Sleep Problems and Solutions
When that peaceful time of the night is constantly interrupted by your baby crying and you are exhausted and frustrated, it's time to say, "I have a problem with my baby's sleep pattern." Take heart, you can fix most of these sleep problems with some simple solutions.
Most healthy term infants can sleep 6 to 8 hours through the night between 4 to 6 months of age. This involves establishing daily eating and sleeping schedules while avoiding some common pitfalls that encourage night waking.
Average Sleep Needs
- Newborns: 16-20 hours a day, sleeping for 1-4 hours then awake for 1-2 hours
- 6 Months: 13-14 hours a day including 2 naps (2-4 hours)
- 1-3 year old: 12 hours a day and naps down to 1 per day (1-3 hours)
Realize that all infants wake several times a night as they go through normal sleep cycles. Sleep problems occur when an infant has not learned to settle himself and cries out for his parent to settle him. By learning to settle himself in the beginning of the evening, he develops the skills to settle himself when he wakes up later in the night.
Make the time before bedtime pleasant with gentle rocking and cuddling, but do not allow him to fall asleep in your arms. Place him in the crib awake and let him work himself to sleep. He may fuss, wanting more holding time. Avoid the temptation to pick him up.
Sleep Associations and Rituals
There are many activities and rituals associated with going to sleep. Once these routines have been established, any change in the pattern makes sleep more difficult. Examples of rituals for adults include putting on pajamas, lying on your side of the bed, fluffing up the pillow, maybe watching TV or reading a book and then turning out the lights. A change such as wearing street clothes to bed, sleeping in a chair, or keeping the lights on may seriously interfere with a good night's sleep.
Infants and children also have rituals and anything that interferes with their ritual disturbs their sleep. Your infant has to be able to do the rituals by himself to be able to go back to sleep in the middle of the night on his own. He can stretch and move to a comfortable position. He can find his thumb to suck on. He can cuddle up with his favorite blanket. But, if his rituals include falling asleep in your arms, sucking on the breast, bottle or pacifier, or being rocked to sleep, he will cry out for you to repeat his ritual to return to sleep.
Avoid infant sleep rituals that require you to be present. This means that you should not allow your baby to fall asleep sucking on a bottle or breast or being rocked to sleep. Feeding immediately before sleep increases night waking by stimulating the gut and altering hormone levels.
Trained Night Feeders
After about 4 months of age, and certainly by 6 months of age, a full-term healthy infant no longer needs to eat during the night. If an infant feeds every 1 to 2 hours during the day he learns to be hungry after two hours. This pattern will be continued into the night. Improve night sleep by extending the daytime feeding periods. By 4 to 6 months of age most infants can be on a schedule of 3 to 4 meals a day.
If you feed your baby in the middle of the night he will establish the pattern of being hungry in the middle of the night, though he does not need the nutrition. Until you stop the habit of night feeding he will cry in the middle of the night and expect you to get up and feed him.
There are two approaches to resolve this problem. The first is to stop night feeding cold turkey. This is effective and works the fastest. Some parents find this too harsh and feel guilty. The other approach is to gradually reduce the amount fed at night. If breast-feeding, reduce the feeding time by one or two minutes a night until the total feeding is eliminated. If bottle-feeding, reduce the amount of formula by one ounce per night or offer water.
An infant who goes to sleep sucking on a pacifier has a problem because the pacifier falls out of his mouth. When he wakes during normal sleep cycles he is unable to resettle himself without the pacifier. So, he cries out for you to come and replace the pacifier. Eliminating the pacifier will cure this sleep problem.
Recent studies have shown some decreased incidence of SIDS (Sudden Infant Death) in infants who use a pacifier and it is now recommended to use a pacifier when first placing a young infant to sleep, but it is not recommended that the pacifier be reinserted if it falls out.
As the incidence of SID decreases by 9 months of age the use of a pacifier would be less beneficial. An alternative to using a pacifier is to help your baby learn to suck her thumb which the infant can position during waking in the middle of the night. However, no studies have shown similar reduced incidents of SIDS in thumb suckers.
Infants love you as much during the night as during the day. They have no idea that you need sleep. They have learned that by crying they can make you appear. They use the same crying technique during the night or the day.
If you have decided to teach your infant to sleep through the night, you need to be prepared to listen to some crying. This often raises guilt feelings about not responding to your baby, but remember that in the end you will both be happier and also better rested.
Again, there are two approaches to eliminate night crying. The fast track is to place your infant down while still awake. Allow him to cry himself to sleep. Avoid all contact. Some particularly strong-willed children can cry for 1 1/2 hours or longer. Occasionally the infant will cry until he vomits. If this occurs simply clean up the mess but minimize your interactions. After several nights your infant will learn to settle himself within 10 to 15 minutes and often much faster.
The slower approach gradually extends the time that you allow your infant to cry. First, place your infant down awake. When he first begins to cry, wait five minutes before you respond. When you do respond, check and reassure yourself that he's okay. Minimize your interactions.
A few soothing words and a few calming strokes are adequate. Don't pick him up or turn on the lights. If he starts to cry again, add five minutes to your response time, which means this time you will wait 10 minutes before responding. Again, minimize your interactions. Each time your infant cries that night add an additional five minutes to the time before responding. On the second night go through the same process, but instead of responding the first time after five minutes of crying, wait 10 minutes.
Add five minutes to each additional response time afterwards. Each following night push the first response time back by an additional five minutes. This technique works well and usually takes five to seven days to teach your child to settle by himself. It is important to have a clock to tell how long to wait before responding. Five minutes of a crying infant can seem like half an hour.
Undertake this when you are determined to follow through. If there are two parents in the household, both have to agree to the program. It's tough enough listening to your baby crying, let alone listening to a partner criticize you for not responding to your crying infant. Stopping in the middle of the program is unfair to your baby and can make solving the sleep problems more difficult in the future.
Separation anxiety is common around 9-12 months of age. If your infant seems extremely fearful and panics when you leave the room, go in and reassure him that he is all right. Don't act upset or reinforce his fears. You may stroke his back but avoid lifting him out of the crib and holding him. Try to minimize your interactions. If you feel it is necessary, you may sit in the room for a short time. A dim night light may help. During the day, spend time playing and hugging to increase his security.
Night Terrors and Nightmares
Often around age 3, toddlers may develop sleep arousal disorders. During a NIGHT TERROR the child may scream, thrash, and have eyes open but not actually be awake. These may occur the same time each night. They are very distressing to witness. However, the children are not actually awake and will have no recall of the event the following day. The natural instinct is to try to awaken and comfort your child but interacting actually may prolong the night terror.
A NIGHTMARE on the other hand is a bad dream and the children are actually awake when they scream out. Comforting and reassurance is needed.
If your child is having difficulties contact your child's doctor's office for further advise.
Infants do not need to be changed in the middle of the night unless you are dealing with a significant diaper rash.
Double diapering or using super-absorbent diapers will reduce the wet, uncomfortable sensation. Changing diapers in the middle of the night will fully awaken the infant, making it more difficult to return to sleep.
- Remember to place your infant down to sleep while tired but still awake so she learns to settle herself
- Keep the sleep setting quiet
- Long naps during the day may contribute to sleep problems. Limit naps to two or three hours. If he naps three times a day reduce it to two. Try to keep the baby up longer in the evening before going for the long night sleep.
- Make an effort to get plenty of physical activity during the day. Lots of fresh air also encourages good sleep.
- Don't do lots of stimulating or tickling activity immediately prior to sleep. Set the stage for sleep with quiet activities such as a song or story.
- Avoid exposing your child to scary stories, television or movies
- Your child may be more comfortable with a night-light
- Sleep problems occur with illness, changes in the household such as visitors or a new baby and often upon returning from vacation
- Children with significant medical or neurological problems commonly have sleep problems and may require a different approach to sleep which can be guided by your doctor.
If you are unsuccessful in teaching your child to sleep through the night, contact your doctor's office.