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A reader wrote asking for advice about how to sleep-train her child.
Dear Dr. Rosen:
I found your blog, Sleeping Angels, through a Google search. My 7-month-old son is not sleeping normally. What form of sleep training is suitable for my son?
Sleeping Situation:
- as a newborn, he slept in a co-sleeper next to our bed;
- at around 3 months, he started waking at 4am, a friend recommended he sleep next to me in bed so that I could get more sleep in between his night feedings, so that’s what we did;
- my son has never slept longer than 3 hours;
- at 6 months, we tried the “swing method” in an effort to transition him back into his co-sleeper
- last week, he started to sleep at 1.5-hour intervals;
- he has been a loud sleeper since he was born (sounds congested);
- I have always nursed him to sleep.
My concerns:
- at his 6-month appointment, his pediatrician indicated my son showed strong signs of separation anxiety for his age;
- he is considered underweight for his age
Any insight you can provide is greatly appreciated.
Thank you,
AJ
Dear AJ,
Thank you for your email. It certainly does sound like you’re having a hard go of things. From your email, it sounds as though there may be several things that are interfering with your son’s sleep.
Although you’ve provided a good history, a couple of very important pieces are missing. How much time is your son spending in bed, and is he on a fixed and regular schedule?
Two of the most common reasons for fragmented sleep are spending too much time in bed, and not being on a regular schedule. Our ability to sleep is based upon our sleep deficit, meaning how deprived of sleep we are, and our internal biological clock, or circadian rhythm. When a child is put down to sleep for more time than his brain needs (and remember: sleep is a biological need), it can become difficult for him to fall and/or to stay asleep. For example, if someone were to lock you into a bedroom for 16 hours, you would not be able to sleep more than 8-10 hours, depending upon how sleep-deprived you were. After that, you’d awaken and look for something to do. The same is true for children and babies. Typically, babies your son’s age sleep about 9 hours at night, and take two 90 minute naps during the day, sleeping around 12 hours in total across the 24-hour day. If he is in bed for longer than that, it may result in his sleep becoming fragmented. Likewise, if his schedule is erratic, it will be difficult to synchronize his internal body clock with the external clock, and make it harder for him to settle into sleep at bedtime.
I’m not a big fan of the “swing method” or any other methods that cause a child to develop an association between an external stimulus (swing, breast, parent rubbing the child’s back) and sleep. We all cycle through different stages of sleep, awakening briefly every now and then across the night. When a child who is accustomed to falling asleep with something awakens, he instinctively seeks it out so that he can fall back asleep, and when he can’t find it, signals (cries) so that someone (you!) will bring it to him. This, too, promotes repeated awakenings. It is far better, once he is on a regular and age-appropriate sleep schedule., to put him down to sleep awake, and allow him to make the final transition to sleep on his own.
Finally: the congestion. Obstructive sleep apnea is a condition in which difficulty breathing during sleep leads to sleep fragmentation and a variety of developmental and physical problems. I suggest that you discuss this with your child’s pediatrician, and it might be useful for you to take a short video of your child’s breathing during sleep that you can show her so that she can decide whether a sleep study might be indicated.
Good Luck!
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Dennis Rosen M.D.
