Secrets of Sleep (with Dr. Sujay Kansagra) #009

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Unlock the secrets to a well-rested brain with Dr. Sujay Kansagra, Doctor and Pediatric Sleep Researcher from Duke University, as we unravel the importance of sleep for emotional regulation and executive function. 

Dr. Kansagra gives us his top tips for sleep hygiene and fostering positive sleep habits and also debunks some sleep myths floating around on social media

Learn how sleep is a non-negotiable not only our kids but OUR mental resilience. Our conversation with Dr. Kansagra offers parents insightful strategies for nurturing sleep hygiene in their little ones, while also caring for their own sleep needs.

Dive into the intricacies of sleep deprivation and its deceptive impact on performance. This episode sheds light on the oft-overlooked truth that in a culture of glorifying less sleep, its actually more sleep that is the key to peak cognitive abilities and emotional stability. 

Finally, for those parents facing the newborn sleep conundrum, we provide real-life tactics for managing those unpredictable first weeks. From the surprising use of breast milk pumped at night to the gentle art of sleep training, discover how to embrace a personalized approach that suits your family's dynamics. 

Whether you're contemplating different sleep training methods or simply seeking solidarity in the sleepless journey of parenthood, this episode is an essential companion for anyone looking to improve their nights, and in turn, their days.

Transcript

Dr. Sujay Kansagra: 0:00

People have actually looked at the connection between the prefrontal cortex, which is part of, you know, making sure we have executive function, we're rational, we're we're, you know, we're doing things stepwise, working memory, et cetera All prefrontal cortex and the connection to the amygdala, which is the emotional centers of our brain. And when we are well rested that connection is much tighter and we're doing much better. But when we get sleep deprived that connection naturally starts to wither away and we can feel it right. We're much more likely, as you mentioned, to be triggered quickly. We are really quick to snap and it's it's all because our brains have no way of actually dealing with deprivation.

Jon Fogel: 0:48

Hello and welcome to the whole parent podcast. I am so excited that you've chosen to be with us today, because we are talking all about sleep. We're talking about sleep training, we're talking about good sleep hygiene, we are talking about night lights and sound machines and all of the questions that you all have about sleep. That is what we are going to be digging into today, and it's not just going to be me. For the first time ever on the whole parent podcast, I am going to be hosting a guest. In this case, it is Dr Suje Kansagra from Duke. He is a leading expert in the field of pediatric sleep research and pediatric neurology. He is a doctor, he knows all of the things about sleep and he happens to align very closely with how I view sleep, and so I was super excited to bring him on the podcast, and I cannot wait for you guys to sink your teeth into, to dig into that episode and for you to learn all, have your questions answered and feel much better, much more confident in raising resilient kids and well rested kids, because, as he points out during this episode, it is so, so important. Sleep is massively important, not only for our kids, but also for us.

Jon Fogel: 2:03

So I want to get into that episode, but before I turn it over to myself in interview form, I want to do one quick thing, and that's to remind you that if you have not yet rated and reviewed this podcast, to please go and do that. Do that on Apple podcast, spotify, wherever you get your podcasts, wherever you're listening to this right now, before we get into the episode, I'm not going to stop the episode in the middle to to give you this call to action, like I normally do. I don't usually say this at the beginning, we just dive right in, but I'm going to say it right now because the stuff we're talking about. It's so riveting I don't want to take time away from that to say it. So I'll be back to remind you to do this at the end of the episode and especially to share this with a friend who has a child who is struggling with sleep.

Jon Fogel: 2:47

Without further ado, it's time for us to meet Dr Suje on the whole parent podcast. All right, I am excited to welcome my first guest of the podcast ever. It is Dr Suje Kansagra from Duke. Dr Kansagra, introduce yourself. Who are you?

Dr. Sujay Kansagra: 3:06

Yeah, John's. First of all, I'm honored to be the first guest. So I am a child neurologist and a sleep medicine medicine physician at Duke. I've been on faculty for gosh about 12 years now, and so day in and day out, I'm seeing children that have difficulty with sleep. That's my life, that's your life.

Jon Fogel: 3:23

So those of us parents who have children who have difficulty with sleep, you deal with us all the time. So this is no sweat to you, that's right.

Dr. Sujay Kansagra: 3:32

This sleep is my life, and so, when it comes to research, when it comes to seeing patients that have challenges, I'm all about it. So, yes, you've come to the right place for sleep and vice. I've come to the right place.

Jon Fogel: 3:43

So you actually don't know this about me, but my father-in-law was actually at one point of one of the like leading sleep apnea researchers. Get out of town, yeah, Dave Carly. So so he, so he, yeah, so he was developed. So I know as much about sleep as I could possibly retain to try and seem interesting to him when I was courting his daughter.

Jon Fogel: 4:07

So that's about how that's about my baseline of sleep is like I was really, really trying to make a good impression and so I learned as much as I could to make him seem like, to make it seem like I knew what I was talking about.

Jon Fogel: 4:18

I'm sure, but we were high school sweetheart, so the bar was pretty low. Yeah, so we're. We're talking about sleep today. We've already done a whole parent episode on a podcast episode on sleep getting your kids to go to sleep but you are the expert on here, and so usually the way that this podcast works is for those who might be listening for the first time maybe this is your first episode I usually am doing this solo and I answer three questions that I get from the community, and so the really fun part of having an awesome research guest, a guest who really is an expert in the fields is that I get to ask the questions that I have and I also get to learn the ways in which I have been messing up. So, suja, you said that you've been following me and you said that, like most of the stuff I say on, sleep is not totally off the wall.

Dr. Sujay Kansagra: 5:04

Right, yeah, that's right. Actually, one of your recent posts on helping your toddler go to sleep was really good, and you actually hit on a technique that we use frequently to help children, particularly if they have some baseline anxiety regarding sleep. So I'm happy to chat about that kind of stuff.

Jon Fogel: 5:18

Yeah, the frequent check-ins.

Dr. Sujay Kansagra: 5:20

Yeah, and I mentioned that on.

Jon Fogel: 5:22

I mentioned that I may be on the anxiety episode as well, that I thought that I did last, but so that that's a helpful tool. But what about some other sleep tips? So if you had, if you had to give me, you know, in 10 minutes or five minutes or whatever, however long you want to go the best sleep tips for parents of infants and toddlers, where would you start with that?

Dr. Sujay Kansagra: 5:42

Gosh, yes, so there's so much and so much changes during those first few years of life. So I'll tell you that the core foundation for a good sleep, we call it sleep hygiene. You know people have heard of dental hygiene and personal hygiene. Sleep hygiene is essentially the things in your environment and your behaviors that can help or hurt your sleep, and so I always start there, and there are really kind of four core pillars when it comes to sleep hygiene. First, it's having a great nighttime routine. It's important for every human being, including infants and toddlers, particularly having 20 minutes before bed, three or four calm, relaxing activities that you do in the same way every single night Super helpful.

Dr. Sujay Kansagra: 6:14

Second thing is avoiding things that we know will disrupt sleep. And so you know, for for that age group it's usually bright lights, and so electronic use starts very early. We know that our children are really tied in with with screens these days because they're everywhere, but you really want to avoid screen time for those 30 minutes prior to bed. Keep the lights a little bit dim, very helpful. Interestingly, you know, when it comes to like caffeine you wouldn't think I'd have to talk about that for the toddler years, but there are toddlers that start having caffeine exposure very early, so I'll mention that as well. No child should have any caffeine. So that's all part of step two avoiding things that can avoid. That can perhaps worsen your sleep, yeah.

Jon Fogel: 6:48

And that just goes all the time right, like no toddler should have caffeine. Ever, ever, ever.

Dr. Sujay Kansagra: 6:52

Yeah, if it was up to me, none of us would ever have caffeine, ever. But you know, at least, at least ideally, even through adolescence, you want to try to limit the amount of caffeine that you have. Okay, the third thing to keep in mind is a comfortable, calm environment. So of course, you know, making sure it's not too noisy, it's dark, cool tends to be best. So we usually say 68 to 72 degrees, but you know, every child is a little bit different. And then fourth is keeping your schedule the same on the weekdays and the weekends, trying to keep things as consistent as possible. Those are the cores of good sleep hygiene.

Jon Fogel: 7:21

Awesome and things like you know, the things that I get asked about all the time are things like what do you think, what do you feel about nightlife sound machines, those kind of sleep aids for toddlers and kids?

Dr. Sujay Kansagra: 7:34

Yeah, I'm a little bit of a purist and so in that sense, if a child is otherwise healthy and doesn't have any other medical disorders that could be disrupting sleep, my goal is always to try to get a child to sleep as independently as possible.

Dr. Sujay Kansagra: 7:46

Yet if they do need some extra help certainly when it comes to white noise machines or sound machines in the background if you're keeping them at an appropriate level when it comes to sound and for children we try to aim as low as possible then it's not necessarily a bad thing. We don't have a lot of data that says it's going to be a harmful longterm, et cetera, as long as the noise level is appropriate. My goal is that if you have, if you expose them to something at the start of the night to help them transition to sleep, it's ideal that that same stimulus is in place throughout the entire night, and with white noise machines you can do that. You can kind of keep it on throughout the night, as long as it's far away from the crib or from their bed, it's not too loud.

Jon Fogel: 8:23

Yeah, and I think for a lot of parents you know the white noise, that's a good note on keeping it. I have a follow-up question to that because actually one of the pieces of advice kind of goes directly against that, and so I'd love to hear your thoughts. But one of the things that I with sound machines, that I hear parents say a lot, is it's not even so much to help them go to sleep, it's more, like you know, I have other kids. What do I do during nap time? My other kids are going to make noise. Can I have some sort of aid to make the environment seem less chaotic for my baby?

Dr. Sujay Kansagra: 8:53

Yes, absolutely. I think it's very helpful in that sense. For sure it helps to drown out background noise et cetera. You know the tricky part about this is that you know the white noise machines. We don't want them to be around forever for the kids and we know there's going to be some level of kind of noise in the environment et cetera throughout their lives, and so we want to be a little bit careful in how we use it. And then if you're traveling, you may not have access to, you know, the white noise all the time, and so it can become a little bit of a dependency. But again, if it's something that you can take with you on trips, if it's something that your child has gotten accustomed to and enjoys, no problem.

Jon Fogel: 9:28

Yeah, well, and that's the real challenge, right, is the balancing being as consistent as possible and, I think, my follow-up question to this, oh so, the thing I was going to mention is nightlights. So I've been a big advocate for, like, as dark as possible, and this is just. This is just seems to be because it's in so many cases, throughout the night, their room is going to be really dark. So, trying to transition away from a nightlight, one of the things that I would mention to parents is you can have a nightlight on a timer that is on when the kid is falling asleep but then goes off. What would be your thoughts on that? Just out of curiosity.

Dr. Sujay Kansagra: 10:02

Yeah. So I think the question for nightlights is if it works for your child Totally fine. You know I wouldn't introduce it unless you feel like there is some some need and your or your child is actually requesting it as a toddler. Because you're right, ideally having things as dark as possible. Now, night lights are usually not bright enough such that they're gonna bother Bobby. When it comes to melatonin secretion, the amount of lux that they put out is pretty low, so you're not gonna have an issue there. But you know child wakes up. You're a little bit more stimulated in your environment because you can see what's going on. The night light might be creating shadows and bother them, etc. And so you know, use it if you it can. Truly it's gonna help your child, but by no means should it be a necessary thing if your child is doing well without it.

Dr. Sujay Kansagra: 10:44

Now, the tricky thing about having something there during the transition to sleep is that every child is gonna wake up, and this is something that I'm always emphasizing to parents. I tell them they're gonna wake up multiple times at night. The awakenings are totally normal. We do that when we go through sleep cycles, the ups and downs, and so the awakening is no problem. If something is really different when they wake up at nighttime, then when they first fall asleep, it might end up leading to more challenges falling back to sleep. So that can include almost anything if you include music that you're playing during the transition to sleep.

Dr. Sujay Kansagra: 11:12

For adults, it's like having a TV on right. We all know that adult that says I have to have a TV on to fall asleep. Yeah, they've become a little bit dependent on that. So when they wake up at night it could be hard to fall asleep. And for infants, notoriously it's. You know, it's caregivers that get in this rigmarole of saying, okay, my child has to be rocked to sleep and then every time they wake up at night they have to be rocked again to fall asleep. So so, ideally, keeping the environment consistent at the time they fall asleep, the same as when they wake up throughout the night. Hopefully the environment will be the same for them.

Jon Fogel: 11:38

Yeah, you know, just on that note, you know one of the pieces of, so we're really really big on sleep in our house and just, I think I get the least amount of sleep of Everyone in our house, to be honest, but but I also have the easiest time going to sleep of anyone in our house. So it's kind of, you know, I wind up being the the nighttime caretaker often, but when I think about all of the things that we've been doing, so we have a seven-year-old who really had a lot of struggles and he's the one who who, in oftentimes the the nightlight thing that has come up with him he's requested one or the check-ins. That was like that's a big one for him. For my of a seven-year-old, a three-year-old and a two-year-old, and my three-year-old and two-year-old, we have gotten significantly. We've we've helped them to become significantly less dependent on us, kind of as we've gone. So my three-year-old basically needed to be rocked to sleep until he was like three and which is a huge. You know we did this with a yoga ball so that it wasn't but.

Jon Fogel: 12:34

But you can imagine, like me going through the airport right. So like I, absolutely I have. I have in my, in my airport bag. Like one third of the things in my bag are things related to my kids sleep. So we have, like, the monitors, we have the sound machines, we have the yoga ball deflated. We have a pump for the yoga ball to pump it up, we have the, and then and then all the other thing you know. We have the blackout curtain. We use this company. Sleep away that, the. You can put like little suction cups on the window and, yes, you make great products, but but it does create this dependence where it's like man, I, I have to almost have a dedicated carry-on so that my kids will sleep, which seems crazy.

Dr. Sujay Kansagra: 13:13

Yeah well, I mean, you certainly put a lot of time and effort into it. I mean it's, it's great to to make sleep a priority. You know, and, and I kind of in my mind, I want to tell you, when it comes, when it comes to gentle parenting, approaches Like sleep should be a core pillar of gentle parenting, because it's so much easier to be a gentle parent when everybody is sleeping Well, particularly the parent you are preaching to the choir here.

Jon Fogel: 13:37

Yeah, you know this, and this is a big, this is actually a big part of you know. This is actually why I tend to separate myself away from like most not most, but many gentle parenting Creators is because they don't think about, they often don't prioritize things like sleep, where it's like man. If you're triggered at your kid like number one, it's either because they're being intolerable because they haven't slept well or you have no tolerance, frustration, tolerance because you haven't and that's right. Yeah, so yeah.

Dr. Sujay Kansagra: 14:09

Can I give you a little bit of nerdy science with this? People have actually looked at the connection between the prefrontal cortex, which is part of, you know, making sure we have executive function, we're rational where we're, you know, we're doing things step-wise, working memory, etc. All prefrontal cortex and the connection to the amygdala, which is the emotional centers of our brain. And when we are well rested that connection is much tighter and we're doing much better. But when we get sleep deprived that connection naturally starts to wither away and we can feel it right. We're much more likely, as you mentioned, to be triggered quickly. We're really quick to snap and it's it's all because our brains have no way of actually dealing with sleep deprivation.

Dr. Sujay Kansagra: 14:48

You know, we know species on the planet and voluntarily sleep deprives itself, except for for humans, and we have no coping mechanisms of sleep deprivation. You know I joke that our soul begins to erode when we're asleep deprived. We just can't handle it and our temperament and our ability to cope with stress definitely is affected with sleep deprivation. But there's some real science to back that up. You know why, why it is so challenging.

Jon Fogel: 15:10

Well, and with kids especially. I mean you know this better than than anyone, but just for our listeners, when your prefrontal cortex is so underdeveloped as a child, you need that connection and those neural synapses to be really tight, because they can't just will their way through, you know, overpowering the amygdala hijack, like they they actually. They require that level of co-regulation because they don't have an ability to just power through, like many.

Dr. Sujay Kansagra: 15:34

Absolutely but.

Jon Fogel: 15:35

But that is what adults are doing when, by the way, right, we're powering through like that. We're not living our best life when we're sleep deprived either 100%.

Dr. Sujay Kansagra: 15:42

You know. So there are so many things that falter when you're sleep deprived, including just your day-to-day mood, your energy level, etc. So your quality of life definitely suffers, but we know it actually impacts just about every medical condition and psychiatric condition you can think of. You know, when you have bad sleep, everything seems to suffer. And so, yes, I'm convinced that most of us are going through life and experiencing consciousness in the semi fog due to lack of sleep and and one of my core missions is to help people live their best Consciousness experience, which includes getting the rest that you need.

Jon Fogel: 16:15

Yeah, I don't know where I heard this is another podcast and I wish I had the citation here, but it was kind of like one of these. You know, alpha male podcast probably. I think I saw it on tiktok or something, but the guy was saying the percentage of the population I'm gonna try and say this exactly right, the percentage of the population that can function on less than six hours of sleep with no Impairment, round it to a whole number and expressed as a present, is zero, zero, that's right.

Dr. Sujay Kansagra: 16:41

Zero percent, correct. Yeah, people like to think that we can become short sleepers. People like to think you can train yourself to get less sleep. People like to come up with these bio hacks and say, oh, now I'm doing polyphasic sleep or I'm cold plunging to decrease my sleep. I mean, there's all sorts of this. You know lunacy out there. It turns out there's based on the best studies that we have. There's actually no way to get accustomed to sleeping less and in fact, the objective measures of how well you're performing Coquitably they do this test called the the cycle mode of vigilance task we have you try to focus for a long period of time. Your performance declines in a fairly linear fashion. The longer sleep deprived and it's actually dose dependent, like the less sleep you're getting, the worst you do over time. But interestingly, your subjective experience of how sleep deprived you are, that does eventually plateau. So you think you know what I'm doing. Okay, I'm not that sleep deprived, yet our brain function or cognitive abilities Continue to worsen, which is a really kind of a scary combination.

Jon Fogel: 17:36

Well, it is especially when you watch TV shows like Grey's Anatomy and you learn that most of your doctors are sleeping like one hour you know this is.

Dr. Sujay Kansagra: 17:43

It's it's bonkers. It's bonkers what we allow Physicians to do. It's actually really interesting because I ended up getting a lot of questions from from pilots saying hey, how do I deal with my jet lag? And I'm like, do you not have Horses on this? There's a FA, not mandate that you have to have them. You know, know how to deal with these types of things. You're flying planes, you know, and so it's pretty bonkers, you know. I think we and and part of this is also just historically and culturally you know, we kind of wear a sleep deprivation as a badge of honor, like, oh look, I didn't sleep very much and we should do the opposite. We should be shaming people that aren't sleeping very well. It's a problem. You know. You're not at your best self when you're sleep deprived.

Jon Fogel: 18:21

No, no, you well, you're not at your best performance, but you're also not at your best as you, as you kind of really put it super well, you're not at your best cognitive and and even like contemplative state right, like that's right if you're if you're, if you're totally I remember being getting a master's degree and when you're, when you're in that process and you're staying up all night because you, like, have a full-time job and a young kid and you're in school and you're pulling all-nighters, man, I was not happy, like I thought that I was happy, but but in reality really not, and so so, let's, let's just transition really quickly to, before we get into some sleep fallacies, because I want, I want to hear, I want to hear this, I want you to spill the tea on all the the sleep fallacies out there.

Jon Fogel: 19:03

But before we get to that, I just want to hit. I we've already kind of talked about toddlers and we've talked a little bit of, talked a lot about adults, newborns so newborns are in a completely different sleep category and then newborn parents new parents are newborn. So so sleep deprived as a population, yes. What are our keys for survival?

Dr. Sujay Kansagra: 19:25

Not even success, but survival, yeah yeah, it is so asleep asleep as a newborn, especially from zero to six weeks of age. It's a complete crapshow when it comes to sleep, and the reason is because children don't really have any semblance of a circadian rhythm, and so people always say, oh, the kid's schedule's flip flop. They think day is night, night is day. Well, turns out, they don't know what day and night even is at that point. And so you are, and they're feeding really fruitfully. Their stomachs are really small and they're working on getting bigger and bigger feeds over time, but they're kind of in demand all the time of eating and waking at random times. So it is a challenge. Now I wish I could just say well, rely on your village, but unfortunately oftentimes you don't have a village around us anymore. I mean, we are really a small group that's helping take care of a child. So first and foremost, I say, especially for moms, which they do unfairly take the brunt during this time, I say please rely on your pediatrician or your OB if you have any concern about postpartum depression. It is incredibly common and there are lots of things that we can do to help. Second, I would say, is I just make sure people understand you, the social media world when it comes to parenting is not real, and so when you see Sally Fitness at two weeks postpartum showing off her six pack and hiking through the Amazon rainforest with her baby on her back, that's not real, and so we have to stop comparing ourselves with things that aren't real.

Dr. Sujay Kansagra: 20:48

Now, practical things that you can do.

Dr. Sujay Kansagra: 20:50

One go ahead and try to actually start a routine very early.

Dr. Sujay Kansagra: 20:53

That's not for your baby, your baby is really not going to care, but it's actually good for you to have something that, if you're doing the same way every single day, consistently, it adds a little bit of control to the chaos, something that's in your control. Second, I would say, when it comes to breastfeeding, if you are breastfeeding, particularly if you're pumping breast milk interestingly your breast milk does have melatonin in it, and so if you're pumping nighttime milk, I actually recommend trying to label it and trying to give that to your baby at nighttime, because that can actually help them sleep. So a real kind of practical thing that you can do. And then know that there's plenty of reasons to be optimistic because, as six weeks starts rolling around, more of that baby sleep is going to be at nighttime and hopefully you're going to start getting more sleep yourself, because there's things that's getting more consolidated. So that's kind of my approach. But hang in there, it does get easier. But those first six weeks are just rough for everyone.

Jon Fogel: 21:43

Yeah, on the podcast we say embrace the suck, Like it's just going to suck. That's right.

Dr. Sujay Kansagra: 21:47

Yeah, that's right. Yeah, and understand that. That is so normal. That is so normal that it's going to be really rough yeah.

Jon Fogel: 21:53

Yeah, I think that that's such a good point and that's such helpful advice, especially, like you said, for moms. I've never heard the breast milk thing of you know, I know the breast milk has melatonin, but that breast milk that is pumped at different times of the day has different amounts based on your circadian rhythm. I mean, that's just, that's right. It kind of goes right in line with the I'm trying to remember what it's called but the skin to the skin thing, where your temperature fluctuates up and down in comparison to your baby, right Like that's similar to the similar. Your body is actually trying to kind of grab their body and pull them into alignment.

Dr. Sujay Kansagra: 22:29

Well, it's interesting because when the baby's in utero, you know your melatonin is a baby's melatonin and so moms do see that that tends to start lining up, that usually the baby's is calm for a good chunk, hopefully, a good chunk of the night. It varies, of course, but it helps the baby get in that pattern. But then once they're out in the world and they're not making it on melatonin, that's when things start getting crazy. So, yes, the breast milk can definitely help. Now, don't go crazy over this, moms, you know, I mean, you have a lot on your plate. It goes first few weeks, and if you can't do it, it's not the end of the world for sure. But again, if it's something that you're able to easily label, go for it.

Jon Fogel: 22:59

Yeah, yeah, if you're putting the date on it anyway, just slap a time on it too.

Dr. Sujay Kansagra: 23:03

Provide them, or Pia, that's right.

Jon Fogel: 23:05

Provide them that you actually know what time it is.

Dr. Sujay Kansagra: 23:07

That's right. We're taking it. We're making a lot of assumptions here. That's right. You got to know what time it is.

Jon Fogel: 23:13

Yeah, my role for newborn hood and I didn't. You know, we did an episode on welcoming a new baby to the family, but it was much more about the older kids. But my, you know, if I was going to I'm, eventually I'll do an episode on my tips for bringing a newborn home and this, actually this episode, I'm sure is going to inform a lot of that. But one of my tips is, with the embracing, the suck is just like resign yourself to ordering DoorDash or whatever you know you're going to get, like that's all you're going to. Like you're not going to eat. Well, like you're going to eat and that's something Like put up the weird dark curtains on your windows. Like like get up and like try and do the day. But as much you know, if you have to just like sleep from 10 am to 3 pm, because that's when you can, it's way better to do that because, like you said, it's temporary and this is not a it's all about getting through and being practical.

Dr. Sujay Kansagra: 24:03

That's right.

Jon Fogel: 24:04

Yeah, awesome, awesome, okay. So let's so. So I also want to make sure that we spend time, a little bit of time, to talk about sleep training and cry it out. But before we do that, what are some sleep fallacies that you see? Other than you know, my baby sleeps through the night at two months old, which that's the one that drives me the most nuts to be honest yeah. Because the stomach, you know, the newborn feedings at two months old, just not enough to get 12 hours of sleep.

Dr. Sujay Kansagra: 24:30

Right, yeah, yeah. Well, I'll tell you that one of the big things is well, let's talk about some fallacies. One is sleep regressions. You know, people always say there's going to be sleep regressions a certain months of age and then we're just doomed to experience them. The data doesn't really bear that out. You know, this was based on some old science that hasn't really, we don't think, is it held true At any given month during the first year of life, about 30% of children are probably going to experience some type of regression almost every single month, you know. And so, and don't consider it a setback Try to stay consistent, try to push through it.

Dr. Sujay Kansagra: 25:02

Don't start making huge changes if what you're doing before is working. You know lots of things are changing with your child when it comes to development, et cetera. Try to maintain consistency and push through. So that's number one.

Dr. Sujay Kansagra: 25:11

Number two you know, when it comes to light exposure, a lot of people are like, oh, I got to get my baby out in the sun, et cetera, during the daytime. And I say, well, yes, light can be helpful, but trust me when I say that day versus night, when it comes to your eyes, it's fairly easy to understand, even if you're indoors because it's so bright during the day. Nothing beats the power of the sun when it comes to brightness in your home even, and so you don't have to go to extra length to get your baby out there and getting tons of light and you want to protect that. You know delicate skin when they're young and avoid direct exposure, and so don't feel the pressure that you have to go. You know taking your baby out into the sun every single day. I'd love to jump into some of the myths regarding sleep training, because I mean, there's so much around that it's a lot to unpack.

Jon Fogel: 25:53

Yeah, you know what is Well, one of the things you said about sleep regressions. You know, this is the thing that I've experienced too, and we're both recording with natural light right now at about 5 pm, so there's plenty of natural light in your home, right?

Jon Fogel: 26:05

But one of the things I just wanted to say about sleep regressions is this is the thing that I kind of experienced anecdotally now with the third child. I think those of us who have multiple kids you realize that if you Google three months sleep regression, there will be 10 articles. If you Google four months sleep regression, there will be 10 articles. If you Google any month sleep, regression.

Dr. Sujay Kansagra: 26:25

John, I just had a 512 month sleep regression recently. You know it was personally you know, it was short lived and we pushed through it, right. I mean, these things happen. Sleep is not linear. You know Sleep is a winding course but hopefully the trajectory is in the upward direction. But know that it's not linear and that's okay.

Jon Fogel: 26:44

Okay, all right, okay. So, with that said, let's really dive in here on sleep training.

Jon Fogel: 26:52

I have strong feelings about sleep training, namely that I have not sleep trained any of my kids but I also appreciate that we live in the United States, in a country that does not have adequate resources for parents, namely, you know, affordable childcare. We don't, as you mentioned before, culturally we don't have any sort of village mindset. You know, from a work perspective, we're elevating people through the ranks who are chronically sleep deprived because they're doing so intentionally. We don't have paid paternal leave. We don't have anywhere near as much paid maternal leave as we need. So, with all those things being said, sleep training may be. I don't wanna demonize anybody who felt that they had to sleep train their child in order to sleep themselves. However, I also see the pendulum swing back the other way, where, if you don't sleep, train your kid, now you're seen as the one who's this is. You know, I saw a video not that long ago. You're, you know why you're. You know why you're abusive if you're not sleep training. So tell us. I mean, it's some random creator, right?

Dr. Sujay Kansagra: 28:00

Let me tell you yeah, let me tell you my personal views as a father, a child neurologist, in a sleep position, and then we can delve in as some of the hard data and the science behind it. First, my personal view is that sleep training based on everything that we know is an option. It's an option for families. No one should ever tell you you have to sleep train. You know no one should ever do that. It's a personal parenting choice and you decide what's best for you. On the flip side, no one should ever say you should not sleep train based on misinformation, to say that it's gonna be harmful to your child or you're being a terrible parent, et cetera. No one should demonize you out of sleep training. So at the end of the day, it's a choice. It's a safe and effective option for those that choose to use it and for families that want to do something to help their child sleep. I hope they don't get swayed by that misinformation of people telling them that they can't because it's harmful and you're gonna hurt your child, et cetera. So that's my 10,000 foot. If you want it, sure, happy to dive into the data. But the other thing that I'll tell you is there are options here.

Dr. Sujay Kansagra: 29:06

There are lots of options, and we use the word sleep training In medicine.

Dr. Sujay Kansagra: 29:10

It's behavioral insomnia of childhood.

Dr. Sujay Kansagra: 29:12

These are behavioral interventions to help with behavioral insomnia of childhood, and the core here is we're trying to teach children to become self-soothers, be able to fall asleep independently, such that when they do have those awakenings we talked about those normal awakenings they look around, everything is the same as when they first fell asleep and they're able to transition back to sleep on their own.

Dr. Sujay Kansagra: 29:30

There are lots of different techniques, but I'll tell you that the cry it out technique, aka the extinction approach it's kind of falling out of favor with everybody. To be honest, people don't really like the extinction approach for many reasons. There is data to support safety and efficacy and that's all great, but nobody really feels good about just saying, okay, just let your child cry it out without any sort of intervention, without any sort of soothing, and so, yes, that technique is there in certain situations, if the family is in crisis mode and we need to make some changes super fast. Yes, that can be an option for some, but it doesn't tend to be the go-to for sleep medicine physicians and for most of the sleep consultants out there in the world. So I'll start with that.

Jon Fogel: 30:06

Yeah, and I think the thing with extinction method or even, like I think, radical firber, I think, is I might say a favor firber method approach.

Dr. Sujay Kansagra: 30:17

Firber yeah.

Jon Fogel: 30:18

So people who take that to an extreme too it can feel that way where it almost becomes an extinction approach at some point. Yeah, the thing that strikes me with that is if you are having violent ideations against your child because of postpartum depression or sleep deprivation or whatever, like extinction is so much preferable to you having holding a child that you are at risk of harming period.

Dr. Sujay Kansagra: 30:46

I'm saying 100%. So let's talk about that, yeah.

Jon Fogel: 30:49

Yeah, can we dive in that, because that's huge? Yeah, before I go on, let's go into that, yeah.

Dr. Sujay Kansagra: 30:56

And feelings of being overwhelmed due to lack of sleep are very real.

Dr. Sujay Kansagra: 30:59

And I will tell you that, in my experience, many terrible things that happen to children are due to fatigue from the caregiver. And I will tell you that I've even had I've had pediatricians. I've had pediatricians tell me that I was so sleep deprived that one night my child was in the middle of the night crying and I walked up to my child and I'm like someone please take my child right now, because I am, I'm not in a safe space. And for a pediatrician to say that when they have all the resources and help and they had another caregiver in the house, I think that's very telling. So, yes, these techniques, particularly if you're feeling overwhelmed and sleep is just not working for you, please think about these because they can really help. And I get tons of comments from moms saying it was literally like a lifesaver for me, like I was so far at the end of my rope when it came to fatigue and exhaustion that sleep training was a lifesaver, and I believe it In many cases. I think it's a lifesaver.

Jon Fogel: 32:05

Well, and then you have on the other side, right, like all that being true and all that, this is the delicate dance of social media. Both of us are on social media. We're on TikTok, we're on Instagram, where your videos are limited to a minute or maybe two minutes, and it's hard to get into these kind of deep nuanced conversations so we can say all of that is true and is necessary and is we have to destigmatize for the parents, for whom you think about the horror stories of a parent who's so sleep deprived but they feel so much internal shame about sleep training that they won't take the steps that they need to do to stay safe. And then the result is their child is hurt, kind of inexcusably or inexplicably hurt in ways beyond what any damage that sleep training ever could have done. And so you think about that and you go, yeah, absolutely.

Jon Fogel: 32:55

And then on the other side you have the parents who feel like if I don't sleep train, I'm a bad parent, and those parents, as you kind of said, the extinction method is widely going on a fashion, primarily because you don't. I've seen crippling mental health concerns, you know, be acted out by women who feel that they can't go into the room with their child, or a dad who can't go into the room and they're like all. Every you know hormone in my body is telling me to go pick this child up, and I'm being told that that would make me a bad parent. And so that creates the other end of the spectrum of you know, if it's causing your mental health to deteriorate and your attachment to your child not that their attachment to you necessarily will be affected but if it's causing the deterioration of your attachment to your child, then maybe you should rethink the method of sleep training that you are.

Dr. Sujay Kansagra: 33:48

Great, such great points. So, john, let's dive into well, one, let's dive into the data that we have regarding the consequences of sleep deprivation, because there's so much information out there, particularly when it comes to benefit versus harm, this risk-benefit kind of analysis here. Right, and it's interesting because the debate there's a hot debate in the social media world, amongst the data and amongst you know, sleep positions and pediatricians, there's really there's no debate and like there's zero debate. And that's because the data that we have shows that in the short and medium term, sleep training has a multitude of benefits when it comes to sleep continuity, when it comes to parental perception of sleep, when it comes to maternal depression scores, when it comes to even things like attachment to your child, marital satisfaction, all those things actually seem to improve with sleep training.

Dr. Sujay Kansagra: 34:39

Sometimes the opposite of what people will say. They say, well, that's going to hurt your attachment. You know the data shows the opposite, actually shows it could improve. But the interesting thing is, when it comes to long-term outcomes, long-term outcomes regarding sleep, if you look five years down the road, it's all kind of a wash. You know, everybody's kind of sleeping pretty much the same. You can't really distinguish a sleep-trained group versus a non-sleep-trained group. So if a family that's like I, really don't want to sleep-trained, am I destined for this terrible sleep? Well, no, the data doesn't say that. You know. The data says that your child may eventually just start sleeping, just as well as any child that was sleep-trained. We don't know how long that might be, but they might do fine. So long-term it's kind of a wash. Now, when it comes to harm, there have been many studies that have looked at short-term, but studies that have also looked five years out, looking at mental health, looking at attachment, looking at behavioral, all these different metrics when it comes to psychosocial analysis of the child, sleep metrics, et cetera. And there's no difference there either, you know, when it comes to anxiety levels or depression scores, et cetera. So we have to take the notion that this is somehow going to cause harm to the child and say, well, the data does not bury that out. All right.

Dr. Sujay Kansagra: 35:44

Then, when it comes to the parent's own kind of well-being, I know that sleep training can be very emotionally taxing. Again, it's parent choice, it's your choice regarding what you want to do, and just know that, when it comes to methods, nobody should also tell you oh, there's one way to do it, and this is the only right way, because the data tells us there are four methods that actually have data to support them. And even within those methods, there are various things you can do to ensure that it's lining up with your own needs and your own expectations for what you want to do as a parent and your desires for how you want to interact with your child during sleep training. And I can just give you one example here, if I can delve into the Furber technique, for example, you know the Furber technique is this technique of intermittent checks, right when you do your nighttime routine, you do all the fun stuff you do with your child, all the hugs, all the kisses. We're not here to take away all the fun and love that you have for your child.

Dr. Sujay Kansagra: 36:37

But once that's done, you put them in their safe sleep space, which is typically the crib, and then you wait and most children that have developed a bit of a dependency on a caregiver to sleep they'll usually start fussing and crying at this point. So what you do is you have a time. You say, okay, in five minutes I'm gonna step away and I'm gonna check it in five minutes and actually go to my child and sue them. Let them know that I'm still here, sue them for a minute, not take them out of the crib, and then you wait, and then you wait another specified period of time. Maybe you wait 10 minutes, and then you wait every like 15 minutes, for example, but you intermittently check.

Dr. Sujay Kansagra: 37:09

That timing is totally arbitrary, you know. So if a parent is like I'm not gonna wait five minutes, that feels like an internal amount of time for me, I say okay, let's check it two minutes, you know, and let's check every two minutes. And the parent says, well, I don't wanna leave the room, I don't want my child to feel abandoned. And I say, well, don't leave the room. You know, sit right there in the room with the child in the corner and just wait these times and be over here reading a book, so your child knows you're still there, you haven't left. So there are lots of ways that you can modify what you do to ensure that you aren't feeling like you've abandoned your child or you're hurting your child anyway, all based on parental preference.

Jon Fogel: 37:43

Well, and I think that that's so profound, just to destigmatize that right Cause, like, as you're talking, I can feel my sense of you know, as, like this parent who's always, always gone to their child as soon as they cry, I can feel this like anxiety. But then what you just described is exactly what we did, which is like no, but I yeah, I was in the room or I went and sat in this chair and then, when my son was, you know, kind of at an age where we could explain to him you know I'm going to leave now, but I'm going to continue to come back, it's just I'm going to do the checks from, not in the room, you know, and so so it's really what you're describing is, I think, probably what a lot of parents do, and they feel like this isn't sleep training. But what you're telling me right now is that is sleep training.

Dr. Sujay Kansagra: 38:28

The core of sleep training is essentially helping your child learn some of those self-sufficiency mechanisms. You know how do I turn my brain from on to off. You know, and at some point, you know, we all learned this skill at some point. You know, everybody learns to fall asleep. But we think that children can develop that skill fairly early, you know, and some as early as four months. But you usually were waiting until around six months just to turn for children, but some turn between four and six months. That skill can actually be taught. And so it's really, you know, giving them that, that skill of self soothing, that I can turn my brain off and then I can do it again when I wake up at night and I look around and I'm like, oh yeah, everything looks about the same. I'm still tired, I'm going to go back to sleep. That's, that's a core of sleep training.

Jon Fogel: 39:08

Sure, and so to those parents who are you know I don't know what the word would be for, but very attachment I don't like saying attachment parents, because it makes it sound like if you don't do this then you're not an attached parent but those parents who are more the way that my wife and I were, where you know we go to our kids every time. What advice would you have for us, cause I know that there's so much advice out there for the parents who are more traditional in the sleep training approaches from the 80s, 90s, 2000s, what about? What about those of us who just cannot stay away? What can we do to foster good sleep hygiene and health for our kids?

Dr. Sujay Kansagra: 39:45

Absolutely so. There are other methods, you know. So I talked about the furbler, the graduate extinction method. There are other methods that are conducive to that very style, and that one is called camping out.

Dr. Sujay Kansagra: 39:53

Camping out is where you make some really slow, gradual changes at the time of transition from wake to sleep and a steps that you don't have to have any prolonged periods of crying, et cetera, that you're always there, essentially. And so how does that look? Well, if you're constantly having to rock your shot to sleep, for example, like oh, I gotta rock them and they won't fall asleep without it, I say, okay, this week what we're gonna do is you're gonna hold them, but you're just gonna rock a little bit back and forth this week until they fall asleep. And when they wake up at night, you're gonna go right to them. You're not gonna let them cry, you're gonna get them out. You're just gonna rock them a little bit until they fall asleep. It's not gonna be as vigorous as you're doing before. They might have a little bit of a harder time but you're right there.

Dr. Sujay Kansagra: 40:30

You're with them, you're helping them transition. Next week, instead of rocking, you're just gonna hold them until they fall asleep, and we're not gonna rock, you're just gonna hold them. And when they wake up, you go right to them and we're just gonna hold them. Week after that, we're gonna put them in the crib while they're still drowsy, but still awake, and we're gonna pat them, pat them, pat them until they fall asleep. So you're right there, you're not leaving them.

Dr. Sujay Kansagra: 40:50

Each of these transitions may be a little bit of fussing, but you're right there as a parent and you're not leaving them on their own. Eventually, the goal is you go from padding to just sitting next to the crib until they fall asleep, and then sitting a few feet away from the crib until they fall asleep, then sitting six feet away, but then sitting right outside the door, but still within line of sight, and then eventually completely out the door. So it's a slow, gradual weaning of parental presence that hopefully still allows you to have that time to respond to your child and not feel like you're leaving them to choir for long periods of time.

Jon Fogel: 41:19

Well, when it builds confidence as much in the child as in the parent too, right? So, like in both of those cases you have, I like to say that you have two brains that you're working with. A lot of parents think that like I can just kind of I'll just do whatever my kid needs. I'm just not gonna matter.

Jon Fogel: 41:34

I'll just do whatever's the right thing to do. No, you won't You'll do the Venn diagram of what works for you and works for your child. You're not gonna do. You know what I mean Like, and all of us will do that. Maybe that Venn diagram has. Wow, I'm really willing to kind of go out of my comfort zone to an extent, more than maybe my partner is, or whatever. But that's all comparing and don't compare right. It's always gonna be a collaboration and between you and your child, and so it sounds like there are so many different ways to do that that can work for parents and what you just described, I mean you know some sort of if there was a whole parent sleep training method. It's somewhere between right, like graduated extinction and the building that confidence, cause I know for me like the only way that I could feel in power as a dad this is pretty vulnerable, but the only way that I could feel in power as a dad like my wife, she just pulls out the boom and that kid's gone. You know what I mean.

Jon Fogel: 42:31

But like I had the yoga ball and the Moby Wrap and I felt like a superhero, cause like my dad like I could just snap, and all my friends who were dad, they're like okay, do this, my wife has to put him to sleep. I'm like, no, I can do it cause I have these tools. But then those tools become dependencies. And then what do I do? So I feel like that's such a good way to say yeah, empower yourself, and then also be willing to adjust slowly in line with your own values and kind of mental health.

Dr. Sujay Kansagra: 43:02

And this is why you know, for me, when it comes to sleep evaluations in my clinic, you know this is why the evaluations take me an hour. They take me along within my epilepsy evaluations because there's so many things to talk about or unpack to make sure that you're doing things in line with what parents desire, what their cultural norms might be and taking into account all the different factors that will. You know, two caregivers having completely different opinions regarding the approach, et cetera. So all that can be very challenging, and sleep is a flash point. It's a time where everybody's tired, everybody, you know. Sometimes parents have different approaches to what's going to work best, and so, yes, come up with a cohesive plan, be consistent and know that there are options. Regardless of your parenting style and your preferences, there are options to help with sleep.

Jon Fogel: 43:43

Yeah, dr Suje, this has been super, super informative. I want you I know that, you know I didn't tell you I was going to do this, but I want you to create a PDF of some kind if you don't have it, or maybe you have it, I just don't know of like the four sleep training methods and you could put them on a scale of like I don't know what you. Maybe there should be a box so that people don't feel like they're one thing or another thing. But it just sounds like you have sleep training methods really that could work for any parent, and even the ones that maybe wouldn't work for a parent can be adapted to work for a parent.

Dr. Sujay Kansagra: 44:17

Yeah, Well, it's funny you mentioned that I've done that. Well, I wrote like a. I wrote a 50 page book that was like to the point, step by step, for every sleep trading method, and I try actually very often I'll just give it away for free through Amazon, because they let me do that every every so often. So certainly get a look out for that. And and you don't need the book, because I essentially go through each of these methods on my social media platform. So I have videos dedicated like each of the various sleep training methods and it's step by step instructions with screenshots. You can take that have it all written out and so you may have to dig a little bit on tick tock. It's one of it's on the playlist, so you can. I have toddler playlist for you know, for toddler issues, and one for all the sleep training approaches, so so check those out.

Jon Fogel: 44:57

Yeah, check them out and I'll link. I'll link the book in the show notes so that people can pick that up. You said it's on Amazon. People can pick that up.

Dr. Sujay Kansagra: 45:04

It was on the on.

Jon Fogel: 45:05

My child won't sleep yet my child won't sleep All right with Dr Suje, who has been so helpful for us today on the whole parent podcast, how can people connect with you? You mentioned your social media. What's your handle? How can people get get great sleep? You know evidence based but also a whole parent approved sleep advice from you.

Dr. Sujay Kansagra: 45:26

It's, yeah, it's that sleep doc is the handle of anywhere on any platform, tick tock Instagram, facebook, youtube. I'm, that's that sleep doc everywhere and and I, yeah, I try to make content is that science based, that's easily applied and it's practical?

Jon Fogel: 45:41

you know, you give you all some options and some things that are like science based practical sleep training, and for those crazy people among us who cannot bear to let our kids cry for any period of time, you have something for us to that you're not going to be left out in the cold.

Dr. Sujay Kansagra: 45:58

All right, something, something for everybody.

Jon Fogel: 45:58

Yeah, there is something for everyone, all right, excellent. Well, thank you so much for being on the podcast and yeah, any last tip, one, one tip to give us as we as we go, or one affirmation, or something like that.

Dr. Sujay Kansagra: 46:11

I love to say that we're all in the search for finding the perfect way to parent, like that one right approach to parenting, and I always like to tell people there are a million right ways to parent. You know there are a million. As long as you're keeping your child safe and you're loving your child, there are a million right ways to do it. So don't feel this pressure that I have to find that one right way to help them sleep with, that one right way to make them eat. You know there are a million right ways to do it and all those ways are okay because your child is going to thrive and be totally fine.

Jon Fogel: 46:39

If you're listening to this before bed, it's time to turn it off so you can get the most possible sleep. Thank you so much for being here with us, dr Sujay, and we'll make sure to catch up with you on social media wherever you are. Hey, thank you, guys, so much for listening to the whole parent podcast today. I hope that you had some of the questions that you have around pediatric sleep answered. As I said at the very beginning of this episode, I am back to remind you that if you have somebody in your life with whom you could share this episode, maybe it's a friend of yours who's been talking about how they've really been struggling to sleep. Maybe it's a person in your life who's pregnant or who's expecting a child, whether that's their first child or not, and you might send in this episode and say hey, you know what? Right in the middle of this episode they talk about newborn sleep, and I think it would be really beneficial to you. Whomever it is, maybe it's your parents. You want to send your parents this episode so that they stop badgering you about sleep training or not sleep training. Whatever it is, find somebody to send this episode to and share it. That is the second to rating and reviewing it. That is the best way that we can spread this message.

Jon Fogel: 47:42

And, as always, I don't say this on most of my podcasts, but, as always, if you are looking for me on social media, if you haven't found me on social media yet, I am at whole parent on all of the social media platforms. You can join me there. You can subscribe to my email list. It's the link that is in the show description here below. You can get on an email list and that's where I put out my most valuable content, including when I let you know when new podcast episodes are upcoming or have already dropped. So if you're not on the email list yet, please go and do that. If you're not following me on the social media yet, please go and do that. And yeah, I just really hope you enjoyed this episode. If you have feedback, I'd love to hear it. Take care.