PREGNANCY

Tips and Tricks from the Sleep Research Expert @ThatSleepDoc

In this episode of The Pulling Curls Podcast, host Hilary Erickson and guest Sujay, aka @thatsleepdoc, untangle the topic of sleep. They discuss sleep training, the effects of sleep deprivation, and tips for improving sleep hygiene. Sujay also shares advice on adjusting circadian rhythms and addressing common sleep issues such as restless leg syndrome and insomnia. Tune in for expert insights on improving sleep for both parents and children.

Find it here on Apple or Spotify Podcasts

Big thanks to our sponsor Family Routines — a lot of good sleep is a good routine, so check it out!

Today’s guest is Sujay Kansagra

Dr. Kansagra is a professor at Duke University Medical Center and double boarded in child neurology and sleep medicine. He is the author of “My Child Won’t Sleep”, a quick guide for sleep-deprived parents. Dr. Kansagra specializes in treating a variety of sleep disorders, including sleep apnea, insomnia, narcolepsy and parasomnias. He is currently doing research on novel technology that helps with insomnia in infants. He can be found on multiple social media platforms with the handle @ThatSleepDoc where nearly 200,000 people follow along for sleep advice.

Timestamps:

00:00 “Pregnancy, parenting tips, and sleep advice podcast.”
05:22 Sleep training helps babies learn to self-soothe.
08:16 Relaxation and technology before bedtime affect sleep.
12:01 Tips for teens: Eat, align with circadian rhythm.
14:17 Enjoy episode, prioritize sleep for you and baby.

Keypoints:

  1. Episode 218 of The Pulling Curls Podcast discusses sleep for both adults and babies, emphasizing the importance of quality sleep.
  2. Host Hilary introduces the guest, Sujay, aka @thatsleepdoc, a double board-certified doctor in child neurology and sleep medicine.
  3. They discuss various sleep training methods, debunking myths and shedding light on the research supporting their effectiveness and safety.
  4. They address the concern of whether sleep training ruins children, emphasizing that there is no evidence of harm to children and no long-term benefits or risks associated with sleep training.
  5. Sujay provides tips for improving sleep hygiene, including establishing a nighttime routine, avoiding substances that interfere with sleep, maintaining a comfortable sleep environment, and keeping a consistent sleep schedule.
  6. The concept of “revenge bedtime procrastination” is discussed, highlighting the tendency to sacrifice sleep for personal time in the evening and the need for lifestyle adjustments if poor sleep becomes a problem.
  7. Sujay shares insights into common sleep issues, such as restless leg syndrome, insomnia, and circadian rhythm disturbances, offering specific strategies for addressing them.
  8. Practical tips for adjusting circadian rhythms are provided, such as managing light exposure, meal timing, and, if necessary, using low-dose melatonin under professional guidance.
  9. Hilary shares her personal experience with implementing Sujay’s recommendations and how it positively impacted her sleep, emphasizing the significance of self-care for mothers and their sleep needs.
  10. The episode concludes with a reminder of the importance of sleep for both parents and babies, encouraging listeners to follow Sujay’s research-backed insights on social media for further guidance.

Producer: Drew Erickson

Transcript
[00:00:00.660] – Hilary Erickson

Hey, guys. Welcome back to the Pulling Curls Podcast. Today on episode 218, we are talking about sleep. Your sleep, your baby’s sleep, everybody’s sleeping. So let’s untangle it.

[00:00:11.540] – Hilary Erickson

Hi, I’m Hilary, a serial overcomplicator. I’m also a nurse, mom to three, and the curly head behind Pulling Curls and the pregnancy nurse. This podcast aims to help us stop overcomplicating things and remember how much easier it is to keep things simple. Let’s smooth out those snarls with Pregnancy and Parenting Untangled, The Pulling Curls Podcast.

[00:00:40.130] – Hilary Erickson

Before we get started, today’s show is sponsored by Family Routines. If you are looking to get into a good night time routine, it is so important to get into a good daytime routine. You can find family routines at pullingcurls.com, or you can find a link in the show notes. T

[00:00:54.920] – Hilary Erickson

oday’s guest, I found him on the TikTok. I was just scrolling through and I was like, Oh, my gosh, this guy has so much good sleep advice for babies and adults. I’m actually using tips, which you’re going to find out in this episode, that are actually starting to work in my own life, which is a big win for Hilary. On social media, he is @ThatSleepDoc. He is a double board-certified doctor in child neurology and sleep medicine, so super important. He is the research behind a lot of this children’s sleep research. He has also written a book called My Child Won’t Sleep. I wanted to introduce today’s guest, Sujay Kansagra. Hey, Sujay. Welcome to the Pulling Curls Podcast.

[00:01:32.570] – Sujay Kansagra

It’s great to be here. Thanks for having me.

[00:01:34.320] – Hilary Erickson

Oh, my gosh. I saw your TikTok. I saw the TikTok where you were like, somebody was saying, You need to look at the sleep research, and you were saying, I am the sleep research. I was like, Oh, yeah, this is who we need to have on the podcast because there are so many tired moms out there thinking that if their baby cries it out, they’re a horrible person.

[00:01:53.800] – Sujay Kansagra

Well, I’m happy to shed light on all the research that’s out there regarding sleep training and helping infants sleep and helping parents get better sleep.

[00:02:01.050] – Hilary Erickson

Yeah, because it’s so important. Research shows, in case anybody’s listening, that if you get more than 4 hours of sleep as a postpartum mom, you’re more likely to not have postpartum depression. I’m always up for trying to get more sleep for the moms out there.

[00:02:15.790] – Sujay Kansagra

I’ll also say that when it comes to sleep deprivation, we know that sleep is so important for everything that the body does, such that if you’re not getting the sleep you need, we know that it worsens almost every medical condition, psychiatric condition you can think of. It’s It’s a biological imperative. We have to sleep and try to get the best sleep we can. Yeah.

[00:02:35.250] – Hilary Erickson

Okay, so first question, Sujay, what do the studies show on if your baby were… If you’re using cry it out in some a method, are you ruining your kids?

[00:02:44.680] – Sujay Kansagra

The short answer is no, you’re not ruining your kids. The longer answer is there are four methods for sleep training that have some data to actually support them. That includes extinction, which is otherwise known as cry it out, which is a method that over time, even sleep physicians, we’ve kind of strayed away from, although it has data to prove its safety and efficacy.

[00:03:06.430] – Sujay Kansagra

The second method is graduated extinction, often known as the FURBR method or controlled crying. The third is camping out, and the fourth is scheduled awakenings. These are the four core methods that actually have data to support them. We actually have a practice parameter within our Academy of Sleep Medicine that goes through each of these.

[00:03:23.810] – Sujay Kansagra

When it comes to the data behind, are you hurting your children? Is it cortisol increasing, et cetera, et et cetera, there is a debate amongst the internet world, but amongst the medical world, there’s really no debate. There’s really no debate. I think it’s really important for people to understand this. People can say whatever they want on social media platforms. When it comes to the research behind sleep training, there is no real debate. The data shows that it’s effective, it’s safe, with clear short and medium term improvements, but no long term benefits or risks. So that’s  the summary.

[00:04:00.790] – Hilary Erickson

Yeah. Essentially, it’s not really helping the baby to sleep train. Is that what I’m sensing or hearing the last caveat?

[00:04:07.250] – Sujay Kansagra

It is.

[00:04:07.860] – Hilary Erickson

Okay.

[00:04:08.440] – Sujay Kansagra

No, so it is. We do think that short term, it helps with a variety of sleep metrics, depending on what you’re measuring. We do think that it helps with sleep continuity for children. But if you look five years out and say, Okay, let me see what the benefits and harms were of sleep training, and you look at a variety of categories, including sleep and sleep behavior and mood and anxiety, there doesn’t appear to be any difference amongst children that were sleep trained versus not sleep trained.

[00:04:33.720] – Sujay Kansagra

So that’s reassuring in two ways. One, people always talk about, Is this going to hurt my child, et cetera? The answer is no. There’s no data that it causes harm to children. The second is, Well, do I have to sleep-train? And the answer there is also no. And this is what I tell people. I said, It’s a personal decision. It’s an individual family decision. As a sleep physician, if I knew there were clear long-term improvements to say, The child is going to become an amazing sleeper for the rest of their in life, then I’d be a little bit more pushy and say, You really should try to sleep train your child if you’re having sleep issues.

[00:05:07.060] – Sujay Kansagra

That’s not the case either. It’s very much a personal decision.

[00:05:09.880] – Hilary Erickson

Yeah. Ultimately, that’s what I came down to just as a nurse. If you’re starting to lose your mind, then you might want to start about sleep training. If you’re loving what you’re doing right then, then keep loving what you’re doing right then.

[00:05:21.780] – Sujay Kansagra

100%. If it’s not broke, there’s no need to fix it. But I always tell families, especially once your child is older than four months, ideally closer to six months, if they’re having repetitive awakenings at night in which they need you to help transition them back to sleep because they haven’t developed that skill of being able to put themselves to sleep in the beginning of the night, that’s where sleep training can be beneficial.

[00:05:43.270] – Sujay Kansagra

It usually follows that pattern. It’s some caregiver assistance at the beginning of the night to help them fall asleep with multiple awakenings, which are totally normal. During these normal awakenings, the child can now not transition back to sleep because they’ve learned to become dependent on something in their environment. Typically a caregiver. The caregiver has to come back in, use that same intervention, help them fall asleep. This causes both the wakenings of the child, to the parent, and usually misery the next day. Yeah.

[00:06:11.430] – Hilary Erickson

Okay. I have not slept great since I had kids. I feel like they ruined me. Having teenagers has a whole new variety of sleep issues involved. But I was asking Sujay if he could recommend a few things just to help sleep in general for all of us, because I think moms, they’re always like, Oh, maybe that’s a menopause symptom. I was like, Great. I’m starting menopause at 40. What can we do? Just a few tips on helping our own sleep.

[00:06:40.790] – Sujay Kansagra

Absolutely. Well, I will start with what I consider the foundation for good sleep. Everybody talks about sleep hygiene, so let’s go through the core pillars of sleep hygiene. What is sleep hygiene? We talk about dental hygiene and personal hygiene. Well, sleep hygiene is essentially your behaviors and things in your environment that could hurt or help your sleep.

[00:06:58.210] – Sujay Kansagra

The core pillars, number one, Having a great night time routine. We talk about this for children, but it’s also important for adults. 20 to 30 minutes prior to bed, having a set of activities that are calm, relaxing, that you do in the same way every single night around the same time leading up to bed. And after these activities, are done, you should be in bed, ready to sleep. So having a great night time routine.

[00:07:18.710] – Sujay Kansagra

Number two is avoiding substances and things in the environment that can hurt your sleep. That includes alcohol, nicotine, caffeine. It includes bright light exposure because light tricks your brain into thinking it’s still daytime, so you decrease your natural melatonin. So these are all things that you want to avoid.

[00:07:33.720] – Sujay Kansagra

The third thing is having a comfortable, cool, quiet sleep environment. So the temperature we usually recommend is between 68 and 72 degrees. The body, when it falls asleep, in order to get into deep sleep, the body does tend to drop the temperature a little bit, core body temperature. So having a cool environment is important.

[00:07:51.900] – Sujay Kansagra

And the fourth part and the final part, is keeping your schedule the same. Ideally keeping your schedule the same, both weekdays and weekends, such that you’re giving your brain adequate sleep opportunity each night, according to what your body needs. Everybody is different, but according to what your body needs, giving your body that opportunity to sleep.

[00:08:10.520] – Hilary Erickson

Yeah, it’s a great thing. I think something, especially as moms, we’re like, I just want to get in that TikTok time before bed.

[00:08:16.500] – Sujay Kansagra

That’s right. Revenge, bedtime, procrastination. So your life is so busy during the day that you’re like, You know what? Now that I have this time to myself, I am going to spend it in the way that I want, even if it means giving up on some sleep. And this is challenging. It’s a problem even for me as a sleep physician. At the end of the night, saying, You know what? Maybe I’ll jump right back on my phone, check a couple of things. And so it does involve a bit of a lifestyle change.

[00:08:40.880] – Sujay Kansagra

And again, it depends on how much of a problem it is for you. If you’re able to get on your social media and scroll through some videos, turn off, fall asleep, and wake up refreshed in the morning, great. You don’t have a problem. But if it’s becoming challenging and sleep is an issue and you’re waking up multiple times, reaching back to your phone, that’s when you need to consider a potentially modification to your activities and habits at night.

[00:09:01.080] – Hilary Erickson

What is it called, revenge, night time?

[00:09:04.480] – Sujay Kansagra

Revenge bedtime procrastination. This is a fun common term that’s out there in the social media world. You’re taking revenge on everything that sucked your time up during the day and giving yourself some of that time back at night, unfortunately, at the harm of your own sleep time.

[00:09:20.110] – Hilary Erickson

Yeah, that’s amazing. Okay, any other tips?

[00:09:23.300] – Sujay Kansagra

Then it comes down to what’s causing sleep issues, and there are a variety of things. During pregnancy, one major thing that comes up is Restless Leg syndrome. Your child is getting lots of your iron supplies, and iron is an important co-factor when it comes to making dopamine in your brain. And dopamine is important, we think, in the pathophysiology of Restless Leg. So you really want to talk to your provider if you’re experiencing Restless Leg and that’s disrupting your sleep.

[00:09:49.460] – Sujay Kansagra

Many parents experience a classic form of insomnia in which the bed becomes a place where we think and we worry and not the place where we rest and relax. And that has a very specific treatment. I’m happy to go into some details there. Some people have a circadian rhythm issue in which their body, they’re natural night owls. And so if they’re expected to go to bed at 9:00 or 10:00, their brain just doesn’t want to shut off until noon or one o’clock. This is typical for our teenagers. We always blame electronic devices, but part of it is actually a natural brain physiology, where we tend to become night owls when we’re teenagers and young adults, but some people have it lifelong.

[00:10:27.510] – Sujay Kansagra

So lots of sleep disorders that come into play once you get past the core of just sleep hygiene.

[00:10:34.370] – Hilary Erickson

Okay, that’s fascinating. Any tips on adjusting your circadian rhythm if you, say, have to get to class? I’m looking at my kids in college.

[00:10:43.020] – Sujay Kansagra

Absolutely. Let’s talk about how you would advance your circadian rhythm, which means how would you train your body to wake up earlier and go to bed earlier? The main thing that actually tells your brain where to set your circadian rhythm is light exposure, a timing of light exposure. The core thing that I usually recommend my patients to do when they’re having a very delayed sleep schedule is you want to definitely avoid bright lights for 30 minutes before bed.

[00:11:10.120] – Sujay Kansagra

Then when you wake up in the morning, you want to get plenty of bright light. So opening up the windows and making sure you’re flooding your eyeballs with light, that tells your body, Hey, morning is here. I should be waking up now, and this should be my normal wake up-time. Over time, as long as you’re exposing your body to light at the right times, it will help you shift in the proper direction.

[00:11:33.270] – Sujay Kansagra

Now, for some people, that’s not enough. Just the timing of light exposure doesn’t do the trick. And that’s where for some of my patients, and this is where I advise your listeners to talk to their own providers, sometimes a very low dose of melatonin taken very early in the evening can also help adjust circadian rhythm.

[00:11:49.140] – Sujay Kansagra

That’s where it actually has good data to support it. Melatonin is not a great sleep aid if you have insomnia. It’s actually good for adjusting your circadian rhythm, having you actually move your bedtime and wake up-time earlier. And in addition to jet lag, that’s another indication for melatonin. But that’s where the data is. Those are some tips.

[00:12:06.400] – Sujay Kansagra

Now, other thing is making sure you’re eating three square meals and ideally trying to eat breakfast in the morning. So for teenagers in particular, when they have this delayed circadian rhythm, when they wake up at seven in the morning, for their body, it feels like it’s still four in the morning, as if we woke up at four in the morning.

[00:12:21.390] – Sujay Kansagra

And it’s not easy to eat at that time for many of our teenagers. They just don’t feel like it. Their body is not ready. But actually trying to get something in your body eating at the times that you should be eating, tells your body, Hey, this is where my circadian should be. We think that can also help keep you lined up in the right spot.

[00:12:38.940] – Hilary Erickson

That’s amazing. I think that’s super helpful because, yes, the teens drag themselves out of bed. They go to high school, they don’t eat on their way. If you could just throw a banana at them, maybe it would help.

[00:12:47.770] – Sujay Kansagra

That could certainly help.

[00:12:49.580] – Hilary Erickson

Okay, so I have to say I scrolled through a bunch of your TikToks yesterday while I was making dinner, and I have the issue that I wake up at 3:00 in the morning and I can’t go back to sleep. I’ve had it for years. It’s Before COVID. Last night, I was like, because I go to bed with a meditation or something on, and then it stops, and then I’m supposed to stay asleep. But you were mentioning, just like a baby needs its mommy to come back in and cuddle it to go back to sleep.

[00:13:13.510] – Hilary Erickson

I, apparently, my brain was like, What happened to the meditation? We’re going to sleep with the meditation, Hilary. It was being my mommy cuddling me back to sleep. Last night, I was like, Okay, I am not… I read until I felt tired, and then I was like, Okay, I’m going to lay here and go to sleep. I slept better because I didn’t need my mommy to come back in because I was a big girl that could go to sleep on her own.

[00:13:36.360] – Sujay Kansagra

I love it. Well, Hilary, let me tell you, first and foremost, something I like to emphasize to everybody is that night time awakenings are normal and expected and to never consider it a failure when you wake up at night time.

[00:13:51.040] – Sujay Kansagra

One of my big pushes for adults is try to become comfortable with being awake in your bed and being totally okay with that. That’s okay. For short periods of time, laying awake in bed, completely a normal part of our physiology. We sleep in sleep cycles where we go into deep sleep and lighter sleep every 90 minutes or so.

[00:14:11.500] – Sujay Kansagra

When we cycle into light sleep, oftentimes we have an awakening. Those Awakenings tend to be a lot more prominent as the night goes on because we’ve paid off a lot of our sleep drive in the early hours. Usually the early 2, 3, 4 hours, usually we don’t even remember any Awakenings. But as the night goes on, we tend to have more robust wakeups. But that’s totally okay.

[00:14:32.660] – Sujay Kansagra

The second thing I will tell you is exactly like you said, if you are using something in your environment to help you transition to sleep, as a purist from a sleep standpoint, I say you want that thing in the environment continuously through the night.

[00:14:48.050] – Sujay Kansagra

For me, that’s something like white noise or noise from a fan. Those are probably okay as long as they’re at a good volume and not too loud. That’s something that can be in your environment the entire night. If you find that soothing, totally fine. But if it’s something that’s going to turn off, like meditation music or some television, et cetera, from a pure sleep standpoint, I say, get your brain accustomed to falling asleep without it, because that way, when you wake up in the middle of the night, you don’t look around and say, I need that back again. I can fall right back asleep. But those are all called sleep onset associations. Anything you’re using in your environment to help you fall asleep. And chances are your brain is going to want that back in place when you wake up in the middle of the night.

[00:15:29.470] – Hilary Erickson

Yeah. Okay, sleep’s important. It’s important for our babies. It’s important for our mommies, our moms as a mom, and it’s important for our kids. So follow… You’re the sleep doc. Is that your username?

[00:15:41.870] – Sujay Kansagra

I’m ThatSleepDoc. That’s right. ThatSleepDoc on just about every social media platform you can imagine. It’s all about the data, and we follow the data. And so 100% agree. We got to look at the science behind sleep before we make conclusions.

[00:15:54.720] – Sujay Kansagra

I will also tell you that depending on when this podcast comes out, we’ve done some fascinating research that is a little bit hush-hush right now, but we’re hoping to introduce a brand new way for parents to help their infant sleep so that infants sleep well and parents sleep well. I hope you’ll follow along with me as I discuss that journey with my followers on social media. It should be interesting and fascinating.

[00:16:17.750] – Hilary Erickson

Sujay, are you going to make a course that costs $1,000 to share that with your followers? Nope.

[00:16:22.440] – Sujay Kansagra

Sleep Education, here’s my big pitch, sleep education should be free. Sleep education will always be free, and I will continue to share everything that I can share through my platforms.

do you just need some organized systems to get started / that's easy -- let's get started together CLICK HERE
[00:16:34.310] – Sujay Kansagra

Interestingly, what we’re going to introduce is a new technology. It’s actually a product. And although I can’t talk too much about it just yet, it’s going to be a product that we think will help infants become better sleepers naturally.

[00:16:46.760] – Hilary Erickson

Oh, that sounds amazing. So thanks for coming on, Sujay. I love that this information is free, and parents get to do what works for them. That’s what I learn mostly today.

[00:16:55.630] – Sujay Kansagra

That’s right. Absolutely. Thanks for having me on.

[00:16:58.090] – Hilary Erickson

Okay, I hope you guys enjoyed this episode, and will think more about your sleep and baby’s sleep. I think what I heard most in this was that your sleep matters, and there are things you can do to help your sleep by helping baby to sleep better or things you can do during the night, because studies show that we need sleep, and we know baby is getting the sleep that they want.

[00:17:16.200] – Hilary Erickson

But sometimes you’re not getting the sleep that you want because maybe you have other kids up, you got to go to work, all those different things. So I hope you guys enjoyed this episode. Definitely find Sujay at @ThatSleepDoc on social media. Follow him. I’m excited to learn more about his research and whatever device it is that can help baby sleep better.

[00:17:32.110] – Hilary Erickson

Okay, stay tuned because next week we are going to talk about organizing under bathroom sink cabinets. I’m going to give you some of my best tips for that. And then the week after that, we are talking about your postpartum plan, which obviously includes how you’re going to get sleep. So stay tuned.

[00:17:46.480] – Hilary Erickson

Thanks for joining us on the Pulling Curls podcast today. If you like today’s episode, please consider reviewing, sharing, subscribing. It really helps our podcast grow. Thank you.

Keywords:

sleep, baby’s sleep, postpartum depression, sleep training, cry it out, extinction method, graduated extinction, camping out, scheduled awakenings, infant sleep, child neurology, sleep medicine, sleep research, sleep hygiene, nighttime routine, alcohol, nicotine, caffeine, light exposure, melatonin, circadian rhythm, restless leg syndrome, insomnia, teenagers, jet lag, meditation, nighttime awakenings, organizing, postpartum plan, social media.

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