May 8, 2019
Parenting can be exhausting, especially if your kids aren’t sleeping well. How do you help your kids get the sleep they need? How do you get the sleep you need? Jen, Annie and Lauren discuss these important questions with Dr. Craig Canapari to get listeners and their kids on their way to better sleep.
What you’ll hear in this episode:
It's Never Too Late to Sleep Train: The Low Stress Way To High Quality Seep for Babies, Kids and Parents - Link when available
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Annie: Welcome to Balance365 Life radio, a podcast that delivers honest conversations about food, fitness, weight, and wellness. I'm your host Annie Brees along with Jennifer Campbell and Lauren Koski. We are personal trainers, nutritionists and founders of Balanced 365. Together we coach thousands of women each day and are on a mission to help them feel healthy, happy, and confident in their bodies on their own terms. Join us here every week as we discuss hot topics pertaining to our physical, mental, and emotional well-being with amazing guests. Enjoy.
Annie: Welcome back to another episode of Balance365 Life radio. Before we dive into today's episode, I want to share with you a really sweet review left for us on iTunes. SPagan84 says, "I beg of you. This is what female need to hear. Annie, Jen and Lauren cover a lot of freaking rad topics. Women empowering one another, women evolving to be the best version of themselves and women learning to love themselves. This podcast is so much more than fitness and nutrition though they have a no bs approach to diet and fitness that applies to real life. I love, love, love the Balance365 life." Thank you so much to all of you who have taken the time to leave us a review on iTunes, we read every single one of them and they all mean so much to us. Alright, let me tell you about today's guest.
Annie: Dr. Canapari is the director of the Yale Pediatric Sleep Center, father and author of his first book, It's Never Too Late to Sleep train. Shortly after becoming a father, Dr. Canapari realized that all of his years of 36 hour hospital shifts didn't come close to preparing him for the sleep deprivation that comes with parenthood. Inside his book, Dr. Canapari helps parents harness the power of habit to chart a clear path to high quality sleep for them and their children. Sound familiar? On today's episode, Lauren, Jen, Dr. Canapari and myself discussed the importance of quality sleep for not just your children, but why it's so important for parents and caregivers as well. Plus he shares a ton of great insight on to how to improve sleep for your whole family regardless of age. Enjoy!
Annie: Welcome to the show. We have a special guest today. Jen, do you want to tell us how you met our special guest?
Jen: Sure. So this is Dr. Craig Canapari. Hello. I found his blog, it would be over four years ago now because I had, my third son was a nightmare between the hours of 7:00 PM and 7:00 AM and I had never experienced this before. My first two were natural sleepers and I was going out of my mind by the time he was one. And so one night it was late and I was googling anything and I came across his blog and I got some answers to my questions and I've followed him ever since.
Annie: Doctor, welcome to the show.
Dr. Canapari: Thank you for having me. And that's very kind. I wish I could actually see what time of night people are reading my site relative to time zone because I suspect it's probably mostly in the middle of the night.
Jen: It was probably 1130 for me and I was like crying and I just, yeah, so now I refer people to your site all the time as, like, an evidence based resource for um, parents whose children have sleep issues, which it's hard, you know, there's just so much. One thing that I will tell you that I appreciate and that I think a lot of our listeners might be able to listen to is that there's a lot of, I don't know if you want to call it pseudoscience or opinion based sleep recommendations online. And when I had my third, um, we lived in New Zealand and I, you know, they just, what I'll say is I was very wrapped up in the natural birthing community by the time I had my third and sleep training is just like "N-O" in that community. Like, your kid's going to get brain damage, they'll have neurological issues, attachment issues for life.
Jen: And so I really thought if I tried to intervene in my child sleep that I was going to give my child brain damage. And what happened is I pretty much got brain damage from that year of trying to deal with him. And I mean I literally felt crazy where I, when he was one, I pretty much had a nervous breakdown and was in therapy and I was a mess. And it was, like, my marriage was falling apart, everything. And it was all because of, I wouldn't say all, you know, nothing happens in a vacuum, but in hindsight now we're four or five years later, I'm like, that year of sleep was like, it made me crazy, like crazy and this stuff is serious and people don't take sleep seriously enough. But like there are some women and men out there that are really, really suffering and they don't know where to turn.
Dr. Canapari: Well, I think there's a, there's a lot of good points in what you're saying and the first thing is that I think that like sleep and bedtime are really personal things for people and, it's a totally separate issue, but you know, in our town, and you know, I've been involved locally, regionally, nationally with sleep issues for teenagers and trying to get more humane start times for teenagers. And there's something personal about bedtime and what happens in your house at night. So people aren't always open to advice. And I think there's also the thread of, it generates a lot of strong feelings for people and people have very strong opinions that aren't always grounded in facts. And I always laugh about the the idea that crying can damage your child's brain. I mean, my kids used to cry all the time over like the dumbest stuff.
Dr. Canapari: Like in the book I talk about my kid was four and found an ant on his donut and he was crying. And I'm like, I don't think it damaged his brain, you know? But I think we're also a little bit more vulnerable when we're sleep deprived that things that are, you know, if you stop for a moment, you're like, you know, I think it's reasonable for me to expect that I get a decent night of sleep my child does. But you're more vulnerable to kind of this judgment that can kind of come in and, and you guys know all this as moms too, I think that the whole sort of mommy shaming thing is real.
Jen: Yes. Yes.
Dr. Canapari: You know, my boys were both born via c sections and the first one was cause he, you know, he couldn't be born any other way. And I remember my wife talking about, you know, some people would say things that almost made her feel like she hadn't, you know, delivered my son.
Jen: Right. Like, are you mom enough?
Dr. Canapari: Yeah, totally. Totally, totally. So I think that it's not that everyone has to sleep train their child. It's not that you have to use cry it out sleep training and it's also that sleep training has such a negative valence in our society. People are like, "Oh, it's just cry it out. And it's just this thing that a lot of people view very negatively." There are lots of things you can do that don't necessarily mean that your child is going to cry more.
Jen: They are not talking about it publicly, but we're all googling it. It's one of those, like, it's become one of those secret underground things that we all want to do but we are afraid to admit it. I experienced this big time. I formula fed my first baby and um, that was horrific. I had a woman come up to me in the grocery store and ask me why he was drinking from a bottle. And it's just, yeah, like you, I've had three children and my youngest is now five and in hindsight I wish I could take all that pain away for new moms. Like I wish I could say, "Hey, it doesn't matter. Like, it really doesn't matter. Once they get up and going, you know, it's just, I can't tell the difference between my three kids who I sleep trained, who I didn't, who had formula, who had breast milk, who was born by epidural, who was born naturally. They're just, just choices that we make."
Dr. Canapari: And especially with the first child, it's so fraught. I remember one of the biggest fights that my wife and I ever had was about what stroller we were going to get. Right. You know, and, and, and you know, I wanted of course this really stupid technological thing that she didn't want. And with the second kid, you're like, "I want the cheapest stroller that I can fit in my car really easily." It's just, you get a little bit more perspective, but I think you're totally right. Like as a parent, you kind of need to give yourself permission to be like, you know what, I'm going to do something a little bit different from some of my peers and it's okay.
Jen: Yeah. In the end, you, you need to be okay. And I guess that was my greatest lesson from having postpartum depression, postpartum anxiety, and like, basically a nervous breakdown as I just talked about. I was not okay. In my pursuit of trying to find what was "the best" way to raise a child, I personally was not okay. And now I just believe so wholeheartedly that children need their parents to be okay and we'll and to be okay we'll all kind of make different choices in that pursuit.
Dr. Canapari: I think that things have kind of pendulumed away from self care for parents, especially moms. And, you know, when the term attachment parenting was coined, it was in the 60s, and back then people were like, "Oh, if your child's crying, you should ignore them because otherwise you're going to spoil them." And clearly that's not true, right? It's natural to comfort your child. And, you know, there was a, uh, a lot of pioneering work done by a woman named Mary Ainsworth that sort of showed that, well, that's not correct and it's okay to comfort your child and be emotionally available for your child. But when we think of attachment parenting now, we often think of, you know, Sears and everything that's kind of come out of Sears' work.
And I agree with a lot of what Sears said is that like, you know, you should be close to your child and it's valuable to make time if you would like to breastfeed to make that a priority. But, you know, there's little room there for the needs of parents, especially moms in that conversation these days. And you know, I tell parents all the time, like, you know, it's okay to fix this for the reason that you're falling apart. Like, you're a better parent if you're not super sleep deprived and your child will benefit. You know, it's totally, you know, and that's kind of my job. They know it's the case, but they almost need someone to give them permission to make some changes.
Jen: And there's not, and you know there's like zero to 60 and then there's like level one, level two. Do you know what I mean? Like not, and I think it's scary to go from zero to 60 but you don't have to necessarily go to 60. There's interventions that can start here where you're comfortable and then you can assess from there.
Dr. Canapari: Totally. It's not a binary thing that like you're doing everything or nothing or they're perfect or it's terrible. It's usually somewhere in between.
Dr. Canapari: And we all know as parents, you figure some things out, you get your kids sleep the way they're going, and then all of a sudden another kids waking up at night or they get a cold or it's never going to be perfect.
Jen: Right. I feel like managing my kids sleep is like this ongoing thing that, you know, there's always something. So anyways, yeah, as long as we're all sleeping good enough, I'm okay.
Dr. Canapari: That's my goal. Have you heard the whole a good enough mother? Donald Winnicott was this psychiatrist and pediatrician in England in the 60s and he coined the term "being the good enough mother." And it's just the idea is like if you love your child and you do your best to take care of them, they're going to turn out fine. You just need to be good enough.
Dr. Canapari: And I, and I just love that idea. It's like, "Hey, look, it's not going to be perfect." And like so much of parenting now is, like, full contact and be like, I've got to get my two year old studying Mandarin or you know, they're not going to law school or something like that. And really it's just, you know, do your best. It's okay.
Annie: Doctor, before we get into some of the questions we have for you, can you tell our listeners a little bit about your book? I feel very special. Your team sent me, an unofficial an uncorrected proof that's not yet for sale. So I feel like VIP having this book here-
Dr. Canapari: It's full of typos.
Annie: You know what, that's great because I'm the world's worst proofreader. Lauren and Jen-
Jen: It makes us feel good enough.
Dr. Canapari: I just went through, I think the final proof and I still found a bunch of stuff and I'm like, "Oh," I'm like, I can barely read it anymore. I've read it like a thousand times. Oh, I'm sorry. Go.
Annie: I thought it was great. It's called, It's Never Too Late to Sleep Train: The Low Stress Way To High Quality Seep for Babies, Kids and Parents. And what I loved about it is that you have this little dedication right in the front of the book there to your wife and kids and it says "You're the reason I get out of bed in the morning, in the case of Teddy, often, literally." It's like you've lived this, like, it's not like you're just some doctor-
Dr. Canapari: I've been in the trenches.
Annie: Yeah. Which I appreciate. So can you tell us a little bit about the book? Like, when will it be for sale? Where can they find it? What's in it? Just give a little overview.
Dr. Canapari: So the book is coming out in May 9th and you know, just to backtrack a little bit, I started writing stuff for parents online, in 2012, back when I was over at Mass General in Boston with the idea of that, my background was in pulmonology. I trained in sleep medicine as well, but I used to do sleep apnea research and the behavior stuff was kinda new to me and I was like, you know, I'm going to start writing these articles for parents and it's going to be my way to master this material as well and to have resources if someone's in the office and I don't have time to go through everything and be like your go to my website, this is exactly what I think is important. And, you know, as going through this over time and kind of learning how to do this as a parent and as a doctor, I realized there's a lot of great sleep books out there, but I generally felt like a lot of them are pretty long.
Dr. Canapari: You know, I think Ferber's book, which is great, it's about 600 pages long and it covers things like narcolepsy in teenagers. And you know, if your one year old can't sleep, you probably don't care that much about that. And I also think that there's been a lot of new research since Weiss, Bluth and Ferber wrote their books that kind of, perhaps demystified this a little bit. And specifically looking at the psychology of habits, which is, you know, habits are such a hot phrase nowadays, right? There was the Charles Duhigg book, James Clear just came up with Atomic Habits. But just the idea of there is an underlying psychology that underlines all these automatic behaviors we have all the time. Right? Those fights we have with our kids, every day, that's a habitual behavior, right?
Dr. Canapari: So if you understand how that works, you can maybe tweak those behaviors to, for lack of a better word, to kind of use the power of these automatic behaviors to help rather than hinder you. So in the book we talk about if you want to change your own habit, and I bet you guys, in terms of what you do, talk a lot about habits with your client.
Jen: It's all we talk about.
Lauren: I have James Clear's book, like, literally right next to me.
Dr. Canapari: Yeah, no, I heard it's great. I haven't read it yet, but I've followed his stuff for a long time.
Jen: Yeah, he's good.
Annie: He's great.
Dr. Canapari: The difference is if you want to change a habit, you're going to change the behavior. You know, if we talk about the habit loop, you have a cue that triggers a behavior and you have a downstream consequence. And it loops around and around. Your child is not going to raise their hand and say, "Hey, you know, mom, you're super tired and I'm just going to stop getting up at 4:30 in the morning." Right? That's the behavior you want to change. So you have to think about what are the upstream things you can change and how can you change your own behavior in the way that you respond to what your child's doing to help to shape their behavior to what you want. So anyway, this book is my summary of the things that I've learned in my journey as a sleep doctor and as a parent. And, my specific focus is in a population that I think people don't focus on as much. Like there's a lot written about infancy and I think infant sleep training is actually really simple.
Dr. Canapari: It's not easy, but it's simple. And I cover that in the book. But also what do you do if your child's a little bit older? What do you do in a toddler or an early school age child where the, when we think about sleep training, we may think about cry it out. That's not going to work in a three or four year old. You know, it might work, but it would be horrible for parent and child. So what are other ways that you can change a child's behavior that really just aren't so unpleasant or scary for parents and kids?
Jen: The reason I found your blog was because my youngest son, no, this wasn't why I found your blog. I found your blog because of sleep aids, my son had a sleep aid and it was me. And, the second time I revisited your blog in detail that was helpful to me was that my youngest son has night terrors. And your, one of your sons had night terrors.
Dr. Canapari: Oh yeah. And now he sleepwalks too. We were just on a vacation with his cousins in the middle of the night, we found him just sitting on the toilet with his pants down, but not awake. And I'm like, his cousins found this pretty amusing as did we, yeah, he's 11. He found it less funny but-
Jen: Right. So yeah, I mean you really have been in the trenches and there isn't a lot of information once you move past the infant years. And so yeah, that was the second time your blog was very helpful to me, was seeing you had, you're not just talking about this, you had experienced night terrors with one of your sons and just the science around it and what, how you guys ended up dealing with it, which is now how I deal with it. And yeah, I mean that stuff is scary and very stressful for parents.
Dr. Canapari: Yeah. And I think that, in some of the things you guys have, with the topics today, just sort of talking about, sleep and sleep debt and I think of sleep as a, it's kind of a capstone skill for parents and families, right. If sleep is good, other things get easier. If sleep is bad, everything gets, everything gets worse.
Jen: So would you call it a skill? Cause I noticed, you know, you're not calling it a habit, you're are calling it a skill. So would you say learning to sleep as a skill?
Dr. Canapari: Well, I think yes. I think especially for, look, you said your two older children were good sleepers. Right?
Dr. Canapari: And, it just kind of came naturally to them and we all have experienced this as parents. Like, you know, my older son is a great sleeper, but when he was little, he was a picky eater and every child is good at some things and bad at other things. So, like, I think some kids sleeping comes naturally to them. Like self soothing, sleeping through the night is very easy. Other children need to need to be taught. And the way we call, sleep training is the process, the term we use to describe teaching our children to sleep independently with our help, either falling asleep or staying asleep. And it's funny, some of the research, one of my colleagues is doing at Yale now, Monica Ordway is, we're looking at sleep as a buffer for toxic stress. Like, you know, stress is, we all know what stresses, right? A little bit of stress as good. You want to study for an exam, you need to be a little bit stressed to do it. But being chronically stressed is, it can really cause harm to health. Like when your son wasn't sleeping for a year-
Jen: I ended up with a registered Dietitian who was amazing, but I had gone down the woo hole, which Lauren, my partner here pointed me out, with diet, but I mean I was breaking out so badly and I was like so inflamed and I thought it must be nutrition related. And there were a couple of people out there willing to tell me it was nutrition related. So it's cutting out all that stuff and it wasn't working. And I had, I did go see two GPs where one prescribed this cream that basically burned my face off. And the second one wanted to put me on the pill, which is fine, but I didn't think that I was like, "No, there's something, like this is not, this is very abnormal for me. I've never struggled with this." It's finally Lauren had said, you need to get to a registered dietitian.
Jen: And she sat down with me, went through what's happening in my life and was like, you need to get some sleep. Like you are so inflamed because your body is so stressed. And that ended up being what it was. It ended up being that when I buckled down and we kind of dealt with these issues with my son and actually what happened was my husband took him away to his parents for five nights cause he just needed to be away from me I think. And within three weeks my, everything was calm. My face was calmed down, starting to heal. Like, I would just wake up and look puffy, like when I was so sleep deprived, I wake up and look puffy and almost feel hungover and that all just, once I fixed our sleep issues, that all went away.
Dr. Canapari: I find that totally believable. And first of all, as a sidebar, how great to find a provider who looked at your whole set of issues and really like, there's no upside for a nutritionist to say "It's actually your sleep," right, financially.
Dr. Canapari: But I think I know, Annie, you work as a trainer, right?
Dr. Canapari: So I bet if your clients aren't getting results, you're probably like, how much sleep are you getting at night, right? Like you can't, you're not gonna you're, you're going to struggle with your weight if you're sleep deprived. You are, I mean, I know you guys wanted to talk about sleep debt. Sleep debt certainly is a real phenomenon. It's hard to measure biologically. It's not like you can do a blood test and say, "Oh, you have, you know, your level of this neurotransmitter is high, that means you're in this amount of sleep debt."
Dr. Canapari: But we know that it's a cumulative phenomenon and you can't really catch up on the weekends. Right. There was a study of teenagers, again, I know we're talking about moms and little kids here, but I think it's very interesting. This researcher named Dean Bebe had this fake summer school for kids that they were enrolled in as a research trial. And they'd have these classes that were kind of boring and they'd sleep deprive the kids for like six hours of sleep a night for two weeks. And they let them sleeping on the weekends. And what they found was every day their performance was getting worse. And if they did, in terms of how they were retaining material, in terms of their vigilance, et cetera, and if they got catch up sleep on the weekends, they got a little bit better, but they didn't get back to their baseline.
Dr. Canapari: So the next week they started off worse than they had in the beginning. So it just is going to keep snowballing. And the classic example is of a parent. I mean I think that there was a research trial published a couple years ago that said single moms are the most sleep deprived people in the United States, hands down, which I find totally believable, right?
Dr. Canapari: If you're working outside of the home, you're a single parent, you know, you are getting your kids to bed and then you have all the work of the household to do. It's just, it's nuts. And it's not like with airline pilots or bus drivers or something like that where we actually have rules saying, well, you have to sleep x amount to do your job. Nobody's, you know, nobody's looking over your shoulder as a parent and saying, "Hey, you know what, it's 10 o'clock, you know, I'll take it from here." Right.
Annie: Wouldn't that be nice?
Dr. Canapari: Yeah, it would be pretty cool.
Annie: That's actually, quite in line. You and I have talked over the phone before this podcast that we address sleep in Balance365 as one of, kind of the habit foundations or habit accelerators because we know, as people in the health and wellness industry that when you're tired, everything just seems harder.
Annie: So in terms of sleep debt, if you have a sleep deprived kid or adult, how can you get out of it? Like how-
Jen: I don't think we defined sleep debt either before we started talking about, so sleep debt Is what accumulates right? Once you go without sleep, you accumulate, you
owe sleep debt.
Dr. Canapari: Yes. Essentially. Essentially if you are consistently sleeping less than the amount of sleep you need, and we know for adults it's anywhere between seven and nine hours of sleep at night. Your sleep requirements might be a little bit different than mine. If you think back to before you had kids and you imagined f you went to bed at a certain time and you could wake up spontaneously without an alarm, that's about how much sleep you need. If you do that consistently over a couple of weeks, of course, none of us with children ever experience that. But it's if you are constantly getting less sleep than you need or your sleep is interrupted frequently as it is if we have a child that's sleeping poorly at home, you're developing sleep debt, which is just the biological imbalance.
Dr. Canapari: When you think about sleep it's sort of like breathing, eating healthy food, breathing clean air, drinking enough water. We know if we eat poorly, we feel worse. If we we're having too many calories, the wrong kinds of calories, but it's the same. It's the same deal with sleep and sleep is, it's very easy to shortchange sleep, right? You can't manufacture extra hours in the day. It's easy to stay up a little bit later and you know, either catch up on work, do your email, fold laundry or even just get caught in that cycle of say, binge watching or something like that. Because we're surrounded by these addictive technologies that want to, you know, have our eyeballs instead of having us go to sleep.
Jen: And, and just to that point, I mean we do, we're human beings are amazingly resilient. So anyone can tolerate a couple nights of bad sleep or a couple of nights of not great eating habits. It's really what we're doing day in and day out, week to month to yearly, right?
Dr. Canapari: Right you can catch up to a degree on weekends, but again, most parents don't have that luxury. I think that the real key is, look, some people have weeks, months, years of sleep debt, the key is just going forward. How are you going to change your life to allow you to start getting caught up on that? And I think even if it's just allowing yourself to get an amount of sleep so you feel rested in the morning. In my clinic, we look at an incremental gains, right? Like if someone's going to sleep at midnight every night, again, I deal with a lot of teenagers who are sleep deprived. I don't want immediately go and be like, well, you should go to bed at eight o'clock night.
We sort of start seeing, well, what, what can we do to get you to sleep at 1130 or 11? Like getting those small incremental gains are going to make someone feel better and be more successful even if it's not perfect. And it's likewise if you're working on your child's sleep issues, again, like little kids usually aren't that sleep deprived, right? Because they're going to make it up during the day. They're going to make it up in the car. They may have naps at preschool. They may nap great a preschool even if they refuse to now for you, which is a really frustrating phenomenon, right.
Lauren: That's happening to us right now.
Dr. Canapari: Yeah. And they're going to catch up but as parents we don't have that luxury, right? We can't take a nap. We need to be attentive when we're driving in the car, giving presentations at work or anything like that. When you get into older children, think later elementary school, middle school, high school, that's when those kids are going to have more difficulty catching up. The biggest reason to fix the problems in young children is to me, it's the benefit for the parents.
Jen: Right, right.
Annie: That's actually something you also addressed in your book, which I so appreciate as you have a section about what sleep training will do for you. You know, it's like it allows, it's like the snowball effect. As I said, everything's just seems harder when you're tired and all of a sudden when you're getting more rest, maybe you have more energy to get in a workout or have some extra time to go do Xyz or you're more productive at work or you're more efficient in the home or what, you know, whatever. It just seems to carry over and spill over into so many areas outside of the bed.
Jen: What happened with my youngest son, and if you think this is way off, Dr. Canapari, you can tell me to shut up. I had three kids in four years and then my last one was this terrible sleeper and then I ended up, you know with the doctor or with that dietitian telling me you need to get some sleep. Even though my acne started clearing up after three weeks of consistent sleep, I noticed that I didn't wake up feeling refreshed for about a year. Like it took like a year for me to feel like I was recovered from those years with the kids.
Dr. Canapari: So I think there's probably a lot of factors there, right. You know, working off a sleep debt is not something that happens easily, right. If perhaps your husband had said, I'm actually going to take all three of the kids for a month.
Dr. Canapari: You could've gotten caught up. But also, and excuse me for presuming you mentioned you were also struggling, struggling with some postpartum depression and that probably also could be factored into this as well.
Jen: And starting this business and you know, there is stress definitely in my life. And also let's go over that year, the kids would get sick and you know, it's not like I had a year of perfect sleep before I felt recovered, but I just remember at that one year mark going like suddenly realizing, "Oh my gosh, I'm waking up in the morning and I'm feeling, like, refreshed." Like, yeah. So it was just, I was just very tired for quite a while after even getting the sleep training and not that, you know, not that things didn't improve for me, right, just by getting better, right? We talk in Balance365, we have this saying called all or something and it's like, when will it ever be perfect? But you can always, you know, there's usually a better choice available to you. It doesn't have to be all or nothing and-
Dr. Canapari: Totally right.
Jen: So and we have a lot of women who talk about, you know, they're just so fried from work and parenting that the evenings feel like the only time they have for themselves, like get the kids in bed at, you know, say 7:30, 8 o'clock and then they stay up til midnight because it's the only time they have for themselves in their week. And they just, they're just like selfish with it. They just crave that alone time so badly. But, and I, we all deserve that. Like, I get it and we all deserve that. But just even saying, okay, well instead of four hours for yourself, can you take three, go to bed at 11 instead of midnight. That gives you something. Right.
Dr. Canapari: Well also, I mean, I think that if you can convince someone to get an extra hour of sleep at night, they're going to be like, "Oh, that is for me. Right?" Like getting that extra sleep is actually a really powerful tool I have to make my life better.
Dr. Canapari: And, you know, I certainly, you know, Annie and I were talking like, you know, to have finally developed an early morning exercise practice and now I just go to bed earlier cause I feel tired at like 10 o'clock at night and wow. You know, I used to stay up til like 1130 or 12 and I'm like, "Wow, I actually feel *inaudible*" and I'm like a sleep doctor, I should know this, right? It was very easy to stay up and like, you know, watch another show on TV or just kinda, you know, the time gets away from you when you're tired, right? You can just sort of be scrolling through Instagram or watching Netflix and all of a sudden you're like, "Holy crap, it's like 1145." Right. And I see parents where their young child is going to sleep at 11 or 12. It's more common than you'd think.
Dr. Canapari: And I'm always saying to people, I'm like, "Look, I love my kids, but I am so done with them by like 8:30 at night. You know, like, they need to go to their place and be on their own so I can, you know, my wife and I can unwind."
Jen: Right, right. Is there any truth to this fact that getting every hour of sleep you get before midnight is like two hours of sleep that you're getting after midnight? Is there any truth to that?
Dr. Canapari: I think that's probably, I haven't heard that. I would say that when it comes down to is, the fit of when you're sleeping versus when your body wants you to sleep.
Jen: Oh, okay.
Dr. Canapari: I don't know if you guys have ever heard the phrase social jetlag. It's something we think about a lot in teenagers, but it can happen a lot in I think mostly not parents cause we get up early on the weekends. But if you think back, I can think back to before I had kids, I had a weekday bedtime and wake time and a weekend wake time and bedtime and wake time, right.
Jen: So your weekends are maybe 2:00 AM to 10:00 AM.
Dr. Canapari: Exactly.
Jen: Yeah. Okay.
Dr. Canapari: So I'm sort of like, on the weekends I was living on California time and the weekdays, I was living in Boston time.
Dr. Canapari: And we know it's not just the duration of sleep, it's the quality of fit to what your natural body clock schedule is that has a lot to do with it. Like, we know that shift workers, even if they get adequate sleep, are more vulnerable to certain types of cancer, certain types of chronic disease because they're not sleeping at a time where their body really wants them to do it and, we know, you know, you probably know, we all know, are we more of a night owl or a morning lark? A lot of us as parents, we become morning larks because we have to, and there's actually, if you look up online, you can look up a morning-ness, this evening-ness questionnaire that will actually tell you where you fall on this continuum.
Dr. Canapari: You know, teenagers are, you know, kids are naturally kind of morning larks. Like most kids before puberty, they tend to want to go to sleep earlier. They want to get up earlier on average though there are exceptions. When they hit puberty, their sleep schedules shifts two or three hours later. So that is our, you know, in the, and that's when all of a sudden your kid that was going to sleep at eight o'clock, can't fall asleep till 11 o'clock at night and it's not just cause they're on snapchat or their smartphones and doing homework on the Chromebook. It's also just their natural biology. So I think that thing you're referring to is probably, you know, get to the idea of are people just not sleeping at a time when their body wants them to do it? That being said, most people are naturally, you know, I'd say if they go to bed between 10 or 11, get up between six or seven. Again, this sounds like a pipe dream for a lot of parents, right? But around there we'll probably feel pretty good.
Jen: Can you shift that too, so if you found yourself to be, I mean it may mean some of us are forced to because of our morning lark children, but I recently, I would have considered myself a night person but starting in November I started getting up at 5:30 in the morning just because it feels like the only I can exercise or on days I'm not working out. I can get some work done before my kids are up. I'm less distracted in the mornings that I am in the evenings for whatever reason. And I feel myself shifting where I'm like-
Dr. Canapari: It absolutely is something that you can shift. So generally, the levers you have to pull are, the most powerful one is light exposure. So light exposure in the evenings will tend to shift your body clock later and these are slow changes although it is always easier to stay up later, than go to bed earlier. Right.
Jen: Right, right.
Dr. Canapari: If you want to shift your sleep period earlier, you could probably go 10 or 15 minutes a night. If you wanted to shift your sleep later. Again, it's not usually what I'm trying to do in the clinic or what most parents are like, "Boy, I'd like to stay up three hours later and get up three hours later."
Dr. Canapari: But it's easier to go in that direction. So light exposure in the evenings is going to push your clock later and think about, well what's the light emitting device that we hold about 12 inches from our face?
Jen: Smartphone. Right.
Dr. Canapari: So smartphones will tend to push people's sleep schedules later. Evening exercise will also push it later.
Jen: Oh, okay.
Dr. Canapari: Conversely, exercising in the morning light exposures, the best is natural light exposure will move things earlier. So someone wants to get in the, you know, like you said, getting up earlier, exercise in the morning. If you can't exercise outside, that's great. Probably in Canada or Connecticut, we're not exercising with natural light in the morning at 5:30 in the morning cause it's still dark out and it's below freezing but those are really helpful things. In our clinic too, we use a lot of Melatonin. Melatonin in the early evenings will help shift people shift their schedules earlier as well. Certainly that's something someone wants to talk about with the doctor.
Jen: Right. If melatonin is right for them.
Dr. Canapari: Right.
Jen: Okay. So back to sleep training kids. I know we don't want to talk too much about infants cause that's not even, we just don't want to spend too much time there because actually our audience has a wide range of age of children. But when I think one of the most controversial things is when to start sleep training a baby.
Dr. Canapari: Sure. And I think that, you know, it's funny, there was a couple of years ago, there was an article in New York Times about a group in Tribeca, which is a very trendy neighborhood in Manhattan, was recommending the people sleep, train their kids at two months of age. And you know, they didn't publish anything on this, but they said they were getting good results. But I think that's a little bit too early. If you look at your average baby between four to six months of age, that's when they're going to start going for longer stretches of sleep at night. They're going to start to be able to fall asleep without being soothed by their parents at bedtime. So that implies to me that naturally speaking, they're evolving the capacity for longer periods of sleeping night.
Dr. Canapari: I would say for most parents, between four to six months is probably the sweet spot.
Dr. Canapari: But before then, you really, you know, the best thing to do is to soothe your baby to sleep, rock them, nurse them, give them a bottle, lay them down in a bed when they're asleep. Then around four to five months, that's when you can start trying to put your baby down drowsy but awake. And, if they fuss a little bit, that's okay. If they're screaming and yelling, maybe they're not quite ready from a biological standpoint. Right. It's, you know, the funny thing about when I had my second son is I'm like, "Oh, he's not exactly like the first one," which if you asked me intellectually I would've said, "Oh, of course they'll be different," but you expect your child to be this kind of the same. And, you know, and I say, parents just try putting them down drowsy but awake and see how it goes. If your child's hysterical, then wait a week or two and try again.
Jen: Right. Okay.
Dr. Canapari: If your child's sleeping through the night and you know, no matter what you do, you don't have to sleep train. Right. You know, it's not something you have to do. The reason you do it is so your child can fall asleep independently and stay asleep for the night so that we can get a good night of sleep.
Annie: So two and a half is maybe a little too old to be coddling to bed. Is that what you're saying?
Dr. Canapari: I mean, I think that it's fine if your child sleeps well at night, right? Like, you know, I always say like, if what you're doing is working, great, you don't have to change a thing. There's nothing, you know, sometimes I lay down with my kids at night at bedtime. My younger ones, like, will kick you out in five minutes. It was like, "That's great dad. You can go." As his words are, "I want to go to sleep in my own time." He doesn't even want me to see him setup his blankets and the older one wants me to stay a little bit longer. And I'm like, "Well, this is precious. He's 11. Pretty soon he's going to want nothing to do with me." So I'm happy to lie there. And I don't think there's anything wrong with it if your child is sleeping great and you're happy with how your child's sleeping, however, if you're not happy with how your child's sleeping, if you have to spend three of those precious hours in the evening laying with them to get them to fall asleep, if they need you multiple times during the night, then you may want to make a change.
Dr. Canapari: Right? But you don't have to change anything if you're happy with the arrangement. The same thing with bed sharing. If you have a family bed and it's going great, provided that you're observing safe sleep practices with an infant, more power to you, that's wonderful. But if you're not happy and if someone's not sleeping well, then you may need to make a change.
Annie: I want to keep the cuddles at bedtime and let her fall asleep on me. I don't want her waking up at night.
Jen: Yeah, that's what I like.
Annie: I want the best of both worlds.
Jen: But I think that's quite common. It's, so there's getting the child to sleep, you know, baby, toddler, child, what, how do you keep a child sleeping?
Dr. Canapari: Now that's the trick, right? So you know, I think it was actually, it was Richard Ferber, which came up with this idea of sleep onset associations. The idea that your child falls asleep under a certain set of circumstances, and then naturally, as he or she goes through the night, she wakes up at night. We've all experienced that. We may wake up at two or three in the morning, adjust our pillow rollover and go back to sleep. You may not even remember it if you're up for five minutes, but you know, as Ferber talks about in his book, if you woke up in another bedroom, you might be like, "What the Hell is going on?" And you might go investigate. So, it's hard to know what babies are thinking. But if your child falls asleep with you present and then goes through a natural awakening at night, she might need you to go back to sleep.
Dr. Canapari: That's why working on independent sleep at bedtime tends to make those nighttime awakenings go away. Because once your child is able to put herself to sleep, she can go back to sleep with a natural awakening. And this dovetails nicely with a phenomenon we've all seen. Your child will have three hours of the deepest sleep of the night, stage three sleep, slow wave sleep at the beginning of the night. So that's like if you're driving back from somewhere, your kid falls asleep. You can pick your kid up, change the diaper, put them in a bed, they don't wake up and that's about two or three hours of sleep.
But then, say you put your child to sleep at eight o'clock, you're getting to bed 11, all of a sudden you hear your kid calling for you, right. Because that's when they come out of that stage of sleep and they go through a period of REM sleep, REM sleep, or dream sleep clusters in the second half of the night. And it happens every two to three hours after 11 o'clock, that's when your child is going to wake up and request your presence.
Jen: That's exactly what's going on in my house. It starts around 11.
Dr. Canapari: Yeah, exactly. Just when you're getting the bad and you're lying-
Dr. Canapari: Maybe tonight's going to be different, right?
Lauren: Right. I remember that sense of dread. 11 o'clock.
Jen: And that's actually when my sons, my boys go to bed at about 7:30, between 7:30 and 8 and they go to bed really well independently. But when my son was having really intense night terrors, I could almost set my watch to it. It was around 10 30 or 11 when he would start screaming. But now he's not having his night terrors s just getting up and coming to find me. And you know, parents are too tired, you're too tired to take them back to the bed. So he crawls in bed with us and I'm not happy with that, but it just seems like our best option right now. And I think what I found, cause I had mentioned earlier, I found on your website to talk about sleep aids and I think I'm my son's sleep aid. Like it's me. It's actually, and when he goes to his grandparents' house, he does not wake up through the night. He sleeps all night. It doesn't go looking for anybody.
Dr. Canapari: Is it frustrating?
Jen: It's so frustrating.
Dr. Canapari: I guess you're doing it wrong. You know, I always like my parents applying like the finest seventies parenting techniques. No, when my kids are over there and I'm like, you know, I just, you know, give them like Coca Cola, like all the stuff that I'm like, I would never permit in my household and, you know, it's fine. But that is one of those things. And that's why I think one of the things in your outline, is I think is, I just want to get to is, is dividing sleep responsibilities in the household. If there's a two parent household, it's very important that both parents participate at bedtime. And, I can't tell you often I hear the story of you know, someone and it's, let's be real here, if it's a mom and a dad in the household, it's usually the mom coming in and saying, "Well, he'll only go asleep for me."
Dr. Canapari: And the dad may say, you know how dads are, "I can't do this. You know, you have to do it." And, you know, I think that best practice is at an early age, get both parents involved at bedtime. But if, you know, sometimes, as you said, sometimes mom needs to go out of town. Right? Like if you can't, if you leave town for a couple of days, guess what? The dad's gonna figure it out and your kid will figure out it as well. It's not like if you, you know, if you had to go away on a work trip, your child would not sleep for five days. Right? Like, that's just not how it works. And I think it's really important that any one of the household who is a caregiver helps.
Dr. Canapari: And, you know, I even give parents a script. I mean, I to say, you know, "I know we're both concerned about our son's sleep. I really need your help. You know, like, the doctor says you need to help at bedtime and I'm going to go out." You know, it's likewise in blended households, if parents are separated, like single parents, et cetera, it's very important that kids have the same set of rules and have consistency at both homes if there are sleep difficulties. This is the struggle for a lot of families. I mean, you know, many, you know, every parent wants the child to sleep well, but say they're at mom's house on the weekdays and on the weekends the Dad may let the kids stay up later, and just lie with them to go to sleep and that you know, that it's fine if things are going great but if things aren't going well it's really important that everyone who cares for the child get on the same page.
Jen: Right. And with the same routines.
Dr. Canapari: I mean it's not going to be the same in both households but as close to possible in terms of the timing, in terms of what you do and specifically in terms of is a parent there when the child falls asleep or not?
Annie: Right, right. Okay. Do you have any, I know you have a whole chapter in your book dedicated to sleep environment and location and I think there's probably a lot information in that chapter that could apply to adults in addition to kids. Do you have any, are there any like non negotiables are things that you would really encourage people to consider in their sleep environment?
Dr. Canapari: Oh man. I'd say getting the screens out of the bedroom and, I think there is, when I started working as a sleep doctor, when I finished my training in 2007, the big argument was does your kid have a TV in the bedroom or not? Right. That was what, you know, that was often the conversation. That's often the conversation I was having with families would be like, "You need to remove the television from your child's room because they're sleeping poorly." Nowadays it's not a conversation about television in the bedroom, it's about tablets, smartphones, et cetera. And we know these devices are corrosive to sleep, you know, as we were talking about earlier, the bright light can actually shift your biological clock later. We also know that these devices are profoundly addictive, right? Like Instagram doesn't make money if you're not looking at Instagram.
Jen: There's a lot of research put in to how to keep people there.
Dr. Canapari: The smartest psychologists in the world are in Silicon Valley trying to addict you to these services.
Dr. Canapari: Yeah. And, I encourage people to keep them out of their bedroom and really to be pretty strict. I love now on, what's the feature called on the iPhone? It's screen time.
Lauren: Screen time. Yeah.
Dr. Canapari: It's generally been a positive with my kids, except when I'm at work on a snow day, say, and they keep sending me messages to give them more screen time, but I think they kind of get it. And I also liked in my phone says at 10 o'clock being like, you know, it basically kind of shuts it down and I can bypass it. But taking that step being like, "Do I really need to keep scrolling through this right now?" You just need that little check and really ideally keeping the devices out of the home because, you know, I'm very careful about shutting off alarms on my phone. My wife has all these alerts on her phone. So if like something on the Guardian website, the UK goes off a news alert goes in the middle of the night, she gets an alarm and I'd be like, do we must we know what, what the queen said in the middle of the night? Sometimes I get up in the middle of the night and I turn off her phone.
Jen: So just getting all those alerts off notifications, like just-
Dr. Canapari: Yeah, if you can keep out of the room and if your kids are little, setting this example now will pay dividends when they get older. Right.
Jen: Yeah. My son, I did this as an incentive for them to get their butts going and get ready for school in the mornings. They are allowed to watch TV or play video games once they are ready for, ready to go for school. So that just got them go hustling. Right. So they could watch some TV before school and when it started they would, that meant 10 of TV before we had to leave for school. But I have found over the last year that it has increased because they're getting up earlier and I am not sure. I'm wondering if that's because there's some kind of habit or something built in where they're there, maybe start rousing a bit in the morning, but then all of a sudden it's like "TV, I can watch TV." And so it's, I didn't mean to, so there's, it's like they're sleeping less and I don't know if there's any science behind that, but I swear if I cut out TV in the morning, they'd sleep longer in the mornings.
Dr. Canapari: Well, I mean, how badly do you want to do that, right?
Jen: I don't know, I don't know if it's negotiable or not.
Dr. Canapari: In general, I like incentives for behaviors that are desirable and really getting kids ready in the morning are one of those situations where you have so little leverage, right?
Dr. Canapari: Like if your child, if your child is difficult in the morning, what is the outcome for them? You have to drive them to school. Like they know that they have you over a barrel. I think that maybe putting a limit on being like, well you know, here's the maximum amount of screen time you could get. But it is one of those things like as you go through the night, your sleep gets lighter and lighter. Right? That's why it's so much harder to get kids to stay asleep. Especially to do early morning awakenings than it is to get them to fall asleep. Both in terms of behavioral techniques and even, cause I see kids with sleep problems bad enough I write for prescriptions.
Dr. Canapari: Any medicine that can last long enough to keep a kid asleep in the morning is going to last too long. You just can't calibrate it that way. So I think that if your children are functioning well in the morning and going to sleep at a reasonable hour, they're getting enough sleep. I wouldn't worry too much about it unless it's disruptive. But if you feel like they're really struggling during the day, like if the teachers are giving you feedback or they're falling asleep on short car trips during the day, then maybe you want to think about a different incentive to get them going.
Annie: Right. Right.
Lauren: I'll say, Jen, something that we did with Elliot this year is she would wake up at like 4:00 AM and come in my room and wake me up. "Is it morning time yet?" Cause it's dark, you know, when she would wake up I'd be like, "No, go back to sleep." She'd come in at five. "Is it morning time yet?" So we got this little alarm clock thing that lights up green when it's morning.
Dr. Canapari: The "Is It Ok To Wake?" clock?
Dr. Canapari: Yeah. No, I think, I think that works really well. And, you know, it's, I think Andy alluded at the beginning, my younger son was, for a while, was a real early riser. I mean, I remember going to Disney World when he was like seven and taking him for walks so my older kid and wife could sleep until 6:30 in the morning, you know, like, I like the okay to wake clock and an older child to who can get it, you can be like, look, "You can get up and play in your room and read books."
Lauren: Yeah. She's five, so she's old enough to understand, you know.
Dr. Canapari: Yeah. I mean a two or three old is just going to roam, right. You know, but and that's the important thing too, you know, in terms of the sleep training conversation, it is very clear that sleep training, even cry it out sleep training is effective and it's safe. But the best study, looking at the safety of it, they were looking at things like that always gets trumpeted as side effects of sleep training, elevated cortisol levels at all, et cetera. It all was fine at the time where kids were age five and it really seemed like most kids were sleeping pretty well by age five, no matter what you do. There are exceptions to this, right. You know, I've explained this in my home, in my clinic certainly, but I think the message to parents is positive. Like address the problems you need to address for your sanity. If you're doing things that you know aren't quite best practices like lying with your two and a half year old until they fall asleep and they sometimes crawl in your bed at night but you can live with that, that's okay. Your child is going to be fine. If you are okay, if you can live with it, right? It's like parenting is an exercise in compromises. You can't potty train your kid and sleep train your kid and like you can't fix everything at once. So it's okay, pick a problem you want to work on and work on that. Let the other stuff slide you're going to be okay.
Annie: I think that's a wonderful message to wrap up on because it's like, it's very much in line with our program as well. Like, find what works for you and it's good enough. That's all the is really important. Even if it's not best practice, you know, the ideal or whatever it is.
Dr. Canapari: Well. Yeah, and I think that if, correct me if I'm wrong, I believe one of the focuses that you guys talk about with, is clients the right term?
Annie: Members, yeah.
Dr. Canapari: Your members is weight control, right? And I just want to leave with you with, I think that's something that's so important is we know that sleep curtailment is associated with increased appetite and increased weight gain. And, I just saw a great research talk showing that the hormonal reasons for this were different for in men and women. But the outcome is kind of the same, that if we sleep poorly, we accumulate more adipose tissue, more fat. We have more hedonic eating, craving for salty, sugary foods. So I think, and of course I'm biased, but for people that are struggling with their weight, improving their sleep is such a important thing to do. And if the way you do that as improving your child's sleep, think about that as another goal why this is worth your effort, right? If, we'd all like to, most of us, you know, want to maintain a healthy weight, and working on sleep is going to help people do that. So I think that's an important message even if your members don't have kids, working on their own sleep is going to be a really high yield thing for them to do in terms of their health.
Jen: Right, right. So like regular sleep will lead to more regulated eating, which leads to a stable regulated weight.
Dr. Canapari: Absolutely.
Annie: There's not much that more sleep wouldn't do good for people. I can't think of any, too many negative outcomes for more sleep.
Dr. Canapari: Yeah, no, absolutely. I think that most of us professionals, grownups, we're working on sleep debt, we need to chip away at it because it's going to help us be healthier, feel better, and you know, to kind of be the people we want to be.
Annie: Yeah. Thank you so much doctor. There's so much good information here. I can't, I think our listeners are just going to really, really appreciate this. And we will send links to go find your book because I'm sure by the time we release it will be out. So congrats on the book and thank you for joining us. We appreciate your time.
Dr. Canapari: Thanks guys. It was fun. And yeah, I'm sorry we didn't answer all the questions you sent me in advance, but I'd be happy to come talk to you guys again some time.
Annie: Yes. We'll have to have you back for sure. Okay.
Dr. Canapari: Take care.
Jen: Thank you.
Dr. Canapari: Bye guys.
Annie: This episode is brought to you by the Balance365 program. If you're ready to say goodbye to quick fixes and false promises and yes to building healthy habits and a life you're 100% in love with, then checkout Balance365.co to learn more.