Sleep and Children

You can do several things to achieve good quality sleep, but be aware of "sleep thieves," as identified below:

Sleep thieves

Despite good sleep habits, some people still find it hard to fall asleep.

• Thinking about things to be done tomorrow
• Thinking about things that happened during the day
• Emotionally upsetting conversations right before bed
• Watching the clock
• Racing thoughts
  

Cognitive Techniques

Sleep and thinking are both behaviors, but doing them at the same time makes it difficult to do either well. Many Soldiers report they have tried but just can't shut down their brains to fall asleep. They often replay the day's events, identify things they have to do tomorrow, and worry about the "what ifs." The inability to fall asleep and stay asleep often has underlying component of stress, anxiety, or worry.

Practicing any of the following recommended techniques can help any of us to enhance our relaxation response. Almost all of the techniques have other benefits beyond relaxation and can make us more aware of our thoughts and feelings in a different way. In some cases, these techniques can enhance our performance through the regular practice of focusing our mind.

Cognitive Behavior Therapy for Insomnia (CBT-i)

There are a few CBT-i programs to help improve sleep. Most CBT-i are designed to be used in tandem with professional care. A partnership of the DOD and VA created the CBT-i app. The mobile app is designed to help you develop good sleep habits and sleep better.

You can:

• Record daily sleep and track insomnia symptom changes with a sleep diary.
• Update your sleep prescription with provider recommendations.
• Use tools and exercises to quiet your mind.
• Learn about sleep, the benefits of sleep hygiene and terms used in CBT-i.
• Set reminder messages with tips, motivation and alarms to change sleep habits.
• The CBT-i Coach   is designed to be used during therapy. It can be used on its own but is not intended to replace therapy. 
  

Fight or Flight

All Soldiers have a survival response called the "fight or flight" response. It is the physiological, automatic response to danger that helps us deal with threats and emergencies. Everyone has experienced this response in a dangerous situation (or to a lesser extent, even when startled). The heart races, breathing rate increases, blood pressure goes up and alertness is enhanced with an intense focus on the perceived threat. All of these physiological responses work in tandem to gather the physical and mental resources needed to respond and survive in these situations.

Recovering from a "fight or flight" response is equally important, but is often overlooked. The relaxation response – which kicks in when the perceived threat has passed - helps us to settle down and return our body to normal operations. Essentially, it helps us to gear down. 

Relaxation Techniques

Just like exercising our muscles, we can exercise our relaxation response. Practicing any of these techniques, even just three times a week, can improve your brain's and body's relaxation response.

Try these out to help settle your mind:

• Journaling or writing things down
• Deep breathing exercises
• Relaxation exercises such as progressive muscle relaxation
• Visualization or guided imagery exercises
• Meditation
• Mental focusing exercises

Journaling or writing things down

Writing things down or journaling helps people to sort out their thinking and feelings by recording the information in writing. Some very disciplined Soldiers journal every night before going to sleep. For others, just the act of writing down their thoughts or tasks allows them to gear down and go to sleep.

So, write it all down:

• In a journal or on a tablet.
• On a piece of paper or pad—put it aside for tomorrow or another time. 
  

Deep Breathing Exercises

Breathing is the essence of being and practicing rhythmic breathing exercises helps to regulate a lot of our bodily functions such as blood pressure, heart rate, and blood circulation among others. Consciously slowing our breathing down stimulates the relaxation response; it results in less tension and provides an overall sense of well-being. There are many types of breathing exercises, so use the one that works for you.

Some forms of deep breathing are:

• Tactical breathing 
  

Tactical breathing

• Sit comfortably with back straight (or try lying on the floor or bed).
• Put one hand on your chest and one on your stomach.
• Breathe in through your nose-feeling your stomach expand and chest moving very little.
• Once you have a deep breath, hold for a few seconds and slowly breathe out through your mouth-exhalation should take longer than the inhalation. As you slowly exhale, drop your shoulders.
• Repeat 5–6 times with the understanding that the more you practice the easier it is to feel relaxed and fall asleep.

Progressive muscle relaxation

This form of relaxation training involves the progressive tensing and relaxing of various muscle groups to create an awareness of tension and relaxation. It moves through all major muscle groups, relaxing them one at a time and this eventually leads to total muscle relaxation. Check out this Human Performance Resources by CHAMP guide. 

REMEMBER: People respond differently to various activities. Some feel pleasant or refreshed, and others feel calm and relaxed after an activity like this one. Some people notice little change the first time, but with practice, your control increases as well as the benefits. If you practice this activity, your ability to relax should increase.

Visualization and guided imagery

Guided imagery is a technique that utilizes all the senses combined with mental imagery to achieve psychological and physiological relaxation. Imagery has a profound impact on many biological functions in the body such as breathing rate, heart rate, blood pressure, and cortisol levels.

If you want to learn how to use imagery to enhance your performance on the APFT or to improve marksmanship consider writing your own script. You can go to the Human Performance Resource Center.

Meditation

Meditation is an ancient practice and it is found in in both eastern and western religions and cultures. It is considered the cornerstone of spiritual development but you do not have to be religious to meditate. Most religions use prayer as the medium in which meditation is often used.

There are different forms of meditation, but the essential element is being fully aware and paying attention. The process of meditation is to calm the mind by paying attention to the thoughts or images in our head.

Mental focusing exercises

Mental focusing exercises aid relaxation. These exercises help us focus and become aware of ourselves, our thoughts, and even our feelings.

Use this exercise to quiet your mind. It is deceptively simple as the mind is busy and full of a variety of thoughts that are often outside of our awareness. As you begin your focusing exercise, your mind will drift from what you want to focus on. This is common—don't get upset! Just be aware that your mind has wandered, and return to your chosen focus.

Follow this guide to begin practicing mental focusing exercises. Identify what you would like to focus on, such as letters of the alphabet a range of numbers, a poem, or a prayer. Say you choose the alphabet; focus on making the letters (all caps or lower case) in the same design.

1. Bring your focus to the letter you are creating; and complete each one in a slow and deliberate manner.
2. Notice that your mind has wandered off.
3. Disengage from that train of thought.
4. Bring your focus back to the letters and continue.

When you notice you are in a relaxed state, you can stop and go to sleep.

Other suggestions:

• Letters: Use all caps or all lower case letters. Draw the letters in your mind in the same style from A to Z. Repeat until you achieve your goal.
• Numbers: Pick a range of numbers, i.e. 20–40. Draw the numbers in your mind in the same style. Repeat until you achieve your goal.
• Poem or prayers: Repeat each word in the prayer or poem until complete. Alternative: Find a synonym for each word in the poem or prayer, or discern the meaning of the poem or prayer in way you could tell your child or friend. 
  

When to seek medical help

Despite your best efforts, even after using much of the information provided in this guide, you somehow still do not feel rested or are unable to achieve a good night's sleep. It is time to see your primary care provider if:

• You have tried for over 2 weeks and/or
• Your roommate or bed partner reports you snoring or having episodes where you stop breathing (apnea)
• You have a sleep diary documenting concerns about your sleep, your sleep environment and your pre-bedtime activities.

You may have a medical condition that needs to be evaluated and treated as soon as possible. Some of these conditions may need further evaluation by sleep or behavioral health specialists or both. Your specialists may require tests to diagnose your specific problem properly.

Treatment also varies depending on the condition that is diagnosed.

While medication may be required to treat some sleep disorders such as narcolepsy, there are many effective non-medication treatment regimens. For example, the use of a Continuous Positive Airway Pressure (CPAP) machine for obstructive sleep apnea or cognitive behavioral therapy for insomnia (CBTi).

Regardless of the sleep disorder you may have, effective evaluations and treatments are available. It is important that you seek help so you can address your problems. You owe it to yourself and those around you to get the best sleep you can.

Sleep nuggets to remember

• Maintain a consistent, regular routine that starts with a fixed bedtime and wake-up time. Set a fixed time to wake up, get out of bed at that time and get exposure to light each day. Pick a time you can maintain 7 days a week then adjust your bedtime so that you target 7 or more hours of sleep.
• Get out of bed if you can't sleep. Only go to bed (and stay in bed) when you feel sleepy. Do not try to force yourself to fall asleep; doing so will tend to make you more awake, worsening the problem. If you do not return to sleep within 20 minutes, get out of bed and do something relaxing. Do not return to bed until you feel sleepy.
• Napping is a good way to make up for poor/reduced night-time sleep, but naps that are too long can cause problems falling asleep or staying asleep later that night. However, do not hesitate to a short nap (20-30 minutes) to "take the edge off" of your sleepiness.
• If you tend to check the clock two or more times during the night, and if you worry that you are not getting enough sleep, cover the clock face or turn it around so that you can't see it.

If you experience sleep problems for more than 2 weeks, consult a healthcare provider.

Resources for more information on sleep:

• National Sleep Foundation Sleep Myths and Facts 
  

SLEEP AND COVID-19

How COVID-19 affects sleep?

• Being cognizant of how COVID-19 media coverage can affect your sleep is important to inform personal prevention or intervention measures.
• Increased anxiety can affect sleep patterns making it harder to fall asleep or get back to sleep at night.
• Feelings of depression are also associated with irregular sleep patterns.

Sleep Facts:

• Obtaining inadequate sleep over multiple consecutive nights results in performance deficits that are comparable to those produced by alcohol intoxication.
• 7 or more hours of quality sleep is required every 24-hour period.
• Exposure to light from computers, phones, television, and video games disrupts the ability to fall asleep and stay asleep, so these items should not be used in bed.
• Caffeinated beverages can delay sleep onset, but they do not actually reduce the need for sleep.  Sleep debt continues to accrue when caffeine is consumed.
• Fatigue from lack of sleep is a leading cause of home/work-place or motor vehicle accidents.  

How to get good quality sleep:

• Set a bedtime that allows for 7 or more hours of sleep and establish a relaxing daily pre-sleep routine.
• Turn off lights and remove light-emitting electronics from your bedroom. To reduce the impact of light use FREE blue light filtering software and apps.
• Go caffeine-free AT LEAST 6 hours before bedtime.
• Sleep in a cool dark room and remove any distractions.
• In loud environments, wear earplugs and/or use white noise to improve sleep quality.

Seek professional help if you:

• Consistently experience sleep difficulty.
• Are often tired during the day (despite having slept at least 7 hours on the previous night).
• Consistently have a reduced ability to perform daytime activities.

*Call your Primary Care or Behavioral Health provider if you are experiencing any of the symptoms listed above.

COVID-19 information:

•  Click here for the Army Public Health Center COVID-19  communication products
• The Military Health System Nurse Advice Line is available 24/7 by phone, web chat, and video chat. Call 1-800-874-2273 option #1
• Army COVID-19 Information Hotline for trusted resources and answers to your questions! 1-800-984-8523 Overseas DSN 312-421-3700 Stateside DSN 421-3700