I have had an interview with Katie, a mother whose 5 month old daughter Ella has begun to wake several times a night and will only settle with a feed, despite being a good sleeper previously.
“That’s right, I remember,” says Katie. “You said you could establish good sleep habits such as not to be afraid of falling asleep and to self-settle, but you wouldn’t deprive her of any feeds to get her to go for 12 hours straight through.”
Katie seems much more cheerful than when I saw her a couple of days ago, possibly because she has put in place a solution to their sleep problems; she shows me the kitchen, how to make up the milk for Ella’s night feeds and then up to my room, next door to Ella’s. I thank her and then suggest that, as it is nearly 10 o’clock, she goes off to bed herself.
“Will you wake me when Ella cries?” she asks.
“No,” I reply. “And Ella will only cry for as long as it takes me to get from my bed to her cot – I promise you I won’t leave her to cry on her own.”
I pop my head round the door to check on Ella and the nursery. I always take a room thermometer with me and look at it each hour during my first night, so that I can judge if the room gets too cold when the heating goes off at night. I check Ella’s temperature several times too, so that I know what a “normal” temperature is for her. She is sleeping peacefully. At the interview Katie and I had discussed several little things that could be tweaked in Ella’s daytime and bedtime routines, which have obviously had a beneficial effect. We have discussed that Ella needs to understand the difference between good and bad sleep habits. It is “good” for Ella and Katie to share bathtime and bedtime, but Katie and I have agreed that I will take over the night time feeds. The night before I started, Ella needed to be fed back to sleep five times and ended up in Katie’s bed; this was a normal amount of times, but the precise times of her wakings varied from night to night, as did the speed with which she returned to sleep. So Katie and I had decided that I would give Ella a dream feed at 10pm and then another feed at 2am, which is more than enough for her nutritional requirements, but that in between those times I would not feed her. Ella would thus learn the difference between feeding for nutrition and feeding for comfort.
I go back to the kitchen and make up a bottle of formula milk, then return to Ella and wake her gently. She is very sleepy and not terribly keen to take the feed, but she manages a good amount, enough to reassure me that she won’t need another feed before 2 am. I re-settle her by 10.30pm, return to my own room and lie down; I know I won’t fall completely asleep, I will doze and have an ear and an eye open for Ella.
And sure enough, at 11.50pm she wakes up. I smile to myself. If I am right, part of Ella’s problem comes from not being able to link her sleep cycles any more. At her age, her sleep cycles will be about 45 minutes. This means that every 45 minutes she will come up from deep non-REM sleep to near-consciousness and rather than falling back to sleep, Ella is forcing herself to wake up because she has become scared of the “falling” feeling. Most babies will sleep through the first few sleep cycles because they are sufficiently tired after the exhaustion of the day, but by about midnight the troubles can begin.
So I go into Ella’s room again, but without a comforting bottle. Ella is more awake and is working out what I am doing here; but she knows that her mother liked me, so she will wait and see what I am going to do. I go over to her cot and kneel beside it, putting my arm through the bars and place my hand on her tummy. I get about 15 seconds grace and a wide-eyed stare through the gloom, before her face crumples and I feel her lungs fill under my hand.
“Ssh, ssh, there, there,” I intone calmly. I make circling motions on her tummy with one hand and I hold both her feet in the other, using my thumb to stroke from her toes to her heels. I continue chanting my mantra, keeping my voice low and gradually she calms down. Different techniques work for different babies, but Ella seems to like the massage so I continue, all the time watching her and feeling her body and breathing become more still.
As Ella remains quiet, I reduce the pressure on her tummy and her feet. Finally I stop moving my hands completely and stop speaking. Her eyes are wide open, still working out what is happening, but she is calm and quiet. I take one hand away from her feet. I take the other away from her tummy. Still no movement. I move away from the cot and whisper, “night, night, sleep tight,” and as I get up from the floor, Ella takes a deep breath and prepares to cry again. Immediately I replace my hands on her tummy and her feet, and start whispering, “ssh, ssh, there, there,” to her. She calms more quickly this time, but is still watching me as if to say, “Don’t you dare leave me!” My main job during this first night is to gain her trust and confidence, and to reassure her that she won’t be left on her own. Eventually, after a lot more calming and soothing, I am able to leave the room as Ella falls back to sleep. I have observed that frequently a baby will cry for about the equivalent of a sleep cycle, or multiples of a sleep cycle, and although this may just be empirical evidence, I am not surprised to note in the Sleep Diary that I have been with Ella for an hour and a half. ✿
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