Solving my child's sleep problems

"In particular, there should be no sneaking about."

                 - Dr Richard Ferber, Solve Your Child's Sleep Problems

Ah. Ferber. Dr Richard Ferber. Richard. May I call you Richard?  I bet some people call you Dick, but let's not go there.

First of all, I am glad I read the book. It would have been easy to write off Ferber as the "CIO guy"; but as people have already commented, that description is actually inaccurate and somewhat unfair. Admittedly, going the Ferber route will almost invariably involve some crying; his basic approach involves changing the baby's learned behaviours and that usually entails a certain amount of resistance from the child.  However as I discovered, there is a lot more to it than simply letting the baby cry herself to sleep.

After he explains in some detail (but clearly, I thought) the biology of sleep; that is, how infant and adult sleep cycles work, Ferber goes on to identify possible causes of sleep problems. And there were three points here that made me go "a-ha!". Or at least, "Ah. Hmmm."    

Sleep associations:

You know, I had heard all about sleep associations almost as as soon as Botany was born. The post-natal group had a whole session on sleep, featuring dire predictions courtesy of the practice nurse. God forbid, you nursed the baby to sleep or drove around with her in the car seat! Because that would be the only way you'd ever get that kid to sleep! Then what would you do! You'd have to go out at 2am in the car!

I remember hearing all this and rolling my eyes, thinking it was a lot of complete bollocks. And sure enough, for the first five months or so, nursing to sleep worked a treat. OK, so she woke up sometimes about an hour after I put her down and I'd have to go back in and nurse her down again for ten mintues or so, and maybe another or twice a night, but she needed to eat anyway, and always went straight back down afterwards and what was all this fuss about sleep associations. Humpfh.

Except...oh. Right. Rolling over, etc, arrived and then it turned into waking three times a night or more and not going straight back down.

Enter Ferber. He uses a helpful analogy to explain what may be going on. Imagine you go to sleep every night with your cosy duvet and pillow, and then someone comes in while you are sleeping and  steals your pillow. Not only that, but they move your sleeping bod to the living room floor and lock you out of your bedroom. So when you wake up (as you will certainly do, since everyone experiences partial wakings during the night), you find yourself cold, uncomfy and pissed off- on the living room floor! And of course you'd be crying for someone to come let you back into your bedroom. Because how the hell are you supposed to sleep on the damn floor? Bastards stole your pillow!

Ferber's point is that it's a recipe for disaster when you use props such as nursing or rocking to get the baby to sleep, then quietly sneak away; because invariably, the wee one is disconcerted to wake up to find things have changed. His method stresses that the baby has to go to sleep, on her own, so that there are no nasty surprises later on in the night when she needs to put herself back to sleep. And you know- given the pattern of Botany's wake-ups, this suddenly made a lot of sense to me. (I know Pantley also talks about sleep associations but evidently not as clearly, since I didn't get it at all. Probably by that point I was glazed over from reading endless anecdotes about "her little Coleton".) 

So step one: change the sleep association. In other words, get Botany to go to sleep on her own in her cot without the boob- so that when she wakes in the night, she doesn't need the boob to go back down.

Night time feedings:

Stop feeding the baby! says Doc F.  His advice is that babies of a certain age can go for so many hours without food and don't need to be chowing down in the night. In fact, it may screw with their digestive systems and contribute to their sleeplessness. If the baby is waking up repeatedly for food, it may be because she has formed the habit of eating at those times. He says it's fine to go on feeding the baby if you want to, but it's a choice, not a biological necessity.

I confess I cringed a bit at this one. Again, not a new concept but one I resisted, because I am not totally comfortable with the the idea of some expert making sweeping generalisations about how much my daughter needs to eat. And if there is any doubt that she might be looking for a feed, I simply cannot bear to think of my baby lying there crying and hungry.  However, on closer reflection, I had to concede that in our case, he may be on the right track with this one, too. For some weeks now, Botany has been waking up bang on the hour of the dreamfeed, then barely eating anything. Same with the 4am wake up.

Step two- cut out all routine night feeds (for example the dreamfeed) and try to cut down on any other unnecessary feeds. At least, that is the theory. Unfortunately, and rather mindfuckingly, Ferber points out that at least intially when making this change, the baby WILL probably be hungry because she is used to eating (even if she doesn't NEED the food). Which brings me back to real unease at a possibly hungry baby lying there crying. Ferber does offer a method whereby you try to stretch the time between feeds-though it's not entirely clear how you are meant to fill the hours of interval with a wakeful, hungry baby. Cuddling? Crying? A rousing chorus of "Wheels on the Bus"?    

Sleep scheduling:

Firstly, take a reality check on how long the baby actually needs to sleep, sez our man Richard F. This idea of sleeping a full 12 hours a night, with three or so hours of napping during the day? Nope. According to the doctor, the average amount of sleep over a 24 hour period for a baby of Botany's age is about 13.5 hours. He claims most babies sleep about 10 hours a night and 2-3 hours during the day- but that can vary depending on the child and what sort of sleep schedule they are on. What I found useful here was to keep a rough log of Botany's sleep patterns for a couple of days to see how much (and when) she was actually asleep. The result startled me somewhat. She goes to bed about 6.45 pm every night. Factoring in all the wake-ups for night feeds, she was sleeping about 9 or so hours. Regardless of when she was last fed at night, her standard wake up time was about 5am, whereupon I would bring her into bed and we would all snooze until 7-7.30am. Overall, it works out at about 11.5 hours. Then three naps during the day of 45 minutes each. Result: she is sleeping an average number of hours (13.5ish) but the sleep is not as consolidated as it could be.

Step three: fiddle with the sleep schedule to see if night time sleep (and thereafter naps) can be possibly be consolidated. Ferber also stresses that any such changes need to take into account the schedule across the whole 24 hour period. It's not enough to, say, just move bedtime later. 

There we go- three succinct steps to sleep heaven!  Sounds so easy and straightforward, no?  Next time, I'll tell you how it's actually going.   

Comments

[Tor]

OK I have a question, for anyone who has done anything that involves your child not needing to feed through the night while you are breastfeeding - what happens to your supply?

We managed about 1 week of (baby-led) long time between nite feeds (6-9hrs). after a week it rebounded and he wanted to feed ALL THE TIME. day and nite. a month later we are averaging 3.5hrs between feeds (a bit longer during day and shorter during nite) and i am exhausted. So am needing to implement some kinda plan but am worried i might start drying up again. (no it didnt seem like his growth spurts.) So what happens to your supply if you fairly quickly do from frequent feeds to long gaps between?

[Bittermama]

Thanks for the great summary of the key points. What brought me around to some form of CIO for both of my babes was reading a lot about the science of sleep and deciding that getting them sufficient sleep was more important than giving them my constant comforting in the middle of the night. It was hard for several nights, but they're both fantastic sleepers now.

I sometimes wonder if my terrible insomnia may be related to the fact that my mom rocked/patted me to sleep until I was... well... in high school maybe? Now I wake in the middle of the night and can't get back to sleep for anything!

[Carla Hinkle]

First off, I am glad you are getting some tools to attack Botany's sleep problems. A non-sleeping baby can just about send you to the looney bin (or at least me!)

On sleep associations/"props" (Baby Whisperer's term): The thing is, I don't think props are necessaryily evil. I am all for props if they are working. Sometimes they work well for a long time ... it is only when they stop working that they become a problem.

Example: my older daughter. I rocked her to sleep, for naps and bedtime, until she was about a year old, when she didn't seem to want it any more. Yes, it was a prop, but it worked like a charm until it wasn't necessary. And she very, very rarely woke up and needed to be rocked back to sleep again after about 4 months old.

Because of this experience, I am bothered by the idea (Ferber isn't the only one who has it) that a baby *must* go to sleep itself, or that baby's sleep is forever doomed. It implies that we can "ruin" a potentially "good" baby, who sleeps well, which I just don't buy.

Anyway. I just wanted to say don't feel bad if you don't succeed entirely in consolidating Botany's sleep, but great if you do. I think some babies are more receptive to tinkering with their sleep, some are much less. (My 2 girls are a great example of this, older slept like a top all night once I introduced the dream feed, younger never did and in fact at 13 months still really doesn't. C'est la vie.)

[Sarah]

Good luck! I know of a few families that have been really helped by this method.

[daysgoby]

You are so smart to really read all this stuff - we read a couple of magazine articles and went at it.

(Pipe down, you there in the back. It worked. And my big healthy six year old does NOT feel neglected or abandoned or whatnot.)

[Timi]

Hi, I think I'm delurking, I don't remember if I've commented before, but I've been reading you forever. Anyway...

My daughter is still really young (3.5 months) so things may go to hell at any moment, but until now we have been doing things very similarly to you guys. Nurse her until she's knocked out and then sneak her into bed. Even though I read the theory about sleep (the book Baby 411 has a nice succinct version of Ferber which is great to read just to give you a heads up about how things work, even when your kid is really little), and I have to admit it makes a lot of sense to me, but I also figured don't fix what isn't broken. So we continued that way until this week when we just couldn't sneak her into bed for the life of us, she would wake up if not when we put her down than about 15 minutes later. So, we decided to try to get her to fall asleep in the crib, we just had no other option. We've been successful about 4 nights in a row now, we still sing and stuff, but I figure baby steps since she's too young for sleep training. What's my point? I'm not sure, just that I relate to where you're coming from. And I hope the new knowledge helps you guys out. I hate hearing my baby cry but the Ferber stuff really makes sense to me.
And in response to Tor, my daughter started sleeping for pretty big chunks of time at about 2 months (don't worry, I'm pretty sure it's a fluke and it will stop once she becomes more aware of her environment) and my supply doesn't seem to have been effected by the lack of nursing at night. The first couple long nights my boobs got really full and leaky and hurt, so I started pumping a bit before I went to bed (always nice to have some in the freezer) and it was fine. I don't feel like it changed my supply because she then nursed more at other points during the day to keep it up.

[B. Mare]

Tor- how old is your baby? I haven't noticed a big increase in the day feeds to compensate yet but then again we are onto solids now, which may be a factor. Also, as a rule of thumb, Botany has always been a big eater during the day (god knows where she puts it) so maybe I just haven't noticed.

Carla- Oh yes, I totally agree with you on the props. I do think some babies don't need to learn to go down awake to learn to go to sleep themselves in this abrupt way- it just happens. And I would have been quite happy to keep nursing B. down if she hadn't been waking up. If it works, it works! . But it just took me a while to accept that actually, it wasn't working so great any more.

[laughing mommy]

Thanks for pointing out that Ferber is not the CIO villian everyone claims him to be. Reading his book is what changed my life... my girls are good sleepers now because of what I learned in that book.

[thalia]

I do so hope some of this works for you, the sleep thing is so debilitating!

[Tor]

whoops I thought I mentioned his age. Sorry. He's Just over 4 months now. He can't roll over yet. He has silent reflux, and managing that threw alot of our initial sleep & feed routines etc out the window. We established new ones but they stopped working after less than 2 months. So we ended up with the whole "whatever it takes", except nothing works for long and I am running out of ideas & sleep and feeding have been getting further and further from the lovely routines we had at 1 month old. He doesn't seem more grumpy or anything, but I am!
OH HE JUST ROLLED OVER! Right then! From back to front! YAY!! :D

[Kath]

Dear Mare, many thanks for that succinct summary. Ferber's ideas seem to make a lot of sense -- and I think we're going to have to go in that direction too, because Banana's nights (and hence ours) have become truly nightmarish. Last night my husband said he'd handle all the wakings, and I got five hours of (sort of) uninterrupted sleep while he got up *three times* to feed the baby. This morning at six, prior to a big nursing session, I noticed that she had drunk only 100 ml in all! It's obviously not real hunger.

Good luck to you! May your nights soon be filled with rest, and a peacefully sleeping Botany.

[Becky]

You really want to focus on the number of nursing sessions a day to ensure that baby isn't starving in the night and to help maintain your supply. Try for at least 8 feeds a day pre-solids and you will still want to keep at least 6-7 feeds after solids before they start really drinking other liquids to help be sure they are hydrated. And, I know Ferber and other pediatricians swear up and down that they don't need night feeds but I really think some babies do. Botany is giving you great signs that she is ready to drop the feedings but if your baby is still nursing frequently at night and during the day and is getting a good fill at each session he/she may still need to eat. We started making sure that Charlie went longer between sessions at night than during the day and then gradually lengthened the time between night nursings while offering more feedings and solids during the day.

The big thing you may find if you drop all night feeds, especially if you drop them abruptly is "a return of your fertility." And, remember that you often ovulate BEFORE your 1st period so use protection even if you haven't gotten one yet but baby is sleeping through the night or over 6 months old.

If you start noticing big supply problems, the ideal thing would be to add back in a feed between 4-6 am (when prolactin levels are highest) but you can also try just adding in a pumping session before bed.

Charlie is still far from a "sleeper" and we started Ferber 7 months ago but he has improved. Just know that there will be ups and downs and that you may have to "tweak" things occasionally. There are also normal sleep regressions periodically along with growth spurts, teething, etc. On the plus side, as Charlie has started getting the hang of sleeping, he, I think, has started sleeping more total since he doesn't have to be completely exhausted to go to sleep.

[Tor]

i'm dying to know how this is going for you?

[Laura]

Barren Mare, what's the next chapter? We're starting Ferber this weekend, and I just have to know what happened with Botany.