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I would just like to start by saying thank you very much to Rachel McGuiness for inviting me to present today. I feel in a very privileged position to be able to talk to you all about an area of research and science which I am incredibly passionate about. I would just like to start by telling you all a bit about myself, and what I do so I can set the scene!
My name is Hayley Moulding and I am a 3rd year PhD student studying at Cardiff University. I work within the MRC Centre for Neuropsychiatric Genetics and Genomics which I think is hard enough to say if English is your first language! My scientific career if you like started at the University of Bristol, just over the Bristol channel in England where I studied Biochemistry with Study in Industry. So I am not entirely sure how familiar you all are with the sandwich degree course. In my third year of my degree I chose to do a placement year where I went to work in a Dementia Research Lab for a year to gain re-life laboratory experience. I graduated from my degree in 2014. From that, I decided that Biochemistry wasn’t really the path I wanted to pursue, but research still was, so I decided that I wanted to go more into psychiatry and investigating genetics and their role relating to the brain. I was very fortunate to be taken onto the MRC Clinical Neuropsychiatric Genetics PhD course at Cardiff University where for my first year, I got to try out 3 different projects. I then got to choose what project I wanted to continue on for my PhD for the next 3 years. This turned out to be my PhD which looks at sleep disturbances in children and adolescents with 22q11.2 deletion syndrome. So 22q11.2 deletion syndrome, just to give a bit of context but I won’t focus on this, is a genetic syndrome which is characterised by a missing section of the 22nd chromosome – an area of that particular chromosome is missing in these individuals and tends to increasing their risk for the development of multiple physical and psychiatric problems in childhood, adolescence and adulthood. The primary reason for why we study this syndrome is the 30% increased risk these children have for developing schizophrenia. Alongside this, in the children that I work with, around 67% of them will experience some type of sleep problem in their child/teenage years. This is where my focus and understanding of sleep comes from! I have worked in the field of sleep now for 2 years and everyday find it continuing to be fascinating and having real-life application. Not only do I work in looking at sleep in children with genetic syndromes and predisposed for psychiatric and developmental problems, but my sleep focus expands into the role of sleep in wellbeing in the general population, working namely with schools and young children to encourage and promote the importance of sleep, and thus why I am here today!
I work for a study called the ECHO Study. We work with children that have the rare genetic syndrome 22q11.2 deletion syndrome as I mentioned before. This syndrome is the second most common syndrome of its type after Down’s syndrome yet not many people have heard of this syndrome. It occurs in around 1 in 2000-4000 individuals. No one has ever looked at the role of sleep in these individuals despite it being a very common complaint in this population by both the parents regarding their own sleep, and the children themselves. I use electroencephalography or EEG to measure the brain activity of these children and adolescents to look at what their brain activity is like during sleep. The aim is to understand how their brain activity differs from the brain activity of their siblings which are unaffected by the syndrome. I can look at what the sleep looks like, how much of the sleep they are getting, whether it be continuous or disrupted, and how this relates to different psychiatric outcomes too. I used this net which produces a trace a little like the one on the right when recording brain activity. The net has 64 little electrodes which pick up brain activity which is basically just electrical activity. It measure the electrical activity after it has all been added together over different areas of the brain. So if you look at the net, you can see it covers the complete head and looking at the picture of me, you can see it comes right down to the eyes. This is important in sleep to be able to determine what stage of sleep you are in. Don’t worry, I will briefly explain the stages of sleep in a bit! If you look at the picture next to it, I have additional sensors that the children will wear. There are little sticky pads near the eyes which measure eye movement, sticky pads under the chin which measure chin movements. Sticky pads and electrodes under the collar bones which measure heart activity. There are also bands which wrap round the individuals chest and abdomen and can measure breathing. There is a nasal cannula which measures breathing and also a small little probe on the end of a finger which measures the amount of oxygen in the blood. If any of you have ever been in hospital, you probably have had a nasal cannula and had one of these little probes on the end of your finger. Ours are a lot more comfortable and not as painful!
So we can start with one very simple question – who can tell me what sleep is? These are the characteristics of sleep, but what do we actually do when we are sleeping. What is actually happening in our bodies and in our brain. I know Katie mentioned something on Monday about circadian rhythms. Hopefully you remembered that bit, but no worries if not. I am going to now touch on that slightly again.
Go through each stage of sleep on different slides – 1,2,3, REM – 4 extra slides This period of impaired consciousness where there is little to no response to anyone, anything or whatever in the environment is a well oiled machine. It works because there are two underlying systems which should work in synchrony with one another. However sometime, one can predominate. They are the homeostatic drive – which is how tired you are and how much tiredness accumulates over a day and the circadian drive which is your own body telling you that you need to sleep because of hormone levels, nutrient levels, external environmental levels like light and temperature. The homestatic drive literally meaning to stay the same, is dependent on what activities you have done during the day, what food you have eaten and what you have dosed your body with! If you have had caffieine like a cup of tea or a coffee, you are delaying this and messing with the homeostatic drive. But don’t think the circadian drive gets away with it. You are also messing with this. With caffeine in particular it will effect both how tired you become and think you are, and biologically how your body thinks you are tired wise, but it will also lead to a delay in your sleep onset. It will result in wakefulness. The circadian part of sleep will follow the lead of the homeostatic part. She goes ‘I am not sleepy yet.’ The circadian bit will do ‘Oh okay, well I was going to peak at around 9-10am for sleepiness, but you seem pretty adamant so you can over-rule me for a bit and keep me up! I will help fall asleep a bit later.’ Caffeine will actually reduce how much melatonin can be released too during the night. Also – Katie mentioned the master clock I think before in the brain. This is where it all goes down and keeps your body in sync. It regulates timings and processes for 24-hour rhythms in the body. We also dependent on light which is intrinsic to the circadian drive and keeps you awake and also when reduced can tend toward sleepiness and for you to go to sleep. We then have what stages sleep is actually composed of. There are 4 stages of sleep, of which three are in a thing called non-REM and one in REM. Don’t worry about that, just remember 3 are where your eyes don’t move, and one is where your eyes move!
Well that is the $1,000,000 question! Does anyone know why we sleep? There are multiple theories out there. Does anyone in the room have any theories you think why we might sleep?
Now this is a different questions. Why do we need sleep is something which research can definitively tell us. We know reasons for why we need to sleep. Maybe we don’t know the fundamental reason for why we do sleep, but we do know using medical research why we need it. The importance of sleep is clear for each and everything individual, but how does sleep differ over a lifetime, and does its importance change.
Child sleep is a major problem. The disruption, the blatant lack of care for it, not just from the child themselves but from the parent also needs to be addressed. So much so that the American Association for Sleep Medicine has provided actual guidelines for the amount of sleep that children and teenagers specifically should be getting. These are recommendations in a consensus statement they released specifically about sleep in children. I should add here, that the UK are not great with regards to having information and sleep medicine. We are severely lagging behind the Americans in our focus on sleep medicine. We have much fewer sleep medicine clinics, with their being 1 in Wales which is currently under review anyway and potentially to be shut down. A lot of the time this is due to the insurance policies and healthcare in America, whereas we don’t have this ‘suing’ world of medicine in the UK. However, America have it wrong for many things, but sleep medicine they have it right. Maybe sometimes it is taken too far, but they know this is an issue and there are hundreds of centres throughout America which focus on sleep medicine. There are potentially hundreds of sleep clinicians and researchers also in this field which means that any recommendations that come out are based on American resources and populations but are used to direct understanding about sleep medicine nonetheless.
We all know what we are like after a poor nights sleep. This can be exacerbated if this is maintained over a long period of time. If we constantly have a poor nights sleep, say everyday for a week we will become moody, unable to work properly, our behaviour will change, we wont be able to have the same relationships we have with people. We could cause some serious damage to ourselves or to someone else. The most car accidents occur around 4-6am when people should be asleep as this is the period of the day when we are biologically, as our bodys are telling us, that we should be asleep and most sleepy.
So, I was fortunate enough one day to get a phone call from Rachel McGuiness who invited me here today, to come into the school to talk about sleep to 8-9 years olds in year 2. I am a massive advocate for engagement and science discussion especially with children, so I jumped at the chance of being able to do this. I was very honoured to be ask, and was excited to be able to go into the school and talk to these children about sleep which is frankly one of my favourite topics to talk about! The challenge I faced however, so to be able to get the students engaged in sleep and get their attention. I wanted them to be able to take something home from the day other than thinking they had an exciting day of messing around. SO I wanted to explain to you a bit about what I did that day with the students.
Rachel provided me with the responses that were taken from the overall wellbeing questionnaire that were asked. From this I could gauge how the children were treating their sleep and see what the main problems were. I could then look at what needed to be addressed. The questions asked looked at how rested the children were in the morning. From these responses we could determine if there would be a daytime impact of this. Asking what time the children go to bed on a school night is also a good way to start to see whether they are getting enough sleep. We would have to ask about the wake timings also to determine the sleep durations though. Looking at screens in the bedroom also adds to the circadian impact of the children’s routines. Looking at the availability of the screens within the room can lead us to start looking at how much the children are playing on these screens and how much time is spent on these. Asking specifically whether these children play on their screens right up until bedtime is a great question to look at how the screen presence could contribute to delayed sleep onset and even circadian delay. Nonetheless, these questions might seem evidently associated with sleep and circadian control, but there were also other questions relating to sleep in an indirect manner. Questions regarding sports, food intake and healthy eating, family activities, emotional valence and confidence. All of these questions are intrinsically linked by sleep. Each of the different questions and outcomes could be modified by having a good nights sleep and sleep duration. Similarly, dependent on the outcomes of the questions, these could relate to having a good nights sleep. For instance, when asking about ‘I am able to recognise my feelings’ – having a better nights sleep could aid in emotional understanding. Similarly, if this individual is chronically sleeping less than they should, they would be at a higher risk for answering this question in a negative manner.
Rachel provided me with the responses that were taken from the overall wellbeing questionnaire that were asked. From this I could gauge how the children were treating their sleep and see what the main problems were. I could then look at what needed to be addressed. So, if Rachel doesn’t mind me reading these out, they found that around 87% of individuals had access to a screen in their own bedroom. I am not surprised by this number, yet it is still horrifying. I find this really troubling that at the age of 7-11 years old, there is direct access to a screen 24/7 hours a day in the bedroom. However, thinking back to when I was 11 years old, the only place where the computer would fit in my house was my room. So, I might now say how awful that is as I realise now as I am a sleep researcher, but I was bought up with having a computer in my room from the age of 11 years old. Before that, I didn’t have access to a computer. It was downstairs until then. However, this does highlight that this issue of having access to a screen isn’t as simple a removing it. If it is a phone, tablet or other form of technology which is easily removable, this could be done. However if this is a desktop computer, this creates more issues. Nonetheless, seeing that 64.7% of these children use this right up until going to sleep is astonishing. I will explain more about the role of blue-light in sleep, but I am sure a lot of you know already how important it is to have time allocated before bedtime to wind down and relax before sleeping. If you are constantly stimulated by blue-light, this will heightened wakefulness and delay the onset of sleep. We see that 45% of the children already go to bed after 9pm, and presumably depending on where they live and their mode of transport to school, they will be up by around 7am. I don’t have evidence of this yet, but I can presume it would be around that time. That means that these 7-11 years old are getting 10 hours sleep. If this is the case, then this is smack bang in the middle of what is recommended by the American Association for Sleep Medicine. However, this is probably not the actual time they go to sleep. The likelihood is that if these children are playing on blue-light screens right up to sleep, they will have more awakenings during the night. They might get to sleep at 9pm, but do they wake up more. Nonetheless, that isn’t as scary as the 5.3% of children who go to sleep after 11pm. This means that they will be getting around 8 hours sleep a night. For a child who is developing both physically and neurologically, this will have a detrimental impact on the attention at school, daytime sleepiness, enthusiasm and physical health also. 8 hours might be okay for some children, but for a small percentage. It might actually be that all of these children need less sleep. However, we cannot tell this without doing a larger study of what the behaviours are before sleep and bedtime, alongside the parental behaviours and what their activities are. So far, this does suggest that actually 55% of children do go to bed before 9 and would suggest that they are getting enough sleep. However, again, I do not know how often they wake up during the night, whether they have any nightmares or night terrors. These could easily be associated with different activities during the day. Especially if the blue-light screen is on a laptop or Xbox and they are playing age-inappropriate games which could lead to further disruption. Also, I have found in the past that parents tend to answer questions in a manner which might not be incriminating. I am not saying that this is for every parent at all. It is our best method of understanding child sleep. Asking parents is what we have. We just have to make sure we are aware of the problems that can occur with this.
What I did with the school? So after Rachel told me about the questionnaire they had done, and the focus on sleep, I went into the school to work with the students! I went in with my colleague Katie, who I think is also going to talk to you today. She is also a sleep researcher at Cardiff University who looks specifically at women with bipolar disorder and the effect of sleep on postpartum psychotic episodes. If anyone has watched Eastenders before and followed to story with Staccie after she had her baby, Katie looks at the role of sleep within this episodes. We discussed what sleep was and dispelled some myths about sleep. We then told the children some facts about sleep and talked about animals and how they sleep and how long then sleep for. We then discussed how the length of time you sleep can depend on your age, but also your preference for when you wake up and when you go to sleep isn’t solely dependent on your age. There are additional factors both genetic and environmental which contribute to this. That is when we decided to find out if they were larks, hummingbirds or owls! So I want to do the same with everyone here if that is okay. To break up the talking for a bit! So if everyone could stand up! What we are going to do is work out whether you tend to go to sleep earlier and wake earlier naturally or tend to go to bed and sleep a lot later and wake later naturally. So this has to be on a day where you don’t have to get up for work, and you don’t have any commitments and times where you have to be somewhere that day. This is a day off when you can do whatever you like! So, I will ask you all three questions, the same three questions I asked the children!
So just to give you a bit of background as to why I have either just labelled you a lark, hummingbird or an owl, looking at what your wake and sleep time preferences can reveal what your chronotype is. Now there is a very complicated and long winded equation that we can use to work out your actual chronotype and everyone&apos;s score, but I didn’t think that would be everyone’s cup of tea, so I have left it to just telling you what bird you are! Usually, you would have to answer a questionnaire which addresses both the work times and the weekend times. This looks at what your sleep behaviours are during the week when presumably you work, compared to times like the weekend where you might not have to go to work. From there, you can work out what your underlying biological rhythm and likelihood of falling asleep at particular times is. This is your chronotype. It is the wanting you have to fall asleep at a particular time of day. For those of you who are owls, you tend to go to bed later than the larks. You will wake later and sleep later. It might not mean that the duration of sleep is different. It just means that the times in which you go to sleep and wake up are different. It is important to remember that: the sleep duration could be exactly the same, it is just the timings. Circadian timing is based on the 24-hour day like I mentioned before. It is something you recognise around 11am when you feel most awake, and around 1-4pm where you feel pretty sleepy. If you don’t feel sleepy, you have the amount of sleep you get exactly right! Well done! Entrainment is a fancy word which means anything going on inside the body, biologically is aligned to your environment and 24-hour clock. It isn’t a coincidence that we sleep during the dark and we are wake during light. It is harder when the clocks change, and for those of us living in the UK at the moment, dark is 4pm. Obviously we can’t sleep them but biologically we should be starting to wind down and if we didn’t have the work commitments we do, we would sleep longer during winter!
So back to the day at Ysgol Bro Eirwg – I hope I pronounced that nearly correctly at least! In addition to teaching the pupils about what chronotype is and telling them about what birds they are aligned with, I explained how important sleep was to the brain and the body. I also had to teach them that the brain is always awake and never sleeps. It is responsible for sleep and thus must remain active during the day and the night to ensure that there is control and functionality in the rhythmicity of the day. Without activity in the brain, there would be no sleep as there would be no nothing. So enough of my talking, I decided I would do some activities with the children. We had pillowcases which I asked the children to draw their dreams on. They could take them home and wash these and use them, and it got them really talking about their dreams and how dreams were related to real-life sometimes. They found that fascinating. Also, another group made some blue-light blocking glasses. I will focus on the role of these in a couple of slides time, so please remember about these! All in all, I thought it was an unbelievably successful day and I have a brilliant time! I hope the pupils did too! So after this day, and having spoken to Rachel, we agreed that I would create a sleep diary prior to the day that I could then hand out to the pupils.
So I devised a sleep diary. It is shown in some of the grabs there on the left hand side of the screen. The aim of a sleep diary is to assess the sleep and wake timings of the individual. It is a subjective assessment of the sleep behaviours alongside the wake behaviours. In my PhD study, I use a sleep diary to complement an actigraphy watch. These watches are a bit like fit-bits and measure the activity of the individual wearing it during the daytime and night-time. Of course, we couldn’t really do this here and I didn’t have the funding too and the sleep diary is usually done for 2 weeks. Here, we did the sleep diary for 1 week. There was also no additional information gathered in this sleep diary either. Usually, I tend to ask the individuals about when they get into bed, when they try to go to sleep, when they go to sleep , when they wake and get out of bed. I did that here. However, I also ask about what they do during the day. I ask about caffeine consumption, I ask about exercise, medication use, whether it was a school day, and whether they did anything out of the ordinary. From this you can get a particularly good estimate of what the general routines are and their sleep-wake cycling. Due to time and resources, these sleep diaries simply looked at when the children when to bed, went to sleep as this is usually a very different time for most especially if they are reading or god forbid, playing on their phones! I then asked when they woke up and what time they got out of bed. From this I hope to be able to start to get a picture of the sleep behaviours and sleep durations in 8-9 years old in this particular school. I also included a bit of colouring in to make it a bit more exciting for them. I did receive some beautifully coloured in pieces of art with some extravagant patterns! I was intrigued to find out what this population would show. I am used to working with individuals that have multiple mental health and physical problems. I look at how their sleep patterns, behaviours and actual brain activity differs and how this related to their problems. Being able to look at a population where these factors aren’t confounding was a very interesting investigation.
So, the sleep diary, which was bilingual – someone translated it for me as unfortunately I am not a welsh speaker, was handed out to the children after the day and also Rachel make sure those who didn’t take one got one! Around 60 diaries were handed out to the children. All of them were either 8 or 9 years old and in year 4 at Primary School. I received 31 sleep diaries back – so a recall of around 50% really isn’t bad at all. That is actually okay! Especially as we depended on the children to take them back home themselves for us! However, those that were filled out completely and correctly to allow me to gather information and put together some graphs was a bit less than that. There were 24 completed. This was 77.4% of those I received back which is good! This meant even though my recall was low – I could at least have a look at doing some pretty graphs and commenting on what I found. Some of which were completed in welsh so that was another hurdle for me to translate! Anyway, I hoped that there would be parent involvement and their definitely was in the majority of sleep diaries that I received back. There were comments from parents and also you could tell from the writing that a parent completed it! Nice and tidy! This does suggest to me though many things which could be the reason why 1) we didn’t get them all back and 2) why they weren’t completed. It could be that the children didn’t give the sleep diaries to parents, or it could be that some parents just aren’t aware of the importance of sleep. It seems obvious to me maybe how important sleep is, but that is because I am in a world of sleep research. If I speak to my family and friends, there are some comments which prove to me that sleep is not a priority. This is what I believe we need to focus on and really hit home with. Sleep is fundamental to mental, physical and social wellbeing. Anyway, I digress! I put together the results I had from the
This is an example of the one of the neatest sheets! I thought it was pretty impressive! Don’t know if that is parent handwriting but I reckon it might not be! Rachel can tell me otherwise probably!!! I asked the students to complete the colouring aspect so it would make the whole activity a bit more exciting. If I can associated exciting and fun things with sleep then that will encourage further interest into sleep.
Looking through the n = 31 sleep diaries that were returned to me before the deadline, there were 24 of these which could be entered into a spreadsheet and analysed. The ones which were unable to be analysed were due to incompletion, or misunderstanding of the objective. Mainly, there wasn’t a full week recorded so I wouldn’t be able to make an assessment of the wake and sleep timings during the week compared to the weekend. Alongside this, I wouldn’t be able to use averages to determine whether there were any changes or differences in the individuals regarding the timings and sleep duration. From the 24 complete responses I had, I could look at the different parameters of sleep and wake. I had the time in bed, the time of sleep onset, the time of waking up, and the time out of bed. These are very different things. People think that the time in bed should be closely associated with the sleep onset however in most cases, especially teenagers and also in children, and in middle aged people, you will see that they go to bed maybe 30 mins-1 hour before their sleep onset. This is presumably related to reading in bed, or god forbid, they are playing on their phones and technology during that time. We all recognise though the at weekends the time between waking up and the time out of bed can be different. We have been told our lives that lie-ins are these luxurious things which we can have at weekends. Ideally, everyone would wake up and get out of bed straight away. This will allow for proper regulation and control of circadian timings. However, if we have a sleep debt, this will be harder and require a lot of effort. If we delay getting out of bed, it will encourage negative behaviours and time in bed associated with not sleeping also.
What did the data show me then. This graphs shows those individuals that slept for longest either during the week or the weekend. I saw that actually, there was a pretty equal spread across those who slept longer on weekdays against those who slept longer on weekends. Don’t be fooled by the graphs with the larger spaced scale. There are only 2 people in it. This is intriguing as this is not the same picture which I tend to see with teenagers and with adults. In this modern 24-hour world where there is constant working, and around the clock interaction, there tends to be an increased sleep duration at weekends to compensate for the business of the week, and the reduction of available sleep during the week. Here, with these children, it doesn’t seem like they have to massively compensate for a lack of sleep, which is reassuring. However, there are still 13 children which do sleep longer on the weekends.
So we can see that these pupils tend to wake earlier on weekdays when they are required to go to school. They tend to wake later on the weekends, by around 40 minutes. You can also see that they go to sleep on average earlier on weekdays ready for the following school day. You can see that they go around 46 minutes later to sleep on weekends compared to weekdays. We have to remember that this is on average and as a result there will be variability within each of the individual sleep durations. That was shown on the previous slide where we actually see 13 children sleep longer on the weekend, whereas actually on average sleep duration is 4 minutes shorter in the total sample. This suggests that there are some extreme differences in sleep durations working to change the timings. On the graph, following on from the same colour scheme before, we see that the sleep durations in orange are for the weekdays and the blue are the weekend. There is great variability. Interestingly though, each of the points which are above or below each other, so the couples, are for that one particular individual so you can see paired data. There are some individuals with the one ringed in red that has great variability in the sleep timings with a substantial shorter sleep duration at the weekend. However looking at the individuals who are ringed in black, we can see there to be basically no variation and pretty much overlap. This does show that there is great variation in even children who are 8-9 years old. You have to remember as well that this does not take any additional socioeconomic factor into account either. We also don’t not what is resulting in the delay at the weekend – it could be sleep debt. However I see that in some instances, especially in the individual ringed in red, instead of the conventional longer sleep duration of the weekend, there is substantially less. This could show that there is more to do on these evenings, or more opportunity to do something even at the age of 8! I presume they aren’t going out out partying, but maybe this could be that parents are less strict and allow their children to stay up longer playing on Xbox’s or computer or interacting with friends online. However, on average we do see there is not much change, which would be considered good! We can’t ignore the individuals though who obviously have some discrepancies at weekends vs. weekdays.
We can determine on average that there isn’t a significant difference in the sleep duration during the week compared to the weekend. However, it needs to be reiterated that this is on average and there is great individual variability in some cases. We do see that the children tend to do to sleep later on weekends and wake up later on average. We have to remember, and I know I keep saying it, that there are individual differences and this pertains to the fact that sleep is a very individualised process which is dependent on the inherent underlying biological rhythms of the person. This will affect when they can sleep best, and wake best, alongside how long they can sleep for. There are people such as Margaret Thatcher and JFKennedy which were renowned for only sleeping for 4 hours a night. The likelihood that they actually did this and went throughout the day without having a nap is highly improbable. However, there will be individual which can have less sleep on average and maintain a constantly healthy life. This can also be seen throughout their life, so even as a child they may tend to sleep a lot less than there peers and function okay. What we have seen here doesn’t model what is seen in teenagers and adults. This is because, at puberty, circadian timing takes a great shift. We all know what it was like to be a teenager and I am sure that we know some teenagers! Teenagers get a bad reputation for being lazy and I am sure that there are some lazy ones out there. However, the going to sleep later, and waking up later is not an artefact of being lazy. It is a biologically dictated rhythm which results in the delay of sleep onset and wake. This however, is not aligned with school and college timings and can result in these teenagers having to wake up a lot earlier than they would biologically want to. This can then result in reduced functionality at school – poorer concentration, attention and performance. I don’t know if any of you have seen the data out there and the campaigns which are predominantly running in America but also here in the UK to certain school districts to delay the start times of school and college. The only problem with this is that yourselves, the teachers won’t have this biological requirement to sleep later and go to sleep later on average. Therefore, that is then causing disruption to your own circadian timings. It is a fine balance and difficult to determine what is best for all. Nonetheless, on average we can take from this that they are getting enough sleep.
However, there are many limitations to this and we need to be careful before celebrating that they are all sleeping like they should be! We haven’t looked at the distribution between gender. It might actually be the case that all of the individuals which sleep longer on the weekends are girls, or vice versa. We don’t know this. It would be important to find this out, and then explore what would be the reason for this, whether it be biological or as a result of particular activities. Age isn’t taken into account. We have 8-9 year olds but I don’t really know how old the children are specifically. I presume that there wouldn’t really be a great deal of variation in the sleep durations dependent on age, but we cannot completely rule this out yet. I don’t have any data relating to socioeconomic background. This is very important with regards to sleeping. The home, the parents, the area they live in, the bedroom they are sleeping in play monumental roles in determining how they individuals sleep and how long they sleep for. Parental sleeping habits and working patterns can play havoc with their children’s sleeping habits also. If there is a parent which works night shifts, this could encourage the children to want to be awake when they are and subsequently lead to their sleeping patterns being reversed. If a bedroom is shared between children, this could encourage delayed sleep onset also. If there is demand for the children to behave a particular way or to eat a particular way or time dependent on parents, this could impact sleep also. There are many different problems that could contribute to sleep behaviours and routine. The importance of knowing the sleep routine and the daytime activity of the individuals is great. I don’t know if all of the individuals which slept longer during the week and less at the weekend did this because at the weekends they are playing on the computers, X-boxes and playstations until 2 am but then still needing to get up at 8 the next day because they are told to or have to. I don’t fully understand the complete picture surrounding each of the individual sleep habits. If this were to be taken on, we would need to collect a lot more data to understand how the sleep is associated with daytime activities. Nonetheless, there is great scope for investigation and understanding of sleep behaviours. The importance of sleep needs to be understood from a young age and how it interacts with every other aspect of life needs to be something we discuss and is in the common domain of debate.
I keep throwing this around saying this phrase without explaining it. I just wanted to tell you a bit about what sleep debt means. Like any debt, you want to pay it back, or give back what you have ‘borrowed.’ During workdays, we tend to wake up earlier but we don’t tend to go to sleep earlier. We might intend on doing so, but it never seems to be the case once you get home, make dinner, sort the children or sort out anything, then go to sleep. We don’t treat sleep as a priority like it should be. We start to accumulate this debt. We don’t sleep for long enough during the week because of our busy lives. So when we have a day off or the weekend comes and we don’t have anything to do, we tend to sleep for longer and to repay the sleep debt. We have compensatory sleep which means we then feel rested and make up for the absent sleep during the week. This is an awful habit and should not be promoted. We should try to go to sleep an wake up at the same time everyday regardless of whether it is a work day or a weekend. Whether you are on holiday or not. However, we have made lie-ins luxurious and people want to have these despite it completely messing up your sleep for the rest of the week and getting your biological clock out of sync. So, that is what happens in adults, but can children have sleep debt? Children tend to be able to play later on computers and X-boxes at the weekend. Parents tend to be more lenient when they don’t have to get up for school and concentrate. However, the evidence in the same we have here shows that actually children are sleeping less during the weekends – now this suggests that they have more to do and want to be up about and sleeping less where the typical adult is trying to sleep longer. It is as if there is a reversal in the sleep debt rebound. The children are actually sleeping longer during the week which suggests they are then compensating for their busy or tiresome weekends. Sleep debt tends to become more obvious when you become older and you have later activities to do, or you have a family. Especially if you are going against your chronotype. So if an owl needs to get up really early, but then still can’t get to sleep until about 4am, they are going to be chronically sleep deprived and on weekends and days off, they will crash to try and claw back the much earned lost sleep.
There are many different things that can cause an accumulation of sleep debt. The fact that we now live a 24-hour existence will little emphasis being put on sleep and people wanting to make their sleep more efficient, reducing the time they perceive as ‘wasted’ on sleep. Everyone is always busy! You ask anyone do they have time to do something else and the answer will probably be no. Business is a subjective thing also! One persons busy is very different from another persons busy. If you have a family, especially a young child this can lead to sleep deprivation and reduced sleep duration. This can mean that the average amount of sleep you should be getting is never actually achieved and as a result you continue to accumulate more sleep debt. As I said, people want to streamline their sleep. There isn’t enough knowledge about how important sleep is. This isn’t really anyone’s fault. It has been misconceived for centuries as laziness and something comparable to death. People frequently say ‘I will sleep when I am dead.’ The irony is, your mortality will reduce and increased risk of earlier death if you have less sleep all together. Habits like drinking alcohol late into the evening and eating late can cause fragmented sleep – this can lead to a reduced sleep duration over the time period. This will cause disruption to you 24-hour body clock. You need time to digest and relax before sleep. If you are focussing on digesting food, then it isn’t dedicated to sleep.
What are the symptoms of sleep debt accumulating? The presumption with incurring a sleep debt that this is as a result of sleep deprivation. That is usually a pretty accurate presumption to make. If you aren’t getting a enough sleep, you are sleep deprived, and if there needs to be more sleep, you need to pay back by getting more. Pay back your debt. So we could say that these are also the symptoms of sleep deprivation also. Physically, sleep is pivotal. If you don’t get enough sleep, the way you look, they way you feel, how healthy you are will take a hit. People say you need ‘beauty sleep’. This is true! Sleeping for the correct amount of time for your biological clock is imperative to look healthy and not have those bags under your eyes. Under your eyes is an area of skin which is incredibly thin. These are areas where water can be retained and cause puffiness if you haven’t had enough sleep, or you have slept in a room which is too hot, and not cooled down before sleeping. Diabetes risk is increased in those who do not sleep enough. The hormone insulin which controls blood sugar levels is controlled over the sleep period. If you do not sleep enough then you will not have proper regulation of the hormone and it could lead to dysfunction. Levels will not be able to dip and rise correctly which could tend to their being increased high levels. This is however associated with weight gain. For those people who do not sleep enough, their eating habits can continue into the night and they could increase calorific intake. At around 2am, this is one of the most metabolically active times for cells to be made. This is highly energy dependent and could encourage the need to eat more! Also, when sleep is deprived, the hormones associated with weight gain and metabolism are also not regulated properly. The two hormones grehlin and leptin are out of sync and can encourage elevated eating. Mental fatigue is also a big worry. Mental health problems are inherently linked to sleep issues. If we do not sleep enough, our ability to understand, problem solve and deduce what is happening day to day is reduced. If we are already predisposed to anxiety or elevation of mood, the sleeping can cause an increase in these symptoms. Sleep is very different in individuals who have anxiety and depression, alongside those with schizophrenia. Sleep is one of the first things that goes wrong, or can be one of the first signs that something is wrong. Ones ability to understand emotion, and to regulate emotion alongside empathising with others can be reduced when they are sleep deprived. There are heightened emotional responses and reduce rational and calm responses to situations.
This is the crème de la crème! I have spoken long enough about what sleep is and what we have found related to sleep, but this is what we can do something about. We need to!! The role of technology and its disastrous impact on sleep needs to be addressed. We all have laptops, tablets, phones and screens even TV’s in living rooms, but some of us also have these in the bedroom. Who here has TV in their room? Who watches this before they go to bed? The blue light is promoting activity in your brain. It is waking you up! Blue light, don’t get me wrong is pivotal for being a healthy individual. We need blue light in the morning to feel wide-awake and get the day underway. The high incidence of depression and suicide in countries such as Sweden and Norway is directly associated with the amount of darkness they are in during winter. They have insufficient blue light. Blue light is needed for mental and physical wellbeing. People with Seasonal Affective Disorder (or SAD) use blue light therapies in the morning to replace the absent blue light in winter. Blue light can help those of us who are owls to wake up early in the morning. If you are an owl but need to get up early, open your curtains straight away and stare out into the sunlight. Ideally go out in the sunlight and this will wake you up. The blue light is supressing a hormone we know as melatonin which I have mentioned before. We have elevated melatonin at night time when we want to sleep. It starts to increase in concentration around 3-4pm that is why we have a circadian dip and we start to become tired. We then have a second wind around 9pm where cortisol another hormone but now related to wakefulness it increasing slightly again. Anyway, blue light stimulated an area of the brain responsible for releasing cortisol and keeping us awake and active. If you are exposing yourself to this at night time, think of how much damage that is doing to delaying your sleep. People expect to be able to read their phones in bed, or play on their X-boxes right up until bedtime, then when they cant get straight to sleep they think something is wrong! Your brain hasn’t had time to chill out and wind down. Your body is still fully active and hasn’t had time to stop before the onslaught of sleep. Your body needs to go through a routine before it can sleep. This includes melatonin increasing, a slight decrease in core body temperature, which can be promoted by increasing it 2 hour before bedtime as well as not taking part in any over stimulatory activities.
This is what is really hitting the headlines nowadays. It is blue-light research. We lived for hundreds, thousands of years in darkness when the sun-set and light when the sun rose! However, with the invention and implementation of light bulbs first in Paris, the words became bright and lit! Nonetheless, back 100 years or so ago, the light bulbs we had we incandescent and yes, very bad for the environment which disposed of. However, with regards to our sleep, these light bulbs would be ideal! There emit a lot more red light than they do blue light. Take the turn of the millennia, the environmental impact of light bulbs became fashionable and within 10 years everywhere had blue-light emitting light bulbs, LEDs and bright bright light! Everywhere you look, outside and inside. The artificial light raining down on us during the wake hours isn’t so bad, but when this is still there after sunset and especially in the evening and night-time, this wreaks havoc with our sleep. We want to have blue light during the daytime to keep us alert and awake. The blue light as a I said before will keep us active and able to concentration and work best. However, when we want to get to sleep, blue light should be removed from our bedroom environments. All technology emitting blue light, and bright light bulbs should be off. We want t encourage filtering blue light and we can do this by using blue-light blocking devices. They aren’t completely reducing the impact of the blue light and its affect on your sleep however. Some of the light can still be seen and cause a delay in your hormone peak and sleep onset. However, they do ameliorate the problem. The issue is here, is that people think they can continue using their phones right up until sleep time because they have a blue-light filter on, or they are wearing red-filter glasses. They think this is enough to warrant being able to continue using their phones right up till sleep. This is still not okay! You are still being kept awake by the screen and the stimulatory output of the phone, whether it be news or social media. This is not a relaxing and calming activity before bedtime.
Not sleeping enough or having disturbed sleep can lead to chronic mental and physical health problems. There will be reduced educational attainment, social interaction, elevated physical health problems including diabetes and weight gain. Not sleeping enough, or not sleeping at the right time in teenagers especially who tend to become nocturnal and not sleep to the early hours can lead to significant weight gain. The hormones related to appetite and weight control and regulated during sleep. If there is short sleep, disrupted sleep or poor sleep at the wrong time of day, these can all lead to weight gain and potentially diabetes. Poor sleep is inherently associated with poor mental health. Sleep is a symptom of many problems such as anxiety, depression, schizophrenia and ADHD or autism. Taking care of sleep and respecting sleep can have a significant impact on your mental and physical wellbeing. In children who are growing both physically and neurologically, not having enough sleep or disrupting their sleep, creating bad sleep habits can cause an onslaught of problems at home and at school. It can lead to cognitive decline and thus poorer educational attainment. If your mental health is affected, it can lead to isolation and more problems with socialising and interacting with people.
We must all think with that then if we turned our phones, our tablets, our laptops, the playstation off, then we will be fine. So it turns out actually, even with having that technology in the room, teenagers have increased disturbed sleep. This has been shown to be as a result of the anticipation of social media or ‘fomo’ the fear of missing out. Teenagers especially and children have such a tehcnological and internet based life that when these functionalities are removed and they have to wait until the morning to see the latest tweet or see the latest post from their mates, this causes anxieties surrounding sleep. This anticipation can disrupt the onset of sleep and can lead to further sleep disruption. The initial disruption isn’t biological as with the increased blue light, but it can have detrimental biological affects from the impact on sleep.
For the sake of children and teenagers to be able to grow up fit and healthy without burden of physical and mental health problems, sleep needs to be talked about and looked at. It is fundamental to the mental, physical and social wellbeing of everyone, not just children. However, it is at the time of childhood and adolescent when we are forging our development and there are physical and neurological changes happening most. If we do not encourage children to sleep longer, to have better sleeping habits and to curb the obsession with a 24-hour world with blue light emitting devices left right and centre, they will never know any different. We will become a world of sleep deprived, ill, under achievers.
There are some very simple tips which can be used for both children and yourselves. Everyone should follow these tips to ensure that they get the best night sleep possible. So, the picture on the left shows a bedroom which is full of light, with the curtains open and light shining in. There is a light on by the bed, but no is trying to sleep in it, so that is absolutely fine. The bed looks unbelievably comfortable and spacious and ready to be slept in comfortably. There are absolutely no electronics in this room – no screens emitting blue light, no technology. This suggests that the owner of this room either doesn’t have any technology or the likelihood is that the technologies are somewhere else in the house. I understand that there isn’t enough room in some houses for this to be the case. Growing up, the only room for our computer was in my room which is of course no ideal but the only place it could be. It is trying to do whats best with the space you have ultimately. Additionally, there is sunlight in this room not just the artificial light of the lamp. This will ensure that your circadian rhythms which work on the 24-hour cycle, will be aligned to the environment and the sunlight. It is light during the day. This room is designed for sleep and comfort. Looking at the picture on the right – obviously you have to take it from me that this is the same room and not just a black square I have added to the slide to fool you! I would never do such a thing! Here we can see that the bedroom is in complete darkness. There is complete removal of light from the room. There is no glow in the room from artificial light. The complete darkness illustrates that it is dark outside and matches the environment. Also, if the complete darkness is maintained, if someone did need to sleep more during the day, such as shift-workers where they completely reverse their sleep-wake cycles, this would be ideal to re-align themselves to the new routine and cycling. That is a different talk for another time though to do with night shift workers!! This bedroom is ideal for the perfect sleep with the darkness being one of the strongest cues alongside light for controlling sleep/wake. We know from studies conducted by the National Sleep Foundation, which I must add is an American National Foundation, that 35% of Americans do not have shades or curtains in their bedrooms. This is obviously going to have a detrimental affect on their sleep-wake cycles. Some people believe they do not need the blinds, or because of expense do not bother. The problem is, they may have sleep problems which have occurred their entire lives if they have always lived like this and they don’t know how badly the light is affecting them as they have not tried to remove the additional light. I guarantee that some of this 35%, if blinds or curtains were added, they would have better nights sleep without even realising they needed one! I of course, can’t say this for everyone. Some people are super sleepers and have resilient sleep cycles even with light. This doesn’t mean that they should sleep with blinding light, it just means that potentially these cues do not interfere with the habits as much. I myself, need complete darkness now, but as a child could not sleep without the light on. I know now that was to do with my Mum always keeping the landing light on for safety and I formed an attachment to it as a child. This is how getting the right routine in place from an early age with children can have long lasting and beneficial impacts on sleep-wake cycling.
Thought I would illustrate how sleep is beautiful. No one can tell me that isn’t cute!
Sleep and Children's Development
The role of sleep in wellbeing
European Commission Office in Wales, Friday 2nd
WHO AM I?
• Graduated 2014 – Biochemistry with Study in Industry (BSc)
• Currently in the 3rd
year of my Medical Research Council
sponsored PhD studentship
• My PhD aims to ‘investigation sleep disturbances in children
and adolescents with 22q11.2 deletion syndrome.’
22Q11.2 DELETION SYNDROME
• Sleep in children with 22q11.2 deletion
syndrome relate to their mental health
• 25-30 X increased risk for schizophrenia;
~40% ADHD; ~35% autism; ~32% anxiety
• Around 67% of them will report at least one
sleep problem in their lifetime
• How does sleep relate to the mental health
HOW MUCH DO YOU KNOW
• On Wednesday, this was featured on BBC News.
• That’s how important sleep is!
• Let’s take a quick quiz!
• Don’t worry – I scored very poorly on it!!
WHAT IS SLEEP?
• A naturally recurring state involving both body and ‘mind’
• Reduced consciousness
• No response to things happening around you
• Closed eyes
• Reduced movement
• Lying down position
• Slower breathing
• Changing heart beat
• Change in blood sugar
WHAT IS SLEEP?
• Two very important parts of sleep:
• Homeostatic drive (meaning ‘staying the same’)
• Circadian drive (meaning ‘around a day’)
• Your brain controls this – master clock
• Light keeps your sleep/wake cycle going
• Non-Rapid Eye Movement Sleep
• Rapid Eye Movement Sleep
STAGE 1 NREM SLEEP
• This is your very light sleep – the
• It is the first stage you go into after
you close your eyes
• Someone could come and wake
you up and it is the time where you
will pretend you weren’t sleeping!
• It happens before deeper sleep
• Activity in your brain slowing down
STAGE 2 NREM SLEEP
• This is where we can look at learning
• Add knowledge
• If someone has learnt something new that
• Important for learning and memory
• Body moving about
STAGE 3 NREM SLEEP
• This is the deepest sleep
• Where memories are remembered
• Deep sleep helps you to remember what you need to
the next day, and forget the rubbish!
• Your body is able to move about
• Eyes aren’t really moving much
• Your brain is still working really hard – just slower!
• This is a stage a bit like being between sleep and
• This is when you dream
• You know just before you wake up, you have
really vivid dreams – REM!
• Your eyes are moving about
• Your body won’t move
WHY DO WE SLEEP?
• No one really knows!
2.Remove waste from the brain
IMPORTANCE OF SLEEP
• Mental wellbeing – mental health problems, talking about emotions, expressing
• Physical wellbeing
• Social wellbeing – good relationships
• Weight maintenance
• Cognitive performance – do well at school
• Avoid accidents – road accidents, Chernobyl, Challenger
HOW MUCH SLEEP DO WE NEED?
• Changes over a lifetime
• We need to maintain the
• Continuous sleep
• Issues at each point of life?
• Is there such thing as too
• Very common for children to have nightmares, night terrors, sleep walk
• Around 8% of children under 10 experience nightmares
• Up to 15% of children under 10 have experienced sleep walking
• Common problems
• Beliefs about sleep – problems with bedroom environment
• TV, films and tales about sleeping
• Parent routines
• Sleep isn’t exciting – apart from on Christmas Eve!
AMERICAN ASSOCIATION FOR
This should be done on a regular basis to promote optimal health.
•Infants aged 4-12 months should sleep 12 to 16 hours per 24 hours (including naps)
•Children aged 1-2 should sleep 11 to 14 hours per 24 hours (including naps)
•Children aged 3-5 should sleep 10 to 13 hours per 24 hours (including naps)
•Children aged 6-12 should sleep 9 to 12 hours per 24 hours
•Teenagers aged 13-18 should sleep 8 to 10 hours per 24 hours
THE IMPORTANCE OF A GOOD
NIGHT’S SLEEP FOR CHILDREN
• Children are growing – mentally, physically
• Increased rates of mental health reports in children
• Neurological changes
• Physical changes
• School pressures
SLEEP AND WELLBEING
• We all know what we are like after a bad nights sleep
• We are more emotional
• Our physical performance is poor
• We can’t concentrate
• Pay attention
• Forming words and speaking is harder!
• How to keep fit and healthy? Don’t do the Gwyneth Paltrow diet – sleep!!!
WHAT ABOUT CHILDREN WITH
• Children with behavioural problems tend to have
• Children with autism or ADHD have more trouble
getting to sleep and maintaining sleep
• They might wake up more during the night, or wake
up especially early and stay awake
• What about being tired and daytime sleepiness?
YSGOL BRO EIRWG
• Phone call from Rachel
• Mentioned Erasmus + and wellbeing
• Sleep questions in a main
• What could I do for them?
YSGOL BRO EIRWG -
• Conducted 22nd
• KS2 – year 3-5, ages 7-11 years old
• Looked at wellbeing generally
• There were 4-dedicated questions
surrounding sleep and circadian
YSGOL BRO EIRWG -
• Conducted 22nd
• KS2 – year 3-5, ages 7-11 years old
• 57% of respondents were female; 43% male
• 87.4% of respondents have access to a screen in their
• 64.7% use this right up until sleep-time at night
• 45% go to bed after 9pm
• 5.3% go to bed at or after 11pm
• Majority of pupils reported being tired at school
VISIT TO YSGOL BRO EIRWG
• Discussion about sleep is and what we do
when we are sleeping
• Are you a lark, a hummingbird or an owl?
• Dream pillowcases
• Blue-light blocking glasses
WHAT TIME DO YOU SLEEP BEST?
• Chrono – to mean ‘time’ in greek
• ‘Time’-type – how much an individual to sleep/wake at a particular time
dependent on their underlying 24-hour rhythms within a 24-hour day.
• Circadian timing
• Matching the environment
• Children different to adults?
YSGOL BRO EIRWG
• Discussion about sleep is and what we do
when we are sleeping
• Are you a lark, a hummingbird or an owl?
• Dream pillowcases
• Blue-light blocking glasses
• A sleep diary does what it says!
• Sleep and wake timings
• Duration of sleep during weekdays vs. duration
of sleep at weekends
• Do 8-9 year olds have lie-ins?
MY SAMPLE GROUP
• Sleep diaries given to ~60 children
• Aged 8-9 years old
• Year 2 at a Welsh primary school
• How many sleep diaries were returned?
• How many sleep diaries were completely filled in
• We had n = 24 complete responses which could be used
• From this I could look at
• The time in bed
• The time asleep
• The time awake
• The time out of bed
• Having these times I calculate:
• The sleep duration (weekdays) - individual and average across all
• The sleep duration (weekends) - individual and average across all
• I looked at sleep debt – was there recovery at the weekend?
• There were n = 11 individuals that
slept longer during the week than
they did at weekends
• There were n = 13 individuals that
slept longer at weekends than
during the week
• This is common for people to sleep
longer at weekends to compensate
for reduced sleep during the week.
• The difference is usually more
marked in adults who usually
accumulate a sleep debt.
DATA – WEEKEND VS. WEEKDAYS
• Average wake time – n =24 – 07:28
• Average sleep onset time – n =24 – 09:21
• Average sleep duration – n =24 – 10:06
• Average wake time – n =24 – 06:48
• Average sleep onset time – n =24 – 08:14
• Average sleep duration – n =24 – 10:10
WHAT DID WE LEARN?
• There is not much difference in wake time, sleep time or sleep duration on
average during the week vs. weekend in this group
• They go to sleep later at weekends, and wake up later on average
• Not much difference however
• There are individual differences
• This doesn’t model what teenagers do, and young adults mainly
• There is usually a sleep debt – this does suggest that these children are
getting the right amount of sleep ON AVERAGE!
• Gender wasn’t accounted for
• Age wasn’t truly accounted for
• Socioeconomic background was taken into account
• Parental sleep behaviours and times were not collected
• Additional information is needed .i.e. use of blue-light technologies
NO MATTER THE AGE, HOW MUCH
DEBT ARE YOU IN?
• Not where you’ve lost money, but loss of sleep!
• This is when the sleep duration is not enough
• You do not sleep enough during the week
• By the weekend or when you aren’t working, you sleep longer
• We say, “You are paying back your sleep debt!”
WHAT CAUSES SLEEP DEBT?
• Busy lives/working late
• Mistreating sleep
• Drinking/eating late
• Anything that prevents you from getting your average amount of sleep
WHAT ARE THE SYMPTOMS OF
• Physical fatigue – lifelong diseases such as diabetes?
• Weight gain
• Mental fatigue – lack of emotion, lack of concentration,
empathy, enthusiasm, mood swings
• Mental health problems
THE ROLE OF TECHNOLOGY
• Technology measures
• Technology ruins sleep –
especially in young
adults, adolescents and
• Control use of blue-light
BLUE LIGHT RESEARCH
• Blue-light blockers do work…but not completely!
• They *reduce* the impact of the blue-light!
• Use red-filters
• You can get apps for phones and
• You can wear some snazzy glasses which can do the trick!
HOW DOES TECHNOLOGY IMPACT
• It delays getting to sleep
• It can cause fragmented and disturbed sleep
• In the mornings, looking at your phone straight away can disrupt the
• This can lead to ill-health – mental and physical
EVEN TURNED-OFF TECHNOLOGY
CAN IMPACT SLEEP/WAKE
WHAT CAN BE DONE?
• We need to look after our sleep,
promote sleep health
• Educate children about the problems
with not getting enough sleep
• Sleep disorders are long-term problems
• Mental health problems, diabetes,
cancer, eye problems
SETTING THE SCENE
What should my bedroom look like during the day?
What should be bedroom look like during the night?
SLEEP IS BEAUTIFUL!
Creating a perfect sleep bedroom
Paediatric sleep guidelines
NHS – Better sleep
Thanks for keeping your eyes open!