If you have a teen who has an eating disorder, then you probably know that getting enough sleep is a key component of their care. But it can be hard to get any teenager to get enough sleep.
And when you add on the disruption created by an eating disorder, it can feel like just one more thing on your list.
Sleep and mental health
Getting enough sleep is a cornerstone of mental health. And while of course a person can recover without getting enough sleep, recovery will likely be easier with sleep hygiene.
There are three essential components of mental health: eating, sleeping, and relating. Parents are able to support mental health by ensuring these three components are fulfilled.
Eating: We support our kids’ mental health by serving consistent, enjoyable meals and supporting them in getting enough fuel for their bodies and minds.
Sleeping: We support our kids’ mental health by establishing healthy sleep habits and boundaries to promote sleep hygiene.
Relationships: We support our kids’ mental health by being in a positive relationship with them, supporting their peer and other relationships, and offering them psychotherapy for additional support.
Teens and sleep
Science has shown that teenagers are not lazy or obstinate when they stay up late. They are actually driven by melatonin levels to stay up later in the night and awake later in the morning than either children or adults. And unfortunately this night-owl behavior is coupled with a biological need for the teenage brain to get 9-10 hours of sleep per night.
It goes without saying that most of our teens don’t get even close to 9-10 hours of sleep. Even teens who are able to fall asleep at midnight are likely only getting 6-7 hours of sleep to accommodate early school start times.
A lack of sleep increases impulsivity, anxiety, and depression. And all of these are associated with eating disorders.
Eating disorders, like many mental disorders, first appear during adolescence. This is a time when the human brain undergoes a massive “pruning” effort to transform the child’s brain into an adult brain. This pruning is part of the maturation of the prefrontal cortex, which is the area responsible for planning, prioritizing and controlling impulses.
A lack of sleep isn’t the sole cause of mental disorders, but many studies have found that it is correlated with mental disorders.
“Sleep loss problems are linked with brain areas that control emotional processes and risk-taking,” says Wendy Troxel, a clinical psychologist and senior behavioral and social scientist at RAND. “Sleep problems and behavioral and mental health problems are linked.”
How to help teens get enough sleep
A lack of quality sleep has a profound impact on our kids’ health, cognition, and behavior. But what can we do about it?
If you’re like many parents navigating eating disorder recovery, then the thought of getting your child through recovery may seem like a heavy enough burden. The idea of adding on a sleep routine can feel unlikely or even impossible.
But setting boundaries around sleep is something you can do. Just like eating enough, eating regularly, and going to therapy, sleep is important for recovery. We can’t force our kids to get the sleep they need, but we can create the conditions that make sleep more likely.
1. Make a family plan
It is important to make sleep a priority for everyone in the family. It just won’t work to tell your teen who has an eating disorder that they need to sleep, but nobody else does. That will feel punitive and is unlikely to work.
Discuss the importance of sleep, and agree that as a family, every member needs to improve his or her sleep hygiene. This foundational agreement is the only way you will be able to successfully implement the following recommendations.
2. Turn off electronics
According to the National Sleep Foundation, “ninety percent of people in the U.S. admit to using a technological device during the hour before turning in, and children often use electronic media to help them relax at night,”
The problem with this trend is that using electronic devices is physiologically and psychologically stimulating and can adversely affect sleep. Yes, all of us believe that we do not fall into the category of people who find electronics disruptive, and all of us believe that our devices help us fall asleep, but the science shows that simply isn’t true.
Using TVs, tablets, smartphones, laptops, or other electronic devices before bed delays your body’s internal clock (a.k.a., your circadian rhythm), suppresses the release of the sleep-inducing hormone melatonin, and makes it more difficult to fall asleep. This is largely due to the short-wavelength, artificial blue light that’s emitted by these devices.
The more electronic devices that a person uses in the evening, the harder it is to fall asleep or stay asleep. Besides increasing your alertness at a time when you should be getting sleepy, which in turn delays your bedtime, using these devices before turning in delays the onset of REM sleep, reduces the total amount of REM sleep, and compromises alertness the next morning. Over time, these effects can add up to a significant, chronic deficiency in sleep. (National Sleep Foundation)
As a family, determine a time at which all electronics must be powered down. All the way. Not left sitting next to you so that you can see texts coming in. You may need to make it physically difficult or impossible for anyone to access the electronics at night.
Here are some options:
1. Shut down the wireless from 10 p.m.-6 a.m. That may seem early to you, but if your teen has to be at school at 8, that means they need a bedtime of 11 p.m. at the latest.
2. Purchase a time-based safe. This can keep your phones locked up until the morning.
3. Create a charging station in the house in which all electronics are stored for the night.
Remember that all members of the family must participate in the activity of powering down – it can’t be something that only the kids have to follow. Your teen who has an eating disorder should not be targeted as the reason for the new sleep habits.
3. Sleep hygiene
Bedtime rituals can be very helpful in signaling the brain to “power down” and prepare for sleep. Each person will have their own ritual, but the important thing is to talk about them as a family. For example, one person may enjoy a shower or a bath. Another may enjoy a cup of something warm and soothing.
Have books and physical reading materials available for everyone. Book-based entertainment is enjoyable but non-stimulating and therefore not disruptive to sleep. Get everyone proper sleeping clothing and invest in nice sheets and pillows so that everyone feels happy in their beds.
Begin turning off lights as the night wears on. Lights signal our brains to stay awake, so gradually turn off and dim household lights to help signal sleep. The best sleep hygiene involves going to sleep and waking up at the same time every day. Based on age and temperament, establish ideal bedtimes for each family member.
4. Avoid overwork
At this point, you may be wondering if this type of sleep program is unrealistic. Perhaps your child tells you they need to remain available for texts and do homework until midnight. If this is the case, then look at your child’s schedule. Enough sleep should be considered non-negotiable for every family member, especially when there is an eating disorder.
You may be surprised to hear that eating and sleeping should be the priority in your home. All other activities should come only once those two fundamental needs are well-met. And the third essential need? Socializing and enjoying life!
Consider reducing your child’s extracurricular load and your expectations so that they are able to complete homework well before 10 p.m.
If your teen is not able to complete all school and sports activities by 10 p.m. then they are overworking. Our teenagers’ brains cannot handle the strain and may develop serious disorders as a result of chronic overwork.
Our culture has created a dangerous precedent in which some teens are going non-stop from 7 a.m. to 11 p.m. every day. And then they begin their relaxation and socializing, both of which are very important. As a result they often stay up well into the morning hours.
This interferes with sleeping, eating, and enjoying life. It is not healthy by any standards. In many cases, our teenagers are working harder and doing more than adults. We simply must edit our teens’ lives to raise healthy kids.
I realize that adding sleep hygiene can be a daunting task when you’re already dealing with a teen who has an eating disorder. If you feel these steps are impossible in your family, then please consider getting some support from a therapist or coach. They can help you set and hold boundaries to support your own and your family’s mental health.
Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.
She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.