COMMENTARY

Back to School: In Praise of the Routine

L. Gregory Lawton, MD

Disclosures

September 26, 2018

The Many Benefits of Sleep

Sleep is another important routine that requires more time and practice than we usually give it. The typical newborn sleeps 14-18 hours a day, inclusive of naps. By the age of 4 years, the routine nap has been abandoned; there is too much in the world to see and do. This change, though, is minor relative to the larger issue of establishing a healthy bedtime routine, sometimes referred to as "sleep hygiene"—a term I abhor, because it conveys a mental image of cleansing.

The sleep pattern, like feeding, is as much about the "where" as the "when" and "how." Start with a plan on when in the evening it makes sense for the family to start the process. The time for a family with two working parents will be different from that of a family with one parent at home or a single-parent household.

Beyond that wrinkle of individual practicality, there are some good, basic ideas. Begin with a bath (the only legitimate hygiene, in my opinion, associated with sleep) and move on to cuddle time, books, songs, and nursery rhymes. Make the setting the child's room. Starting the process in the parent's room, if it becomes the routine, creates confusion and contributes to middle-of-the-night expectations, whereas keeping the entire process in the child's room simplifies the routine for the child.

As toddlers morph into school-age children, preteens, and teenagers...the potential for introduction of less healthy bedtime routines increases.

Set the lights down. Parents can unwind and model this experience to their children in softer tones, silly giggles, and comforting touches. "It's time to slow down so we can all recharge and have energy for tomorrow. And I love you. And I will dream about you. And you can dream about me. And we will play again tomorrow as we will embark on more adventures."

This is also the time for Dr Seuss and Cat in the Hat or whatever variation on lovable literature the family prefers. Reading time before bed sets a mood for sleep, creates an intimate time of sharing, and serves as a foundation for a lifetime of reading. The rhymes and alliteration of children's books can spark an interest in the written word, the telling of stories, and the sharing of ideas.

Later on, as toddlers morph into school-age children, preteens, and teenagers, parents become disengaged from the sleep routine and the potential for introduction of less healthy or wholesome bedtime routines increases. And one of those decidedly less healthy routines is the near universal use of devices—tablets, smartphones, televisions. A systematic review[2] of 67 studies published over 15 years examining the link between screen time and sleep came to an indisputable conclusion: Over 90% of the studies found that use of these devices was linked to poor sleep.

Fast-forwarding to the precollege and college years, a recent article in the New York Times[3] listed all the reasons why sleep still matters for these older teens/young adults. The lack of a healthy sleep routine in college students can manifest itself in lower exam scores; grade point averages; and even, according to a study[4] conducted at Stanford with members of the men's basketball team, free throw percentages.

None of this should come as an epiphany. Since 2011, commercial pilots have been mandated to have at least 10 hours of uninterrupted sleep between shifts.[5] Ask a teen how willing they would be to get on a plane if they knew that the pilot had only had 4 hours of sleep but had just slammed an energy drink. Only the most sleep-deprived teen would think that to be a good idea. The concept of sufficient sleep is not difficult to sell to parents and teens, but the practicality of making sufficient sleep a routine can be.

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