"Midnight Madness: Advice on winning the nightly war from the “Sleep Lady”

“If I could just get a good night sleep…” is the frequent refrain of parents of infants to elementary schoolers. Getting children to go to bed and stay in bed can be one of the hardest tasks of early parenthood.

At Maryland Family we thought it might be helpful to collect some of the worst sleep “nightmares” from area parents and have a local expert, “Sleep Lady” Kim West—author of “Good Night, Sleep Tight”--- work her bedtime magic.

We asked for input in our February issue, and soon the questions flooded in. Many parents at the end of their rope and some just mildly curious, shared their stories with us. We narrowed it down to four questions that best represented the recurring themes we encountered and forwarded them to West, a social worker in private practice in Annapolis. Here is what the Sleep Lady had to say.

The Staller
Q. My 4-year-old tries to prolong our goodnight routine as long as he can. He repeatedly comes out of his room and makes requests, saying he cannot fall asleep. We start our bedtime routine around 8 p.m., but sometimes he doesn’t fall asleep until it’s almost 10. Any advice? Mendy, Owings Mills

A. A 4 year-old needs on average 11 and a half hours of sleep at night. So if your son wakes at 7 a.m. on average then he needs to be asleep by 7:30p.m. Therefore, make sure you are catching his sleep window correctly, that is the natural bedtime window when he can go to sleep easily and quickly. If you wait too long and he gets overtired he will become wired and it will take longer and be harder for him to get to sleep. Based on this information, decide on what time “lights out” will be and be firm. Blame it on the clock and give him a 5- or 10-minute warning. Create a sleep manners chart (see sidebar, page 22), and if he needs you nearby consider sitting out in the hallway until he is asleep, moving farther away each night.

The Sneaker
Q. Our nearly 6-year-old gets into our bed every night since we moved him into a big bed when he was 2. He is stealthy so part of the problem is we don’t notice him in the act, we just wake at some point to find him there. At that point,, I don’t really care where anyone is sleeping as long as they aren’t waking me up, so we rarely move him. But now he’s getting bigger and our queen-size bed is too small. Sometimes we move him to a bed on the floor, but eventually he climbs back in. We have tried a reward system, but this hasn’t worked since sleeping with us is the biggest reward of all. Now his 3-year-old brother also wants to get into the bed as well. Part of the issue is our own ambivalence on the issue. My husband and I both like him in the bed—except for the crowded part and the different standard for each kid. And we’re not willing to buy a bigger bed. When what we try doesn’t work, we end back at the same place. What should we do?
Chris, Columbia

A. The most important thing you wrote was that you and your husband are ambivalent about sharing your bed with your children. Don’t do anything until you have made a decision and are prepared to be consistent for as long as it takes. It takes longer to solve a sleep problem for 6- and 3-years-old than it does for a 6-month-old, and they are counting on you changing your mind or backing down on your decision.

If you decide you no longer want to co-sleep, then have a family meeting and tell your children the new rules and that they will be returned to their beds each night they get out. Hang a bell on your bedroom door so when they push the door open you will wake up enough to return them. Create a sleep manners chart and reward the behavior you want to see more of. Be prepared to get less sleep while you address this problem.

The Manipulator
Q. Our 3-year-old will not go to bed without me lying in bed at her side. I am not able to leave her room until she is fast asleep. If she notices me leaving the room, she grabs me and begins to cry. The problem is, she cries until she makes herself vomit. We then end up changing bedding and pajamas and have to start all over trying to get her to sleep. We recognize this a a form of manipulation, but we feel helpless. Any suggestions?
Amy, Owings Mills

A. I would have a family meeting, create a sleep manners chart and tell your daughter that you will stay with her as she learns to put herself to sleep, but you will not lie down with her anymore. Sit by her bed with minimal interaction and offer physical reassurance such as patting or rubbing her back intermittently (so you don’t create a new problem). Stay until she is completely asleep--- no sneaking out. Each time she wakens during the night do the same thing. Every three nights move your chair slightly farther away from the bed so she doesn’t come to depend on you sitting by her side at bedtime or all night. Eventually move to the door, then the hallway in view and then finally out of view.

Review her sleep manners chart each morning and praise the behavior you want to see more of. I find when we stay with our children while they are learning to put themselves to sleep, they don’t usually vomit. Make sure she isn’t having a large glass of milk right before bed. If she does vomit, clean it up with little discussion or fanfare so she doesn’t get “rewarded” for it. She will learn quickly that it just isn’t worth it—and it doesn’t feel that great either!

The All-Night Diner
Q. My 1-year-old daughter has always had sleep problems. As an infant she was plagued with reflux and would cry every time she was laid flat. For the first three months she slept upright in either my husband’s or my arms, a baby carrier, her car seat or a bouncy seat, but only for two-hour stretches. When she was 5 months old I got very sick and totally exhausted, so we began to let her sleep in bed with us. She would nurse herself to sleep laying next to me. Although I never intended to co-sleep, it seemed the path of least resistance. We attached the crib to the side of our bed, with her still waking about every two hours at night to breastfeed.

She eventually grew out of reflux and at about 11 months we moved her into her own room. We placed a mattress on the floor, and I lay down next to her and nurse her to sleep. After she falls asleep, I can leave without worrying about her hurting herself. However, she is still waking every one to two hours and can not seem to go sleep without nursing. Her sleeping is fitful and difficult. She will suckle for a bit but then pull off, thrash around and sometimes attempt to crawl out of bed. I end up spending most of my night on the floor mattress with her, trying to get her to stay there and stay asleep.

I am exhausted. Although I once thought I would never try a cry-it-out method, I am so delirious from a full year of no sleep that I am considering it as an option, even though it would break my heart. Please help.
Christine, Ellicott City

A. When children suffer from reflux, we have to do whatever it takes to get by until we can get the reflux under control so they can eat well and lay down without discomfort. Don’t feel guilty about whatever desperate measures you had to take. If your daughter’s reflux is now under control and she no longer needs to receive calories during the night (I realize it may be a habit now) then you can begin to address her sleep problems.

Unless you plan on continuing to co-sleep with her, I would plan on starting at bed time (ideally on a day when she has had good naps). Nurse her with the light on until she is drowsy but awake and then put her in the crib with light off (and a nightlight on). Stay until she is completely asleep.

Depending on what her eating patterns have been, you may need to consider nursing her once during the night for two to three nights to help switch her clock to “receiving calories” during the day. Talk to your pediatrician about this. Treat all other night awakenings the same—sit by her crib and pat, shush, pick up if needed, etc. until she is asleep. You may want to sleep on the mattress in her room for a few nights so you can respond quickly to her. After the first four nights move your chair farther away every three nights. You can use these same methods for naps. At this age, she needs two naps totaling 2 and a half hours and on average 11 hours and 15 minutes of sleep at night.

Sidebar:
Chart Your Progress
A “Sleep Manners Chart” is a sticker chart that outlines the new sleep rules and expectations for the child as determined by the parents. It is used as positive reinforcement. Some examples of rules are “Puts self to sleep without Mommy or Daddy laying down with you” or “Lies quietly in bed” or “Stays in bed until the wake up music comes on”. Parents must be specific and list three to five behaviors they want to see from their child. The manners or rules are reviewed each night and stars or stickers are given out each morning.

Maryland Family Magazine
By Betsy Stein
May 20, 2006