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PDA and the Biology of Sleep
398 Plays3 days ago
In this episode we’re chatting to Nathalie Shek, a paediatric occupational therapist who works with neurodivergent children, young people and families. Sleep hygiene advice such as creating routines can often create extra demands, so we’ll be talking about the biology of sleep what helps to make common sleeping difficulties a little easier.
You can find out more on our website or and find more episodes, including a Q&A with Nathalie when you sign up to the PDA Training Hub.
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Transcript
Introduction to PDA Life Podcast
00:00:02
Speaker
Welcome to PDA Life, the podcast brought to you by the PDA Society, where we'll be exploring the highs and lows of pathological demand avoidance. I'm Rachel. And I'm Sarah, and we're your hosts.
00:00:14
Speaker
As the UK's only PDA charity, we're bringing together PDAers, carers, clinicians and researchers to answer the questions which matter to you most. Hello and welcome to this episode of our podcast.
Episode Topic: Neurodivergent Children and Sleep Difficulties
00:00:26
Speaker
My name's Rachel and I'm your host. Today we're going to be talking about why neurodivergent children may have sleep
Guest Introduction: Natalie Sheck
00:00:33
Speaker
difficulties. And my guest today is Natalie Sheck.
00:00:36
Speaker
Natalie is an advanced practitioner occupational therapist. Her clinical specialism is working with children, young people and families with neurodiversity. Natalie has a specialist interest in sensory processing, trauma and attachment and how these impact on engagement in the occupations that children and young people want or need to do in their daily lives.
00:00:59
Speaker
So welcome Natalie to our podcast. Thank you, it's lovely to be here Rachel. It's great to have you, thank
Biological Importance of Sleep
00:01:05
Speaker
you. So we're going to be talking about sleep today. So i guess one thing that people don't often talk about is what actually is sleep and why is it important for our brains that we get enough sleep? So sleep is really important and it's an active biological process. And it isn't just about rest. It's about a 24 hour occupation because what happens during the day directly shapes how we sleep at night and how we sleep shapes how we function during the day. So it's not something that just switches on at bedtime. You know, the body's sleep wake system is continuous and cyclical. So during the day, you've got light exposure, movement, meals, emotional regulation, sensory input, and this all feeds into our circadian rhythm and sleep pressure system. And our brains build up adizine, can't pronounce it, apologies, which is a chemical that makes us sleepy. So while our exposure to daylight helps set the timing for when melatonin will be released later on, daytime regulation, activity levels, environment and routines are just as much part of sleep hygiene as bedtime itself. And then when you get to sleep, sleep allows the brain and body to restore, integrate sensory and emotional experiences and regulate hormones ready for the next day. And the quality of sleep that influences daytime attention, emotional balance, sensory process and even immune function is so important. So occupationally speaking, if we view sleep as an occupation, it's one that is prepared, protected and supported across the full 24 hours.
00:02:36
Speaker
And in during that sleep, the brain goes into through cycles that consolidate learning, restore the body, balance hormones, etc etc um and it also sorts and stores memories clears out waste products and resets the nervous system so for children sleep has got a direct impact on their growth emotional regulation attention and it's essential as food and physical movement are So if we look from a sensory integration lens, sleep helps the brain organise all information it's taken during the day. But when children don't get enough restorative sleep, they appear dysregulated, impulsive or wired, which is why you see the nervous system trying to cope with fatigue.
00:03:17
Speaker
So, yeah, it really is a 24 hour
Circadian Rhythm in Neurodivergent Individuals
00:03:19
Speaker
thing then, isn't it? And it's so important, as you said, all those jobs that that sleep provides our body to be able to do is so important that so that we get enough sleep. So you mentioned there during your explanation, something called circadian rhythm. So what what is that how does it influence when and how we sleep?
00:03:37
Speaker
So circadian rhythm is our internal body clock. It's roughly a 24 hour rhythm and that regulates our awake and sleep cycles. And it's controlled by the brain's super chasmic nucleus, which responds to light, temperature and social cues. So, for example, like exposure to daylight in the morning helps the brain release cortisone to wake us up, while darkness triggers release of melatonin to prayers to sleep. But for neurodivergent individuals, that rhythm can be more sensitive or less predictable. So light screens and dire inconsistent routines can easily disrupt it. And understanding this helps us to realise it's not about bad habits. Sometimes it's just, you know, your internal clock runs differently. and So that's what your circadian rhythm is. So each everybody's might be slightly differently. like Absolutely. Absolutely. We're not all the same.
00:04:27
Speaker
Yeah. So are there ah other ways then that neurodivergent children, particularly particularly those with PDA profile of autism, might experience fear in sleep differently then because of sensory processing or emotional regulation differences?
Unique Sleep Experiences of Neurodivergent Children
00:04:42
Speaker
Absolutely. So many neurodivergent children process sensory input. and emotions in very unique ways. Their nervous systems might stay on a higher alert for longer or even when they look tired their body's still in a state of hypervigilance. And sensory sensitivities like noise, temperature, clothing, textures or light can make winding down much harder. For some lying still feels uncomfortable, for others the transition from doing to resting triggers anxiety or loss of control. And for PDAs the idea of you must go to sleep can itself feel threatening or demand-based. So Supporting autonomy and co-regulation rather than control is key here. And for autists, routines and predictable sensory environments often make sleep safer and more attainable. and So, yeah, it is different. And do you think for PDAs in particular, then, that that you mentioned sleep demand, do you
Sleep Stages and Their Health Impact
00:05:33
Speaker
think that's... sort of got a a massive part to play absolutely it really does so we often hear um about different stages of sleep like deep sleep or r rem can you walk us through and what happens in each of these stages maybe because i think lots of people might have heard the names but don't actually understand what you know don't actually know what they are but Yeah, no, not absolutely, Rachel, I can do that. and So there is, when you look up sort of sleep, stages of sleep, there's some models that talk about stages up to five, but that's because they have staged stages three and four is split into deep sleep. So that's why you might see stage five. So some say one to four and one say one to five, and that's the difference there. But there there are two main types of sleep. You've got your non REM, which includes the light and the deep sleep and then REM, which are rapid eye movements. So you stage one and two is your light sleep. And that's when your body starts to relax, your heart rate and breathing slow and we can easily wake up. So, you know, if someone can easily wake you up when you're trying to settle to sleep and that's your non REM sleep. stage and then your stage three is your deep sleep and the body focuses on physical repair and growth and growth hormones are released here and then you've got your ah ah rem sleep and the brain becomes active again and then you start having dreams that's usually when it happens and this stage supports learning memory emotional processing and each stage has a purpose so your deep sleep restores the body and r rem helps us process emotions experiences and if you miss out on one This can make your child or yourself physically tired, emotionally fragile. And we go through these stages of sleep. This doesn't happen through one cycle. It happens through many cycles throughout the night. So it's not just one, two, three, four, am sleep and then you wake up. this This cycle happens quite a couple of times throughout the night while you're sleeping. um And they do say, you know, when you're when you're dreaming, it feels like you're dreaming for hours. But The longest they're saying that you dream for is is no more than 10, 15 minutes. So it feels longer than it is, but it is quite interesting.
00:07:44
Speaker
Yeah, yeah. So I guess, yeah, I didn't realise that you have, you go through those stages multiple times a night. So I guess that's then when, you know, you said, was it stages one and two were the bits where you could easily wake up?
00:07:57
Speaker
Correct. yeah That's halfway through the night then. If something easily wakes you up, that's why you, yeah. Correct. So again, then that would have implications definitely for, um you know, sort of many neurodivergent children and PDA is that that's, you know, so maybe it's a sensory sensitivity has woken them up at that stage. And that's why it's easier for them to wake them if they're not in that deep sleep.
00:08:19
Speaker
That's right. That's right, Jo. Okay,
Defining Enough Sleep for Neurodivergent Children
00:08:22
Speaker
great. So um when we talk about how much sleep children actually need, this is often based on generalized guidelines. You know, I think, you know, we're theres often in sort of that eight hours sleep that we're always told that we all need. But what what is enough sleep? and What does really look like in practice? And is it, you know, especially for neurodivergent children, is it the same or is it different or what?
00:08:46
Speaker
So enough sleep isn't about the number of hours you have, it's about the quality and it has to fit with your individual nervous system. So enough sleep for neurodivergent children, k includ including you know PDAs and autists and ADHDers or sensory differences, doesn't always match the standard 8-12 hours guidelines. it's It's more about focusing on the restorative and the regulator sleep.
00:09:10
Speaker
than just the time in bed. So some near-divergent kids have shifted circadian rhythms, so they're sleeping late or they're waking early, and short daytime naps may be critical restorative periods for them, ah but are not problematic. So the sleep may be fragmented, but they can still function if rest periods are safe, low pressurised and low demanding. um So, you know, it does look very, very different. And it's all about whether the child wakes up reasonably regulated, not necessarily happy, but able to engage. So if, you know, if the mornings are consistently full of meltdowns, hyperactivity or sluggish is a sign that the nervous system isn't getting a restorative rest. even if they're in bed for long periods. So the focus is on how they feel, function and recover rather than forcing bedtime or comparing them to their peers or or the guidelines because it's not going to fit that nervous system.
00:10:03
Speaker
So it is not there's definitely not a one size fits all. Then it's definitely how your individual child is responding. Agreed. Agreed.
Naps and Tailored Sleep Cycles
00:10:11
Speaker
OK. And something else you said then as well was that if I understood it correctly, was that if they if they wake up, if they're not and if they're having short periods of sleep during the night, but they are making it up with naps during the daytime and that seems to help able to help them function.
00:10:27
Speaker
Is that ah that is that OK for them to keep doing that is something that is that something we should encourage or because, again, we're often told that way that, you know, we need to sleep at night and if you have daytime naps, it ruins your nighttime sleep and all that sort of thing. So can we encourage that napping for neurodivergent children or not?
00:10:45
Speaker
I mean, it If we if we think about and with neurodivergent children and PDA, if you think about the melatonin levels and they also have a delay in terms of the release of melatonin, it's actually much later. Some of the research says. um We have to think we have to think about, you know, that amount of releases melatonin. That's not going to be the same as a neurotypical child. I think it's about looking at when they wake up in the morning.
00:11:13
Speaker
Do they seem engaged? Do they seem like they can function? and But, you know, it is really difficult families because if you've got, you know, if mom and dad are neurotypical and we follow that circadian rhythm, it's it's very challenging, isn't it? But it's trying to think of, it's about low demands, and low expectations. And, you know, it's kind of is kind of trying to look it in that way. And I think with the guidelines, they are based on neurotypical, you know, children, etc., which is is quite hard when it comes to someone who has a different nervous system that, you know, doesn't work along those guidelines. It's just really trying to think of that low demand, low pressure.
00:11:53
Speaker
Yeah, and I guess it's what works it was's what works for that individual family, isn't it? Because I know it's our support service, we have lots of parents contact our support service and a lot of them talk about sleep in that the child won't go to sleep or that the child is um sort of sleeping for short periods of time, but then they're tired all day and then they can't get them to school. But it's that it's working out that balance, isn't it, that works for that individual family? Because again, you know,
00:12:20
Speaker
different parents have different demands on them as well as the demands that are on the children and whether or not that's you know it's possible to for them to let their for that enable their child to be able to sleep during the day if they're out of work that might not be possible but whereas others that might work at home and it is possible so It's a real tricky one, isn't it? It's very, very tricky. And I think, you know, with, with um you know, things in place, especially when you've got school and you have like, I mean, it's similar to, i know this may be going right off topic, but if you're thinking about teenagers who and sleep cycles change when they get,
00:12:55
Speaker
you know, their hormones and they stay up much, much later and they want to sleep more in the day and they need longer amounts of sleep. And that's to do with the the biology, I'm afraid. You know, that's just way is. But they start school at nine o'clock, half eight. It doesn't doesn't really work. And I know they've done studies where they've pushed um school time to much later and they've actually found better results with the children because they fitted around the biology of it and it's similar to for PDAs and autists you know their their nervous system and you know the biology is different when it comes to neurotypical kids and and unfortunately when it comes to routines and other systems out there it's it's mainly not complementing the biology of of these individuals and I think it's it's kind of challenging that and looking at that a little bit more you know and what would work and but yeah it needs to be tailored for the family Yeah, definitely. It's got to work for the whole family as a unit, isn't it, rather than just the individual.
Daily Demands and Their Effect on Sleep
00:13:48
Speaker
OK, let's circle back a little bit to what we were talking about earlier then, and when we were talking about the different points sort of and during the night.
00:13:56
Speaker
um Are there particular moments, as we've we mentioned earlier, like falling asleep, staying asleep or early waking, that tend to be more tricky for neurodivergent children?
00:14:06
Speaker
And if so, why? I mean mean, if we're thinking about circadian rhythms for neurodivergent children, and you know, sometimes, you know, with those, they're about free running the circadian rhythms. and And sometimes it's about, you know, avoiding force or, you know, avoid to force the earlier bedtime because it's increased arousal levels. ah Focus instead of anchoring the morning, you know, they use more light exposure, you know, with within 30 minutes of waking, know, You know, if, you know, with if wake time is consistent within that tolerance level, even if the bedtime shifts, and you know, it's about increasing it gradually. so increasing it, you know, the wake time and getting more light during the day than anything else. um
00:14:53
Speaker
and And I think it's about, you know, just shifting a little bit because what what what we find is, you know, within those those waking those waking times is because melatonin is deficient, you know, there's there's some research that talks about the genetic difference, the ASMT gene that causes lower overall sleep hormone production. and You know, sometimes we need to think about, you know, making sure the daytime is full of demands so it has an impact at night. and But the thing is, we also need to shift a little bit because a lot of, you know, when when we're thinking about those sleep cycles, you know, their sleep cycles because of the delay, that r REM might be later. So instead of like, for instance, if you're r REM, if it if it takes certain about maybe 20, 25 minutes to get through stages
00:15:41
Speaker
of of of sleep or thirty minutes then we think about when r REM is going to happen. And and the r REM is really quite important for restorative, like i said earlier, about emotional processing and hormone production and and regulation of those. It's about making sure you get a lot of that r REM because if you have children that are sleeping through the stages and they skip a stage in the sleep stage, you know you're going to have a tired child in the morning. Yeah. So, you know, like going back to that 24 hour occupation is so vital. What they do in the day is going to affect how the sleep quality is when they do sleep, whether nighttime on the day.
00:16:21
Speaker
Yeah. And I guess and I guess then that's also very tricky. Then if any of you lay the PDA element on top of that, the you know what they do in the day impacts what they do at night but if you if you if the individual is struggling with demands anyway and maybe you've got to lower what demands are occurring in the daytime which then might impact the sleep as well which then will reduce the capacity for demands following day doesn't it so you get into the a bit of that negative cycle then don't you when it's it in You do, you do. And if they've had a lot of demands in the day, you think about nighttime, you know, this is a time where they're like, right, I want autonomy now. i want control of this situation. I've had so many demands all day. The nighttime is a time where I can now take control of this. And that's where you get, you know, the pushbacks, the push and pull. So it's really just thinking about that when it comes to occupation in the day and what the demands of the environment is in the day.
00:17:15
Speaker
Yeah, yeah, yeah. oh it's it's It's fascinating, isn't it? it's It's so complex, isn't it? It really, really is.
Conclusion: Sleep as a Biological Issue
00:17:21
Speaker
Okay, and I know we're goingnna we're going to go on and we're going to record Q&A session with on questions that our listeners have sent in, which will be on our training hub soon. But just to finish off our podcast then, is there one key thing that parents should understand about the biology of sleep?
00:17:40
Speaker
that can help m support their PDA child with sleep? So, yeah, bit difficult to one key challenge. There's a few, actually. um But yeah, you know, it's mostly it's mainly trying to think that sleep is not purely behavioural. You know, it's a biological and a relational approach you know part of part of our day part of our day or night 24 hour and a child who can't sleep isn't being defiant you know their nervous system may be stuck in a state that doesn't yet feel safe enough to rest and and trying to understand that the brain and body they need that co-regulation through calm presidents predictable routine sensory comfort emotional safety and you know and it can really shift how parents feel so it it helps them to move from what's wrong with my child to what does my child's nervous system need to feel safe enough to rest and that that is the key that i would say for for people to try and really for for me to challenge those perspectives around that
00:18:43
Speaker
Yeah. Yeah. and um And it's not, you know, if you've got a child, it's not going to sleep. It very often isn't a choice, is it? That's right. It's not. It's your it's our nervous system responding and it's the survival, you know, it's the survival stress state. um And that's what they're doing to survive. So, yeah, it's not it's not defiance at all. so now Brilliant. OK. Thank you ever so much, Natalie. it's That's really, really insightful. I think we've sort of covered a number of things there that, you know, we often talk about sleep strategies, but we don't talk about a lot of the biology that goes on behind sleeps. And I've sort of learned a lot today. So thank you so much for that. And as I say, we are going to go on. in a minute and record our Q&A session. So, but if you do want to hear more and find out some specific strategies to help the sleep, then please do head over to our training hub and have a look at the Q&A that Natalie and I are going record. So thanks once again, Natalie. We really appreciate it. Thank you. It's a pleasure. Thank you, Rachel.
00:19:38
Speaker
And thank you to our listeners for listening in. Until next time, please take care of yourself. Bye-bye.