In this conversation, Dr. Angela Tzelepis discusses the importance of sleep and its benefits, particularly for children. She explains how sleep restores vital energies, contributes to good development, and protects brain health. Dr. Tzelepis also addresses common sleep disorders in children, such as insomnia and sleep apnea, and the challenges of using CPAP machines. She highlights the role of sleep hygiene and the impact of electronics on sleep quality. Additionally, she discusses the relationship between anxiety and sleep problems and provides insights into behavioral interventions for improving sleep.
Lola Dada-Olley (00:07.3)
Dr. Zelefis, thank you so very much for joining us on the Not Your Mama's Autism podcast.
Angela Tzelepis (00:15.527)
Thank you for inviting me. I'm looking forward to our conversation.
Lola Dada-Olley (00:21.518)
Me too. I look forward to talking about sleep. Sleep is one of my favorite hobbies. I don't do it enough. And I think someone like you, I love it. I actually included in my bio when I talk, when I give my talk, I flat out put it in there that I enjoy sleep. And sleep is one of my pastimes. So I took me longer than I should have to understand the
Angela Tzelepis (00:29.762)
Yep.
Lola Dada-Olley (00:49.614)
of sleep. So for those of us that maybe took things for granted, I know in recent years it's been a lot more to the forefront the importance of getting good sleep, but for those of us who still need some time to fully get to where we need to be when it comes to sleep, what are some of the benefits of sleeping regularly?
Angela Tzelepis (01:07.291)
Yeah.
Yeah.
Yeah, you're definitely right. There's been an explosion in understanding sleep. think in the years past, it was really under appreciated. And now I, you know, put it up there with, you know, all those good habits that we should be doing like eating well and exercising and sleep. That's, that's up there. And so what are the benefits of sleep there? It basically it restores our vital energies. It gives us a
a relief from the day long bombardment of stimulation and aggravations and things like that. So it gives us a time to kind of restore ourselves. And for kids, what's really important is that during deep sleep, there's a release of a growth hormone that really contributes to good development. so sleep in children is especially important.
Angela Tzelepis (02:12.507)
what we know about sleep, a lot of what we know about sleep comes from, what's that?
Lola Dada-Olley (02:13.264)
So when you're talking.
Lola Dada-Olley (02:20.827)
go ahead, go ahead, I'll follow up.
Angela Tzelepis (02:24.337)
We're still okay. A lot of what we know about sleep comes from the research of sleep deprivation or not having enough sleep. And that's really where you'll see it clinically. You'll see kids that don't have enough sleep, they fall asleep in class, teens and adults get drowsy while they're driving. And in fact, one of the leading causes of accidents is not alcohol. It's actually
drowsy driving, even though there's not campaigns out there like there are for drunk driving. Because all it takes is one brief moment of a micro sleep where you're not off and you get in an accident. And then the other thing we see a lot with kids that are sleep deprived is that they're irritable. They have, they can't regulate themselves. And so they can look like
they have ADHD or they can look like they have other problems, but it may be a lot to do with not having enough sleep. You need sleep to be able to concentrate, pay attention, so you'll find sleep deprived kids don't do as well in school, they're not off in class, and they have a hard time focusing on their work. So it has huge, huge implications.
Lola Dada-Olley (03:49.966)
You mentioned sleep, tying sleep to growth and children. This is also tied to brain health as well. Could you tell us a little bit about the importance of sleep to growing brains?
Angela Tzelepis (04:07.525)
Yes, yes, it's important for the growing brain. In fact, there's a growing body of research that's showing us the physiological effects of sleep and inadequate sleep. so there's research that shows that, there's huge body of research now supporting that lack of sleep, inadequate sleep leads to obesity because there's
certain hormones that get released during sleep that suppress appetite. And if you're not getting adequate sleep, that appetite suppression isn't going to be there. So it can lead to overeating, feeling hungry a lot, and then it can contribute to obesity. It can contribute to diabetes, heart problems, hypertension. And in fact, there's even more recent studies that are showing that
The better your sleep is during your adult years, your young years into adulthood, the more protective that is from dementias and Alzheimer's. So it has significant implications on protecting the brain in many ways. And it's a very complicated science and I can't speak to the details of that, but I do understand, clearly understand the impact it has on our overall health.
Lola Dada-Olley (05:19.568)
Hmm.
Angela Tzelepis (05:34.833)
You know, not just feeling good in the moment, but it has a lot of long term implications.
Lola Dada-Olley (05:43.608)
You are a clinical psychiatrist. You consult at Easterseals on the autism evaluation. It's like, what did I say? I'm sorry, did I say clinical? I meant clinical psychologist. Did I say psychiatrist? I'm sorry. Yes, you are a clinical psychologist. Psychologist, apologies. Yes, you do. Yes, yes, yes. You are a clinical psychologist at Easterseals on the autism evaluation team. And you also.
Angela Tzelepis (05:48.125)
psychologist.
Angela Tzelepis (05:52.561)
Yes. You said psychiatrist. I'm a clinical psychologist. Yeah. Yeah. I have a PhD, not an MD. Yeah.
Lola Dada-Olley (06:11.576)
work at Children's Hospital of Michigan in the pediatric sleep clinic. So that's where I really wanted to hone in on when it comes to that's why I brought up growing brains. And so in your practice, what are some common sleep disorders that you see in growing and growing kids?
Angela Tzelepis (06:33.819)
Yeah, yeah, in kids. Probably the most common thing that we see and I see in practice is insomnia, that difficulty falling asleep, falling asleep at the beginning of the night, but then also staying asleep throughout the night. So those those awakenings that happen in the middle of the night and then difficulty falling back asleep. That's I think
the biggest and most challenging thing. We have in the sleep clinic, we see a lot of kids with sleep related breathing problems, sleep apnea, and that disrupts And one of our challenges in working with children that have sleep apnea is helping them get on board and complying with the use of CPAP.
on a regular basis. And it's especially challenging with kids that have autism because of the sensitivities that they have. It's hard for them to wear a CPAP machine. And then I would say the other thing that we see almost regularly, I see it in my clinical practice as a psychologist, and then in the sleep clinic is poor sleep hygiene. People not...
Lola Dada-Olley (07:33.305)
Mmm.
Angela Tzelepis (07:58.299)
giving sleep the importance that it needs and not engaging in good practices that will assure good sleep. And then there's other things that we see, but those are, I would say, big three things that we deal with, the insomnia, the sleep apnea, and poor sleep habits.
Lola Dada-Olley (08:22.202)
I want to dig a little deeper on the sleep apnea portion of your answer. So sleep apnea and then with kids with autism, the CPAP machine and having maybe some sensory challenges depending on the child, it could be definitely challenging. But are there alternatives like mouth devices or oral devices? there something that other things that folks on the spectrum or other neurodivergent people can do?
Angela Tzelepis (08:48.731)
Yeah, yeah, yeah. Well, the first thing that we actually look at with kids is their tonsils and adenoids and see if those can be removed, if that's contributing to the apnea. And if you can do that surgically and then reduce the difficulty with breathing, that is success.
But if you have to use the app, the machine, there are different masks. The industry has worked towards creating different masks, nose masks, and masks that can be more comfortable. And so there are options, but it's still a challenge. It's going to be a challenge. So the mouth guard, those we don't do in our sleep clinic. You'd have to go to a dentist and see if you're...
you know, candidate for the mouth guards. At the end of the day, is a huge struggle. It's a problem for adults that don't have any of these developmental challenges or sensitivities. Compliance rate for adults is low. So when we move it down to...
Lola Dada-Olley (10:01.668)
Yeah, sensory, yeah.
Lola Dada-Olley (10:12.686)
Yeah.
Angela Tzelepis (10:14.807)
to get kids to do it, it's very frustrating for families. But we work with them and we try to, you know, we have what we call desensitization protocols, getting them to get used to the mask and the air pressure during the daytime and try to make it into a more fun thing as much as possible. It takes a lot of support from the family. It's not like you can...
your kid to bed with that mask on and then expect that they're going to be using it throughout the night.
Lola Dada-Olley (10:53.53)
You also mentioned insomnia, and I wanted to dig deeper there a bit. So with insomnia based on what you've seen in your practice over several years now, are there certain triggers to it that you've seen in your practice as to what causes that, particularly for neurodivergent kids or adults as well?
Angela Tzelepis (11:18.415)
Yeah.
Angela Tzelepis (11:22.757)
Yeah. So, or adults, yeah. Probably one of, you know, there's a number of factors and a number of situations and behaviors that go into, that contribute to insomnia. would say probably the first is bad sleep hygiene, bad sleep habits. And starting with having inconsistent bedtimes, inconsistent sleep times.
Our sleep in our brain requires us to be consistent that we're going to bed and falling asleep at around the same time every day and waking up at the same time every day. And when you deviate too much by an hour or more, you can have some flexibility, but if you deviate several hours a day where you're sleeping in, if you sleep in, then it's going to be hard to fall asleep the next night.
and then you're going to bed later and then you're sleeping in longer. And so that inconsistency is probably the number one cause of insomnia, I would say. The other thing is use of electronics. People, not just children, but adults go to bed with tablets and phones and
You know, that leads to a lot of stimulation. Your mind is busy with whatever it is that you're looking at, whether you're playing games or you're chatting with somebody or shopping or whatever you're doing that keeps your mind going. But above and beyond that, what using electronics at bedtime does in your bed is that it's sending light signals from the eyes to the brain and it's telling the brain to stay awake. And we have a natural
hormone that gets released called melatonin, which most a lot of people have heard of. Melatonin is what's released to help us sleep. And the thing though with the release of melatonin, it only happens when the environment is conducive to sleep, meaning that it has to be dark. If the minute you send a signal to the brain, a light signal, the melatonin production drops.
Angela Tzelepis (13:48.445)
So you're not getting your melatonin to help you fall asleep. And that is a big contributor to sleep problems. I tell families all the time in the sleep clinic that, you know, 150 years ago, people didn't have sleep problems. Not the way that we do today. It was dark and you slept and it was light and you were awake. Now with, you know, the advent of...
Lola Dada-Olley (14:07.726)
Hmm
Angela Tzelepis (14:18.213)
light bulb and we've got more light in their homes and then more and more light and now we got light right in our hands and sending signal to the brain. We've created a society with many sleep problems. So this is across the board whether you have any developmental challenges or not that is a significant contributor to sleep problems and falling asleep.
Angela Tzelepis (14:46.717)
You know, those are the big contributors to insomnia. The other is, well, there's more. Taking naps during the day is going to make it hard to fall asleep. And then we move into the realm of other challenges like anxiety. Children on the spectrum, neurodivergent children and individuals have
can have a lot of anxiety. And so the more anxiety that's present, the more challenging your sleep is going to be, because you're laying in bed thinking. For children, they're afraid of the dark. They're thinking of monsters. They want their parent next to them. For adolescents and adults, we're thinking about all of the challenges of the day and what's going to happen tomorrow and who said what to who.
that kind of anxiety can lead to sleep problems. And then, you know.
Lola Dada-Olley (15:51.556)
that also lead to going to bed and then waking up in the middle of the night? One of the things you mentioned earlier. Could that also, could anxiety also be a contributing factor?
Angela Tzelepis (15:59.567)
Yeah, yeah. yeah, what could yes, anxiety. Yeah, you know, what what happens is that, you know, there's this idea that that that sleep is that you fall asleep and you stay asleep throughout the night. But that's not how sleep works. In fact, you know, we go through sleep cycles, and we go from a light sleep to a deep sleep, and then we go back to a light sleep. And we do that five to six times a night. And when you come back to the light sleep, you're going to briefly wake up, you know, for
10, 15, 20 seconds.
Lola Dada-Olley (17:23.504)
So let me dig deeper on that. So I have two children on the spectrum. I have one with significant sleep issues. And this, what you just said about the waking up in the middle of the night and looking around and not seeing your parent, depending on the season,
Our baby girl could, she's 11 now, she could probably wake up depending on the week, three to four times a week around 2 a wakes up, walks into our room and looks for dad. So is that, how would you wean off of that? It's interesting, I didn't realize that it was a, they may not be used to going back to sleep without a parent.
Lola Dada-Olley (18:29.328)
We pray with her and put her down to bed and then we close the door and she'll fall asleep on her own. But then in the middle of the night, she will wake up, walk into our room and look for her dad.
Lola Dada-Olley (21:08.528)
Yeah, it happened the other night, which might be why I had that Ferdinand, that slip of calling you psychiatrist instead of psychologist. I have apologies for that. Apologies for that. that is something to think about. Thank you. So thinking about sleep generally, what are some common misconceptions you've come across in your practice when people talk to you about sleep or maybe when you talk to others about sleep?
Lola Dada-Olley (22:26.617)
Okay.
Lola Dada-Olley (23:25.253)
Right.
Lola Dada-Olley (24:22.842)
based on what you see.
Lola Dada-Olley (24:29.284)
Go ahead, finish what you were saying.
Lola Dada-Olley (25:14.394)
So moving from misconceptions to things you've seen in your practice, industry research you've either participated in or you've come across, what could be some of the reasons as to why some neurodivergent people struggle with sleep?
Lola Dada-Olley (28:35.48)
of taking all this together and thank you for including that. think it's really important to look at not only the holistic nature of the person that you're treating, but also the holistic nature of the environment around them. So with thinking that through some more, can you walk us through some of your more challenging situations that you've come across and some behavioral interventions that have
proven to be successful.
Lola Dada-Olley (32:21.444)
Hmm.
Lola Dada-Olley (33:30.436)
Yeah.
Lola Dada-Olley (33:55.114)
Yeah, I can imagine. can imagine, especially if you have... Yeah, especially if you have work though early in the morning, that's really tough. That's really tough. But it's definitely, it's a marathon, not a sprint is what you're saying from a behavioral intervention point of view, which makes sense. That's a lot of what positive behavioral support, you know, all those types of...
all those types of philosophies, that's where it comes from. The incremental progress is still progress, so that makes complete sense.
Lola Dada-Olley (34:49.572)
Yeah.
Lola Dada-Olley (36:26.426)
So we talked about sleep hygiene.
Lola Dada-Olley (36:59.242)
because I was going to follow up.
true. I was going to follow up with that because I heard that the power nap is supposed to be a way to at least power through the rest of your day. that's helpful. So we talked a little bit about sleep hygiene, but what does sleep, what does good sleep hygiene look like?
Lola Dada-Olley (37:28.324)
So like setting the tone. Yeah. So setting the tone as you go into the evening.
Lola Dada-Olley (40:41.399)
Hmm.
Lola Dada-Olley (40:49.39)
You might be describing me there as well. Okay.
Lola Dada-Olley (41:09.166)
to stay asleep on their own apparently.
Lola Dada-Olley (42:05.678)
be some white noise what does white noise work
Lola Dada-Olley (43:05.257)
Sounds wonderful. Thank you. Thank you really and truly. I appreciate you spending time. So let's say you are either a child or an adult, neurodivergent or a family member, a loved one who wants to help their loved one get better sleep. Where should they start?
If they don't have the doctor's lupus near them right away, at least, where would they start?
Lola Dada-Olley (44:34.992)
Thank Thank you. It's much appreciated. Thank you for all that you do.
Lola Dada-Olley (45:07.032)
Wonderful. Yeah, please do. Please. And I'll also put in the show notes.
Lola Dada-Olley (45:19.824)
Thank you. What's the name of the site?
Lola Dada-Olley (45:27.383)
okay, that's the name on the side. Okay. Thank you. Thank you so much.
