Healthy Sleep Habits, Happy Child Read online

  ANNA'S TRANSITION FROM TWO NAPS TO ONE

  At eighteen months it became apparent that Anna was ready to make the transition from two naps to one, but would need some help because she fought the morning nap. We began, as Dr. Weissbluth suggested in his book, by gradually delaying the morning nap till 11:00 A.M. or so. Over a two-week window we were able to continue to push back the nap to sometime between noon and 1:00 P.M.

  In his book, Dr. Weissbluth suggested an earlier bedtime to help prevent night waking or early-morning waking. Anna was going to bed at 6:30 P.M. and sleeping until 7:00 A.M., SO we really questioned this theory. My husband and I agreed that Dr. Weissbluth's advice has always been right on the money, so we decided to put her down an hour earlier. We feared that she would wake up at 5:30 or 6:00 A.M. after her usual twelve or thirteen hours of sleep. To our surprise, she awoke at 9:00 A.M., and she was in the most cheerful mood to date!

  Family, friends, even strangers constantly tell us what a happy, cheerful child we have. The reality is that she is a very well-rested child.

  Not napping means lost sleep. Over an extended period of time, children do not sleep longer at night when their naps are brief. Of course, once in a while—when relatives visit or when a painful ear infection keeps the child awake—a child will make up lost daytime sleep with longer night sleep. But day in and day out, you should not expect to satisfy your child's need to sleep by cutting corners on naps and then trying to compensate by putting your child to sleep for the night at an earlier hour. What you wind up with is a cranky or demanding brat in the late afternoon or early evening. Your child pays a price for nap deprivation, and so do you.

  PRACTICAL POINT

  When your child does not nap well and you keep him up in the evening, he suffers.

  Spending hours holding your child in your arms or in a rocking chair while he is in a light, twilight sleep also is lost sleep because you have delayed the time when he will fall into a deep slumber. It is similar to having a bedtime that is too late. It's a waste of your time as well. Brief catnaps during the day, “motion” sleep in cars or baby swings, light sleep in the stroller at the pool, and naps at the wrong time are all poor-quality sleep.

  Here is an example of how one family learned to appreciate napping.

  HOW CHARLEY'S PARENTS BECAME NAP ZEALOTS

  I am aware that the practice of toting your baby along with you on every occasion is the new social thing. No doubt it stems from the “me” generation's philosophy that a baby should not be allowed to interfere with your lifestyle. So parents everywhere are seen with their infants: in grocery stores, restaurants, the homes of friends… and for the unflappable, at cocktail parties, dinner affairs, even cross-country trips. Although some of these examples may appear to be extreme, be advised, new mothers, that the pressure is on to be a “nouvelle” mom.

  As with anything in vogue, you need the appropriate raw material to make it work. And the fact is, my husband, Tom, and I simply do not have the baby to make this new “porta-kid” trend work for us. Oh, we tried. But it was, and continues to be, completely futile. So we gave it up when Charley was three months old.

  Charley is now seven months into his life. From the beginning, there has been only one of life's necessities that he requires as much as milk and oxygen, and that is sleep. In fact, we used to shake him when we first brought him home to make sure he was alive. The baby slept… serious sleep.

  In the beginning he would sleep anywhere. After his second month, he would sleep only in his crib. And that's another subject. I maintain that the person(s) who decreed that a child's bed should be “stimulating” and full of colored linens and mobiles did not have a child of his/her own! If I had to do it all over again, I would buy a solid, dark-colored comforter and pads. After Charley's second month, he would spend hours on end trying to pick the red, white, and blue flowers off the sheet. This is no lie. And he would scream unmercifully for us to remove this distraction, which was preventing him from needed slumber!

  Since his second month, Charley has slept through the night and half of the day. If we disallowed him this necessity, he became a different baby. “Crabby” did not do justice to his fatigue condition. Without this sleep, our peaceful, alert, sweet, and cuddly baby turned into a raging beast. We did this to him when we denied him sleep—not according to our expectations but according to his own internal requirements.

  Charley gave us his cues, simply and clearly. He doesn't cry at first. He mumbles, then grumbles, and finally, if his unaware parents or sitters persist, he wails.

  At first we couldn't believe he was tired so often. We changed his diapers a thousand times and force-fed bottles. We took him on endless trips in the buggy and walked him incessantly in the Snugli, trying to calm our “miserable” baby with the rhythm of our heartbeats. Nothing worked. Nothing, that is, until we finally, out of sheer nervous exhaustion, laid him in his bed to sleep.

  Charley still naps four to five times during the course of a day. He's also a very happy child. When Tom and I go anywhere, we go alone, leaving our contented, sleeping son in the hands of a competent baby-sitter. Our friends, especially our childless friends, think we're overprotective. Well, thank God, Charley is not their baby. We are no longer concerned about our parental image; uneducated criticism doesn't count. If we cannot find a baby-sitter, we don't go. We simply would have a better time watching television … anything, even doing the laundry, beats the hell out of making your baby and yourselves crazy. And our family is now harmonious, having discovered the secret of sleep.

  PRACTICAL POINT

  When you maintain a healthy nap schedule and your child sleeps well during the day, jealous friends will accuse you of being overprotective. They'll say, “It's not real life” or “Bring her along so she'll learn to play with other children” or “You're really spoiling her.” Suggestion: Change friends, or keep your baby's long naps a family secret.

  Sleep Consolidation

  Consolidated sleep means uninterrupted sleep, sleep that is continuous and not disrupted by awakenings. When awakenings or complete arousals break our slumber, we call it disrupted sleep or sleep fragmentation. Abnormal shifts of sleep rhythms toward lighter sleep, even if we do not awaken completely, also cause sleep fragmentation. Ten hours of consolidated sleep is not the same as ten hours of fragmented sleep. Doctors, firefighters, and mothers of newborns or sick children who have their sleep interrupted frequently know this very well.

  The effects of sleep fragmentation are similar to the effects of reduced total sleep: daytime sleepiness increases and performance measurably decreases. Among healthy adults, even one night of sleep fragmentation will produce decreases in mental flexibility and sustained attention, as well as impairment of mood. Adults with fragmented sleep often fight the ill effects of fragmented sleep with extra caffeine. Alcohol unmasks or uncovers the hidden fatigue and makes them “feel tired.” However, well-rested pre teens who are given the same amount of alcohol, during research studies, do not “feel tired.”

  PRACTICAL POINT

  Let sleeping babies lie! Never awaken a sleeping baby. Destroying sleep continuity is unhealthy.

  Protective Arousals

  Sometimes our brains awaken us in order to prevent asphyxiation in our sleep. These awakenings, or protective arousals, occur when we have difficulty breathing during sleep, which can be caused by large tonsils or adenoids obstructing the air passage. (I will discuss this problem in detail in Chapter 10.)

  Arousals may also prevent crib deaths, or sudden infant death syndrome (SIDS), which kills young infants. This tragedy might be caused by a failure to maintain breathing during sleep or a failure to awaken when breathing starts to become difficult.

  MAJOR POINT

  Some arousals from sleep are normal.

  Sleep Fragmentation

  After several months of age—beyond the age when crib death is most common—frequent arousals are usually harmful, because they destroy sleep continuity. Arousals ar
e complete awakening from either a light, deep, or REM sleep. Arousals can also be thought of as a quick shift from deep sleep to light sleep without a complete awakening.

  FIGURE 4: AROUSALS DURING SLEEP

  Figure 4 is a simplified illustration of the cycling from deep sleep to light sleep that normally occurs after about four months of age. During partial arousals, we stay in a light sleep state and do not awaken. But during complete arousals, or awakenings, we might become aware that we are looking at the clock, rolling over, changing arm positions, or scratching a leg. This awareness is dim and brief, and we return to sleep promptly.

  As we can see, arousals come in several forms, and depending on which types occur, how many times they happen, and how long they last, we pay a price: increased daytime sleepiness and decreased performance. Some arousals, however, always occur naturally during healthy sleep. The brain, not the stomach, makes arousals. Please don't confuse arousals from sleep with hunger.

  It's not just night sleep that can be fragmented. I believe naps can also be fragmented when parents rely on “motion” sleep in a baby swing or car, or when they allow catnaps in the stroller. Holding your dozing child in your arms in a rocking chair during the day also probably prevents good-quality day sleep. These naps are too brief or too light to be restorative. Stationary sleep is best. If you use a swing for soothing, turn it off once your baby falls asleep.

  PRACTICAL POINT

  After four months, naps of less than one hour cannot count as “real” naps. Sometimes a nap of forty-five minutes may be all your child needs, but naps of less than thirty minutes don't help.

  By four to eight months of age, infants should have at least a midmorning nap and one in the early afternoon, and the total nap duration should be two to four hours. Night sleep is ten to twelve hours, with one, two, or no interruptions for bottle-feeding. If you are breast-feeding and using a family bed, you might feed your baby at night many times. In this situation, both mother and baby are often more asleep than awake during the feeding and neither suffer from sleep fragmentation. When children do not get healthy, consolidated sleep, we call the problem “night waking.” As I will discuss later, night waking itself is usually due to normally occurring arousals. The real problem is the child's inability or difficulty returning to sleep unassisted.

  PRACTICAL POINT

  Some arousals from sleep are normal. Problems occur when children have difficulty returning to sleep by themselves. They have not learned the process of “Falling asleep.”

  Sleep Schedule, Timing of Sleep

  Figures 5 and 6 show the times when most children awaken or go to sleep. These graphs are based on data from the same 2,019 children referred to in Figures 1 through 3 (see pages 21-23). Looking at the graphs, you can see, for example, that 90 percent of preschool children (those under the age of six) fall asleep before 9:00 P.M., and 10 percent of children between the ages of two and six fall asleep before 7:00 P.M.

  MAJOR POINT

  Junk food is not healthy for our bodies. Neither is a “junk sleep” schedule. You try not to let your child become overly hungry, so don't let your child become overly tired.

  When sleep/wake schedules are not in synchrony with other biological rhythms, attentiveness, vigilance, and task performance are measurably decreased and moods are altered. Jet-lag syndrome is one example of this. Another is the poor sleep quality some shift workers suffer due to abnormal sleep schedules. Shift workers complain mainly of headaches and stomachaches. These are the most common complaints of older children with unhealthy sleep schedules. So if your child doesn't appear to be very sick but has frequent headaches or episodes of vague abdominal pain, especially near the end of the day, ask yourself if he might be overtired. A clue would be that he no longer has the energy or drive that he once had.

  When thinking about sleep schedules in babies and toddlers, consider sleep to be “food” for the brain, just as breast milk or formula is food for the body. You don't breast-feed on the run while doing errands; instead, you find a reasonably quiet space. Same for naps. You don't withhold feeding because it is socially inconvenient; you anticipate when your child might become hungry. Same for naps. You don't try to force-feed your baby when she's not hungry; you know a hungry period will naturally come. Same for naps. A parent coming home late from work would not starve his baby by withholding food until he arrived and could feed the child. Same for the bedtime hour; don't “sleep starve” your baby's brain by keeping her up too late.

  Night Sleep Organization

  Before six weeks of age, the longest single sleep period, unfortunately, is randomly distributed around the clock. In some babies, this longest sleep may actually be only two to three hours! But by six weeks of age (or six weeks after the due date, for babies born early), the longest single sleep period will predictably occur in the evening hours and last three to five hours.

  PRACTICAL POINT

  During these early weeks, you may find breast-feeding too demanding or too frequent, and think that you might want to quit so that you can get some rest. On the other hand, you also may want to continue nursing. Hang in there until your baby is past six weeks of age. Then you, too, will get more night sleep.

  After six weeks of age, babies sleep longer at night. So do moms! Also, babies start social smiling at their parents, and they then become less fussy or irritable. Life in the family definitely changes after six weeks. One exception is the premature baby, whose parents might have to wait until about six weeks after the expected date of delivery. Another exception is the extremely fussy/colicky baby, whose parents might have to wait until their child is three or four months old.

  Daytime Sleep Organization

  At about three to four months of age, daytime sleep is organized into two or three long naps instead of many brief, irregular ones. Mothers, especially nursing mothers, should learn to nap when their baby naps. You never know what the night will bring; you might be up a lot holding, walking, or nursing.

  Abnormal sleep schedules usually evolve in infants and young children when parents keep them up too late at night. Parents do this because they (1) enjoy playing with their baby, (2) cannot put the child to sleep, but wait for their child to crash from total exhaustion, or (3) both. Some parents leave work late, have a long commute to the day-care site to pick up their child, and then arrive home even later. This lifestyle is extremely difficult for the child if naps are not regular at the day-care center and he is put down too late to sleep at night. Unfortunately, if both parents are working outside the home, then naps may suffer on weekends because the parents do too many errands with the child or attempt to spend too much time playing with their child to make up for the minimal time together during the week. Sleeping well during the day may also suffer when parents skip naps in favor of organized, scheduled preschool activities. These baby classes are usually fun for both child and parent, but if they take up too much time, the child becomes overtired.

  One common mistake is keeping bedtime at exactly the same hour every night. Usually this hour is too late and is based more on the parents’ wishes than the child's sleep needs. It is important to have a fairly regular routine of soothing events before putting your child to sleep, but it makes biological sense to vary the bedtime a little. The time when your child needs to go to sleep at night depends on his age, how long his previous nap lasted, and how long his wakeful period was just before the bedtime hour. The time when he wants to go to sleep may be altogether different! Obviously, the bedtime hour is not fixed or unchanging. If your child is unusually active in the afternoon or if she misses a good afternoon nap, then she should be put to sleep earlier.

  This is true even if a parent, returning home late from work, does not get to see her child. If one parent is arriving home late, then she or he might walk in the house and immediately begin a twenty-to thirty-minute soothing-to-sleep routine without playtime. If the parent returns very late, the child should be put to bed as usual; keeping a tired child up to play wit
h a tired parent does no one any good. At the cost to the parent of having less time with his child, the benefit is no bedtime battles, no night-waking habits, no early-morning arousals, good-quality naps, a well-rested child, a well-rested spouse, and relaxed private time for the parents in the evening. Usually under these circumstances there is morning time to spend together and relaxed weekends for the family because everyone is well rested.

  The completely opposite scenario occurs when one parent, usually the father, demands that the other parent, usually the mother, keep their child up late so that he can play with him or her. Not only does the child suffer, but it is the mother who is the unappreciated victim, because she is trying to maintain marital harmony and trying to keep her child well rested—and she can't do both. Obviously this is not simply a child's sleep problem but a family problem.

  PRACTICAL POINT

  To establish healthy sleep schedules at four to eight months of age, become your infant's timekeeper. Set his clock on healthy time.

  Allowing brief naps in the early evening or long late-afternoon naps in order to keep a child up late at night will eventually ruin healthy sleep schedules. If your child misses his early-afternoon nap, in order for him to be able to fall asleep close to his biological bedtime hour and avoid the overtired state, it is better to have no nap and an early bedtime than a late nap and a late bedtime. Similarly, you may occasionally need to wake your baby in the morning in order to establish an age-appropriate midmorning nap that is needed to set the sleep schedule for the rest of the day.