The Sleep Lady

 CASE STUDY: eighteen month old awake all night.

MRS T, had just had baby number two and was still struggling with her toddler's sleep. Charlie was waking five or six times a night.

Each time he woke mum or dad would go in, pick him up, give him a drink, sometimes taking him out of his room if he became very distressed. Charlie could sometimes be awake for two hours at a time, would then nod off and be awake again 45 minutes later. Needless to say, both parents were at the end of their tether.

I went round to visit the Ts at their home and spent a long time talking to both parents, finding out what they had done in the past to try and get Charlie to sleep and what they would like to achieve. It became clear that over a period of time both parents had tried to get Charlie to sleep through the night, but each time they put their plan into action they became unclear on how long to persevere for and what their end goals were going to be, then through uncertainty and exhaustion they would give in. All this had done, was to confuse Charlie.

Both parents decided with baby number two now at home, sleep was a priority. We looked at putting a plan into action around Charlie and his character and what the parents felt comfortable with. Charlie is a happy wee man, he gets lots of attention from mum and dad, is a good eater, and socialises well. Mum could quite happily leave him with friends or relatives and Charlie was comfortable with this happening. Charlie already had a great bedtime routine, it was just the going to sleep that was a problem and then staying asleep all night.

We therefore decided on a 'leave him to cry it out approach'. Both parents felt they would benefit from me being with them for the first three nights while we put this plan into action.

The first bit of the plan was to explain to Charlie what was to happen that night, "mummy and daddy would give him a big kiss, then put him in his cot and leave him, he would not get out of his cot until morning when the curtains would be opened".

NIGHT 1 saw me arrive at bath time, dad reminded Charlie of what was to happen that night. Charlie was put to bed, after a quick story, dad had to give Charlie a big kiss and then leave the room. Mum, dad and I sat on the stairs and waited, as predicted Charlie started shouting. We gave home five minutes and then I sent dad in to pop his head round the door. We had chosen a few clear words to repeat each time mum or dad had to go in, "Charlie, it is night time go to sleep". We had also perfected the tone of voice to use, firm but kind, no angry tones were to be used. The crying got louder as dad left the room, we gave him three minutes and dad popped his head round the door repeating his words. This went on for 40 minutes when Charlie fell asleep. Greatly relieved we all had a glass of wine. I stayed all night and Charlie woke twice in the night. Dad was sent in each time and each time Charlie protested for 15 minutes before settling himself. He woke for good at 6.30 in the morning.

NIGHT 2 was the same, crying was less each time.

NIGHT 3 was worse, with Charlie protesting for 55 minutes, but he did not wake in the middle of the night.

NIGHT 4, mum and dad were on their own, knowing I was at the end of the phone. Charlie went straight to sleep!

Charlie became brighter, livelier and his eczema also began to clear up as he became used to having twelve hours sleep a night. Mum and dad were both relaxed and therefore able to enjoy being parents to two lively boys. Baby number three has also now arrived in the household.

CASE STUDY: Reflux

G phoned, her baby girl Katie had been very unsettled from birth, crying excessively. She would not sleep lying down and would only settle if she was being walked around in her baby sling. Katie was now ten weeks old and had not become any easier.

Both mum and dad were at the end of their tether. Before my first visit I had asked the parents to keep a diary of Katie's sleep and eating times and how much food she was taking at each feed.

I popped in to do a home visit. Mum had tried to breast feed, but found Katie was very unsettled and crying a lot, they then moved her onto formula, this had seemed to help for a while, but she was now even more unsettled. They were worried she was not eating enough in the day, so had upped her feeds. She would be content for a while but after 45 mins would become very uncomfortable. They were upping her feeds and stretching the time between feeds.

The other problem was putting her in her cot, as soon as she was laid down she would scream.

The first thing I did was to look at her weight chart. Katie was slipping down her weight line. I then looked at how much formula she was taking in a day, how long each feed took and what she was like feeding.

Mum mentioned that each feed could take up to an hour, that when the feed began there would be a lot of gurgling in her stomach and then Katie would start screaming and writhing.

I assessed that I thought she may have reflux, and recommended they make an appointment straight away to see their GP.

While waiting to see the GP I suggested they give Katie little feeds, little and often. She would be offered three ounces every hour and a half to two hours, for the first week of me seeing them.

We discussed reflux and how it could affect sleep, (many babies who have reflux find lying flat on their backs causes them to become very uncomfortable). I recommended they purchase an Amby Nest www.naturesnest.co.uk. With the Amby Nest onsite and confirmation from her GP that little Katie did suffer from reflux (www.livingwithreflux.org), we started to establish a slow gentle routine, focussing on incorporating regular sleep and feeding times. We did not at this stage enter into a direct sleep programme.

Gradually Katie became more settled, her routine became established and by the time she was four months old, we gradually introduced Katie to a good nighttime sleep programme.

Katie is now a good little sleeper.  

CASE STUDY: Seperation Anxiety

MRS A called about her wee boy Oliver who was 15 months old. Oliver had been a great sleeper. However since starting nursery, he had become very clingy during the day and became hysterical when waking up in the middle of the night.

The problem had escalated to settling him at night in his cot when he would scream uncontrollably, sometimes being sick. Mum had reverted to taking him into her bed and staying with him until he fell asleep when she would transfer him to his cot. Oliver would sleep soundly until 1am when he would wake up screaming. Nothing but taking him into her bed would calm him down. All the time this had been going on, Oliver had become more and more distressed at being left at nursery. At the same time as calling me, both parents had decided to withdraw Oliver from nursery until he became more settled.

I worked with mum over the telephone.

We established that Oliver had a good bedtime routine, as well as a day time routine. He was a good eater and after a quick once over by the health visitor, I knew he was gaining weight well, that he showed no signs of an ear infection and at this stage was not teething. We concluded that now was a good time to start a sleep programme.

I felt there was a link between Oliver starting nursery and the well documented 'separation anxiety', a natural developmental stage in most children. However Oliver did seem to be over anxious at being left.

On this information we decided the best way forward was a slowly slowly, gradual withdrawal from Oliver as he began to settle in his cot.

Mum was to place a chair next to Oliver and a mattress on the floor. She would sit by the cot while Oliver settled initially, telling him that once he was asleep and she came up to bed, she would sleep on the mattress. While he was settling she was to place the chair next to his head side of the cot, but that she was not to talk to him, or give him eye contact. If he became restless, demanding her attention, she was to leave his side and stand by the door until he settled. She was not to go out of his sight. This took 20 minutes on NIGHT 1.

When it was time for her to go to bed, she settled herself on the mattress. As usual Oliver woke and screamed, mum quietly spoke to him from the mattress, saying "mummies here, go back to sleep". At first Oliver protested loudly, but mum just went and stood by the door until he stopped, she then went back to her mattress. She carried out the same process of settling him during his daytime nap.

After three days she reported Oliver was settling happily. We then moved the chair and the mattress to the foot of the cot. This again took three nights.

NIGHT 7 saw the chair and mattress by the door.

NIGHT 10, mum had to settle Oliver in his cot and then go into her bedroom and bang around making sounds he could relate to. She also had to tell him if he woke up in the middle of the night she would be in her bedroom. If he cried she had to pop her head round and reassure him.

By NIGHT 17, Oliver was sleeping well. He was happy and content and mum and dad were relaxed, and they were sleeping back in their own room.

Oliver is now happily settled into a new nursery and still sleeping well.