Sleep problems in children, interview with Prof Michael Gradisar

Sleep problems in children, interview with Prof Michael Gradisar

Sleep is important for a child’s physical growth and cognitive development. However, around 25-50% of young children suffer from some kind of sleep problem [1]. Bad sleep has an impact on the child’s development and daily life, but can also influence the sleep and stress levels of the parents.

Michael Gradisar is a clinical psychologist, sleep researcher, and Head of Sleep Science at Sleep Cycle AB. He specializes in sleep problems in children and young adults.

“I fell in love with the whole concept of sleep, because it’s something that we all do and can relate to.”

 

How did you become a sleep researcher?

“My goal was to become a clinical psychologist, and I had the opportunity to work at an insomnia clinic for children. I realized that there was not much research on sleep in children yet, so that fascinated me. I could build treatments, and test it in clinical practice. It’s great to do research that’s interesting, but also helps people at the same time.”

 

What sleep problems occur in children?

“Children can get really anxious at night which prevents them from falling asleep. They believe that once they go to sleep, they can be attacked or taken away. Worrying about a threat of someone breaking in, makes them very alert to their surroundings at night.”

“Children can get really anxious at night which prevents them from falling asleep”

 

How does this impact their parents?

“Children can experience separation anxiety from their parents at night. Some children sleep in their parents’ bed or next to them on a mattress and others need their parents to be with them until they fall asleep. Parents are likely to think: “How can I get my bedroom back? My child is way too old to sleep next to us.” 

“Children can experience separation anxiety from their parents at night”

 

How do you treat insomnia in children?

“The treatment of insomnia in children is similar to the treatment in adults, but we focus more on treating separation anxiety and building up sleepiness during the day. If a child feels more sleepy at night, after a while we see that children don’t care about burglars anymore, and just want to go to sleep. We also do relaxation training, which is part of cognitive behavior therapy for insomnia.”

 

How can breathing with Somnox help?

“Children can follow the breathing rhythm which helps them calm down and prepare for bed. Instead of worrying about a burglar coming in that’s going to harm them, they just focus on their breath. Somnox can also provide children with a sense of security, similar to sleeping with a pet in bed. Children refocus their attention away from potential fears to the Somnox Breathe and Sleep Robot.”

“Somnox can provide children a sense of security, similar to sleeping with a pet”

“Children refocus their attention away from potential fears to the Somnox Breathe and Sleep Robot”

 

What’s the advantage of Somnox over a teddy bear?

“There is a difference between a teddy bear and a Somox Breathe and Sleep Robot. If a child doesn’t have his or her teddy, he or she cannot fall asleep. Somnox can teach a child how to deal with a bad night by breathing exercises. So even if a child doesn’t have Somnox, they can use slow breathing to calm down.”

“Somnox can teach a child how to deal with a bad night by breathing exercises”

How can parents help their children with their sleep?

“It’s important for parents to understand that their child is anxious. Rather than telling them that no one is coming into their bedroom, it’s better to use questions and logic. With practice, the child can come to the conclusion himself or herself that nothing is going to happen.”

 

How much sleep do children need?

Michael: “Children need just enough sleep to function and feel okay the next day. Parents should realize that all kids are different, so they need to experiment and see what bedtime works best for their child.”

 

Overall, what’s your best sleep tip?

Sleep loves structure. Having structure in your life, for example, having regularity in your bed times, what you do leading up to bedtime and what you do when you wake up in the morning, is the best thing for good sleep.

“Having structure in your life is the best thing for good sleep”

 

For anyone looking to improve their sleep, Somnox 2 is your science-backed sleep companion that guides you towards slow-paced breathing that helps you fall asleep faster, worry less and wake up rested. 70% of our users improved their sleep quality within 4 weeks. Interested? Sign up for early access.

How breathing calms the mind and body, explained by expert Patrick McKeown

How breathing calms the mind and body, explained by expert Patrick McKeown

Many Americans experience considerable stress, according to the Stress in America 2020 Survey. In a stressed state, you may experience difficulty relaxing during the day and falling asleep at night. After a bad night’s sleep, you wake up tired, experience low energy and may have a bad mood. This can in turn contribute to trouble sleeping. A vicious cycle exists of stress and bad sleep, which can lead to chronic sleep problems. Patrick McKeown explains how breathing calms the mind and body, and how you can break this vicious cycle.

 

How can we break the vicious cycle of stress and bad sleep?

To break this vicious cycle, you will need to lower overall stress levels and experience more moments of relaxation during the day. According to Patrick McKeown, breathing is a tool to establish a more relaxed state. Patrick: “Breathing can bring calmness into the body and mind. To launch your body’s relaxation response, you will need to change your breathing pattern.” 

“Breathing can bring calmness into the body and mind”

 

How should we breathe to launch the body’s relaxation response?

Patrick: “If you are stressed and have an agitated mind, you can experience faster and shallow breathing. For relaxation, you need to breathe slowly, low and through the nose.”

  • Slow down the exhalation. During exhalation, the Vagus Nerve kicks in. This nerve is responsible for your relaxation response. A breathing rate of 4.5 6.5 breaths per minute is optimal to stimulate the Vagus Nerve. So take a soft breath in and slowly breathe out for relaxation.
  • Breathe low in your belly, using the diaphragm. Simply put your hands on either side of your lower ribs. As you breathe in, you will feel the ribs gently moving out, as you breathe out, you will feel them moving in. If you place Somnox 2 Breathe & Sleep Companion on your belly, it can help you breathe slowly and bring your awareness to abdominal breathing to encourage low breathing.
  • Always breathe through your nose. If you breathe through your nose, the air is prepared to be easily transferred from the lungs to the bloodstream. The mouth does not have any added value to your breath.

“For relaxation, you need to breathe slow, low and through the nose”

In the table below you find the differences between stressed and relaxed breathing.

Stressed breathing pattern Relaxed controlled breathing pattern
Fast breathing Slow breathing (4.5 – 6.5 breaths per minute)
Upper chest breathing Diaphragmatic breathing
Mouth breathing with sighs Nose breathing

 

What breathing exercise can relieve stress?

Patrick: “Slow exhalation helps combat stress by shifting your attention from the stressful situation to your breathing. With this breathing exercise, you help the brain interpret the stressful situation as a safe situation.” 

  1. Put your hands on either side of your lower ribs
  2. Breathe in through your nose for four seconds
  3. Breathe out through your nose for six seconds
  4. Continue until you feel more calm

 

How can we use breathing to fall asleep more easily?

Patrick McKeown recommends practicing slow breathing before going to bed: “Before bed, practice slow breathing for 10 to 15 minutes. Take a very soft gentle breath in through your nose, and allow a relaxed and slow breath out. You should not hear yourself breathing, so take very light and slow breaths. The volume of air you breathe should be less than what you normally breathe. This will create a feeling of air hunger. The goal of the exercise is to feel that you would like to take in a deeper breath. This type of breathing activates the body’s relaxation response plus your mind is less likely to wander while focusing on your breath.”

“Before bed, practice slow breathing for 10 to 15 minutes” 

 

Do you have any other breathing tips to improve sleep?

Patrick: “For healthy breathing, your bedroom should be airy, cool and dust-free. Also, train to rest your tongue on the roof of your mouth. This may help prevent sleep apnea, which can disturb your sleep. If you wake up with a moist mouth, you are breathing well for sleep.”

 

How does Somnox contribute to relaxation and better sleep? 

Patrick: “Many people experience over stimulation of the mind during the day and struggle to down regulate the mind before sleep. With Somnox, an individual can shift attention from the mind onto the Breathe & Sleep Robot and do guided breathing exercises to calm the mind. Somnox can be part of an evening routine that helps individuals to fall asleep more readily.”

“With Somnox, an individual can shift attention from the mind onto the Breathe & Sleep Robot and do guided breathing exercises to calm the mind”

Patrick: “Another benefit of Somnox is that you can tailor the breathing to your own breathing. Someone who experiences anxiety and has fast upper chest breathing might find it too difficult to slow down to six breaths per minute. Whereas, if you told this person to slow down the breathing just a little more, this is easier.”

“Another benefit of Somnox is that you can tailor the breathing to your own breathing”

Patrick: “Further, if you hug something, the Vagus Nerve is stimulated, which helps you relax. Somnox can be your companion through the night as it breathes with you.”

“Somnox can be your companion through the night as it breathes with you”

For anyone looking to improve their sleep, Somnox 2 is your science-backed sleep companion that guides you towards slow-paced breathing that helps you fall asleep faster, worry less and wake up rested. 70% of our users improved their sleep quality within 4 weeks. Interested? Sign up for early access.

10-year-old Finn has been falling asleep easily for 2 years, thanks to Somnox

10-year-old Finn has been falling asleep easily for 2 years, thanks to Somnox

10-year-old Finn had long term difficulties with falling asleep. He was often still awake at 11:30 PM. Ever since he started using Somnox, it has become much easier for him to fall asleep. Finn, together with his mother Karin, share their experiences with the Somnox Breathe and Sleep Companion. 

  • Name: Finn
  • Age: 10           
  • Grade: Sixth grade elementary school
  • Hobbies: Playing tennis, the violin, and Pokémon games

How was your sleep before Somnox? 

Finn: “Before using Somnox, I just couldn’t get to sleep and was sometimes still wide awake after 2 hours. Every night I was tossing and turning and just couldn’t clear my head. That’s why I couldn’t get to sleep.”

Finn’s mother Karin adds: “He used to reflect endlessly on the things that happened during the day. He would still be awake late at night, and when we used to go up to bed ourselves, we would hear him shout “Sleep tight!” from his room.”

“Before using Somnox, I just couldn’t get to sleep and was sometimes still wide awake after 2 hours.”

How did you find out about Somnox?

Karin has spent a considerable time searching the Internet for anything to aid Finn with his sleeping difficulties. “You don’t want to give your child sleeping drugs, so I was trying to find natural remedies.” She eventually came across the Somnox Breathe and Sleep Companion, which was given to Finn as a Christmas present. 

Finn: “I had seen clips of the Somnox Breathe and Sleep Companion and wanted to try it so badly. I couldn’t stop crying for over 15 minutes when I opened my present, that’s how happy I was! The first night we tried out all the buttons and sleeping positions. I used it properly the next night and when I did, I dozed straight off and had the best sleep I’d had in ages.” 

How does Somnox help you sleep?

Finn likes it when someone is close to him, so he doesn’t feel alone. Somnox can provide him this feeling of affection and closeness. Finn: ”It’s like you are lying against someone who is already asleep. This relaxes me and makes me feel safe.” His mother adds: “I think Somnox was a turning point for Finn. He used to lie awake overthinking and worrying. He sleeps so much better now. Wherever we go, so does Somnox, even on big trips.” 

”It’s like you are lying against someone who is already asleep. This relaxes me and makes me feel safe.”

How do you use Somnox?

Karin: “Finn only really uses ‘Somnox Sense’, as this makes the Breathe and Sleep Companion adjust itself to his own breathing pattern, which he enjoys the most.” Finn: “I copy the breathing pattern of the Somnox, just like I would do if I was lying next to mom or dad.”

“I copy the breathing pattern of the Somnox, just like I would do if I was lying next to mom or dad.”

Could Somox help other children as well?

By now Finn has both Somnox 1 and Somnox 2. He often lets other kids use Somnox 1. Karin: “One of our Somnoxes was loaned to an 8-year-old girl to try out. She could not sleep on her own and was always seeking close contact from her parents. Thanks to Somnox she can now fall asleep in her own bed. It’s not only amazing for her, but takes a ton of added pressure away from her parents as well.”

10-year-old Finn has been falling asleep easily for 2 years, thanks to Somnox

For anyone looking to improve their sleep, Somnox 2 is your science-backed sleep companion that guides you towards slow-paced breathing that helps you fall asleep faster, worry less and wake up rested. 70% of our users improved their sleep quality within 4 weeks. Interested? Sign up for early access.

How coherent breathing with Somnox can help you calm down

How coherent breathing with Somnox can help you calm down

Somnox’ mission is to unlock human potential by improving the sleep of 100 million people by 2030. We are continually working with sleep science experts, neuroscientists and health professionals to ensure that our products live up to this goal. In our last experiment, we investigated how the Sleep Robot supports coherent breathing to calm you down. We observed that coherent breathing exercises with the Somnox Sleep Robot before bedtime and just after waking up aligns your breathing and heart rate, and helps decrease resting heart rate, which are indicators of relaxation. More research into the effects of coherent breathing will be done in future studies.

Somnox is committed to developing products that you can trust. We continually improve our products based upon user experiences and the latest research. Sleep has a large impact on your wellbeing and it is important that we take your health seriously. Therefore, we will keep sharing our learnings with you. Wondering whether Somnox is right for you? Take our quiz and get our free advice.

 

What is coherent breathing?

You breathe in and breathe out, without actually thinking about it. You unconsciously inhale to let air into your lungs and oxygenate your body’s tissues. What’s unique about breathing is that you can take it under conscious control too. Coherent breathing is all about conscious, slow and rhythmic breathing. Your natural breathing rate ranges from ten to twenty breaths per minute (1). With coherent breathing, you decrease this breathing rate significantly to six breaths per minute. This has been proven to have a relaxing effect on the body and mind (2).

 

The effect of coherent breathing has something to do with your autonomic nervous system, which can be divided into the sympathetic and parasympathetic nervous system. The sympathetic nervous system controls your stress responses (fight-or-flight) (3,4). The parasympathetic nervous system makes sure your body gets rest for restorative purposes (rest and digest) (3,4). A lower breathing rate and longer exhales lead to parasympathetic effects that initiate a relaxation response (2,5,6). Thus, slow coherent breathing transforms the body from a stressed state into a relaxed state which is favorable for a good night’s sleep (7).

Coherent breathing example: breathe in for four seconds… and breathe out for six seconds… do this breathing exercise for 10 minutes.

How is coherent breathing related to your heartbeat?

What’s interesting, is that coherent breathing impacts your heart rate. While breathing in, your heart rate goes up and while breathing out, your heart rate slightly decreases (see Figure 1 below) (8). This phenomenon is called heart coherence, and is reached during coherent breathing or when experiencing positive emotions, such as love, joy and gratitude. It’s a sign of a happy and healthy body that is resilient to stressful events that can be encountered during the day (9).    Breathing and heart rate

Figure 1: Heart rate goes up while breathing in and heart rate goes down while breathing out. This occurs when you practice coherent breathing and is a sign of a stress-resilient body.

 

How to do coherent breathing with Somnox?

Coherent breathing can relieve stress and therefore help you fall asleep more easily (9). You can use the Somnox Sleep Robot to do coherent breathing exercises (see Figure 2). We recommend performing these exercises just before going to bed for a good night’s sleep, or just after waking up to start the day peacefully.

The following settings for the Sleep Robot are recommended:

  • Program: Napping
  • Breathing start rate: 6 breaths per minute
  • Breathing end rate: 6 breaths per minute
  • Breathing duration: 10-15 minutes
  • Select some soothing sounds according to your preference

You can change your breathing settings in the mobile application. More information how to do this can be found here: 

Sleep Robot and heart coherence

Figure 2: With the Sleep Robot, you can practice coherent breathing which consists of a regular breathing pattern and has a sinus-like effect on heart rate. This is a sign of parasympathetic dominance.

 

Let’s take a closer look at our experiment

The Somnox Sleep Robot is designed to let go of stress and prepare the mind for sleep with breathing exercises. After all, hyperarousal (an overactive body and mind) is a very important sleep influencing factor (10-12). Heart rate is an important measure for stress. Therefore, Somnox has investigated the effects of coherent breathing with the Sleep Robot on heart rate.

Five volunteers participated in this four-week experiment. In week one, baseline heart rate measurements were done daily in the morning. In week two, three and four, participants did coherent breathing exercises in the morning and evening while heart rate was monitored (using the PolarH10 Chest Monitor). The breathing exercises consisted of a daily 10-minute program with a breathing rate of 5 or 6 breaths per minute guided by the Somnox Sleep Robot. 

Our research team has performed the data analysis and gained two important findings.

Finding (1): coherent breathing with the Sleep Robot has an effect on heart rate and leads to heart coherence 

Our research team observed that coherent breathing exercises with the Sleep Robot indeed have effects on heart rate and leads to heart coherence. While breathing in, heart rate goes up and while breathing out, heart rate goes down. This is a sign of parasympathetic activity which is part of the relaxation mechanism of your body. In the video below, Julian Jagtenberg, founder of Somnox, demonstrates this phenomenon.

Finding (2): coherent breathing with the Sleep Robot can decrease resting heart rate

We also observed that coherent breathing with the Sleep Robot decreased resting heart rate over the timeframe of four weeks in three out of five participants (see Figure 3). In week one, baseline measurements were conducted. In week two, three and four, participants did coherent breathing exercises with the Sleep Robot. As you can see in Figure 3, resting heart rate decreased or stayed almost constant compared to week one. A lower resting heart rate is a sign of relaxation and overall health & wellbeing, and therefore interesting to investigate further in future experiments.

Resting heart rate over time

Figure 3: This graph shows the resting heart rate of participants over four weeks.

 

What’s next?

Stress has a large impact on your sleep. The Sleep Robot can help initiate a relaxation response with coherent breathing exercises. These exercises give you a calm mind and prepare you for bed. In our experiment, we observed effects on heart rate which is an important parameter for evaluating stress and relaxation factors. We want to keep exploring the effects of breathing exercises with the Sleep Robot on relaxation and sleep.

Somnox is committed to developing products that you can trust. We continually improve our products based upon user experiences and the latest research. Sleep has a large impact on your wellbeing and it is important that we take your health seriously. Therefore, we will keep sharing our learnings with you. Wondering whether Somnox is right for you? Take our quiz and get our free advice.

 

Learn more about our latest findings: https://somnox.com/blog/research-sci-somnox/

References

  1. Russo MA, Santarelli DM, O’Rourke D. The physiological effects of slow breathing in the healthy human. Breathe. 2017;13(4):298-309
  2. Lin IM, Tai LY, Fan SY. Breathing at a rate of 5.5 breaths per minute with equal inhalation-to-exhalation ratio increases heart rate variability. International Journal of Psychophysiology. 2014;91(3):206-211
  3. Jänig W. Autonomic Nervous System. In: Schmidt R, Thews G, ed. by. Human Physiology. 2nd ed. Berlin: Springer; 1989. P.333-370
  4. Buijs RM. The autonomic nervous system: a balancing act. Handb Clin Neurol. 2013;117:1- 11
  5. Pal GK, Velkumary S, Madanmohan. Effect of short-term practice of breathing exercises on autonomic functions in normal human volunteers. Indian J Med Res. 2004;120(2):115-21
  6. Sunil Naik G, Gaur G, Pal G. Effect of Modified Slow Breathing Exercise on Perceived Stress and Basal Cardiovascular Parameters. Int J Yoga. 2019;11(1):53-58
  7. Jerath R, Beveridge C, Barnes V. Self-regulation of breathing as an adjunctive treatment of insomnia. Front Psychiatry. 2018;9(780):1-7
  8. Pinsky, M., 2006. Chapter 34 Heart–Lung Interactions. In: R. Albert, A. Slutsky, M. Ranieri and J. Takala, ed., Clinical Critical Care Medicine. [online] Mosby, pp.369-382. Available at: https://www.sciencedirect.com/science/article/pii/B9780323028448500391 
  9. Steffen P, Austin T, DeBarros A, Brown T. The Impact of Resonance Frequency Breathing on Measures of Heart Rate Variability, Blood Pressure and Mood. Front Public Health. 2017;5(222):1-6
Research: Sleep Condition Indicator (SCI) & Somnox

Research: Sleep Condition Indicator (SCI) & Somnox

Goal

Somnox has performed research into the efficacy of the Sleep Robot in the third quarter of 2020. The aim of this study was to investigate whether the Sleep Robot would mitigate the participants’ insomnia related sleep problems.

 

Method

Participants were consumers that bought a new Sleep Robot via one of Somnox’ commercial channels. In total, 24 participants completed the study. They were asked to use the Sleep Robot at home like they normally would. Insomnia related sleep problems were evaluated at three time points: before Sleep Robot use, after two weeks and after a month of robot use (approximately 30 days). 

Insomnia related sleep problems were evaluated using the validated SCI questionnaire. This questionnaire consists of eight items: 

  1. How long does it take you to fall asleep?
  2. If you then wake up during the night, how long are you awake for in total?
  3. How many nights a week do you have a problem with your sleep?
  4. How would you rate your sleep quality? 
  5. Thinking about the last month, to what extent has poor sleep affected your mood, energy or relationships?
  6. Thinking about the last month, to what extent has poor sleep affected your concentration, productivity or ability to stay awake?
  7. Thinking about the last month, to what extent has poor sleep troubled you in general?
  8. How long have you had a problem with your sleep?

 

The SCI questionnaire was sent to new Somnox clients before Sleep Robot use (baseline), after two weeks of Sleep Robot use and after one month of Sleep Robot use. Based upon answers to the questions mentioned above, the SCI score was calculated. This score was representative for the severity of insomnia related sleep problems. The baseline SCI score was compared with the SCI score after two weeks and after one month. Furthermore, the answers to the questions were evaluated separately. Per question, baseline results were compared with results after one month of Sleep Robot use.

 

Results

SCI score

After two weeks, 42% of participants experienced an improvement of SCI score and after one month this was 71% of participants. Between week 2 and one month, 63% of participants improved their SCI score.

SCI questions separately 

After one month of Sleep Robot use, the total time of awakenings during the night improved from 46-60 minutes to 16-30 minutes (question 2). Moreover, the number of nights during which participants experienced sleep problems decreased from 5-7 to 4 (question 3). Participants were more energetic and improved their mood during the day (question 5). Answers to the other questions of the SCI questionnaire are listed in the table below.

 

Somnox SCI results

 

Conclusion

Based upon the results of the SCI questionnaire, we can state that the Sleep Robot improves

  • the time it takes to fall asleep
  • the total time of awakenings during the night
  • sleep quality
  • energy and mood during the day

Looking at the SCI score overall, 71% of participants improved their score after one month meaning that the Sleep Robot helped mitigate insomnia related sleep problems. Participants experienced the biggest improvement between week two and one month. Thus, Somnox can advise their users to use the Sleep Robot at least for one month to experience sleep improvements. This is in line with other sleep- and behavioural therapies. Future studies must focus on evaluating the effect over a longer period of time.