The thorny issue of how to improve nighttime sleep is tricky to tackle generically, as the advice I would usually offer is individually tailored to my clients. The trouble is – no one single strategy works for everyone, so without knowing your unique situation, all I can offer is some general advice.
Realistic expectations about nighttime sleep:
Ok, so in an ideal world, most parents would love 2 things:
- To be able to put their baby/babies down for sleep awake when they want to, and for their baby to fall asleep peacefully
- For their baby to sleep through the night from a young age, without crying
Given that you’re reading this, I’m guessing that you don’t live in this Disney sugar coated dreamworld! I’m also guessing that you’re desperately hoping that I can share with you the secret to achieving the above. I wish I could friends. I really do. You know I’ll never lie to you – here are a few truths:
- It’s normal for babies to wake in the night
- Some babies wake more than others
- Some babies naturally sleep for long stretches at night
- There are multiple factors which influence a child’s sleep, including health, age, development, and environment
- Genetics may play a larger role than previously thought
- There are very few quick and gentle sleep techniques
- Giving solids or formula to make a baby sleep longer usually does not work
- However your child is falling asleep, it is only a problem if it’s a problem for you.
But Lyndsey, I’m so tired!!
I know. I feel your pain! Ok, having laid out the bad news, here’s what you can do to improve your child’s sleep, without even tackling nighttime sleep (more on that later):
- Keep a sleep diary. There are lots on the internet, some with an academic focus, some are quite specific, others are intended for older children and others are basic and more generic, like this one. Mine is a fairly chunky and holistic affair! I ask questions about how your child falls asleep, naps, health, skin, stool, eating and feeding. Of course I also gather basic information about day and nighttime sleep. I would suggest you keep the diary for at least 3-5 days, to get a good idea of your baby or child’s sleep habits.
- Expose your child to plenty of natural daylight, with age-appropriate exercise and a good diet
- Work on your child’s naps. Over-tiredness is a killer to nighttime sleep. Check my earlier blog here and make sure that you are spotting the early signs of tiredness.
- Try an earlier bedtime. Often, crankiness in the evening is attributed to ‘colic’, when sometimes it is better explained by over-tiredness. First note when your little one gets cranky for a few days, and then experiment with putting them to bed 20 minutes before the fussing starts. You want your child to take about 15-20 minutes to fall asleep. If they’re asleep faster than this, then they are over-tired. Experiment with when you need to do bedtime to get that magical 15-20 minutes.
- Work on your child’s sleep environment/sleep hygiene. Declutter their sleep space, make sure you have a really blacked out room, that the temperature is between 16-18C, and it’s a restful place. Avoid screens, artificial lighting and excitement!
- Instigate a ‘calm-down’ time 10-15 minutes before the bedtime routine. This will help your child’s brain to shift gears and be more ready to fall asleep. After teatime, clear up, then dim the lights, tidy the toys, turn off the TV and radio, and only play calmer activities. I love treasure baskets at this time of day, and recommend them to nearly everyone with a small child!
- Ensure you practice a consistent bedtime routine. Do this at every single sleep, with a mini version of the bedtime routine at naps. Include 3-4 calming activities, and aim for the bedtime routine to take about 30 minutes.
- Consider whether there is anything making your child uncomfortable. I prefer to treat the underlying cause of the problem, rather than leap straight for a sleep solution. Allergy, skin conditions, anaemia, sensory problems and many others can affect sleep. Eliminate any of these and you may find the sleep improves by itself.
- Work on the emotional states of everyone at home. Stress, anxiety, depression and tension all rob us of vital hours of sleep. I often suggest keeping a thought journal and doing a cathartic ‘dump’ of all the negative emotions you (understandably) feel about sleep. Children are masters at reacting to our stress, which is doubly frustrating when their lack of sleep is the cause of the stress!
Tackling nighttime sleep gently
Once you’ve dealt with as many of the sleep influencing factors as possible, if you still have a sleep problem, it’s likely to be easier to tackle, as you will have laid the foundations. Please don’t feel you need to! Sleep is a highly personal and individual beast. What’s right for one family is not right for another.
- If your child falls asleep feeding, consider feeding them at the start of the bedtime routine. Often parents try to top their child up at the last possible minute. I can’t tell you enough, nighttime sleep is usually not all that related to hunger. Moving the feed earlier allows time for digestion, eliminates problems of wind and bloating, and in my experience, improves nighttime sleep.
- If your child is dummy dependent, consider removing the dummy just as they are falling asleep.
- If you lie next to your child to help them sleep, consider moving further away
- Do not move on with any sleep strategy until your child is tolerating the current one. We don’t want to cause stress, and any sleep solution needs to be sustainable.
- Could your partner take over the nights to give you some respite?
- If your child wakes in the night for feeds, you’ll need to consider whether this a) bothers you, b) is developmentally appropriate, c) is habitual, d) is necessary for your child, either nutritionally, emotionally or physically. For example, a 7 month old baby waking 2-3 times for feeds is probably normal. A 1 year old waking for feeds 4-5 times a night could almost certainly do without a couple of those! Then, there’s the problem of individual perspectives. I worked with a mum who had a severe health problem, and her 6 month old was waking 3 times a night. Normal, perhaps, but this mum was drowning in exhaustion. For that family, the sleep problem is about the family context, not really the individual child. Everyone’s threshold for defining a sleep problem is different. I always say that the right time to tackle sleep is when it is genuinely becoming unsustainable for a family, and they have made an informed choice to take steps to improve it.
- There are a lot of sleep techniques out there. This is not some closely guarded secret! They each have their pros and cons. Some involve more crying (in arms) than others. Some are faster than others. Not all are appropriate for children of all ages. I recently completed a review of all the ‘gentle’ techniques I could find – it’s pretty long and wordy! You’ll find it in my forthcoming book.
- One technique I like to use if a parent hates the idea of crying is to overlap some new sleep cues over the one that’s currently working, then slowly withdraw the primary sleep trigger. This takes ages, but often involves very little crying. If time is a factor, then ‘hug-it-out’ is another option. Parents are often reassured that their child is being comforted the whole time through the change, but it can be a rough few nights. A middle ground is to use some form of gradual retreat, doing less and less of what the child needs to fall asleep.
Nighttime sleep – the ultimate goal?
No, I don’t think so! My approach is more holistic than that. I consider the following steps when I’m working with a family:
- Promoting parental wellness, mental health and confidence
- Supporting optimised nutrition, feeding and eating
- Correcting underlying health problems which may be contributing to sleep disturbance
- Understanding sleep pathology: including night terrors, obstructive sleep apnoea, confusional arousals, nightmares, bedwetting, circadian rhythm disturbance, over-tiredness and more
- Encouraging a family centred approach, empowering families to have strong bonds and function optimally as a unit
- Managing and reducing anxiety in children and parents, understanding the complex interplay between family members
- Promoting independence in day and nighttime sleep using gentle, supportive, creative and age appropriate strategies
You’ll note that independent nighttime sleep is the last one on my list! I would much rather a family felt closer and parents felt more confident in their parenting style than their child achieved 12 straight hours of sleep. Often, tiredness is caused by much more than just sleep deprivation. I often find that factors such as owl/lark incompatibility, introversion/extroversion, and a lack of ‘adult time’ are the contributory factors to exhaustion and burnout. If you can’t face tackling nighttime sleep, then consider working on the related aspects instead – you may find you feel better!
Lyndsey Hookway is a paediatric nurse, health visitor, IBCLC and holistic sleep and behaviour coach. She works privately at www.feedsleepbond.com as well as for the NHS and as an independent lecturer and trainer. She offers webinars and bespoke training for health professionals, childcare, sleep and maternity carers and parents. Her first book will be published at the end of 2017.