Thursday, May 26, 2011

John's First Year: Sleep Through the Night

When I was pregnant, I read a veritable library of books on labor and delivery. This despite the fact that I was a labor and delivery nurse and already knew quite a bit about the subject. I failed to read anything about newborns. In my nursing career, I dealt with babies up to a few hours old until they went to the nursery. I reasoned that I would be okay with those early hours. Which only left me with the remaining 17.999 years to figure out.

When we got relatively settled in Houston, I made a beeline to the library to get books on babies. Infant sleep was at the forefront of my mind because my sleep was being rudely interrupted night after night.

Sleep training is a very controversial topic these days it seems. I certainly don't consider myself an expert on that or anything else in parenting. I only have one easy baby who I have managed to keep alive for a merely a year. I'm a parenting novice. Nevertheless, I wanted to share what worked for us in getting John to sleep through the night. He is a fabulous sleeper. No doubt his easy temperament has something to do with his good sleep habits. But I think our choices helped too. In fact, I truly believe we could have ended up with a totally different baby had we not established the habits that we did. I'll never know this for sure, but I have reasons for believing this way. I'm recording what worked for us in detail as much so that I'll remember it for the next baby as the hope that this information might be of use to anyone else.

Since about day three of his life, John has slept well at night. Don't get me wrong, he woke up every few hours to eat but he went back to sleep easily. I never had one of those up all night, pacing the halls with a screaming baby nights (see? parenting novice). Most of our sleep trouble involved napping and getting him to sleep initially at night.

The first book I read on the subject of sleep was Baby 411. It's not specifically about sleep but I liked the section on sleep. It laid out many of the popular sleep theories and methods and evaluated them side by side. I liked the aspect that I could gather a few different theories and then research them on my own. That said, the authors definitely favored the method popularized by Richard Ferber in Solve Your Child's Sleep Problems, which I also read and found useful. Based mostly on those two books, here are the principles that I followed:

1) For the first two months do whatever you have to do to get the kid to sleep.

Fortunately for me, I didn't have to use drastic measures to get John to sleep. But the idea is that babies under four months aren't good at self-soothing. Which means they might need help to get to sleep. At this point letting them cry it out might not work (though I know some people for whom it has worked) because they are not neurologically mature enough to calm themselves down. For John, what worked to get him to sleep was rocking and swaddling. I would swaddle him up and rock him to sleep for naps. Before bed and during the night I nursed him.

2) Months 3-4 establish good sleep habits.

I guess what constitutes good sleep habits is up for debate. But the routine that was most often recommended to me by friends and pediatricians was eat, wake, sleep. This order of things prevents the baby from needing to eat to fall asleep (Though I did nurse John to sleep before bed. And during the night, of course, there was ideally no "wake time" in the cycle). During these months I was still rocking him to sleep. But I was also trying to get him to fall into a routine, which he did pretty easily. It might surprise you to learn, as it did me, that babies take naps as often as every 1.5 hours. If your baby is fussy and you've fed him recently (and there's nothing else obviously wrong with him), he might be crying because he's tired. That was often the case with us. I tried to notice when he would become tired, like when he would doze off in the swing, and then I'd lay him down for a nap. So we fell into an eat, wake, sleep cycle with him napping every 2-ish hours. The naps would last anywhere from 30 minutes to 2 hours. This was by no means a rigid schedule. But it was a routine that helped me to plan my day and to anticipate what John would need.

3) Starting around 4 months old put the baby down tired but awake so that he can learn to fall asleep without help.

Finally after four months and 11 pounds of weight gain (for John!), I was exhausted by rocking that chunk of a boy to sleep multiple times per day and was ready for him to learn the art of falling to sleep on his own. I had been assured by all of my reading and by speaking to John's pediatrician that a four month old is fully capable of soothing himself to sleep, despite initial protests (crying). So, I nixed the rocking and put him in his crib drowsy but not asleep. He cried. Mostly for 5 minutes or less. But sometimes longer. Rarely for 20 minutes or more.

Here's why I think I could have ended up with a totally different baby if I'd made different choices: In my reading, it was also frequently recommended to go in and comfort and reassure the baby (without picking him up) at varying intervals while he is learning to fall asleep on his own. I tried that. Only, when I would go into the room, instead of being comforted, John would become enraged. Angry that I was in the room but was not picking him up to play. So I stopped going in. And when I stopped going in, he fell asleep more quickly with less crying. I think if I would have gotten worked up and continued to go in and out of his room attempting to soothe him, he might never have fallen asleep. Then I would never have gotten any sleep. Which means that one of us would most likely have been committed to a state institution by now.

There were several months like this where for every nap and before bed I would put him down tired but awake and he would cry. Like I said, usually only for a few minutes. But gradually, he learned to go to sleep on his own. Around somewhere between 6 and 8 months, if he cried at all, it was only long enough for him to get his thumb into his mouth. Today, I can put him in his crib fully awake for a nap or for bedtime. He smiles at me while I blow kisses to him from the doorway and he lays down and goes to sleep. He takes two good naps and sleeps for 11 hours at night. It took some time, and some research and some discipline, but I think our sleep training has been a success! We are all healthy, happy and well-rested around here these days. (Unless I decide to stay up all night reading...)

Of course, there's no one method that will work for everyone and it's import to do what works for you. But I've met several people who have 9,10, 11 months olds and older who mention to me that their babies still wake every two hours at night like a newborn and require 30 minutes or more to be rocked back to sleep. When do any of them get any sleep between waking, feeding and putting back to sleep?! I imagine the entire family is exhausted! I never give my advice unless asked (unless it's on my blog where people can feel free to read or not...) but I want to tell them that it doesn't have to be that way! Of course, if you prefer to have the company of your 11 month old throughout the night, more power to you. But if you'd like an unbroken night of rest, it is possible. You don't have to do what I did, but find a way that will work for you and stick with it!

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