34    International Journal of the Whole Child 2020, VOL. 5, NO. 2 Children and Families: Health and Wellness Sleep Hygiene: Evidence for a Healthy Family Habit Barbara Whitman Lancastera aMiddle Tennessee State University Dr. Lancaster is a women’s health nurse practitioner and assistant professor at Middle Tennessee State University where she is delighted to teach in the undergraduate and graduate nursing programs. A registered nurse for 37 years she enjoys getting to partner with women to achieve their optimal health and well-being. Dr. Lancaster is a nationally certified menopause practitioner and has done research regarding the need for menopause workshops. Dr. Lancaster’s call is mission work where she has served both nationally and internationally and has a love for Africa! Her greatest joy is being a wife, mother, and grandmother. “Now I lay me down to sleep” … this is a closing thought said by many children as they get into their beds and begin their journey to sleep. Sleep…it is a daily ritual or routine that humans practice throughout time. Sleep is important for all ages—it is what revitalizes and rejuvenates individuals; yet, sleep is a mystery. Why do we sleep? Why is it important? The scientific community continues to research these questions. This article focuses on the topic of sleep hygiene including describing sleep hygiene, providing the evidence-based literature, and highlighting how sleep remains important in family life and wellness. Sleep Hygiene For 30 years, The National Sleep Foundation continues to serve as the leading expert voice in the world of sleep science and health (National Sleep Foundation, n.d.). Sleep remains vital for our mental, emotional, and physical well-being. Problems such as obesity, diabetes, poor decision making, accidents, and mood instability have been associated with not having good restorative sleep (National Sleep Foundation, n.d.). Sleep hygiene is a term used to describe the habit of sleep and what constitutes good sleep. The authorities at the National Sleep Foundation describe sleep hygiene as divided into four categories: 1.) Creating a sleep-inducing bedroom of comfort and relaxation. This includes a good mattress and pillow(s), clean sheets, and a cool room temperature that is suggested to be 70 degrees or less. Tantamount to this sleep-inducing environment is to diminish lighting, create a quiet zone (meaning no television, radio or people noise), and to introduce a relaxing scent such as lavender. 35    2.) Optimizing your sleep schedule. Identify wake and sleep times that do not vary. It is imperative to have close wake and sleep times throughout the week. In other words, do not get up at 6 O’clock one morning and 10 O’clock another morning. Try to maintain similar wake and sleep times. Build in a healthy sleep time to your schedule. You can do this, just provide thoughtful regard to the schedule. Lastly, be cautious regarding naps. The best time to take a nap, if you need one, is after lunch and for about 20 minutes. 3.) Crafting a pre-bedtime ritual. Poor pre-bedtime habits contribute to insomnia. Winding down for approximately 30 minutes prior to bedtime is part of a healthy ritual. Suggestions include enjoying quiet reading, listening to soothing music, and decreasing stimulation. Prior to bedtime, lowering lighting helps to increase the hormone melatonin which aides in restful sleeping. Finally, about 30 minutes prior to bedtime, disconnecting from devices is recommended. 4.) Fostering pro-sleep habits during the day. Our internal clocks depend on the light of day. During the day open your blinds and drapes and “let the sun shine in”. Move about as much as possible. Increase your physical activity. Monitor your caffeine and alcohol intake. Mediate how much you eat later in the day as it will be more difficult to fall asleep if your body is trying to digest a larger meal. If you are a smoker, do your best to not smoke at least one hour prior to bedtime. If you cannot fall asleep:  Try some relaxing stretches.  Do not try and force sleep, get out of bed if 20 minutes has passed and sit in a comfortable chair/couch and read a non-stimulating type of book/magazine. Experts suggest if you are having trouble with sleeping that you keep a sleep diary and connect with a sleep specialist. To clarify healthy sleeping possibilities, the Sleep Foundation.org, recommends the bedroom climate consist of three main activities (three S’s):  Sleep  Sex (adults)  Sickness When the bedroom is used for other activities, the brain becomes confused. Sleep is supposed to rest the brain, so it is important the bedroom emanate tranquility. For some people, healthy sleeping practices come easier as they were raised in a family environment that cultivated this attitude. For others, it is a ritual to newly construct. Bathory and Tomopoulous (2017) describe how sleep problems are common in those less than five years of age. These problems are associated with decreased school performance, obesity, and poor behavior. If the child is experiencing sleep problems, then the parent(s) may as well experience negative sleep issues. Thus, the entire family dynamic may suffer. Sleep habits are often not discussed at routine well visits to a healthcare provider (Bathory & Tomopoulous, 2017). Most healthcare providers including pediatricians do not receive much training regarding sleep medicine (Bathory & Tomopoulous, 2017). Sleep patterns change throughout the course of one’s life and appear especially evident in the first five years of life (Bathory & Tomopoulous, 2017). It is important effective counseling regarding childhood sleep also take into account other 36    issues. For example, child/parent factors such as temperament/interaction and environmental factors such as culture, geography, and home context become powerful influencers on sleep and quality of sleep (Bathory & Tomopoulous, 2017). The American Academy of Pediatrics (n.d.) recommends parents initiate promoting sleep hygiene early on in a child’s life. This includes a sleep promoting environment and a positive bedtime routine in infancy. A peaceful setting and calming behavior go far in creating a conducive environment for sleep. Lin, Strong, Scott, Brostrom, Pakpour and Webb (2018), in their study regarding adolescents and a theory-based sleep hygiene intervention, found that sleep influenced the quality of life. Their findings purported that sleep hygiene is associated with psychologic health because good sleep hygiene practices increased sleep quality and allowed the body and mind the ability to recover from daily physical and psychological exertion. Making the bedroom more restful is part of the sleep hygiene criteria. Decreasing media and noise remain vital to a restful environment. Keeping bed time and wake time fairly close in time and not sleeping later on the weekends demonstrated important factors in the adolescent group. The adolescents in the study were asked to help plan improved sleep hygiene practices; thus, affording them a sense of autonomy in their structuring particular life choices. Lin et al. (2018) provided adolescents with information regarding sleep and health consequences, pros and cons associated with sleep hygiene practices, strategies toward restructuring the physical environment in their bedrooms, consideration for social support, tips for action planning and problem solving, and ways to self-monitor their behaviors. The findings concluded adolescents did well in being part of the solution to ensuring positive sleep hygiene practices (Lin et al., 2018). Current research data suggest society indicates a fear of missing out (FoMO). This includes the nocturnal use of social media which may result in sleep disturbances and may adversely affect the quality of sleep one may experience (Tandon, Kaur, Dhir, & Mantymakir, 2020). FoMO is coupled with compulsive social media use (CSMU). FoMO is more strongly associated with CSMU among the working professional. Findings indicated this interaction to adversely affect the quality of sleep and undermine the brain’s ability to rest. These findings indicate the need to create interventions to reduce the deleterious impact of the social media interaction on sleep. Tandon et al. (2020) describe a systematic review of literature by Alonzo et al. in 2019 which concluded that poor sleep quality contributed to depression and anxiety occurring in individuals who have excessive activity with social media. It is important to maintain boundaries which include realizing the need for positive sleep hygiene practices across all seasons of life. We can learn from a traditional farmer’s schedule: a farmer went to bed when it became dark and arose when the first light of day caused the rooster to crow. These are the normal circadian rhythms that guided mankind for years. You may not live on a farm, yet, it is the time to create a healthy sleep habit within your family. Healthy sleep is important for both physical and mental health; healthy sleep improves productivity and overall quality of life. Everyone, from children to older adults, can benefit from better sleep, and sleep hygiene can play a key part in achieving that goal. Visit the National Sleep Foundation as well as the Sleep Foundation website. Turn off the television, tablet and phone. Play a game as a family, take a walk after supper, and read a 37    book together. Begin a positive, relaxing and tranquil bedtime ritual for the health and well-being of all family members. 38    References Alonzo, R., Hussain, J., Anderson, K. & Stranges, S. (2019). Interplay between social media use, sleep quality, and mental health outcome in youth: A systematic review. Sleep Medicine, 64: S365. https://doi:10.1016/j.sleep.2019.11.1017. American Academy of Pediatrics. (n.d.), Healthy Sleep Habits: How many hours does your child need? HealthyChildren.Org. https://www.healthychildren.org/English/healthy- living/sleep/Pages/healthy-sleep-habits-how-many-hours-does-your-child-need.aspx Bathory, E., & Tomopoulos, S. (2017). Sleep regulation, physiology and development, sleep duration and patterns, and sleep hygiene in infants, toddlers, and preschool-age. Current Problems in Pediatrics and Adolescents in Healthcare 47(2), 29-42. https://doi.org/10.1016/j.cppeds.2016.12.001. Lin, C., Strong, C., Scott, A., Brostrom, A., Pakpour, A., & Webb, T. (2018). A cluster randomized controlled trial of a theory-based sleep hygiene intervention for adolescents. Sleep,41(11). https://doi.org/10.1093/sleep/zsy170. National Sleep Foundation (n.d.). Retrieved from www.sleepfoundation.org [Accessed September 20-25, 2020]. Tandon, A., Kaur, P., Dhir, A., & Mantymaki, M. (2020). Sleepless due to social media? Investigating problematic sleep due to social media and social media sleep hygiene. Computers in Human Behavior, 113. https://doi.org/10.1016/j.chb.2020.106487. Final Copy IJWC 12.10.2020 34 Final Copy IJWC 12.10.2020 35 Final Copy IJWC 12.10.2020 36 Final Copy IJWC 12.10.2020 37 Final Copy IJWC 12.10.2020 38