From Multiple Wakes To Sleeping All Night. Meet baby Sam.
- Dr Fallon Cook.
Meeting Sam.
When I first met Sam, a happy 5 month old baby boy, his parents, June and Ben, were feeling quite anxious about his broken sleep. They were exhausted and nothing they had tried had helped. I saw them via Telehealth in our Virtual Sleep Clinic.
The problem.
June and Ben’s primary concerns were:
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Sam was crying a lot at nap time
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When Sam would finally fall asleep he would only nap for 30 minutes unless he was being held
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Sam could only fall asleep if he was feeding and often needed to be held for a long time before he could be transferred to his cot
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He had to be constantly resettled overnight
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Everyone was exhausted
June and Ben knew that feeding him to sleep and then gently putting him down in his cot, was causing him to wake up multiple times overnight wanting to be held back to sleep again.
They’d already worked very persistently at supporting him to settle in his cot, but he seemed exceptionally resistant to this. He would cry for a long time before eventually, June and Ben would give in and feed him to sleep.
The sleep diary assessment.
First we looked at Sam’s sleep diary. Sam was averaging around 11.5 hours of sleep per 24 hours. On some nights he would wake 2 times to feed, which is normal and expected for his age, however, other nights Sam would wake up to 6 times and requiring intense support for up to an hour in order to resume sleeping.
This is Sam’s sleep diary before his first appointment with us. Note the frequent wake ups early on in the night and several instances when it took longer than 1 hour to resettle Sam at night.
Assessment of mood, temperament & tiredness.
Factors including mood and temperament can have a huge influence on sleep and can also give us clues about what types of strategies are likely to be the best fit.
June and Ben described Sam is a very happy, relaxed and easy-going baby. They described how Sam only ever cried at nap time and bed time. Sam enjoyed being alert and active while awake, and enjoyed smiling and interacting with his parents.
He was cranky at nap time and bed time because he wasn’t ready for sleep. Age-based sleep schedules were not a good fit for Sam at all. When other babies his age were tired and cranky and ready for sleep, Sam was wide awake and looking to play.
Sam is what we refer to as a ‘low sleep needs baby.’ These are babies who seem to need less sleep than other babies their age - they cope perfectly well on less sleep than is typical for their age, and even when opportunities to sleep more/longer are offered, they tend not to.
Why are sleep needs so important?
We all have a unique amount of sleep that we need in order to function well. Some adults do well with only 6-7 hours of sleep, whilst others need closer to 9-10 hours. You know when you’re meeting your sleep needs because you feel well rested and able to cope well during the day.
Babies are similar, they also have varying sleep needs. Some 5 month old babies need a lot of sleep (14-15 hours) and some don’t appear to need all that much (11-12 hours).
We always look at the baby in front of us. If they’re happy, well rested, and enjoying play time, then they’re probably getting enough sleep - even if they don’t meet aged-based norms for total sleep duration.
One of the most common factors that can make settling difficult, is when a baby’s unique sleep needs aren’t being accounted for - often parents are following a generic age-based schedule that isn’t suitable for their child’s unique needs.
It’s unusual for parents to not be offering enough opportunity for their baby to sleep. Usually we find parents are aiming for more day sleep than their baby actually needs and this can make settling extremely difficult.
The solution.
We created a sleep plan tailored specifically to Sam’s sleep needs. This included:
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Giving Sam just 3 short (30-40 minute) naps each day, spaced out across the day. This immediately took pressure off June and Ben - they could let Sam play for longer between naps and only had to settle him when he was tired and clearly ready for sleep. June and Ben no longer had to spend time trying to resettle Sam if he woke after only a 30-40 minute nap. Sam was happier with more play time, and June and Ben reclaimed more than an hour from their day since they no longer had to spend so long trying to settle/resettle Sam.
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Steps to work on cot settling. With Sam’s revised sleep schedule he was much more tired at bedtime and more receptive to falling asleep in his cot. June and Ben chose an approach that allowed them to stay present with Sam while he fell asleep in his cot, and that allowed them to offer extremely frequent reassurance while Sam made the adjustment to cot settling.
The result.
June and Ben spent 3 days working on the new schedule before they started work on cot settling. This allowed more sleep pressure (or sleep drive) to build up in the evenings. Once sleep pressure was high enough at bedtime, Sam was ready to start settling in his cot.
June and Ben were nervous about starting the steps for cot settling because they’d had a really hard time during previous attempts. But it went so much better than expected!
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It took Sam around 30 minutes to fall asleep on the first attempt at cot settling.
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Every settle thereafter was easier, typically taking only a few minutes for Sam to drift off to sleep and with very little or no crying.
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On the 2nd night Sam slept from 8pm-7am!
Let’s have a look at how Sam’s sleep diary changed:
Notice the difference between the number of night wakings before treatment (in red) and after treatment (in green). Sam also managed to increase his total daily sleep by an hour.
Follow up care.
June, Ben and little Sam attended a review appointment, two weeks after their initial appointment. June and Ben were thrilled with Sam’s progress. Everyone was better rested and happier. The plan was easier to implement than expected and progress was faster than June and Ben thought would be possible.
During the review appointment I helped June and Ben plan for the future - so they were armed with a detailed plan for how to tackle common difficulties that can derail good sleep - like illness, teething, and separation anxiety. This plan also included detail on how and when to drop naps as Sam gets older.
“Sam’s sleep has changed so much because of your guidance - we would never have figured all this out without your advice on settling, sleep pressure and understanding why he cries at bedtime. Thank you so much for your help and guidance.
Key points to remember.
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Babies with low sleep pressure are extremely hard to settle - if you’ve tried multiple approaches and found that nothing has worked for your baby, then it’s likely they have a sleep pressure difficulty that is impacting their progress.
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If you are struggling with your baby, toddler, or pre-schoolers sleep, get help sooner rather than later. Sleep is important for the wellbeing of you and your child and sleep can often be improved quite quickly.
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Book in for an initial appointment in one of our clinics. We will take a close look at your child’s unique sleep needs, temperament and settling, and develop a sleep plan tailored specifically to their needs.
Do you have a tricky case? We specialise in particularly tricky sleep cases, which is why we are trusted by GP’s, paediatrician’s and health nurses.
Dr Fallon Cook, PhD.
Paediatric Sleep Practitioner
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