Category Archives: Sleep

Sleep for School Success

Sleep_For_Success_Post_8_8_16It’s time for a new school year! Parents everywhere are gathering school supplies and buying new clothes, shoes, and back packs. Children are getting their well-child check-ups and vaccinations. Part of school preparation should be an evaluation of every child’s sleep.

There has been a lot of talk in the media lately about the importance of sleep as an integral part of maintaining a healthy lifestyle. Did you know that sleep is also critical to help children to achieve success in school?

Sleep and Learning
There are multiple studies that tell us that sleep is essential for learning. Sleep helps children to be able to concentrate better in school and helps them to be able to retain information better. Good sleep helps students with their decision-making, their ability to plan, and helps them to think critically.

How to Evaluate Sleep in Children
The first step in a sleep evaluation is to ask the simple question: “How is the child sleeping?” Signs of possible sleeping difficulties include:

  1. Restlessness during sleep
  2. Waking up during the night
  3. Kicking legs in sleep
  4. Excessive snoring
  5. Appearing “not rested” after sleeping at night
  6. Excessive sleepiness during the day

The Pediatric Epworth Sleepiness Scale
Daytime sleepiness may be a key indicator of sleeping problems at night. Parents and health care providers can use a very simple tool to help determine if a child is too sleepy during the day. The child is scored on a scale of 1-3 for each of the eight items on the tool. The score is totaled and, if the child scores a 10 or more, they are considered to be too sleepy. Children with high scores should be referred to their primary care provider or a sleep specialist for further evaluation. Here is an example:

Pediatric Epworth Sleepiness Scale

How likely is your child to doze off or fall asleep in the following situations, in contrast to feeling just tired?

Use the following scale to choose the most appropriate number for each situation:
0 = Would never doze or sleep
1 = Slight chance of dozing or sleeping
2 = Moderate chance of dozing or sleeping
3 = High chance of dozing or sleeping

_____ Sitting and reading
_____ Watching TV
_____ Sitting inactive in a public place
_____ Being a passenger in a motor vehicle without a break
_____ Lying down in the afternoon when circumstances permit
_____ Sitting and talking to someone
_____ Sitting quietly after lunch
_____ Doing homework or taking a test

Total score: __________

Reference: Johns MW. A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep 1991; 14(6):540-5.

Every child should be evaluated for sleeping problems at the beginning of each school year. Early identification of sleeping problems, with early treatment, can help children start the school year alert and ready to learn!

Tips for Summer Sleep

Tips_4_Summer_1I have a lot of patients that come through my practice who are on wonderful sleep schedules during the school year. Their parents and I worked really hard to make sure that there was a good sleep routine in place and that they were practicing excellent sleep hygiene practices. Their children’s sleep had improved dramatically and everybody was happy. That is, until school ended for the summer.

Remembering Summer Vacation
As a child, I remember that the most wonderful thing about summer vacation was the total lack of routine. It was great to be allowed to stay up past my regular bed time and to be allowed to sleep in as late as I wanted the next day. For some children, the freedom to set their own sleep and wake schedules is fine. For children with sleeping problems, it can be a disaster.

I could tell when things started to go awry with my patients. The phone calls started approximately 2 weeks after school ended. Patients who were previously going to sleep easily and sleeping the majority of the night uninterrupted, were now having problems settling down for the night and were having the return of night awakenings.

A Change in Habits
It takes about three weeks for a habit to form. It takes only a couple of nights of poor sleep and poor sleep habits to cause a major set back. It is now July and we are still fighting to re-establish the good sleep routines that we had previously worked so hard to put in place.

So, what happened? What caused my patients to suddenly regress to old sleep habits?

Tips_4_Summer_2Routine, Routine, Routine
The first thing was a change in routine. Anyone who helps families of children who are poor sleepers will tell you that the main treatment for sleeping problems is routine, routine, routine. When school ended and the child was allowed to sleep later in the mornings and to stay up later at night, it completely disrupted their sleep cycle.

In addition to changes in routine, families went on vacations or took trips out of town. Children were forced to sleep in different beds, they may have had to move back into the parent bed due to space constraints, and may have had to go without their comfort measures that they normally used to self-soothe themselves to sleep.

And then, there is the daylight issue. The sun is out much longer this time of year than it is during the school year. And we all know that sunlight turns off sleep hormones.

So, what do we do?

Getting Rid of those Summer Time Blues
I have been encouraging families to establish a “summer routine” for their children. Try to keep wake and bed times the same every day – even on weekends. This routine should even stay in place, as much as possible, on vacations and trips out of town. Families should try to keep the summer routine as reasonably close to the school routine as possible. A “reasonable” routine would be to wake up the child an hour or so later than when they would wake for school. Bed times should be scheduled similarly.

Tips_4_Summer_3Trips Out of Town
Trips out of town may take a little planning. Families should think about sleeping arrangements ahead of time. Is it possible for the child who took months to move out of the parent bed to have their own bed on vacation? Can they pack the lavender diffuser and white noise machine? Can they make sure that the child avoids caffeine sources and that they eat a snack high in tryptophan before bed? Can the family continue to turn off electronics (including the TV in the hotel room) 1-2 hours before bed?

Finally, if families have not done so, I ask them to install black out curtains on the windows in the child’s room. The less sunlight the child is exposed to toward the end of the day, the more likely they will have timely and adequate release of those crucial sleep hormones.

Unlearn Bad Habits
Depending on where families are located, school will be starting back in the next 4-8 weeks. It is time to unlearn bad habits and restart sleep training so that when school rolls around, children can hit the ground running. Families should take advantage of all that they have learned and put it to good use. A little planning for summer sleep is all that it takes!

For more information about your child’s sleep, please click here:

Snoozing Through School

Snooze_Post_6-9-16We all know how challenging it can be to make sure that our children have adequate sleep. Children have busy lives and quiet evenings at home are compromised by after school activities and homework. In addition, many children have poor sleep habits that contribute to their inability to fall asleep within a reasonable time and to stay asleep through the night.

Approximately 20-30% of all children have problems related to sleep. Although approximately 27% of school age children do not get enough sleep, school age children are known to receive the least amount of attention regarding evaluation of their sleep. In a classroom of 20 students, five or six students will have not slept well the night before. In a school with a student population of 300, over 80 students will have sleeping problems. That equates to a least four full classrooms of students who did not sleep well!

So, what is sleep? Sleep is a reversible state where a person disengages and has a lack of response to their environment. Sleep is characterized by reduced activity and specific positioning such as laying down with eyes closed. We all have different stages in our sleep. Sleep cycles alternate throughout the night and last 90-110 minutes. REM (rapid eye movement) sleep is “dream sleep” and occurs primarily in the second half of the night in children. REM is characterized by dreaming / nightmares, absent skeletal muscle tone, low body temperature, eye movements, muscle twitching, and facial grimacing. REM occurs within 70-100 minutes after sleep onset and lasts for 5 minutes.

Non-REM sleep occurs primarily in the first half of the night and consists of three stages. N1 sleep is the sleep/wake transition characterized by jerking muscle movements. N1 sleep lasts 30 seconds to 5 minutes. Children are easy to awaken from this stage.

N2 sleep is true sleep and lasts 5-25 minutes. Specific brain waves include sleep spindles and K-complexes. N3 sleep is deep sleep. Patients are very hard to awaken from this stage. N3 sleep lasts 30-45 minutes and is followed by a brief arousal before going into a lighter sleep stage. Activities that occur in non-REM sleep include sleep walking and night terrors.

Recommendations from the National Sleep Foundation are that school age children need at least 9-11 hours of sleep at night. Inadequate sleep results in problems with health and psychosocial well-being. Sleepy children in the classroom may show poor impulse control, low levels of motivation, poor emotional control, poor comprehension of material, and poor time management skills. In addition to potentially falling asleep in class, children may exhibit risk taking behavior regardless of consequences, have poor short term memory, display problems processing information, show chronic tardiness, and may have a lot of physical complaints. A sleepy child cannot possibly reach their maximum potential!

Sleep is essential for a child’s biological and psychological health. Slow wave deep sleep is necessary to restore the body and is required for optimal learning. Sleep is needed to release growth hormones and is necessary for memory consolidation. REM, or dreaming sleep, is needed for emotional memory processing and is essential for growth and development of the central nervous system.

Learning issues affected by sleep include: cognitive and academic functioning, problems remaining alert, difficulty concentrating, and decreased executive functioning skills (generating hypotheses, abstract reasoning, and information processing). Poor sleep also affects behavior and may cause interference with emotional operations. Inadequate sleep may increase depression, increase risk taking behavior, worsen a lack of emotional control, and cause anxiety, aggression, and hyperactivity. Insufficient sleep has also been shown to decrease optimism and self-esteem. Poor sleep can cause weight gain, slowed growth, and changes in immune responses.

Physiological factors that affect sleep include: sleep apnea (prolonged pauses in breathing at night), low iron stores, limbs moving too much at night, bedwetting, circadian rhythm (internal clock) problems, and chronic illnesses such as asthma, epilepsy, and pain. Environmental factors include demands from school, extracurricular activities, electronic socializing, electronic media use, work, and early school start times.

Schools are ideal settings to be used to screen children for sleeping problems and to promote sleep education. Quick assessment tools such as the Epworth Sleepiness Scale (modified pediatric version) or the BEARS Sleep Questionnaire can be quickly and easily administered at the beginning of the school year, or any time when sleep problems are suspected. Schools can also be instrumental in promoting sleep hygiene education and supporting later school start times for middle and high school students. We owe it to our children to help them to achieve a better night’s sleep. Sleep assessment and education in the schools is a great way to start.


Bananas_Post_5-20-16Greetings Sound Sleepers! In my last blog post “THE FOOD FACTOR, HOW TO EAT FOR A GOOD NIGHT’S SLEEP” we discussed foods that contain Magnesium, a mineral known for it’s function in allowing the body to relax it’s muscles.

One of the foods we discussed that was high in Magnesium was the BANANA! Did you know that the average Americans eats 27 Lbs of bananas per year according to the Chiquita Banana website?

Today I want to share with you an excellent and easy dessert that you and your child can enjoy an hour or so before bedtime that would be a great choice for someone who needs a little extra boost to help them to snooze! I call it Gloria’s Banana Pudding because I learned this simple recipe when, the summer I turned 15, I had the opportunity to spend 6 weeks in Guadalajara, Mexico with a host family. My host Mama, Gloria, would make this simple dish as dessert often and it became one of my “go to” healthy sweet tooth fixes!

bananas_1One ripe banana.
2 Tablespoons Greek Yogurt.
Crushed nuts (optional, but another great source of Magnesium).

bananas_2Peel and slice or break up banana. Put in your Tablespoons of Greek Yogurt and mash and blend with a fork.

bananas_3Sprinkle with crushed nuts and ENJOY! Isn’t it surprising how something so simple can taste so sweet? (This is also delicious frozen)

Be Well,


Sleep and Children with Autism

Autism_Post_4-28-16Children with autism may be faced with multiple challenges including problems with socialization, behavior, and learning. A common problem among children with autism is an inability to achieve restful sleep. Sleep problems are prevalent in the autistic population and can be a common complaint voiced by parents.

We know that sleep deprivation has a detrimental effect on children and their families. Problems sleeping have been linked to behavior problems in children as well as symptoms of attention -deficit/hyperactivity (ADHD). Poor sleep makes it difficult to concentrate in school and to perform executive functioning activities such as the ability to organize and plan. When children are not well-rested, they can have increased problems with other chronic conditions such as epilepsy, asthma, and diabetes. In addition, poor sleep has been associated with an increased risk of obesity.

Sleep problems in children can include a variety of problems with breathing, movement of arms and legs, inability to fall asleep and stay asleep, and sleep-related behaviors such as sleep walking, sleep talking, and teeth grinding. A difficult night of sleep makes it difficult for a child to achieve their maximum potential the next day. Sleep problems in children with autism may be especially severe and may require the help of a team of specialists dedicated to helping the child, and family, sleep better.

Autism_Post_4-28-16_2Approximately 70% of children with autism have problems sleeping. Outside factors in the world of the child with autism that may influence his or her inability to sleep include sensory sensitivities and disruptions in routine. Internal factors may include anxiety, an inability to settle down for the night, difficulty reading social cues, and an inability to regulate emotions. Physical factors in children with autism that may interfere with sleep include differences in the production and regulation of sleep hormones and sleep neurotransmitters (chemical messengers that help to transmit signals in the brain).

  • Are sleep problems common in children with autism? Yes
  • Is it OK for children to have poor sleep because they have autism? No
  • Is there anything that can be done to help children with autism to sleep better? Yes

The first step to getting children with autism to sleep better is to ask the question, “How is the child with autism sleeping?” Do they have difficulty falling asleep, staying asleep, or both? Are there symptoms of potential physical problems including snoring, pauses in breathing during sleep, restless sleep, sleeping in unusual positions, or kicking legs in sleep? If there is the potential for a physical problem related to sleep, the child should be evaluated by their primary care provider or a sleep specialist with consideration toward obtaining a sleep study.

Children with autism are children first. They have some of the same problems as unaffected children. Attention should be given to obtaining control of any underlying chronic conditions such as asthma, GE reflux, and diabetes. While sleep problems can make chronic conditions worse, chronic conditions can also make it difficult for the child to sleep well.

Sensory issues can affect the ability of the child with autism to settle down for the night. Bright lights, noises, textures of bed clothes and linens can all make it difficult for children to relax. Children with autism are often crave routine and have difficulty making transitions. The bedtime routine is critical. All sleep training strategies stress routine, routine, routine, and consistency, consistency, consistency. The bedtime routine should start approximately 1-2 hours before bed and proceed as close to the same way each night. This also helps the child learn the social cues associated with getting ready for bed: decreasing household activity, dimming house lights, taking a bath, brushing teeth, etc. If things are done in the same order, at the same time every night, the child will more likely realize that bed time is soon to follow.

Autism_Post_4-28-16_3Many children with autism use tablets, computers, and other electronic devices to self-soothe. Children may use these devices for multiple hours during the day and into the night. The use of electronics during the evening and night hours can interfere with sleep in a number of ways. First of all, if they are being used at night, the child is not giving their body the opportunity to go to sleep. Second, the light from electronic devices has been shown to interfere with the release of sleep hormones in the brain such as melatonin. Eliminating or limiting electronic devices in the evening and night for children with autism can be challenging. If decreasing screen time is an impossibility, efforts can be made to dim the screen light or the child can be encouraged to use special glasses that block blue light – the type of light that can interfere with sleep.

Children who are restless at night may benefit from weighted blankets or Lycra sheets to help them to settle down at night. If there are no sensitivities, white noise such as a fan or looping music may be helpful. Children without sensitivities to touch may benefit from a light massage or vibration to help them to settle down before bed.

Finally, there is the question about whether children with autism should be medicated for sleep. Medication should always be considered carefully, and should be only considered after examination of sleep hygiene and sleep training practices. In some instances, children with anxiety and hyperactivity that cannot be otherwise controlled may benefit from medication to help them to settle down for the night. In addition, differences in the production of sleep hormones and neurotransmitters in children with autism may require the need for sleep medications to help to address those conditions. Parents should discuss the need for sleep medications with their child’s medical provider.

Sleeping problems in children with autism can be due to multiple factors. However, it is not appropriate to assume that just because a child has autism that they should be unable to sleep. There are treatment methods that can be used to help children with autism to achieve restful, restorative sleep. Sleep should be an achievable goal for all children with autism and their families.

Ten Reasons Why Parents Should Evaluate Their Child’s Sleep


  1. Good sleep helps your child to do well in school

Children who are tired cannot concentrate and focus well in school. A good night’s sleep may help your child’s grades improve.

  1. Good sleep helps to improve your child’s behavior

Sleepy children may misbehave, have more emotional meltdowns, and be more easily irritated.

  1. Good sleep helps to keep your child’s weight under control

Poor sleep contributes to obesity. Too many of the hormones that contribute to weight gain are released when you don’t sleep well. Also, lack of sleep provides more opportunities to snack!

  1. Good sleep helps to keep your child’s chronic illnesses under control

Studies show that asthma, diabetes, seizures, and other chronic problems can worsen in children who do not sleep well.

  1. Good sleep helps to promote your child’s growth and development

Growth hormones are released during sleep. A good night’s sleep helps your child to be more alert and able to learn new skills.

  1. Poor sleep may look like ADHD or other behavior problems in children

Sleepy children may show signs of ADHD and have other behavior problems. Also, children with ADHD often have problems sleeping.

  1. One child with poor sleep can be disruptive to the entire family

When one child does not sleep well, often parents do not sleep well. Other siblings in the home may also be affected by an overly active, noisy environment at night.

  1. Poor sleep leads to missed days from work and school

Sleepy children have been shown to have increased tardiness to school and to miss more days from school. This affects the ability of parents to get to work and to be productive once there.

  1. Poor sleep can cause dental problems in your child

Children who are mouth breathers or tooth grinders can develop problems with their teeth over time.

  1. Good sleep is essential for your child’s health and well-being

A good night’s sleep is critical for the health of your child’s body, but also helps to promote feelings of wellness and good self-esteem.

Welcome To Our New Blog

Welcome to the new blog for Emerald Coast Pediatric Sleep Consultants! The purpose of this site is to inform parents, children, and health providers about healthy sleep and lifestyle habits that promote restful, restorative sleep.

At Emerald Coast Pediatric Sleep Consultants we believe that sleep impacts all aspects of a child’s health. Also, things in a child’s lifestyle directly impact their ability to sleep well. On this site there will be information about pediatric sleep disorders and methods to treat common sleeping problems in children. We will have articles about how to eat healthy, stress reduction, exercise, and relaxation techniques that can be used with the whole family.

My name is Sonia Smith. I am the owner and clinician at Emerald Coast Pediatric Sleep Consultants. I have been a pediatric nurse for 30 years and have been a Certified Pediatric Nurse Practitioner for 25 years. I have experience in primary care, pulmonology, emergency medicine, and neurology. I have been involved in the field of pediatric sleep medicine since 2010. I will receive my Doctor of Nursing Practice degree in May, 2016. I will be blogging on topics related to sleep medicine and sleep training for children.

I am very proud to have several guest bloggers who are experts in their fields who have offered to share their wisdom with you. Lorie Ward is a Certified Health Coach and will be blogging on nutrition and exercise topics related to sleep. Her goals are to help people improve their lifestyle choices to possibly reduce their need for medicine. Her areas of interest include food-healing, growing and preparing organic foods, and fitness.

Bree Conklin is a certified psychotherapist who will share with you topics about managing anxiety, stress, and behavior. Finally, Mary Dawn McRae is certified in Applied Behavior Analysis – a specialized approach to the treatment of behavior problems in children. We are grateful for their time and expertise.

We encourage you to check out our other multimedia sites for additional information and timely tips about sleep. The web site is Follow us on Facebook, Twitter, and Pinterest as well! We look forward to helping to improve your child’s sleep!