30 01, 2017

Sleeping Through the Night; Two Mistakes Most Parents Make and How to Avoid Them

January 30th, 2017|Categories: Baby Sleep, Toddler Sleep|

Sleeping Through the Night

Whenever I teach workshops or talk to parent groups, I will hear “I just have a quick question-why isn’t my child sleeping through the night?”.

Although the question may be quick, the answer isn’t. It’s difficult to give a short summary in a sentence or two.

There are a plethora of reasons for night wakings, and in order to be able to offer advice, I need to know specifics about that child; age, personality, sleep temperament, napping routine, bedtime, plus more.

What’s Your Definition?

“Sleeping through the night” means something different to every parent. And it can look different at various ages.

We have different expectations for a four month old versus a four year old. The first one will likely still need to wake up to feed during the night, whereas the latter won’t.

If the four month old wakes up to eat twice a night but goes right back to sleep and overall sleeps 11-12 hours each night, I would consider that sleeping through the night. If the four year old did the same thing, I would not.

Keep in mind that children and adults alike, do not technically sleep straight through the night, without waking. We all wake up throughout our sleep cycles, however most of the time it is not a full, conscious, “gee, I’m awake and it’s 3am” type of waking.

We shift our position, get comfortable and go back to sleep. This will occur in children as well. This a normal and healthy sleep pattern. The trouble happens when a baby or child fully wakes up and signals, cries or calls for a parent multiple times a night.

A Tale of Two Culprits

But putting those details aside, and assuming a child is healthy, and I can summarize the two main mistakes that parents inadvertently make that can cause and encourage night wakings.

First, I want to preface the information with the caveat that you should always check with your child’s doctor if you believe there may be a medical reason for the sleep issues.

This can include (but is not limited to) severe reflux, poor weight gain due to breastfeeding difficulties, insufficient transfer of milk, tongue or lip ties, snoring, mouth breathing, food or environmental allergies, restless leg syndrome or obstructed sleep apnea.

If no medical issues are present, then one of the following two issues may be at play;

  • Sleep debt accumulation: the child is chronically sleep deprived and exhausted
  • Sleep Associations: the child is unable to fall asleep independently

What is a Sleep Debt?

Sleep debt is the cumulative effect of not getting enough sleep, and leaves your baby, toddler or preschooler feeling mentally worn-out, physically exhausted, and can dramatically impact their mood, thought, and behaviours.

In most cases sleep debt occurs when a child habitually does not get the required amount of sleep each day and night, leading to chronic sleep deprivation.

This occurs most often when children are;

  • being kept awake for too long during the day,
  • naps that may not be occurring at the right biological times,
  • or bedtimes that are too late.

A sleep debt can be thought of like a financial debt; the more money you take out, the greater the debt becomes. If you don’t replenish the money, the debt remains.

Similarly, the longer the child goes without the proper amount of rest, the more overtired they are and the bigger the sleep debt becomes.

In both examples, if the debt is large, making a small one-time deposit doesn’t clear up the debt.

How Do I Know if My Child Has Sleep Debt?

When children are overtired, they can get revved up as their body releases more stimulating hormones such as cortisol and adrenaline in an effort to counter the exhaustion.

It is common for parents to tell me that their toddler will have a ton of energy in the evening, or as they try to rock their baby to sleep, the child is crying in their arms, pushing away and arching their bodies. The harder the parent works, the harder the child resists the attempts to soothe her.

Being overtired also manifests itself as;

  • seemingly scared of or,
  • hating their crib/bed,
  • excess crying,
  • taking extended periods to go to sleep.
  • Appears to not be tired and acts hyper, almost manic
  • Clingy behavior
  • Unable to settle

Getting Out of Debt

Luckily, these issues can be resolved by adjusting the child’s routine so that they are getting more sleep. One of the easiest ways to do this is by moving bedtime earlier in the evening.

For children under the age of 5, regular bedtimes earlier than 7:30PM work best. If you suspect your child has a sleep debt, then moving bedtime up by 20 – 30 minutes may help them feel more rested.

Some children even need a bedtime closer to 45 minutes to an hour earlier. If you’re not sure, this wake time infographic below can help you determine the right bedtime for your child.

 

Can you guess what the number one follow up question is, when I suggest an earlier bedtime? Parents wonder if it means their child will now wake up earlier in the morning.

To that I say a resounding “no”.

The reason is that when a child is overtired, doing an earlier bedtime allows their brain to acquire more cycles of sleep, which is like putting money into their sleep bank and reducing the sleep debt.

Why Your Child Needs an Early Bed Time

During a child’s sleep, their brain cycles through REM and Non-REM (NREM) types of sleep.

REM sleep is light, active, helps to consolidate memories and results in dreaming.

NREM is a deep sleep that helps the body to repair itself, release growth hormones and helps to clear the sleep debt.

The structure of night time sleep is such that there are more cycles of the deep NREM sleep in the first part of the night than there are later on.

When a child is overtired, an early bedtime helps to take advantage of this.

When we put a child to bed too late, the potential maximum cycles of Non-Rem sleep that they could be receiving, is cut off.

Part of this is due to the fact that a child’s morning wake up time is biologically set. A young child that goes to bed at 7pm has a better night and more cycles of NREM than a child that goes to bed at 9pm.

They will both likely still wake up at the same time in the morning. And if they don’t, for many children, if they do sleep in (past 7/7:30am), it can be a red flag that their body is extremely overtired and the quality of their sleep is already compromised.

Naps Are Necessary For Sleeping Through the Night

How many of you have been given the advice to skip your child’s nap because it will help them sleep better at night?Did you know that doing so will almost guarantee the opposite to happen?

Ensuring your child is taking long, regular naps is a crucial component for a healthy, debt-free and sleeping though the night, routine.

This is much easier said than done, I know. Helping a child to nap better can be a challenge because it takes much longer for a child’s brain to consolidate naps than it does for night time sleep. Whereas night sleep starts to get on track within a week of dedicated work and problem solving, naps take closer to 2-3 weeks.

 

Get your FREE copy of HELP YOUR CHILD SLEEP THROUGH THE NIGHT, 5 TIPS EVERY PARENT NEEDS TO KNOW.

The good news is that it absolutely can be done! By maintaining a regular napping routine that matches a child’s natural sleep rhythm, we can help a child get the maximum amount of sleep cycles they need for a healthy nap.

The timing of when a nap happens is just as important as how long the child naps. This important fact is often overlooked when sleep problems are discussed.

To begin with, consider how long your child can stay awake in between naps. It will slightly increase the older your child gets, but only slightly.

For more tips on napping, see here and here.

The Skill of Falling Asleep Independently

The second area that commonly causes sleep problems in children over four months of age are sleep associations. Around four months of age your baby’s circadian rhythms will begin to mature, allowing your baby to develop the ability to fall asleep on their own. However, sometimes as parents we don’t realize that this transition is taking place. Out of love, we continue to “help” until our child becomes so dependent on our methods, that it feels like they “need” it to get to sleep.

These can include:

  • Physical stimulation, such as rocking, holding, or bouncing
  • External props, such as feeding, soothers, or bottles

When we begin to remove the extra help, this can produce tears of frustration in our little ones. If you’re a parent overwhelmed with sleep deprivation yourself, it can be difficult to recognize this. But keeping the context of the crying in mind can be helpful. If you’ve taken your child’s daytime routine into proper consideration, have fed and changed your child, then the crying that is happening is a result of being frustrated.

Consistency is Key

Once you’ve determined which external factors are at play you can start to remove them. This is the act of sleep training.

Sleep training is ONLY helpful in these situations. It does not fix a child that is waking and crying at night because of a poor daytime routine-that will continue to happen long after a sleep association has been weaned if the sleep debt is not first addressed.

Now, I know that the term most people are familiar with is Crying-It-Out (CIO) (AKA Extinction), but that isn’t your only option. You can choose to wean sleep associations slowly or quickly, depending on your preferences.

The key here is consistency: every day, every nap, every bedtime, and every night waking (minus the one or two that are for true nutritional purposes). For more information see my sleep training series here.

Ensuring that you remove bedtime “associations” not only helps establish a healthy bedtime pattern, but children who fall asleep without a sleep association experience better night sleep cycle transitions. This, combined with an age-appropriate daytime routine, in turns leads to children sleeping through the night.

Compare the dotted line with the solid line in the image below and you will see how a child that can move through sleep cycles easily has a deeper and more restorative sleep.

 

 

 

Removing all the sleep associations in the world won’t help if you don’t address an underlying sleep deficit and keep your child on a healthy sleep routine. It’s also important to introduce these changes during times when you are distraction-free and can focus on the task at hand, so avoid attempting to implement any changes during vacations, travel, when you are hosting visitors or doing home renovations.

If you find yourself slipping back into old habits then break the changes up into small, manageable steps. The easiest first step is to make sure that your child is napping at appropriate intervals, and that bedtime is consistent and meets their needs. This is the foundation for any sleep training that you may want to implement later on.

If you have a child that isn’t sleeping through the night, you may be too tired to make any changes yourself. Are you feeling overwhelmed and want someone to make a plan for you and guide you through the process? Book your consultation today and save yourself time and frustration or join me during one of my free Q and A sessions every Wednesday night from 8-9pm CST on the Baby Sleep 101 Facebook page.

 

 

18 02, 2015

Baby Sleep 101 Sleep Help: Free Online Sleep Advice for Baby and Child

February 18th, 2015|Categories: Baby Sleep, Preschooler Sleep, Toddler Sleep|Tags: |

Looking for free online sleep advice for your baby or child? Visit our Facebook page every Wednesday!

If you’re a parent looking for sleep advice, it can be a confusing endeavor. One book contradicts another book and they never seem to answer the questions you have for your situation. When you ask 5 friends for what they did, you get five different answers with 5 different personality types of children. It’s enough to make a tired parent go crazy!

Take heart, dear parents because tonight, and every Wednesday night at 8pm CST, you can get free help for your specific question on the Baby Sleep 101’s Facebook page.

All you need to do is “like” the page and the new Q and A thread at 8:00pm CST and post your question (one per person) and I’ll answer as many as I can within the hour in order of receipt.

See you there!

14 01, 2015

4 Month Sleep Regression: What It Is and How To Fix It

January 14th, 2015|Categories: 4 Month Sleep Regression, Baby Sleep|Tags: , , |

4 Month Sleep Regression

I get weekly emails from parents along the lines of ” Help! My once great sleeper hit the 4 month sleep regression and now she’s waking 4-6 times a night!”

Typically these parents had a great sleeper prior to four months of age, thought they had hit the baby sleep jackpot, and then out of nowhere, BAM, their child started waking multiple times a night.

Since many children experience the 4 month sleep regression, it’s helpful to have an explanation of why this occurs and how to stop problems from continuing.

What you need to know about the 4 month sleep regression

First, let me point out this sleep regression can happen anywhere between 3.5-5 months. This is a biological shift in how your child’s brain is organizing sleep, so like any milestone; sitting, crawling, talking, etc., this one tends to happen around a certain month, but will depend on your child’s development.

Second, it’s important to note that this isn’t a true regression. The term “regression” is a double edged sword; simultaneously explaining that things have gone backward, but yet filled with hope that sleep will once again return to your child.

However, your baby will never again sleep like they did before. This means that what can start as a “regression” can continue on for many months later if not tackled head on. (Cue the theme from Jaws 😉 )

If you’re like me with my first child who was sleeping 8-10 hours by 10 weeks old, this will seem depressing at first glance. However, if your child is similar to my second who was only clocking 3 hours straight at the most at the 3.5 month mark, then this may fill you with joy.

But here is the good news. Actually, I think it’s fantastic news;

After four months of age, your child’s sleep is becoming more mature and while they may not technically sleep the same anymore, it does mean that you have more control over the situation. You can have your great sleeper back or, start to work on your child’s poor sleep habits now by helping them learn how to consolidate sleep going forward.

 So, what happened? The 4 month sleep regression explained.

Prior to this milestone, your baby was having two immature sleep states; active and quiet sleep. However, as she progressed toward the four month mark, her sleep was developing and within the quiet stage, unbeknownst to you; multiple stages of sleep were evolving.

At two or three months, you were able to rock, hold, feed, or offer a pacifier to your little one and she would drift off and stay asleep. But as she made her way closer to the fourth month, you may have found yourself preforming these tasks more frequently through the night.

At first, feedings may have increased and attributing it to a growth spurt, you kept on feeding each time she woke, whether it was 1, 2 or 6 times a night. Or, you started to find that her pacifier needed to be replaced more frequently. You thought possibly she didn’t like that particular brand anymore and you bought her another.

But what was really going on, was that your little one was beginning to transition through sleep cycles. After 4 months of age, your child’s sleep is more like an adult’s and she has REM sleep (active, light or dreaming state) and Non-REM (deep, restorative, slow wave) sleep. One complete cycle is about 40-50 minutes long, depending on age.

Not only does the type of sleep mature, but after 4 months, the Non-Rem sleep has multiple stages (1-4) and that means that sleep associations can form.

During the first stage of the Non-Rem sleep, your child is aware or associates certain factors in her environment with how she falls asleep. Meaning, that if your child is being rocked/nursed/held/driven/bounced to sleep, or even to the very drowsy “I’m-soo-relaxed-that-I-can’t-keep-my-eyes-open” point, they will come to expect that each time one cycle is complete at the end of stage four, in order to be able to go back to sleep.

4 month old sleeepKeeping in mind that one cycle averages around 45 minutes in length, you will begin to understand why we start to see short naps and frequent night wakings emerge at this point.

If you’re a tired parent (are there any other kind?), you will likely do whatever it takes to get your little one back to sleep quickly. Very often this means feeding, rocking or replacing the pacifier back in.

Although this “works”, it is reinforcing the dependency on the sleep association and will actually perpetuate the problem as the development of sleep cycles is a permanent change in your child’s sleep.

 

Need help getting your child to sleep through the night after the four month sleep regression? Download the FREE sleep guide; Help Your Child Sleep Through the Night.

How to Fix the 4th Month Sleep Regression

We know that the sleep problems we see develop around 4 months of age are a result of a cognitive development and therefore not a true regression. This means that if we don’t address why the issues are happening, we can expect to see unhealthy sleep habits and unrestorative sleep for both baby and parent going forward. The longer both go without consolidated sleep, the more overtired they will become.

Here are some tips on how to prevent or fix the problems that may result after 4 months of age.

4 Month Sleep Regression Fix #1

Age Appropriate Schedule: Schedule, routine, pattern; call it what you will, but the greatest tip I can give you is to make sure your child is not being kept up longer than she can handle at this point; especially at bedtime. Your child is likely already overtired from the multiple night wakings, so respecting her need to sleep and have an earlier bedtime will be important to see success.

4 Month Sleep Regression Fix #2.

Wind Down Routine: If you haven’t already, begin to have a wind down routine in place before each sleep period. It’s important though that your child is now awake when you place her in the crib. This will be a new experience for her, so start your wind down earlier.

4 Month Sleep Regression Fix #3

Sleep Environment: After 4 months, your baby is becoming very aware of their surroundings and this includes when you want them to go to sleep. To encourage the most healthiest, deepest and restorative sleep, most sleep should be now taken in their crib.

4 Month Sleep Regression Fix #4

Encourage Full Feeds: Babies this age are increasingly curious about the world around them. It is very common for them to only nurse or feed for a minute or two and then stop to watch the cat run across the room or look at the tv when they hear a noise and then not return to feeding. This in turn can cause them to seek extra calories at night. To reverse this tendency, ensure that you are feeding your baby in an un-stimulating environment to minimize as much distraction as possible. Many parents have also found it beneficial to feed their baby first thing in the morning and then after each nap.

4 Month Sleep Regression Fix #5

Reduce Sleep Associations: When you’re ready, this is now a great time to begin to help your child fall asleep without relying on external help. After creating an age appropriate routine for them, you can choose a sleep training method that you feel comfortable maintaining consistently for a few weeks. At 4 months of age, she will still need 1-2 night feeds,  but all other wakings that aren’t a result of true hunger can be responded to with the sleep training method of your choice.

The 4 month sleep regression can be a tricky time to wade through for many parents. I hope these suggestions help you, but if you feel that you need more help, download the free sleep guide,

If you rather have personalized help to navigate through your unique situation book a 30 or 60 minute consultation call and we can get into even more detailed help.

 

29 09, 2014

Sleep Associations; What You Need To Know Before Sleep Training

September 29th, 2014|Categories: Baby Sleep, Sleep Training|

Sleep Associations; How do they Impact Sleep Training?

“Why sleep train?”

The term “sleep training” is a common one in the vernacular of new parents. It’s frequently discussed when parents talk about how tired they are and usually, everyone has an opinion about it, one way or another.

However, what is often overlooked in the discussion, is what caused the sleep issues to developed, triggering a parent to consider sleep training.

I have had clients tell me that they had friends, family and even strangers tell them that “this time passes so quickly”, or “they’re only young once, just enjoy it”, when they started to share their sleep struggles.

While these sentiments are usually well-intended, it can make a tired parent feel guilty or shameful for reaching out for help. Instead of reassuring  the parent, it can come across as trying to minimize the difficulties of sleep deprivation.

The good news  is that exceptional sleep habits can be introduced, but sometimes those well-meaning friends and family just don’t understand what causes the problem (and neither may you), and therefore don’t realize that “just wait and it’ll pass” isn’t always true.

Where Problems Usually Start

The need to help change sleep habits is usually born out of one or both of the following issues;

1. Lack of ,or ill-timed routine causing overtiredness

and/or

2. Sleep associations.

Both of these issues can be tackled after four months of age when a child’s circadian rhythms begin to mature. Prior to that you can follow the suggestions here and here.

To understand sleep associations (also called sleep props or crutches) one needs to have a basic understanding about the science of sleep and what happens to a baby’s sleep patterns around four months of age.

The Fourth Month Sleep “Regression”

Around four months of age, (in reality it could be anywhere from three to five months), parents may notice their child beginning to wake up more frequently at night and only catnap throughout the day. Often whatever “tools” used to work for the parents stop working or loose their efficiency. This time period is so common with parents around the world that the term “fourth month sleep regression” is a popular one.

However, this stage is not a regression at all, but rather an exciting and large cognitive development! (If you’re going through this right now, stay with me. I know it sounds crazy, but it’s true. 😉 )

The reason for these changes are all due to your child’s brain and the organization of sleep in the human body.

Prior to that fourth month mark, a baby’s sleep was quite immature and undeveloped. But after they move through the four month time frame, their sleep, in particular, their NREM sleep begins to develop into more of an adult-like cycle.

Sleep Cycles

Mature sleep patterns consist of both REM (active sleep) and Non-REM (deep sleep) patterns.Within the NREM sleep, after four months of age, children begin to cycle through four stages  like adults do, multiple times.  In the early months, one cycle is about 45 minutes in length and later matures to around 90 minutes.

A child will fall asleep in stage one, proceed through stages two, three and four (all getting progressively deeper stages of sleep) and then exit out of stage four. At this point they come to a transition point and have a partial awakening and either go back to sleep or wake up completely. For more information, see this awesome diagram here. It is at this transition point that many sleep issues begin to rear their head.

Why does this happen?

Two words: (cue the Jaws theme music here 😉 )

Sleep Associations

When that cognitive growth happened around the fourth month, a baby began to associate stage one (the falling asleep point) with certain conditions or environments. After every complete cycle, they then again needed those same conditions or environments to be present so they could fall back asleep. This is a normal part of human sleep. We all have sleep associations whether it be cool pillows, side sleeping or wanting blankets on or off.

But problems sometimes occur when the sleep association is something the parent must do for the child, instead of the child doing for themselves.

For example; if a child was rocked to sleep and then laid down in the crib,  they would have fallen asleep in stage one associating falling asleep with being rocked. Perhaps when they were three months old, it wasn’t an issue, but after their sleep patterns mature, each time they come out of stage four and try to re-enter into stage one, they will want to be rocked again to fall back asleep. If they aren’t, then that child would likely wake completely up and call for their parents.

Sleep Associations and Sleep Training

Since this association is reinforced repeatedly day and night, the child doesn’t learn how to transition independently. It is therefore inaccurate to say that this is a phase that will pass. Falling asleep unassisted is a learnt skill. If the sleep association doesn’t transfer from being parent-controlled to child-controlled, then it is likely to continue to interfere with sleep.

For some parents this isn’t a problem and for other families it is.

Sleep training would be an option for those families who would want to change those associations from something the parent is doing, to something the child can do for themselves.

Why Sleep Training Won’t Work

Sleep training does not work however, when a child is on a poor routine, being kept up too long and has a bedtime that is too late.

When children are overtired, they don’t go to sleep easily, nor do they have solid, deep and restorative sleep. Instead, multiple night wakings and short naps are present. Unfortunately these can also easily be confused with sleep association issues and often will lead people to say sleep training doesn’t work.

Sleep training also doesn’t mean that your child will never wake again at night. Sickness makes kids feel awful (just like in adults) and they tend to not sleep as well. Physical and cognitive milestones, and some even say teething, may also cause some bumps in the road of sleep. However, a well-rested and independent sleeper handles those bumps efficiently and quickly returns to sleeping solidly again after those events have passed.

When You’re Ready

Once you’re ready and are sure that you’re child’s night wakings or short naps are due to sleep associations, then it would be time to pick the sleep training method that you’re comfortable with and concentrate on changing those associations.  Changing sleep habits takes some time so it’s best to do it when you have a block of time to focus on it, but if you’re consistent your child can learn to get themselves to sleep and transition through sleep cycles independently!

Overtired or sleep associations? If you are confused about why your child is waking at night or taking short naps, Baby Sleep 101 can help with our FREE sleep guide.

22 08, 2014

Co-Sleeping To Crib: How to Make the Transition

August 22nd, 2014|Categories: Baby Sleep, Co-Sleeping, Toddler Sleep|Tags: |

Co-Sleeping.

It’s a concept sometimes loaded with controversy.

However, many families choose to do it-whether it is pre-planned and intentional, or reactive and out of desperation.

Regardless of the reason, if you are at the point where you are ready to transition your child from co-sleeping (bed-sharing) with you, to sleeping in their own space, you might be feeling a bit nervous. A thousand questions can pop into your mind, namely: How do I get from bed to crib as painlessly as possible?

As a pediatric sleep consultant, I’ve helped many parents successfully navigate through this transition. Although it can seem daunting at the start, having a plan in place will help ease your hesitations and see success.

Here are five tips to assist with the transition.

Rest Up For Success

Begin with ensuring that your child is well-rested. This one step is critical for a smooth transition, yet many parents fail to do it. An overtired child is going to resist sleeping in a new location a lot more AND have more night wakings, than a well-rested child. To prevent this, maintain a regular nap routine and keep bedtime early.

Agree on a Time

Next, talk with your partner and determine a date for when you would like your child in their own space. Having a goal will help you put your plan into action.

Create Positive Associations

Before making the switch to the new sleeping location, allow your child to spend some playtime in their crib every day. At first, when it is new to them, stay close and play games of peek-a-boo, or let them hang out with their favourite toy. As their confidence grows, leave the room for a few seconds to a few minutes to allow your child to get accustomed with being in that space independently.

Relocate

The next step is to move with your child into their room. Take a mattress to the floor of your child’s room and co-sleep in there for one to three nights. Move a little further away from your child each night during this phase.

Into the Crib

The final step is to put your child to sleep for the night in their crib. Once you do this, it is important to be consistent with it. Like any skill we teach our children, we can only expect them to be as consistent as we are. Taking them out after the first night waking and returning to co-sleeping is unfair to your child as it’s confusing. Have confidence in your child and trust that they can learn new skills!

Transitioning from co-sleeping to crib can seem challenging at first, but if you follow these tips, everyone will be sleeping happily in their own bed before you know it!

 

This article first appeared on  Modern Mama.

 

After you read the article, come back here and let us know in the comments below, what worked for you when you transitioned your little one.