Podcast #791: Set Your Kids Up for a Lifetime of Healthy Sleep

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Brett McKay: Brett McKay here and welcome to another edition of The Art of Manliness podcast. When urologist and sleep specialist, Dr. Chris Winter sees adult patients in his sleep clinic, they often come to him because of a struggle with insomnia, which as he described in a previous appearance on the AoM podcast, is caused by stressing too much about sleep, so that going to bed becomes an anxious and fear-inducing routine that sabotages the natural needs and rhythms of the sleep cycle. Chris would see fewer adult patients like this if when they were kids, their parents set them up to have a healthy relationship with sleep. How to establish that kind of healthy relationship is something Chris writes about in his latest book, The Rested Child and is the topic for our conversation today. Chris will take us through what parents should know about their kids sleep from the womb to young adulthood, with tips on both how to improve your children’s sleep and how to avoid messing it up, including his take on co-sleeping, why he’d let his kids go to bed whenever they wanted, and why he discourages giving children melatonin to help them sleep. After show’s over, check out our show notes at aom.is/kidsleep.

Chris Winter, welcome back to the show.

Dr. Chris Winter: Hey Brett. It’s an honor to be back.

Brett McKay: So we had you on the show a few years ago to discuss your book, The Sleep Solution, it’s all about how to manage the most common sleep problems that you see people have. The latest book is called The Rested Child, and it’s all about sleeping kids. So in our conversation, The Sleep Solution, we talked about the health consequences for adults, if they don’t get enough sleep or they have poor sleep, are there unique health consequences for children?

Dr. Chris Winter: It’s interesting, unique. I think they are unique in the sense that maybe the difference between a child sleep problem and an adult has to do with kids are laying foundations. In other words, I was talking to a patient today who was a good sleeper, now he is 58, he is struggling, versus somebody who deals with something or develops something when they’re young, and that almost gets incorporated into who they are. In fact, one of the chapters in my book, I write about good sleepers, bad sleepers. What does that mean? If you meet somebody at dinner parties, well, I’ve always been a bad sleeper, what exactly are they saying? And where did that label come from, which I find to be really fascinating. I was talking to somebody the other day, I said, “I’ve never had a parent in my clinic who’s brought their children and said, ‘Well, there’s Keith. He’s my smart child. And that’s Daryl over there. He’s dumb as dirt’, in front of the kid,” you would never do that. And if I said, well, “Is Daryl your stupid child or your smart child?” that parent would probably get very upset with me and maybe never come back.

What’s interesting is the way they talk about sleep with their kids, they’ll often say, “Oh, Daryl’s my great sleeper, but Keith, he’s the worst sleeper God ever put on this earth,” right in front of the child who’s sitting there playing with Lego. So it’s interesting, I think that the consequences sometimes with children’s sleep is that they develop identities and behaviors about sleep that are very rooted developmentally. It’s like learning to swim when you’re little versus learning to swim when you’re in your 40s, it’s really a different thing, or acquiring a language. And the other thing that I think tends to happen is that because children are developing and the things that are happening in their lives are pushing them in directions, they’re accelerating in school, they’re going to college, you’ve decided not to go to college. Maybe do something different. How much of that decision is being made because of problems related to their sleep, so it always concerns me when I see children who are excessively sleepy and struggling in school because forces beyond their control are making determinations about them.

And one of the things I want to avoid is dealing with a 31-year-old who says, “I probably have had narcolepsy ever since I was a kid, I can’t believe it’s taking 20 years to figure this out,” and they often have this look like, “If I had known that when I was in high school, I think my life would be very different than it is now.” And so, I want disorders of sleep to be addressed quickly and efficiently, so that that child can lead their best, happiest life, frankly. And I think sometimes with adults, it’s a little bit different.

Brett McKay: So you want the child to have a great sleeping life all of their life, there’s also health issues, I think we’ll get into this a little bit, the role of sleep in growth, particularly for teenagers. But also, a lot of parents are concerned about their child’s sleep because they’re concerned about their own sleep. If their child’s not sleeping well, then the parent… I imagine a lot of the patients you see with sleeping problems, it’s like, “Well, my kid he just keeps waking up and he’s not a good sleeper,” so helping your kids sleep also helps your sleep as well.

Dr. Chris Winter: Absolutely. I was just in Nashville last night giving a lecture about narcolepsy, which is a disorder where individuals are excessively sleepy, they have a very unique relationship with sleep and that they want it all the time. And I was talking to another doctor and he said that one of the patients that he had diagnosed with narcolepsy, it was a 20-year-old somewhere mid-college age years, the parents had come with her to the doctor’s visit, and when he said, “I think you’re child has narcolepsy,” the mother said, it was kind of emotional and said, “Oh, my God, I always thought she was our great sleeper.” And it’s interesting because my guess is it would look that way to a parent of a young child who when you say, “Okay kids, it’s time for bed,” this child is already there. They put themselves to bed and every time you put that child down to nap, they went to sleep immediately. Again, you’re back to that good sleeper, bad sleeper, I think to your point, Brett, part of that evaluation has to do with how much is the sleep affecting or not affecting the parent, so in that metric, the child was great. I diagnosed narcolepsy in a major league baseball player.

And I talked, I said, “Do you mind if I call your mom?” And he’s like, “No, I don’t mind at all.” And so I called his mom, and the mother said, “It’s funny, when he was a high school student, he would play baseball, and then in between innings would come off the field, go to the dug out, put his glove on the bench and go right to sleep. And then his teammates would wake him up if it was he’s turn to bat or if he had to go back out on the field again.” I said, “What’d you think about that?” And she said, “I don’t know, I just thought he was working really hard,” so it’s amazing what we will tolerate, what we will make an excuse for particularly if it’s not affecting her own sleep.

Brett McKay: Okay, so I think it’d be useful to structure this conversation so that we go through the different stages of a child’s sleep development and unique needs of each other’s perks. I imagine we got listeners who are parents who’ve got a kid at these different stages, but the first question to ask, When do we start sleeping as a fetus, do we have an idea when that happens?

Dr. Chris Winter: Yeah, we do. And I write about that. Sleep in a fetus does look different than it does in an older child or a child obviously that’s been born. Both the timing of it, but also the brain activity is just inherently different. Now, this is a very difficult thing to study because it’s difficult to get a kid to wear a Fitbit when they’re inside of a mother’s uterus, but we can look at these types of things and relatively early on in the child’s development, these stages of arousal and less arousal start to emerge. And that’s important, because if you are a parent or you’re expecting to be a parent one day, you can influence that sleep based upon your own activity, so the mother’s schedule, the mother’s exercise, is it regular? Is it sporadic? Is she a shift worker, is she somebody who works 9-5 everyday, exercises every day for 30 minutes at noon, has a very routine eating schedule, movement schedule? They’ve done studies that looked at how rocking, talking to a child, even driving influences a child’s rhythm. So I always tell parents, you’re going to start to create and help your child organize his sleep before you meet him or her, which is just absolutely fascinating to me. And that’s why in the book I write, that this process of sleep is happening well before the child is born. And what’s cool is you can influence it.

Brett McKay: Okay, so the mother, her actions can influence the child’s sleep before it’s even born. What about genetics, what role does genetics play in our sleep habits?

Dr. Chris Winter: Absolutely. So genetically, I like to think about a few things. Genetics could be potentially endless in terms of its influence on the sleep, but the things that I think that are most relevant to a parent and maybe to a child are three things, number one, how much sleep does your child need as an individual? We talk a lot about eight hours, but it’s really a lot more unique to your own child. And unfortunately is rapidly changing during those childhood years, so nobody would be shocked if I told them, “You know what? Regardless of what your child needs genetically, it will probably be more when they’re 6-months-old than when they’re 6-years-old or 16-years-old.” I included in the book a chart that you can look up in the National Sleep Foundation, if you type in National Sleep Foundation sleep need by age, there’s this really cool chart that they’ve put out there that kind of shows that bell curve distribution of sleep, the average, but what the outliers are that are considered normal for a child who’s just been born all the way up to their senior citizen discount at the movie theater. And what you see is, slowly as we mature in age, we lose sleep, so grandma and grandpa tend to need a lot less sleep than their grandchildren. And so it’s not only just a matter of figuring how much you need, it’s how much do you need in this point in your life because it can change.

So sleep need is highly genetically determined, so if you’re somebody who’s a trauma surgeon and you work, you feel pretty good getting six hours of sleep at night, you could very well pass that on to your daughter and she’ll be an amazing trauma surgeon like her mom. The other genetic pieces are, when do you prefer your sleep, and so there’s this idea of chronotype meaning, are you a night owl? Are you a morning person? The idea of chronotype has been around for decades, even though it’s gotten a little bit more attention of late, and so it doesn’t mean that you can’t do something in the morning if you’re a night owl or vice versa, but when you think about children, it’s extremely important because by and large, most kids tend to be what we call phase delayed. They’re more on the night owl part of the spectrum than the morning part of the spectrum, and I think that has a lot of relevance. If your child maybe struggles in math and you know that they’re very night-oriented, they may struggle with a school start time that’s early, in fact, there’s a whole movement wanting to make school start times later to facilitate most children’s circadian rhythm.

But one of the things I talk about in the book is there are assessments that you can do for your children, and if you do an assessment on your child and determine that he is extremely night-oriented, that might be a tool that you could use with the school to say, “Look, he cannot take trigonometry at 8:00 AM, we really need him in that 3 o’clock trigonometry block, or we would like help making arrangements for him to take this at a community college or something. So I think that that understanding of timing is extremely important. The third genetic variable I call horsepower, ’cause I’ve never really heard it referred to anything meaningful. What it is, is if you deprive a child of sleep, a teenager, you have three teenage kids, and you make them stay up all night studying art history, and then you give them a test the next day on Renaissance painters. Which of your children are able to do that and which are not, meaning that, how do we deal with inadequate sleep? And it’s a very double-edged sword. I think that a lot of people that I went to medical school with had that horsepower gene, we could stay up all night and run around the hospital and put needles in people’s necks and function pretty well the next day, or at least we thought we were.

Versus there are some people I’ve met might even be married to one that after 11, 12 o’clock, they’re not going to be particularly helpful getting your hemorrhaging under control if you came in their emergency room. So we find that individuals who possess that ability to go without sleep, can become quite successful, they just kind of outwork everybody, but the other edge of that sword is they can often die when they’re 55 because they’re able to not get an adequate amount of sleep and do okay, so we always want to be encouraging people to get the right amount of sleep, don’t be scared about not getting it, but don’t be cavalier about the fact that I’ve got a daughter who’s like, “Look, as long as I get two or three hours off sleep, I’m good the next day.” Well, being good, however you define that, and being healthy and living a long life might be mutually exclusive, so we always want to watch out for those types of kids that live in our household, the high achievers, straight As, stay up all night studying Latin, played two different sports and a musical instrument, just because you can do it may not mean you should.

Brett McKay: Okay, so a child’s sleep patterns, they’re influenced by genetics. The mother is also playing a role. That child is born. You bring the baby home. A lot of parents probably notice first off that your baby just, it eats and sleeps, why do you do newborns sleep so much? What’s going on there?

Dr. Chris Winter: Yeah, so it’s an interesting question. You’re being sneaky, Brett, ’cause what you’re essentially asking me is, why do we sleep? And I think it’s always fun to say to people that we really don’t know why exactly. Now, what’s interesting about kids is that during this period of massive growth, that’s what distinguishes a child from an adult in some ways that they’re very busy growing, and we know that the majority of growth hormone, what makes an individual essentially grow is produced during deep sleep, and so when you actually look at a chart… There’s a wonderful chart that you can find if you look it up, that looks at how much light sleep, deep sleep, dreaming and wakefulness during the night we have over the course of our lives, and what you notice when you look at that is the diminishment in our sleep over time seems to be most tied to a lack of deep sleep. In other words, the amount of dreaming we do seems about the same, the amount of light sleep is about the same, deep sleep is about the… I’m sorry, dream sleep’s about the same, light sleep’s about the same, wakefulness might get a little bit more as you get older, but deep sleep rapidly decreases as we age, so kids are getting tons of deep sleep. And we know this as parents, you can wake him up in the car seat and pick him up, take him into their bedroom, they just out cold, you can put their pajamas on, they never wake up.

That’s deep sleep. You can’t even wake them up to bring them in the car and put their pjs on. So, that deep sleep is when the child is making growth hormone, so I think the big thing that’s happening there with children is their bodies are exceptionally focused on this deep sleep because it’s the necessary component of growth that makes these kids get bigger. In fact, sometimes when you have children who are falling off their growth curve, and I give a couple of examples of real patients that we’ve seen where they’re chugging along 80% height and weight, when they go to the pediatrician, they plot that out on the chart and you get real proud when your kid’s in the 80th percentile or 90th percentile for height or whatever, then all of a sudden, the next time you visit, they’re in the 60th percentile and then maybe even less the next time, so that trajectory they were on is starting to fall off. A lot of times that can be a subtle indication that there is something going on with their sleep because their sleep disturbance is affecting their deep sleep, their deep sleep is affecting growth and now they’re not growing, so the most common one you see is something like sleep apnea. Kid has big tonsils, they’re not breathing well during the night, and what’s crazy is you take the kids tonsils out and all of a sudden their growth just surges.

And one of the things I predict will come out of COVID, and this is my own prediction, this is not being supported by any scientific study that I’m aware of at this point, is that a lot of kids were basically told during COVID, do not come to swim practice, do not come to your early morning prayer group, everything’s cancelled. And in fact, we’re not even gonna start school until 9:30, and that’s gonna be a Zoom school, so you could log in, turn your camera and microphone off and keep on sleeping if you wanted to. So a lot of kids during COVID, we did this kind of accidental massive experiment on what happens if we almost force kids to get more sleep, and I’ve anecdotally sort of collected a lot of experiences from people that said, “Wow, my kids really grew a lot, they had growth surges during COVID.” I have two boys that were high school students at the time, and one of them, a senior had kind of stopped growing, the other one had not, but they both had huge surges in their growth during this time. Now, my senior was a swimmer, so he was used to getting up at 4:30, 5 o’clock every morning, seven days a week, and suddenly was told, “No, you can sleep till 9:00 or 10:00 now if you want to. So it’ll be really interesting to see that, but that growth hormone is really tied to that infant sleep experience, and it’s probably essential for developing a healthy body and mind.

Brett McKay: Alright, so newborns are sleeping a lot ’cause they’re growing a lot, not only physically, but their brain, there’s a lot going on with their brain, and a lot happens with our brain while we sleep. When a parent comes to you with a newborn that’s having sleeping problems, what are the most common problems and what are parents doing maybe unintentionally to exacerbate the problem?

Dr. Chris Winter: Yeah, so I think if we’re looking at newborns, young children, probably the biggest problem that they have is, and I don’t mean to sound flip about this, it’s a lack of maturity in the sense that that brain has not really started to organize itself into a period of wakefulness and a period or periods of sleep. And I think that for most parents, what they’re dealing with… And we get parents all the time who bring us very young children and what they’ll say is, I get a little note, “Here’s your patient, you’re seeing him at 3 o’clock, and here’s the complaint, can’t sleep or their baby won’t sleep.” I’m approaching 50. I have never seen a child that won’t sleep. I’ve never heard of one, never seen more with my own eyes. Maybe they exist, but I’m not privy to it. So what the parent is basically saying is the child’s not sleeping in a predictable or efficient way. And parents can get a lot done if they know what’s going to happen, even if they’re not sleeping that much. If they know, “Okay, well, that’s fine. When are they gonna sleep? If you can tell me that.” It really makes the difference.

So I think a lot of parents just need a plan, but the plan that your book is reading might not be the plan that’s perfect for your child, it’s awesome that Blake Lively and Ryan Reynolds post, “This is the schedule we have for our perfect little child, and here’s how he or she is sleeping.” And you think, “Well, great, this is the person that helped Blake Lively and Ryan Reynold’s baby sleep, is gonna help my baby sleep. I’m gonna put my child on that schedule, which could very well work, it might not, because again, your child has very different genes than that other child. So it’s really about understanding how much sleep does your kid need? And so one thing I tell parents all the time to do is, for the next week or two, I want you to write down every minute that they’re sleeping, so you put them down at 8 o’clock, they slept until 10:00 and woke up and they were up until 11:30, and then they fell back to sleep again, they took a 20-minute nap during the day on the ride to Whole Foods, and then they fell asleep in this little bouncy chair that your grandmother got you.

You track every little bit of it, and then over two weeks, when that’s done, add up all that time divided by 14 days and you’ll get a sleep time for 24 hours, so essentially how much sleep is your child getting right now, on average, every 24 hours. And when that number is calculated, now you can split that up and arrange the schedule in the way that you would like it, or watch your other child. But what I often find parents doing is they’ve got a child who’s sleeping a relatively small amount, but they’re trying to get the child to sleep for 17 hours. And one of the things I want you to pay attention to when you look at that National Sleep Foundation chart is the tremendous variance when you look at young kids in terms of how much sleep they need, and what I mean by that is a newborn, zero to three months could be sleeping anywhere from 11-19 hours every 24. So that means when you’re sitting in a park with your friend who both of you have babies that are somewhere in that zero to three-month range, what your friend is telling you to do, what you’re telling your friend to do could be very wrong if you’ve got an 11-hour baby and they’ve got a 19-hour baby. And once again, the 19-hour baby is always the good sleeper and the 11-hour baby is the bad sleeper, but it’s not. They’re both fine, there just needs to be an understanding of what that child needs, and I sometimes think that that’s sometimes lost.

Brett McKay: So figure out how much sleep your newborn needs and your child needs and then from there, do you recommend establishing a schedule saying, “Okay, we’re gonna get one nap at this time, and then you’re gonna go to bed at this time to get most of your sleep”?

Dr. Chris Winter: So my answer to that is yes, but it’s qualified in the sense that if a parent… I ran into a parent in a dinner party, and they said, “You know what? We don’t really have a schedule for our child, we just let him or her be awake and sleep whenever they want to.” My first question would be, “How is that working out for you?” If the answer is “Lovely, well, we are so happy,” then I don’t really have a problem with it, this is your child. You’re fully qualified to make those decisions. Now, if you ask me how many parents have come to my clinic asking for help getting their kids off of a schedule and sleeping whenever they want to, that number as of today is zero. So I wanna be very clear, I wrote this book for individuals who are struggling to make something happen that they want to have happen with their kid’s sleep. If you have a child who kind of sleeps whenever her or she wants to and it’s working out well for you, you can keep doing that. I’ve got personal beliefs about that, in terms of a kid who eats whenever he wants to, goes to school whenever he wants to, and sleeps whenever he wants to, that can create problems.

Brain is like a schedule. Our brains do nothing accidentally, we don’t release hormones accidentally, we don’t create digestive tides accidentally, our brain is like a schedule and it’s kind of tied to the sun. So if the parent is saying, “Look, we would like our child on a more of a predictable sleep schedule, then, yes, I think that once you’ve determined how much sleep you need, it’s time to start sort of divvying out into sort of sleep periods that make sense for your child and your family’s lives.

Brett McKay: We’re gonna take quick break for a word from our sponsors. And now back to the show. So a lot of parents, when the child’s a newborn, they’ll do things like swaddling or co-sleeping. What are your thoughts on that?

Dr. Chris Winter: Swaddling is interesting. Why do we hug people, isn’t it? If you think about it like, Okay, you see your friend and your friend is pretty upset about something and you get this idea in your head, “I’m gonna walk over, I’m gonna put my arms around him, and I’m gonna squeeze him, and that’s gonna make him feel better.” And it does. Hugging does make us feel better. And the reason for it is that we’ve got sensors at the end of some nerves that respond to pressure and that pressure is comforting, and that’s why weighted blankets, that’s why swaddling is helpful for some people, they like that feeling of pressure. I always ask people when you go to dentist and they put that lead apron on you before they do x-rays, how does that make you feel? And if the answer is, “Well, I kinda like it,” ’cause personally, I do, I think it’s lovely, then you might really respond well to a weighted blanket or something of that nature. So swaddling to me is fine. It’s kind of natural, it’s a great little technique for getting a kid to kind of relax and settle down, who just popped out of a womb.

In terms of co-sleeping, I wanna be careful about this one too. I don’t have a problem with co-sleeping, if that’s something you’ve decided to do with your child or children. I do think we have to be careful when children are young. The American Academy of Pediatrics just came out with more definitive guidelines about that, which were always sort of reluctant to do and that I don’t think a child should be in bed with a parent until they’re at least a year old, and now they can be in a bassinet right next to your bed. But I just think that idea of you sleeping with the child, it can be problematic, and I write about this in the book that I have been privy to several episodes where parents have inadvertently killed children. And one of them was a family member of somebody who works for me, so a very close relationship, and it was absolutely devastating. The mother got up for work, picked up the child, took care of it, put it in bed with the husband, which they did frequently, but in this point, the husband just kind of rolled over a little bit too close to the baby and suffocated it.

Now, this is only been, what? Five or six times in my career have I been sort of a part of this, so I can’t make big definitive statements, but in all five, the parents said, “We will never do this again.” It was, I think in the book I wrote, it was like a bomb went off in the family, the family I’m talking about, who gave me permission to talk about this, they are now divorced, significant, significant grief that I don’t think will ever end. I just don’t see it as something that’s really worth it. I think you can snuggle with your kid, you can cradle them, you can put them in baby bjorns and do stuff, but when it comes to that early sleeping as a one-year-old, I just think safety is so important, even though it can be rare. I put the statistics of crib death and things like that in there, it’s a leading cause of little ones dying. I’ve just never seen it like, when you talk to these Cliff jumpers or people who climb mountains, they’ll tell you, “I can’t imagine a world where I’m not doing this dangerous activity, so if unfortunately, I pass away doing it, it’s okay because I’m sort of dead if I’m not doing it.”

I’ve never met anybody who’s sort of talked about sleeping with children like that. Maybe they exist, but it’s somebody else’s life, it’s this beautiful, innocent little person next to you, and I just think put him in a bassinet and be safe. Let’s eliminate this risk, and when they get old enough to protect themselves and move their head around and whatnot, then really that’s your choice to make, I think.

Brett McKay: Alright, so the newborn period, babies are gonna sleep a lot, the big problem there for parents is like maybe the baby is not sleeping when the parent would like the baby to sleep. He has his own schedule, but I think the key there is like babies probably get enough sleep, you gotta figure out how much sleep it needs in a 24-hour period, and then kinda nudge the baby into a schedule that fits. And again, there’s qualifications of that, but moving on to toddler and school age years, I imagine the amount of sleep they need starts to slowly reduce with these kids, you know, five, six, seven, eight-year-olds. Like what are the big problems you see with parents that parents have there?

Dr. Chris Winter: Yeah, part of it is, once you’ve figured it out, it starts to change. It’s called COVID. Okay, we figured it out. Oh no, there’s a new variant, so you’re constantly having variables change in your algorithm, so with toddlers, you run into the problems of, they’re starting to maybe need less sleep, so when do you drop that particular nap and when does it stay? The other thing with toddlers are they can do stuff like get out of their crib, so when you put the baby in the bed, he can cry and fuss and make little whipping sounds, but he can’t really go anywhere. I write about one of my children, really at a very young age, figured out how to get out of his crib, he could climb out, and we heard it one night when we were watching television this thump and we walked up and he’s just walking around in his room. And literally, once that cat’s out of the bag, it’s very difficult to… You can’t reason with them. Everybody was like, “Oh my gosh, it’s so great, your child is walking so early,” and what in the world is great about this, he can walk, but he has absolutely no sense. I’m worried he’s gonna get out of his crib and stick his finger in a socket or something, so that starts to become a problem.

The idea of you’re waking up at 3 o’clock in the morning, your child is standing over, or has crawled into bed with you, that’s a whole new issue of, You can’t really lock them in their bedroom, for heaven sake, so what are you going to do to convince the child to be in that bedroom? And then I also think at that same time, they’re interested in what you’re doing. And so the idea of a nap time or something, they’re constantly coming out and what people call curtain calls, “I need some water, and my blue crayon is dull and Can you sharpen that? And I can’t find my blanket,” so you’re constantly trying to convince them to stay in your room and do this and do that, so I think that’s sort of the toddler year problem that a lot of people deal with. And I wrote in the book, one of the things that we did when our kids were pretty young was we told them, “We don’t need you to sleep, we just want you to be in your bedroom and we’re all gonna have a rest period,” we never talked about sleep, we didn’t talk about napping, that Okay, at 10 o’clock or 1 o’clock, everybody has a rest time, so I need you to color or you can play with your cars, you can dress your dolls up, you can write Mommy a picture or write daddy a letter or whatever you wanna do.

And you can sleep if you want to, but you don’t have to, just rest, resting is good for your body, and if you just lie in your bed and think about things and imagine what your dream tree house would look like or draw a picture of it. All this resting is very good for your body.” One of the things we start to do in the toddler years is determine the child’s relationship to sleep. So when the kid comes out of the bedroom, when they don’t take a nap, they’re up the entire time, is, Are you excited about that? Are you angry with them, is there stress in your voice when you’re dealing with them? Because a lot of the times we start to create a performance pressure. It’s like that overbearing parent that every time the kid strikes out, “You gotta keep her elbow up, you gotta do this, you go do that,” and you’re yelling from the stands, and now the kid is so freaked out about striking out or disappointing mom or dad at the baseball game that they really approach the plate very differently than another kid who’s like, “I don’t know, I’ll just go there and swing the bat, if I hit it, great, if I don’t, it’s no big deal. I still get dinner no matter what.”

So creating that relationship and those ideas and that emotion around sleep is really important in those toddler years, ’cause I think that that’s where we create the 31-year-old who says, “You know, I’ve been a bad sleeper all my life,” that I still don’t know what that necessarily means, but we can kind of create that [0:34:11.7] ____ in kids.

Brett McKay: Oh, yeah. That’s interesting, especially for school-aged children, like when they’re nine, you actually don’t set a strict time to go to sleep schedule, you have a time to wake up schedule that’s strict, but you don’t have a time to go to sleep, but there is a go-to bed time?

Dr. Chris Winter: Yeah. And I think that one of the problems that we’ve created, or one of the mistakes that we make is we focus a lot on bedtime, but not as much as maybe we should on wake times. You’re absolutely right. And when you say strict, meaning our kids are going to wake up in our house somewhere around 7:00 or 8:00 every day. Now, there are exceptions, you were at some travel soccer game or something, or a swim meet and they didn’t get in until whatever, then sure you can sleep a little bit later if you want to, but by and large, we want that day to start and be extremely stereotyped. It’s gonna be the same every day. You’re gonna get up, I’m gonna open up your blinds, I’m gonna sing a goofy song in the morning, I’m gonna scratch your back. I’m gonna say it’s gonna be a great day, I’m so excited to share it with you or whatever. It’s positive, it’s not punitive, and I’m not a drill… I got a son at the Naval Academy, it’s not what we’re talking about here, blowing a bugle and screaming at you to get up and do push-ups, it’s just, “Hey, it’s time to get up and get going.”

And you’re going to have kids who say things like, “Oh, I’m too tired, and can I go to school late? And I don’t do anything in my first three periods, so could you just take me to school at lunch and… ” “No, we don’t want to do that, not because we’re mean, but it’s because we’re, Hey, this is the da, y we’re gonna start it and it’s gonna be great and you’re gonna feel better in 30 minutes once you get up and shower, and it’s not gonna be a big deal.” So yes, we always wanna focus on that. Now, the flip side is the bedtime, I think what we did was we had a time where I needed you to be in your bedroom, “Hey, it’s 8 o’clock for you young one, it’s 10 o’clock for you older kid, whatever, it’s time to be in your bedroom.” Now, we have a very strict rule that there’s no phones or electronics in the bedroom. Now, that’s harder as they get older, and they’re like, “Look, dad, all my homework is on my computer,” so it becomes a little bit more of a challenge, but by and large, be in your bedroom, read your books, color, look at your toys, do whatever you wanna do, just no electronics, Snapchat, Instagram, nothing like that.

You go to bed when you want to. If you’re sleepy, go to bed, if you’re not, oh, by all means, stay up, read another comic book. I really want you to. I don’t really want you trying to go to bed when you’re not sleepy. And we really instilled that idea in our kids at a young age, sort of welcoming it, “Hey, if you wanna stay up, it’s okay, now we’re gonna wake up at the same time every morning, we’re not gonna let you take a three hour nap on Saturday, but if you don’t feel the need to go to sleep at this point, that’s fine. Now, remember all the kids give you this look like, “Are you kidding me? I can just stay and read more comic books.” And it fades. It was like the study they did many years ago, where they brought kids into cafeterias, and said, “Eat whatever you want,” and there’s vegetables on this table, desserts on this table. And for the first three days they ate nothing but dessert, but check in with them a month later and they’re actually balancing their meal quite lovely. And without being told to do so.

So what you’re trying to do is with every child and really with every adult, is, I want you to have a healthy relationship with sleep, and that means that you respect it, that you work on getting enough, but you’re not fearful if things don’t work out perfectly. I want you right there in the middle, I don’t want you to be the person who’s terrified and taking tons of sleeping pills, ’cause you’re worried that if you get in bed and it takes you more [0:37:38.5] ____ to fall asleep, all this lost. I also don’t want you to be the 28-year-old trauma surgeon who’s like, “Yeah, as long as they get three hours of sleep, I’m fine because she’s not.” She’s fooling herself, just because she can take your spleen out on three hours of sleep, and maybe that should be applauded, but she is headed for some problem in the future, even though she seems to be functioning quite well right now, I want somebody in the middle of those two people.

Brett McKay: So something I’ve seen an increase in with parents is, parents who give their toddlers or school age children melatonin gummies before they go to bed each night. You discouraged that. Why is that?

Dr. Chris Winter: Yeah, so I’ll be clear, I don’t think you’re gonna harm your kid giving the melatonin gummies, although there are some melatonin products that also have seratonin, and then that can be kind of an issue. But by and large, first and foremost, it’s unclear when you give your child a melatonin gummy, what you’re actually giving them. There was a recent study not too long ago that looked at melatonin products we give adults and kids and the variance even within the same brand or the same bottle can be tremendous, so the idea that we know we’re giving our kids three milligrams of melatonin every night with the gummy bear is not true, God knows what you’re giving them. I will also say that there was a study that was done, it basically said, Look, it’d be pretty difficult to hurt yourself with melatonin, so I don’t like it, but I’m not trying to fearmonger here, we’re hurting our children. I give you the melatonin. No, I don’t think chemically we are, but I do think we’re hurting them in different way, we’re hurting them in that, we’re not really addressing the problem.

You’re giving your child a melatonin gummy bear every night. Why? I’ve never met a parent says, “Oh, it’s because my kids sleeps wonderfully, but we just thought this would even enhance that even more.” I’ve never met that person, like a supplement, they’re giving it to them because their kid can’t sleep, and chances are, they’ve gone to a pediatrician, gotten that advice from a doctor who probably has gotten very little, if any training whatsoever, so melatonin gummy bears are a pediatrician’s best friend, because they’re harmless and they allow the pediatrician to do something quickly for a problem that often doesn’t have a quick solution. My child won’t sleep. A pediatrician does not have time, amidst his flu shots and asthma treatments, the school physicals to sit down for an hour, talk to you about what is going on with your child that makes you feel like you can’t sleep. So here’s the [0:40:06.7] ____ trust the melatonin gummy bears. Next patient, I don’t fault the pediatrician. I think there was a study that was done that said 25% of pediatricians have never gotten any sleep training, even though sleep problems are some of the most common things that they’re forced to deal with, and the average pediatrician’s gotten, what? Two to four hours, something like that. I think the average employee at Mattress firm has gotten 200 hours.

So it’s a real problem in terms of the education gap here, so to me, the problem with the melatonin gummy bear is sort of like, I’ve taken my child to the doctor because there’s some blood trickling out of their nose, and the doctor keeps shoving a melatonin gummy bear up their nose and says, “See, the problem, you don’t see it anymore, it’s gone.” No, the problem is not gone, it’s just hidden now. So we haven’t fixed anything or he’s gonna take melatonin gummy bears for the rest of their life? We’re really missing an opportunity to sit down and talk to that child or the parent and say, Let’s figure out where the sleeplessness is coming from. And I say that sort of in quotations in that again, I’ve never met a child that can’t sleep. So it’s better define the problem so we can better solve it, because when we don’t we go down the Michael Jackson pathway, which is Michael Jackson couldn’t sleep. So let’s give him a melatonin gummy bear, that didn’t work, let’s give him some stronger pills, well those don’t work either.

Let’s send a surgeon to his house to anesthetize him every night. Well, that killed him. So again, we’re not killing kids with melatonin gummy bears, but we are setting them down this pathway of, I’ve got a brain that doesn’t sleep, so I have to take this great flavor Chewy in order to be able to sleep. Which really isn’t true, and I don’t want any child believing that. So if there is a sleep problem, let’s diagnose it and fix it and move forward and not just simply cover it up.

Brett McKay: Alright, so don’t default to giving kids melatonin because you think they got a sleeping problem, I mean, they might have a sleeping disorder that’s stopping them from sleeping, but those are rare, the more likely scenario is that the kids just not sleeping when the parent wants them to go to sleep or it’s convenient for the parent, and so instead of giving them melatonin maybe the parent just needs to try that thing you were talking about, where you tell the kid, you gotta be in your bedroom at a certain time, but they can go to sleep whenever they want, and then regardless of what time they go to sleep, you wake them up at the same time, and hopefully that will just naturally get things on track. So that’s school age kids. What about high school kids? What are the big issues you see with sleep in this period?

Dr. Chris Winter: High school? Technology in school. And I’m married to a teacher, both my parents are school teachers, I love teachers, I’m not bashing school at all. I do get to places sometimes where I think this algorithm does not work, I remember one time I was asked by the NCAA to come out with a group of doctors and talk to them about the sleep in their athletes, and I thought, “Well, I’m a good sleep doctor and I’ve worked all these pro athletes, I’m gonna arrive in Indianapolis and I’m gonna tell them exactly what to do, I’m gonna solve the problem.” And I remember sitting there listening to an NCAA swimmer from Indiana, a school in Indiana, talk to me about his schedule, and then this was dear to me because I’ve got a collegiate swimmer too, and when I was done listening to his schedule of mandatory workouts, well, these workouts are mandatory, but you have to go. And we have mandatory study hall, we cannot miss or be late to a class, I remember thinking, “Well, this doesn’t add up to the number of hours in a week. Like, how are you doing this?” And to be blunt, my son, who was a swimmer, collegiate swimmer, so I was spending 27 hours a week doing my sport and I just couldn’t do it, I’m not strong enough academically to be able to lose an entire day and be able to keep my grades where I want them to be.

So he decided after his first year of swimming that he was done. So to me, I think that school can be that for some people, I think every child has the right to go to school, play an instrument, and play a sport, and be able to fit all that into a 24-hour day or a regular work week, and when I look at my own children, sometimes I’m like, “My God, why do you have four tests tomorrow, do your teachers not discuss that, and when were you made aware of this project?” And I just feel like sometimes schools… And I’ve gotten letters and communications from parents that are just… They’re not the experience I had in high school, what they’re experiencing in high school is kind of what I experienced in medical school, like the math doesn’t work out and it’s dangerous, but hey, it’s only for a few years and it’ll be okay after that’s done. So school is a big problem, I think technology is a massive problem, and I don’t have the answer for that, so if you’re looking for the answer to technology, I might provide some guidance here and there, but I’m gonna tell you right now, save your money, do not buy my book, I do not have the answer to how to get technology under control with your child, it’s just everywhere and everything’s working against us.

We have strict rules about technology in our family. I follow them as well. I do not bring a cell phone into my bedroom, we plugged them all up in the kitchen at night, but I had one child build a phone out of a piece of wood, and he would plug the wood up every night ’cause I thought it was a phone, as it was an iPhone case, and he had his phone up in his bedroom and it’s like a little drug for kids, and it always upsets me when the parent brings the child in, I’m talking to the eight-year-old and the five-year-olds rummaging around in the purse, grabs the cell phone out and sitting there the entire time we’re talking on that phone like it’s begun, it’s happening. They’re getting that little dopamine hit in their brain and to wrestle that phone out of their hand is gonna be tough. I was talking to a professional football player who said, “I get home… ” Because I’ve got a problem with my phone, I’m addicted to it, and it’s hurting me professionally. He said, “I get home and I put the phone in a drawer.” And he goes, “An hour later, I’m sitting on the couch with the phone in my hand”, he goes, “I’m not entirely sure how it got there.” I mean, that’s the kind of dialogue you would hear with a drug addict.

And so I think that those two things within the teenage years or something, parents have to be extremely organized and thoughtful about as to how they’re gonna deal with technology, cell phones, streaming services, computers in your bedroom, whatever, as well as schools that can sometimes, I think, overstep what they should be doing from a work perspective with our kids. And again, I’m not a snowflake, I don’t know what the word would be for it. I mean, work the kids, make them work and you make them organize, but it sometimes I’m just kind of like, “What on earth were they thinking when they gave you this five-page paper to do today when you’ve got these two other exams going on? And so it just seems mean to me.” Like make them write the paper because they do it next week when they’ve got nothing going on, and so anyway, I just think those are two things we have to be very organized about.

Brett McKay: And I think with the school thing to him or just in the high school years, you may as a parent have to subtly encourage or discourage your kids from taking on too much, so they’re like, “Well, I wanna do this third sport.” Well, maybe not.

Dr. Chris Winter: Yes. And I think that there are kids out there and schedules out there that they can do it, and if you’re saying, “Well, my kids sleeping a ton and is playing three sports and others 10, great, I don’t have a problem with it. I think that, like you said, they’re entitled to one sport, if they wanna play two concurrently or I wanna do a sport doing Quiz Team, Model UN and this other thing, they might have to cut things out a little bit, I think beyond, What’s a right and a privilege? And what’s a privilege? I think you have a right to one sport and maybe one other activity, I think everything beyond that becomes a privilege, so yeah, I think we as parents do have to step in because it’s kind of an arms race, is it. “Well, Susie’s taking three APs and two”, they say, and I wanna get into a great college, and I think that that’s a very difficult thing for parents to know when to be like, “Hey look, just take the standard level this or the honors level this. It’s gonna be okay. [chuckle] You’re gonna be fine.”

I don’t meet a lot of adults who are drinking in bars because they didn’t do AP Psychology their junior year, they instead took just regular biology, and all was lost when that happened, but it’s hard in the moment, like dealing with kids in schools was definitely the most unexpectedly hard thing for me personally, as a parent, I just had no idea the kinds of pressures and things that they would be exposed to because it just wasn’t what I was exposed to as a high school student.

Brett McKay: So it sounds like the overarching goal as a parent when you’re trying to help your kid sleep is, Okay, your kids are sleeping.

Dr. Chris Winter: Yes, they are.

Brett McKay: Yeah, absolutely. Most kids don’t have a serious sleep disorder, usually if the problem is there, maybe they’re not sleeping when you’d like them to. So I think the goal is as a parent throughout from crib to college is to, I don’t know, just help your kids develop good sleeping habits, and have a good relationship with sleep.

Dr. Chris Winter: Yeah. And to be on the look out when you feel like there might be something wrong with sleep, and the problem there, particularly in the teenage years, is I think we’re as a medical community much more likely to jump to the idea of depression or anxiety or ADHD before we actually consider, Oh, maybe his concentration is okay, there’s just something going on with his sleep. So if you as a parent think, my child sleeps a lot and always just seems tired. Like when my mother-in-law comes to town, she always says, “Jonathan always look so tired.” I think that that’s where you want to sort of exercise that parental radar that you have, because you know that child better than anybody in the world, particularly the doctor, and say, You know what? Yeah, he is struggling with some attention and he has been a bit moody or more depressed lately, but I’d like to explore more about his sleep because I don’t think that it’s as healthy as it could be. To me, it’s always disappointing when we figure out a sleep problem of somebody who’s been dealing with those symptoms for years, it’s all that lost time and energy, and so to me, I think a sleep evaluation so that they can sort of make the proper arrangements to figuring out what they need to do to get help and be that advocate because it can be life-changing for a kid.

Brett McKay: Well, Chris, this has been a great conversation. Where can people go to learn more about the book and your work?

Dr. Chris Winter: Yeah, so the book is available wherever books are sold, it’s called ‘The Rested Child: Why Your Tired, Wired Or Irritable Child May Have a Sleep Disorder And How To Help’, and you can buy it on Amazon. And then my social media is drchriswinter, like Dr. Chris Winter, D-R-C-H-R-I-S W-I-N-T-E-R, Twitter and Instagram, and I try to put good stuff about adults and kids sleep on those feeds as well too, and yeah, so I really appreciate the time and the spotlight, this is a book that I think would be very helpful to parents and really look forward to it being in their hands.

Brett McKay: Well, Chris Winter, thanks for your time. It’s been a pleasure.

Dr. Chris Winter: Hey, Brett, I really appreciate your time too. Thank you so much.

Brett McKay: My guest today was Dr. Chris Winter, he’s the author of the book, The Rested Child, it’s available on Amazon.com and bookstores everywhere. You can find more information about his work at our show notes at aom.is/kidsleep where you find links to resources we delve deeper into this topic.

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