And she speaks internationally
• 49:27and nationally on top of this.
• 49:29So it was an interesting conversation
• 49:30at my son's graduation with a
• 49:32mother that caused graduation with
• 49:34a mother that my son thought, well,
• 49:35you two are gonna have so much in common.
• 49:37I really.
• 49:39Oh, I thought you were talking to so and so.
• 49:41I knew you guys would get along.
• 49:42I said maybe we'll talk about that later.
• 49:46You're a little different in our opinion.
• 49:53Maybe leave that there. Oh, please, Ansley.
• 49:58So just a quick question.
• 50:02I love it. But the, the, the main,
• 50:04the main question that I have is I
• 50:07know that you focused on families and,
• 50:10and young children.
• 50:12For the longest time, I,
• 50:13I identified as a parent of young children,
• 50:16but now I have to bite the
• 50:18bullet and acknowledge that my
• 50:19kids are becoming teenagers.
• 50:21So, but that being said,
• 50:26would this be something that
• 50:29could be feasibly done with
• 50:31adolescent or teen population?
• 50:33And I'm thinking what the,
• 50:36the thought that's coming to
• 50:38my mind is mood disorders.
• 50:41Usually one of the core symptoms is
• 50:45alterations in their sleep patterns.
• 50:48And we know that for a fact,
• 50:50adolescents start to have changes
• 50:52in their sleep patterns just
• 50:54because they're adolescents,
• 50:55right, developmentally.
• 50:56So it would be really,
• 50:58really interesting to kind of
• 51:01map out kind of like the sleep
• 51:04patterns of depressed kids
• 51:06versus the sleep patterns of non
• 51:09depressed kids kind of coping for,
• 51:11for, you know,
• 51:13different things.
• 51:15And one of the things that we've
• 51:17been seeing in our in our adolescent
• 51:20population is that a lot of them are
• 51:23self medicating for sleep issues.
• 51:26So either using marijuana or actually
• 51:30even using alcohol to help sleep.
• 51:33And you're talking about 1415 year olds,
• 51:36so I don't know if if that would be
• 51:39something I can send you an e-mail and
• 51:41we can try to figure something out.
• 51:44But
• 51:44Oh yeah, I mean,
• 51:46you definitely are speaking my language.
• 51:48I would say the answer for the first
• 51:50part with Doctor Owens at Harvard.
• 51:52I'm consulting on a intervention she's
• 51:55developing for school age children.
• 51:57And so she and I are talking about
• 51:59what I'd love to do is I actually want
• 52:01to create the program from prenatal.
• 52:03So just like we have breastfeeding
• 52:06classes for prenatal families,
• 52:07I think we should have sleep
• 52:09preparation and talk about the 1st.
• 52:12I mean, I feel like it would be very
• 52:14empowering to talk to a new parent
• 52:16and help them and let them know that
• 52:18there's only two stages of sleep and
• 52:19for the first two or three months.
• 52:21So actually the whole confusion
• 52:22the night and they hear these
• 52:24things about confusing their night
• 52:25and the day it it doesn't it.
• 52:28That's powerful information.
• 52:29So I'd love to do it from
• 52:31prenatal through school aid.
• 52:32Adolescence are a unique set of
• 52:36other set of circumstances and
• 52:40it'd be a whole nother talk.
• 52:41But I will just highlight a couple things.
• 52:43You really hit the nail on the head when
• 52:45you said about the the change in pattern.
• 52:48And a lot of families don't
• 52:50understand that adolescence,
• 52:52their Physiology changes that they
• 52:55become their bedtime if their
• 52:58circadian rhythm shifts to a bedtime
• 53:00that would be closer to 10:50 PM.
• 53:04And so that becomes very challenging
• 53:07when schools are starting at
• 53:107:15 AM and they're expected to
• 53:12be in the classroom at 7:15 AM.
• 53:15And which means like in my neighborhood,
• 53:17they were picking up for school
• 53:18at 6:00 AM on the bus.
• 53:20We recommend the American Academy
• 53:23Pediatrics that and sleep society that that
• 53:26I'm sorry that school starts to be 8:30.
• 53:29And in Colorado they've done some
• 53:30great work where they have shifted
• 53:32the school start time and they have
• 53:35seen a reduction in adolescent
• 53:37depression and in suicidality.
• 53:40And so this is what so I think
• 53:43we all would say,
• 53:44but then we why we should
• 53:45just be changing this.
• 53:47It becomes a very complex because in
• 53:49New Haven the issue is that to have
• 53:52the younger children go into school
• 53:54earlier means they get off the bus
• 53:57earlier and they don't have families,
• 53:59don't have the child care,
• 54:00so the older children have
• 54:01to get off the bus earlier.
• 54:03And Greenwich,
• 54:04the issue that they've been resistant
• 54:06about late school start time is
• 54:08because the teachers can't afford
• 54:10to live in Greenwich and so they
• 54:12have resisted it because they
• 54:13don't want to be in the traffic.
• 54:15It would change the traffic pattern.
• 54:16So the the reasons for each town
• 54:18and why they don't want to do the
• 54:21delayed school start time becomes
• 54:23is very unique and challenging.
• 54:25But the literature and the
• 54:27evidence is there that these kids,
• 54:29you can't get the adequate amount
• 54:31of sleep if your bedtime Physiology
• 54:34is 10:50 PM and you have to get
• 54:37up at 5:30 to do your hair,
• 54:40eat your breakfast and get ready
• 54:42for school.
• 54:44So there's a lot of important work.
• 54:46And oh, and one last thing,
• 54:47sorry about the alcohol marijuana.
• 54:49The keynote address here at the
• 54:51sleep conference was actually
• 54:53I was took a picture of it
• 54:55because alcohol and marijuana,
• 54:56both marijuana has not been tested.
• 54:59We don't have a lot of studies on it,
• 55:01but it's we know for a fact that alcohol
• 55:04actually makes your sleep worse.
• 55:07So while it might help them fall asleep,
• 55:08their sleep quality is very
• 55:11reduced and they it's a reduction
• 55:13in flow wave sleep and REM sleep.
• 55:15And it looks like marijuana is also the same,
• 55:18which I was a little surprised about
• 55:20because you hear a lot of people
• 55:21talking about taking gummies and
• 55:23things like that to help them to sleep.
• 55:24But we definitely need more data on
• 55:31my son during COVID had a his first job.
• 55:35When I feel you, by the way,
• 55:36because my kids are now adults.
• 55:38They're 19 and 22, which is going to
• 55:40make Nancy fall off her chair and Sarah,
• 55:43but like they're they're now adults.
• 55:45But when he was 16 was during COVID
• 55:48working at CVS and I found a bottle
• 55:51of 10 milligram melatonin CVS brand
• 55:53on his night stand and I lost my mind.
• 55:56And then I called myself
• 55:58and mentalized and said,
• 55:59tell me what you're doing this.
• 56:01And I said it would never recommend
• 56:0310 milligrams, never CVS brand.
• 56:05What were you thinking?
• 56:06So with the bottle said it
• 56:07will help you sleep better.
• 56:08So since he was only going to
• 56:10sleep for five or six hours,
• 56:11he thought he could stay up later,
• 56:13have a shorter period of time
• 56:15to have better quality sleep
• 56:16and but totally misunderstood.
• 56:18And then went on to tell me that
• 56:20the bottle was returned by a
• 56:21customer and they are not allowed
• 56:23to put it back on the shelf.
• 56:24And so he, he didn't buy it, he just took it.
• 56:27So now I was dealing with taking 10
• 56:30milligrams CVS brand returned bottle.
• 56:33Smart kid and Nancy will know
• 56:34exactly which fun I'm talking about.
• 56:40Adolescent risk taking. Yes.
• 56:43Yeah. The way they think is a
• 56:44whole different, you know it,
• 56:46it just surprises you every time.
• 56:48I'm like, what
• 56:48did you think?
• 56:51Monica? Thank you again
• 56:52for joining us today.
• 56:53For Grand Rat especially,
• 56:54it's just such short notice.
• 56:56That was a really interesting talk
• 56:57and I guess probably sparked a
• 56:58lot of ideas for our community.
• 57:00So anyone who is interested
• 57:01in collaborating with Monica,
• 57:02please feel free to reach out
• 57:04and thank you once again.
• 57:06Thank you, Sir. Thanks for
• 57:08having me everyone. Bye bye.