I've Moved!

Since the launch of my website (a couple months after this blog), I've been planning to integrate the two sites, but I never found the time/energy/know how/whatever it takes to actually make it happen.  Well, I finally did it as a part of a site redesign.  Now my blog is at www.everyonesleeps.com/blog.html

Come join us!

Sleep and Sick or Hurt Kids

I've been meaning to write on this topic for a while, but I never managed to get around to it.  There always seemed to be a more pressing issue to address.  Then, one of my 2.5 year-old twins made it personally relevant.  A little over a week ago, she fell off the top of a playground set at school, and she broke her leg – badly.  The officially diagnosis is a “displaced oblique fracture of the tibia.”  Basically, the larger, weight bearing bone in the lower part of her leg broke into two pieces, and the two pieces were not lined up.

Needless to say, she was in A LOT of pain, and it affected her sleep.  She needed her pain medication every 6 hours, and the medication didn’t fully cover the pain so didn’t sleep soundly even when she was medicated.  So, what did I do?  I did what any mommy would (and what I have told my clients to do); I took care of my baby!  I slept on the floor in the twins’ room (thank you Aerobed Inflatable mattress), and I set an alarm on my phone to make sure I gave her pain medication as soon as she was due.  I didn’t end up needing that alarm – she woke up crying.  Each time she woke, I held her hand, rubbed her back and head, and I reassured her that I was there.  Did I comfort her back to sleep? Yep!  It wasn’t appropriate to expect her to do it herself while in pain, so I didn’t.  That’s actually why I spend so much time going over client histories. We have to make sure the child isn’t hurting before we can expect independent sleep. 

 If you look at Maslow’s Hierarchy of Needs, it’s clear your child’s physical and security needs have to be satisfied BEFORE they can learn self-soothing and independence!

Playing in her chair

Thankfully, my little one is doing a lot better now.  

Getting a cast seemed to provide enough stability that she was finally able to relax, and she loves that it is bright pink (even if my husband thought she needed something more subdued!)  She is only taking Ibuprofen now, and she doesn’t even need that all the time.  She’s not going to be swimming for about 2 months, and she has a little wheelchair to use at school now, but she’ll be ok.

For a lot of families, the story would end there, and it’s very possible that they’d have a sleep problem.  The two nights of sleeping on the floor, soothing and comforting at every wake-up, may have caused the child to want to see Mommy in the middle of the night.  That was certainly the case with my little girl.  She asked me to sleep in her room, and she asked me to help her fall asleep.  So, how did I get her back to falling asleep independently and sleeping through the night again?  Extinction, also known as “cry it out” would certainly work.  She already had the skills, so it wouldn’t even take very long, but I wasn’t comfortable with a lot more crying after all she had just been through.  So, I did a modified version of the fading approach known as “The Sleep Lady Shuffle,” which allowed me to sit next her while she fell asleep on her own initially and then move away from her gradually.  Normally, this process takes about 2 weeks, but when you’re “reminding” a child how to sleep independently again, it’s only a couple days.  For my daughter, it took three days to get her back on track, and there weren’t many tears, just a lot of complaining. 

To answer the question I get regularly, please go to your child in the middle of the night if there is really something wrong!  If it's a minor issue with a clear resolution, like teething or a leg stuck in the rail, help him and then let him fall back to sleep on his own.  If it's something more significant that isn't easily resolved, like a broken leg or the stomach flu, parent through it.  Do what you need to do to make your baby feel better (even if your baby is 6 years old)!  As parents, loving and caring for our little ones is our primary responsibility.  (I'm sure I don't have to tell you that part though!)  Once the crisis has passed, however, it is critical that you help him return to sleeping independently.  Yes, he'll still want you to hold him and cuddle all night, but he doesn't NEED it anymore.  If you make it clear that the expectations haven't changed, your child will pick up on that very quickly, much faster than the first time you taught this skill.  Once again, it’s about consistency.  

I love my child, but I don't want to see her at 5am!

I recently posted a question on Facebook asking everyone for their biggest kid sleep challenge, and more than 2/3 of the answers came down to the same issue – early rising.  For children between 6 months and 6 years, an age-appropriate wake-up time is anytime from 6 to 8am, with the majority falling somewhere in the 7 o’clock hour.  Early rising is trying to start the day earlier than that, usually around 4 or 5am, and it’s no fun for any of us.  As adults, our bodies are secreting large quantities of hormones to keep us asleep a little longer so that we can reach our required 8 hours of sleep, and most kids haven’t gotten their 11 or so either.  So, what gives?  Why do they wake up, and more importantly, how can we make it stop?!

To get to the bottom this troublesome phenomenon, you have to start by understanding a little bit about sleep.  When a child “sleeps through the night,” he doesn’t actually stay asleep for 10-12 hours.  A sleep cycle, for anyone over 4 months old, is about 3 to 4 hours long, so he actually wakes up 2 or 3 times each night and has to fall back to sleep.  For most of us, this happens pretty seamlessly; we find the cold spot on the pillow or roll over, and we’re back to sleep without ever noticing we were awake in the first place.  However, that doesn’t always happen.  Think about when you wake up about 30 minutes before your alarm and just can’t get back to sleep.  For a lot of our kids, that’s exactly what causes early rising!    

Early rising is actually the first thing to go wrong when a child’s sleep starts to deteriorate and the last thing to improve when their sleep schedule is on the mend.  Here are the most common reasons we see our kids in the wee hours of the morning:     

• Going to bed too drowsy (or asleep) – The easiest time for a child to fall asleep is bedtime.  She has social cues, a calming bedtime routine, and even darkness to tell her it’s time.  Plus, her body is releasing melatonin that makes her calm, relaxed, and ready to sleep.  As the night progresses, each time she falls back to sleep is more difficult than the one that preceded it.  This is why it is SO important for your child to fall asleep independently at bedtime!  (That means, it should take her 10 to 15 minutes to fall asleep after you put her in her bed or crib!) If she doesn’t practice at the easiest time, it’s very likely she won’t be able to apply the skill at the most difficult time, 4 or 5 am.
• Going to bed too late – I know this is counter-intuitive, but keeping a child under 6 up late will only lead to an EARLIER wake up.  As we discussed before, your child’s body releases melatonin as his natural bedtime approaches to help him fall asleep.  (For the vast majority of kids between 6 months and 6 years old, that is between 6 and 8pm.)  Unfortunately, if you miss that time, the body releases cortisol to counteract the melatonin.  That hormone is what causes the overtired behavior that we all know too well (crying, hyperactivity, crankiness, inflexibility, unstable mood, etc).  It also makes is VERY difficult for your child to fall asleep, and it makes it even more difficult for him to fall back to sleep throughout the night.  For a lot of kids, that’s enough to make it TOO difficult in the wee hours of the morning!
• Staying awake too long between last nap and bedtime – This is very similar to the late bedtime problem.  For children under 15 months who are taking two naps a day, the time between waking up from the afternoon nap and falling asleep for bed should be no longer than 4 hours, and many younger kids are better with an even smaller interval.  Older toddlers and preschoolers who take only one nap can often go a bit longer, but it still should not exceed 5 hours.  Otherwise, you get that cortisol.
• Nap deprivation – This is another one that goes against a lot of the advice parents get.  Keeping your child awake during the day WILL NOT lead to better sleep!  In fact, it’s the complete opposite; nap deprivation can, and will lead to cortisol release, and completely disrupts nighttime sleep.  Plus, it usually makes for a really unhappy child and parent!
• Unintentionally reinforcing the early rising – Of course, none of us would do anything to encourage our child to wake up at 4am on purpose!  However, I’ve talked to many parents who go into desperation mode and “do whatever it takes” to get back in bed.  This has includes feeding, turning on the TV, bringing the child to the parents' bed, and giving high interest toys.  When we are half-asleep, this makes perfect sense because it lets us finish sleeping.   Other parents have decided to choose their battles and just get up for the day (and usually provide the aforementioned food or high interest toys).  Unfortunately, both of these strategies end up rewarding our child for waking up early.  Instead, it’s important to treat the early rising wake ups exactly the same way we treat a middle of the night waking.  I usually tell parents to pretend it’s 1am :-)

If you know that none of the reasons above apply to you, you may want to investigate medical conditions that affect sleep such as acidreflux, obstructive sleep apnea, and uncontrolled allergies, eczema, or asthma.  Any of these conditions can make it simply too difficult to fall back asleep that final time of the night.  If you suspect a medical cause for your child’s sleep difficulties, PLEASE consult with your pediatrician!

What if it doesn't work?

That's actually one of the more common questions that I get from families (and I suspect many others are thinking it!)  Thankfully, my clients have found that it usually does work, but there are times when problems come up that seem to make no sense.  Maybe we make a lot of progress (sleeping through the night, taking pretty good naps, etc), but we can't quite seem to get rid of those 5am wake ups.  Other times, a child just can't seem to nap longer than 30 minutes.  These puzzles usually have one of two solutions.  Either the child is getting mixed messages of some sort or we are dealing with an underlying medical condition.

Let's start with the mixed messages.  As I've said before, consistency REALLY is one of the biggest keys to sleep coaching.  Unfortunately, being consistent is much easier said than done.  As human beings we don't see the world in black and white, and we even more likely to see exceptions when it comes to our kids.  When I was teaching my girls to fall asleep at night, I freely admit that my mind went to all sorts of places when they woke up.  What if she is hungry?  What if her tummy hurts?  What if....  The bottom line is, it's actually a lot more compassionate to NOT pick them up/nurse them/bottle feed them in those moments of weakness.  It just sends mixed messages, confuses them, and leaves them unsure of what to expect in the middle of the night.  That leads to more wake ups and more crying.

Underlying medical conditions are a topic close to my heart right now.  My oldest daughter seemed to be sleeping perfectly.  She went to bed on time, stayed in her bed all night without calling out or seeming upset, got up at a reasonable time, and took great naps.  Unfortunately, she also seemed tired and cranky in the evenings, often woke up cranky, and never seemed well rested.  About a month ago, after some testing, we determined that she had mild Obstructive Sleep Apnea (OSA) and Restless Leg Syndrome (RLS).  Now that those conditions are being treated, she's a much happier little girl, and she's MUCH better rested.  Some other conditions that can really wreak havoc on sleep are acid reflux, allergies, asthma, and eczema.  Once we get those issues handled (by visiting the pediatrician), sleep success comes quickly!

HELP! My 10 month old wants to get up at 4:30 am!

My daughter is a pretty decent sleeper, most nights waking up only once (maybe twice) to nurse, then she goes right back to sleep. The problem is that after that late wakeup (generally around 4:30 or 5), she'll go back to sleep for thirty minutes and be up again. The only way to get her back to sleep then is to put her in bed with me and let her nurse the rest of the morning until 6:30 or 7. While these snuggles are quite wonderful, I'd like to actually, you know, get up and enjoy a cup of coffee in peace before the kids get up. It does get light here before 5 a.m. so I wondered if that was to blame. I hung dark curtains over her window for a week but she was still up early every day. She goes to bed at 7 pm so I don't think she's truly ready to be up for the day at 5. Especially when she'll go back to sleep in my bed for another hour and a half, or sometimes two. She gets between 2.5-3 hours of naps in per day. Any suggestions or do I need to suck it up?

Sara

Sara,

Early rising, which I define as waking up for the day before 6am, is one of the most common (and most frustrating) problems that I hear about as a sleep coach.  Thankfully, there are ways to stop it, so you do not need to "just suck it up!" 

To answer from a general perspective, here are the main causes of early rising.  See if any of them sound like they would apply to your situation.  Unfortunately, it only takes one in a lot of cases!

1.  Too late of a bedtime
2.  Putting your child to bed asleep (or too drowsy)
3.  Nap deprivation
4.  Too long of an awake period between the last nap of the day and bedtime

To your specific situation, she's 10, so she should be getting 11 hours at night and 3 or a little more during the day, spread over 2 naps.  It sounds like you're doing pretty well on that front, so #3 isn't sounding likely to me.  7pm is a perfectly reasonable bedtime, so that eliminates #1.  As for #4, she can probably go about 3.5 hours between her last nap and bedtime at 9 mos. 

Beyond this stuff, I'd direct you to blackout shades (which you've already done).  In a lot of cases, early awakenings are reinforced if you bring them to bed with you at that 4-5am time.  I can even start to slowly creep earlier!  So, I'd be careful about how you respond.  If you treat it the same as any other night waking, you're more likely to have success eliminating it!