Sleepless Nights: What to do When your Baby Just Won’t Stay Asleep
by
Magdalena Ball

Everyone asks the same question of new parents – “Is he or she good?”, meaning, does your baby sleep well? People joke about sleepless nights and experienced parents smile enigmatically, but babies who don’t sleep can bring their parents to the brink of despair. parents can often feel like failures when their babies don’t sleep. So what can you do if you are one of the reputed 1 in 3 parents whose children don’t sleep like angels through the night? Well, firstly, be glad you live in Australia, where there are lots of free services available to help you. Secondly, take advantage of those services. The many clinics, health professionals, hotlines, books and web pages are there to help. Some of these are detailed below. In the meantime, there are a range of techniques you can try, and even if you end up seeking help, it is useful to know what the different theories are and how they are applied. In this article I will try to present a brief overview of the different techniques and options for extra assistance, hopefully to help sleep deprived parents to at least decide on a way of moving forward with their sleepless angels.

Sleeplessness is Common and Normal

Night waking is normal. It is important for parents to recognise this and stop beating themselves up over their waking problems. Babies under 6 months often wake at night for nutrition, since their little stomachs are not able to hold enough to sustain them for more than 4 hours maximum. There is a suggestion that babies who wake more frequently are also at less risk of SIDS (www.parentsoup.com), and that “the human infant may need the stimulation of night wakings to assist with normal neurologic function that controls breathing. (McKenna 1993) “ Babies who feed during the night will likely help minimise maternal fertility, so there is a beneficial side to night waking and it is definitely not something which should be seen as abnormal. From 6 months on there is teething pain, separation anxiety and perhaps a few nightmares from things which are scary in books and on television. Getting used to digesting solids can often cause discomfort, especially as new foods are introduced. This is why many sleep problems settle down by 18 months to 2 years when the teething ends and digestive system is fairly robust.

Establishing a Routine

One of the simplest ways to address your child’s sleep problems is to ‘learn about sleep cues’ – those regular routine things used to get your child to sleep and keep him or her that way. Things such as a dark room, a particular bed, a cuddly toy, a dummy, particular music or even a good night kiss and patting are all recommended. Some suggestions include:

Having a set time to go to bed.
Establishing a consistent bedtime routine, such as taking a bath, putting on pyjamas, brushing teeth, going to the bathroom, telling a story, etc,
Make sure the bedtime environment is consistent all night long.
Playing quiet games, stories, or singing soft songs
Having a regular night-time bath
Wrapping
Music (see below)

Some other easy to try suggestions

Limit the Dummy
You could try limiting the use of a dummy during the day, as they may cause your baby to have less daytime milk and therefore be hungrier at night.

Baby Massage
The American Academy of Paediatrics (AAP) suggest that massage can help improve sleeplessness in babies. There are courses run at many baby health clinics or you can book into a private centre, get a book out of the library or just follow these instructions: Gently stroke and knead on three regions of a child's body: the face, neck, head and shoulders; the arms and hands; and the back, legs and feet. You can also try some massage oil (or just olive oil).

Bed Sharing
In many non-Western countries babies sleep with their parents. Benefits include easy breastfeeding, extra bonding time (especially important for working parents), and coordination of sleep cycles. If your child actually sleeps as a result, the benefits are obvious. Some babies still wake though and this can be very disrupting, especially when only one parent was disrupted before.

Music
You can purchase one of the special tapes or CDs made just for this purpose or just put on some gentle classical music or softly sung songs. If you use the same songs over and over kids will immediately associate the music with bedtime, which helps in establishing that crucial routine.

Motion
Does your child always go to sleep in the car? Gentle motion often calms babies. A motorised crib (Infantcare’s Soothe ‘n’ Snooze or Mother’s Dream Babysleepers) or swinging seat or baby sling can often help.

Make sure your child is sleepy
This involves knowing the signs of sleepiness (see below for some references which cover this).

The big behavioural change – Controlled Crying

There are differing degrees and names, but the basic process is the same. You use a behavioural training process to teach children to put themselves to sleep, rather than rely on comfort from their parents. It is definitely the most advocated method by health professionals. These experts, and the many authors who have written on the topic such as Dr Richard Ferber and Dr Brian Symons (whose method described in the book Silent Nights was successfully roadtested on A Current Affair) suggest that the baby needs to learn to get to sleep by his/her self. For many parents, the pain and even danger of sleepless nights outweighs the short term pain involved in going through the process of controlled crying. Not all sleep problems are behavioural though. If your child seems unhappy or cries a lot during the day, it is worth getting him or her checked for common ailments like reflux, allergies or an inguinal hernia, especially if you are contemplating some form of crying it out, which can worsen these conditions. Also Controlled Crying is generally not recommended for babies under 3 months, who are too young to get into a fixed routine and need lots of regular feeds.

The basic process is as follows: after following a set routine such as the ones described above, put baby in bed, tuck in, say ‘good night’ and leave. When he cries, leave him for a set time (5-10 minutes on average, although the times do vary amongst experts), then go back, ‘check’ him, tuck him in and leave. Do not pick your baby up. Do this until he or she goes to sleep. Some methods advocate increasing the time intervals. If your child gets up, follow same repetitive phrase and tone of voice and put back to bed. If baby wakes in the night, do exactly the same as before. As I’ve mentioned before, consistency is critical, and be prepared for a battle of wills.

A more gentle method is to stay and sit by the cot or bed, stroking and patting as necessary. Over the next few nights gradually stroke/pat for shorter periods and move yourself closer to the door.

When you are at your wits end

Tresillian offers phone counselling for Sydneysiders on 02 97875255 or outside of Sydney on 1800657357. They do have a very well respected in-house stay service which allows parents to stay for one to three days. You need a referral for this from some sort of health professional (baby health nurse or doctor) but the stay itself and all services provided are free. You will be allowed to get some sleep and hands-on personalised assistance will be provided to help teach you and your child the best way to get sleep.

Family Care Cottages If you live outside of Sydney it might not be that easy to get to Trisillian or Karitane, especially if you have other older children to care for. There are Family Care Cottages attached to a number of local hospitals. Call the hospital near you and ask if there is a Family Care Cottage. They offer similar services to Tresillian and Karitane.

Sleep Clinics Most major hospitals have a sleep clinic (usually part of the Respiratory department) and can provide counselling or targeted help. Some offer overnight stays. Some of these clinics might focus on problems like Sleep Apnoea or sleeping disorders in adults, so best to check first. If you call your local hospital they can provide guidance.

Karitane is similar to Tresillian and offers phone counselling on Sydney (02) 97941852 or outside of Sydney phone 1800 677 961. They have their own Family Care Cottages in Liverpool and Randwick which offer both young and older baby sleep problem assistance. Their web site on http://www.swsahs.nsw.gov.au/karitane/sleep.htm offers an outline of their sleep program in large scale charts and a fair amount of detail on dealing with sleep issues.

QE II Family Centre is part of Parentlink’s Postnatal referral service and they can help you find local support for your sleep problems, including information on the Family Care Cottages in your area. phone 02 62052000.

Products

There are lots of products targeted at sleep deprived parents and some of them make excessive claims for success. Here is a sample:

CDs
There are many CDs available to help your child to sleep. Sleep Baby Sleep – lullaies by Nicolette Larson can be ordered directly from Amazon on: http://www.amazon.com/exec/obidos/ASIN/B0000029FT/bananasinpyjamas/107-9381412-1137333

Music for Dreaming is a CD or Tape of continuous instrumental music made in Australia by specialist Cherie Ross. Ms Ross claims that this product is vastly superior to other types of music, using instruments chosen for their similarity to womb sounds, and is used in baby hospitals around the country. Visit http://www.birthbabiesbeyond.com.au/relaxation_music.htm or phone Cherie Ross on (03) 9867-8338.

If you are going to try massage, there are a number of massage oils available. The Weleda range’s Calendula oil is made specifically for babies and contains chamomile extracts and lavender oil. For more information or to order click on: http://www.puttingitright.com.au/calendulababyoil.htm

Jurlique’s Aromastone is an electric operated vaporiser which can be left on 24 hours a day for use in aromatherapy. Jurlique also carries a range of aromatherapy oils, massage oils and soothing bath products for babies. For more information visit their web site at http://www.jurlique.com.au/products/nursery.htm or phone them on 1800805286.

Baby and Sleep, the first six months (a family guidence video) offers help in recognising tired signs in babies, and makes suggestions on how to create a regular routine and interpret a baby’s cries. Price is $29.95 plus $4.95 postage Australia wide: http://www.babyandfamily.com/framesets/about.htm

Too Cool to Sleep is another video which suggests that 90% of unsettled babies are actually cold, and provides information on the symptoms of a cold baby and ways to address it. Cost is $A35.00 plus postage: http://home.vicnet.net.au/~eden/

You could also try Infant Calm, a product designed to assist with “infant insomnia and physical restlessness.” It contains Chamomile, Passionflower and Monkshood and is meant to be particularly helpful with teething. See: http://www.brauer.com.au/interface/base.htm for more information or to order.

Web sites offering advice

There are many web sites offering chats, advice and information. The big ones like parentsoup (www.parentsoup.com), Babyplace (www.baby-place.com), or Parents.com (www.parents.com) all provide information on sleep. Most also offer support groups, email lists and places to post queries or requests for help. There is also: http://www.parenting.nsw.gov.au/parents_0_2s.asp A nicely presented and printable Acrobat file on Sleep in the Preschool Years, including information on sleep cycles, causes of night waking and suggestions on what to do which don’t involve lots of crying.
http://www.ozemail.com.au/~dobeid/sleep.htm if you are having difficulties with cry it out techniques and want some moral support, or want to learn more about bed sleeping, check out the Australian Attachment Parenting website, where Controlled Crying is definitely taboo (warning, some of the opinions can tend toward the extreme, although I generally agree with their philosophies).
http://www.naturalchild.com/research/harvard_attention.html (Article from Harvard Gazette on potential damage from crying it out techniques)

About the author: Magdalena Ball is content manager for The Compulsive Reader, Preschool Entertainment, and is the author of The Art of Assessment: How to Review Anything. Her fiction, poetry, reviews, interviews, and essays have appeared in many on-line and print publications.