Q&A: Mindfulness program improves sleep in children of low socioeconomic status

A school-based health and mindfulness program improved objective measurements of sleep over a 2-year period in children from communities of low socioeconomic status, according to findings published in Journal of Clinical Sleep Medicine.

“Previous studies have emphasized the role of a stressful environment in the disturbed sleep of [children of low socioeconomic status (SES)], including social and family stress, food and housing insecurity, and crowded or noisy residential environments,” the researchers wrote. “Indeed, SES-associated chronic stress in childhood has been linked to with poor long-term outcomes, including exaggerated physiological responses to acute stress in adulthood.”

As a result, the development and review of early interventions that teach children strategies for coping with chronic stress may be “particularly important” for alleviating the impact of SES-associated stress on trajectories of physical and mental health, according to Christina F. Chick, PhD, a postdoctoral research fellow in the department of psychiatry and behavioral sciences, and colleagues.

Healio Neurology spoke with Chick to learn more about the study results and the potential implications for clinicians and families.

Healio Neurology: What prompted this research?

Chick: For a lot of us, it is difficult to relax enough to fall asleep and children are no exception. Social media, homework and struggles with their peers or parents can all keep children up at night.

Most children in the United States are sleeping, on average, 2 hours less than the recommended amount per night and that adds up to a significant cost for their mental and physical health. When kids do not sleep enough, it is harder for them to regulate their emotions and, therefore, to regulate their behavior. Decreases in sleep during the transition from childhood to adolescence are a normal part of development, but when kids are already not getting enough sleep, and their sleep then decreases further, it becomes much more of a concern. If we can help them to sleep longer and better, we would give them a head start for their emotional, physical and even cognitive health.

Healio Neurology: How big of a problem is poor sleep in the at-risk population studied?

Chick: Unfortunately, we know from previous research that children who grow up in communities of low SES face additional stressors, and, importantly, that they have poorer self-reported quality of sleep. One reason for this is environmental: They are likely to live in neighborhoods with a higher density of residents, which might mean more noise or light during sleep. Another reason is logistical: Families with fewer financial resources are more likely to have multiple people sleeping in the same room. If a child shares a bedroom with an older kid who goes to bed later, or with a parent who wakes up earlier to go to work, the lights go off later and turn on earlier, making it more difficult to get consolidated sleep.

Healio Neurology: Can you provide an overview of the study results?

Chick: We partnered with a local school district to teach kids skills they could use to manage their own stress levels. First, we taught them mindfulness, which means awareness of their emotional state and how their bodies feel when they are stressed. We then taught them skills like yoga-based movements and slow, deep breathing practices, which they could use to calm down their nervous systems when they were feeling upset or stressed. As they got older, we even taught them some of the science about how these practices affect their nervous systems.

Children who learned these skills gained an average of over an hour of sleep per night in the 2 years of the study. They also got almost half an hour more of rapid eye movement sleep, which is important for cognitive and emotional health. It is usually during REM sleep that we dream. REM sleep also helps us consolidate memories, which is important for retaining the learning that happens during school.

In contrast, children the same age who did not receive the curriculum decreased their sleep by an hour over the same period.

The decrease in the comparison group is consistent with what we typically see as kids enter puberty and face the increased social stresses of junior high. However, for kids to not only not lose sleep, but actually gain sleep, is remarkable. We think this is because they were able to navigate new stressors using the skills they learned to calm their nervous systems.

Healio Neurology: Did you observe anything surprising or unexpected?

Chick: The curriculum was not specifically focused on improving sleep, for example, by improving sleep hygiene. Nevertheless, the skills that children learned in this curriculum benefitted their sleep.

I was surprised that, even though the children's stress levels did not change over time, their sleep still improved. What this tells me is that children were able to implement the skills that they learned in the curriculum to calm their nervous system when they were stressed. The children who reported using the breathing exercises more frequently outside of the classroom were the ones whose sleep improved the most. This suggests that they were applying these skills effectively when facing a stressful situation in "real life.”

My takeaway is that, although children cannot control the amount of stress in their lives, they can still influence how their bodies responds to that stress, which has measurable effects on their sleep.

Healio Neurology: How might the results from this study be used in clinical practice?

Chick: There is solid theoretical and empirical basis for why a curriculum like this would benefit sleep. The results we observed are encouraging and suggest that it might be appropriate to consider refining aspects of the curriculum for potential use as a clinical intervention to improve sleep. But that is down the road.

In the meantime, it could be worthwhile for parents to consider implementing a family "breathing break" with their kids. This would be an opportunity to teach kids some of the breathing techniques and invite them to notice how their bodies feel before and after they have engaged in slow, deep breathing.

Healio Neurology: What are the next steps for this research?

Chick: We are eager to examine whether the gains in sleep translated into other benefits in, for example, school attendance, grades, behavior or mental health. Due to a variety of biological and social factors, the transition from late childhood to early adolescence is when many psychiatric symptoms first emerge, and sleep is tightly linked to those symptoms. I am eager to know whether teaching kids to calm their nervous system, and the resulting benefits to their sleep, may have served as a protective factor against the development of psychiatric symptoms such as depression or anxiety.

Reference:

Chick CF, et al. J Clin Sleep Med. 2021;doi:10.5664/jcsm.9508.