Month: August 2023

It’s tempting at this time of year to let summer sleep schedules stay in place or let bedtimes slide, especially when parents feel tired out, too. But it’s important that children have a regular routine — and that they are sleeping during the dark hours and awake during the light ones, as our bodies do best that way. That’s true for families who are home-schooling, as well: even when the trip to school is just a walk to the kitchen table, allowing for more sleep than those catching an early bus may get, no child should be spending all morning in bed.

Sleep is crucial for all of us, and this is particularly true for children. Without enough quality sleep, children are more likely to have health and behavioral problems — and difficulty learning.

Here are a few simple things you can do to help your child get the sleep they need.

Have a regular schedule

Our bodies do best when we go to bed and wake up at roughly the same time every day.

• Children and teens need eight to 10 hours of sleep. Count back 10 hours from when your child needs to get up in the morning. That’s roughly the time they need to be getting ready for bed (for younger children, count back 11 hours).
• For example, if your teen needs to be up at 7, then they should be getting ready for bed by 9, and in bed by 10 (since most of us don’t fall asleep the moment our head hits the pillow). A younger child should start getting ready (bathing, etc.) by around 8.
• Understand that teens are biologically wired to fall asleep later and wake up later and will naturally have later bedtimes. Unfortunately, most school districts don’t accommodate to this, so you are often working against biology.
• While it’s okay to stay up a bit later on weekends, don’t let the bedtime vary by more than an hour or so.

Turn off the screens before bed

The blue light emitted by screens can keep us awake.

• It’s best if the screens can be off two hours before you want your child asleep. Use that time when they start getting ready for bed as the time that the screens go off.
• The only real way to achieve this is to get all devices out of the bedroom. (So true!)
• Teens will fight you on this. If you can, hold firm (and buy them an alarm clock if they say they need their phone for this). At the very least, be sure that the phone is on Do Not Disturb mode overnight.

Have an environment that encourages sleep

• Quiet things down. If you are watching TV, turn the volume down, and in general try to not make much noise after children go to bed.
• Consider a white noise machine, or a fan (or air conditioner if you live somewhere warm). There are also white noise apps for those teens who won’t give up their phones.
• Room-darkening curtains can make a difference for children who tend to wake up at the first light of dawn — or who can’t fall asleep if it’s not fully dark outside.

Know how other factors influence sleep

• Busy teens often have difficulty getting everything done in time to get enough sleep. Talk with your teen about their daily schedule and look for ways to help them get more shut-eye, such as getting homework done during the school day, or limiting video games or other activities that eat into homework time. Sleep needs to be the priority.
• Limit caffeine. It’s best not to have any, but certainly nothing from mid-afternoon on.
• Limit naps! For a tired older child naps may seem like a good idea, but they can interfere with nighttime sleep. Naptime is okay through preschool.
• Make sure your child gets exercise. It’s not only important for their health, it helps their sleep.
• Have calming routines before bed (not exercise!).

If your child is having trouble falling asleep, or is waking up at night, talk to your doctor. It’s also important to talk to your doctor if your child is snoring or having other breathing problems at night. Don’t ever ignore a sleep problem; always ask for help.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

Online gambling — all those websites and apps that offer casino games, sports betting, poker, fantasy sports, and lotteries — can be exciting and entertaining. It’s an estimated $9.5 billion per year business, and growing. But for millions of Americans, what starts as occasional fun can lead to devastating gambling-related problems.

“You can experience harm from gambling, including addiction, just like you can with alcohol or other drugs,” says Debi LaPlante, director of the Division on Addiction at Harvard-affiliated Cambridge Health Alliance.

Who is being harmed?

In fact, the American Psychiatric Association’s classification of mental health disorders places gambling disorder in the section defining substance-related and addictive disorders, along with problems like opioid use disorder and alcohol use disorder.

In the US, about 1% of adults (two million) are estimated to have a severe gambling problem, and 2% to 3% (four to six million) are thought have a mild or moderate problem.

How can you recognize a possible gambling problem?

The Brief Biosocial Gambling Screen from the Cambridge Health Alliance’s Division on Addiction tests for gambling disorder risk by asking three questions:

• During the past 12 months, have you become restless, irritable, or anxious when trying to stop and/or cut down on gambling?
• During the past 12 months, have you tried to keep your family or friends from knowing how much you gambled?
• During the past 12 months, did you have such financial trouble due to gambling that you had to get help with living expenses from family, friends, or welfare?

“If you answer yes to any of these questions, you should evaluate your gambling and how it fits into your life, and seek out further assessment,” says LaPlante.

How do you know if you’re engaging in harmless or harmful gambling?

A gambling addiction often occurs gradually. The line between harmless and harmful is often blurred, so people don’t always recognize they have a problem until it becomes severe. Here is what is considered the threshold of low-risk gambling:

• You gamble no more than 1% of household income.
• You gamble no more than four days per month.
• You don’t gamble at more than two types of games.

What does gambling disorder share with other forms of addiction?

Gambling disorder shares certain risk factors with other types of addiction:

• genetics
• faulty thought patterns
• impulse control disorders
• availability in one’s community
• poverty.

Like other types of addiction, gambling-related problems can lead to disrupted romantic, social, and work relationships. Feelings of withdrawal when someone tries to cut back are similar, too.

Does online gambling affect the brain?

Gambling games can affect people at the neurobiological level. Many games have features that trick the brain into thinking a loss is actually a win. For example, a slot machine displays celebratory music, sounds, and lights for a $3 return on a $5 bet.

“Research has found that our sympathetic nervous system responds to losses celebrated as wins the same way it responds to actual wins,” says LaPlante. “This is a powerful reinforcer, and just one example of games affecting brains.”

How can you find help for problem gambling?

Finding help for gambling can be challenging because, unlike for other types of addiction, the number of professionals who treat gambling addiction is limited, according to LaPlante. “Also, because of shame and stigma, people are less likely to acknowledge that gambling can become a problem,” she says.

Still, resources such as Gamblers Anonymous, local and national crisis helplines like 1-800-GAMBLER, self-help books such as Your First Step to Change, and local departments of public health are available to connect people to help.

Addiction treatment is not an exact science, and success varies from person to person. Some treatments have shown promise for gambling disorders, such as cognitive behavioral therapy (CBT) and motivational interviewing.

With CBT, people work with a therapist to help identify faulty thoughts and behaviors, such as the feeling one is “due to win” after a string of losses, and then learn tools to reframe those harmful thought patterns and respond to them more appropriately. During motivational interviewing, a person works with a counselor to enhance their motivation to change by together examining their ambivalence about change.

“If the gambling addiction is a symptom of another mental or physical health problem, addressing those issues is essential,” says LaPlante.

What does recovery from a gambling problem look like?

Different people have different ideas about what it means to be recovered from gambling addiction. For some, this means completely cutting gambling out of their life; for others, it means cutting back.

“Ideally, the treatment experience will include plans to prevent lapses that take people away from maintaining their own goals,” says LaPlante.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD