פרק 43 : הפרעות שינה עם ד”ר אורית סטולר נוירולוגית ילדים

בפרק הזה של "מעבר לספקטרום," ד"ר אורית סטולר מצטרפת אלינו לשיחה מרתקת על נושאים הקשורים לשינה, במיוחד בקרב ילדים על הספקטרום האוטיסטי. ד"ר סטולר, נוירולוגית ילדים ומומחית להתפתחות הילד, מדגישה את החשיבות הרבה של השינה לתפקוד היומיומי ולבריאות הכללית של הילד והמשפחה.

חשיבות השינה לילדים ולמטפלים

הצטרפו אלינו כדי לחקור את החשיבות המהותית של שינה עבור הילדים וגם עבור מטפליהם. גלו איך החוסר בשינה, או שינה לקויה, משפיעים על הזיכרון, תפקוד המערכת החיסונית, המצב הרוח ועל הבריאות הכללית, במיוחד עבור ילדים בספקטרום האוטיזם. אנו מספקים תובנות מקצועיות ליצירת סביבת שינה מעודדת, עם דגש על הפחתת חשיפה לאור ולרעש. שיחתנו כוללת טיפים מעשיים לניהול הפרעות שינה ודנה בתפקיד המלטונין, המורכבויות שבנתינת תרופות לילדים, ובהשפעה הרחבה של חוסר שינה על גדילת הילד והתנהגותו.

טיפים ממומחה: ד"ר אורית סטולר על טיפול בהפרעות שינה

ד"ר סטולר משתפת בהתערבויות רפואיות והתנהגותיות יקרות ערך שיכולות לעזור לילדים להשיג איכות שינה טובה יותר. אנו צוללים לגישות מורכבות לטיפול בהפרעות שינה, ממלטונין ותרופות ועד לטיפול במצבים רפואיים רקעיים כמו רפלוקס. עם שילוב של עצות מומחים וסיפורים מובנים, הפרק מטרתו לתמוך ולהשרות השראה להורים המנווטים במורכבויות של גידול ילדים עם אוטיזם.

הפרק היה עשיר במידע חשוב ומעשי להורים לילדים על הספקטרום. הוא כלל טיפים להתמודדות עם בעיות שינה ושיפור איכות החיים של הילדים והמשפחה כולה. ד"ר סטולר העניקה כלים והבנה מעמיקה להורים המעוניינים לשפר את איכות השינה והחיים של ילדיהם.

אל תחמיצו את הפרק המרתק הזה! האזינו עכשיו ושתפו עם חברים ומשפחה שיכולים להפיק תועלת מהמידע החשוב הזה.

Chapters

• 0:40 Parenting and Challenges of Autism
• 16:56 Understanding the Importance of Sleep
• 24:47 Creating a Sleep-Inducing Environment
• 40:00 Options for Using Melatonin in Israel
• 48:59 Challenges With Giving Medication to Children
• 53:42 Navigating Sleep Disorder Treatments in Children
• 58:45 Managing Reflux in Children's Sleep

Transcript

דר אורית סטולר : 0:40

Autism. Okay, I see them growing here. I have patients who are already 20 plus and also the families. There is something. There is no doubt that it takes you to a different place, but I think that the marriage in general it took you to a different place. So it's just a different thing. And then it's really a test of the strength Of the person, where he comes from, what powers he has and what relationship he has. You can talk about this for hours and hours. There are some that the relationship, on the contrary, strengthens and there are some that break. There are a lot of jobs that show a very high probability of relatively high divorce among parents of special needs children and basically it's the basis of what's there, and basically it's the basis of what's there. So whenever they come out of my examination, I always tell the parents that they need to invest in the relationship.

אנה אברהמי : 1:39

They have to because otherwise it's complicated. The truth is that I didn't get it, but the truth is that it's the tree. There's also a really nice book called Far From the Tree. I heard about it, I didn't forget, and it's really nice really. But there's a very big part there for parents, for special needs that really makes the difference between getting out of the closet and we have this episode of the rise of a special family, and he says there that it takes the relationship to the edge. To the edge like either it strengthens or it breaks.

דר אורית סטולר : 2:15

One of the problems I have, from the place I'm in, as a person who is involved in research. I will soon introduce myself, like what I do, but the problem is ומחקר. אני תכף אציג את עצמי מה אני עושה, אבל הבעיה היא בהכללה ואחד הדברים שאנחנו רואים בכנסים. אני יושבת בכנסים, יש כנסים בינלאומיים של חוקרים לא של רופים, אלא יותר של חוקרים ששם אני יותר אוהבת ללכת, כי שם יש את הדברים החדשים, ויש המון ש and there are new things. And there is a lot of talk about the difference between those who are profound autism, those who are the autistic children in the lower class, what we call them. They are an individuality in itself that, in a certain sense, is neglected, is not strengthened right in the world of research, because when I do work, it is easier to take the children who are verbal and connected Thank you, and their voice is. Now. There's a very nice study that I always tell about that took a group of neurotypical people and did this game of passing a word, that they pass it. You know that you pass a word and it has to pass from one to the other yes, like a broken phone, right, a broken phone that you connect to the word. And they took one circle of neurotypicals, one of the autists in high-profile and one of a circle, one of the neurotypicals, one of the autists in high-level work and one of this, one of that. And between us, the neurotypicals, the message passed. Among the autists in high-level work the message passes perfectly. They communicate well. The problem was in this one, this one. There it was established. And I think that when we talk about these in high-level work, we talk about a different communication. שכשמדברים על אלה בתפקוד הגבוה. אנחנו מדברים על תקשורת אחרת. שאנחנו צריכים לגשר. אנחנו מדברים שפות שונות. יש לנו תרבות שונה וצריך כמו להתפגש, כמו ללכת לסין. אתה צריך ללמוד את התרבות, את השפה. זה משהו אחד, אבל אנחנו צריכים לזכור שבתחת In DSM-5, I believe that in DSM-6 there are some changes there is this group of profound autism that we slightly mute their voice.

דר אורית סטולר : 5:10

In the world of research, in the world of communication, we hear them less. And also the parental experience there is very, very different, because being a parent of a child with a high job is not necessarily easier. I think you're always on the edge that I'll do a little more and he'll be normal. I'll do a little more and he'll. This is as good as it gets. But I'm assuming that you understand that you're dealing with life quality and quality life and not combining them. But everyone is a world full of us. We need to really separate and be careful not to do the analysis that was done in DSM. Unfortunately. Then I thought it was right. Today I think it's not a good thing for everyone, but we'll see what happens.

אנה אברהמי : 6:04

Okay, not that we got involved no notv kez lo bishu ze itkanasmo Tishmi rega Amosal agid lach shenachno moklitot eser dakot kulel piteron bayotechniyot ve'a seharot sheniyamdu shalosh pahamin Ze lo. It was very exciting and I'm so happy you're here. I'll show you how to present it as it comes to you. It was important for me to say about the subject of the common language. I signed with my 8-year-old son the inspiration for this podcast David for Minecraft. I gave him Minecraft because he loves Minecraft. We got there and it. It was, at the same time, an exciting and exciting experience. Okay, because he entered there to the people of Sugu. They, in a second and a half, connected Everyone. He entered to children who already know each other and around this Minecraft. They are like communicating Thank you and the joy that he had on his face that's what was always also also makes you happy and also makes Reema happy when she says I'm not of his kind, like he has here a group that he found.

דר אורית סטולר : 7:41

But I think that, anna, I think that this experience also makes a child in a normative development she can endure. But it's great. It's great because I think that's where we need to go and whenever parents come to me so at a young age I often speak, my language is let's see how we give the child the maximum of tools to allow him to integrate into the world and to be, in the end, an adult, independent and happy in the world and to play a role. By the way, that's also what I want for my children. I want them to be independent, happy and happy. After that, I want more. Yes, I want them to be renewed with people I love and I want them to be in university and I want and want, but in the actual line, I want them to be satisfied, independent and active. Now, when you hold on to this basic thing, then in the first stage, in the young children, my always recommendations to the parents are let's bring them here First of all. Let's bring them here. But when I get to the stage where I see that the child is already active let's say a child at 6, 7 years old then my advice is let's look for where the child is good, what motivates him, let's strengthen his strengths, Because a child or a person on the train is first and foremost a child.

דר אורית סטולר : 8:53

He is first and foremost a person and, like all of us, we are born from success. So if the child is good at music, you will teach him to learn music. Then you will teach him to work at the communication clinics all day, shalom to learn to draw. If he's good at taking pictures, he'll take pictures. The problem is that most autists are really good at sitting in front of a screen and doing things Right. So here you need to see how you take something functional. You know Good.

אנה אברהמי : 9:34

So, dr Oritz Toller, you came here because you were talking about sleep. Let me introduce you because I feel like I'm going to hear some very, very important speech, so I'll introduce myself to you because I think you have some very important talent.

דר אורית סטולר : 9:47

So I will introduce myself First of all. Thank you, anna. It's great and I'm very happy to be a part of it, because I think that these places that you create a platform that allows parents to listen in their time, in their place. One of the problems is that there are people who are available to listen to you when you say why that it's not good that they arrive at 3 am. Shalom that parents receive that. Sometimes I hold my head and I say God, keep like, where did they get this thing from? So a word about me. And then it started. So I'm a neurologist for children. I'm not a psychiatrist. I'm a neurologist for children, a specialist in neurology and development of the child.

דר אורית סטולר : 10:35

I finished the apprenticeship with children in Meir in Kfar Saba and then I moved to Ichilov. There I did my degree in neurology and development of the child and then I was more than a decade in the doctor's office in the autism center. It was also a diagnosis that over time I got worse at the old age, especially at the young. I did a pharmacological surgery that treated a pediatric patient with autistic children and I was responsible for the alutaf drug in autistic children and I was responsible for the treatment, which is a lot around. The issue of. It started with food and sleep. It was things like that. I believe that they are the basis for us human beings in general and they were, were always in focus. And then I got involved in the issue of medical cannabis and in the end I finished, a few years ago, a very large study oncabi. I took myself to run the children's development center in the Sharon district. I found a framework, a center. First of all, maccabi I'm not a person of medical schools. I've always worked in medical schools and I was able to find a lot of motivation over the country. Not just in Maccabi, but all over the country are some kind of black box. There are patients who don't know how to handle it and there is a lot of good will and very high motivation to do something good.

דר אורית סטולר : 12:18

There ויש המון רצון טוב ומוטיבציה מאוד גבוהה לעשות שם משהו טוב. ואני מרגישה ברת מזל להיות חלק מאיזשהו ניסיון לעשות שם השינויים על כל כך הרבה רובדים. אפשר לדבר על זה פודקאסט שלם על כל הבעיות שיש, כל כל מה שצריך לעשות. אבל באמת חשוב לי להגיד. But it's really important for me to say that there are professional people, and very qualified people. People spend a lot of money to come to me to do tests. In my case, I think I'm doing a much better job, especially in the hospitals in Maccabi. But not for that we met. And what about sleep? So I'll tell a short story and then we'll start.

דר אורית סטולר : 13:03

There was a family member who came to me with a lot of behavioral problems and I was in the pharmacology department and I started taking amnesia. I started thinking the child is sick, the child is not communicating, and the child is this and that, a lot of things. And then, in such a natural way, but without any expectation that something would happen, I asked a question. I said, okay, this child is healthy, by the way, he eats well, he sleeps. And then he said, wow, he doesn't sleep. What does that mean? He doesn't sleep? So they said no, a six-year-old child was beaten on the hands of his parents. She is abusing his mother. And then she, quietly, quietly, like a baby, she put him in the bed. This happens around 12. And then she tells me I have 10 minutes to do, a workout to get ready to do, because I know that at 12.30, maximum one she wakes up again.

דר אורית סטולר : 13:55

And, in short, I saw a family in distress. His animals don't sleep at all at home. They went to sleep at the house of his grandmother who lives not far. A couple of parents whose mother left work. First of all a woman with depression, a pediatric patient, the father. I asked him tell me a little so he was sure he would get a promotion, but he did not succeed in achieving the promotion. All the friends who were in his position, he was no longer in touch with them.

דר אורית סטולר : 14:21

In short, a family in distress. And then I said they left everything. First of all, let's take care of the sleep, because a child doesn't sleep. He says that the whole family doesn't sleep. And if the whole family doesn't sleep, how can they act? And then I went and looked and you see studies that show Clearly that sleep disorders Affect or one of the parents who doesn't work. They work from home. There is a lot more anxiety, depression, anxiety. There is a lot more use of psychiatric drugs in the parents and the children. The probability of children with children who don't sleep is much higher than in the other parents. So I understood that. From my point of view, when we talk about autism, this is the emergency situation. This is a, so because of that, it's very important for me to be here, and because of that we meet.

אנה אברהמי : 15:27

Wow, because I don't know how, at least once a month, a parent who takes a baby and goes to the streets and starts crying Because from the moment he starts with urology and all the fever and all that attacks it Again. That's why this podcast exists and everyone says that time is the most important. But you see, it's only half a year and it's about sleep. I can't Not agree with you more. And it's exactly. I always say it. It's like it's against the Geneva Agreement.

דר אורית סטולר : 16:11

That is, they hold you in a bed, not human.

אנה אברהמי : 16:15

it's impossible not to sleep, and I also advise sleep for babies. So I also decided to come to my family and just see how, all of a sudden, everyone starts to be more healthy after two or three months.

דר אורית סטולר : 16:29

No, it's amazing because when you think about sleep, we spend a third of our lives in sleep. That is, if a person lives 90 years, 30 years, he sleeps. When you understand these numbers, you understand that we sleep so much. And then the question is what happens there this year? Shema Yishen Kilo kshata mevin eta misparim eyle eta mevin sh'nachnu kol kach harbe zman yishenim v'az ha-shelay ma korey. Shama be'etzeh ba shena azoti Lama Z'lo rak anachnu Z'kol ha-chayot yishenot Afilo ha-dolfin yesh lo shnei mochot ve'mohach. What do you need to sleep? That's a question and it's a fascinating topic, because what we're, first of all, it's a topic that has been studied for 20 years. You see the trend of jobs that go and try to understand better all this subject of sleep. And when we talk about sleep, there are a few things you need to understand. Sleeping is not a privilege, it's something that is a need. It's a need on many levels, for example I'll give an example. For example, we know that let's say, a psalter player, someone who has a concert in a psalter. So the first thing they tell a person is to play your piece, go to sleep and get up tomorrow and you'll be much better. And there are amazing works that show the ability, for example, to give people some kind of routine of four days to study and then, for example, they do it at 10 in the morning, they do it at 10 in the evening and then they do it again at 10 in the morning and you really see the accuracy and the quality improve after the sleep. It's the issue of clarifying things. We know that in sleep there are constant processes in which memories turn into something that is lost, both memory and learning. It only happens in sleep. That is, if I want to study for a test, the best thing I need to do is read the material and go to sleep. This is the place where sleep, the material becomes mine. In fact, it goes through some process of loss in the right area of the brain which it remains with me. But I also want to connect this to other places, for example, cancer, right, so cancer and the immune system. Today we know that people who don't sleep get more sick and they have more cancer, more infectious diseases, for example, people who work in hospitals, for example, nurses and people like that.

דר אורית סטולר : 19:19

Shalom Yeter, machalot levaviyot Yeshe arbe yoter asmanah v'sakeret le'anashim shelo yeshenim V'dikaon v'shinuim b'matzav haruach ze barur shanachnu royim arbe yoter V'yesht ta'alich, norah ma'anyen, shigilu otorak v'shanim haachanot shani ani lo yatech, let'er otor v'. That is, there is a cleansing process Because what happens? The brain works, it needs a lot of energy In this process of energy consumption. We consume substances that the body does not need and it happens in the brain. This substance that happens is the substance that makes us feel the beauty, it makes us want to go to sleep. And what happens in the sleep? The cells in the brain, the CSF, absorb the brain and just make a sponge cleaning all this material that we have cleaned and we don't need and allows us to function.

אנה אברהמי : 20:12

Wow, and if we don't sleep, it's like passing a smart tooth instead of washing your teeth.

דר אורית סטולר : 20:17

Right, it's the easiest thing there is. And what are the advantages of that? Wow, that is. Sleeping is not a privilege, it's something that is a waste. People who don't sleep, their quality of life is less good, money problems. I always say, when I did support in children's medicine and I was in the hospital, yes, now, in our time, there were no demonstrations and there was no all Shalom. The child's mood is the same, right, the other thing I was in a movement all the time. I was afraid that if I sit I will fall and I ate junk. I ate everything on my hand just to stay in peace. The stone was damaged. The mood, the function, the mood. You are shorter, you are more annoying, you are impossible when you don't sleep.

אנה אברהמי : 21:51

So sleep is not a privilege and it's not a right, but it's a right. You're inevitably, I don't know.

דר אורית סטולר : 22:03

Right, right, no, totally. We also need to remember that for every age I'm still a pediatrician there is the number of hours of sleep that we need for them. That is, the number of hours of sleep for babies is different than for a child in the middle and we need to remember that for everyone. There are his recommendations. Within the recommendations there is a line. There is no right and no wrong. There are adults who have six hours of sleep and there are those who need eight or nine.

דר אורית סטולר : 22:31

So there is some kind of biological framework that exists. So if I need a little bit of sleep and let's say I can deal theoretically with, let's say, in the ideal world, I say I need six hours of sleep, I often benefit from the five, but I pay for it at some price, which is not always clear. Shana, when they reach my age there are other things. There is the transition age, there is hormone and there are other things that enter, that interfere. So the sleep problem is a bit different. But when they talk to me about children, I have to adapt the expectations to the age that is. You cannot expect an adult to sleep 12 hours.

אנה אברהמי : 23:20

You have to adapt it. Let's talk for a moment about how sleep habits are created and what needs to be done, for example, even in regular children. How does this mechanism be created? Besides, I'm tired, I'm tired, right.

דר אורית סטולר : 23:39

So first of all, we know that I'll divide it into two. There's the biological part and there's the environmental and behavioral part. There's the biological part and there's the environmental part. In the biological part, first of all, there are people who have genetic disorders that cause sleep disorders. Those are people who have a real damage to their DNA, which you see in families. For example, the issue of restless leg. It's something that runs in families. You see the parents like this, you see the children like this, and then it's another intervention, it's a violation of itself that you have to deal with.

דר אורית סטולר : 24:14

But if we're talking about sleep in general, there are a lot of systems that are involved in it. But the big things I'll put the big things and we won't look at the resolutions of the colnicin, but the big and not look like the results of the colonic acid. But in large, basically, in the area, if I go from the back inside, there is an area where there is a part of the brain that collects the light, what happens around, and actually releases to us a hormone called melatonin. Melatonin releases its Q or the release to the brain. ובעצם מפריש לנו הורמון שנקרא המלטונים. המלטונים משתחרר הוא הקיוש שלו או הגירוי לשחרור הוא הדברים הסביבתיים, שזה האור. אז אם אני רואה הרבה אור, אז המלטונים יורד. ואם אני נמצאת במקום חשוך, וזה, אז זה יירד, למשל to the airport. So there's fluorescent light. This fluorescent does an inabitia on the release of melatonin. Basically they don't want to be diluted on the airport floor. On the airport floor it's a place that doesn't have day and night. Actually.

אנה אברהמי : 25:17

Or that the employees don't do it intentionally so that we don't feel tired and don't go home.

דר אורית סטולר : 25:22

Right, right, so this is fluorescent, so the light is one place we have and the melatonin is what creates the beginning of the sleep or the entry into sleep. And we'll go back to melatonin because here we have a place to talk about it in terms of absorption. But there are other substances that are released. For example, as I said, let's say, physical activity, fatigue, also mental, let's say, if I'm very, very focused, then the body, the effort in the brain, releases this waste that I talked about earlier. Also, it, when the levels rise, is what makes us feel the fatigue. Because of that, we recommend people to do physical activity during the day, to be active, to create this material so that it will be useful to us, so that it will make our sleep better. So, in order to sleep, from a physiological point of view, you need to have no genetic problem. You need a biological clock that will work with sleep and sleep that is activated in the environment, and you need to be busy and active and create your first cues. But I want to talk a little bit about the things of the environment. ואתה צריך להיות עסוק ולהיות פעיל ולייצר את הסימנים ה-QOs הראשונים שלך. אבל אני רוצה לדבר מילה על הדברים של הסביבה ועל האורטיסטים, כמו שדיברת קודם כל. עכשיו אני אתחיל עם הילדים על הרצף. אחד הדברים שאנחנו רואים במחקרים זה שלהרבה מהילדים על הרצ, thank you, but you need to use it in a way. That's also in a way. That's also in a way. That's also in a way. That's also in a way. That's also in a way. That's also in a way. That's also in a way. That's also in a way. That's also in a way. That's also in a way. That's also in a way. That's also in a way. That's also in a way. That's also in a way. That's also in a way. That's also in a way. That's also in a way. That's also in a way. That's also in a way that's l'aider à la maison.

דר אורית סטולר : 27:42

מפחיד, תחשבו איזה פחד זה ללכת תישון. אתה רוצה מנעים ואתה לא יודע מה קורה. לך, מפחיד ממש. אז צריך להתאים את הסביבה, אז להכשיך את הבית, להוריד את הקצת, להתחיל לדבר בשקט יותר.

אנה אברהמי : 27:55

אי אפשר ללכת תישון כשכל הבית צועק. אני, I would have been quieter. I would not have done it with my film. No, but look, you have to create an environment that invites sleep.

דר אורית סטולר : 28:06

So one of the things I always tell the parents come on, keep the house okay, turn off the television. You need silence, you need to allow to feel Like, let's say, if you go to a spa, for example, something. When you go in, the smell, the light, the pressure goes down, everything will be quieter, you start to breathe slower, you feel healthy before they come to you, because what they do there, they put a dark room, they create an atmosphere that invites this peace. This needs to be brought home. So it's impossible't expect from a child that the parents are screaming and laughing and there's a mess and now you have to sleep, sleep there. It doesn't work like that. We'll lose. You can't force him to go to bed. You can force him to go to bed, but sleep is not. It won't work. I'm joking, huh. So the thing you need to do is to make the house feel good, to make the house feel good, to create air. When we talk about children with autism, it's very important the temperature, the sleep, the bed. Sometimes all you need to do is put on the child such a heavy sleep because he needs the weight from children who have a problem with their feeling, with their tactile, that they are always looking for a deep touch, that they are always looking. A heavy seed can solve part of the problem for us. For example, we need fences. Parents sometimes put fences that are not suitable. We sometimes need to put fences without too much pollution, something quiet and not right. First of all, let's start with that. There is nothing that includes everyone. Shalom T'argishu. Ma'a temperatura T'arichu ma'a temerifim T'staklu misaviv ve'az tegidu li ima davar haze mat'im Olai shama a ba'aya Haya a mishpacha she ba'a elay ve'asinu ta targil haze ve'istabe'a ve'a yeled kol pamוקר.

דר אורית סטולר : 30:24

כשאתה נכנסים לחדר, תצלמו את החדר שהוא הולך לישון ותצלמו את החדר שהוא קם. ומה ראינו בתמונה? שהאור של הפנס? רחוב נחבה, כן, נחבה. אז מה שהאבא עשה, חמוד בחיי, מה אנשים עושים לפעמים? הוא התקשר and asked them not to wear the mask because he could sleep.

דר אורית סטולר : 30:46

So listen, sometimes people do strange things, but we solved the problem of the outside light not being able to see until there was no outside light. So you have to look and see, right, you don't always need drugs, but sometimes you need environmental things. So first of all, you have to create the light, the temperature, the environmental conditions, and then there's the part of the routine. Every child, including me, I also believe that you, and certainly children on the train, love routine. Knowing what's keeping you is creating an anxiety and silence. We love routines because there's something predictable about it. So to create a routine around the sleep and you can use pictures that have the clear order and then to take off the velcro every time Now I clenched my teeth, now I washed, now I ate, now I'm reading a book and now I go to bed and go to sleep Okay, to turn it into a structured routine and a plan. That is there. Okay, that will disappear. It's the most terrible thing you need to do now.

אנה אברהמי : 32:06

But if things are like this, if they don't go out, it's some kind of circle with what you can't get out of.

דר אורית סטולר : 32:11

So we're starting a speech, anna, to say, wow, what fun we're going to sleep now. What fun for us. Do you know what fun it's going to be? We're going to rest, to sleep, to be relaxed.

אנה אברהמי : 32:25

That's the end you have to start with that, Although it's very interesting to me. I really feel like I'm starting to lose weight, Although I got my period today. No, but I want to say that you can remember all this, talk about the change in a positive way and organize the room and do this, and that you can do it when you have the strength as a parent. Okay, Because, for example, I'm in a kind of secret place that's been seen so far, and the house, everything is raw.

דר אורית סטולר : 33:08

I think that when I hear this voice, that it's a voice that I hear that the parents feel that there's no capacity to make any process, that they're tired, that they can't anymore, that they're no longer active. This is the stage that I do turn to medical intervention. Sometimes, okay, because I feel that there's no one to work. Sometimes, okay, because I feel like I don't have anyone to work with. Okay, you can't give a drug alone. But first of all, you have to feel a little bit and then. So let's talk a little bit about what options I have and how I think about drug treatment. First of all, it's not my preference. It's always my preference. There are a lot of people today who are sleep experts, who deserve to be approached and get advice. There are sleep advisors. A lot of them are in the market. There. There is no competition. I sometimes hear crazy things and there are some great ones and some you caught me, so I'm going to go back to what I was saying.

אנה אברהמי : 34:10

No, no, I'll say it. It's fine, you say it. I went to be a sleep assistant because I wanted to get rid of people to use Super Nanny's tools. Okay, and I like all this Dr Spock thing. He got it back. He got it back on his own, on this annoying method. Okay, the private units I did them for free and the groups I did them almost for free. I need this very much from the recommendations, from the things I personally. I have four children. I didn't believe in this way. First of all, I'll start with this. We're talking about cry it out. Yes, yes, I don't, for the sake of it.

דר אורית סטולר : 34:46

We're talking about this method of accommodation. Yes, we're not talking about this.

אנה אברהמי : 35:07

We're talking about this treatment method that they teach a baby when they put him in the room and they let him cry, and all the variations of the two minutes and the five minutes and to go back, all the variations are suffering and a real injury in the brain of the baby. Don't do it. I think it's a injury in the faith. It's a injury in the faith, ממשית במוח של התינוק. אל תעזור את זה.

דר אורית סטולר : 35:28

אני חושבת שזה פגיעה באמון, זה בעיקר זה, פגיעה באמון. אני אחלק את זה גם לשתיים. אני חושבת שהורים שבאים ואומרים שהילד לא ישם. ואז הם מספרים לי שהוא קם באמצע הלילה. ואז השאלה שלי כשאתה? When he comes to the bed, he falls asleep immediately. If they tell me, yes, he has no sleep problem, it's a problem with sleep habits. If he doesn't manage to fall asleep in the parents' bed, then it's already a sleep problem and then we have to talk about it. But if the child falls asleep in the parents' presence without a problem, it's a habit.

דר אורית סטולר : 36:06

Now, let's say, a parent comes and tells me first of all, I want to take a step back and talk. When we talk about sleep problems in children, but in autistic children in particular, first of all, it's very different. 80% of children on the chain have sleep problems. The difference between sleep problems of a child on the chain and a child with a development disorder, which is much less than that, let's say, in this regular population, about 5-6% of the children have sleep disorders. In children with disabilities, we're talking about 25%, 50%, depending on who you're talking to. In autistics, we're talking about 80%. But what's the difference? That for children, the recipe doesn't work if we don't hurry.

דר אורית סטולר : 36:40

That is, they also see adults who don't sleep, so we have to help them. Okay, when we talk about sleep problems, we talk about how many problems? Usually we talk about insomnia, which is difficult in sleep itself. There are sleep problems in other places that we will not talk about right now. There will be no time. When we talk about insomnia, we divide it into several parts. There are children who do not manage to sleep. They enter the bed and they do not sleep, and it can take an hour, an hour and a half, and they are waking up. They can't manage to relax themselves, they don't manage to breathe and get into sleep. And there are those who have biotic behavior that they don't manage to get into the room themselves which then you have to see how we increase the motivation and how we change the language.

דר אורית סטולר : 37:42

And there are those who just get up to destroy their mother and then they just leave the room every two minutes and run away Right. And then the question is why they do it and what is the reward? What do they get as a result of it? Yes, when you wake up and you can't go back to sleep, so that's a problem. And then we have the children who wake up very early, the early wakings.

דר אורית סטולר : 38:13

So first of all, let's talk about what to fix and what not to fix. First of all, we talked about every age has its own length of sleep that he needs to sleep. I expect a child to wake up in half an hour. I expect that after a year or two the child will have a routine of Shabbat Shalom and again, we expect that the waking up will be according to the time of sleep that he needs and not so early. That is a child who woke up at 5 in the morning. Of course there is some problem Now, when you talk about integration, it depends on where.

דר אורית סטולר : 39:01

So, for example, a child who woke up in the middle of the night and does not manage to wake up. So my first question is how? How did he sleep in the beginning? Because if I have a parent who tells me that he goes into the bed with the child and he hugs him on the back and he makes him feel nice, and that's how the child sleeps at 8 o'clock in the evening. So when he wakes up at 3 o'clock he's waiting for the same thing to go back to sleep.

אנה אברהמי : 39:26

He doesn't know how to sleep. This is in young people.

דר אורית סטולר : 39:27

young people not necessarily, if I take big children, even children say 7 or 8, if they're used to calming down with a screen, with an iPad, when they wake up at 3 in the morning they'll want their iPad and the iPad wakes them up. It hurts in the sleep. So the habits how you calm down at first, they want their iPad and the iPad wakes them up. It hurts in sleep. So the habits, how you sleep at first, will affect how you sleep in the middle of the night. When we talk about sleep, everyone has sleep cycles, all of us. All of us.

דר אורית סטולר : 40:03

Every hour and a half we reach a sleep stage that is between sleep and awareness. Okay, this flexibility, okay, when you have a partial awareness, it's not sleep. The brain waves, they're specific waves and you're a little aware of what's happening. You hear what's happening. Now, if I'm autistic and I have a sensory, sensory sensitivity, I'll be exhausted, exhausted at this stage and I don't have to go back to sleep because I wake up, I smell, I hear, I'm angry, everything. If I'm a person who has OCD and I'm obsessive, I had a girl who what she did was wake up. She would leave the bed, arrange the bed, arrange all her things, go back to bed and go to sleep. But it's too, את המיטה, מסדרת את כל הבובות שלה, חוזרת למיטה והולכת לישון.

דר אורית סטולר : 40:50

אבל זה יותר מדי פעולות בשביל לחזור לישון. אז אם יש מחשבות תורדניות, זה גם כן יכול לפגוע. זאת אומרת, אני צריכה כל מקרה לקחת ולפתוח אותו ולנסות להבין מה הסיבה שבגללו he doesn't manage to recover in the beginning, doesn't manage to recover first, or why did he get up early. And the intervention will be in the same there is behavioral intervention and then there is medical intervention for each of the situations.

אנה אברהמי : 41:15

So let's talk for a moment about things that can be taken and not done. I will ask you about the melatonin that we mentioned that does not come from a doctor, but from these kind of red-hot dogs that I know, without a label, in iHerb and in Israel it's no, no, no, and melatonin has to be labeled, right. So can you jump in if you know, if you're sure you know?

דר אורית סטולר : 41:43

So I want to talk first of all. Why is melatonin legal for children with autism? We said earlier, there is logic. After all, it's pretty safe and its safety profile is also very known. And it's also very safe, that is. I have no problem. It's something.

אנה אברהמי : 42:02

It's a coincidence that it's easy for me to give it to her, because I know she doesn't have any symptoms of HIV usually Because I know she doesn't have any symptoms of HIV in general and it's not familiar Because I had mothers that I knew. As you say, the woman doesn't sleep for five days. You can't give her pills from the stress and I brought her the melatonin and she didn't give it to her daughter because she was afraid it would cause her.

דר אורית סטולר : 42:26

So it's not. It's a natural substance. The body releases it. Now there's this market in the United States, in Canada, where they put it in OTC. They put it in the supermarket. In other words, in the United States you can go and buy milk, bread and melatonin and there are complete supplies. And I went to visit my family. There are little kids. They give every child a bottle before he goes to sleep and it's like something terrible in the mainstream there. I don't like it. Okay, it doesn't have to be like that. No, I don't like it.

דר אורית סטולר : 42:53

Now, one of the things that happens with this that it's OTC, that it's over the counter in the United States, and that's what you're inviting in iHerb is that there's no criticism about it. That means, do your job. Is that there is no discussion about it? That is, they did a job and took from a lot of companies and measured what is inside. Is there a connection between what is inside this jelly bean, inside this doobie, to what is written on the box? Are there differences between different boxes? There is no unity at all. That is, for example, there are patients who buy from IARP because it is much more expensive and it is very sensitive. These doobies are small. There are patients who buy L-Bi-I-R because it's much more sensitive and it's very dangerous. These pills or pills there are all kinds of methods it's very easy to give and then they contact me and say the child doesn't sleep. So I say, okay, buy again, invite again, because maybe the next class will have L-Bi-I-R and it won't. You know, there's no restriction. That means you can take one, 3 mg, l'macharat, 5 mg.

דר אורית סטולר : 43:50

אין על זה שום פיקוח. מה שבטוח. הדבר היחידי שהם מפקחים כשזה תוסף מזון בצורה כזאת, זה שזה יהיה בטוח שזה לא יכול להרוג את הילד. שאין בזה ריאלים, אבל אף אחד לא מפתיח שיש בפנים על בא� and the amount they say there is.

דר אורית סטולר : 44:03

But one of the things we know in melatonin and in sleep in general that the placebo effect has a very important place. So it also works. So I'm not against it. But I want to talk about what happens in Israel.

דר אורית סטולר : 44:22

In Israel you can get melatonin and you can get it in the form of syrup in a long-term preparation. And you can get melatonin and you can get it in the form of syrup in a raw preparation and you can get it in. So there is melatonin. You need to request it in a raw preparation, usually as syrup or there are small balls that you can swallow them or stick them. But there is this In Israel.

דר אורית סטולר : 44:42

It only takes a lot more. It's more complex, much simpler, much more easy to order it, recommend it in iHerb or through the internet. But in Israel there is a drug that I have been using a lot in recent years. It's called Sleneto, which is basically like a syringe. Those who have we know that they are over 55 years old with problems with their eyes they often get a syringe. That is melatonin in a liquid form.

דר אורית סטולר : 45:06

שמייל 55 עם בעיות שינה, הם מקבלים הרבה פעמים סירקדין שזה מלטונים בשחרור מושאה. זאת אומרת, שאתה לוקח את הכדור ויש שחרור של מלטונים בהתחלה שעוזר לך להיכנס לשינה, ואז יש שחרור איתי לאורך כל הלילה כדי לאפשר ל� Shabbat Shalom. First of all, it's rare we know exactly if I say there's 2 mg, there's 2 mg, I mean there's 5, because it's a drug and you get at first the 5 mg and then you get the 5 mg released at night and it really helps those who wake up at night. So in Israel the solutions for melatonin are actually 3 options. We have the online invitation and I don't cancel it. I'm not one of those who say Gewalt. No, I think if it works, it works. I can fully understand its advantage. It's easy to give it, it doesn't cost much. There are many advantages. There's the second option for children whose only problem is to enter the cell. Yes, from the.

דר אורית סטולר : 46:56

שפתרתי את הבעיה עם זה. וממצאים על זה די הרבה זמן. יש ילדים שבאיזשהו שלב פתאום זה מפסיק לעבוד. אז צריך לבדוק למה. אז אני עושה לפעמים חלון, שאני מפסיקה לתקופה קצרה ועד מחזרה, ואז זה חוזר לעבוד. אבל magiim lematzav she amalatonin ulo apitaron az yestanu pitronot nosofim aval ani kodem yishal otahana im yestachot sheilot legabe amalatonin vim no az ani yavor letipulim acherin Koimko ani rota lagid lach masho benogea le tzerkadin Ani lakachti otor ani rashmuli otor ki y Zaman mizman mizman At nisit parm.

אנה אברהמי : 47:38

Ahad liknot tzerkadin ba beit merkachet hem mitnayagim aleich kilu at konah heroin. Ken benora Le ritalin le inan shal ha ritalin hem nu hem choshdim pachot Ki katuv laim ki kshem lamedu ha rokachim ze amur laim. So when someone who is 30 years old comes to them, they say you're trying to get rid of it. You're trying to get rid of it and I stopped taking T-Rex. I just decided to do it once a month. It helped me. But all this matter is just and not here and yes, here. So who?

דר אורית סטולר : 48:12

There is no medical advice. I will say such a thing. There is no excuse. It's a decision that is economic. I think it's not doctor at all. There's no reason for that.

אנה אברהמי : 48:20

I know now. I had a sense of humor from my neurologist. I had a sense of humor in addition to the fact that I would present to them every time yes, she's conscious, and this is the matter of this bureaucracy sometimes and that's what I mean.

אנה אברהמי : 48:40

For example, if I go to some kind of network network store and there was a really nice seller there, I will always go to Facebook to write to them about it, and even if there was a really bad seller, I will also write to them about it, Because sometimes the business owner just doesn't understand why the businesses don't go. He just has a reminder that he doesn't like people. Anyway, leave it sorry. How do we convince them to take it Again? I think we have the potential for the dogs of iHerb here at home All of them, by the way and we need to move forward to something more pleasant and fun. And I don't convince not the big one and not the small one to take something that is not a dog at night, not the syrup and the balls. How do you have an experience?

דר אורית סטולר : 49:29

So, first of all, the boys, the company that created us for Neto, did a few things. One, they have a number of phones that you can call and there isיווי 24-7 או 8-8.

אנה אברהמי : 49:42

אני חושבת שהם עובדים אני חושבת אם זה היה 24-7, זה גיוני.

דר אורית סטולר : 49:49

אני חושבת ש אני יודעת שהם עובדים עד מאוחר בערב. אני לא זוכרת בדיוק את השעות, אבל צריך לבדוק. אבל פתחו קו חם כזה שיושבות שם אנשי. But they developed a hotline where professional people sit there who can help and hear the private story and try to help and do it. I can say from the clinic usually with the Sloneto there is no problem. That is, either I tell the parents to put it in a cup with milk, for example, so it is mixed, and then they just take a cup of milk or chocolate or something like that. It's a good idea. But I have to say that a lot of kids I've been using this sleneto for years and a lot of kids just take it. It's written, it's smaller than a cigarette. They just put it. The kids themselves take it and put it in their mouth.

דר אורית סטולר : 50:50

I have videos that parents sent me. There were parents who came and said how do I give it, is it possible? They came and said how do I give it, is it possible? And then I gave them all kinds of ideas and then after a while they send me a video. They say here, take this. He takes it, he puts it in his mouth and it's over. You know, sometimes we're in such a hurry and the child doesn't even care. It doesn't even move him. So the great thing is, it depends on how we approach it and what we say. Like that, without much, you have to do it simply, not to get into pressure before it happens at all. Do it simply like that you were a slaneto.

דר אורית סטולר : 51:26

I think you need a recommendation from a neurologist or a psychiatrist children, I think and then the family doctor can continue with it.

אנה אברהמי : 51:39

But it's also a problem because you can't solve it. But I just write it down. The meaning of it is 500 years and still to go and find this neuropsychologist.

דר אורית סטולר : 51:52

You're right. I don't know if today doctors have already developed it. We need to see if doctors today can write it down. It could be that if there's a diagnosis of autism in the system, if it's written ASD in the system, then it could be that children's doctors can also write it. I need to check it. I'll tell you.

אנה אברהמי : 52:10

I'll check it before I leave the show and I'll write it in the comments. There are no symptoms. What are the?

דר אורית סטולר : 52:17

symptoms. There are almost no symptoms. The things that cause anything, first of all, everything changes. And the things that cause them. They are not things that are consequent. That is, I cannot say, for example, that I give to a baby Ritalin. Then I can tell the baby I mean, I always tell the baby that there is a high chance that there will be a decrease in appetite, there will be a decrease. I can't say the same thing about the platonists. I can say it when I give Prosa, I can say it, I can say it when I give Trisperdal, but when I give the platonists there are all kinds of people parents, come to me sometimes and tell me things I don't know if it's related or not related.

דר אורית סטולר : 53:01

Look at the symptoms of the camomile. It's a fear of God because everything is written there. When I did the study Listen to me, this is weird I did a study on cannabis here. I'll tell you how do you write this list. It's a mess. I did a work on cannabis and a child was sick. He was sick probably because he had a virus, but I'll write it as a is possible because the child takes cannabis.

דר אורית סטולר : 53:25

So what do you do with this? So I already understood with time that the it's a good solution. It doesn't have to be the first solution. First of all, you have to do environmental behavioral things and I can recommend you to great women who are really professional people who can talk about it and give very smart advice in the field. But there are cases in which, like you, tia Ardana, when you tell me I'm tired, I haven't slept, אנשים את אומרת לי אני עייפה, אני כבר שנים לא ישנה, אין לי כוח, אין לי כוח.

דר אורית סטולר : 54:03

אז, במקרה הזה, אני אגיד בואי ניקח טיפול תרופתי, נשם קודם כל תשנים. ואחרי שאת ישנה, נכניס התערבות התנהגותית ונוריד. את זאת אומרת קודם כל, אני צריכה לייצר איזשהו שקט, מה שנקרא ולאפשר. אני רוצה לדבר על עוד אפשרויות, טיפול תרופתיות שקיימות. לא לכולם מלטונים עוזר.

דר אורית סטולר : 54:32

זה שאלה מה הבעיה? אם הילד הוא מאוד, מאוד חרדתי, למשל, או יש לו אובססיות מאוד משמעותיות או מחש, or he has very significant obsessions or extraordinary thoughts, it's not certain that the melatonin will solve the problem. In such a case I have to look at what happens all day long. And if the child is constantly in anxiety, in obsessions and constantly in a loop with himself, the melatonin will not solve the problem. Maybe he will calm down, but when he wakes up he is not sure that it will help. And then the intervention needs to be in a different group, because I need to treat what leaves him the air, the fever.

דר אורית סטולר : 55:11

So I would go to another treatment. I would go, for example, to Esus Arise, like Prozac or things, if the child is in constant silence. That is, he is one of those children who the knowledge of these children, who are constantly in motion, constantly in silence. They are not able to base themselves at any stage of the day. So why would they base themselves at night? That is, they are not able to reach this state. This silence is so internal that then I would go to a group of other drugs, I would maybe drink a resperdal.

דר אורית סטולר : 55:40

הם לא מצליחים להגיע לרוגע הזה. האי שקט הזה הוא כל כך פנימי. שאז הייתי הולכת לקבוצה של תרופות אחרות, הייתי אולי שוקלת ריס פרדל, אולי הייתי לוקחת קנאביס רפואי, אולי הריפלי. הייתי הולכת לקבוצת תרופות שהיא שונה ז. The problem of sleep is visible to what is happening during the day and then the intervention will be if I have a child who is quiet, or a very violent child or a child, so the resperdal may also break me all day, but it will also allow the child to sleep and I will improve it. Because a child who does not sleep we have already said so there are more behavioral problems, more violence. There is more cognitive damage, memory problems, problems with memory, problems with money, problems with language, problems with growth, because the growth hormone is released. That means you have to look at the child as a whole and see if I can. If it's just sleep, then I usually go to the platonist as a first choice.

אנה אברהמי : 56:34

Wow, okay, but well, but to go and try, because that's what we want. I want to encourage our sponsors to do Not to say it doesn't suit me, not to say I don't give doctors a chance not to say that To go and check and try and understand what the price is. In the end they will think that this podcast will be a dream by doctors' companies or something like that, because we just recorded a episode about Ritalin that I encourage you to try.

דר אורית סטולר : 57:16

Don't say no is. I want to clarify something. I believe that sleep disorders need to be solved. With sleep disorders we need to change the environment, the routines, the routines. That's the solution.

דר אורית סטולר : 57:30

I don't like children on medical treatments. I think our job as parents is to give them a basket of drugs so they can live and develop without the addition of chemicals. But when I hear you, kilim kidei sheim yukhlu lichyod vlitpatech blit ossefet shel chimikalim Aval kshani shomat otach betor dugma she dibra karega az biga ze igati la tipul atrofati Veaz yeshamu trofot Aval ani ruta nora chashuv li lagid od mila Vim yesh meser shani ruta laavir Shabbat Shalom Shema Shirot o'er. It could be that he has, ah, it could be that he has obstructive sleep apnea, that he has a problem with breathing at all, that he's blocking such a sleep, that there is so the intervention in these cases. Or it could be that he has epilepsy. It could also be or allergies.

דר אורית סטולר : 58:31

I have a daughter who suffers from atopic dermatitis, asthma of the skin. Listen, it's hurting you, I'm going to get a haircut. You get up in the middle of the night and you get a haircut. The treatment is not melatonin, it's not Risperdal, it's not Ariplai, it's to treat the skin. Children with reflux. The treatment is not melatonin, it's not Risperdal, it's not antacids. It's to treat the reflux, it's to give them antacids or to increase the bed. So we have to remember and if there's something I want you to take from today, from this conversation of ours, that children on the chain are first of all children and they can have sleep problems because of children, stubbornness, go to bed when you're stubborn.

דר אורית סטולר : 59:16

I wake up sometimes with a headache. It's terrible, it's unbearable.

אנה אברהמי : 59:26

So we have to deal with it. Udi Kargan has a great part in the stand-up where he says he ate a lot of pizza before bed and then he wakes up. And he wakes up from half a hangover, half something, and he says it's exactly that, dr Orit Stoller. Thank you so much. It's been a pleasure. Thank you for the opportunity. It was really exciting and also free and also funny and also very, very inspiring.

דר אורית סטולר : 59:50

I just have to say thank you, dana, first of all, for the opportunity to be part of your initiative. I think it's all very important. I think there's no one like an experienced owner. The ability to bring all this and to allow a platform for people to get information is something that everyone needs information from elsewhere. It's a platform that is suitable for some people and it's wonderful. So keep doing it and thank you, tamshi filasoto ve'kuda.