Re-Release: The importance of sleep in early childhood with Dr. Nilong Vyas

Christina Kozik:

Hello and welcome to Just Needs, a podcast where we talk about parenting children with disabilities. I’m your host, Christina Kozik, and I’m so glad you’re here. This podcast is a project of Exceptional Lives, a nonprofit organization that supports families like yours. You can learn more about Exceptional Lives at our website, www.exceptionallives.org.

 

This week I have another great interview for you guys. Today I am talking with Dr. Nilong Vyas. Dr. Vyas is a board-certified pediatrician and one of the top sleep consultants in the country. She has worked with parents for over 15 years and is so grateful to be referred to as a sleep doctor. Welcome, Dr. Vyas, and thank you for joining me today.

 

Dr. Nilong Vyas:

Thank you so much for having me. I’m looking forward to getting into talking about sleep, one of the things I love to do.

 

Christina Kozik:

Absolutely. So I just want to share with you and with our listeners, I got to listen to you as part of a panel many years ago when I was a new mom. And we were very fortunate that we did not have any sleep problems, but it was just so great to listen to you and to listen to some of the other panelists that were there as a new mom and just get some tips and tricks that I think really helped our family as we were getting started in this new stage of life.

 

Dr. Nilong Vyas:

Yes. And there’s so much to know and learn, and everyone’s there to offer advice. And it’s hard to know what you should listen to and what you shouldn’t and where you should follow your gut, because you’re like, “I’m a new mom. I don’t know anything.”

But there’s a lot of stuff you know. You just have to trust your gut, but it’s good to have the advice of experts as well to guide you when you get lost.

 

Christina Kozik:

Absolutely. So that leads me to my first question.

What does a sleep consultant do?

 

Dr. Nilong Vyas:

That’s a great question, because there are so many varieties of sleep consultants out there. It’s a booming business these days, and they all have varying degrees of experience.

 

Some of them are moms who have struggled with the sleep with their children and found a way, and so they’re teaching families. And some have a little more certification or education, but a good sleep consultant helps families identify areas in their lives where they can make changes to optimize sleep patterns and get children falling asleep independently and through the night. That should be their primary function, in a nutshell.

 

I specifically help parents not only with sleep, but also with mealtime battles, behavior, discipline issues, because often those things are all tied together. If a child is giving you bedtime disruptions, they’re most likely giving you mealtime disruptions and bath time, getting into the car seat. All of those can be potential struggles, and I teach parents how to deal with all of that together in a holistic approach.

 

And also I look at the sleep issues from a scientific and developmental lens and focus on the recommendation based on the developmental needs of the child. Because if the child’s not sleeping well, they’re likely not eating well and having a lot of tantrums, and that means the rest of the family isn’t sleeping well.

So it’s a whole family approach to get everyone sleeping as they should.

 

Christina Kozik:

Oh, do I know that. Do I know that. While we did not have sleep issues when my son was younger, once he got a little bit older … So he has ADHD. So once that became more apparent that that was what he had and that’s what we were dealing with, we started having sleep issues.

 

And so we would have a child who would either wake up in the night and come in and climb into our bed. I always joke and say I didn’t start co-sleeping until my son was four. Or we had a child that would wake up at 3:00 or 4:00 in the morning and couldn’t go back to sleep. And so it made for a very long day for all of us.

 

So I love that you have this holistic approach, looking at everything and how it all fits together to create, I guess you would call it a sleep plan for that family.

 

Dr. Nilong Vyas:

Exactly. Specific to first, obviously to the developmental principals necessary for the child, but also the parenting practices for the family. Every family is so different, and what they want out of the family relationship is different. Parents’ work schedules are different.

 

So sometimes you might read a book that says a child should sleep 7:00 to 7:00, but the parent gets home from work at 6:00 PM, and it’s hard to put the child to bed at 7:00 without having any … You miss out on that family opportunity and family time.

 

Christina Kozik:

Absolutely.

 

Dr. Nilong Vyas:

So those schedules need to be adjusted to optimize that, but also making sure that the child is getting adequate sleep. If they have to be awake at 6:00 AM to get ready for school or daycare, then getting them to bed at 9:00 may not be the best solution.

So balancing all of that is important, and a consultant that can take a look at that specifically for each family is crucial.

 

Christina Kozik:

That’s great. So that leads into the next question.

Why is sleep so important?

 

Dr. Nilong Vyas:

Yes. So as we learn more, so much research is being devoted towards figuring out why we sleep and why sleep is important. And what we’ve discovered is just as the body has a lymphatic system that cleans itself, the brain has something called the glymphatic system, and that’s what’s responsible for cleaning the brain, and it’s during sleep that that system gets activated.

 

So the brain is cleaning itself at night during sleep. It’s consolidating memories. It’s putting all the activities, emotions, experiences of the day and compartmentalizing it for easier access in the future.

 

So it’s a crucial part of the day, and it’s just as important as eating and breathing. But often sleep gets put last on that list of priorities, because there’s so much fun stuff to do. And it’s like you hear that adage, “I’ll sleep when I’m dead. The kid will get enough sleep. We have to get to activities. We have to do things. We have sports, we have school, we have homework.” And sleep always gets the shaft in that scenario. They’re like, “All right, we’ll just go to bed a little later. We’ll try to sleep in on the weekends.”

 

But I was just quoted in an article saying, “Just like if you miss a few days at the gym, you can’t then that following day have double the amount of weights to make up for what you lost.” It’s the same thing with sleep. If you miss a couple of hours here and there, you can’t sleep extra to make up for it. You may be able to take a nap here and there to balance it out, but for kids who have chronic sleep debt and sleep loss, they just don’t make it up.

 

And during zero to three is when the crucial brain development is happening, and missing out on sleep at that time can be deleterious to their health. And I always tell parents, “It’s not like they won’t read, write, walk and talk. They will, but they may not do it at their full potential if they’re not getting adequate sleep.”

 

Christina Kozik:

You just blew my mind with that glymphatic system. I had never heard that before, and so that’s really cool.

 

And I know I can say this, and I’m sure a lot of our listeners can say that it’s always that, “Oh, we’ll just make it up on the weekends, and we’ll have a low-key weekend, or we have one day a week where we don’t do anything.” But really it’s a daily thing. And I know in our family we try to limit extracurricular activities so that way we’re still having time together, we’re still eating together, and we’re still getting to bed pretty close to the bedtime that we have.

 

Dr. Nilong Vyas:

And that’s so important. Just like we focus on three meals and two snacks a day, just like that, it needs to be a constant. And cutting back on it can just lead to mood changes for the child, not being able to focus in school, being tired, just cranky, and they’re no fun to be around. And then there’s all this frustration around bedtime, and it just snowballs from there.

 

But I remember when I first had my kids, a friend was like, “Don’t put your kid on a 7:00 to 7:00 schedule. That’s crazy, because then you’ll never be able to go out to dinner. You’ll never be able to do fun stuff.” But the child needs that 10-and-a-half, 12 hours of sleep overnight, and if that means you get a babysitter and go out to dinner so the child can still get the 12 hours of sleep, that’s a good option.

 

Or sometimes if a foundation is there and the kid is getting really good sleep, then having a day here and there where the cycle or schedule is messed up is all fine too. It’s just creating that good foundation where there is consistency the majority of the time. And then if there’s disruptions to that, it’s not going to be the end of the world for the child or the family.

 

Christina Kozik:

That’s good. That’s good to know. So what are some tips that families can maybe … I don’t want to say tips, but…

What are some things that families can look at and say, “Hey, maybe we need to create a good sleep schedule,” or “We need to create good sleep hygiene?” And how can they go about maybe doing some small changes to start that shift?

 

Dr. Nilong Vyas:

So a good sleep hygiene is really important, because that’s what signals to the brain that it’s time for sleep. So when you have a consistent activity schedule that this happens and this happens and this happens, then the brain is triggered to start releasing all the chemical and hormonal cascades, which ultimately allows for good quality sleep.

 

So when that schedule or routine is hindered in any way, it just sends those signals to the brain like, well, maybe it’s not time because there’s a lot of light that the child is seeing, or there’s a lot of activity.

 

I always hear all the time, “My kid has FOMO.” Well, if those activities are constantly happening, then even if the brain is giving the signals to the body that, “Hey, I’m getting tired, I’m sleepy,” there’s all this fun activity, the body and the brain are always going to be like, “Well, this is more fun. I would much rather do this than the boring sleep thing.”

So once you create that system, then it just becomes a habit. Just like anything in life that you want to do consistently, creating a good habit is what allows all those systems to function appropriately.

 

So it’s super important to have a routine, and a lot of times parents are like, “Oh, I don’t want to do a routine because it’s just so long and drawn out.” But it doesn’t have to be a long, drawn-out thing. It can be super quick. Just going in the room, pulling down the curtains, reading a book, singing a song, rocking or cuddling or talking about the day and then going to bed. It can be just a quick series of events.

 

And how you know that a sleep routine may need to be instituted is if a child is really resisting bedtime, all the what I call shenanigans, all the delay tactics. I need one more hug and one more kiss and one more this and one more that. Now I need to pee, and now I’m thirsty, now I’m hungry.

 

If there is a consistency with that routine, like every day they know after we brush our teeth, then we go into the bed, and then we pick a couple of books, and then it’s always the same every time, that can help them be on board with what’s going to happen at the end of that as well, because they know what to expect.

 

And a lot of kids end up, even the ones that have sleep difficulties, sometimes tend to do really well in a daycare situation, younger kids, because in daycares or even schools, there’s always the same thing that happens. They know that there’s circle time, and then after circle time there’s outside time, and then after that there’s lunch or snack. And so they know what to expect, and knowing what to expect is part of the battle with kids and bedtime meltdowns and tantrums when they’re disrupting it in the sense of just hesitating bedtime.

 

If they know what’s going to happen next, then the resistance goes down a lot. And that may mean something simple like having a checklist, that every day these are the steps that we take. And then the parent can say, “All right, we brushed our teeth, check. Now it’s time to put pajamas on, check. Now it’s time to read books, check.” And then the child knows, and then they’ll be like, “Now it’s time for X, Y, and Z,” because they’ll come to expect it and know what’s next instead of it always being different.

 

Christina Kozik:

So what you just described reminds me of when my son was younger. In addition to ADHD, he also has a couple of other letters behind that, and so one of those sets of letters is OCD. And when he was a toddler, he had a very particular order that we had to go in for bedtime. And if you turned off the light out of sequence, he would get up, and he would go turn it on, and he would be like, “No, we have to read first, and then you turn off the light,” or whatever it was.

 

And as annoying as it was, it was also very cute, because he had his routine and was very set in it. And that was probably the last stage of him getting really good sleep before he started waking up. And he’s always been an early riser, but being an extra early riser. So that just triggered that memory for me.

 

Dr. Nilong Vyas:

And having that routine, if it’s a simple routine, it can also be modified when you’re traveling or even if the child is sick. You can still say, “Let’s cuddle in bed maybe a few minutes longer since you’re not feeling well,” and still do the same order of reading books, singing songs, rocking for a little bit or cuddling. So it can move with the child, and it can continue even when they’re older.

 

Christina Kozik:

Right, right. Awesome. So I have a question that I received from some crowdsourcing, and I thought it was a great question.

And so the question is, if your child is a terrible sleeper, everybody wants to tell you what you’re doing wrong or what they did that worked for their child. How do I know if there is a problem with something I’m doing, or if there’s something more going on with the child?

 

Dr. Nilong Vyas:

That’s a great question. So often the advice people offer is not wrong, but it may be wrong for you and your family. So every family varies on what’s important to them and how the schedule can and should work for them. And it’s hard to follow just a cookie cutter approach that what works for one person, because the situation and the child is different, so it may not work for them.

 

So having a personalized approach is essential, because then the family might be doing something before bedtime that they’re unaware is something that will impact the child’s ability to sleep well. And without having that education, they’ll continue to do it without knowing that it’s that particular behavior that’s causing the unwanted behavior.

 

So for example, so many of my clients come to me and say they have a routine where the child or family wind down by watching TV right before bed. So that may seem, in that moment, the child’s vegged out, and you’re cozy, and you’re cuddling on the bed or the sofa. And you feel like, all right, now the show’s over, we’re going to go to bed. But then by the time you transition the child to bed, start the bedtime routine, the child can potentially be so wound up, and then it takes two hours to fall asleep. So that’s a situation where a parent may be doing this thing as part of their routine, like watching TV as a family, not realizing that that’s the culprit that could be causing the issue, the bedtime issue.

 

Because what’s happening is the blue light from the device influences the body to secrete the adequate amounts of melatonin that’s required for the child to fall asleep and forces them into a more wakeful state. So even though the child’s vegged out while watching TV, that stimulation, even if the melatonin levels were starting to rise, the TV halts that process, and then now they’re just wound up, wide awake, and then it takes another couple of hours to get them calmed down and to sleep.

So sometimes it’s just about education and knowing what to do and how to do it, because everyone’s doing the best they can, the best advice they can. 

 

There’s so much information available online, so you’re like, “Oh my gosh, this is a plethora of information. I’m just going to Google all my problems and figure out how to solve them.” But everyone’s giving so much information, a lot of it’s contradictory, and not all of it applies and can be applied to that family in particular. And so that’s what families should look out for. Take everything with a grain of salt and say, “Hey, how can I extrapolate this to fit my situation?”

 

And then getting educated by someone who knows what they’re talking about, because sometimes that’s half the issue, that you get all this information, and it isn’t accurate. How many TikTok videos there are about sleep and how to fall asleep quickly. I’m asked all the time, “Can you comment on the accuracy of this?” I’m like, “It should be the other way around. The physician should be writing the article saying. ‘This is how you do it,’ and then the TikTokkers should promote that.”

 

Christina Kozik:

Right. Absolutely. As you were talking about the one size doesn’t fit all approach, it reminded me, I have two friends. And so one, their kids go to bed very late, but they also sleep in very early, they homeschool, so they have that flexibility.

 

And then I have another friend who her two children have always fallen asleep at 6:00. There’s nothing she can do to keep them awake. That’s just what their bodies have always done. And so they’ve embraced it, and it’s what works for them.

 

And then we fall in the middle. And when we were new moms, we would exchange, “Oh, this is working for us, and this is working for us.” And there was a lot of similarities, but there was also a lot of differences.

 

And just like you’re saying, TV doesn’t work for us. I say that, and my kid falls asleep watching TV most nights, but he’s in his bed. We don’t do the family on the couch and then try to move him, because we found that that wound him up. But our other friends, their kids, they’ll fall asleep doing anything, if it’s bedtime.

 

Dr. Nilong Vyas:

It’s the right time.

 

Christina Kozik:

And so that made me think of how all three of us, even though we had kids all around the same age, we were going through all of the different developmental milestones around the same time, every kid is different, and every family dynamic is different. And so I really appreciate you reiterating that.

 

Dr. Nilong Vyas:

And you’ve got to go with what works for your family, at the end of the day.

 

Christina Kozik:

So I have one more question here, and it’s around medication to sleep.

So sometimes a doctor or a pediatrician will suggest medication or maybe even melatonin to help a child sleep. And how do you know when it’s a good idea and when it is worth any side effects that the medication may have?

 

Dr. Nilong Vyas:

So there can be a place for medicine in certain cases where kids have a sleep-wake cycle disorder, they have diminished melatonin stores or other medical situations. But most children and all families typically who are having trouble sleeping have some behavior that they can change, adjust, something with the routine, something with the temperature, light, what they’re specifically doing when the child’s falling asleep, what they do when the child wakes up. So there’s always some behavior that can be modified that I like to explore before starting medications.

 

I think a lot of times if parents are going to pediatricians and repetitively saying, “We’re having sleep difficulties, sleep difficulties,” in a 15-minute visit or if it’s just an aside to a well visit or the kid’s there for an ear infection saying, “Oh yeah, also we don’t sleep well,” and you’ve said this six times already, let’s try melatonin.

 

But a lot of times there isn’t enough time to get into the nitty-gritty of what specifically is happening at bedtime and what could be changed, what could be adjusted. And a lot of times there’s behavioral changes that can be made that will help them start falling asleep better at bedtime and then staying asleep through the night.

 

And there is, like I said, a place for melatonin. Often it’s either with those medical conditions I mentioned, or with jet lag travel, there’s a great need for that, or if a child is just off their schedule, or if they’ve recently started ADHD medication, there’s a whole handful of situations where medication is appropriate.

 

But often what happens when it’s just like, “Oh my gosh, I’m so frustrated. This isn’t working. My child’s waking up or not falling asleep. Bedtime’s taking three hours. Let me try melatonin. Somebody said it worked great for them. Let me try it.” And it either works, but works for a short period of time. And then a lot of families have rebound from the melatonin, and the child falls asleep within seconds and then wakes up at 3:00 or 4:00 AM wide awake. And so it’s this catch-22. What do you want, a quick fix?

 

Christina Kozik:

That was our experience with melatonin. And so we don’t use it because I was like, “I’d rather fight the battle at night and get him to sleep all the way through the night than have to send him to school having woken up at 4:00 in the morning.”

 

Dr. Nilong Vyas:

And then they’re sleepy right when it’s time to wake up. And so again, it has to be a curated approach for that family. So I’m not completely opposed to it, but I’m also hesitant to recommend it until all of those other things have been tried.

 

If we’ve tried all the behavioral approaches, but even families, I think when we initially spoke, I worked with families with ASD, and children with ASD can have sleep-wake cycle issues and may benefit from melatonin. But often just behavioral changes get them sleeping through the night. So having that on hand as the magic bullet to help fix a cycle if a child’s off track is fine, but then being mindful not to keep them on it, especially if you’re seeing those rebound side effects.

 

And the other thing that’s important to note is whenever you’re given any medication exogenously, meaning from the outside, for something that you already make internally, the feedback loop says, “Hey, wait a minute. I don’t need to make this anymore or make as much of it anymore, because I’m getting it from somewhere else.” And so the natural rhythms of the body making the melatonin gets suppressed by getting melatonin from outside. So then you need more and more melatonin to have that same effect, and then your body is just not making it the way it is meant to.

 

And even though it seems so benign because it’s over the counter, you can get it anywhere, and it’s in gummy form and easy to administer. And that, I think, makes it difficult for parents because they’re like, “Well, I’m having sleep difficulties. There’s this medicine that everyone says works great. I can get it for cheap over the counter, so it must be safe.”

 

But a lot of the melatonin hasn’t been tested, because it’s considered a supplement. And they tested a variety of different brands and pills, and because of the gummy formation, there may be a lot of medication in the left side of the gummy and not enough in the right side.

 

Christina Kozik:

Oh, goodness.

 

Dr. Nilong Vyas:

And sometimes parents split it in half because they can’t get a dose that’s small enough for their child. And between the different pills, even in the same bottle, there wasn’t consistency with the dosage within the gummy. So some nights they might be getting a much larger dose than what’s listed on the bottle and some nights getting a much smaller dose. And so trying to work through the behavioral things first and then using that as a second line, if needed, is my approach.

 

Christina Kozik:

Awesome. That’s such good information, so thank you. And if families wanted to reach out to you, where can they find you?

 

Dr. Nilong Vyas:

So they can look on my website, www.sleeplessinnola.com, and if they want to just chat for a few minutes to see if we’re a good fit and ask questions and give me what the difficulties are, they can schedule a free appointment at www.sleeplessinnola.com\consult. And then I’ll chat with them, tell them what the different packages are and then see if we’re a good fit.

 

And hopefully I feel like every family who comes to me is in need of some assistance, and I would love to work with every single family and help them reach their goals. Because sleep is so crucial, as we talked about, and it really impacts the child’s mood, their behavior, the way they interact with the world. And so focusing on that, even though it’s difficult, even though it’s really hard to change what you’re doing, and sometimes it can feel overwhelming for parents like, “Oh, I don’t want to work on this because I know it’s going to be hard.”

 

But once you do that work, it’s so awesome. You do your routine, you put your child to sleep. They fall asleep, and they stay asleep through the night. They’re better rested. They’re happier. They will listen to you better because they’re well rested, and everything falls into place a lot better when the child’s rested.

So even though it’s hard, do that favor for yourself, mom and dads that are listening, and give yourself that gift of better sleep for you and your child. 

So sleeplessinnola.com, I’m a pediatrician, and I focus specifically on the sleep needs of all children from birth through adolescence. Neurotypical, atypical, medical conditions, I do all of it.

 

Christina Kozik:

Awesome. That’s so great. That’s so great. Well, listeners and families that are listening, we will have a link to Dr. Vyas’s site in our show notes. And with that, I think we’re going to sign off.

 

Dr. Nilong Vyas:

Thank you so much for having me.

 

Christina Kozik:

Thank you for joining us.

 

Dr. Nilong Vyas:

I hope it makes a difference in somebody’s life.

 

Christina Kozik:

I think it will. I think it will. These are some great advice, and just a better understanding of how the whole process works I know will help people. I’m already thinking of some things that we could tweak in our own house after just this conversation. So yes.

 

Dr. Nilong Vyas:

Awesome.

 

Christina Kozik:

Thank you so much.

 

Dr. Nilong Vyas:

Of course.

 

Christina Kozik:

This podcast is hosted by me, Christina Kozik, for Exceptional Lives. You can subscribe and follow the podcast at our website, www.exceptionallives.org/justneedspodcast. Our website has hub articles, we have a disability services finder for Louisiana and Massachusetts, as well as blogs and podcast episodes for you to enjoy.

 

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