Q. My son is nearly 18 months and still hasn’t slept a full night. He always wakes and wants to get into my bed! And I give in…
A After 18 months of interrupted sleep you must be feeling exhausted. Motherhood is challenging at the best of times and being sleep-deprived can make it even harder. With ongoing sleep issues, you will need an entire sleep overhaul and some significant lifestyle changes – but it will be worth it when both you and your little man start to get consolidated uninterrupted sleep. At this age, it is easy to resign yourself to perhaps accepting that it will never get better, but I can assure you with some subtle changes you will see improvements almost straight away, and in general a complete transformation within three to four weeks.
Where does he sleep?
First of all, you will need to start to define his place of sleep. Decide where you want him to sleep and stick to it. Make sure that he starts off his bedtime sleep in his own room and cot and then he can put himself to sleep without a dependency on a bottle/nursing or your presence. If this is the case then you will have to weaken this dependency by removing it and replacing with a calm bedtime routine, again, in his room only. I would recommend that you entirely avoid your bedroom both at bedtime and in the morning to help him understand the changes. I find the easiest way to do this is to start with you beside him at bedtime offering support and reassurance and then over a week to 10 days, move yourself out of the room in gradual phases.
Get the daytime routine right
More importantly, I would encourage you to ensure that you have a feeding and sleeping balance to the day ensuring that he gets enough to eat and drink throughout the day, coupled with appropriate outdoor activity and fresh air. At 18 months, he will probably require a nap from one and half to two and a half hours during the day. I would recommend that this sleep happens after 12 noon and after he has had his lunch. To establish a day sleep, you will need to make sure that he is woken in the morning no later than 7.30am. Finally, you will help him learn if you observe an early bedtime too. Start the process from around 6.30pm onwards having provided a drink of milk if appropriate before you head to the bedroom. Spend about 20-30 minutes winding him down before you want him to get into his cot and start going to sleep.
Work at it
When he wakes overnight you will have to break the cycle of waking with patience and consistency. “Giving in” is a very normal response, but it won’t help you achieve your sleep goals. It may be labour-intensive to begin with, but it will gradually improve and if he has stayed awake for a long period overnight, that will also shrink provided that you see it through each time. I wish you all the best and would strongly encourage you to make these adjustments as soon as possible.
Q. I am breastfeeding my six-month-old baby and want to continue to do so for the foreseeable future. Every night he wakes up once and if I feed him immediately, he will fall straight back to sleep. In order to minimise disruption to everyone else in the house I feed him in the bed beside me and we all fall back to sleep for the rest of the night. This routine works so well, I’m reluctant to change it. He will go to sleep in the evening in his own cot, so I don’t feel I’m getting him into a ‘bad habit’, so to speak, but I seem to have a lot of peers, some breast feeders, some not, who think what I’m doing is almost sinful! Can you tell me if it’s okay to continue what I’m doing?
A. Firstly, it is great that you have your little person and yourself in a lovely routine, with a level of independence and a defined place of sleep at bedtime and that your baby is also just waking once for a potentially required feed. Although, the health agenda strongly discourages bed-sharing, as a practitioner and as a breast feeding mum myself, I am aware that this is a very efficient approach, provided it works for you, and also you are making an informed decision where safe sleep is concerned. To that end, I would remind you that in general our beds are not designed with small children in mind, so ensure that it is a firm flat surface with no loose covers and at no time can your child get stuck in gaps between bed and wall and indeed under covers or pillows.
It is not recommended for your child to be placed up high but rather low down with their mouths close to your breast. Naturally, breastfeeding mums envelope their offspring in a typical ‘c-shape’ position and it is suggested that your presence and breathing along with feeding help to regulate your baby. That said, even with a cot we may not always achieve a risk-free environment. With SIDS, it would appear that the largest contributory factor may be smoking. If either parent has had alcohol or drugs, including over- the-counter medication, then bed-sharing should not really be an option. If you are in the slightest bit concerned then a co-sleeping/side car cot may be a good solution for you to consider. This attaches directly to the bed and creates a separate but still close sleeping environment for you and baby.
Bear in mind that if you commit to bed-sharing for any portion of the night, your baby will possibly develop an expectation to sleep with you and at some point you may then have to work on weakening this association when you would like this to happen, but there is not real ideal time to do this.
Once, safe sleep is being observed within an informed capacity, considering the health agenda, then getting enough restful sleep for the entire family unit is of equal importance. What you do right now suits you and I would not allow yourself to change due to ‘peer pressure’.
Q. My little girl is 10 months and in the last few months her night-time sleep has become really disturbed. She could be tossing and turning all night and wakes up tired whereas for her naps during the day she is out for the count with very little movement. Why is there a difference between day and night sleeps?
A. Restless sleep can be caused by a number of factors with day and night-time sleep differing greatly anyway. Initially I would rule out any reflux, allergies, food intolerances, wind, and constipation with your GP that typically can present with a restless sleeper, specifically at night-time. I would also want to make sure that it is not pain related, but since it has been going on for a few months I think you would know at this stage. Then the first area I would look at would be comfort: that you have an appropriate cot and firm mattress and then examine the sleep clothes, bedding and temperature of the room and child. We don’t sleep well if we are too hot or too cold, so assess that this is not contributing to the issue. Maintain the bedroom temperature between 16-20 degrees and ensure that the room is cleaned and aired daily. You may also want to make sure that her sleeping clothes are not too tight and big enough and the bedding is a comfortable, suitable texture for her.
One of the biggest causes of restless sleep in children can be overtiredness from either inadequate or poorly timed naps and/or a bedtime that it too late. That coupled with how your baby goes to sleep can often result in an unsettled presentation throughout the night that you report.
A well-rested child from the day time, with a suitable bed time and of course able to go to sleep without intervention from the parent will routinely sleep better and longer and deeper, than one who is not.
At 10 months your baby requires around three hours of naps during the day-time balanced between two naps, one within two to three hours of waking in the morning and another about three hours later again. Ideally these naps would be equal in duration and if they are not then I would advise that the second nap is the longer of the two. Furthermore, in this age group it is important that your child is asleep at bedtime within not more than four hours of waking from the second nap. Being awake longer can mean your child is overtired come bed-time, despite having adequate day-time sleep. This normally means that bed time is between 7pm-8pm and maybe earlier if the naps are not long enough or higher up in the day.
Finally, I would ensure that your baby is able to go to sleep without a prop – be it, your presence, a bottle, soother, holding, or rocking, for example. Even if you have the timings right and your child is napping well during the day, if you are involved in the onset of sleep, you may experience a high level of restlessness then too. I hope that helps shed some light on your problem and gives you some areas to work on.
Q. How do I get my three-year-old to sleep when she is put to bed? Bedtime is 7:30pm but she can stay awake until 11pm some nights even after we’ve had a busy day. She does play for a bit at bedtime and other times she will sit chatting to her teddy or reading a book in the dark! She shares a room with her six-year-old sister, as we don’t have an extra room. There are times both girls play a little at bedtime but the six-year-old is generally asleep fairly quickly. Both children wake between 7:30am and 8:30am. My three-year-old stopped napping at aged two.
A Unfortunately you can’t make a person sleep. With children in this age group you want them to have healthy sleep habits; to fall asleep independently and in a timely fashion. To help this happen you need to create the right environment at the right time. Your daughter seems to finds it difficult to switch off. This is creating an overtired cycle, with a late bedtime asleep and a normal wake time, which means that some nights she is only getting 7-9 hours overnight when she will probably need 10.5-12 hours. With a child stuck in a late sleep phase and becoming increasingly overtired, you will need to concentrate on a few key areas detailed below:
– A regular wake time of 7.30am, despite the time she went to sleep. This will reset the body clock and help establish an age appropriate bedtime of ideally in bed asleep between 7-8pm.
– Ensure high level activity, ideally outdoors, weather permitting, for about one hour a day between morning and afternoon.
– Observe a healthy balanced diet, reducing and eliminating processed or high sugar orientated food. Make sure vitamins are taken first thing in the day. Avoid eating food too close to sleep time.
– Stay well hydrated to assist production of the sleep hormone melatonin.
– Minimise screen/electronic media time, especially in the two hours or one hour at the very least before bedtime to help the brain relax in advance of sleep. This action alone can correct a late sleep phase.
– Make sure both girls have ground rules for room sharing. For example no talking or playing once lights out. Both ladies need to co-operate here.
One hour before bedtime, wind the house down. Darken the rooms, turn down the lighting. Give your child a 20-30 minutes wind-down in the bedroom, timed so that she is not becoming overtired in advance of bedtime. At the start I would begin this practise by 6.30pm aiming for her to be asleep between 7-8pm. This time should be spent in the bedroom and again needs to be low key: close curtains, dim lights, get into sleep clothes. Read stories and chat about the day; all outside of the bed. Some gentle stretching exercises can also help wind her down and prepare her body for sleep.
Once lights out time arrives, then you should encourage no more talking or playing. You may need to remove the distractions to facilitate cooperation. Make sure the room is dark enough.
Making all these changes nearly always help sleep to come sooner and more easily for a child. It won’t happen immediately, but over three to four weeks you are likely to see an improvement. Good luck!