S02E11 ‘Sleepy but awake’: Annie O’Connell’s sleep wisdom, Pt.1


Annie Part 1: Occupational Therapist and Sleep Specialist Annie O’Connell joins Michael and Dino to discuss how good sleep is one of the biggest factors in quality of life.

Occupational Therapist and Sleep Specialist Annie O’Connell joins Michael and Dino to discuss how good sleep is one of the biggest factors in quality of life. 

In the first part of this two-part interview, Annie discusses the three main components of sleep, explains melatonin and it’s role in sleep, how waterbeds led her to specialise in sleep and answers the most important question, how good are siestas?!

Some resources discussed by Annie in the episode:

Australian sleep health foundation

‘A clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems‘ by Jodi Mindell and Judith Owens

Podcast: Why we sleep by Matthew walker

[00:00:00] Michael: Hello, and welcome to the integration station, your go-to Pediatric Occupational Therapy podcast, brought to you by the O T F C group. Today, Dino and I are joined by Annie O’Connell, an occupational therapist with over 30 years of clinical experience and a sleep specialist. Who has worked in a variety of pediatric settings in South Australia and overseas from 2003 to 2015, and he was the lead practitioner for the Sleep-Wise Project.

This project was developed by Child Youth Services through the previously Disability sa, which worked on addressing sleep disturbances in young people with developmental disabil. Annie completed her master’s in OT by researching sleep disturbances in children with autism and the use of a water bed. In 2003, Annie’s received an Australia Day Award from the Department of Families and Communities for her role in the Sleep Wise Project, and was also awarded a Churchill Fellowship in 2009.

To further explore the management of sleep disturbances in the uk, USA, and Canada. And in 2010, Annie received an OT Australia Achievement Award for her innovation in service delivery. Annie has since developed the sleep ability and sleep with Disability PD supports for health practitioners with additional references and support for parents and carers to increase their knowledge of sleep and support for sleep.

In today’s podcast, Annie discusses a range of practices to support. Some sleep myths, how to continue to work on sleep practices and the effectiveness of sleep hygiene, unpacking key terms such as melatonin, the functional impacts of sleep, and the impact on quality of life, as well as touching on components of sleep practices from different cultures, and also a thorough answer of the top 10 most common sleep.

Thank you everyone for joining today. Today I’ve got Dino with me who is with us again for another series, for another series, for another episode. Thank you for joining us tonight, Dino, and we have a very special guest, as mentioned in the intro. Annie O’Connell. Annie, thank you very much.

Thank you. No, good to be here. As mentioned in the introduction Annie is a, a sleep specialist and a sleep specialist ot. And having done some training under Annie when you took the sleep wise module and the training number, number of years ago now with, when it was disability essay, I believe.

Yeah. Mm-hmm. A while ago now. I was certainly. Quite taken by how much of an impact sleep has on, on everybody. And the, the training just opened my eyes to the the, the role of sleep. And as OTs, we are really focusing on those meaningful activities, but also on, on function and, and sleep. When you don’t get it, can really impact on function.

So I guess just going back to the start then before we came up here, you mentioned you. Graduated from OT over 40 years ago. So you’ve been in OT for a very long time now? Long time now. Lots of experience. Lots of experience, yes. It adds up. Yeah. How did you go from okay, OT then into specializing in sleep?

Was, was there a moment, was there something in there that made you question or can you just talk

[00:03:28] Annie: us through that? Yeah. At the time I was working for the autism. Association, which is now autism essay, and I was certified in sensing integration and I got talked into doing my masters by Chris Chaparro, Dr.

Chris Chaparro, who’s with the University of Sydney, and she became my supervisor. And I went through what subjects I was actually. Interested in, I wanted to design playgrounds at one stage. I think I would’ve really enjoyed that. Yeah. But in the end it was sleep because I had way too many children not sleeping who were actually clients and families, which were really stressed.

And some of them at that stage would’ve been through really popular. And the parents often had a water bed and their kids would. Go into their watered the whole time. So I did my master’s on the effectiveness of a watered with children, with sleep difficulties with autism. So after three years or whatever, it took me to do my actual research, putting water beds in into different homes and putting children on the water beds.

When I’d finished, I went down to what was I, dsc, which then became dissa, which da da da da da. And I just said that I think we should be doing a lot more to support families with, with children who’ve got sleep difficulties. And I think you are the. You might be the organization that could look at that.

And luckily for me Deb Atkins had just completed the toilet time manual. Mm-hmm. And so they decided to employ me two days a week and to write the sleep wise manual. Yeah. And they had a concept then that they would go on and they would do manuals in all the areas. Oh. But I was the second and.

Money that was, it stopped, or managers changed or what? Yeah. Sorry.

[00:05:31] Michael: Go down. I,

[00:05:32] Dino: I, I, I vaguely remember hearing that. You all correct me if I’m wrong, but didn’t you also receive like a, a grant or an award for studying as

[00:05:44] Annie: well? Like once I had. Done the seat wise manual and we ran training. I did get an Australia Day grant through the state government, but I went on to apply for a Churchill Fellowship.

So and based on that, I was successful in 2019 and. No, 2009, 10 years in that one. And so I went overseas and Churchill Fellowships are amazing. Yeah, because you travel the world, meeting all the gurus in that area and you realize actually that what we have got in Australia is pretty amazing.

Yeah. But you just need to refine it really well. Yeah.

[00:06:29] Dino: So, but that’s a big thing, Annie. That’s not something that they. No to every

[00:06:32] Michael: time we had Oh, no, no.

[00:06:34] Dino: That’s an amazing achievement. It is, it is too modest to, to,

[00:06:37] Michael: I was about to say it’s reference

[00:06:38] Dino: it, but it’s referencing remember the time thing.

Absolutely. It was quite amazing.

[00:06:43] Annie: I wrote a list a while back and I think we’ve got at least, at least seven OTs in South Australia alone who’ve had churches. Wow. In areas of arthritis hands maxi action, got one for looking at quitting smoking with people with mental illness. So they’re, they’re actually out there.

Yeah. Yeah. So if you go around Australia, I, I haven’t counted up, but it was for some some association. Memory thing, so Yeah. Yeah. They’re out there. Yeah. Yeah. And in fact, I’d encourage any OT who’s got a bit of a specialty to go for it, because funding’s often quite tricky for, for a therapist like that if you’re not attached to a university.

Yeah. And, but the difference in, in how you go about your practice really is heightened by spending six weeks with other. Other specialists. Yeah.

[00:07:43] Dino: Mm-hmm. It’s definitely something worth i I mentioning because we don’t often look at things outside of

[00:07:50] Annie: you, you guys could easily do it for sensory integration or sensory play.

Yeah. We’ll look in, we’ll

[00:07:55] Dino: put somebody on it, Michael. We’ll put somebody, we’ll give ’em a job.

[00:07:58] Michael: I think it’s always, yeah, always worth the looking for that. I guess way to, whether it’s to, I don’t wanna say justify or to strengthen the, the evidence base of things or to people have special interests as yourself.

You know, you saw a gap, you saw it as something that was so functionally impacting for a lot of families, and people were like, well, here you go. We can help support that. Question on, on your time away, where, where, was there one place where you worked?

[00:08:28] Annie: Or that you just loved? I went to there was an organization called Sleep Scotland, so Oh yeah.

I was in Edinburgh doing their course went over two weeks, which was very similar to the sleep-wise in region. But I did go to quite a few places in the UK and I went to Canada and then I popped down into two places. And so the Judith Owen. And Jodi Mindell wrote the, the, the pediatric textbook on sleep, right?

Mm-hmm. And so I had time with both of those people.

[00:09:02] Michael: Oh,

[00:09:03] Dino: Annie, can you, can you break down in, I guess, in a simplest way possible what sleep is, what it does for us, and why it is so important, particularly for children? Mm-hmm. In, in, as in as much as you can. In a way that would, would be would be understood really easily by parents in particular.

[00:09:25] Annie: So pretty well. If you wanna balance out any other occupational activity, whether it’s play or school or self-care, you need adequate sleep. And the sleep helps you, it releases the growth factor. It, it improves your immune system. It does all the consolidation of learning and memory patterns. You need it for your.

Health, but you also need it for your mental or emotional regulation. So pretty well any of your difficult daytime behaviors are often increased dramatically because of not enough sleep to process the other sort of areas. So really if you look at occupational performance model, Sleep actually comes in under rest.

So you need we all need to have restful activities or relaxing activities to balance the, the doing busy activities and sleep then falls in under that as well. And sleep is a very complex process. It’s a very natural process. It doesn’t, particularly in our very busy society now, doesn’t always take sort of gets pushed to the side a little bit or broken up.

And why also important is that if the children aren’t sleeping, the parents aren’t sleeping, and the stress levels. Up there and as soon as you get better sleep, you can reduce the stress levels for everybody in a whole family. So really good sleep makes quality of life. It makes a huge change if, if people can get.

Decent sleep. Does that sort of answer the question? How much sleep do you get? I’m a really good sleeper.

[00:11:16] Dino: What’s a good sleeper? So I, I’m thinking here. Amount and quality. So eight,

[00:11:21] Annie: eight hours. Yeah. Yep. And if you wanna go to any of the, the big gurus that. But of course it’s different with children cuz infants can look, you can talk about averages or you can talk about ranges, but they, they can sleep a lot.

Like some ba new babies can sleep 18 hours outta 24. But young children you sort of. You’re often getting around about 12. So that’s half of the day, age, age range for 12 hours. Around, around the two to three year age group, school-aged children should be getting 10 plus. Mm-hmm. And then adults. And that will be teenagers actually need a lot of sleep, but they often don’t get it because of the way there’s a pable and neural in the brain and you actually need sleep to accommodate.

Sort of changing. Yeah. All that pruning. Yeah. Yeah, yeah. And so eight hours even for some people more. And then pretty well. As people get older the quality can sometimes change it. So people over 60 or 70 might be sleeping on and off that sort of length of time, but that might be much more fractured.

Mm-hmm. So, yes. The three things that you worry about with sleep is the quantity. Mm-hmm. The quality and the timing. The timing in relation to a day. Right. So the three aspects that you need to really look at in detail,

[00:12:59] Dino: what’s your opinion about siestas?

[00:13:01] Michael: Wonderful. Put

[00:13:04] Annie: our hands up for Siesta. We are designed as a natural dip in attention. Mm-hmm. You can. It shows you if you have that, if you do some learning before a siesta compared to a person who learns in Dunham Siesta, you have that in your brain. It’s retained. It’s embedded.

Yeah. Far be wow. Far better. And a lot of the research on Naps for Children will show that the kids have a nap, regular nap, sleep better at. Because they’re not hyperactive, they’re not too burnt out. They’re not getting that second wind as much. So yes, siestas are good if you can’t actually sleep, just even having a rest time.

Yeah. And doing some breathing. Mm-hmm.

[00:13:49] Michael: What about cuz I know there’s, so, for example, with some of these younger ones, one thing that often gets suggested is not sleeping at night, not getting enough quality sleep at night, drop the day nap. Particularly in that sort of toddler, two, three age to build up sleep pressure.

I mean, I, I know every case is different, but, oh

[00:14:08] Annie: yeah. But I would still have a quiet time. Some downtime to the brain can. Yep. And definitely in that, in that early afternoon. Mm-hmm. After lunch, just have a, have a chill out time and let put some music on or, or read a book or whatever. And if they fall asleep, they do then,

[00:14:25] Dino: so they’re having the TV on blaring some 24 hours of No, this car attorneys or Disney.

[00:14:32] Annie: And in fact, you know, the good sleep practices, just some of those things can make the biggest difference to sleep. So you don’t even need a huge intervention plan. You can just do some really simple things like having a quiet time, like hour before bed, turning off a lot of the screens, dimming your lights.

We do think that’s, you know, no more yelling and screaming. Yeah.

[00:14:56] Dino: So, I mean, we encourage those practices and I think it’s great to reinforce that. But I, I think the one that I’ve, I always, always stuck with me was that not having screens before. Bedtime and that, and that includes having children in front of tv.


[00:15:13] Annie: And now we’ve got pads and that, and you know, part of that is if you look at light therapy and you look at melatonin, bright lights, Inhibit melatonin. So you need to have less light and, and that’s why you often can quiet and screens or put reli, red cellophane over them just so that you can actually en entice the melatonin to enter the blood system and, and assist it

[00:15:42] Michael: and built in.

Now. So explain

[00:15:43] Dino: a little bit about what melatonin is for our listeners and what

[00:15:46] Annie: it’s important, right? It’s a neuro hormone and it is made in the body and. In various glands, but predominantly the pen gland who all, who sort of is the coordinator of all the different melatonin sites. And as you get a sleep debt, you get tired and your alertness goes down, the melatonin is released into the bloodstream and it’s in, in little increments over five hours.

Once you get to a certain spot where this alertness drops, where your debt goes and you’ve got enough melatonin in your system, you go to sleep. Mm-hmm. It then increases in your body till about three o’clock in the morning and then it starts decreasing up when it’s Less in your blood and you have got over your sleep depth, you wake up, but it is reaction into light.

So definitely having bright lights. Really can impact on people getting to sleep. And we can actually use that in intervention. So for example, if I wanted to get someone to fall asleep earlier, I’d do dim light therapy for two hours prior to bed. If I wanted them to stay up later, I’d give them bright light therapy in the morning.

I would reverse the opposite. So one of the best things that a family can do if you haven’t got a child in a good sleep pattern is to open the curtains and let the sunlight into the room at a regular time. I can tell you a little story about that. There was a a mom presented an OT conference with me and she had canceled me.

My visit and the OT kept trying to get me down and this mum said to said in the OT conference that she didn’t wanna see me. That’s she hadn’t been able to fill out her diary and she just felt overwhelmed. She had four children. Yeah. And so we went in the first. You know, by the time we finished, I said, okay, the only thing I want you to try to do is to open the curtains at seven o’clock in the morning.

This little boy wasn’t getting to school to around about 11, and so the goal was to get him to school. And so the next time I saw them, they’d actually swapped the bedrooms the brother and put this little boy into a room with an eastern. Window so that they could open the curtains, get the sun. They opened the door, it was near here at the kitchen.

And so this little boy started waking up earlier. And once we got him waking at a more regular time getting to school, we could then start working on what was happening. Mm-hmm. At night. So it can be as simple as opening a curtain.

[00:18:28] Dino: You know what, I didn’t realize the importance of that, that element alone in, in terms of looking at.

Also looking at wake.

[00:18:37] Annie: Yeah. Whenever you do a sleep plan, you actually should work at the wake time. Mm-hmm. Start, you start there

[00:18:47] Dino: because then you know what time to that they should be going to sleep at.

[00:18:49] Annie: If you’ve done a good sleep diary Yeah. And you’ve got good information and good data, you can actually begin to make that pattern and it’s all about and training the brain into a sleep weight pattern.


[00:19:02] Michael: early. Children be trained in sleep practices, then? Like is there, is it’s, I mean obviously there’s, there’s maybe some level, but how early

[00:19:10] Annie: would you they suggest that you don’t do anything before four months. Mm-hmm. Some of us would say six months because of attachment type of issues, but definitely in that first year, you can begin to shape it.

[00:19:26] Dino: I, I know that I had one terrible sleeper who would wake up. Every hour on the hour. And it was great fun when she was awake, but then it got to the point where two and three in the morning, those hours, it wasn’t fun because she was waking out of those rhythmic every day, every hour, that cycle. And we as parents were quite lost about what to do.

And I remember we, we went to the, the so-called sleep, the sleep doctor at that stage, and I think he was name Norwood. Yeah. Brian Simon. Yeah. And you know, his advice isn’t for everyone. No, it was, it was it. I actually, I actually remember not being able to stay at, stay home for that period of listening to my daughter, poor daughter crying.

Mm-hmm. But I remember going back much earlier bef before when we had our son to get ideas about what. Could develop better sleep habits and that that worked. Like you know about I think he said don’t have a, don’t have him in your room to start with and let him start to be able to put himself to sleep, even if he’s making noises.

It’s okay. And like some of those some of that advice was really helpful, but I, I think it was quite ch it can be quite challenging

[00:20:33] Annie: for parents. I’d say half of the people I know found it really good and half dear and I, I can think of an OT who had four children and. Could do one technique with one child but not the other child.

Yeah. So that’s how different they all are. Yeah. And then you have to take on some of parenting styles and cultural differences. Yeah,

[00:20:54] Dino: the co-sleeping is an interesting one for lots of coaches.

[00:20:57] Annie: It’s, isn’t it, it’s a really big thing because co-sleeping is so common with that. Yeah. That

[00:21:01] Michael: was my next question.

What? Yeah. Oh, sorry. No, ab absolutely. I I think it’s a good segue so you know, what are, what are you, I mean, cuz there, there’s research on that as well. Mm-hmm. But there are certainly cultural differences where that’s many people would sleep in the same bedroom and,

[00:21:18] Annie: and all around the world. They’re all ages.

Yeah. Yeah. So all we know is that with a lot of those kids, they will, typical kids will grow up and they’ll be quite happy sleeping in their own spaces. They’ll move away from the parents at some stage. The kids with disability often don’t. Mm-hmm. Yeah. So they co-sleeping for longer. Mm-hmm. I had one family and the mum was menopausal and, and the dad was on a c a P machine and they had their 15 year old incontinent child in between them, and they really wanted him to sleep independently.

So, because none of them were sleeping well. Mm-hmm. Quality or quantity. Yeah. And so, you know, I’ve had people come up to me at conferences and they, they’ve still got their 21 year old child with them, but it’s often because of medical. Things. Yeah, like seizures and, and you understand it. So I suppose you gotta talk to yourself or talk to your family and what, what are you comfortable with about co-sleeping?

But if, if you need to be that close to a child, maybe sleeping in a separate bed and. At least a set a goal of of them falling asleep in their own bed by themself. So I had one mom who had to climb into bed. To get their, her little boy asleep. And when he said, well, okay, how are we gonna get it so that you, they don’t drag you into bed every time.

Yep. Well, she used to say prayers with the kids. All she did was extend her prayer time and she prayed stuff, but they fell asleep. So you gotta, you gotta find, you gotta find whatever works away, but basically away. Another, another mum, we had dad stand at the door room and mum went to the shower and he can say, listen, mum’s still in the shower.

You go to. I’m still in the shower. You know, it’s sort of how to break up the patterns and how to still know what you are aiming for and the idea of a child falling asleep by themselves in a place. Is that once what the researchers showed is that if they learn to sell Sue, then they can often wake at night and sell Sue back to sleep.

Right. Without the parents Yeah. Need, without coming to,

[00:23:26] Dino: to look for the parents to jump, because that’s the, that can be another issue, can about sleep. That they’re fine getting to sleep, but they wake up and they’re in the parents’ bed. Mm. And then that’s where they stay for the rest

[00:23:35] Annie: of the night. Yes. And then the musical beds start.

Yeah. Yeah. And then you have to make a decision. What you want to do about that. Yeah,

[00:23:43] Michael: it lot more complicated.

[00:23:45] Dino: It’s really complicated. And when you’re a sleep deprived parent, we’re not yet, we’re not talking about being able to look at it logically at certain and no, and think systematically about sleep when it’s four in the morning and you both maybe.

Potentially have to get to work and it hasn’t been a great few days. And it’s, it’s, it contests,

[00:24:03] Annie: there’s, there’s lots of research on sleep de deprivation studies and those studies reduce that sleep from eight to five. We have got heaps of parents who are only getting five hours of sleep a night. Yeah.

They are equivalent to the sleep deprivation studies. Wow. I, in fact, you’d probably even question whether they should be driving.

[00:24:25] Dino: Wow. I, I, yeah, I’m trying to think how many, there was years that I probably got four and a half to five hours sleep, and I don’t remember many of those years

[00:24:34] Annie: and no, and, and how many, what I did on that day.

What do you get now?

[00:24:37] Dino: I’m, I’m up at four 30 in the morning, but I won’t go to bed now any later than about nine, nine. Yeah. Like I, I used to be a,

[00:24:47] Annie: a one or two for seven

[00:24:48] Dino: hours-ish. Yeah, yeah. I used to be at one or two o’clock in the morning and up at five. That would be my, and I did that for years and I,

[00:24:55] Michael: I, I couldn’t do it.

Yeah. Yeah.

[00:24:59] Annie: I think and, and actually men can sleep. A bit less than women, but often women get less because of babies. Yeah. And children and stuff like that. Whereas

[00:25:07] Dino: now I’m, I’m, I really look forward to going to, I’m getting older too, but I look forward to that sleep and I feel really good. Like, I, I can get through a day.

Yeah. I’m getting up at

[00:25:17] Michael: four

[00:25:17] Annie: 30, but I, the different, the difference when you can say, so the one thing that we haven’t talked about here, maybe that question is coming. You’ve gotta you’ve gotta really get some good data and really good sleep interview, but you really have to do the good medical checks.

Yeah. There mustn’t be any pain. And if there is pain that has to be dealt with, and it might be that they need, I had one, one guy who needed his wisdom teeth. Yeah. And it’s a dental work done before we could do an intervention. Lots of them need their breathing checked. Mm. Is, is skin problems. Yeah. And children shouldn’t have bowel actions overnight.

And if they are, they’re probably constipated. So you need in t checks and, and you need to get all that worked out. Yeah. Before you can do a a sleep-wise type intervention.

[00:26:16] Dino: I have a child who doesn’t sleep or a child that gets to sleep, but then doesn’t. Asleep. Is there a process or where can families go, like if they need expert help beyond what we can advise from our, you know, from our, I guess our experience,

[00:26:35] Annie: there’s a, there’s a lot of therapists out there who are trained in the sleep wise approach.

Mm-hmm. So, and in that approach, you provides sleep education on what is typical sleep. And then you do sleep d. You might do a screening tool first. Yeah. Mm-hmm. Then you do a sleep diary. Then you do a sleep interview, which can take an hour, an hour and a half, and it’ll be depending on how much you’ve already worked with that family and the child, when you realize you’ve gotta refer off for medical assistance to get some of the issues worked at.

Mm-hmm. When you’ve got a bit of a plan like that, then you can start From the diary beginning to work out what the. Could be. Then you can start looking at the sleep plan and you begin by looking at communication. How are you gonna communicate to the child what you’re wanting? Is it a, a single picture?

Mm. Is it a pillow or is it, you know, a detailed sleep story? Sort of social story. Sort of fair. Yep. A really detailed sleep. Yeah. And then you look at all the sensory options to meet the child’s needs and preferences. And also for them, for some of those cues to become the sleep association. So one of my funny stories, and everyone laughs at this, but this it, it wasn’t me, it was another therapist working and the, the child went to sleep stroking the mother’s hair.

Oh. So the mother went and bought two wigs. Sounds like my son continue. And I watched it in her shampoo and tied. The wig to the side of the cot and that child associated sleep with that and it became a calming thing. So they used to even take the hair in the car mm-hmm. As the calming thing. And I look, it sounds a bit bizarre, but it it got mum out of the room.

Yeah. And it kept the child And you can then shape it. Yeah. Like you can probably move it onto a doll or something like that.

[00:28:31] Michael: That’s good. It was, it was. My wife and my son are currently in that where when he’s really tired he will need mum’s hair. Mum’s hair. Yeah. He likes mum’s hair and we’ve had that conversation about can we replace it with something else?

And trying to give him, he can self sooth and very tactile, but the hair is.

[00:28:48] Annie: Is the go-to. It’s the goals. I, I know, I know another dad, he Yeah. Head was his ear. Yeah, yeah, yeah. That the little child just wanted to, needed something in their hand. Yeah. So you often have to find that. And it might, they might be a little bit upset initially having not person attached to it, but, but you can get,

[00:29:07] Michael: so I guess that’s where the, and I guess that’s where the OTs are, are really well skilled in that and they’re identifying it, it.

Just a, an attachment thing, there’s a sensory component to it as well. Absolutely. And okay, what can I replace that with and then make that an effective replacement and a transitioning away.

[00:29:24] Annie: Yeah. And then change it over time.

[00:29:25] Michael: Yeah.

[00:29:27] Dino: Touch is, is such an important regulator. Mm-hmm. And, and I, I, I even remember you working with a, a.

You know, child where the, the blanket, the blankie was the big, huge thing. And all we did over time was keep reducing the size of the blanket until it became like a postage stamp. Yeah. But it took a long time and that, that was enough. Like it became just a

[00:29:48] Annie: postage stamp, you know some kids get so attached to their computers and their screens and this kid wanted to take it to bed.

He had was on the spectrum, and so we took a photograph and laminated. And he took the photograph. Yeah. Yeah. And that was, it was the, he, he saw the computer being locked into a cupboard, so he knew where it was. Yeah. But, but he just needed, that was his little security. Yeah. Wow. So yeah, you can come out with some quiet novel ideas about making a child like their sleeping sleep environment and feel comfortable in, and, you know, following them.

It, it is.

[00:30:26] Dino: Coming up with ideas a lot of the time, and I think that that experience is, is quite similar with toilet training as well. And, and you know, having, you know, you just hear countless hundreds and hundreds of stories over the years and then what eventually works and you catalog them and you, you, you, it’s about interview and finding information and thinking, well, that’s, An awareness of, or, and that strategy could work and then, you know, changing things and, but trying to start in one area and then go from there.

It’s a bit, it’s a bit like being a bit of a detective as well. I think

[00:30:57] Annie: unbelievably like a detective and setting really little goals. Yeah. And, and knowing what you are gonna do first and, and then, and then what will be the next goal and what will be the next goal, but trying

[00:31:07] Dino: to stay within a, a, a range that you can understand what it.

You did that change? Not changing too many things. Yes, because if you change too many things, sometimes if it works, you don’t know why it, it worked, or if something could have worked, but it was counted by something that didn’t work, you wouldn’t know. Sometimes some of the

[00:31:25] Annie: sensory stuff, a lot of families will try and you, because they’re quite nurturing, they’re quite caring type of things to do.

And then they’ll just fall off the wayside, you know? They’ll stop using it. Yeah. And they’ll, but it’ll be one thing. It might be a particular. It’s off toy or it might be a blanket or you know, it could be, it could be anything. A torch a wind up torch or something. Mm-hmm. But any of those things, the child will keep using it if, if they need it or the parent will reinforce it that way.

[00:31:56] Dino: Would any, was there ever a child or a young person that you came across that nothing worked like.

[00:32:05] Annie: You know, I mentioned about the watered I had one family and this young woman didn’t respond to any visuals, so we had to use a pillow as her communication, and we tried a whole lot of stuff and it didn’t work. And in the end, we got a variety club and got a, a water. And we had to get an alarm cuz her mother had a hearing aid and it had to go an alarm in the doorway, which then went to the mother in the bed because we couldn’t close the door cuz the girl would get.

And young woman get very upset. And when, and she, because she was doubly in incontinent, she, she did wake at night and would come out, and so she had to be turned around. But the watered was really useful. I’m sure there are others who I have, you know, it haven’t, because it was just too hard for some of the families.

I suppose I, I’m probably telling you the good stories because I, you know, I, I know some of those. Mm-hmm. Some, and definitely in our research that we did, there were some families that started with us but didn’t get around to a sleep plan or left the states something. And definitely if the parents have got their own health issues Mm.

And a complex families with, you know, a lot going on. Yeah. And some of the children with the genetic syndromes are a little bit different there. Sleep patterns are a little bit more they fluctuate. Yeah, a lot more. So you need perhaps you really, you want to aim for them to be feeling very happy and safe in their bedroom.

So even if they’re not sleeping, they’re resting and the family are getting enough sleep. So that, that’s sort of it’s, it’s slightly trickier.

[00:33:52] Michael: You mentioned before about, you know, with the release melt tone over that five hour period and there’s like a sweet spot where it’s like, boom, that’s where you’re tired.

I don’t know if there are apps or things that do track that or show that, or parents journal that or something because it’s almost the, if you can get that on a piece of paper that, oh, that’s your time and. Let’s

[00:34:11] Annie: transition. Yeah. It’s very, it’s very hard to do because Yeah. In, in the results they do, like once every five hours they’ll do a urine or a slider.

Yeah. So it’s really, yeah. It’s too expensive. It’s too hard. It’s too messy. So you you have to, you do a lot more sort of observation. Yeah. But you know, if, if you remember what it was like to have jet lag, yes. Mm-hmm. Right. And then how many days. Take for you to, yeah. Okay. Took you a couple of days. Will you just imagine that melatonin being readjusted?

See, you can see that it does, but we have kids whose rhythms are so whacked that if, so they were flying to perf, we would start moving their bedtime a week before they flew. Yeah. Mm-hmm. Just so that they weren’t, and daylight saving is the other one. Yeah. That a lot of parents will tell me that sleep got, Particularly worse for a week.

Yep. Or two before the melatonin so that can, you can sort of get that. Yeah, absolutely. Range of that. Just from that, just thinking of daylight saving

[00:35:18] Michael: teenagers and adolescents, I know there’s things like, you know, delayed sleep onset and those sort of things. Have you done much in that, in that field in terms of the role of that and how much that impacts?

[00:35:29] Annie: So that is really interesting. Yeah. Cuz. A study in South America where they looked at teenagers in cities, teenagers in a village with electric lights at night, and teenagers who didn’t have any access to light. Yeah. And the ones in the all dark situation didn’t have delayed sleep face syndrome.

So there there is, it’s an environmental thing. More so it, it’s both. There can, it can be hormones. But it can also be light Yeah. As well. And so yeah, so it is, it’s, it’s quite tricky. And they have looked at melatonin with some of those kids, but it often makes them really groggy the next day. Yeah.

So there are some of those kids would do better with cognitive behavioral techniques. Okay.

[00:36:16] Dino: Interesting. Mellen, so, Parents sometimes try, or their GP or pediatrician might prescribe melatonin. Do you have a.

[00:36:27] Annie: So there was a really great study in the uk with over 200 kids on the spectrum, and they sent out a behavioral booklet on sleep, and 44% of the people did not continue with a melatonin trial because the sleep had improved with the behavioral booklet.

Wow. So there’s a lot of kids out there who would really benefit from the sleep-wise intervention and. I then have on that plan other things. Mm-hmm. And I put melatonin. Mm. In there. We know that there are subgroups who actually need melatonin. Yep. So we know from the genetic profiling now that a lot of them don’t have the right some genes that don’t have the right receptors for melatonin or don’t, or they don’t produce enough.

So there is a, absent your subgroup. Who actually benefit from clinical doses of melatonin? Not, not the homopathic, not over the accountant stuff, but Yeah. Clinic. The clinic.

[00:37:32] Michael: Describe clinic.

[00:37:33] Dino: Yeah. Yeah, yeah. Okay. So if I was a parent and wanted to find out whether my child fit into that subgroup, what, how would I do

[00:37:39] Annie: that?

I, I would do a sleep-wise intervention first. Mm-hmm. And if they’re still not falling asleep at a consistent time. I would con, I would, you’d refer on Yes. And that, that, that then that’s the difficulty because not, no, not everyone knows everything about melatonin. Right. And so they get a little bit of, there can be some confusion around it.

Thank you

[00:38:02] Michael: so much for listening and for your continued support. Please subscribe to the integration station on Spotify, apple Podcasts, or wherever you get your podcasts. And feel free to give us a short review if you have 30 seconds. If you have any questions you’d like to discuss, Dino and I hope to have a q and a episode in the future.

So please send any questions to the integration station email podcast au or via the OTC website, OT ffc. Dot com au slash podcast and we’ll try and answer them on an episode. And as always, shout out to you Fletch. Until next time, it’s goodbye for me.

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