Part IV
Family and Community Support



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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits Part IV Family and Community Support

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits 12 Supporting Your Teen When teenage patients come to my sleep center, they usually come with a parent. Most parents want to be part of the office visit both to hear what I have to say but also to tell me what’s going on at home. This, very often, includes the aggravation they’re having with their teens from trying to get them out of bed in the morning, battles they’re having over getting homework done at anything like a reasonable hour, struggles they’re going through trying to cope with grumpy, exhausted noncommunicators, and conflicts over bedtimes and falling grades. Most parents are concerned about what’s happening to their tired teens, but they’re not sure what the problems really are and don’t know how to solve them. That can lead to high-decibel control wars— and very unhappy kids and parents. Occasionally those control wars break out in my office. When I’m trying to gather information, the adolescent gives her view— sometimes slumped in the chair, grunting out a couple of words—and the parent provides his or her perspective—which the patient then contradicts and the parent repeats, well, let’s just say more firmly. This can go on and on until things get so heated that I have to call a timeout in order to sort out the facts and get everyone focused on working on the problems.

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits One Patient Says … “When you’re a teenager, everything your parents say or do sounds like they’re yelling at you. It’s not necessarily that their voices are raised—at least not in the beginning. It’s just that everything they say feels like they’re trying to change you. As a teenager you want to be independent. You don’t want anyone telling you what to do.” Parent-teen teamwork is key to helping adolescents get more and better sleep. While it’s ultimately the adolescent who has to deal with the results of the biological changes that are affecting her body, parents need to play a supporting role in helping that effort take place. Supporting—not fighting. Supporting—not micromanaging. We all need to understand that it’s impossible to make teens sleep just because we want them to or by trying to dictate their every move. It is possible, though, to make it more likely they’ll get the sleep they need by taking the following steps. Take the Problem Seriously As you now know, sleep deprivation is a serious problem—so it needs to be taken seriously. Though we all wish it were otherwise, it’s a problem that affects most teens and one that affects every aspect of their being. In a review of a number of studies on sleep deprivation, G. G. Alvarez and N. T. Ayas of the University of British Columbia and Vancouver General Hospital stated that “A healthy amount of sleep is paramount to leading a healthy and productive lifestyle” and that less than seven hours of sleep a night puts people “at an increased risk of all-cause mortality.” The researchers concluded that “sleep should not be considered a luxury.” The first step, then, to ending the sleep wars and helping your teen get more rest is to make sleep a priority for both your teen and your family, including younger children (getting them into good habits now can prevent problems later). Parents need to realize that their teen’s exhaustion and health and mood issues are not the result of a “bad stage” that she is going through and that the problem won’t go away

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits One Parent Says … “Parents need to come to grips with the fact that not getting enough sleep is really a problem. It’s not a figment of your imagination and it’s not a figment of your child’s. You can waste years thinking that your child is just going to snap out of it, but they don’t do that. As soon as you face up to the fact it makes a huge difference.” unless both they and their teen do something about it. The parents of patients I see say, without exception, that once they understood the problem and took it seriously, their kids started to do much better. So, parents, we need to wake up to our teens’ sleepiness. A huge 71 percent of parents of adolescents, according to the National Sleep Foundation’s 2006 Sleep in America poll, believe that their teen gets enough sleep every school night or almost every school night. Talk to Your Teen Communicating with your teen is critical as you work together to improve sleep habits. Begin by discussing all the changes of adolescence as well as the importance of sleep; you can use this book as a guide and suggest that your teen reads at least a few parts of it. Then keep talking as your teen develops a sleep program, works at making changes, has successes and failures, and reaps the benefits of sufficient sleep. While that’s going on, guide, support, and encourage without taking over— your teen needs to lead the charge and you need to step back into the role of first lieutenant. Establish the Ground Rules A close friend of mine used to spend his mornings trying to roust his teenage daughter out of bed for school. He would get up, use the bathroom, and then pound on his daughter’s door and yell, “Time to get up, Maria.” Then he’d head back to the bathroom and shave, and then pound on his daughter’s door again and yell again, “Time to get up, Maria.” And then he would get dressed and—you get the picture. Every morning before he left for work he made repeated attempts to get

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits Maria out of bed—and ended up angry and stressed when he finally faced an equally angry and stressed daughter before they both flew out the door. My friend called this mode of operation “integrated nagging.” I call it unconstructive, unpleasant, and unnecessary. I speak from experience. As I said in the introduction, my husband and I used to be continually on Elyssa’s case to get her out the door in the morning. It’s a terrible way for both parents and students to greet each day. A much better way to handle the start of the day, and other times that can erupt into harsh words, is to agree with your teen ahead of time on how you’re going to get through such times more calmly. As you talk about the changes that need to be made and as your teen develops a sleep program, set up some rules of engagement for keeping things under control: both what will happen in each circumstance— what the teen will do and what you and your spouse will do—and what is acceptable behavior. When I talk with teens and their parents during the first office visit, I challenge them to go home and quietly discuss what needs to be done and how they’re going to do it. For example, if getting their teen up and out in the morning has been an ongoing source of contention for them, I ask that the teen and the parents find a better way to handle it. I recommend that the family have this talk in the evening when the teen is awake, at her best, and perhaps even apologetic for obnoxious morning behavior. In Maria and her dad Louis’s case, instead of banging on Maria’s door every five minutes and yelling, Louis could tell Maria that he’ll knock on her door twice but no more—and that she still has to get to school on time. She could say that she won’t yell at him when he tries to wake her (she often yelled things she didn’t mean, and it was hard for him not to be offended) and that she’ll be responsible for getting to school on time. They both could agree not to hold a grudge against each other if the morning doesn’t go well. Figure out what your rules are going to be; drawing up a written contract is very helpful. Will you agree to knock on your teen’s door twice and then not anymore? Or would your teen prefer that you come

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits into the room and actually give her a little shake? Does your teen want you to back off completely and let her handle her sleep and wake-up times on her own? If your teen knows she can’t get up on her own, will she commit to not yelling at you if you agree to wake her up? (This may be very difficult for your teen, because teens roused from deep slow wave or REM sleep may be barely conscious and not remember later what they said; taping them when they wake up may give you credibility in the negotiations.) If late-night TV watching is a problem, will you both agree that your teen will lose her driving privileges for a week if she stays up until midnight watching? Both of you need to talk about your areas of contention and then clearly define what you’re both willing to commit to, what you won’t take (you don’t need to take any verbal abuse from your teen), and what will happen if things go awry. Then you’ve got to stick to your plan—which may take some biting of the tongue on your part. For example, if your teen stays up late watching television, you have to keep yourself from getting out of bed and going downstairs to admonish her to go to sleep. Instead, you have to calmly ask for her car key the next morning if no driving privileges was the agreed-upon consequence. If you think you’ll be tempted to make a nasty comment at some point, you might want to write down ahead of time the straightforward, unantagonistic words you’ll say. If things go well, you might also want to have a list at the ready of positive things you can say or have a reward system in place. One last point here: Sometimes it turns out that one parent is better able to deal with all the sleep issues than the other, so that person should be the one to take them on. For example, if you’re a very meticulous, very structured, very organized kind of person, a teen who straggles out in the morning at the last possible second looking a little Another Parent Says … “Talking over all the sore points and writing up an agreement ended all the pulling and pushing we were going through. I found I had to distance myself sometimes, which was hard, but I learned that that was much better than interfering too much because that just made Matt angry and rebellious.”

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits Another Parent Says … “Once we made the agreement, spelling everything out, I didn’t need to interfere. Alicia got herself up in the mornings, wore her light visor, and remembered to take her melatonin in the late afternoon. She’s managing her sleep problems and is pretty proud of herself. I’m thrilled to find out that she’s mature enough to handle everything on her own. I’m especially glad because she’ll be a good role model for my younger child Jake, who’s already starting to have a lot of trouble waking up in time for middle school.” less than pulled together may drive you batty, even if she’s actually fulfilling her part of the bargain. But if your spouse doesn’t get as upset, it may be best if he or she is the one to work with your teen. Sit down with your spouse and discuss if one or both of you will oversee the agreement. (If neither of you can deal with waking your teen up in the morning, you can arrange to use a wake-up service like Awake123 [www.wake123.com], MyCalls [www.mycalls.net], or Wakeupland [www.wakeupland.com] or ask someone who’s not as likely to get screamed at, like a grandparent, to do the honors. Or buy an incredibly loud alarm clock.) Don’t Be an Enabler Sticking to your agreement can take more than biting your tongue. It may also require that you change some of your habits. That’s because, without even realizing it, many of us are enabling our adolescents’ bad sleep habits and taking on ourselves the responsibility that should be theirs. My good friend Joan is a case in point. Every morning for months, Joan had driven her 14-year-old son Ira and her 16-year-old daughter Sarah to school because they couldn’t get themselves out of bed in time to make the school bus. Joan would call them and call them to get up, but they never would. Then, at the last minute, they’d drag themselves out but the bus would already have come. So, in her bathrobe, Joan ended up driving them to school every day. The whole thing was infuriating and making her a wreck.

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits When I heard this story, I counseled Joan that she needed to make an immediate change; her kids had shifted the responsibility for getting to school on time—which was theirs—onto her all-too-accepting shoulders. But before she did she needed to sit down with her kids and tell them what was going to happen. In a calm voice, she needed to say that she wasn’t going to drive them to school anymore, that they had alarm clocks, food in the kitchen, and a bus at their disposal and that they needed to make use of them. She also needed to tell them that if they missed the bus they would still have to get themselves to school on time, which would mean they would have to walk. Joan agreed. She knew it was the right thing to do and that she had to stop enabling her kids’ lack of responsibility. But she worried that her kids might suffer if they missed the bus again and she had to follow through. It was two miles from their home to school. And it was in the middle of winter, with temperatures in the 30s. I told her that walking a few miles would be great exercise for her kids, and if she worried they’d be cold she should suggest they wear gloves and hats. That night, Joan sat down with her kids. Without yelling or getting angry, she told them that from then on she expected them to take the bus to school every morning. She said she would no longer be available to drive them. If they missed the bus because they were late getting up, they would have to get to school on their own. Well, the next morning came, and guess what? Her kids rolled out of bed at the last minute as usual and asked her to drive them to school “just one more time.” But Joan held the line. She told them she wasn’t going to drive them, as she had warned, and recommended they wear gloves and hats for the walk to school. Her kids couldn’t believe it. They yelled, they pleaded, they told her she was a terrible mother for making her children walk to school in such cold weather. Her son, the major manipulator, even threatened to call Child Protective Services. Both kids were still protesting when they finally bundled up, slammed out the door, and headed down the driveway. But they walked. And they made it to school (Joan called the school to make sure). And from then on they woke up in time to take the bus; Joan never had to drive them to school again. By holding firm she

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits stopped playing her children’s game and started to receive their respect. TAKING A POSITIVE APPROACH It’s important not to be an enabler, but it’s also important not to take on sleep issues like a vendetta. The agreement you make with your teen does need to be enforced, but you don’t want it to be the cause of another war. If things don’t go well, it’s not necessary to rant and rave; the consequences that were established should simply go into effect. And if things do go well, some positive, reinforcing words will go far. You can even set up a reward system if you want. Whenever you can, it’s also a good idea to give your teen the benefit of the doubt. For example, if your agreement says she’ll wear the light visor for 20 minutes every morning, let her try going without it in the summer when she feels she gets more outdoor light and has less trouble waking up. For a lot of teens, especially those who have often had the way smoothed for them, it can be hard to take on sleep-related responsibilities. But teens really need to understand that they’re plenty old enough to take on the job of regulating their sleep-wake schedule and for being a responsible family member. As parents we should support them, but it’s not up to us to shoulder the entire load. We don’t need to try to wake them 20 times in the morning, we don’t need to stay up late putting together a school lunch the night before, we don’t need to wake up from our own sleep to make sure they didn’t fall asleep in front of the TV. If we do, we’re just enabling the continuation of their bad sleep habits and keeping our teens from growing up. A reality check of the dynamics in your household will help you see if some changes need to be made. Work to Change School Start Times One of the best ways you can support your teen is to join with other parents and local advocacy groups to have the schools in your area start later in the morning. The extra sleep teens would get would pro-

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits vide a wealth of health benefits, plus schools that have made the change report across-the-board learning improvement. For details on how you can help support this very important effort, see Chapter 13. Set a Good Example You know that old expression “The apple doesn’t fall far from the tree”? As you work with your teen to increase the amount of sleep she gets and to make improvements in all sleep-related parts of your teen’s life, it’s extremely important that you model good sleep habits yourself. Your teen might seem to pay absolutely no attention to you, and to care even less about what you’re doing, but, believe me, most teens watch carefully what their parents do—sometimes to jump on them, of course, but sometimes to learn, and mimic, the way things should be done. I bet your teen is no exception. So here are some pointers for being the best influence you can be on your teen’s effort to get more and better sleep. And there’s a bonus here: If you follow them, not only will you be a supportive, caring parent, but you’ll be helping yourself get a better night’s sleep too. Watch Your Night-Owl Behavior If you tend to stay up late most nights, watching TV, working, or just catching up on the things you didn’t get done during the day, your teen may think that it’s not that important for her to get to sleep by 11:00. Adults do need less sleep than adolescents, but we still should aim on getting eight hours (at the very least seven hours) and getting to sleep around 11:00 ourselves. Try giving yourself an earlier curfew, and think about turning the tables and asking your teen to help you out. When I say good-night to Elyssa, she says, “Good-night, Mom,” in a way that means “You, too.” Watch Your Own TV Watching I’ve talked a lot already about how bad an influence I think TV is on teens’ ability to fall asleep. Well, it’s not good for adults either. Many adults have a TV in their bedroom and can get caught up watching emotion-provoking shows before sleep or turn on the news for a

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits few minutes and end up involved in a two-hour movie. TV watching from bed can be great if you do it for just a short time, mainly to relax. But you might relax even more by following a quiet wind-down routine (see below). If you do want to watch TV before bed and your kids complain that they should be able to as well, let them know that, although you watch a bit, you’re already organized for the next day and always able to get to work on time. Wind Down Before Bed As it is for your teen, it’s a great idea to spend the last hour or so before bed disconnecting from the stresses of the day and getting relaxed before going to sleep. If you watch TV, keep the sound low and look for something nonviolent. Better yet, listen to music, read, or do some light stretching (see a suggested routine on page 170) or yoga. A household wind-down time will help everyone sleep better—and get along better too. Keep Caffeine and Alcohol to a Minimum If you want your teen to limit caffeine and avoid alcohol, it will help enormously for you to do likewise. If you get enough sleep, you won’t need that second—or third—cup of a.m. coffee to come alive. And you definitely should avoid both coffee and tea at dinner and in the evening—they’ll only keep you awake. I also suggest limiting nighttime alcohol to a glass of wine with dinner. Alcohol can interrupt your sleep, especially in the early morning between 2:00 and 5:00 a.m. It can also rev up emotions when you’re trying to calm them down. Don’t Work in Your Bedroom Does it drive you crazy to walk into your teen’s room and see the bed covered with books, papers, clothes, and sports equipment? Do you wonder how your teen can relax and sleep with all that stuff everywhere? The same might be asked about you. While many adults like to get into bed to work on their laptops or pay bills, it turns the bedroom into a work and activity area instead of a place for relaxation and sleep. You can set a good example by doing your work at your desk or on the

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits dining room table and keeping your bedroom as a haven for relaxing and getting your ZZZZs. Don’t Overprogram Yourself If you’re stressed and not sleeping well, there’s a good chance that, like many of us, you’re completely overprogrammed. You work, raise your family, take care of your home and yard and pet, volunteer for several organizations, and on and on; there’s little time to breathe, let alone relax. Not only is that bad for you, it can be damaging to your kids as well. It can take away from family time and it can lead kids to think that being busy every minute of the day is normal and that they should do it too. And that, as you probably know from experience, can make you stressed and interrupt your sleep. As you work to support your teen, it may be a good idea to take a look at your own activity level. Then try to establish more realistic— and healthy—expectations for both of you. Increase Your Family Time As you take a look at your schedule, it may be a good time to consider how much time you, your spouse, and your kids spend as a family. If you’re not together much, it can be difficult to share values, have experiences that keep you close, and simply enjoy the pleasure of each other’s company. When home becomes a place just to coordinate Another Parent Says … “I work about nine hours a day, and then come home to making dinner, helping with homework, doing laundry, and paying bills. I also coach my daughter’s soccer team, help out at church, work in the yard, and volunteer at Recording for the Blind. When my daughter started showing signs of exhaustion, I realized she was as overcommitted as I was. She gets up at 5:30 in the morning to go to religious school, then has high school classes till 3:00, soccer practice from 4:00 to 6:00, then dinner, homework, and helping me with her younger brother. On the weekends she has games and works at the local movie theater at night.”

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits calendars, the richness of life can get squeezed out and stress and disconnection can squeeze in. It also becomes the norm for your children’s future families. To make room for family time, consider an all-house wind-down time. Listen to music together, play cards, or watch a relaxing video. Or set up a weekly family exercise time. Go for a run or a walk or work out on some home exercise equipment such as free weights or jump ropes. If your kids don’t get hysterical watching you, put on some music and dance. Also try to have at least a couple of meals a week as a family. IT’S A FACT Eating together isn’t just good for togetherness; it’s also good for health and nutrition. A recent study detailed in the Archives of Family Medicine noted that children who have regular meals with their family eat more fruits and vegetables and less fat and fewer fried foods. Follow Through I talked earlier about the need to stick to your agreement and to enforce the consequences if your teen doesn’t abide by the rules. But it’s also very important to make sure that the whole treatment package is carried out. Not long ago I saw a teen and his mom and recommended that the boy use a light visor in the morning and take melatonin in the late afternoon. At the follow-up visit a few weeks later, I asked the mom how the light treatments were going and she said, “Oh, we never got the visor. I didn’t think it was that important.” She never bought the visor and, surprise, surprise, her son’s severe sleep delay was just as bad as ever. Part of solving a sleep problem is taking the problem seriously. And part of taking things seriously is following through with treatment. Get a light visor if it’s needed. Get a watch with an alarm if your teen needs a reminder to take her melatonin. Remember to recharge the light visor if you take on that responsibility. Call the family to din-

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits ner earlier if that keeps your teen from having trouble falling asleep on a full stomach. Commit to doing everything you can do to put all the recommendations in this book, and any recommendations from your teen’s doctor, to work. Keep Your Own Sleep Log Keeping a log of your own sleep schedule and habits is a great way to see if you, like your teen, need to make a few changes. Do you routinely run a sleep deficit? Do you have trouble falling asleep most nights? Pinpointing any problems can get you on the road to solving them and give you some insight into what your teen is dealing with. You may also want to track how much caffeine and alcohol you take in and see what effect they’re having on your ability to sleep well. For helpful information, you might also want to keep a sleep log for your teen, whether or not she’s keeping one as well. Tracking all family members’ habits will give you insight into the family dynamic. Last but Not Least: Be Patient and Caring A little restraint and a lot of love will go a long way in helping your teen become healthier and happier—and encourage your teen, I hope, to be patient and caring with you!

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