Alex Mortlock Explains Circadian Rhythm Syndromes & Complex Sleep Challenges

Debbie:
Hey Alex, thank you so much for joining me on the podcast.

Alex Mortlock:
Debbie, thank you for having me.

Debbie:
Yeah, I am so looking forward to this conversation. So I just want to say, first of all, thank you for accepting my invitation from the stranger saying, please come talk to me about this stuff. My community needs to hear more. But before we dive in, would you kind of share a little bit about your work and your special or your personal interest in the topic we’re going to be exploring today, which is complex sleep challenges in neurodivergent kids?

Alex Mortlock:
Yeah, so I’m a clinical psychologist and I’m based in Christchurch in New Zealand. I work in my own private practice and I’ve worked, kind of specialized in treating sleep problems for almost 15 years And insomnia, circadian rhythm, sleep disorders, and sometimes helping out in a multidisciplinary team. with people with other conditions like restless leg syndrome and sleep apnea and narcolepsy and really the full range of sleep disorders. And then I also work a lot with neurodivergent individuals, autism and ADHD a lot as well. yeah, I just find these topics particularly fascinating. I’ve got my own history of sleep problems and I’ve got neurodivergent children myself and those areas overlap pretty frequently.

Debbie:
Yeah, it’s great when your personal and professional lives intersect and you can kind of, I mean, that’s what my life has been like for the past, you know, 15 plus years too. we’ve explored sleep challenges before on the show, specifically, you know, things like kids with ADHD who have trouble turning off their brains at night, right? Or who struggle to fall asleep. And we’ve discussed sleep apnea and how that’s kind of more common maybe in kids with ADHD than people may realize. But what we’re going to be talking about today is completely new terrain for me. I was on a community call with some folks in my differently wired club who were sharing what they had been experiencing and talking about some of the language you just use, circadian rhythm. sleep disorders and then delayed sleep phase disorder. like, what is all of this stuff? And so I really set out to try to find someone to explore this with me on the show here. Because as I started researching, I’m realizing, this is a real challenge for a lot of people. And it seems like it’s hard to get information. Like the parents who are negotiating this stuff are feeling pretty isolated in what they’re going through.

Alex Mortlock:
Yeah, yeah, absolutely. While there’s really topics we deal with every day, you know, working in sleep, these terms like circadian rhythms and delayed sleep phase syndrome are not widely known, understood topics, I don’t think. And yet they’re really common problems, especially for neurodivergent children. I think developing an understanding of the circadian rhythm especially can be so helpful. for optimizing the sleep of our children, which is so often a problem. Certainly my own children, I’m thinking about that. They haven’t developed pronounced sleep disorders, but partly I think that’s because they’re not quite old enough yet. They’re not teenagers yet. But also because we’ve been thinking about that since they were quite young in order to prevent sleep problems developing, just knowing that there’s quite a high risk of that.

Debbie:
So all right, let me take a step back. because my hunch is that many listeners aren’t familiar with this terminology. So would you kind of lay the groundwork for us a little bit and maybe share what circadian rhythm sleep disorders are? And just, yeah, is there a definition for it? And maybe talk about some of the different ways it can present?

Alex Mortlock:
Yeah, absolutely. So the circadian rhythm is essentially a body clock. It’s our underlying physiological mechanism that essentially determines when we’re able to sleep and when we’re likely to be awake. When it’s functioning well, it’s nicely kind of aligned with the cycle of day and night. promotes wakefulness during the day and it promotes sleepiness during the night. And I guess most of us are probably familiar with it being out of alignment when we travel overseas. And if you fly to the other side of the world, you’ll experience immediate misalignment and you’ll want to be asleep during the day and you’ll want to be awake at night. And you’ve suddenly acquired a circadian rhythm. problem, known as jet lag. And for most people jet lag is a fairly brief problem that naturally goes away over a few days. But for a lot of people living in the modern world especially, they can develop chronic circadian rhythm disorders. And the most common of those is something called delayed sleep phase syndrome. And that’s where people’s internal body clock is chronically delayed relative to the local time zone. And so it’s a little bit like their internal body clock thinks they’re maybe three or four or five time zones further around the world than they really are. when it’s delayed sleep phase syndrome, that’s in a westerly direction around the world from where they actually are. Occasionally people have something called advanced sleep phase syndrome, which is where their body clock runs earlier than the local time zone. And it’s a little bit like they’re somewhere to the east of where they actually are in the world. That’s sort of a bit more common in older folk who wake up too early. and go to bed very early.

Debbie:
Already I’ve got questions. So, okay, so delayed sleep phase disorder is basically like, would you think that someone who’s a night owl who’s up till three in the morning, and then they sleep until like three in the afternoon or whatever, would that be an example? And is it something that is consistent? It’s just that their entire clock is on a yeah, I guess a different rhythm.

Alex Mortlock:
Yeah, exactly. So the typical person with delayed sleep phase syndrome is up until 1 or 2 3 a.m. and then they’re not waking until the late morning or after. Some people with delayed sleep phase syndrome are literally staying up and doing activities until well after midnight. Whereas some people actually will go to bed at a normal time. go to bed at 10 or 11 p.m. but they just can’t sleep and they’ll actually lie awake in bed for hours just staring at the ceiling or just tossing and turning in the state of full of really just being alert and being in this fully awake state nowhere near sleep is incredibly frustrating just just unpleasant state that goes on and on on and on for hours and they typically think they have insomnia when really they have a circadian misalignment

Debbie:
Wow, okay.

Alex Mortlock:
Yeah, no amount of relaxation will let them sleep because it’s not actually the anxiety that’s keeping them awake. They may be anxious or they may be completely relaxed, but they won’t fall asleep because their body clock has not prepared their body and their brain to fall asleep. They won’t do so for several hours. That’s the typical case and that’s what we see in a lot of teenagers and a lot of people in their early 20s. It’s very common. But we also see it in adults past the 20s as Yeah, and particularly in folk with ADHD, it’s really common for ADHD folks to have it well into their middle adulthood. And of course, for children with ADHD, they’re more likely to have it from earlier teenage years as well.

Debbie:
So I’m just going to like full disclosure, I’m already connecting dots in my own home right now that I was not anticipating. So I’m going to set that to the side. OK, I’m going to stay in my interviewer role here, but I’m definitely already starting to realize that this is heading closer to home than I thought. Okay, there’s one other sleep disorder that I want to also just get kind of a general definition of before we dive any further. And that’s something called Non-24. Am I saying that right? Non-24 sleep disorder?

Alex Mortlock:
Yeah, yeah, that’s, it’s, it’s really when circadian rhythm is not, following a regular schedule. So most people with delayed sleep phase syndrome, their body clock is delayed, but it’s reasonably consistent. So they’ll fall asleep typically between two or three or four a.m. and it’s a similar time each night and it doesn’t change too much over time. Whereas some people have a very varied circadian rhythm and it’s sort of all over the place. And some nights they’ll fall asleep at 2 a.m. Some nights they’ll fall asleep at 6 a.m. Some nights they’ll fall asleep at 11 a.m. and they’ll sleep through until 7 p.m. If you drew a chart of their sleep over the 24-hour cycle, it would look like there was no real pattern to when they were awake and when they were asleep. It sort of looks like a newborn baby almost. In reality, there’s almost always a circadian rhythm. And it’s just following maybe a 26-hour pattern. because our circadian rhythm can actually stretch and actually it naturally kind of wants to stretch. And even for the average person, it would naturally follow maybe a 24 and a half hour cycle if we weren’t exposed to the factors that entrain it into a 24 hour cycle each day. Its exposure to bright light in the morning. and during the early part of the day that kind of locks our body clock into the 24 hour cycle, it’s exposure to And if we were to be in an environment where there was no exposure to that cycle of light, there’s been research, for example, with people living in caves with no clocks and who are freely left just choose where they want to stay up and when they want to go to bed. And also people living in laboratories with no windows, no clocks, no external cues of what time yeah, their body clocks follow roughly 24 and a half So everybody’s body clock is slightly non 24 hour, but some people seem to have even longer natural circadian period. It might be 26 hours. and they will just get more and more out of sync each day. You know, the fact that we spend a lot of time indoors means we don’t, and a lot of us don’t get exposure to natural light a lot during a typical day. If we’re inside at home and time off and we’re in maybe an office building or a school or a university room during the day, and then at night time, we’ve got exposure to electric lighting and screens. And that pattern of exposure to light is so unnatural that it just confuses our circadian rhythm. And so for sensitive individuals, that can lead to this non 24 hour pattern. I think one thing to keep in mind is that some folk are very sensitive. And some people kind of have this sort of robust biological clock that can put up with a lot of confusing stimuli and they still can sleep quite well. And it’s really a thing. And so it seems that our neurodivergent children and adults are genetically sensitive to circadian disturbance. And they kind of need a more natural circadian environment in order to sleep well, generally. They need more light exposure during the morning and less light exposure at night, generally. They have a good functioning circadian rhythm.

Debbie:
You mentioned that neurodivergent people or some people might be more genetically predisposed to having these types of sleep challenges. And I’d love it if you could unpack that a little bit specifically related to neurodivergence and what we know about that, is it about melatonin? Is it about the sensitivities? Is it a combination of factors?

Alex Mortlock:
Yeah, well, I think one of the factors that has been discovered is about variation in the sensitivity to light and how responsive people, individuals, circadian system is to different levels of light. So with this delayed sleep phase tendency. and this is more common in neurodivergent folk, are more sensitive to the delaying effects of evening light exposure than people whose body clocks are more early, so they’re sort of the night owls. The same amount of light in the evening will delay their sleep by a greater degree. and the threshold of brightness of light that might have a delaying effect, and it has that effect partially through suppressing the amount of melatonin that their brains will naturally produce in the evening, is the threshold for that suppression effect is lower. And so a dim light can have a detrimental effect, or a relatively dim light might be enough to have a detrimental effect. Whereas morning larks or people who naturally go to bed early, go to sleep early, wake up early, they can tolerate light at night time quite well and it doesn’t seem to delay their sleep. I’m a bit like that. I can put up with light and it doesn’t seem to delay my sleep. then the opposite is true in the morning. So in the morning, Delayed sleep phase syndrome people are less sensitive to And so they need more light in the morning to get the beneficial effect of light in promoting early waking and promoting earlier onset of sleep and greater ease of falling asleep. So the sort of light levels you might get in a typical home, even a well-lit home, even a home with lots of windows, is not enough. they really, to get to benefit, would need to go get exposure to Or for some using light boxes or light visors, which you can get now, which have LED lights built into a frame, and you just wear them like a pair of glasses. And they’ve got just a little blue or blue green. LEDs. yeah, so the genetic difference, one of the mechanisms at least is that reduced sensitivity to light in the morning and therefore greater need for more bright light. And so it’s sort of a, it’s a bit of a burden almost. if you recognize that and you factor that in, you can really prevent your body clock delaying. or slowly bring your body clock earlier, regularly dimming the light in those hours before bed. But actually more importantly getting more bright light in the early part of the day. That’s the part that makes the most difference.

Debbie:
So I’m wondering about kids then, do they develop this? if they’re already kind of wired to be more sensitive to these signals. But then you mentioned earlier kind of it’s common in the teen years and we see that more teen college age students. Is it something that can be developed? Is that because the habits then reinforce what’s happening with their circadian rhythms?

Alex Mortlock:
Developmental, biological change associated with adolescents. So there have been studies looking at young people living societies that don’t have electricity and have no electric lighting devices. I think in Amazonian tribes and tribes living in New Guinea. The teenagers there still stay up an hour or two later than their parents and still want to sleep in longer in the morning. so it’s certainly not entirely environmental. There really is a very real physiological age-related change. One can only speculate why nature might want teenagers to stay up late later than their parents. It’s magnified by any behaviors that might lead to more light exposure at nighttime or less light exposure in the morning. If an individual has a habit of using their phone, using their computer late at night before bed and especially in bed, then that’s going to delay sleep.

Debbie:
Like check, check, check.

Alex Mortlock:
Yeah, that’s a fun one. And there was a study recently that found that the most detrimental habit is actually phone use in bed. And that’s actually really common to use the phone during the night. So a reasonable number of teenagers, without their parents being aware, are actually reporting checking their phone throughout the night. So they’ll wake up, you know, at 1am, at 3am, 4am and check their phone for notifications and maybe even send messages to people, you know, in the middle of the night. And the light exposure that they get in the middle of the night is the time when our system is at its most sensitive. So the system is especially responsive in terms of the delaying effect to light exposure that we get right in the very middle of night. That’s the key time to not be doing that. If your teenagers can leave their phone out of there that time, that would be a good habit.

Debbie:
Let me ask you then, how would a parent know if what’s going on with their child is something like delayed phase sleep disorder, circadian rhythm disorder, because also as you’re describing, we know that teenagers and adolescents like their clock does tend to shift, which is why so many schools are for high school. They’re having start times be later. So what is the threshold for this being something that would be considered a complex sleep issue versus kind of just typical kind of late 19?

Alex Mortlock:
Yeah. It is somewhat subjective, So it really depends on whether it’s causing impairment and causing distress. So a problem if it’s a problem. Like for some people, they might follow a pattern where it’s varied, their sleep is very delayed and they are sleeping from 4am until until midday, but they’re actually okay with that. And they might be working in entertainment, they might be working in hospitality, their job involves them staying up till midnight. And they don’t have to start work at 4pm. And that’s just fine. have a very late running circadian rhythm. it’s not maladaptive though, so we wouldn’t call that a disorder. Other people the delay might be relatively small and their circadian rhythm might have them sleeping between say 1 a.m. And 9 a.m. But they have to get up at 6 a.m. And so they’re only getting five hours sleep. That would then be a disorder because they’ll sleep five hours, especially for a teenager not way near enough. It’s not enough for an adult either. So it’s really relative to the individual circumstances. I think it tends to be relatively obvious when you talk to a family, you talk to the young person. They tend to know, most teenagers I’ve talked to tend to know that they have a sleep problem. The families certainly know. I think the fact that it’s common doesn’t mean it’s not a problem if that makes sense. Yeah, and then and even if it’s even if it’s only two hours. Out of. What might be ideal that can still be a really significant problem. I think it’s pretty large percentage of teenagers, especially in America, where schools start so early, in so many places. In New Zealand, schools start at nine o’clock or so, and teenagers are often not having to wake up until eight o’clock. But from my understanding, in America, high schoolers often start a lot earlier than that.

Debbie:
Yeah, they could for sure. Yeah.

Alex Mortlock:
Yeah, and that can be quite a challenge, makes it a problem.

Debbie:
Before we get into what to do if our kids are struggling with these sleep challenges, I have one more question. And this is something a member of my community asked me about, and it was also super relatable. And this idea kids who do get nine hours of sleep, I’m using air quotes, like on paper, they’re getting nine hours of sleep. They consistently verbalize, I didn’t get it, I didn’t sleep well, I’m always tired, it doesn’t matter how much sleep I get. Is that something separate? Might that be indicative of something like sleep apnea or some other type of sleep challenge?

Alex Mortlock:
Yeah, yeah, I would start, I would be starting to think about the something’s not right about the quality of the sleep. So the amount of sleep is good. That’s unlikely to be a circadian rhythm disorder or insomnia. Something about that quality isn’t, isn’t, isn’t good. You know, the most common sleep disorder affecting quality of sleep is a breathing related sleep disorder. Sleep apnea is a fairly common problem. It’s more common in older adults, of course, but a reasonable number of young people as well sleep apnea and it’s certainly more common in neurodivergent young people. for reasons that seem to know for certain. I listened to actually a podcast talking about hypermobility and the connection between hypermobility and sleep apnea. One pathway may be that the upper airway is actually more collapsible in people with hypermobility syndrome and that overlap with autism especially. may explain some of the sleep apnea. And so, I guess, if your child is sleepy, despite getting enough sleep, one thing to be thinking about would be, are they snoring or showing other signs of poor breathing? You know, if you can sneak in and sort of closely observe your sleeping child breathing, do they see their breathing noisy, especially? That’s the key thing to think about. Does it seem to be irregular? there pauses? Does it seem to be straining to breathe easily? know, someone that age, a young person should be breathing very easily during sleep. It shouldn’t be. if it is an effort, that’s going to be lessening the depth of their sleep. Any airway resistance is going to lead to lighter sleep.

Debbie:
Okay. Super interesting. And I’ll just say that the connection between hypermobility and sleep apnea is fascinating. I’m working to get someone on the show to talk about hypermobility. So now I know to also see if I can loop that in. So thank you for sharing that. But okay, so let’s pivot back. That was a little bit of a detour. Let’s pivot back to circadian rhythm. differences, however we want to define that. So I guess the big question is can they be treated? Can we help kids who struggle with this? What does that look like?

Alex Mortlock:
Yeah, yeah, absolutely, absolutely. The goal is to realign the circadian rhythm with their desired sleep schedule. Generally, that’s something that you do gradually. And so you’re trying forward their internal body clock in incremental steps over a period of usually a couple of weeks because they are kind of stubborn in only responding to small. maybe 15 minutes a day, something like that is a sort of an approximation. The key things that will drive that change are getting, as we talked about, getting more bright light exposure. after the sleep phase. So after you’re a young person wakes up getting bright light, most research studies use 30 minutes of light over, they use a threshold of 10,000 lux of light. So lux is a unit of illumination at a surface sometimes use light boxes. which are like very, very bright boxes. I’ve actually got some in here I’m using to light my room, things like this.

Debbie:
Yeah, I have one of those.

Alex Mortlock:
But I know, I know, yeah. And you can get well over 10,000 lux by just going outside. So that’s the best way to do it. Even an overcast day will be probably 20,000 or more lux. A bright day can be 100,000 getting light visors. do have some, they’re not in the room with me. a few different brands, the Luminets, the AOs, ProPeaks. look online, there’s various different options. I don’t know which ones, to be honest, are better than others. A pretty straightforward mechanism, really. You’re just trying to light up your eye socket. Those are quite good because you can wear them around the house while you’re doing your morning routine you’re having breakfast or getting ready. We actually do that with my son, he puts them first thing actually when I wake him up in the morning. First thing he does is his light vases that helps him to fall asleep more easily at night time. So you get the light exposure at least half an hour of that sufficient brightness after waking. A key thing is you don’t want to get that light too early. Your young person is waking quite late, currently, if they’re waking at 11 AM, that’s when they naturally wake up. like on the weekend or on a day off, that’s their biological wake time. You don’t want to get the light exposure too early. If you get that light exposure before 9am, like say they have days where they’re getting up for school or for work or something and they’re getting up at 8am. If they get exposure to light that early, like two hours or more before their natural wake time, that light can actually backfire. and further delay their body clock. So if you get light that’s earlier than about two hours before the natural wake time, it will have the wrong effect, the opposite effect of what you want.

Debbie:
Hmm. What do we know what a natural wake time is though? Like, is it what they would sleep in and on weekends or what if they’re just catching up from their exhaustion for the whole week? How do we figure that out?

Alex Mortlock:
Yeah, exactly. I guess the other way to think about it is that turnover time where light goes from delaying your body clock to pushing your body clock earlier is about six hours after you fall you’re sort of the time you naturally fall asleep. And so you are having to estimate that. You can work it out. physiologically, but it involves a very uncomfortable to measure your internal body temperature, swallowing a very expensive pill to measure your internal body temperature. And so you estimate that time. But most people, it’s not really, you don’t need to get it exact, because you want to get the bright light exposure well after that critical threshold time anyway. But it’s, It’s key to be aware of that because a lot of people, big part of maintaining their problem is that they’re actually forcing themselves up a few hours before their natural wake time quite regularly. And that may be the time they’re getting the most light exposure. So they may be falling asleep at 3 a.m. They’re getting up every day at 8 a.m. or 7 a.m. even. to go to school or go to work or university. And that’s the only time they’re outdoors. Is that brief commute. That’s when they’re getting bright light exposure. That’s the exact worst possible time to be getting it, because that’s when their system is at its most sensitive to the delaying effect of light. And then the rest of the morning they’re indoors and they’re not getting any light exposure at the time that would help move their body clock earlier, which would be light. Later in the morning, even in the early afternoon, the light would be beneficial. Then that’s kind of actually trapping them into this delayed phase position. That’s one thing to be aware of. If your body clock is quite delayed like that and your natural rate time is late morning and you’re forced to get up early in the morning because of your commitments, you may actually want to avoid light early in the morning. and wear sunglasses, wear a hat. If you’re indoors, keep the light levels low for the first of the early morning as you’re getting started on this strategy. And get the light exposure towards the late morning to start with, and then gradually move it earlier, just to complicate things for you there a little bit more.

Debbie:
I’m getting, yeah, to complicate, I’m getting a sense of, I mean, when you first said, yeah, so you’re gonna want to move this in 15 minute increments and slowly start to readjust. And, you know, was like, okay, that sounds pretty straightforward, but this actually does sound like it is a very complex process. And there are a lot of factors to consider and why a parent would want to have the support of a professional to help navigate this, right?

Alex Mortlock:
Yeah, it’s in. Yeah, yes. this is where seeing a sleep specialist, going to a sleep clinic, seeing a psychologist or a sleep doctor, someone who specializes in sleep medicine can be helpful when it’s complicated. I think you can’t do much harm by trying. The worst that can happen is that your body clock moves a little bit earlier or a little bit later if you try it out at home. And there’s a pretty good chance that you’ll benefit from things. But when it gets complicated, it certainly is helpful to see someone who specializes in this. Most psychologists probably won’t have enough training in this to understand the circadian rhythm complexities. They’ll have some understanding, perhaps not in the full detail.

Debbie:
Yeah, mean, it does seem to be something that there’s not a lot of information on. I mean, this is a topic I’ve been looking to cover on the show for a while. And I was so happy that I found you. And I read an article that you wrote, which listeners I’ll share in the show notes. It’s not like it’s super easy to find someone who really understands the nuances of this with kids, and especially with that neurodivergent affirming lens. Because that’s also going to complicate things, especially, you know, with a lot of listeners who have kids who have a more, you know, demand avoidant profile, for example. And so, trying to get support or support a child in making these changes couldn’t be even more complex with those kids, right?

Alex Mortlock:
Yeah, yeah, absolutely. Yeah, I think a huge aspect of this is around motivation and kind of adhering to this plan a routine. Obviously, it only works the youngster to that schedule. so getting the buy in. child and for me the client is absolutely essential. a big part of I guess the energy is trying to connect with the client. So when I’m working with kids and teenagers, this combination of working with the parents and working directly with the young person. And a lot of what I’m thinking about is how to make this appealing to the young person and how to tie this in with things that matter to them. Thinking about their, you know, what do they care about? how might this help them with the things they care about? Thinking about their sports or their energy hobbies, their social life, know, it’s about their know, what is it that they care about? yeah, imposing it as regimented. top-down sort of rules, that they could easily backfire.

Debbie:
Yes. Yeah, and I imagine as kids get older that buy-in is even more and more important. It has to matter to them in the first place. Even though I know, I just want to acknowledge for parents who have kids who are navigating this how challenging it can be. Because as a parent, you just constantly feel like you’re trying to keep things on track. always having to be the one getting your kid up and doing all of those things. Of course, the child not being happy about that and everyone’s tired. I know a lot of people get stuck in this kind of really painful cycle. I’m going to have to wrap up soon. And before I do that, I’m going to put you on the spot and say, would you be willing to come back in the future to answer some specific questions from folks? Because we just couldn’t get into everything in this time period.

Alex Mortlock:
Yeah, of course. Yeah, yeah, very happy.

Debbie:
Would you do that? OK, thank you. I mean, I think this is such that there’s so much more that we could explore together. let me ask a question about melatonin, because that is something that so many families use. We used it from when my child was very young of that inability to just shut down at night and actually fall asleep. And so what are your thoughts on melatonin specifically for these kinds of complex sleep issues?

Alex Mortlock:
I guess there’s a lot of uncertainty about melatonin. Like we don’t, it’s not, it’s not as well researched as we’d like or as I’d like, I suppose. And it’s safety profile is I think it’s not, it’s not as well understood as I’d like it to be. We don’t, at the same time, it doesn’t look like there’s any known danger to using it. Sort of that I’ve come across either. For a lot of neurodivergent kids, it seems to be very helpful. My son takes a low dose of melatonin for his sleep and continues and finds that really beneficial. So I’m quite happy using it for him. There’s research specifically for delayed sleep phase syndrome and using melatonin. specifically to move the body clock earlier as well. It’s used in a slightly different way to how it might be used for a sort of a more straightforward insomnia. then in the research studies using it for advancing the body clock, people take a very low dose and they take it a lot earlier. So the general recommendation is taking, believe it’s 0.2 very small dose, five to seven hours before the current average sleep onset. And if the child is falling asleep at 1 a.m., they would be taking it in the late afternoon, early evening. It would involve some kind of a tablet to get the load. You’d want to talk to your prescriber about this to make sure that your general practitioner or pediatrician is on board when dealing with medications. In my country, at least until recently, melatonin was a prescription medication that’s now over the counter. But I certainly recommend that. It seems that the melatonin sends a signal to the body clock and the brain at night time, that it needs to start getting itself ready for sleep. It doesn’t at that dose have a sedating effect. So when people take it for bringing their body clock earlier, they take this tiny dose of melatonin in the evening. They don’t feel sleepy, but it seems to draw forward the timing at which their body clock does generate sleep. as you’re bringing forward the body clock, you actually bring forward the timing of the melatonin as well. So you’re always taking it five to seven hours before sleep So that’s another sort of way of using that. And interestingly, studies on how much melatonin does the brain naturally produce during the night suggests that the natural amount would be about 0.3 milligrams a night. And so a lot of people are taking, you know, three milligrams in a tablet, would already be times the amount the brain naturally produces. Some people are taking 10 milligrams, which would be more than 30 times the natural quantity, which is pretty incredible. And so I’m a proponent of low dose melatonin. And there’s also studies comparing the efficacy of different doses. in finding that higher doses are no more effective than lower doses anyway. It seems to be not really dose responsive like most other medications. It seems to be more like an on-off type effect. And just having it there has an effect, having more of it doesn’t seem to have a better effect.

Debbie:
Interesting. I’m going to ask you two more questions, and then we are really going to wrap up. So one question is just if we’re kind of zooming I said, are there ways that we can get kids back on track? And this is something that you can get back on a regular schedule with the right motivation and the right intervention. So I just want to kind of leave listeners with a little bit of hope if this is something that they’re navigating that if your child has, you know, a non 24s, you know, it’s been had this delete delayed sleep phase challenges for a while now it is possible with the right support to get on to a better schedule.

Alex Mortlock:
Yeah, yeah, absolutely. Yeah, yeah, yeah, yeah, yeah, the body clock will respond to these environmental effects. I think consistency is the key thing, so it is. It is about how consistently these effects are applied and that’s where the challenge lies. But it really can really come together I think it is also with. about the developmental benefits that come with maturity as well. And so it is also remembering that for most people it is a phase that improves with age. so as your youngster gets older, their body clock generally moves earlier. But yes.

Debbie:
Yeah. I always say that time is on our side, you know, in that our kids are going to continue to grow and mature in age and develop and things will start to come together. And as we know with neurodivergent kids, that process can sometimes take longer than with neurotypical kids.

Alex Mortlock:
It’s really about routine. Routine is such a big thing with sleep. Quite a number of my clients, you know, they like routine and they ultimately can get on board with routine around sleep. And they kind of like gadgets. So they kind of liked light exposure, the light visors. In the morning, you clients, that’s kind of appealed to them. In a matching gadget that you can wear at night, orange tinted glasses, which block blue light at night time, which suppresses melatonin. And so if you can combine light devices in the morning with orange glasses at night for some kids that can be appealing. Not certainly not for all, not for all, but.

Debbie:
Yeah. Well, I’ll include links to some of those things in the show notes to listeners if you want to get a sense of, not that you should buy this particular light box or light visor, but just so you can check it out and see what it’s like and if that’s something you want to explore. I’m going to look into the light visor. We do have a light box here and my kid has one at university. More for seasonal affective disorder during the dark winters, but it’s good to know that they can be used this way as well. Do you have any other resources or favorite websites or organizations or books, anything that listeners navigating this could check out?

Alex Mortlock:
I think that there’s one book that I think I found most helpful, it’s a little older now. It’s called Reset Your Inner Clock. Michael Turman, who was kind of a pioneer in the field of what came to be called chrono, chronotherapy. really spells out in very practical terms, to go about this type of therapy. It’s written very sort of a self-help book in a way. Very, very, very, very practical. It emphasizes using lightboxes. And I think wherever it talks about using lightboxes, you can think about just going outside or using a light visor. That’s a little dated because it was pre LED technology. that’s probably the best single book that I’ve encountered. No doubt that there will be YouTube videos and probably TikTok videos now explore this. I don’t have any specific ones that I’d recommend. look some up. As I mentioned, I wrote a short article for Attitude that could be worth reading.

Debbie:
Yes, it is worth reading. I’ll definitely share it with listeners, I encourage you to check that out. And I’ll share a link to this book as I came to this conversation with three pages of questions. And I, I think probably this conversation, I’ll hear from a lot of folks too, because I think we are just kind of scratching the surface. of all, I want to say thank you for getting up. Well, you explain that you are a morning person. So this isn’t the first thing for you, but I appreciate you spending time with us this morning and talking us through all of this and explaining it in such detail. And yes, I would love it if you want to come back down the road and we’ll dive into it a little deeper.

Alex Mortlock:
Yeah, absolutely. Yeah, I really enjoyed the conversation and thanks for inviting me on. Happy to come back.

Debbie:
Yes, thank you. Sounds wonderful. All right. Thanks, Alex and enjoy the rest of your day.

Alex Mortlock:
No problem, no problem, all the best.