Sleep IS Underrated with Pediatric Sleep Specialist Innessa Donskoy MD

In this episode, Dr. Innessa Donskoy, a pediatric sleep specialist, discussed sleep problems and how to help kids sleep better.
Dr. Innessa Donskoy is a Pediatric Sleep Medicine attending physician at Advocate Children’s Hospital, specializing in the diagnosis and treatment of sleep disorders in infants, children, and adolescents. She completed her residency training in General Pediatrics at the University of Illinois at Chicago, followed by a fellowship in Sleep Medicine at Northwestern University and Ann & Robert H. Lurie Children’s Hospital of Chicago. After completing her fellowship, she joined Advocate Children’s Hospital as a Pediatric Sleep Medicine Physician and has advanced  into the position of Director of Sleep Education. She has played a key role in expanding the program into a comprehensive clinical, educational, and research-focused service for families and trainees, while also helping develop it as a training site for medical students, Pediatric residents, and Sleep Medicine fellows. Her academic contributions include multiple review articles, conference presentations at national sleep, pulmonary, and telemedicine meetings, as well as authorship of several textbook chapters in major sleep medicine references. She is actively involved in public education and advocacy, with contributions to community talks, news publications, and media appearances on outlets such as CBC, NBC, WGN, and FOX, focusing on pediatric sleep health in relation to time changes, school transitions, and emerging research in the field. 

https://www.youtube.com/watch?v=erSUcm4C4aY

Please note that while I am a pediatrician, I am not your child's pediatrician. This podcast is for informational purposes only and does not constitute medical advice. For any medical concerns or decisions, please reach out to your child’s health care professional.
Cover art by Charlotte Feldman

Transcript

0:11

Welcome to Kids Matter. I'm Dr. Elisa Minkin. As a pediatrician, mom and grandma, I understand how challenging it can be to help our kids grow into their best selves. We are so much more powerful together. Here I will be sharing the knowledge and wisdom of a wide range of people who understand and care deeply about children. I'm hoping for your input as well because kids really do matter. They are our future.

Alisa Minkin 0:41

Welcome back to the Kids Matter podcast. I'm really honored and really excited to be here today with Dr. Anessa Dunskoy. Dr. Dunskoy is a pediatric sleep medicine attending physician at Advocate Children's Hospital, specializing in the diagnosis and treatment of sleep disorders in infants, children, and adolescents. She completed her residency training in general pediatrics at the University of Illinois at Chicago, followed by a fellowship in sleep medicine at Northwestern University and Ann and Robert H. Lurie Children's Hospital of Chicago. After completing her fellowship, she joined Advocate Children's Hospital as a pediatric sleep medicine physician and has advanced into the position of director of sleep education. Wow. She is actively involved in public education and advocacy with contributions to community talks, news publications, and media appearances on outlets such as CBC, NBC, WGN, and Fox News. So this is really, really exciting, and I wanna say that this is my second go-round with you. On my previous podcast, the Jewish Orthodox Women's Medical Association, or JOWMA podcast, you came on, and we talked more basic about sleep, and I want to link that and not repeat that here, even though this is a different podcast. And what I really wanna talk about today is our more challenging sleepers. And I'm really excited to do this because my granddaughter has sleep challenges, and so I'm hoping to learn something here. So thank you so much for joining me. I want to first talk about the possible causes of a poor sleeper in infancy. But before I say that, I just wanna say it's not your fault, moms and dads. Okay? We've got this perfect social media stuff, and this is not perfect social media parenting. This is gonna be real parenting and not guilt, shaming, or any of that.

Innessa Donskoy 2:37

I love that you led with that. I think that we don't hear it enough because sometimes when it comes to sleep or, or anything that our child is ex-sus-expected to do well, right? we take it as a failure on our parts, and

Alisa Minkin 2:53

I'm speaking to myself as well

Innessa Donskoy 2:56

say

Alisa Minkin 2:57

I say this, right? But what am I doing wrong? When the reality is, is, you know, the, the poor sleeper,

Innessa Donskoy 3:06

sleeper, the kid who's never

Alisa Minkin 3:08

bad sleeper, the kid who's

Innessa Donskoy 3:13

with

Alisa Minkin 3:13

never slept well with what's happening today.

Innessa Donskoy 3:15

and, and

Alisa Minkin 3:16

And, and they'll tell me that never a day in their life

Innessa Donskoy 3:19

has

Alisa Minkin 3:19

has this child-

Innessa Donskoy 3:20

well.

Alisa Minkin 3:21

Uh-huh.

Innessa Donskoy 3:22

what I often, what I often, I often

Alisa Minkin 3:24

What an amazing young man or woman

Innessa Donskoy 3:31

with

Alisa Minkin 3:32

with what an amazingly powerful brain. Right? Our brain is in- Right. It is creative.

Innessa Donskoy 3:40

It

Alisa Minkin 3:40

It is--

Innessa Donskoy 3:41

it

Alisa Minkin 3:42

it has

Innessa Donskoy 3:42

that it

Alisa Minkin 3:43

and it stores save a

Innessa Donskoy 3:48

right? It can be methodic. And that same powerful

Alisa Minkin 3:53

brain

Innessa Donskoy 3:54

to

Alisa Minkin 3:54

needs to know how to turn on

Innessa Donskoy 3:57

and go to

Alisa Minkin 3:59

go to sleep.

Innessa Donskoy 4:00

And the irony,

Alisa Minkin 4:01

is that the more creative and intellectual, not all,

Innessa Donskoy 4:08

ruminative

Alisa Minkin 4:08

but in a general brain child is the

Innessa Donskoy 4:11

the harder

Alisa Minkin 4:12

harder that sleep itself becomes.

Innessa Donskoy 4:15

I never like

Alisa Minkin 4:16

So I never like to think of this as like a character trait. I like to think of this as a skill. Sleep is a skill like any other skill,

Innessa Donskoy 4:25

So

Alisa Minkin 4:26

So if

Innessa Donskoy 4:27

was, let's

Alisa Minkin 4:27

was, let's say, if I was a therapist and someone would come and say, "You know, my child has never walked and they're a non-walker. They've never walked a day in their life." What am I gonna do? I'm gonna say,

Innessa Donskoy 4:41

"Let's come

Alisa Minkin 4:41

"Let's look for the to teaching them

Innessa Donskoy 4:44

how

Alisa Minkin 4:45

how to walk

Innessa Donskoy 4:46

their

Alisa Minkin 4:47

their level, meeting them where they're at, understanding what are the underpinnings of this? Yes, how did this begin?

Innessa Donskoy 4:54

What

Alisa Minkin 4:55

What happened in early infancy that made the kind of natural progression of learning to walk hard?" And you can take the word walk away

Innessa Donskoy 5:04

insert

Alisa Minkin 5:04

insert sleep and the conversation is exactly the same.

Innessa Donskoy 5:09

right? What

Alisa Minkin 5:10

What kind of unraveling process, job was hard and went through infancy and, you know, preschool, toddlerhood, childhood

Innessa Donskoy 5:19

that

Alisa Minkin 5:19

that could have made

Innessa Donskoy 5:21

hard. We, we

Alisa Minkin 5:22

If I think of sleep,

Innessa Donskoy 5:24

and, and

Alisa Minkin 5:24

and, and insomnia, I'm gonna use

Innessa Donskoy 5:26

insomnia and sleep problems

Alisa Minkin 5:28

kind of interchangeably here. Insomnia, chronic insomnia is difficulty with initiating and maintaining sleep for more than three nights.

Innessa Donskoy 5:39

think colloquially, we just

Alisa Minkin 5:40

we just kind of talk about insomnia as difficulty,

Innessa Donskoy 5:44

difficulty with

Alisa Minkin 5:45

with sleep. I'll use them interchangeably.

Innessa Donskoy 5:47

easy. But the truth

Alisa Minkin 5:49

is that insomnia falls into sort of what we call the three P pyramid of development,

Innessa Donskoy 5:56

right? The

Alisa Minkin 5:56

right? The first P

Innessa Donskoy 5:57

is

Alisa Minkin 5:58

is sort of what we call our

Innessa Donskoy 6:00

predisposing factors, right? Everyone is sort

Alisa Minkin 6:04

is sort of

Innessa Donskoy 6:05

with a

Alisa Minkin 6:06

the genetics of sleep. Isn't that genetic? You go, "Genetics and sleep curves?"

Innessa Donskoy 6:12

You

Alisa Minkin 6:13

No, you know, smart

Innessa Donskoy 6:14

talk about all the

Alisa Minkin 6:14

people have the whole genetic thing and got it all figured. You know, John Mears and Right? Well, think of it like

Innessa Donskoy 6:25

self

Alisa Minkin 6:25

look. So some subjects wouldn't look like

Innessa Donskoy 6:28

bad in

Alisa Minkin 6:29

another. Right? Some of us have dark hair, some of us have light hair,

Innessa Donskoy 6:32

and we

Alisa Minkin 6:33

and then we have a makeup that predisposes It could actually be a better mood for sleep, certain tasks.

Innessa Donskoy 6:42

poetry,

Alisa Minkin 6:42

treat

Innessa Donskoy 6:43

sleep.

Alisa Minkin 6:44

sleep

Innessa Donskoy 6:44

is

Alisa Minkin 6:45

is one of them. There are some

Innessa Donskoy 6:47

we

Alisa Minkin 6:47

people that think that there are certain,

Innessa Donskoy 6:50

certain

Alisa Minkin 6:50

certain genetic markers that can make sleeping more intense. And just reflecting on yourself and, and your family on both sides can help you see

Innessa Donskoy 7:00

are

Alisa Minkin 7:00

there could be a little bit of a spotlight behind where

Innessa Donskoy 7:03

runs through

Alisa Minkin 7:04

through our family lines difficulty with sleep.

Innessa Donskoy 7:08

But just

Alisa Minkin 7:08

But just because there's previous sleep doctor doesn't mean there is necessarily gonna be

Innessa Donskoy 7:13

difficulty for this

Alisa Minkin 7:14

for this child. A lot will come what I call precipitating factors that, that they're just really normal

Innessa Donskoy 7:20

S- stuff

Alisa Minkin 7:22

stuff that happens.

Innessa Donskoy 7:24

what I say, right?

Alisa Minkin 7:25

Right? Sometimes,

Innessa Donskoy 7:27

can

Alisa Minkin 7:27

can be a major shift

Innessa Donskoy 7:29

the

Alisa Minkin 7:30

in the home, a major shift in the schedule, a major shift in,

Innessa Donskoy 7:35

dynamics or

Alisa Minkin 7:36

of a new child,

Innessa Donskoy 7:37

Sometimes when we get

Alisa Minkin 7:39

to get excited about, a new thing to check

Innessa Donskoy 7:41

that we

Alisa Minkin 7:42

we

Innessa Donskoy 7:43

implement,

Alisa Minkin 7:44

those change,

Innessa Donskoy 7:46

Nobody

Alisa Minkin 7:46

Nobody knows this. You know, something that changes our whole family, but for kids it can

Innessa Donskoy 7:52

and

Alisa Minkin 7:52

be a big thing and it can be just as bad as anybody else that we're stressed and people can precipitate more than-- We've all had a little bit of sleep deprivation in a child that's afraid of smoke,

Innessa Donskoy 8:03

maybe

Alisa Minkin 8:04

maybe jet-lagged, having sleep already.

Innessa Donskoy 8:07

And by the

Alisa Minkin 8:08

And by the way, this is where living in-

Innessa Donskoy 8:10

also

Alisa Minkin 8:10

say, yeah right? That is like a

Innessa Donskoy 8:13

regression

Alisa Minkin 8:13

pressure cooker. Sometimes we don't even notice how stressful it

Innessa Donskoy 8:18

And this

Alisa Minkin 8:18

I think of some of these changes like with my foster parents when they got married. You know, they turned out to

Innessa Donskoy 8:27

up.

Alisa Minkin 8:28

be the perfect couple for each other. They were married and they had a little bit too many siblings. Right? And just like, I mean, we're gonna think more about

Innessa Donskoy 8:37

being,

Alisa Minkin 8:37

being, about exciting,

Innessa Donskoy 8:40

positively

Alisa Minkin 8:41

exciting,

Innessa Donskoy 8:42

Not even just stressful,

Alisa Minkin 8:43

stressful because we,

Innessa Donskoy 8:44

of

Alisa Minkin 8:45

we sort of typically know that stressful things, but again, if we stressful things make things sleep harder. But positively stressful things do. Exciting things. What is excitement in our brain?

Innessa Donskoy 8:57

serotonin, it's

Alisa Minkin 8:58

dopamine, it's norepinephrine, all of these neurotransmitter chemicals in our brain that tell us to be excited. They are also linked to delaying neurotransmitters. But they're in our brain.

Innessa Donskoy 9:10

they stay in our

Alisa Minkin 9:11

They stay in our brain even though it's seven-thirty. It's supposed to be bedtime. Or ten-thirty. Right. But right.

Innessa Donskoy 9:21

dissipate, right? And so that can, that can bring on one of these sleep regressions, which really, if

Alisa Minkin 9:28

Which really we're just quick to breaking down because I'm a little bit of a stimulant excitement referring to just you

Innessa Donskoy 9:34

That's what

Alisa Minkin 9:34

That's what a sleep regression is.

Innessa Donskoy 9:36

celebrated. It's

Alisa Minkin 9:37

It's hard on us.

Innessa Donskoy 9:39

on

Alisa Minkin 9:39

hard on them,

Innessa Donskoy 9:40

But it's

Alisa Minkin 9:41

but it's good. It means they're making these changes and hopefully learning new things and wanting to,

Innessa Donskoy 9:46

to

Alisa Minkin 9:46

wanting to reflect on what it meant to be in a baby way,

Innessa Donskoy 9:49

right?

Alisa Minkin 9:50

right? So again,

Innessa Donskoy 9:51

predisposing

Alisa Minkin 9:53

factors that maybe make the family more likely to sleep like this. We have precipitating things that bubble up, and then the most important thing is the perpetuating factors. These are the things that we do as parents that maintain the

Innessa Donskoy 10:13

around.

Alisa Minkin 10:14

issues over time. And this is actually where a lot of the focus, attention, and the most action is for change, right? Because

Innessa Donskoy 10:24

changing what we're

Alisa Minkin 10:25

we're doing the implementing those predisposing or precipitating factors. We have to, you know, change the perpetuating ones.

Innessa Donskoy 10:33

understanding what

Alisa Minkin 10:35

one day off are really key. Sometimes they're, they're increased like a,

Innessa Donskoy 10:42

at, at

Alisa Minkin 10:43

an emphasis

Innessa Donskoy 10:44

the schedule, right? Or, or

Alisa Minkin 10:46

we put on certain things

Innessa Donskoy 10:48

where we

Alisa Minkin 10:48

our clinics and in what we do. And at different ages, different perpetuating,

Innessa Donskoy 10:54

factors, you know,

Alisa Minkin 10:56

you know,

Innessa Donskoy 10:56

can

Alisa Minkin 10:57

come to the front. For example,

Innessa Donskoy 10:59

the

Alisa Minkin 10:59

in a child that's a little over a month, right, it's about putting sleep into the day,

Innessa Donskoy 11:06

giving, like,

Alisa Minkin 11:06

having like naps in the day

Innessa Donskoy 11:08

be a

Alisa Minkin 11:08

can be a perpetuating factor,

Innessa Donskoy 11:10

sleep at

Alisa Minkin 11:10

sleep at night harder because you still have sleep making it into the day. Whereas in a younger

Innessa Donskoy 11:15

where

Alisa Minkin 11:15

child where napping would be

Innessa Donskoy 11:17

completely

Alisa Minkin 11:18

completely appropriate,

Innessa Donskoy 11:19

not

Alisa Minkin 11:19

it's not necessarily- I mean, even then, though, I think any experienced parent knows there's that dead zone in the day. If they go to sleep, that's it. Even the younger kids, right? Actually,

Innessa Donskoy 11:31

about what time that

Alisa Minkin 11:33

the opposite. That is

Innessa Donskoy 11:33

their

Alisa Minkin 11:34

their child.

Innessa Donskoy 11:35

they're gonna

Alisa Minkin 11:35

They're gonna find that oftentimes they reinforce each other,

Innessa Donskoy 11:40

And so

Alisa Minkin 11:40

right? And so that's why it's

Innessa Donskoy 11:42

important

Alisa Minkin 11:43

important to know your child's sleeping schedule.

Innessa Donskoy 11:47

a

Alisa Minkin 11:47

am a big fan of sleep logs. Big, big, big.

Innessa Donskoy 11:51

I like

Alisa Minkin 11:52

I like data, and I like charting it,

Innessa Donskoy 11:55

I

Alisa Minkin 11:55

and I often find that even when things feel totally random,

Innessa Donskoy 11:59

there's

Alisa Minkin 12:00

there's no rhyme or reason to what's going on, sometimes logging for one to two weeks reveals to you

Innessa Donskoy 12:07

you're

Alisa Minkin 12:08

as you are logging it, a pattern that you never saw

Innessa Donskoy 12:12

So

Alisa Minkin 12:13

So

Innessa Donskoy 12:13

one thing that I

Alisa Minkin 12:14

something that I always really

Innessa Donskoy 12:15

turn

Alisa Minkin 12:16

turn to

Innessa Donskoy 12:17

not just to

Alisa Minkin 12:18

just to buy me some time to think about what I think is going on,

Innessa Donskoy 12:21

also to

Alisa Minkin 12:22

but also have the family just reflect on

Innessa Donskoy 12:24

w- w- what's

Alisa Minkin 12:25

what's happening Today, today

Innessa Donskoy 12:28

is I

Alisa Minkin 12:28

is I like, my youngest two and then your kind of UC lesson as my favorite sleep blog,

Innessa Donskoy 12:34

that

Alisa Minkin 12:34

one that actually for a, for a kiddo who,

Innessa Donskoy 12:37

to

Alisa Minkin 12:37

who likes to color and is, is aware of them,

Innessa Donskoy 12:39

them

Alisa Minkin 12:40

they have a little bit about themselves. Obviously, a parent is going to be doing as much as they can to help them.

Innessa Donskoy 12:45

boxes where you're

Alisa Minkin 12:46

majority of sleep stuff covering I think that they can for every sort of talk. Generally,

Innessa Donskoy 12:52

it for

Alisa Minkin 12:53

you do it for two weeks at a time, and then you gradually step back. You see, you see the,

Innessa Donskoy 12:58

that, I, I'm gonna hesitate to use

Alisa Minkin 13:01

to use the word, but I'll use it anyway, windows

Innessa Donskoy 13:04

of

Alisa Minkin 13:05

of sleep, and they

Innessa Donskoy 13:06

start

Alisa Minkin 13:08

to present themselves. Baby,

Innessa Donskoy 13:10

meaning

Alisa Minkin 13:11

often is much more honor than they realize as to how long the baby can kind of be awake for. They do

Innessa Donskoy 13:15

long a

Alisa Minkin 13:16

babies, they're pretty consistent with the, the, the long rather than the

Innessa Donskoy 13:26

than an exception, right? How

Alisa Minkin 13:28

I often think that they really make a lot of people

Innessa Donskoy 13:34

sort of

Alisa Minkin 13:34

think, "How high is this going to be?" Sort of to again, maybe a sleepier part is too

Innessa Donskoy 13:40

asleep

Alisa Minkin 13:40

of a sleep is very important,

Innessa Donskoy 13:42

start

Alisa Minkin 13:42

we start to see

Innessa Donskoy 13:43

patterns.

Alisa Minkin 13:45

you explain what you mean by sleep pressure? We talked about it in the other one, but I don't remember.

Innessa Donskoy 13:49

Yeah. S- so s- sleep pressure is just

Alisa Minkin 13:53

Just sometimes

Innessa Donskoy 13:58

to be

Alisa Minkin 13:59

it's the two,

Innessa Donskoy 14:00

asleep.

Alisa Minkin 14:02

two

Innessa Donskoy 14:03

very

Alisa Minkin 14:04

very likely to be the densest

Innessa Donskoy 14:06

that kind of

Alisa Minkin 14:07

kind of tracks that sleep. So as that builds up in the brain,

Innessa Donskoy 14:11

get

Alisa Minkin 14:11

he gets sleepy enough to fall asleep, and different people have different thresholds of how much sleep pressure they can tolerate. Someone can stay up

Innessa Donskoy 14:25

hours and be

Alisa Minkin 14:26

and feel fine. Someone can stay up sixteen, and we know that with the little ones, little, little ones will sometimes have,

Innessa Donskoy 14:34

they can't

Alisa Minkin 14:34

they can't tolerate more than thirty to sixty minutes of sleep pressure before they need to take a nap.

Innessa Donskoy 14:41

what

Alisa Minkin 14:41

And what happens at that nap is that they pay

Innessa Donskoy 14:44

that

Alisa Minkin 14:44

their sleep pressure that was low enough they wake up,

Innessa Donskoy 14:49

and then

Alisa Minkin 14:49

but then they do it over again. So really in early, early life where poor sleep, sleep difference,

Innessa Donskoy 14:57

pressure. That's

Alisa Minkin 14:59

that's the biggest driver of infant sleep. The circadian rhythm,

Innessa Donskoy 15:04

that

Alisa Minkin 15:04

I think that internal twenty-four-hour clock starts to develop and continues to develop as a baby

Innessa Donskoy 15:11

in,

Alisa Minkin 15:12

in,

Innessa Donskoy 15:12

you know,

Alisa Minkin 15:13

you know, a stable, really stable home

Innessa Donskoy 15:15

with consistent

Alisa Minkin 15:17

mornings and

Innessa Donskoy 15:19

cycles. But

Alisa Minkin 15:21

but at first, at first, at first,

Innessa Donskoy 15:23

they don't

Alisa Minkin 15:23

they don't have a time

Innessa Donskoy 15:25

They are

Alisa Minkin 15:26

They're essentially just staying awake as long as they can

Innessa Donskoy 15:29

until they

Alisa Minkin 15:30

till they fall asleep, staying asleep as long

Innessa Donskoy 15:32

can,

Alisa Minkin 15:33

and then doing it

Innessa Donskoy 15:34

and

Alisa Minkin 15:35

over and over.

Innessa Donskoy 15:36

which is

Alisa Minkin 15:36

Which is why making

Innessa Donskoy 15:38

is

Alisa Minkin 15:38

babies is

Innessa Donskoy 15:39

so

Alisa Minkin 15:39

so, so challenging and, and unfair.

Innessa Donskoy 15:41

I

Alisa Minkin 15:42

I feel our early

Innessa Donskoy 15:43

Really,

Alisa Minkin 15:44

really like

Innessa Donskoy 15:45

months younger,

Alisa Minkin 15:46

or under

Innessa Donskoy 15:47

you know, I might, I

Alisa Minkin 15:47

you know, I may have a baby literally saying that, but I, I really hesitate to

Innessa Donskoy 15:52

firm

Alisa Minkin 15:52

firm

Innessa Donskoy 15:53

about

Alisa Minkin 15:53

about how long

Innessa Donskoy 15:54

baby

Alisa Minkin 15:55

baby can stay awake or

Innessa Donskoy 15:56

this baby

Alisa Minkin 15:56

baby needs to sleep or and then relieve

Innessa Donskoy 16:00

they're

Alisa Minkin 16:01

because they are sort of figuring it out themselves. Their family is figuring them out. And rather than follow some sort of arbitrary sort of agreed upon rule of two to nine- 12 by 12. Feels like you're dancing around the 12 by 12.

Innessa Donskoy 16:17

Yeah. It's,

Alisa Minkin 16:19

You know,

Innessa Donskoy 16:22

grace. And I

Alisa Minkin 16:23

and the fact that, you know,

Innessa Donskoy 16:25

if we're

Alisa Minkin 16:25

if we're not relaxed,

Innessa Donskoy 16:27

we need to

Alisa Minkin 16:28

we need a big, big relax

Innessa Donskoy 16:30

That fake

Alisa Minkin 16:30

of thing into the waking phenomena because the one thing that the baby

Innessa Donskoy 16:34

sensing is stress. It is

Alisa Minkin 16:37

It is sensing stress,

Innessa Donskoy 16:38

and

Alisa Minkin 16:39

and it

Innessa Donskoy 16:40

to know

Alisa Minkin 16:41

to know that we're calm

Innessa Donskoy 16:42

and,

Alisa Minkin 16:43

and that we're well now,

Innessa Donskoy 16:44

if

Alisa Minkin 16:45

and if we're nursing, then we're literally passing on that stress, right? And so we need to

Innessa Donskoy 16:52

create

Alisa Minkin 16:53

communicate this, "I think you're well,"

Innessa Donskoy 16:57

of

Alisa Minkin 16:57

and the,

Innessa Donskoy 16:58

I'm going to attend to

Alisa Minkin 17:00

of attending to your needs and identifying needs

Innessa Donskoy 17:03

gonna learn

Alisa Minkin 17:05

ourselves together. We're gonna...

Innessa Donskoy 17:06

some boundaries. I

Alisa Minkin 17:08

The babies, I think,

Innessa Donskoy 17:09

are

Alisa Minkin 17:09

the babies are...

Innessa Donskoy 17:10

I think we also

Alisa Minkin 17:11

We also talked about this in a bit of the lesson we led too, but starting to really aid

Innessa Donskoy 17:16

sort

Alisa Minkin 17:16

that sort of dying zone in your

Innessa Donskoy 17:18

even

Alisa Minkin 17:18

home and upon coming home is so, so important.

Innessa Donskoy 17:22

whenever

Alisa Minkin 17:23

whenever we're used to rising as this parent and coming into a beautiful place and

Innessa Donskoy 17:29

and

Alisa Minkin 17:29

we can settle into an activity and

Innessa Donskoy 17:34

rest

Alisa Minkin 17:35

on our needs during this period. We, when it's our sort of more internal

Innessa Donskoy 17:41

when lights

Alisa Minkin 17:42

lights get dim, the swan sounds get quiet, and even when we're interrupted or this baby's woken up for its whatever meal for me,

Innessa Donskoy 17:51

diaper

Alisa Minkin 17:52

that we're giving

Innessa Donskoy 17:53

the night

Alisa Minkin 17:54

baby sort of the need to get this sort of right, we're still quiet and things are still

Innessa Donskoy 17:59

so that

Alisa Minkin 17:59

dim so that they're reinforcing the late dark cycle that's actually gonna build the internal circadian rhythm. I love that. That's excellent. So what we were talking about was basically giving sleep cues, giving sleep cues, which is good. But I wanna-- I-- Okay. I wanna go back to the perpetuating factors because I feel like we really need to go into that more because as a pediatrician, I, I do see this. I do see that parents are unintentionally doing some things that are counterproductive, and I think since that's something we do have potential control over, I wanna talk about that more, please.

Innessa Donskoy 18:33

I mean, we, we really... It... The perpetuating factors, again, they, they change based on age, but

Alisa Minkin 18:39

And

Innessa Donskoy 18:40

want to make a decision for right now that we're not okay with sticking with that decision long term. this is the, this is the stuff we do to get baby to fall asleep just,

Alisa Minkin 18:53

then

Innessa Donskoy 18:53

this one time, and then it

Alisa Minkin 18:55

becomes a little bit of a rocking thing.

Innessa Donskoy 19:00

you know,

Alisa Minkin 19:01

you know,

Innessa Donskoy 19:02

we won't get into,

Alisa Minkin 19:03

and to like the safety part of it,

Innessa Donskoy 19:05

the bed

Alisa Minkin 19:05

the bed sharing is a no. Multiple babies require one to follow. But it's

Innessa Donskoy 19:10

is then

Alisa Minkin 19:11

that,

Innessa Donskoy 19:11

that is

Alisa Minkin 19:12

that is something that the baby will become accustomed to and

Innessa Donskoy 19:15

no-

Alisa Minkin 19:16

don't

Innessa Donskoy 19:16

to

Alisa Minkin 19:17

to enter

Innessa Donskoy 19:18

in

Alisa Minkin 19:19

sleep in this way.

Innessa Donskoy 19:20

When, when

Alisa Minkin 19:21

When, when babies obviously wouldn't. They are entering sleep.

Innessa Donskoy 19:27

cycles. They're

Alisa Minkin 19:29

They're

Innessa Donskoy 19:29

sleep,

Alisa Minkin 19:30

sleep. We're talking about agencies. People

Innessa Donskoy 19:34

going between

Alisa Minkin 19:35

are sleeping and breathing.

Innessa Donskoy 19:37

but we,

Alisa Minkin 19:37

But we are entering sleep from a sleep cycle.

Innessa Donskoy 19:41

In

Alisa Minkin 19:42

You can see there,

Innessa Donskoy 19:43

between

Alisa Minkin 19:44

between thirty to ninety minutes long.

Innessa Donskoy 19:46

longer and

Alisa Minkin 19:47

go longer. It only goes to ninety minutes by

Innessa Donskoy 19:49

year

Alisa Minkin 19:49

one year of life.

Innessa Donskoy 19:50

So they

Alisa Minkin 19:50

So they can't be in it for

Innessa Donskoy 19:52

why

Alisa Minkin 19:52

that way in order to make

Innessa Donskoy 19:54

But

Alisa Minkin 19:54

Once they finish that

Innessa Donskoy 19:56

they will need to fall

Alisa Minkin 19:57

cycle, they will

Innessa Donskoy 19:58

again.

Alisa Minkin 19:58

again into the next sleep cycle. But if you are not still nursing, rocking,

Innessa Donskoy 20:06

holding, patting

Alisa Minkin 20:08

patting their tush,

Innessa Donskoy 20:09

whatever

Alisa Minkin 20:10

whatever thing you're doing,

Innessa Donskoy 20:12

not

Alisa Minkin 20:12

you are not doing it anymore. They will find--

Innessa Donskoy 20:15

They will

Alisa Minkin 20:15

They will

Innessa Donskoy 20:16

you

Alisa Minkin 20:16

argue with their cry, their sleepy way. They will be like, "No."

Innessa Donskoy 20:19

you're...

Alisa Minkin 20:20

are--

Innessa Donskoy 20:20

You have

Alisa Minkin 20:21

You have lost an interest in

Innessa Donskoy 20:23

cycles, you've left. You

Alisa Minkin 20:25

with them. You have to come back. They're on an aim to enter sleep

Innessa Donskoy 20:31

a different

Alisa Minkin 20:31

different way.

Innessa Donskoy 20:32

If

Alisa Minkin 20:33

People

Innessa Donskoy 20:33

teaching them

Alisa Minkin 20:34

teaching them the vertical hurdle,

Innessa Donskoy 20:36

this is how

Alisa Minkin 20:36

this is the only way you start to sleep tight. But they're not.

Innessa Donskoy 20:39

need it

Alisa Minkin 20:40

it

Innessa Donskoy 20:41

single

Alisa Minkin 20:42

night they enter sleep cycles again. That's really an important point, and we kind of skipped right over a couple of things. First of all, I wanna say that the twelve by twelve, just to clarify, is a program to teach children to sleep twelve hours by twelve weeks old. And, Actually, for some people it works. Okay? So we're not going against that, but any program that you think is a one-size-fits-all, it's not true because every kid is different. So I just wanna make that point. I don't wanna be disrespectful to that program across the board, but back to that, you know, not perfect parenting, there is no perfect solution for everyone. Okay?

Innessa Donskoy 21:19

I'll, I'll... I don't wanna interrupt you, but yes, I

Alisa Minkin 21:22

Yes.

Innessa Donskoy 21:23

agree. This isn't meant to poo-poo any

Alisa Minkin 21:26

Right. Right.

Innessa Donskoy 21:27

the truth is, is that there are, there are going to be things that you find that just click and resonate with you as a parent, or, and/or really work for this particular kid, and that is amazing. And congratulations that you've found the right sort of combo, right, for you, and this mother or, or parent-child dyad, right? But yes, I completely agree with you. It doesn't necessarily then mean that it will work for another child, even another one of your children. It's so hard for parents sometimes to come in with their, you know, second or third or, or beyond child and say, "I don't get it. This worked for everybody else. Why isn't it working for this kid?" Right? And, and it's 'cause they're a unique human. And

Alisa Minkin 22:20

Exactly.

Innessa Donskoy 22:21

and they're adults, you're never gonna believe that you compared this

Alisa Minkin 22:26

Right. Because

Innessa Donskoy 22:27

Gosh, th- this one's like on Wall Street, this one's like, you know, learning, like learning full time. They're, they're so different, so why do we expect them to be so identical, right?

Alisa Minkin 22:37

want them to sleep. Okay. I wanna go back over a couple more things. Speaking of sleep, okay, in terms of co-sleeping or, or bed sharing, we are just going to put that aside. That is just outside the scope. We are gonna emphasize safe s- safe sleep practice, but also acknowledge that some people choose to do this. We, we, we cannot fit that into today but I just wanna put that out there. Now, some people, I think more people are choosing to bring the babies in bed with them out of desperation, okay? As opposed to as a planned choice, and that, to me, is the biggest problem of all because they are the least likely to take practices to make it safer, right? And so th- that's a concern, but they also may not realize that they didn't start as they meant to go on, that they took something on, and they're the ones who why the kid's still in their bed, you know, however many years later. But, but, but the issue with that is it, it... The, the real, to me, the real nitty-gritty issue is whether you agree that a child needs to learn to self-soothe because there is an ideology, right, this attachment parenting kind of style where you believe that it is your job to soothe your child, and I'm just putting it out there. My concern as a pediatrician is that I'm concerned for parents being asked to parent twenty-four seven, three sixty-five, this intensive parenting style. And I think that what often happens is nobody sleeps well. That's my, my take here. I'm not trying to be disrespectful to anything. I just-- I don't know if people really understand what happens over time in this particular situation. You can talk about it to say that.

Innessa Donskoy 24:18

mean, I, I, I'm, I'm by no means e-even a

Alisa Minkin 24:23

I'm again, an expert in, in attachment parenting.

Innessa Donskoy 24:27

it, but

Alisa Minkin 24:28

But it-- But it's interesting to hear

Innessa Donskoy 24:30

to hear

Alisa Minkin 24:30

to hear that like dichotomy of is it the child's responsibility? I still say there's a parent's responsibility.

Innessa Donskoy 24:37

be honest

Alisa Minkin 24:37

But honestly too,

Innessa Donskoy 24:39

I think

Alisa Minkin 24:39

I think it's a parent's responsibility to help that child

Innessa Donskoy 24:44

recognize and

Alisa Minkin 24:46

and foster

Innessa Donskoy 24:48

the

Alisa Minkin 24:48

his feelings and

Innessa Donskoy 24:51

think

Alisa Minkin 24:51

I think that looks different as they develop a distinct identity. Different kids.

Innessa Donskoy 24:57

and different kids,

Alisa Minkin 24:58

Yes. Because for me, when I

Innessa Donskoy 25:01

different

Alisa Minkin 25:01

think that relationship

Innessa Donskoy 25:06

to access Recognizing their

Alisa Minkin 25:10

the same way

Innessa Donskoy 25:13

choosing the way to respond, right? This is such

Alisa Minkin 25:16

when this is a challenging situation for a baby or a

Innessa Donskoy 25:17

a mature thing we're asking

Alisa Minkin 25:19

is to do what all kids do.

Innessa Donskoy 25:23

I think parents

Alisa Minkin 25:24

think that... Lots of

Innessa Donskoy 25:27

pa- the parents

Alisa Minkin 25:28

parent parents I've,

Innessa Donskoy 25:29

in

Alisa Minkin 25:29

seen in clinic too is they go, "Oh, we have to reflect on the child's day."

Innessa Donskoy 25:34

really, and

Alisa Minkin 25:35

Really? What helps them fall into it?

Innessa Donskoy 25:38

What helps

Alisa Minkin 25:39

helps them

Innessa Donskoy 25:40

kind of

Alisa Minkin 25:40

kind of calm and,

Innessa Donskoy 25:42

the

Alisa Minkin 25:42

and feel love and, and anxiety or look like, like feeling safe and then separating from

Innessa Donskoy 25:49

or, or

Alisa Minkin 25:50

for me, it's particularly extreme about that with the challenges of

Innessa Donskoy 25:55

of the

Alisa Minkin 25:55

the day because often times as a mom with a

Innessa Donskoy 25:58

particular

Alisa Minkin 26:00

phrase, tools, sounds, toys, whatever it is,

Innessa Donskoy 26:06

can

Alisa Minkin 26:06

I'm getting

Innessa Donskoy 26:07

helpful to take

Alisa Minkin 26:08

to take into the night. And I'm gonna-- This is where, where sleep care becomes

Innessa Donskoy 26:13

unique. The

Alisa Minkin 26:15

The things that I've heard them and I'm like,

Innessa Donskoy 26:18

hard

Alisa Minkin 26:18

hard

Innessa Donskoy 26:19

trucks or into

Alisa Minkin 26:21

into bed with them." Right? And

Innessa Donskoy 26:22

right?

Alisa Minkin 26:22

I, I... Crazy things that, that just in the day, into the night.

Innessa Donskoy 26:26

seem to help in the day, into the

Alisa Minkin 26:29

Right? And

Innessa Donskoy 26:30

And I,

Alisa Minkin 26:30

I, and I think also we're talking a lot about--

Innessa Donskoy 26:33

we're

Alisa Minkin 26:33

I think we're talking about larger neurotypical care. We need to move on to

Innessa Donskoy 26:35

mostly. then

Alisa Minkin 26:37

neurodivergent.

Innessa Donskoy 26:38

what, when you, when you talk about kiddos who are a little bit or neuroatypical it opens the door even more

Alisa Minkin 26:47

To creative and right?

Innessa Donskoy 26:52

is so

Alisa Minkin 26:53

is so much discussion about screens and the light,

Innessa Donskoy 26:57

like

Alisa Minkin 26:58

also like the, the content that can be alerting for kids.

Innessa Donskoy 27:02

Even though

Alisa Minkin 27:03

you know, screens are where you spend throughout the day. But do you know that

Innessa Donskoy 27:12

who's neurodivergent, and I'm asking them to take their

Alisa Minkin 27:17

is their modes of communication and self-soothing? If they're a divergent and I'm asking them to take their devices into bed,

Innessa Donskoy 27:22

in

Alisa Minkin 27:22

it- Really?

Innessa Donskoy 27:23

way. Yeah. If that's what they you- need in their unique case. This is, again, there's no cookie cutters

Alisa Minkin 27:30

Oh, wow

Innessa Donskoy 27:31

they're non-verbal, this is their only way to get their needs communicated and met, and you are essentially duct taping, you know, their mouth by removing it at

Alisa Minkin 27:41

give me tremendous anxiety it's going to relax and trust enough to close their eyes and fall asleep.

Innessa Donskoy 27:49

right?

Alisa Minkin 27:50

Right? So, so there is a lot to be said about different things, really, really case by case. Wow. Do you mean kids who have an augmentative communication device, or are you talking about kids who are just watching screens? Because when you... You know, a lot of these kids just like to watch videos, it will never end. How will they fall asleep?

Innessa Donskoy 28:08

Right. So, so I'm, I'm

Alisa Minkin 28:10

gonna

Innessa Donskoy 28:13

I'll be honest, it, it really depends. It depends on what that device is doing for them at that moment. And this might be our bridge to, you know, the next

Alisa Minkin 28:24

need sort of sleep

Innessa Donskoy 28:25

take in

Alisa Minkin 28:26

think,

Innessa Donskoy 28:26

sleep

Alisa Minkin 28:26

the point here is that it's not one size fits all. I love

Innessa Donskoy 28:34

no means endorsing watching screens before bed

Alisa Minkin 28:38

I, I... But, but, but the point that you're making is so incredibly important that each child is different, number one. And number two, neurodivergent kids tend to have more sleep problems, more severe sleep problems, right? And so the answer is going to be different, and there they are going to be going on social media and seeing, "Oh, my kid fell asleep with the 12 by 12," whatever. And they're like, "Why is my kid like, you know, 13 years old and not sleep?" I'm making this up. But, you know, I mean, like, these are really, these are really huge problems. What other, what other nuggets do you have for neurodivergent families?

Innessa Donskoy 29:12

So again, I think find, finding patterns is, is very, very important. You know, we can have... When it comes to difficulty with falling and staying asleep, sometimes it's important to distinguish this from an internal kind of time zone or circadian rhythm disorder. So sometimes our s- child's sleep can feel unpredictable, but when we take a step back and we kind of log and track it, we realize it's just set later perhaps

Alisa Minkin 29:41

Or absence of a blanket or pillow or is it an overnight care? You know, they might be taking their sleep that's split

Innessa Donskoy 29:49

into

Alisa Minkin 29:50

into, into two or more,

Innessa Donskoy 29:53

of

Alisa Minkin 29:53

big pockets of time.

Innessa Donskoy 29:54

I see this

Alisa Minkin 29:55

seen this a lot in neurodivergent kiddos where they might have like a delayed sleep wake phase, meaning they're falling and staying asleep significantly later than their age-matched peers. Not sleeping enough

Innessa Donskoy 30:09

weekdays, right? 'Cause

Alisa Minkin 30:10

right? 'Cause they're kind of caught between two different rhythms. So

Innessa Donskoy 30:13

and then there's

Alisa Minkin 30:14

then they're splitting this big huge chunk of nap

Innessa Donskoy 30:16

their

Alisa Minkin 30:16

into their day,

Innessa Donskoy 30:18

then

Alisa Minkin 30:18

then it's, it's actually

Innessa Donskoy 30:19

from their night.

Alisa Minkin 30:20

their nights where they end up with

Innessa Donskoy 30:22

broken

Alisa Minkin 30:23

sleep across the board. So

Innessa Donskoy 30:26

it,

Alisa Minkin 30:26

tracking it, I think, is very important. Understanding the pattern. Enlist the help.

Innessa Donskoy 30:30

the

Alisa Minkin 30:31

Enlist the help of a sleep coach or doctor or sleep psychologist

Innessa Donskoy 30:37

a

Alisa Minkin 30:37

if you're having a hard time finding the pattern yourself. But also be very ready to,

Innessa Donskoy 30:43

to notice

Alisa Minkin 30:44

notice that the

Innessa Donskoy 30:45

hours

Alisa Minkin 30:46

hours your child

Innessa Donskoy 30:47

may

Alisa Minkin 30:48

needs may not fit their age.

Innessa Donskoy 30:50

meaning

Alisa Minkin 30:51

meaning those, you know, agreed upon

Innessa Donskoy 30:52

Sleep

Alisa Minkin 30:53

Sleep Foundation, Academy of Sleep Medicine, their nation,

Innessa Donskoy 30:55

recommended amount of hours,

Alisa Minkin 30:57

hours for age. But often I find that those are much, much especially with kiddos on the autism spectrum.

Innessa Donskoy 31:08

I don't know

Alisa Minkin 31:09

I don't know if they

Innessa Donskoy 31:10

sleep

Alisa Minkin 31:10

less sleep or they're getting less sleep. But often I find that

Innessa Donskoy 31:15

we

Alisa Minkin 31:15

we sort of decide with the family on

Innessa Donskoy 31:19

this is the

Alisa Minkin 31:19

this is the amount of sleep we're gonna aim for and

Innessa Donskoy 31:23

much

Alisa Minkin 31:23

we're much more reasonable with our expectations of time in and out of bed, suddenly

Innessa Donskoy 31:28

falling and

Alisa Minkin 31:29

falling and staying asleep becomes easier. That in and of itself is sometimes

Innessa Donskoy 31:37

more

Alisa Minkin 31:37

more beneficial than reaching a certain

Innessa Donskoy 31:40

predetermined

Alisa Minkin 31:40

And I turn that on- I see. I see.

Innessa Donskoy 31:44

sleep, right? Consolidated sleep in a dependable time

Alisa Minkin 31:48

Broken sleep and solid blocks.

Innessa Donskoy 31:50

that is

Alisa Minkin 31:51

is even more refreshing than

Innessa Donskoy 31:54

meeting a

Alisa Minkin 31:55

hitting a certain

Innessa Donskoy 31:56

of

Alisa Minkin 31:56

amount of numbers. Not to completely ignore school, but this is where it comes down to

Innessa Donskoy 32:00

every kid

Alisa Minkin 32:01

every kid is so unique. Right. So what you're saying is some kids may not fit the mold, and you're fighting against what they need, actually.

Innessa Donskoy 32:09

Yep. Yep, and so then we're putting them in bed too early, and maybe we're

Alisa Minkin 32:13

Yeah.

Innessa Donskoy 32:13

sleep medicine medication, I mean,

Alisa Minkin 32:16

To sleep maybe for up to sixty minutes, but they're in the

Innessa Donskoy 32:23

and were we to have stepped back and say, "Well,

Alisa Minkin 32:26

middle of the night until like half and then into the summer. They may need a sort of couple rest sleep, right? The more restricted the time in bed was stolen from them, that may mean falling and staying asleep

Innessa Donskoy 32:38

can now come more easily even without medication, maybe. And, and now we've got a, like, a window we

Alisa Minkin 32:45

now

Innessa Donskoy 32:46

depend on."

Alisa Minkin 32:48

come with me speaking about medication, maybe. And, and now we've got a window into- I wanna talk about medication, but before you mentioned sleep coaches. How do you know who to go to? And this is why we're talking about a family, it's really distressing, okay? The child's sleep issues, for whatever reason, are really distressing. They don't know what to do. Who do they go to first? How do they choose between a sleep coach and a sleep doctor like you? And did you mention a third professional?

Innessa Donskoy 33:06

Sleep psychologists,

Alisa Minkin 33:08

Sleep psychologist. So sleep doctor, sleep physician, which you are, sleep psychologist, and a sleep coach. How do you know? Who do you get to first?

Innessa Donskoy 33:15

there's sleep consultants too and

Alisa Minkin 33:18

that different from a sleep coach? Is that just an-

Innessa Donskoy 33:20

Yes. No, they're all, they're all different. So the truth is, is that there's a very

Alisa Minkin 33:26

very broad variety

Innessa Donskoy 33:29

different

Alisa Minkin 33:29

different people talking about sleep. Some of them are immensely evidence-based and thoughtful,

Innessa Donskoy 33:39

and very

Alisa Minkin 33:39

very like tailor, will tailor the care to each child.

Innessa Donskoy 33:44

Others

Alisa Minkin 33:44

Others are very cookie cutter. This is the package.

Innessa Donskoy 33:48

amount of

Alisa Minkin 33:48

amount of money for the package. You watch the videos, and that's the sleep care.

Innessa Donskoy 33:54

the

Alisa Minkin 33:54

So the one thing that I'll say is that just be careful, careful who

Innessa Donskoy 33:59

turning for

Alisa Minkin 34:00

for care, and also how much money you're spending for care.

Innessa Donskoy 34:05

You know, it-

Alisa Minkin 34:05

You know, it, it's, it's so heartbreaking

Innessa Donskoy 34:07

a

Alisa Minkin 34:08

when a

Innessa Donskoy 34:08

will, will

Alisa Minkin 34:09

will, will spend a tremendous amount of money and sort of get advice that's not, that's not right for them. I'm like, "Why are you paying for something else

Innessa Donskoy 34:17

not

Alisa Minkin 34:17

that's just not right for them?" So

Innessa Donskoy 34:19

I would

Alisa Minkin 34:19

but honestly, and my answer is obviously biased because I had come from the perspective of sleep medicine.

Innessa Donskoy 34:25

that

Alisa Minkin 34:26

So

Innessa Donskoy 34:26

I say what I

Alisa Minkin 34:27

listen to what I say next, but I would, would start talking with your pediatrician.

Innessa Donskoy 34:30

Often a

Alisa Minkin 34:31

a pediatrician will know community resources, and if you happen to be in an area of the country

Innessa Donskoy 34:37

a

Alisa Minkin 34:37

with a pediatric sleep medicine program,

Innessa Donskoy 34:40

they can

Alisa Minkin 34:40

they can refer you

Innessa Donskoy 34:41

pediatric

Alisa Minkin 34:42

a pediatric sleep medicine doctor like myself

Innessa Donskoy 34:44

in

Alisa Minkin 34:45

that's in your insurance network,

Innessa Donskoy 34:47

your

Alisa Minkin 34:47

your insurance can

Innessa Donskoy 34:49

for

Alisa Minkin 34:49

pay for it like any other doctor visit,

Innessa Donskoy 34:52

will

Alisa Minkin 34:52

which will hopefully be

Innessa Donskoy 34:53

least

Alisa Minkin 34:53

the least amount of money you have to pay.

Innessa Donskoy 34:55

Depending on where

Alisa Minkin 34:56

on where you are in the country, the sleep medicine department may also be attached to a sleep psychologist, and these are even better

Innessa Donskoy 35:05

than,

Alisa Minkin 35:05

than, than sleep doctors, honestly. I have so many amazing colleagues that are sleep psychologists in Chicago Boston, Philadelphia. There's a lot of them out there.

Innessa Donskoy 35:16

many of them

Alisa Minkin 35:16

many of them do research, but a lot of them do clinical care as well, and they are phenomenal because not only do they have evidence-based

Innessa Donskoy 35:23

medicine background, but they

Alisa Minkin 35:25

background, but they also have the psychological background attached to

Innessa Donskoy 35:29

that

Alisa Minkin 35:30

that training. They can assess different psychiatric needs that medical doctors never

Innessa Donskoy 35:37

So really,

Alisa Minkin 35:37

So really one of my favorite things to do with complex cases is to partner

Innessa Donskoy 35:41

and

Alisa Minkin 35:42

and have somebody to

Innessa Donskoy 35:43

care

Alisa Minkin 35:43

take care of the medical or even medication side of it. That way the psychologist can help manage with cognitive behavioral therapy and insomnia and other behavioral techniques. But then we have the whole team working to try

Innessa Donskoy 35:54

That can help,

Alisa Minkin 35:55

fix things.

Innessa Donskoy 35:58

There are

Alisa Minkin 35:59

are amazing updated sleep 15 and

Innessa Donskoy 36:03

consultants

Alisa Minkin 36:04

programs out there. And actually

Innessa Donskoy 36:05

I'm not

Alisa Minkin 36:06

I'm not looking or promoting anyone, but I, I actually

Innessa Donskoy 36:09

and do some

Alisa Minkin 36:10

I do some lectures for the

Innessa Donskoy 36:11

Academy run by

Alisa Minkin 36:12

run

Innessa Donskoy 36:13

Lazarus. He's

Alisa Minkin 36:15

amazing and,

Innessa Donskoy 36:16

what you can

Alisa Minkin 36:17

you can't get enough of him.

Innessa Donskoy 36:18

a

Alisa Minkin 36:19

I just love him, which is...

Innessa Donskoy 36:21

where they come

Alisa Minkin 36:22

I think I'm going off

Innessa Donskoy 36:22

sort of

Alisa Minkin 36:23

for now. I'm talking

Innessa Donskoy 36:24

education

Alisa Minkin 36:25

medical education.

Innessa Donskoy 36:26

whatever

Alisa Minkin 36:26

Whatever that...

Innessa Donskoy 36:27

that they're getting, right?

Alisa Minkin 36:29

Right? If they are actively learning

Innessa Donskoy 36:32

their

Alisa Minkin 36:33

and putting it on the case,

Innessa Donskoy 36:34

you'll be in

Alisa Minkin 36:34

then putting it in good hands is an absolute

Innessa Donskoy 36:37

best

Alisa Minkin 36:37

best thing to hear someone say.

Innessa Donskoy 36:40

when you

Alisa Minkin 36:40

only thing to hear someone say is, "If you could,

Innessa Donskoy 36:43

think

Alisa Minkin 36:44

you should be

Innessa Donskoy 36:44

them,

Alisa Minkin 36:44

kind of on that because it may have been to you that this, this is being run by a

Innessa Donskoy 36:48

ability,

Alisa Minkin 36:49

review and then it'll

Innessa Donskoy 36:51

someone

Alisa Minkin 36:51

someone else." If someone ever says that to you,

Innessa Donskoy 36:54

that's probably

Alisa Minkin 36:55

probably the smartest thing- 'Cause they know their limits. 'Cause they know their limits

Innessa Donskoy 36:59

know what they know, and they

Alisa Minkin 37:01

staff than anyone else. And if

Innessa Donskoy 37:05

ever

Alisa Minkin 37:06

else comes up

Innessa Donskoy 37:07

to

Alisa Minkin 37:07

to the

Innessa Donskoy 37:08

with that, it's, it means

Alisa Minkin 37:10

it's that they care so much about

Innessa Donskoy 37:12

child that

Alisa Minkin 37:14

that

Innessa Donskoy 37:14

get

Alisa Minkin 37:14

they wanna get you the right one. I love that, and I want you to talk to me as a pediatrician and other pediatricians listening as to when that family comes to us, some resources and some questions we should ask. What pediatricians should know, what parents should know that should be ruled out, right? Because we don't want to miss medical conditions. We're not gonna be able to go into great detail, but just maybe some basics

Innessa Donskoy 37:39

Okay. Yes, absolutely. So my, my little five-second speech on sleep basics is that sleep should be still and silent. So

Alisa Minkin 37:50

your baby is tossing and turning and moving and rolling

Innessa Donskoy 37:57

about the bed,

Alisa Minkin 37:59

and not still,

Innessa Donskoy 38:01

that

Alisa Minkin 38:01

that might be something to bring up to your pediatrician. Sometimes incredibly simple things lead to restlessness in sleep, nutrition being a big one.

Innessa Donskoy 38:11

So don't go

Alisa Minkin 38:11

don't go self-treating that.

Innessa Donskoy 38:13

pediatrician about if

Alisa Minkin 38:14

about if your baby is very restless in sleep.

Innessa Donskoy 38:17

And if your pediatrician says, "I don't know

Alisa Minkin 38:19

says they don't know what to do about that, ask for a sleep medicine referral.

Innessa Donskoy 38:22

And not only

Alisa Minkin 38:23

not only can still breathing be an issue, but so you should think to come in

Innessa Donskoy 38:29

check and

Alisa Minkin 38:31

and listen and feel if

Innessa Donskoy 38:32

your

Alisa Minkin 38:33

your baby, you know, is having their chest and belly heavily rise up and down quietly. If your baby is snoring,

Innessa Donskoy 38:40

snoring, grunting,

Alisa Minkin 38:42

breathing, making any noises

Innessa Donskoy 38:45

this

Alisa Minkin 38:45

this repeatedly

Innessa Donskoy 38:46

in sleep,

Alisa Minkin 38:47

their sleep, if they're mouth breathing, if they are tossing, if they are taking big breaths like that or grinding their teeth constantly after you think it's from a little bit of a cooler towel, that is also

Innessa Donskoy 38:59

hundred

Alisa Minkin 38:59

hundred percent something to bring back to the pediatrician.

Innessa Donskoy 39:04

baby

Alisa Minkin 39:04

A baby who's moving like that excessively or breathing uncomfortably should be evaluated for other sleep disorders like sleep apnea,

Innessa Donskoy 39:12

or periodic limb

Alisa Minkin 39:13

limb movements in sleep. And the, the most important thing to remember about a baby

Innessa Donskoy 39:18

that

Alisa Minkin 39:18

is that we don't want to be giving anything before a sleep medication is

Innessa Donskoy 39:23

we

Alisa Minkin 39:24

between the point that

Innessa Donskoy 39:25

safe

Alisa Minkin 39:26

safe for that baby

Innessa Donskoy 39:27

stay

Alisa Minkin 39:27

stay asleep.

Innessa Donskoy 39:28

sometimes kids,

Alisa Minkin 39:30

it is babies with sleep apnea, with limb movement disorder, they're waking up multiple times temporarily to breathe,

Innessa Donskoy 39:38

to move, right?

Alisa Minkin 39:39

right? And so that is that child that we wanna just see if... You know,

Innessa Donskoy 39:44

Co-commonly,

Alisa Minkin 39:45

parents will come in and they'll go, "Well, we've already tried things like Benadryl

Innessa Donskoy 39:50

Melatonin. A baby

Alisa Minkin 39:52

A baby like that, we wanna make sure it is safe to stay asleep first. Literally don't try this at home, right? Do you wanna speak a little bit about Benadryl and sleep? 'Cause parents do do this. And then melatonin, and then I'd like just a little bit about what else is out there from your doctor, your specialist doctor, right? I don't even know this is usually prescribed by pediatricians.

Innessa Donskoy 40:17

Yeah. Well, I mean, the truth is that Benadryl and and melatonin are available over the counter in the US. Acro- across the, Out- outside of the US, melatonin actually

Alisa Minkin 40:27

actually needs a prescription.

Innessa Donskoy 40:29

But these are

Alisa Minkin 40:30

but these are commonly available over-the-counter, you know, medic-

Innessa Donskoy 40:33

I, I say

Alisa Minkin 40:34

I say medications loosely because they're not regulated like medications in the US either. They're regulated more like a food.

Innessa Donskoy 40:42

And so,

Alisa Minkin 40:43

And so, so one of actually the, the most disconcerting things about melatonin

Innessa Donskoy 40:46

that,

Alisa Minkin 40:47

that,

Innessa Donskoy 40:48

w- the amount

Alisa Minkin 40:49

the amount of milligrams that says

Innessa Donskoy 40:51

bottle, the

Alisa Minkin 40:52

the liquid, the gummy

Innessa Donskoy 40:53

not

Alisa Minkin 40:54

not be how much is in that bottle or even gummy to gummy, pill to pill in that bottle, which is terrifying. I think in twenty seventeen

Innessa Donskoy 41:04

there

Alisa Minkin 41:05

there was a study that came out that did some,

Innessa Donskoy 41:07

purchasing of

Alisa Minkin 41:08

of over-the-counter melatonin formulations and batch testing them, and there was a very alarming mismatch

Innessa Donskoy 41:15

many

Alisa Minkin 41:15

in how many milligrams of melatonin were truly in,

Innessa Donskoy 41:19

the formulations based on the

Alisa Minkin 41:20

based on the way that they were sort of labeled.

Innessa Donskoy 41:22

that's the one

Alisa Minkin 41:23

that's the one thing to remember is that it,

Innessa Donskoy 41:25

regulated like a

Alisa Minkin 41:26

like a medication

Innessa Donskoy 41:26

but it

Alisa Minkin 41:27

it is a medication. So they're different. Benadryl is an antihistamine. Histamine is a wake-promoting neurotransmitter in the brain.

Innessa Donskoy 41:37

antihistamine will block

Alisa Minkin 41:39

block that,

Innessa Donskoy 41:39

those

Alisa Minkin 41:40

those wake signals,

Innessa Donskoy 41:41

give

Alisa Minkin 41:41

and give a sleepy, sedating effect.

Innessa Donskoy 41:44

It

Alisa Minkin 41:45

It can also suppress,

Innessa Donskoy 41:47

just,

Alisa Minkin 41:48

just like how, how well a baby responds

Innessa Donskoy 41:51

having

Alisa Minkin 41:51

having trouble breathing. So I

Innessa Donskoy 41:53

not

Alisa Minkin 41:54

not recommend giving any antihistamine if

Innessa Donskoy 41:57

if you're

Alisa Minkin 41:57

you have those signs of

Innessa Donskoy 41:59

breathing.

Alisa Minkin 42:00

breathing. But know that it's going to mask their wake signals, and this baby might fall asleep.

Innessa Donskoy 42:08

interestingly,

Alisa Minkin 42:10

antihistamines make things like restless legs worse. Mm-hmm. So there are some paradoxical effects. You can sometimes see maybe like the opposite. Instead of

Innessa Donskoy 42:19

asleep,

Alisa Minkin 42:19

asleep, like a lot of

Innessa Donskoy 42:20

even

Alisa Minkin 42:20

agitation and antsiness.

Innessa Donskoy 42:23

sometimes a

Alisa Minkin 42:24

sometimes a clue that there might be a restless leg movement there.

Innessa Donskoy 42:27

But

Alisa Minkin 42:28

but it's not gonna let a single movement from that Benadryl go away. That baby will wake up,

Innessa Donskoy 42:33

will

Alisa Minkin 42:33

but they will be used to that. In fact, they grow used to that dose,

Innessa Donskoy 42:37

and they may

Alisa Minkin 42:38

and they become dependent on

Innessa Donskoy 42:39

that

Alisa Minkin 42:39

that sedating effect for sleeping.

Innessa Donskoy 42:43

Not,

Alisa Minkin 42:43

not, not to mention the, the ethical discussion- Right.

Innessa Donskoy 42:46

of kind of- blindly treating a, a

Alisa Minkin 42:50

the best thing just you're sort of deciding your baby has insomnia, an infant insomnia that's not amenable to behavioral techniques, and you're sort of self-treating with an antihistamine medication.

Innessa Donskoy 43:04

It might

Alisa Minkin 43:04

it might also be just causing problems later

Innessa Donskoy 43:08

where we're

Alisa Minkin 43:08

where we're gonna have to In a way we're getting close to the sleepy cues that come naturally, right? The sleepiness that's gonna come from the antihistamine is gonna be far more potent and overwhelming than the natural sleepiness that comes in hours before we're ready to fall asleep. And so if we're used to that effect and that is what sleepiness feels like,

Innessa Donskoy 43:31

going to

Alisa Minkin 43:31

it's going to be very hard for us to, to recognize our own internal cues.

Innessa Donskoy 43:37

So that's

Alisa Minkin 43:37

so that's Benadryl. Mel-melatonin, I mean,

Innessa Donskoy 43:40

say

Alisa Minkin 43:40

can say the similar, a similar sort of,

Innessa Donskoy 43:44

issue

Alisa Minkin 43:44

issue on sort of self-diagnosing and

Innessa Donskoy 43:47

treating. you can

Alisa Minkin 43:50

you can also make a similar argument that the melatonin is going to be sedating. It's going to have a sedating effect. And so that will be what a child expects sleepiness to feel like,

Innessa Donskoy 44:02

right?

Alisa Minkin 44:03

right?

Innessa Donskoy 44:03

and it's

Alisa Minkin 44:04

and it's not, it's not going to match what their internal sleepy cues feel like, which means they'll have to,

Innessa Donskoy 44:09

some

Alisa Minkin 44:10

at some point anyway, learn again

Innessa Donskoy 44:13

or learn

Alisa Minkin 44:14

or learn for the first time what naturally falling asleep feels like.

Innessa Donskoy 44:19

problem

Alisa Minkin 44:19

difficult thing with melatonin

Innessa Donskoy 44:21

is

Alisa Minkin 44:21

is that

Innessa Donskoy 44:23

it can actually

Alisa Minkin 44:24

for

Innessa Donskoy 44:28

right

Alisa Minkin 44:28

right sort of sleep is harder.

Innessa Donskoy 44:31

So this is

Alisa Minkin 44:32

So this is where it becomes a little bit tricky. Melatonin has different receptors in our brain that it can act on.

Innessa Donskoy 44:39

Some of those

Alisa Minkin 44:39

Some of those receptors sort of control our internal circadian

Innessa Donskoy 44:43

our

Alisa Minkin 44:43

rhythm and things

Innessa Donskoy 44:44

and

Alisa Minkin 44:44

like that. And some of those are just

Innessa Donskoy 44:46

sleepy

Alisa Minkin 44:47

sleepy sedating cues. So

Innessa Donskoy 44:50

when it

Alisa Minkin 44:50

when it comes to,

Innessa Donskoy 44:51

jet lag, traveling, needing to

Alisa Minkin 44:55

you need to realign your circadian rhythm.

Innessa Donskoy 44:58

melatonin is

Alisa Minkin 44:59

is often indicated medication,

Innessa Donskoy 45:02

pediatrics,

Alisa Minkin 45:04

resetting the internal clock. So

Innessa Donskoy 45:09

it

Alisa Minkin 45:09

it, it does have very medically sound there.

Innessa Donskoy 45:10

real sort of medically sound role there. But the way it's

Alisa Minkin 45:15

way it's often used in

Innessa Donskoy 45:18

kind of

Alisa Minkin 45:18

kind of everyday culture is I feel like it's used much more for either the insomnia, like we said in the beginning, just difficulty

Innessa Donskoy 45:25

and

Alisa Minkin 45:25

falling and staying asleep. And then it gets used

Innessa Donskoy 45:29

Sort

Alisa Minkin 45:29

sort of very

Innessa Donskoy 45:30

very

Alisa Minkin 45:30

differently rather than intentionally

Innessa Donskoy 45:34

bring an

Alisa Minkin 45:36

an internal clock

Innessa Donskoy 45:37

backward, it's just sort

Alisa Minkin 45:38

It's just sort of given right before bed to

Innessa Donskoy 45:41

on

Alisa Minkin 45:41

on that sleepiness

Innessa Donskoy 45:43

put someone to

Alisa Minkin 45:44

to sleep. It's actually not the best choice for insomnia management from a pharmacologic standpoint.

Innessa Donskoy 45:54

there

Alisa Minkin 45:54

there are much more effective medications even for pediatric insomnia.

Innessa Donskoy 46:01

And not

Alisa Minkin 46:01

and not only are those medications much more

Innessa Donskoy 46:03

but

Alisa Minkin 46:04

effective, but we know what

Innessa Donskoy 46:06

effects to look out for. So,

Alisa Minkin 46:09

effects

Innessa Donskoy 46:09

melatonin

Alisa Minkin 46:11

you know,

Innessa Donskoy 46:11

hasn't really

Alisa Minkin 46:12

hasn't really been studied given the longer

Innessa Donskoy 46:15

neurotypical children. And

Alisa Minkin 46:18

and so

Innessa Donskoy 46:18

actually

Alisa Minkin 46:19

actually are a little bit blinded to

Innessa Donskoy 46:21

what are the

Alisa Minkin 46:22

what are the long-term effects of being on

Innessa Donskoy 46:25

medication for

Alisa Minkin 46:26

for sleep. We

Innessa Donskoy 46:27

W- we

Alisa Minkin 46:28

don't know,

Innessa Donskoy 46:28

that

Alisa Minkin 46:29

and that makes it very, very hard to

Innessa Donskoy 46:31

a

Alisa Minkin 46:31

give a family appropriate guidance on,

Innessa Donskoy 46:33

look

Alisa Minkin 46:33

"Well, look out for this, and if you see this,

Innessa Donskoy 46:35

me a

Alisa Minkin 46:35

you know, give me a call and we'll stop the medication."

Innessa Donskoy 46:38

we

Alisa Minkin 46:38

We, we don't know any of that for melatonin.

Innessa Donskoy 46:40

so

Alisa Minkin 46:40

so it's, it's kind of like a guessing game.

Innessa Donskoy 46:43

So not

Alisa Minkin 46:44

so not only is it not really effective

Innessa Donskoy 46:46

for insomnia

Alisa Minkin 46:47

all the time,

Innessa Donskoy 46:47

time,

Alisa Minkin 46:48

don't know

Innessa Donskoy 46:48

but

Alisa Minkin 46:49

what to look

Innessa Donskoy 46:49

we

Alisa Minkin 46:49

for in the way of any- To push back a little

Innessa Donskoy 46:51

to look for

Alisa Minkin 46:52

for

Innessa Donskoy 46:52

the

Alisa Minkin 46:52

the neurodivergent

Innessa Donskoy 46:53

run.

Alisa Minkin 46:53

kids I do think we do have evidence there, A-

Innessa Donskoy 47:02

So for the neurodivergent kids, absolutely. Yes. So yes, for the neurotypical we don't, but now for ADHD and especially autism, there is

Alisa Minkin 47:11

It's great data for the two-year cohort that was followed on extended release melatonin.

Innessa Donskoy 47:20

melatonin that found they did nicely for sleep onset and maintenance, Yeah, In the neurodivergent population, we do have more data to support it. It's still not phenomenal, but a two-year follow-out was very exciting to see a few years ago. So I think there will be hopefully more and more coming from those groups

Alisa Minkin 47:42

It's still not phenomenal, but a two-year follow-up was very exciting to see a few years ago. So I think there will be hopefully more and more coming from those groups. But I think- I wanna say two more things. Yes, it is under the FDA regulat- not FDA approved, so you don't necessarily know how pure, what, how much milligrams is in it. But I do believe that you can find out more reliable brands, that you have a much better chance. And I'm not asking you to give any. We're not giving any medical advice here at all. This is not for medical specific advice. But that's another reason to go to you know, your pediatrician or have a referral out so that you get an appropriate, not just any random melatonin

Innessa Donskoy 48:11

Yes, yes.

Alisa Minkin 48:12

if you're going to use it

Innessa Donskoy 48:13

Yes, and then, and I think the USP verified check on bottles, my understanding, and this is what we kind of tell patients now, is that that is at least a company that's having somebody batch test

Alisa Minkin 48:28

Third-party testing. Mm-hmm. Yeah, so there are some indications, and then you may, you know, your pediatrician may know some good brands. Again, we're not giving those any recommendations here.

Innessa Donskoy 48:36

Yeah.

Alisa Minkin 48:37

so that was another thing, and the other thing I wanted to point out is that melatonin, as you mentioned, helps you fall asleep but not stay asleep. So I wanted to clarify when you mentioned extension, extended release, why that was so important.

Innessa Donskoy 48:50

Yes. Yes, yes. So

Alisa Minkin 48:52

Yes.

Innessa Donskoy 48:52

Yes, it's a sedating medication, which means that once it's gone, it's gone, and it's very likely still the

Alisa Minkin 48:57

are

Innessa Donskoy 49:01

There are extended-release

Alisa Minkin 49:03

least a little bit of formulations out there, but again,

Innessa Donskoy 49:06

this is

Alisa Minkin 49:06

if this is something that you're sitting thinking, "I wonder if my child needs that,"

Innessa Donskoy 49:10

that's a

Alisa Minkin 49:11

that's a conversation I recommend you just have with someone else

Innessa Donskoy 49:15

can,

Alisa Minkin 49:15

who can, who can kind of guide you on, you know, perhaps identifying really the sleep disorder or disorders that are going on

Innessa Donskoy 49:23

really the

Alisa Minkin 49:24

and really the nice,

Innessa Donskoy 49:25

the

Alisa Minkin 49:25

the, the right next steps of treatment. I'm gonna... I promise I'll let you go. So I'm gonna let you go, but I really, I'm so grateful for this opportunity for people to understand, you know, the range of professionals out there and just emphasize again, you're the parent. You have your, your, your mother instinct, your, your father instinct. If your child is, is not getting the help they need, go, go to the next level. I think that's really important, and look what, look what sleep physicians can do. This is great. You're amazing.

Innessa Donskoy 49:53

Yeah, and if there's anything else I can also add is that comparison is, is like the root of

Alisa Minkin 50:01

Like the root cause. Yeah.

Innessa Donskoy 50:02

right? I'll, I'll often hear feedback

Alisa Minkin 50:04

and hear feedback that like, "Well, my neighbor's child goes to bed at this time," or, "The other kids in my kid's class go to bed at that time." And the truth is, is that if you are feeling like your child

Innessa Donskoy 50:17

is having

Alisa Minkin 50:18

is having difficulty falling and staying asleep

Innessa Donskoy 50:21

on

Alisa Minkin 50:21

on their schedule and in

Innessa Donskoy 50:24

kind

Alisa Minkin 50:24

your kind of

Innessa Donskoy 50:24

world, that's

Alisa Minkin 50:25

that's what's important. But if things are going great and your kiddo's thriving, but their sleep schedule is just different than someone else's, that's okay. You didn't read the book. That's okay. So

Innessa Donskoy 50:39

Yeah.

Alisa Minkin 50:39

thank you so, so much for doing this with me.

Innessa Donskoy 50:42

Well, it was my pleasure, my pleasure. I hope I'll get to see

Alisa Minkin 50:45

Oh, my pleasure. It was amazing. I know. Sorry for the glitches, everybody.

50:52

Thank you for listening to Kids Matter. Raising Healthy, happy Children Takes a village, and I'm grateful you are part of ours. If today's conversation resonated with you, please share this episode with another parent, grandparent, teacher, or anyone who cares about kids. Together we can build a supportive community our children deserve. I'd love to hear from you. Share your thoughts, questions, or suggestions for future topics at Kids Matter podcast@gmail.com. With no explanation for your voice truly matters. Until next time, keep advocating for the children in your life because kids really do matter. They are our future. I'm Dr. Elisa Minkin and this has been Kids Matter. Please note that while I am a pediatrician, I am not your child's ped. This podcast is for informational purposes only and does not constitute medical. For any medical concerns or decisions. Reach out to your child's healthcare professional.