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Frequent Night Wakings


These questions and answers are about children who tend to nightwake frequently. Some questions that you might find answers to are: Until What Age Are Nightwakings Appropriate?, My Child Sleeps Well During the Day So Why is He Nightwaking?


What is Disturbed Sleep?by Dr. Marc Weissbluth:

1. Abnormal sleep schedules (going to bed too late, sleeping too late in the morning, napping at the wrong times)

2. Brief sleep durations (not enough sleep overall)

3. Sleep Fragmentation (waking up too often)

4. Nap deprivation (no naps or brief naps)

5. Prolonged latency to sleep (taking a long time to fall asleep)

6. Too-active sleep (lots of tossing and turning)

7. Difficulty breathing during sleep

Night Waking is NOT Caused By (Dr. Marc Weissbluth):

1. Too much sugar in the diet

2. Hypoglycemia at night

3. Zinc deficiencies

4. Pinworms

5.Gastroesophageal reflux (which has been treated)

Teething, contrary to popular belief, does not cause night waking. If you asked parents what happens when teething occurs, the answer is...everything! All illnesses, fevers, and ear infections that happen to occur around the time a tooth erupts are blames on teething. Throughout medical history, doctors used the diagnosis "teething problems" as a smoke screen to hide their ignorance. In fact, at the end of the nineteenth century, 5 percent of deaths in children in England were attributed to teething.

A proper study of problems caused by eruption of teeth was performed in Finland in 1969. Based on daily visits and testing of 233 children between the ages of 4 and 30 months, it concluded that teething does not cause fevers, elevated white blood cell counts, or inflammation. And most important, teething does not cause nightwaking.

Nightwaking between the ages of six and eighteen months is more likely due to nap deprivation, overstimulation, or abnormal sleep schedules-not teething.

Growing pains also do not cause night waking. One study examined 2,178 children between six and nineteen years of age and found that 16 percent complained of severe pain localized deep in the arms and legs. Usually the pain was deep in the thighs, behind the knees, or in the calves. The pain usually occurred late in the afternoon or in the early evenings.

But when the growth rates of these affected children were compared to children without pain, there was no difference. In other words, growing pains do not occur during periods of rapid growth! Blaming night waking on growing pains is a handy excuse. But the rubbing, massaging, hot-water bottles, or other forms of parent soothing at night are really serving the emotional needs of the parent or child and not reducing organic pain.

Night Waking May Be Caused By:

1. Fever

2. Painful ear infections

3. Itching related to atopic dermatitis or eczema


OLDER CHILDREN

In one study of children between one and two years of age, about 20 percent woke up five or more times a week, while in another study of three-year-old children, 26 percent woke up at least three times a week. Unfortunately, you simply cannot assume that difficulty returning to sleep unassisted will magically go away. Returning to sleep unassisted is a learned skill; you should expect problems to persist in your child until she learns how to soothe herself back to sleep without your help.

Also, in the study of one-and two-year-olds children, those who woke up frequently were much more likely to incur an injury such as a broken bone or a cut requiring medical attention than those who slept through-while only 17 percent of good sleepers had injuries, 40 percent of the night wakers were injured!

The majority of children between the ages of one and five have a bedtime routine less than thirty minutes long, go to sleep with the lights off, and fall asleep less than thirty minutes after going to bed. Night waking occurs in the older children in this group once a week; only a few awaken once a night. If your child's pattern between the ages of one and five is substantially different, consider the possibility that your child is among the 20 percent of children in this group with disturbed sleep. If so, then you might also later notice the excessive daytime sleepiness that has been observed in about 5 percent to 10 percent of children between the ages of five and fourteen years.(to continue soon)

Questions For Over One Year of Age:

Question to Dr. Weissbluth from Parent Soup's Sleep Training Board

I'll fill you in on a few facts first. (2.5 years)1. She wakes up at about 7:45am 2. She naps once from about 1pm-2:30pm or 3pm 3. Her bedtime ritual consists of having a bath(8pm), then having a piece of fruit & milk and then reading to her 8:30 or 9. 4. Ear infections, construction on our house and moving to a new room have contributed to the problem. About 6 months ago the problem started. We were sleeping in our basement waiting to move into our new addition and she started to give us problems going to bed. She would cry and cry unless she could sleep with us in our bed. After she fell asleep, we would transfer her to her crib. Then in the middle of the night she would wake up once or twice (this became a habit with an ear infection at about 1.5 yrs of age). About mid December we moved into our addition and she got her own room with a "big bed". Then we would put her to bed, read her a book and let her play until she fell asleep. This worked great, she was sleeping and napping in her own room with my husband getting up in the middle of the night to put her back to sleep when she awoke. Then about mid to end of January she started coming out of her room and sneaking down the stairs at bedtime and would keep doing this(despite repeated returns to her room from husband and I until one of us would lie with her until she went to sleep (this has now become her ritual at naptime too). Almost always this would take 1 to 1.5 hrs to achieve (her bedtime hour is now 10 or 10:30). Then we asked the babysitter to cut her nap to 1 hr so that she would fall asleep earlier. This just made her the crabbiest female around with her bedtime still at 10 or 10:30 as she would lie there awake. We changed her naptime back as this was affecting her development. We then let her sleep with us as there were no bedtime squabbles this way and things were easier this way. She also doesn't wake up in the middle of the night in our bed. Now she gets up when we turn the lights out and won't lie down until we threaten her with taking a privilege away. With our 2nd on the way and due in June I would like to have her sleeping in her own room soon. I would also like some time to myself at night just to unwind. She is a very busy little girl and by the time bedtime comes I don't have the patience to deal with her testing me. Could you please suggest someway to help us get her to sleep in her own room.

Answer/(Includes SLEEP RULES)

A Package of Suggestions: Here is a package of suggestions: none will work if tried individually, all will work if tried together.

I. Control the wake up time. Wake her up so that she never starts the day after 7AM. This is designed to make it easier for her to have an early naptime and an early bedtime. II. Sleep Rules: A poster is made and placed in her bedroom titled "your daughter's name"'s SLEEP RULES. At bedtime we 1.Stay in bed. 2. Close our eyes. 3. Stay quiet. 4. Try to sleep. The rules are recited at nap and at night and she is told that if she cooperates she will receive a reward and a privilege. The reward is a treat, a star, a sticker and a privilege is something passive such as watching VCR tapes, TV, or computer games. Additional privileges can be withheld sequentially if the initial restriction is not sufficiently motivational. III. Early bedtime: Lights out at 6-8 PM depending on nap or no nap, active versus quiet day. Be flexible and early. IV. Silent return to sleep. She is told that everybody needs their sleep and if she leaves her room than father will gently put her back to bed. And, although "we love you very much, when we put you back in to your bed, we are not going to talk to you". You're attitude is calm and firm, not sweet or stern. Silence is key. V. Do not reinforce her night wakings. Let her learn to soothe herself to sleep if she awakens after bedtime. If you go to her at night, you interfere with the development of this skill. If this is unacceptable to you, then the father should go and time-limit the duration of soothing by using a kitchen timer placed under a pillow. When the timer sounds, father kisses daughter and leaves. Good luck!!


Questions For Under 1 Year of Age(to Dr. Weissbluth from Parent Soup's Sleep Training Board)

Hello I'm hoping you can help me. My son is 8 months old and still wakes up 1-2x's a night. Here's his daily routine: wakes up about 5:00 (and will go back to sleep for an hour if I'm lucky); takes a morning nap from about 9:30 to 11:30; afternoon nap about 2:00-3:00; and goes down to sleep for the night about 7:15. His bedtime used to be about 8:30 and it has gotten progressively earlier and earlier because he gets so crabby. When he wakes at night I usually go in and rock him for a while and put him down. He then usually continues to scream until I nurse him. I have just finsished your book "Healthy Sleep Habits; Happy Child" and am still confused. You say 1 night waking to eat is normal but at what age should this stop? I was going to try the "cry it out" method but I don't want to do this if it in not really time yet. PLEASE HELP!!!

Answer

Nightwakings are normal for all babies up through 9 months of age who have no sleeping problems. Breast fed babies who are sleeping with their mother might get up more often and continue to awaken for feeding beyond nine months of age without any sleeping *problems.

Question

My dd is 6 1/2 months old. 1. time awake: approx. 8:00 a.m. 2. time & duration of nap(s) 11:00 a.m. for approx. 45 min., then 3:00 p.m. for approx. 45 min. 3. method and duration of soothing to sleep: bottle-feeding usually takes 45 min. 4. time of bedtime: 7:00 - 7:30 p.m. 5. frequency and duration of night wakings: from bedtime to midnight she wakes every hour, sleeps from midnight to 3:00 - 4:00 a.m. and then wakes every hour from then on. 6. what is your most common response at night: bottlefeed with water (just started this week) 7. any special circumstances, etc.: sleeps in our bed, we want to make the transition to the crib in her own room, what with the frequent night wakings it is making it impossible. She will not settle herself to sleep when she is ready for a nap or bed. Wants the bottle. She wakes up after 15 minutes into her nap and cries and then we give her a bottle and she falls back asleep. Often she just wants to feel the nipple in her mouth for comfort, doesn't even drink the contents. UPDATE SINCE ORIGINAL POSTINGS: I've been giving her water at night, but it doesn't seem to help. Maybe it's her teeth - her fussiness has increased. She took a nap this morning at 10:00 a.m. and woke up every 10 minutes wanting the bottle in her mouth. I am lost and tired.

Answer

Please consider putting your daughter on an age-appropriate sleeping schedule. Control the wake up time: wake her every morning at about 7AM. Napping: no mattter how she looks, soother her to sleep at 9AM and 1PM; no third nap in the late afternoon/early evening. Early bed time: around 5-6PM (this is temporary until naps become regular and long, then it might be 6-7PM). No reinforcing night wakings except once in the middle of the night and again in the very early morning for feeding; no go at other times. The expectation is that after three or four days she should be sleeping much better. DO NOT DO THIS unless you can do all of the above and your husband agrees and you can commit yourself to 3-4 days.

Follow-Up Question To Above Conversation:

1. When you say soothing her too sleep, can you give me an example of what type of soothing would be appropriate as we have been giving her a bottle to get her too sleep.

2. When you say no reinforcing at night wakings, do you mean to let her cry as I have been giving her water when she wakes.

Follow-Up Answer to Above Conversation:

Soothing to sleep means doing anything that is calming or lulling to make the transition or wind down from active to quiet from alert to sleepy: lullabies, massage, rhythmic motions, humming or singing quietly, or encouraging sucking. Using the breast or bottle or pacifier to help your child fall asleep is fine as long as the child does not fall asleep with a bottle of formula in the mouth. The duration of soothing should be your decision, but if it is substantially longer than 20-30 minutes, you run the risk of your child protesting when being put down because your baby simply has become accustomed to the pleasure of your soothing efforts.

Arousals and vocalizations at night are common in all babies and young children. If you feed your baby when she is hungry, then briefly soothe her, she will usually promptly go back to sleep. If you respond to the arousals when she is not hungry, then you will teach her to fight sleep with more intensity, to become more completely aroused, in order to enjoy the pleasure of your company. Letting her learn to return to sleep unassisted means that you go to her only when she is hungry. You do not want to interfere with the natural rising of the sleep process by providing social stimulation when she biologically needs to sleep.

When you start early, when naps are motionless and occur at the right time, when the bedtime is early, when you are consistent in how you soothe your child, then night arousals tend to be partial arousals, brief arousals, and quiet arousals. The opposite is also true.


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