Sleep and Screens During COVID-19

[Dr. Pam Hurst-Della Pietra]: Welcome everyone to this week’s Ask the Experts workshop. I am Dr. Pamela Hurst-Della Pietra, founder, and president of Children and Screens: Institute of Digital Media and Child Development, and host of this popular weekly series. Thank you for being here today, and thank you in advance to our terrific panelists. As many of you know, Children’s Screens is one of the nation’s leading nonprofit organizations that focuses on digital media’s physical, psychosocial, emotional, behavioral, and physical impacts on toddlers, children, and adolescents. We partner with researchers, clinicians, public health professionals, educators, parents, and more to advance the science around digital media and child health, educate the public and policymakers, inform clinical practice, and improve the lives of young people and their families. Along with a commitment to support research into the impacts of the increased digital media use during the pandemic, we are helping families by hosting these weekly webinars to feature interdisciplinary experts discussing the topics and questions on all of our minds in the midst of COVID-19. Today we are focusing on something we all need, and many of us don’t get enough of, sleep! During the pandemic, family sleep habits have changed dramatically. If your kids are rolling out of bed afternoon and you uh are worried about how they’ll function during the school year, uh because the sleep schedules are out of whack, our experts are here to acknowledge your concerns and provide you with tools to improve the sleep of everyone in your household. Our panelists have reviewed the questions you submitted and will answer as many as they can. Some of you were notified prior to the workshop that you may be called upon to answer your questions live on camera. If Dr. Czeisler calls your name, you will be temporarily authorized to start your camera and audio. Please do so, tell us who you are, and ask your question. If you have additional questions during the workshop, please type them into the Q&A box at the bottom of your screen. If your question is selected for the panel, we will reply in the Q&A box and then invite you to ask your question live on camera. We are recording today’s workshop and hope to upload a video onto youtube in the coming days. You’ll receive a link to our youtube channel tomorrow, where you can find videos from our past webinars on our youtube channel as well. It is now my great pleasure to introduce our moderator, Dr. Charles Czeisler. One of the world’s foremost authorities on sleep and sleep research, Dr. Czeisler is the Director of the Division of Sleep Medicine at Harvard Medical School, and the Chief and Senior Physician in the Division of Sleep and Circadian Disorders in the Departments of Medicine and Neurology at Brigham and Women’s Hospital. Dr. Czeisler has spent over 40 years researching human sleep and the physiology of the human circadian clock and has been a friend and trusted advisor to Children and Screens for many years. Welcome, Chuck.

 

[Dr. Charles Czeisler]: Welcome to sleep and screens during COVID-19. I’m pleased to introduce Dr. Rebecca Robbins, she’s a postdoctoral fellow at the Brigham and Women’s Hospital and Harvard Medical School where her research uses marketing, and communication, and novel tools and technologies like smartphones, and other mobile devices to design persuasive behavioral change interventions to improve population sleep health. It’s a pleasure to have you here Rebecca to join this panel uh over to you.

 

[Dr. Rebecca Robbins]:  Thank you so much for that kind introduction. It’s great to be here. So we thought we would start out the session by doing a quick assessment of your knowledge when it comes to sleep, and kids, sleep in kids, and teens as well. So I’m going to put up a couple of slides, and we’re also going to do this in an interactive way via Zoom, so my colleague will put all put up some questions for you all to answer. So are these true or false, these statements that you’re seeing on the screen. Number one, heavy or loud snoring for my child means that they are sleeping deeply. Is that true or is that false? Number two, experiencing a night terror is a traumatic event for my child. True or is that false? Number three, if I move my child’s bedtime later they will wake up later. True or false? Number four, melatonin is safe for my child because it is natural. True or false? And number five, kids who are good sleepers sleep through the night. True or false? Now we’re scrolling on to a section about um your overall knowledge about sleep and teenagers. So with that in mind, number six, uh technology the statement technology is the main reason that teenagers can’t go to sleep at a reasonable time. Is that true or is that false? Number seven, if school starts later teens will just stay up later. Is that true or false? Number eight, we are caudling our teens by letting them sleep in. Is that true or is that false that statement? Number nine, teens who fall asleep in class are lazy. Is that true or false? And finally, number 10, teenagers have little control over their sleep. Is that statement true in your opinion, or is that false? So leave these up here for just another moment, and we will reveal the answers at the end of the presentation so make sure to stay awake and take good notes. All right I’ll pass it off now to the next panelist, and will we keep this poll up perhaps so others can respond or? Gabriella I’ll let you handle, oh terrific my colleague is saying yes we will leave the poll up, so if you’re just joining the discussion now please feel free to head over to that poll and take our quiz on kids’ sleep and teens. And I’ll pass it over to the next presenter, back to you Chuck.

 

[Dr. Charles Czeisler]: Great, thank you very much Rebecca for that for providing that uh, quiz um I’m it’s a great pleasure for me to introduce Kim West. Kim is a licensed clinical social worker who has been practicing child and family therapist for more than 21 years, and the creator of the Sleep Lady Shuffle, a gentle and proven method to get a good night’s sleep for you and your child. She is the author of the Sleep Ladies Good Night Sleep Tight and a series of accompanying workbooks. Uh it’s a great pleasure to have you here to join our panel Kim and I look forward to hearing from you.

 

[Kim West]: All right, I’ll unmute myself there, um welcome everybody, today I’m going to be talking about practical tips for parents on how to promote healthy sleep while managing screen time for your children ages 0 to 6. So my colleague, let me see here, my slide to change, my colleague Lauren Hale who’s going to be speaking in this webinar today, has done some research using about the use of media and sleep, and she summarizes the effects of parents and kids using lit screens, at bedtime, close to their face as having the following effects: delayed bedtimes, which all of us are seeing during COVID too, taking longer to get to sleep, which means increased battles between parent and child at bedtime, the sleep quality is reduced, and the total sleep time is decreased. So that means there are a lot of tired parents and children out there. And as you know, sleep is critical for our immune system, to our mental health, and our children’s learning. So this is why we really want to start to create soothing bedtime routines without screens. I’ve also found in my practice of 25 years, that there are a lot of adults who use TVs and tablets as a negative sleep association. In other words, something they need to go to sleep and help them get back to sleep. And those same parents will sometimes then use a tv or a screen for their children to go to sleep, and back to sleep, and thereby creating that same negative sleep association for them. So if your child has a tv in their bed, I would absolutely recommend you to remove the tv, and if you’re willing remove the tv from your own bedroom, and share with your child that you want them to learn how to put themselves to sleep without the tv and that you’re going to learn along with them. So that will also mean of course tablets. Um there’s another interesting study that supports the importance of benefits of the screen free bedtime that Douglas Teti, a professor of Psychology and Human Development at Penn State did, where he found that parents’ emotional availability at bedtime, promotes feelings of safety, and security, and as a result better-regulated sleep. So you may say, well how do I become more emotionally available to my child, what does that really mean? So here I’ve listed a few things that I think are really doable, and the first one is just to not bring your phone or a tablet into your children’s room. Really give your child that focused attention for 20 or so minutes. You could ask them if they want to read a book, or play a puzzle, or have some quiet activity. Maybe let them choose the book, and then one of my favorite memories with my children is have fun reading the book. Animate the characters, point out the pictures, and really help them connect it with real life. And then, of course, have as much loving touch during your bedtime routine. Kisses and hugs and just you know caresses are really soothing, comforting to our children. You could even point out something that they’ve learned during the day, or something that they did well, or something that they want to share with you. And then, of course, you can also do some yoga poses, again you see how this is relaxing to you the parent, and the child. And you may know this, but I’m a big proponent of reading, um to your children at bed. Uh, and I really want you to try to embrace the calming power of reading particularly picture books, and storytelling. So I want to just share with you two findings in research, and one is that they’ve found that research shows that the good old-fashioned picture books, even those that maybe you and your child have memorized, are great ways to not only develop the brain, but also are great for bonding, and soothing, especially at that time. So your baby’s not only learning some of the elements of reading, like turning the pages and distinguishing words, but by reading picture books, you’re also helping that neural connection and their ability to eventually learn to read all by themselves. And this engagement that you have with your child while you’re reading a picture book fosters that closeness, and that interaction that helps with security, bedtime cues, and healthy sleep routines. And we all need more of a sense of security now, in these uh difficult times. So picture books is a simple thing that you can implement and put into your bedtime routine. There’s another interesting study that Dr. Gerhard did, she helped people in Kauai after the hurricane and Nihi and she was trying to help them with their perspective and gain a sense of safety. And she found when she studied these adults and asked them what were their fondest memories of their childhood, it was resoundingly uh having a parent or a loved one read them a picture book, or tell them a story. And that had stayed with them their whole lives. By the way, after I read that I went and asked my own grown children if they agreed with that, and they said they did and they um went on to tell me great stories and memories they had of some of the picture books that we would read together. So it’s just another reminder, that reading books, and telling stories can be a real calming activity that can make your baby feel comforted, and reassured. So that old adage of you know, kids thrive on routine has never been sure or never been truer than it is right now. So another tip I’d like to share with you is to create a screen use schedule. So remember habits are formed during the preschool years, so this is a great time to start those rituals and routines and habits. So here’s a list of some places that you can start. So one to two hours of screen time a day total. Actually, there’s some research that suggests a one-hour maximum of screen time for children until they’re 10 years of age. And then no screens one hour before bed, remember screens are even background tv, uh phone, tablet and of course a television. And age-appropriate content, this is um helpful because are, helpful to remember because our children cannot regulate um as easily as we can. You know, they can’t watch an action movie with violence and just shut it off and walk away and be able to go um to sleep quickly. So be careful of what they’re watching. And then I would suggest that you create screen-free rules in your family as a whole and that everybody practices them. You know some of the common ones are no screens at the tv table, I mean I understand that back in the pre-COVID days when we would go to a restaurant that sometimes we’d give our kids screens to entertain them, um in the restaurant but at least try to have this rule at home. Um and then you yourself also not using the phone as an alarm clock. So a fourth tip is to prepare for a back-to-school schedule. So you may say to yourself, well you know my children are too young or they’re going back to school virtually I still would encourage you to go back to a routine, where you have a set or regular bedtime and a regular wake-up time. Remember, routines help us all feel calmer and more reassured, and I realized that our all of our schedules have gotten off um because of COVID, and so you may be wondering where in the world am I going to start, my two-year-old has been going to bed at 10 o’clock and sleeping in, or maybe not sleeping in and being even more sleep deprived. So I wanted to go over with you how I like to figure out what your child’s ideal bedtime is, and how to get there. So this is a chart that um the source is from the American Academy of Pediatrics with the average sleep times. Now remember, these are just averages, but I like to say that your children shouldn’t be off these averages by more than an hour in total. So let’s say um even though these have some pretty big ranges, let’s say your two-year-old needs on average 11 hours of sleep at night and two hours during the day, which I have found in my practice to be pretty spot on. Um, and you had in your old schedule um a time where your two-year-old had to get up at 7:00 a.m, but now uh they’re going to bed really late. So let’s go back to that goal of we want your child getting up at 7 am. That means they would have to be asleep by 8 pm in order to get those 11 hours at night. So that means you should start your soothing bedtime routine by probably 7:15, 7:30. You give your child that time. So you could say to me all right Kim, well I love the old-fashioned meter or the old eight o’clock bedtime, but how am I gonna get there, we’ve been going to bed at you know 9, 10, 10: 30 sometimes, so that’s where I tell you to do what I call the math backwards. So figure out, if your two-year-old needs 11 hours of sleep at night, um this last uh column and they have to get up at seven they need to be asleep by eight. So in order to have them be tired enough to go to sleep at eight, you need to start waking them up earlier. So we always start by regulating the wake-up. So if they’ve been sleeping until 8, 8:30 I would start waking up them up at 7:30 for a few days, and then finally get to 7 a.m. which will help you to slowly move the bedtime earlier at the same time. So my final tip is that when you wake them up early at 7:00 am and it’s a sunny day I would suggest that you get outside, even if it’s just to sit on your front porch while you’re having a cup of coffee and see how many birds you could find, just to get that light exposure which helps set that internal clock. And remember having a schedule and that calming routine will help your child feel reassured and will bring back that sense of ritual routine and predictability that we’re all looking for at this time. So I hope these tips are helpful and that you can find at least one that you can implement into your family life and your bedtime, thank you.

 

[Dr. Charles Czeisler]: Thank you so much Kim for sharing your vast knowledge on this topic. I would encourage the those who are attending today if you have any questions for Kim or any of the panelists please use the chat function where you can ask a question there’s a question and answer function where you can ask a question,  and please indicate whether or not you wish to ask the question live on camera, or you want me to read the question for you. Okay, we have a question that has come in. It is a question for Kim, and it is what time should I cut out screen time during the day for a two-year-old like how many hours before bed before bedtime? Uh, Kim can you please address that question that has come in?

 

[Kim West]: Yes, so that’s a great question. So I would say at least an hour. So if bedtime if you’re if we use the example like I talked about your two-year-old needs to wake up at seven they need a.m they need 11 hours of sleep they have to be asleep by eight I would and you’re going to start your bedtime routine at 7 30. I would say stop screen time by 6:30.

 

[Dr. Charles Czeisler]: Okay thank you very much, and now another question, how important are naps for a child between four and five years old?

 

[Kim West]: Actually the average age uh the average uh age to drop naps is four years of age. There are some children that do need a nap in the afternoon, but most do not after the age of four.

 

[Dr. Charles Czeisler]: Okay great, thank you, Kim. And can you touch on how screen time and sleep impact each other specifically in kids, newborns to three years of age in that population?

 

[Kim West]: Um yes it’s like my colleague Lauren Hale talked about that it creates delayed bedtimes, it takes longer for the child to get to sleep, meaning more battles with the parents, the quality of sleep is reduced, and the length of time a total sleep is decreased, both for the parent and the child. So tired children.

 

[Dr. Charles Czeisler]: All right uh now how do you calculate hours of sleep for a child that is waking up multiple times throughout the night? Uh, this is from a parent who says her child goes to sleep without a fight but is waking up so often that she ends up sleeping until 10 or 11 a.m. even though she goes to sleep about 9 or 9:30 p.m.

 

[Kim West]: And she doesn’t say how old the child is?

 

[Dr. Charles Czeisler]: She’s eight.

 

[Kim West]: Eight um I would still work on regulating the wake-up, kind of like I talked about in terms of figuring out the ideal bedtime, and then uh so that there can be enough sleep pressure built up so the end of the bedtime, and then work on is there any negative sleep association that needs to be addressed at bedtime. For instance, are you lying down with your child to get them to go to sleep, and therefore when they wake during the night they need you to lay back down with them? And of course, ruling out any underlying medical condition that could be causing your child to wake frequently during the night. 

 

[Dr. Charles Czeisler]: Okay great, now here’s here’s another question um the question is I usually have to wake my six-year-old in the night so she doesn’t wet the bed, any suggestions to avoid bedwetting and have the whole night’s sleep?

 

[Kim West]: Yeah so bedwetting um there can be multiple causes, one could be family history and so you’d want to ask you know the parents are is there any family history of not of difficulty staying dry at night, um because usually, you’ll find that if one of the parents had difficulty and it was until eight years of age as an example that that’s when the child will, so you want to talk to your pediatrician about that. The another one can be of course emotional causes, and the third one can be obstructive sleep apnea often caused by enlarged tonsils and adenoids. Again I would go back to the pediatrician because waking them before, for instance, due to go to bed to bring them to the bathroom doesn’t always solve the trick, uh, or solve the problem. And then the final thing you can do is well that would be more like I think I’ll just stick with that I would encourage you to go back to the pediatrician um because they to see if there’s any family history and to rule out obstructive sleep apnea.

 

[Dr. Charles Czeisler]: Okay great thank you, Kim, uh here’s another question and if the if the attendees could please indicate whether you want to answer whether you want to ask the question on camera that would be helpful, otherwise I’ll just read them. Here’s the next general question, we are having great calming bedtimes but our daughter is starting to get more upset as we go to leave the room, god we’ve all heard we’ve all experienced that. Any tips for dealing with that negotiation, and then the appearances or manipulation at times?

 

[Kim West]: I really think that we have to change some of our associations with bedtime um with our children and that’s why it’s so wonderful to have a bedtime routine in their room, shade down, and not a rushing through to get to the lights out, but but really have a dedicated time you know that some some of that emotional availability that uh Dr. Teti is talking about where we’re really focused on our our child because a lot of times not always but lots of times some of the battles is about that not that them wanting more attention from you and wanting more um connection uh before the big separation of sleep. So I think building in more time, and screen-free time, and also more emotional availability at bedtime really can help.

 

[Dr. Charles Czeisler]: Thank you very much, uh we’re going to go on uh thank you very much Kim we we have we have more questions flooding in but I think we’re going to save them for later if we have time, um because we need to move on to the next panelist. The next panelist is Wendy Troxel. Dr. Troxel is a senior behavioral social scientist at the Rand Corporation and an adjunct faculty member in Psychiatry and Psychology at the University of Pittsburgh. She’s a Licensed Clinical Psychologist and Certified Behavioral Medicine Sleep Specialist. Dr. Troxel is internationally recognized for her work on sleep in couples, how sleep affects health in the global economy, and how social environments, including public policy, affect sleep. Dr. Troxell it’s a pleasure to have you today, we look forward to your presentation. 

 

[Dr. Wendy M. Troxel]: Thanks so much, let me just make sure I’m not muted, uh yes I’m good. Great so we’re gonna um fast forward a bit uh in the age spectrum uh to move from uh little ones uh that Kim so uh uh nicely uh spoke about and now uh fast forward uh towards uh our teenager’s sleep and the challenges that they face. And before I dive in I want to just do a little exercise for everybody to kind of wake everybody up uh I’m used to doing these presentations in person so miss you all I hope everybody is enjoying virtually, so let’s just imagine we’re in a room together and this is interactive so in a second I’m going to show you some pictures of sort of your typical american families, um eating breakfast and I want you to take a moment just to look at those pictures and reflect on, and maybe even call out um uh through the chat box and I’ll try to see them if I can um what about these pictures looks like your typical american family, even your family, and what about those pictures doesn’t quite measure up to reality. Okay is everybody ready here we go. Just a typical morning in your average family. What do people think? I don’t know how many people in the audience are parents of teenagers, I happen to have two of my own um, and I can tell you that this looks in fact nothing like our families in the morning. I’m gonna try to see if I can see some comments. Here we go. Some people are laughing, I’m going to start reading some of these comments which are pretty much spot on. Definitely not mine, my kids um have their phones, um nope rarely looks like this, unreasonable everyone is smiling, right they’re all far too happy um and they’re also sitting down to get together. Yeah, so I’m glad that uh it’s not just me who uh thinks that this is far from reality. I mean the very idea that we would all be sitting down together, with you know the morning light you know shining through this is certainly not true. During the uh typical school year and everybody’s just so darn happy. So I’m going to give a disclaimer about this talk, the truth of the matter is nothing I’m going to say today is actually going to magically turn any one of you or your teenagers in particular into any of these happy morning people. And as I’ll discuss actually the likelihood of your teenagers being one of these happy morning people during this specific stage of their development is very unlikely. However I am going to try to give you some tips uh to support your teenager’s sleep, and also your sleep as well, and maybe decrease some of those battles with our teens. So I’ll cover some of the basics very briefly about why sleep is important, particularly for teenagers, why it’s so difficult for our teens to get the sleep they need, and particularly during a pandemic, and then I’ll give some tips on how both parents and communities can support healthy teen sleep. So very briefly, and Kim touched on this at the earlier spectra age spectrum already but let me just say that our sleep needs do change throughout the lifespan with infants and younger children needing the most amount of sleep, and adults typically needing somewhere around seven to nine hours. People often think about teenagers though as these like little adults but I’m here to tell you that they’re not. Their brains and bodies are still dramatically developing and rapidly developing and during periods of rapid development, um human beings need more sleep. So teenagers need less sleep than younger children, but they do need more sleep than adults. So on average teenagers, the recommendation by scientific consensus is that teenagers should get about eight to ten hours of sleep per night. Unfortunately, um we live in a culture where there are many of us who are simply not sleeping enough. About two out of three adults uh regularly achieves the optimal sleep duration for their age group, again the seven to nine-hour range. But among teenagers the situation is much more dire, only about one in ten teens regularly achieves the optimal nine and a quarter hours of sleep per night that their developing brains and bodies need to function optimally. And here’s where we get to why sleep is so important, and when we sacrifice sleep and when we allow our teens particularly to sacrifice sleep why there are really profound consequences. So you can think about sleep as as fuel for the brain and given that you know learning and going to school and becoming educated is one of the primary tasks of the adolescent years, it’s really important to see the connections um between healthy sleep and how it promotes our alertness, our memory consolidation, and our ability to learn. Again critical tasks um of um an of an adolescent learner. Sleep is also a biological necessity and when we sacrifice it, it will affect our our performance and even our safety. We see this in car crash rates caused by drowsy drivers teenagers being one of the most high risk populations for drowsy driving crashes. Sleep is also essential uh for uh both brain and body um and social social emotional development and this is where I’m super passionate, again having two teenagers of my own I can see this um and I know as a scientist that the teenage years are a period of dramatic change. Uh when we’re really shaping um behaviors that can last a lifetime and our brains are also still developing. And finally, sleep is absolutely vital to both our mental and physical health, um and particularly during um the scary times we’re in now um with the threat of coronavirus it bears a reminder that sleep as Kim also mentioned, is also critical for healthy immune functioning. So we all can do better uh to protect the sleep um and try to promote healthy sleep in our families, including in our teenagers. So I mentioned that teenagers are a really high risk group for being for getting insufficient sleep so why is that? There are actually lots of reasons, some of which are in our control, and some of which are out of our control. Here are some of the factors that we actually can control and as families we really want to start curbing um some of these factors that do influence, negatively influence our teen’s ability to get adequate sleep. So there are of course the increasing social and academic demands that we see when our kids enter middle school and high school. Of the seminar today, we know that the increasingly excessive use of technology and social media, um you know that many of our teens are absolutely addicted to is also contributing to teen sleep loss. And of course there’s also that you know the banty frappuccinos and monster energy drinks and all these other highly caffeinated and sugary um drinks that many teens are using, in part as a compensatory strategy to deal with their sleep deprivation, but unfortunately it can create this vicious cycle with poor sleep leading to increased consumption of caffeine. Caffeine we know, is a powerful disruptor of sleep which can further exacerbate sleep problems and so the cycle continues. So these are actually factors that to some extent we can control, and I really do encourage families to put a concerted effort into trying to curb some of these modifiable factors. But there’s one factor that we can’t really control, and that’s teen’s sleep wake biology, and how it’s actually in conflict with early school schedules, at least during the normal school year we’ll see what happens this year. So during the adolescent years specifically, teenagers see a delay in their biological clocks which govern our sleep wake rhythms, specifically during the teenage years teenagers are biologically predisposed to stay awake later and sleep in later. So they’re not actually just lazy, this is part of their biology. And right at the time that we see this biological shift in their sleep wake patterns, we have school times that are starting earlier and earlier. So the struggle is real, and teens are caught in the middle and that’s one of the major factors that’s been identified by substantial research showing why teens are so sleep deprived. So I now want to shift a little bit to talk about what’s going on right now, and in the milieu of all those factors that are kind of already um exacerbating uh teens sleep and making it difficult uh for them to get the sleep that they need now we’re in a pandemic and lots of things have happened that are making sleep for all of us much more challenging, and and teenagers in particular are very vulnerable for another number of reasons. So first, there’s the increased stress and anxiety that many of us are feeling, teenagers pick up um their parents feelings, teenagers you know they’re they’re like you know pretty aware human beings they’re picking up all sorts of content about you know fearful things um uh in social media, and through their friends, and again also picking it up from you know seeing how their parents are also stressed. The stress and anxiety can increase the risk for sleep disturbance. As Kim mentioned, teenagers too they’re not just many adults and by the way adults too function better on regular consistent routines, but with the removal of normal school schedules, with the significant reduction in sort of teens normal you know sports practices, band practice, all these things that help to set a daily routine, um all of this in many situations has been either removed or significantly reduced and teens just like younger children, adults as well, we function better, our sleep is better when we have sort of predictable inconsistent routines so this is something that parents really, unfortunately, need to take a more active role in now when we don’t have those normal external factors that are guiding routines at this moment. And then finally, another factor that is really salient during the pandemic is what we’re seeing is an increase in social isolation and loneliness. One of the really unique characteristics of the teenage years, one of the reasons why I find teenagers so fascinating um is that I mean we’re all social beings as human beings, but teenagers in particular are very much dependent on their social connections particularly uh their peer relationships, and this is again part of this natural stage of development. And so the stay-at-home orders um that many of us have been facing and just the significant social disruptions do have a profound impact on teen social well-being and their mental health which can exacerbate sleep problems for many. So what can you do about it? I want to give just a few uh tips on how to support your teen’s sleep, but to be honest these can also support your own sleep as well. So as mentioned, setting a consistent sleep schedule and probably being more effortful about it in these days is really important. With teens one of the biggest problems, particularly once school starts if it starts at a normal uh sort of schedule is that you’re going to see these vastly flip-flopping schedules for teenagers during the weekday when they have to wake up excessively early and on the weekends when they shift back to their natural rhythms which prefer later bedtimes and later wake times. Um and this flip-flopping schedule and very erratic sleep routines um can make it very difficult to get healthy sleep throughout the week and there are also some consequences of um dramatically shifting sleep-wake schedules. It’s sort of like being on jet lag all the time if you felt that you know it’s not a comfortable position. So my recommendation, and again this is both a sleep scientist and a parent of two teenagers myself so I try to find a middle ground here try to keep your teenager’s sleep-wake schedules within about a two-hour window of what they have to do during the week so you don’t have these vastly shifting schedules, and as Kim said to start this process early, do not wait till the night before school starts if it’s starting even in a virtual sense um don’t do it the night before to try to get them on a sleep-wake schedule, try to back it up at least two weeks before the school year starts. This is going to be a consistent theme throughout this webinar, make bedrooms technology and social media free zones. As Lauren will discuss next, um there’s not only sort of the direct effects of the light exposure from technology, think that can disrupt teens sleep but it’s also the content. Just think about what you were like when you were a teenager and you know if we had access um to these little devices that told us all the gossip many of much of which is happening you know after you know parents go to bed you know between the hours of 10 and 2 a.m. You know, just reading that content oh who’s breaking up with who, who’s in a fight, this is all very socially stimulating and can disrupt sleep. So that’s why um bedrooms should be media-free and technology-free zones. Have some wind-down time for your teen before sleep, ideally without technology. Again, the need for wind down does not stop when our children become teenagers, we all can use a healthy relaxing wind down without technology, and teenagers again this is a time when they’re learning healthy habits that could really set the stage for adulthood. So you helping them, and modeling for them a wind-down routine before bedtime instead of just racing off to bed is really setting the stage for healthy living into adulthood. Get physical, teenagers all of us need physical activity and this has been really I think a challenge for many uh during the pandemic. Physical activity itself is good for our sleep, and also ideally, outside physical activity has profound benefits for our mental health, our physical health, and our sleep because sunlight exposure during the day is a really powerful cue to set our internal biological rhythms. And with that I want to conclude, so there’s enough time for questions and for my fellow presenters um but I want to just recognize for parents who are out there and maybe struggling, and feel that this is a constant battle that yes, it is a struggle and teen sleep problems are real um and some of this may seem insurmountable, but there are small steps that you know every parent, every family can take to make incremental changes that can make a big difference in our teenagers lives. Thank you.

 

[Dr. Charles Czeisler]:  Well thank you very much uh Wendy, I really appreciate your presentation. Uh, we our first question is coming from Francesca Bignami, uh Francesca thank you so much for joining us, and uh please feel free to ask your question. 

 

[Francesca Bignami]: Okay well thanks so much for those presentations, and I  think I have I’m a mother of a seven-year-old so he kind of falls right in between the two age groups you were just talking about. Um and he’s always been a night owl, and the pandemic has made it that much more difficult because even though we can control his screen time with no problem, and we can do the same routines with no problem because we live in a densely populated urban environment where we don’t have a yard and we don’t have easy access to parks either because they were shut down at the beginning of the pandemic and now with the heat, it’s really hard to get out there, um I was wondering if you have tips for how I get him into that schedule because also if I wake him up in the morning at the prescribed times, I have to be with him the whole time because otherwise he’ll just go back to bed or he’ll ask for screen time that kind of thing. And of course, I can’t do that because I’m a working parent. So um so I can’t leave him to his own devices after I try to get him into that normal um schedule and so any tips would be very very welcome. 

 

[Dr. Wendy M. Troxel]: Yes, well thanks so much Francesca for um your question and um uh asking it live, and um I just want to start by saying, I feel for you um and I think that’s really challenging um you know the stay-at-home orders have been challenging for everybody, but particularly those I think who live in densely populate populated areas, who haven’t had the access to um sort of the relief and their escape of being outside that’s really challenging. And you’re right, that so much indoor time combined with lack of a normal schedule can really be disruptive uh to a child’s sleep. And you mentioned that your a child is sort of a natural night owl and that’s a good point that um even we see this development shift for most kids when they become teenagers that kind of all of them for the teenage years, the majority of them do become at least temporarily, these night owls. But there are also individual differences um that are in large part uh genetically driven, where some people are just naturally um even your seven-year-old, more night owls than um morning people. So uh briefly I would say there’s a couple things that I would suggest uh with your son. Number one, try to do small increments of shifts, uh rather than really big ones sort of like adjusting to jet lag, um and you know as much as you may have sort of an ideal goal in mind for him, um of like when you want him to be waking up and going to bed. Um you know our bodies and our brains have a really hard time doing massive shifts and that’s why jet lag is hard, so even if you could do over successive nights trying to back your child’s bedtime and wake up time out by 15 minutes, it’ll be a little bit more gradual for him. I’m hoping in terms of uh you know kind of where we are in the pandemic, that you’re now more able um to get him outside and I realize that you’re you may be limited um with your availability too, and that’s just believe me a struggle that many working parents are having. But you know, to the extent you can um you know even a brief walk um outside um in the morning and you know to kind of get that first burst of morning light. Morning light exposure is sort of one of the most uh important cues to set our internal biological clocks, so I would really focus on that. Even if you had to set, I see a window in your background, I see the sun shining through that’s a lot of light exposure so getting him you know even if he’s doing homework or reading or doing something that maybe you can sort of monitor, put him by the window at least so he’s getting some of that morning light exposure which can help to shift his rhythms as well. And by the same token, watch how much light he’s being exposed to in the evening because light in the evening will shift his rhythms back, and to the extent possible try to have some physical activity whether it be a walk, or running around outside, getting him on his bike, if it’s safe in your community and if not there are a gazillion online free apps now that um you know maybe you could try you know some sort of exercise even in the home. Um just because physical activity to kind of spend some of that an energy, particularly for a seven-year-old is so important.

 

 [Francesca Bignami]: Thank you, thanks very much.

 

 [Dr. Charles Czeisler]: And thank you so much uh for joining us. Uh, our next question uh which was asked you know in the in the pre-question period is my son is 16 he’ll be 17 in October since school officially ended in June he’s wanted to stay up late playing video games until 3 am. When he’s not playing video games, he’s on his iPad watching youtube or Netflix. During the week, I make him turn in by midnight, but on the weekends I let him stay up as he wants which is usually until about three or four o’clock in the morning. I know he doesn’t have anything to do right now that he needs to do in order to get up early for, but it doesn’t seem healthy for him to keep those hours. What is your advice, what is too much screen time?

 

[Dr. Wendy M. Troxel]: Yeah well, it’s I think Lauren is going to talk more about what is too much screen time, um so let me just focus on sort of the shifting sleep-wake schedule that you’re talking about, and with a 15 and a 17-year-old in my own home believe me I speak from experience, and I see this happening. And it is really hard as parents because there is a lot of time for these kids to now fill. I mean with all the normal things that make their schedule so busy, you know virtually vanished overnight for many of us and I’m glad you’re asking this question now because assuming um your teenager is going back to some level of school whether in person or virtual, the sooner you can start reining in that schedule the better. The natural tendency with teenagers is going to be to drift later and later because that’s their sort of, that’s sort of what they’re predisposed to do during the teenage years, they’re naturally night owls. And so that’s what you’re seeing um when you see your teenager when left to his own devices um on the weekend he’s staying up to 3 am. I would really start to try to rein that in, um, and putting some limits on the technology use, particularly at bedtime. So if he’s gaming um in the bedroom, you know I hate to say it but um one of the best things you can do is uh take the technology out of the bedroom, um video gaming particularly at night is um really disruptive to sleep. Teenagers still have trouble you know sort of regulating, and um uh reigning themselves in. And you know video games are designed to be addictive, um and so if it’s in his room he’s just going to and you know he’s also got this you know natural tendency to stay up later much more so that we do as adults, so you know that tendency to shift later and later is going to keep on happening when he has the reinforcement of being able to game in his bedroom. So get the gaming out of the bedroom, I would start reining in the weekend schedule as well as the weekday schedule to bring those um more in line, and yes having a wake-up time even if it seems like there’s nothing to do during the day. That’s really important because it’s important reminder for our kids that there is something to wake up for and you might have to be kind of creative and effortful in helping your teenager even, um to kind of have some goals during the day. Um, my own teens um thought I was completely crazy um but at the beginning of the pandemic I kid you not, I had star charts for my 15 and 17 year old which were they were not happy about at all, but on that star chart I had a you know some few basic things that I wanted to make sure that they were doing every day to support their mental and physical health. That included reading every day, that included doing something outside every day, doing something physically active, and then doing a chore around the house. All of these things are important for us being good human beings and keeping the mind and the body healthy. Um, and I gave them the choice um I will keep the star chart going uh as long as if you’re not doing it on your own. As soon as you show me that you can regulate and do these behaviors on your own, you know I’ll take away the you know you know demeaning star chart which made them felt like feel like um you know school-aged children again. Uh but believe me it motivated them.

 

 [Dr. Charles Czeisler]: Well thank you very much uh Kim, we have another we have a couple more great questions here. What time should I cut out cut out screen time during the day for a two-year-old, like how many hours before, uh I’m sorry I’m sorry Wendy that was a question that was asked before. How do I create interest in anything else, our kids beg for screens and sulk about all else. We hide screens regularly, uh what do they do, what do they do Wendy?

 

[Dr. Wendy M. Troxel]: Yes and I think Lauren will touch on some of this as well, um but very briefly you’re not alone, I think being creative about uh you know like I have mentioned before for some families you know um I’m not only recommend that everybody gets uh technology out of the bedroom at least an hour before bedtime, have a central place where your uh phones tablets etc can recharge as you recharge and get a good night um of healthy sleep. Um, but you might have to be creative because these you know kids and teenagers are sneaky um, and very smart, and they you know even you know have it under lock and key if necessary. Um get creative because it’s that important um to you know to make sure that technology is not disrupting your teen’s sleep, um in terms of encouraging other behaviors model other behaviors. I mean and yes, sometimes our kids and our teenagers need a little bit of um scaffolding we call it, a little showing of like okay well if they don’t naturally think oh I want to go ride a bike well suggest that you’ll go on a bike ride with them, or reading a book with them show them that you do other activities other than constantly look at your phone. And that can be a good way um to reinforce other behaviors other than the constant screen use.

 

 [Dr. Charles Czeisler]: Great, um here’s a uh here’s another question, I’m struggling with my parenting role of my 24-year-old who has temporarily had to move back home during the pandemic. He has regressed to bad sleep habits and wants to go to sleep at 3 a.m. and get up at 1 pm. That doesn’t work for my sleep habits, so we are back to arguing. Help! So now here’s a little bit of an older kid who’s moved back home. 

 

[Dr. Wendy M. Troxel]: Yeah, I mean this is I’m so such a disruptive uh time we’re living through, and these normal life transitions that we all expected uh you know with the child launching and you know going off into the world, many families are having their you know 24 year old is basically a very late adolescent um you know the adolescent years do span, and you know you probably thought that you know your child was launched and now because the pandemic um your child’s back. And that can be you know battles can ensue because you know he’s a you know young adult at least or a late adolescent but this is your home. So setting some rules about what’s okay in your home is critically important, um, and laying some groundwork um down during the daytime when you guys are both sort of um have your you know mental faculties around you don’t do this in the middle of the night, um really set some rules and explain that this is not just about your child’s sleep patterns, um but it’s also affecting you and having someone awake in the middle of the night and sleeping during the day is really disruptive to the whole household. So while in your house, you know the your rules do apply and again trying to speak from a place of um how it’s not just affecting your child, but it’s also affecting you and that some ground rules for you to be able to maintain the peace in the household have to be met.

 

 [Dr. Charles Czeisler]: Great, um uh here’s another uh question that’s just come in, what’s a good tech free wind down activity for teens? A tech-free wind-down activity.

 

[Dr. Wendy M. Troxel]: Yeah, well you know, just like all of us I mean I think that we forget that there was a time without technology, and uh you know things like reading books used to be um you know much more prevalent before we substituted that uh with technology. And I think many of us, we are all um you know to blame for that. Um and so you know reading books, doing a puzzle as a family, I mean I think some families have noticed one of the small uh benefits um of uh so much staying at home is things like you know doing puzzles have you know skyrocketed in uh in terms of prevalence. I think that type of activity, um that’s mentally stimulating but relaxing can be very good. Also as a parent of a teenager, I think anything that you can do that actually engages your your teenager is so important. They’ve got a lot going on in their lives, and they can be difficult but they’re really special human beings, and so finding ways to interact and engage in a way that’s non-threatening to your teenager that you know can let you just sort of be a human being that not always their parent um uh you know just giving them rules um that you can find some enjoyable activities together. That’s also a great um uh sort of goal to have in mind with the wind down for teenagers, maybe even actually engaging with the family, so playing a board game, um doing a puzzle, or you know having the team um read on their own and again the more that you model that as a parent the more likely you are to have a teenager um who will develop similar behaviors. 

 

 [Dr. Charles Czeisler]: And what do you think about the idea, you mentioned reading, um but what about letting kids read novels uh when they’re in bed uh without using a screen, is that is that a problem uh in terms of their timing of their bedtimes? Or how do you suggest that they handle that? 

 

[Dr. Wendy M. Troxel]: You know, I think that it it really depends on the child, for many people reading particularly if it’s an actual book not um you know an ebook, um that reading can be soporific. I mean I think it depends on on the teenager, you know I think the biggest problem right now is so few teenagers are reading before bedtime. So I do think we have to get that habit back. If you happen to have a child or a teenager who is an avid reader, who gets like lost in a book, which is a wonderful thing, then maybe that wouldn’t be the best strategy for them. For most teenagers I’ve seen that is not the problem. Um you know they do get lost in their phones, um but getting lost in a book is generally not the problem that I’m I’m seeing. Again if you’re if you happen to have a teen who is such an avid reader, you might have to think about another activity or to do the reading before getting into bed. But again, I don’t see a whole lot of that. 

 

 [Dr. Charles Czeisler]: Okay and what do you suggest as a wind-down activity for teens if they’re not in the habit of reading? 

 

[Dr. Wendy M. Troxel]: Yeah I mean I think that you know that’s something to explore with your teenager, you can kind of talk about it, you can um you know talk about what works for you, um and um sort of explore ideas if they’re not a reader um and maybe they’re not a novel reader but maybe they would like um to look at a magazine, or you know um or if they’re interested in playing a game, or listening to music, um provide and I would suggest that if they’re going to do it on a device if they do it outside of their room and so that when they go to bed you know the bed is simply for sleep. Um, I think it’s really a kind of um it’s an important exploration. And if you focus on it, as this is about developing behaviors that will last a lifetime. You know because many of us as adults, um you know in my insomnia practice I often see that you know adults with insomnia one of the challenges is um we live in a culture where we race off to bed and we have forgotten how to wind down, so whether that means doing some you know yoga exercises, or breathing, or listening to music, or talking to somebody, um socially engaging that can also be calming. Um so there are activities, but we just need to be uh I think more effortful and more creative about it. 

 

[Dr. Charles Czeisler]: And one of the uh one of the uh folks writing in and said what about ebooks. And and if I might jump in here, you you there are things that you can do to to reduce the the amount of blue and rich light that is emanating from the screens. You can reverse the the color so that it’s white letters on a black screen, you can use programs like f dot lux as well as um night shift on iPhones and things like that to uh to eliminate some of the bluer colors on the screen, and make them longer wavelength light. And and also the third thing is to reduce the intensity of the light coming from the device. And all those things will help if you’re using an ebook instead of a printed book. Then we have another question uh Dr. Troxel for you, my 16-year-old is battling anxiety and depression but refuses to practice good healthy habits like exercising daily, eating healthy meals, and disconnecting from devices, so they can keep a regular schedule. Some of it’s attributable to her depression, but part of it is just her being rebellious. What do you suggest to help her help herself so that I’m being the parent, I’m not constantly on her case, which causes more friction in our relationship? 

 

[Dr. Wendy M. Troxel]: Sure yeah, well first let me just say that there is a two-way street between sleep problems and mental health problems. Sleep problems are a symptom of virtually every known mental health problem, but sleep problems can also predict or exacerbate existing mental health problems. So being mindful, and doing everything you can to support your teen’s sleep is really important, particularly in this context. And I understand that it can be very um difficult and you want to not be in constant battle with your teenager. So I would really encourage you to um you know kind of set some ground rules and um try to get your teenager engaged in making small steps to make a difference. And again if you’re hopefully if you’re working routine is working with a therapist already, I think some of these things like creating a daily routine, um and you know sometimes deferring to a higher power and you know removing you as a parent. So if there is a therapist involved, I think that that can be very useful um but so having that third party could be helpful. If not, you know just helping your team to sort of understand that you know having routines is really important to support your mental health um and so it’s not about you know you know you against her, um it’s really about doing what’s best for her. Um, trying to make small steps um to encourage you know some level of social um engagement during the day, because that can um uh make both sleep problems more likely as well as mental health problems exacerbated, making sure that there’s some sunlight exposure during the day, that she’s getting out and that she’s doing something. Too much time alone, socially isolated, and sedentary is only going to exacerbate her mental health issues as well as her sleep problems. And again if you’re struggling to manage it and you’re not already engaged with a mental health provider, I would absolutely encourage that. 

 

[Dr. Charles Czeisler]: Well thank you so much, Dr. Troxel, I really appreciate your participation in today’s panel. We have more questions flooding in, but we need to move on to the next panelist and if there’s time at the end we’ll go back to some of these open questions. Um our next panelist, Dr. Lauren Hale is a professor of family population and preventive medicine at Stony Brook Medicine and is an expert in the social patterns of sleep and how it contributes to a cycle of inequality and health and well-being. Dr. Hale is the founding editor-in-chief of the Sleep Health Journal and is the Vice Chair of the National Sleep Foundation. It’s a pleasure to have you here Lauren, and we look forward to hearing what you have to say. 

 

[Dr. Lauren Hale]: Hi, thank you, everyone. Uh, thank you Dr. Czeisler. Uh so uh a lot of what I’m going to say has been touched upon, and I only have about 10 minutes but what I’m going to focus on is the relationship between sleep health and screens, with a few slides at the end uh addressing what we know about how sleep and screens have changed during COVID-19. So is this working? Okay, first I want to acknowledge uh that I do receive some funding from NIH and I’m affiliated as a volunteer with uh various uh nonprofits. The National Sleep Foundation, Pajama Program, and of course Children and Screens which is the organizing uh body of this uh seminar. I also want to lend some credibility to uh what I know about COVID-19, I’m part of a 10-person team of what we call nerdy girls, we run a social media account uh called Dear Pandemic where we help translate science about the pandemic for for the greater good. And um if you want to check us out we’re always producing good shareable information we’re on Facebook, Instagram, and Twitter. So hopefully the combination of my sleep research uh for the last 20 years plus my COVID-19 equips me to answer some of your questions today. I also want to add credibility is that I’m also a parent of a five-year-old and a nine-year-old. I work full-time and so does my partner so I really understand and empathize with the challenges we are all experiencing right now, and honestly you may hear my five-year-old in the background singing to himself. This is just an extremely hard time, and uh screens and sleep are two of the activities that people are doing most during this time, so I’m glad you’re logged in to hear us talk about it. So what do we know about screens and sleep? I started studying deeply studying screens of sleep in 2015 when I was it were actually 2014 when I was in the middle of collecting data, actographic data, on almost a thousand teens from 20 cities around the country, and one of my key research questions was understanding how screens, not just in the bedroom but throughout the day, affected nighttime sleep. And as part of my preparation for analyzing that data, which I’ll show you a little bit later, was conducting a systematic lit review. And at that point, my grad student and I identified about 70 papers, I think this was actually through 2014 but it was released in 2015, uh that had original research on this topic. Since then the number of articles studying screens and sleep has uh doubled if not tripled uh because of technology this is a huge question, but the results frankly haven’t changed that much and I’m best at sharing the published paper or I’m most comfortable sharing the published paper so let me briefly summarize that. Uh out of the then 70 or so papers that we looked at over 90% of them indicated a negative association between exposure to screen time, either during the day or in the hour or two before bedtime there’s not harmonization across studies on how screen time was measured. Uh and a range of sleep outcomes. The most common aspects of sleep that are affected we’re later sleep onset, which means going to bed later, uh shorter sleep duration, meaning shorter nighttime sleep, and poorer sleep quality. Uh and it’s it’s a dose response relationship in any study that measured it that way, the more sleep the more screen time you’re exposed to over the course of the day, and the later your bedtime. And it’s not a huge number, but it’s anywhere between three and eight minutes per additional hour of screen time. So if you’re looking at, for example, five hours of screen time exposure versus one hour, that’s an eight-minute delay versus a 40-minute delay in bedtime. So it does add up, and 30 minutes of sleep uh less or later is certainly clinically relevant and that’s been shown in an in a number of um the school start later paper showing that just getting teens to bed later, I mean to sleep longer by 20 minutes, you see improvements in grades reductions, in car accidents, and other things. So what are the mechanisms, people always ask this question and it’s very uh complicated, but I’m going to focus on the three that we primarily have looked at in the literature. The first is time displacement. Time that you, or your teen, or your kid is on a screen is directly eating into time that they can be sleeping. Especially with regard to sleep onset, or bedtime. There is a reason why the CEO of Netflix has declared that one of its primary competitors is sleep. The CEO of Netflix is fighting against our human biology and need to sleep by making one episode transitions seamlessly into the next episode without you even having to touch a button. That is the time displacement argument. The second argument is the psychological arousal. Exposure to screens, whether it’s video games, uh television shows, movies, or social media it’s very psychologically arousing and it works differently for different people. For your 12-year-old daughter, it might mean ruminating after looking on a social media account and seeing her three best friends out bowling, and she didn’t even know that they were going. It is normal and natural to ruminate after social exclusion. And one way you can avoid that rumination, that will keep you up at night, and uh one way you could avoid that is by reducing the screen exposure, especially the social media exposure at night. Other ways that the psychological arousal can happen could be through emotional content, violent content, that are often found in movies or video games. And so the third mechanism refers to the alerting effects of blue light that Dr. Czeisler and Dr. Troxel already spoke about, at this this exposure to light suppresses your melatonin which is sleep-promoting. So we’ve got three things going on, time displacement, psychological arousal, and the physiological arousal. And all of them work against your body naturally falling asleep. Now because science is iterative, I have to stay up on the literature in last year, in part in response to some of the work that myself and Monique Le Bourgeois have done on screens and sleep, common sense media asked a question about who is sleeping with screens next to their bed, are they waking them up, and sure enough they found among teens, 30 percent of teens report having a mobile device in or on their bed. Which in itself even if you don’t use it, is a predictor of insufficient sleep, and 36 percent report that they wake up to because their phone beeped or bleeped or somebody tweeted or they wanted to see what was going on at one two or three in the morning. And I looked at that when that came out and I was like oh my gosh, our three mechanisms are incomplete. I have I had to go back and revise what our three mechanisms were, our fourth one is also the actual awakening that occurs during the night because we sleep with these devices so close to us. Uh I’m gonna in the interest of time, sort of fly through this slide although years of work went into it. Uh, Dr. Troxel pointed out there are a lot of reasons why our teens are not getting enough sleep. Screen time is part of a cluster of social and behavioral factors that that we as parents and teenagers can modify. Caffeine consumption, school work, extracurricular activities all of those things work against our kids sleep uh sleep health. There’s also the physiological phase delay, and then there’s also the structural factors. This figure shows quite clearly, using actographic data remember we we looked at a thousand teenagers from across the country, that the only teens who had enough time in bed to meet the minimum eight to ten hours were those who had high schools, this is the green um dot in box, um who had high schools that started at 8:30 in the morning or later. So this is an entirely different conversation about when high school should start for optimal sleep health, but it’s actually pretty relevant to the current situation because we’re in maybe not as much anymore, but we’re in a national shutdown where we don’t have these constraints of needing to wake up by a certain time. It’s not just even normal summer, where there’s um camp, or um uh work, things are different right now and actually, it’s almost like we don’t have school start times at the moment. Maybe things will resume or starting to resume around the country. And here’s a brief uh image from an important paper that Jean Twenge published in 2017, showing two national studies, uh and the bar for insufficient sleep here is seven hours or less per night. Remember Dr. Troxel said the consensus statement recommends eight to ten hours, so this is seven or fewer. As you can see, there’s been a slight shift upward uh in the percentage of teens in the US who are not getting the sleep they need. And especially went up around 2012, and Dr. Twenge’s work looked at the range of possibilities that could be predicting this change, and what she found is similar to something somebody mentioned in the chat room earlier, is that uh the kids are sleeping with their smartphones. Look at this picture of my good friend’s nephew, here is he’s surrounded by technology in the middle of the day and he’s got the death grip on his smartphone. You know he can’t get rid of his phone he’s holding onto his phone and what happened in 2012 according to Twenge’s work is that was when cell phones really became pervasive amongst everyone including teenagers. It became expected that everybody have their phone and they’re bringing them to bed. So let’s briefly summarize some recent findings of what we know about sleep during COVID-19. Uh for better or worse, I had a study with my colleagues at Emory in Barrow County, Georgia, where we collected data at two high schools uh during the first week in March, it was self-reported data, and then we went back to them in May. 761 students, a reasonable representation of these two semi-rural school districts. Some rural schools in a district and what we found, and mind you self-reported sleep is usually an overestimate of actual sleep, but during uh early March before they were COVID lockdowns, and before many people were thinking about it, especially teenagers in Georgia, these students reported 7.5 and 7.8 hours per night respectively. After the lockdowns, about six weeks later each of those high schools experienced an average of 1.1-hour increase in sleep. So actually, from a sleep health perspective with the removal of the early morning constraint, we’re seeing increases in sleep duration. But it’s not as is um positive as I would like, because we’re also seeing big shifts in timing, um bedtime, the median bedtime shifted from about 11 pm to 1 am, and the waking up um shifted from 5:45 which that is way too early to about 10 a.m. So we see more sleep overall, later shifts in timing, and slight increases in insomnia symptoms, and napping behaviors. And this is consistent with two studies that I’m aware of in adults, uh actually three studies, um Fitbit data, Dr. Robbins has some data also from a wearable device showing that adults are sleeping a little bit longer, not as not an hour longer but about 25 minutes longer, and uh just last week a study came out showing increases in sleep problems among adults. So teens are more or less parroting what’s happening in adults, but maybe uh to a bigger degree in terms of a delay and addition of sleep power. I’d like to say they’re maybe catching up. Uh, so a lot of this has already been mentioned in the by the prior speakers. Encourage a family bedtime routine, role model it, don’t have electronic media in that routine. Uh charge your devices in a different room, as you can see I’ve got a little sleeping bed and a little sleeping bag down at the bottom we have that it’s in our kitchen. The one area that I didn’t hear is many people talk about is that I don’t want you to underestimate your kids. Your kids understand stuff, and you can talk with them about why you have your rules. And you could say, you know in my case let’s say, mommy studies sleep I want to tell you why we take the devices away at 7:30. You know, I have to confess that shifted over COVID, but you know this is how you get kids to willingly cooperate with your rules. And uh kids can understand that and work with them uh to get the results you want. So I think I’m gonna stop there and uh.

 

[Dr. Charles Czeisler]: Thank you so much, Lauren, we really appreciate it. Uh, we have time for uh a couple of questions, um and so the first one is going to be how do you suggest uh how do you help suggest provide support to parents who are struggling with their child’s sleep impacted by screens late at night?

 

[Dr. Lauren Hale]: I know, it’s hard. Uh, this goes back to many of the tips that Wendy had advised to some of those parents who ask questions, is work with your kids to find alternatives. It is not enough to just grab the phones and hide them in a box, you really need to say let’s figure out a routine that’s going to work with you. Maybe reading is not your thing, but maybe we could go for an evening stroll, or have tea outside, or do something where you can be emotionally available and open to uh a calming bedtime routine that isn’t involving screens. I know this is hard, I am not an expert at it, but I think you need to work with them in a way that helps them find something else they can do. 

 

[Dr. Charles Czeisler]: Okay great, now here we have a paradoxical situation in which elementary education, middle school, many schools are going virtual. Uh and can you speak specifically to the effects of all of that screen time on five to twelve-year-olds, and then at the same time address the question of whether there’s research on the impact of screen times at different times of day or night on young children’s sleep, in other words, does it matter when you’re exposed to the screens?

 

[Dr. Lauren Hale]: Uh I’ll start with that one because I have uh more confidence in my answer on that one, uh unfortunately a lot of the research on screens and sleep did not add has not to date adequately differentiated the timing of when screen exposure um occurs. So you can’t always say, that oh daytime screen time doesn’t affect sleep. And there’s a there’s a reasonable assumption that most screen exposure doesn’t happen during the daytime because they’ve been in school, they’ve been in school. So when is it happening, of course, it’s happening after they come home from school. There are of course some kids who get their screen time in the morning but a lot of it’s happening at night, and that’s basically what the data have been indicated that any amount of screen time is during the day is affecting increased um later bedtimes, basically. But, now that we have this extended period with a lot of kids not in school, we might be able to have better data on if you have it early in the day, it’s not as bad. I tend to believe that like for like theoretical reasons we would think you know pushing back the bedtime, the light exposure at night, that’s all things uh time displacement and those are things where you think screens closer to bedtime are worse for your sleep than screens during the day. But,

 

[Dr. Charles Czeisler]: All right.

 

[Dr. Lauren Hale]: If you’re doing screens all day, then yeah sorry. 

 

[Dr. Charles Czeisler]: Yeah, thank you very much uh uh Dr. Hale. We we need to move on to uh sorry Dr. Robbins and then we’ll if there’s time at the end we’ll get back to more questions. Uh so Dr. Robbins, uh I’ve already introduced you and we want to hear how how did everyone do on those quizzes and uh and and realize the myths, and and uh we look forward to your presentation. 

 

[Dr. Rebecca Robbins]: Thank you Dr. Czeisler, all right uh so the results are in. I’ve been busily putting uh the results together, tabulating um the some of your responses to the the quiz earlier on, and many most of you did pick up that these are in fact myths. These are um incorrect statements, so what you’re you’re seeing here on my screen are your responses uh the correct response which was uh marking false to some of these questions these statements that we quizzed you on earlier. So we’re gonna go through each of these, debunk them, and do so quickly so we can get to a couple more questions and I welcome input from all of my collaborators on the call. Now number one, heavy and loud snoring for my child means they are deeply asleep. 88 of you correctly reported that this is a myth. That is, um is not true. Uh heavy and loud snoring is not an ideal uh scenario it’s uh one of the most common symptoms of obstructive sleep apnea, which is a concerning sleep disorder uh which is actually relatively common among children, and one other additional symptom to look for if you’re thinking your child might be a candidate for that disorder, is excessive daytime sleepiness. But independent of os of obstructive sleep apnea, loud snoring is also associated with adverse outcomes. So it might be something to talk to your health care provider, not in fact a statement that your child is sleeping deeply. Now number two, 58% of you correctly reported false to this myth. Experiencing a night terror is a traumatic event for my child. Now this is false, a night terror occurs um occasionally in children, and it is a um a component of um these occurrences happen in largely non-rem sleep and it’s a demonstration of a real severe fear and um concerning behavior from your child, but it is actually an event that’s not at all remembered by your child. So it is not traumatic for them, although it may be traumatic for the parent. Uh, number three, on the child sleep myth 78% of you got this correct, and said that this statement is indeed a myth and that’s that my child’s bedtime if I move it later, they will just wake up later. And this is a myth, if we put our children to bed a little bit later, they will simply wake up at the normal time uh very much creatures of habit so the best thing would be as all uh presenters have discussed uh bedtime routine, and consistent sleep schedule. Because the later bedtime will just be associated with shorter sleep duration. Uh number four, seventy percent of you reported that this is an indeed false melatonin statement. Melatonin is safe for my child because it is natural. Now um we are seeing surprising uh reports of the proportion of of children who are being um given melatonin supplements. Of of course melatonin uh naturally occurring, um is a hormone in the brain that’s associated with sleep regulation, but when you take it in pill form a couple of things. Number one, we don’t always know its purity. There have been some studies to show that when you see melatonin labeled as such at the grocery store, or the drugstore that when we look scientifically at the components of those substances that it’s not fully melatonin. In fact, it’s much less melatonin than is on the label. In addition, uh melatonin we do see in animal research, uh has some pretty concerning outcomes. Um in terms of uh adverse impacts on uh reproductive organs for instance so we don’t know its purity or its long-term implications and the best strategies are the behavioral tips and strategies that we’ve gone through today. Number five, uh 54% of you did correctly pick up that this is a false statement. That this statement that is kids who are good sleepers will sleep through the night. Now uh we’ll distinguish here between an awakening where your child is up and you know running around the house and a short arousal. Uh an arousal from sleep happens on average research shows among children uh between ages two and nine on average about twice an hour so quite frequently and so therefore awakenings or brief um arousals from sleep are quite developmentally normal. But as your child goes through those uh you know bouts where they might experience awakenings, all of the tips and strategies that have been shared so far, um you know soothing them back to sleep, coming back to that relaxing bedtime routines. I just love to open up to my colleagues if anyone else has any other comments to add before we go over to the teenager sleep myths. Okay just in the interest of time, moving right along uh and here perhaps uh Dr. Troxel could uh pass it over. I think this was a myth that came um from you and 50% of the audience correctly said that technology is uh the main reason teachers can’t go to sleep at a reasonable time. Uh, 50% of you reported that that statement is false, uh would anyone else any of my colleagues like to take this or um. You all certainly now know after the presentation that technology is one of the factors but teens are really fighting their physiology when it comes to good sleep. Now number two, if teens um sleep later or excuse me a school start later teens will just stay up later. And this is a false statement, and 66 percent of you correctly uh noted that this is false. That um if maybe I could pass this over to you Dr. Trozel to take this one. 

 

[Dr. Wendy M. Troxel]: Oh happily and I am happy to see that two-thirds um uh correctly identifies as a myth. Um, we actually have substantial research showing that when schools start later, kids actually do get more sleep. Their bedtime stay roughly the same, but their wake times get extended resulting in more sleep. And again this relates to some of the work that Dr. Hale just presented uh that you know one of the potential you know um benefits of uh the stay-at-home orders um and changes in school schedules has been that uh we are seeing that teens are getting more sleep when the constraint of early school start times is removed. The problem is now, that their schedules are just so erratic, um but school start times are a major uh constraint to teens getting at the adequate sleep they need, and studies have shown this.

 

[Dr. Rebecca Robbins]: Terrific and the third uh sleep myth for teens is we are coddling our teens by letting them sleep in. 86 percent correctly noted this as a myth. Uh, do you also want to take this one, Dr. Troxel?

 

 [Dr. Wendy M. Troxel]: Happily, um you know I like to say that you know this is the same thing as as if you would say you know, you know my two-year-old um you know if a two-year-old we know needs a nap, and we would never say um you know to a parent of a two-year-old you know don’t let Johnny nap because then he won’t be ready uh for kindergarten when he can’t take a nap. When we have this uh myth that by letting kids get by letting teenagers get the sleep they need, we’re coddling them or not preparing them for the real world. It’s that same um you know misconception, by allowing our teenagers to get the sleep they need, far from coddling them we’re actually just supporting their healthy brain and physical and emotional development to make them stronger, more more resilient adults. 

 

[Dr. Rebecca Robbins]: Terrific, and next uh teens who fall asleep in class are lazy. Uh, exciting to see 98% uh correctly refuted this statement as a myth for all the reasons uh you’ve all now heard on the webinar, teens are just fighting against their physiology to get good sleep uh during these years, and when that’s compounded with an early school start time, and a later bedtime preference that leaves very little time for sleep, resulting in significant daytime sleepiness. So this is a kind of an artifact of those barriers that teens face when it comes to their sleep, and not that they are lazy. Uh last but not least, teenagers have little control over their sleep. Dr. Troxel, would you like to take this one?

 

 [Dr. Wendy Troxel]: Uh that that’s an um a tough one honestly because um I do think we put teenagers in a rough spot. Um the fact is uh that teenagers don’t control their biology, they also don’t control school start times, though we as families and communities can and I believe should um encourage school districts uh to consider later school start times because the evidence does show that later school start times do help to support teen sleep. There are certainly factors that teens do control, and parents can also support in their own families like all the tips we discussed in terms of curbing technology use at bedtime, managing light exposure, having a wind-down team, and having a consistent uh sleep-wake routine. But it’s not all in their control particularly when we have these policy-level influences that are constraining their opportunity for sleep.

 

[Dr. Rebecca Robbins]: Terrific, so I will go ahead and stop my screen share, and Dr. Czeisler pass it back to you in case there are any other questions to close out the webinar on the myths or anything else. 

 

[Dr. Charles Czeisler]: Well, well, I would like to at this point thank you very much uh for that wonderful presentation Rebecca. Uh, I’d like to pass the baton to uh uh Dr. Pamela Hurst-Della Pietra.

 

[Dr. Pamela Hurst-Della Pietra]: Thank you all for thank you, Chuck, thank you all for coming and participating in such an informative and engaging conversation. Uh, also thanks to our wonderful panelists Kim, Wendy, Lauren, and Rebecca for sharing your insights and expertise. We invite you to share uh the youtube video you’ll receive of today’s workshop with your fellow parents, teachers, clinicians, researchers, and friends. Our discussions about digital media use and children’s well-being will continue throughout the summer with weekly Wednesday workshops. Next Wednesday’s workshop on August 19th, fact or fake, focuses on misinformation and how to spot it. On Wednesday, August 26th we will host a conversation to answer the question: school’s back now what? We know both of these topics are especially important right now, and hope you’ll join us to hear what the experts have to say. When you leave the workshop you’ll see a link to a short survey. Please click on the link, and let us know what you thought of today’s workshop. Thanks again, and everyone be safe and well. 

 

[Dr. Charles Czeisler]: Thank you for organizing this Pamela. We really appreciate it and for leading the Children and Screens effort. Uh you know it’s really been a fantastic journey and and we appreciate it and thank all the panelists as well. 

 

[Dr. Pamela Hurst-Della Pietra]: Thank you.