Maggie McKay (Host): Did you know that sleep duration and quality have a direct impact on mental health? For children, their developing brains can be especially impacted. Today, our guest is Dr. Katherine McClellan with Shriner's Children's Portland. She's the in-house child psychologist to tell us about the importance of good sleeping habits and how exactly sleep and mental health are connected.

Host: Welcome to Healing Heroes PDX, the podcast series from the specialists at Shriner's Hospitals for Children in Portland. Thank you so much for being here today, Dr. McClellan. I can't wait to hear more about this, why sleep matters to a child's mental health. I never really thought about that. But to start, could you please introduce yourself and tell us about your role as a pediatric psychologist at Shriner's Children's Portland?

Catherine McClellan, PhD: Absolutely, and thank you so much for having me. I have a lot of different roles here at Shriners in Portland. But overall, my job and my role here is to help patients and children have the best possible outcomes from their care here, and that includes making sure that we're paying attention to and monitoring the behavioral health or the mental wellbeing of our patients in addition to their physical wellbeing and orthopedic health.

Host: And how are mental health and sleep connected?

Catherine McClellan, PhD: That is a great question. Sleep is something that we call a biological imperative. You can think of sleep as something that's similar to food, so we need nutrition to thrive, to grow and to do our very best. The exact same is true for sleep. Not getting enough sleep has many impacts on your brain and mental health. In particular, we know that insufficient sleep impacts both our prefrontal cortex, and that's a part of our brain that helps us manage impulsive behavior and focus on our actions as well as our amygdala, which is what we sometimes call our emotional center. So in addition to not being able to focus and attend and concentrate as much as we need to when we don't have enough sleep, we also know that when we don't get enough sleep, people are more likely to feel anxious and depressed, irritable or moody, simply because we're running on an empty tank and we just don't have the resources to fend off some of these hard feelings.

Host: Right. And what trends have you noticed in mental health or sleeping patterns in children?

Catherine McClellan, PhD: Well, I think we're all pretty aware about how the pandemic has interrupted mental health as well as sleeping patterns in many of our youth. There was a period of time during the pandemic when many teens especially had reverted to full nocturnal schedules. I think right now, one of the most important trends that we're seeing is just how hard it can be for adolescents to truly get the sleep they need. Most teenagers actually need about eight and a half to nine hours of sleep nightly. High schools typically start very early, earlier than elementary schools and middle schools, 7:30 is actually the national average start time for high schools.

Host: 7:30?

Catherine McClellan, PhD: 7:30. Isn't that rough?

Host: Oh, my goodness. I don't even want to do that, and I'm an adult.

Catherine McClellan, PhD: I can understand that. And this is really especially hard for teens who naturally just, due the changes in their biology and their development, tend to fall asleep later. And often, they don't even feel tired until about 11:00 or 12:00. So, getting up in time to go to school is really challenging and kids just don't have enough opportunity to get their hours they need in bed.

Host: So Dr. McClellan, why does sleep matter to a developing child? What role does it play?

Catherine McClellan, PhD: Well, getting enough sleep gives our children the very best opportunity to learn from the world around them, and that's really their job and their developmental task. Without enough sleep, children can struggle to focus and concentrate. In fact, there's many children who can look just like they have symptoms of ADHD, including hyperactivity, when in reality their brain just doesn't have enough sleep to do its whole job.

When learning is harder, many children can start to develop feelings of low self-worth. And this can translate into later feelings of depression and anxiety because kids aren't necessarily able to keep up with their peers and manage their emotions as well when they're not getting enough sleep.

Host: And we've been talking about the developing child, what ages are we talking about? Like birth to high school or to college or what?

Catherine McClellan, PhD: Absolutely. You know, our brain continues to develop well into our late 20s, especially that prefrontal cortex area. I'm focusing right now on sort of the zero to 18 years here when we're talking about sleep.

Host: And what are common contributors to poor sleep?

Catherine McClellan, PhD: There's internal factors that can impact sleep, like tendencies towards sleep apnea or other difficulties. But the biggest contributors really are the external factors, so the external environment that we're all living in. So, we know that things like electronic media use late into the evenings, earlier school start times and schedules, for example, if you're jam-packed with sports or other family events, sometimes we have schedules that just don't allow for enough time to sleep, and those factors are some of the biggest contributors. Fortunately, some of those factors are modifiable.

Host: What about kids' diets and how late they eat dinner, for instance?

Catherine McClellan, PhD: We certainly want to allow kids enough time that they can have a full meal and digest, not going to sleep too hungry or too full. Of course, we really need to pay attention to caffeine, because we know that that can have a big impact on sleep.

Host: Do you have any advice for families with questions about mental health or sleep care in children?

Catherine McClellan, PhD: If I had one piece of advice that I would want to give a family, I would want to talk about something called anchoring the wake time. You know, there's a lot of different techniques and steps you can take to improve sleep time. But typically, you want to work with one step at a time, so you can be sure it's working or not working before you introduce a different technique.

So by anchoring the wake time, what you're doing is you're keeping your wake time consistent. And that's a single best step you can take when you're working on sleep. So, not varying a whole lot on weekends, up to two hours on weekends for students who have to get up early. But in general, if you get up at about the same time every day, you have an opportunity to develop your sleep drive or your sleep hunger. It's kind of like eating. If you have a huge snack before dinner, you're really not going to be very hungry or able to eat a good meal at dinner. So by anchoring the wake time and avoiding naps, what you can do is you can build up that sleep pressure in adults. That means you need to be awake for about 16 hours before you're tired enough to go to sleep. In kids, it can be a lot less. But by avoiding naps and keeping that wake time about the same every morning, kids and adults are able to be tired enough to fall asleep when it's time.

Host: And do we need to go to bed at the same time every day except for weekends?

Catherine McClellan, PhD: That's ideal. But if you are only are able to focus on one step at a time, I would always start with anchoring that wake time.

Host: Dr. McClellan, in closing, is there anything else you'd like to share that we didn't cover?

Catherine McClellan, PhD: The one thing that I would like to share is that a lot of times children can look like they're having serious mental health concerns, like depression, anxiety, symptoms of ADHD, poor decision making, impulsivity. Many of those conditions are actually just reflecting kids not getting enough sleep. So if there's one thing that you can focus on in your parenting or help your children develop skills around, making sure they learn how to be healthy sleepers is one of the most important gifts you can give to them.

Host: Thank you so much for being with us today and making the time and sharing all this useful information and your expertise. I'm sure you've helped a lot of parents and children. We appreciate it.

Catherine McClellan, PhD: Thank you.

Again, that's Dr. Catherine McClellan. To find out more, head on over to our website at shrinersportland.org. That's shrinersportland.org. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. And that concludes this episode of Healing Heroes PDX with Shriner's Children's Portland.