Katie’s 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.
On this first night, I am focussing on gaining her trust. I have given her a dream feed at 10pm and then soothed her to sleep between 11.50pm and 1.20am.
I make careful notes in the Sleep Diary of the time I spent in Ella’s nursery, what I did while I was there and how Ella responded. I turn out my light and relax onto my pillows, still listening out for Ella and keeping an eye on the monitor.
40 minutes later, the monitor leaps into life and I can hear Ella – I am at her cot side in a trice, immediately soothing her and whispering, “shh, shh, there, there,” to her as I did before. My focus on Ella is total, I am willing her to calm herself down and reach a level of tranquillity from which she can fall asleep. At the back of my brain, I am confirming the thoughts that I have previously had about Ella’s sleep issues; she is now old enough to be aware of the world around her, so she is not falling asleep as easily as she used to – she thinks she needs ‘help’ to get back to sleep. My job is to teach her that she can fall asleep by herself, but for tonight it will be enough for her to trust me.
It takes another 45 minutes of calming Ella down before I can leave the room. Her behaviour swings between wide-eyed calm (which doesn’t fool me for a moment as I can feel the tension in her body) through intermittent grizzling (where her breathing is shallow, panting and uneven) to full blown crying where I can hear the anger in her voice. The crying, when Ella is expressing her frustration, actually lasts for a very short time because she is still in the process of working out who I am. The grizzling is the main way she is communicating with me tonight, letting me know she doesn’t really approve of the situation but is prepared to give me the benefit of the doubt. The wide-eyed calm is the point at which she might fall asleep, but I need the tension to leave her body, so I continue the massaging techniques which worked well earlier in the night.
Eventually she allows herself to fall asleep and I leave the room, remembering my thoughts and noting them in the Diary. I am ready for Ella to wake a lot more tonight. Her usual habit is at least five times, but since I am a new person in her life she will probably wake more frequently to see if I am still around. The important thing is to make sure she is confident with me and to begin to put in place the techniques on which we will base her sleep training.
As expected, I am in and out of Ella’s room 8 times in the next few hours. On most occasions she calms down and falls asleep fairly quickly, but it is evident that she is not getting the quality of sleep she needs. She is sleeping just below the level of consciousness; she is not allowing herself to fall deeply asleep into the non-REM sleep that is so necessary to an infant’s mental and physical development in the first few years of her life.
Katie has done exactly the right thing in calling me in before the situation deteriorates even further; bad sleep habits rarely correct themselves and although sleep-deprived children can manage on less sleep than they need, the cumulative effects can be disastrous in many ways. Research shows that babies and children benefit from sleep training not only in regard to the better quality of sleep, but also in regard to other behavioural issues such as less crying, less irritability, more confident detachment, strong self-esteem and emotional wellbeing. It is reassuring to note that none of the studies found any adverse effects and, in fact, babies who participated in sleep training programmes were found to be more secure, more predictable and generally happier following treatment.
In addition, sleep deprivation inhibits the production of certain hormones and accelerates the production of others. If allowed to go unchecked, this hormone imbalance results in obesity, increased fat storage, stunted development, depression, irritability and a weakened immune system.
I have noted that society as a whole seems to pride itself on being able to cope with little sleep, whilst being unaware of the negative impact this is having on their lifestyle. An infant needs sufficient sleep for her body to be able to develop properly and for her brain to be able to assimilate the new things happening in her life. So sleep is a natural, necessary part of our lives, and my job is to create the appropriate sleep environment, instil the relevant sleep habits and enable parents to understand how important it is for their baby.
After a very disrupted night, Ella finally falls asleep for the last time at 5.30am until I wake her at 7am. She smiles at me in recognition; I get her dressed and take her into her mother’s room. Katie looks at me with sleepy eyes. “How did it go?” she asks, “Ella and I have been making friends, haven’t we?” I smile at Ella who grins back at me.
I show Katie the Diary. Having glanced through it she looks at me in horror. “Not a great night, at all,” she grimaces. I tell her it’s a good foundation for the first night and tonight we will build on it.
“You will definitely see improvement from here on,” I reassure her.
“And will Ella need more naps today, to make up for the disrupted night?” she asks me.
“No,” I tell her. “The important thing is to keep everything consistent. Keep to the nap times we decided on: put her down, do whatever you need to do to get her to go to sleep, but as soon as the allocated time is up, wake her and continue with her day.”
“And do I write everything in the Diary too?” she asks.
“Yes, please,” I reply, as I leave them cuddling on the bed. “See you tonight!” ✿
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