Dr Fallon (00:37)
Hi and welcome back to Brand New Little People. And this week is a very special episode because we are going to be giving you the ultimate guide to night waking. I'm your host, Dr. Fallon Cook and I'm here with Dr. Laura Conway. How are you going Laura?
Dr Laura (00:53)
I'm good, thanks, Fallon. How are you?
Dr Fallon (00:56)
Yeah, I'm good. You know, we've had like a lot of questions come through about night waking. It's a really recurrent theme. And we realized we hadn't had an episode really focused on this for a while. And it's interesting. I was saying to my husband last night, you know, when you think back to when the kids were little, like, what's the real standout thing, the thing that was the most challenging to manage? And he said, oh, night waking. So yeah, yeah. And even now, you know, I'd
Dr Laura (01:21)
Yes.
Dr Fallon (01:24)
your kids are older and so are mine, but at night, you know, when you wake up and you hear, mom, I always like pause for a couple of seconds thinking, no, no, no, I dreamt it. I dreamt it. That wasn't real. And then a few seconds later, mom, oh gosh, here we go. Yeah, exactly. And there's far fewer nightwakings happening. So don't worry parents, it does reduce dramatically. But,
Dr Laura (01:30)
Yeah.
Yeah. Yeah. Here we go. What is it this time? Yeah.
Yes.
Dr Fallon (01:54)
When you're in the trenches with your baby or toddler and you're having lots of night wakes, it is a killer. It really flows into every part of your day. It might mean that you're really dreading the nights. It might mean that you're feeling so fatigued that you're worried about safety and driving a car and you know, you're having to juggle work as well or other children. It's so tough.
Dr Laura (01:59)
Mm -hmm.
Mmm.
Yeah, yeah, it's really tough. And when the wakings that your baby or toddler are having overnight are really unpredictable. You know, sometimes we say those sleep diaries, don't we, Fallon, where a scatter gun, where the wakes are just all over the shop and really frequent. Sometimes you might get a couple of hours after bedtime before they wake up. Other times they're going down for one sleep cycle.
Dr Fallon (02:32)
Hmm.
Dr Laura (02:45)
And then the wakes can be relentless after that. It's then can really begin to impact on your mental wellbeing because you think, well, I'm really tired, but is there any point me going to sleep now? Because I know that they might be awake again in another sleep cycle or I might get two hours. I don't know. And then it's just that torture of not knowing what to expect. And we see parents in clinic who are just absolutely exhausted.
Dr Fallon (03:02)
Mmm.
Yes.
Dr Laura (03:14)
because they have had weeks, months, sometimes years of this. And they're very concerned about their baby or toddlers functioning. But I also have some concerns around them and how they're managing because it's so important to be a functioning member of society, to be well -rested.
Dr Fallon (03:19)
Yeah.
Hmm.
Yes. Yeah, absolutely. It's important for the entire family's wellbeing. And I think it's, you know, there are different causes for night waking. And I think what parents should hold onto is the fact that most are manageable. So most we can actually do something about. But let's start with the cause of night wakings where we can't change anything. And that is when there's a physiological cause. So if you've got a really little baby,
Dr Laura (03:45)
Mm.
Mm -hmm.
Yeah.
Mm -hmm.
Dr Fallon (04:07)
they're going to wake up because they need to feed. There's not really going to be much you can do about that. Aside from if you have a partner trying to share those overnight feeds is a really good idea. So yeah, there are going to be some young babies or some older ones who might be unwell who really just need to feed. And things like pain and illness or discomfort, you know, they're very valid reasons for a baby or a toddler to wake up at night. That's not something we can really change. But the physiological,
Dr Laura (04:24)
Mm -hmm.
Dr Fallon (04:36)
causes of night waking tend to be fleeting. They don't hang around forever. Your little baby won't need to feed multiple times overnight forever. And pain and illness, you know, they might hang around for a few days, but then they resolve as well. What I think we could dive into in today's episode, Laura, is the other three main causes of night waking problems.
Dr Laura (04:53)
Yeah.
Dr Fallon (05:00)
because I think it really helps parents to think through some of these things, because there might be some things you can change that are going to make a really big difference. So very briefly, we have to think about the circadian rhythm. Sometimes there's very low sleep drive overnight, and that's causing nightwakes, sleep associations. So if your baby's falling asleep with something happening around them and they wake overnight and that's no longer there, that can contribute to night waking and also motivation.
Dr Laura (05:05)
Mmm.
Mm -hmm.
Dr Fallon (05:26)
So sometimes they're feeling really motivated to wake, especially toddlers who wake up really early in the morning. That's often, yeah, there's some motivation at play there. So let's dive into the circadian rhythm, Laura. There's a couple of different ways night wakes will present depending on what's happening with a child's circadian rhythm. Tell us about what those night wakes might look like if there is sort of low sleep pressure happening at night time.
Dr Laura (05:31)
Yes.
Yeah, one of the common ways that we see circadian rhythm disturbance occurring is when you have a baby or toddler who is awake overnight for an extended period of time. And that might be half an hour, it might be up to two or three hours overnight. And some parents will know exactly when it's going to happen.
that it's always at one o 'clock, they're always awake from one until three. And other parents experiencing a little bit more unpredictability, but generally there is at least one long wake overnight. And we sometimes refer to those as split nights or biphasic nights. And what's happening is that your baby is often going off to sleep, doing a big long stretch of sleep where the sleep pressure starts to fall and then it bottoms out.
at say midnight, one o 'clock and then your baby or toddler is awake for a good long stretch of time during which time that sleep pressure is getting really high before they do another stretch of sleep and that can present as your baby or toddler being wide awake, smiling, chatting, wanting to play or sometimes it can present in a way that your baby or toddler wants to go back to sleep.
Dr Fallon (06:56)
Mmm.
Dr Laura (07:15)
they simply can't and they can be quite frustrated and they might go back to sleep for a few minutes in their cot and then they sit up again and then they lie down and they try again or if they're not in their cot it might just be on and off you for a long period of time and then you're not able to put them back down into their cot until a good stretch of time has passed and then they'll do their second stretch of sleep. So that's one of the common presentations of a circadian rhythm.
Dr Fallon (07:16)
Hmm.
Dr Laura (07:45)
disruption. Thalen, do you want to describe the other common one?
Dr Fallon (07:46)
Hmm.
Yeah, yeah. So some parents will see this sort of lower sleep pressure overnight as being just a lot of very brief wake ups that are scattered right across the night. And this is, I think is really painful for parents because they're not themselves able to get their own long stretch of sleep in before the baby starts to wake up or the toddler starts to wake up. And so often, whether you're getting like the split nights where it's just a solid block of, you know, an hour or more,
Dr Laura (07:58)
Hmm.
Dr Fallon (08:17)
or lots of tiny little frequent night wakes right across the night. It really pays to think about that daily rhythm, which is something we talk about a lot on here and there's a lot of content you can work through on SunBowl around how to set up a really good daily rhythm. But essentially if sleep pressure is too low at night time and it's causing night wakes, there's an imbalance happening where almost certainly your child is getting more day sleep than they need.
Dr Laura (08:29)
Mm -hmm.
Mm -hmm.
Dr Fallon (08:43)
that's causing tricky nights. And because they have a tricky night, they wake up and you know what, they need more day sleep to make it through the day. It's a really vicious cycle. So we often say to families, have a look at how much sleep your baby is averaging, build out a daily rhythm that fits that really neatly so that when they're put down for sleep at night, they're ready for it. Their circadian rhythm is kind of expecting to get a lot of sleep overnight. And that's when that type of difficulty tends to start resolving.
Dr Laura (08:53)
Yeah.
Yeah, yeah, definitely. And you may be looking at reducing the nap duration, reducing the number of naps, or if you've got an older toddler, you may be looking to drop the nap altogether. So that you know that your toddlers are building that sleep pressure nice and high at the by the start of the night, and then they have high enough sleep pressure to be able to maintain their sleep all night long, without having the frequent wakes or that one long wake in the middle of the night. So the good news is that
Dr Fallon (09:14)
Hmm.
Mmm.
Yeah.
Dr Laura (09:42)
It can be relatively straightforward to reduce the number of wakes that your baby or toddler is having overnight, just by looking at the timing and getting a firm understanding of your baby or toddler's unique sleep needs and adjusting the schedule accordingly. We often see in clinic families reporting that they just making some timing changes, they immediately see improvements in the problems that they were having with the overnight wakes.
Dr Fallon (09:52)
Mmm.
Hmmmm
Dr Laura (10:12)
and it can be a really good, quick, easy win for you and your family. Which does bring me on to the next main cause of overnight wakes that we were gonna talk about, Falon, which is sleep associations. Because sometimes what we find is that the families who make changes to the...
Dr Fallon (10:22)
Mmm.
Mmm.
Dr Laura (10:40)
the ratio of day to night sleep do see some big improvements straight away, but they're not able to see a complete improvement in overnight wakes because those babies or toddlers are still needing an association that is dependent on the parents doing something present at the start of the night.
Dr Fallon (11:03)
Mmm.
Dr Laura (11:06)
So that when they wake up overnight and that dependent sleep association is no longer there. Even if we've got the timing pretty much on point, the babies or toddlers are still going to wake up as they come up into light sleep because that sleep association that they need to resettle just isn't there. And then it's really important to address how your baby is going to sleep.
Dr Fallon (11:18)
Mmm.
Yeah.
Yeah. And working on these two things in combination is something that we, we do a lot of because we see from families that they've been to services that either worked on one thing or the other, but not both. Like there's lots of services that can teach you how to help your baby fall asleep in their cot without needing a lot of assistance. But if you haven't got that timing piece right, and there's some low sleep pressure happening at nighttime, it won't stick. It just won't stick. And.
Dr Laura (11:46)
Yes!
Dr Fallon (12:02)
vice versa, some people say, oh, forget about how you settle them, settle them, however you like, let's just get that sleep pressure at nighttime roaringly high. But then that won't result in a complete resolution of the sleep difficulties you're having either. So definitely working on both together, I think that's how we managed to resolve some of the trickier, more persistent sleep problems. But yeah, with sleep associations, so a lot of parents have heard of sleep associations. And like you've said, Laura, it is about if you...
Dr Laura (12:22)
Yes.
Dr Fallon (12:30)
You know, the best example is thinking about adults. If you fall asleep in your bed with your doona and your pillow, that's what you're expecting to have on you and around you when you wake up overnight. And if you wake up and your pillow is not there or you find yourself on the couch, you're going to think, what the heck? And you're going to spring awake and you're not going to go back to sleep until you get everything just right. Pillow under your head and your doona back on again. And that's because every human from about four months of age,
Dr Laura (12:46)
Yeah.
Dr Fallon (12:58)
When we come up into light sleep at the end of a sleep cycle, we have what we sort of call a systems check where your brain is going, is the temperature okay? Are we comfortable? Is the nappy wet? Am I hungry? It's checking all these things, but it's also checking, has anything around me changed while I was asleep? Because if it has, it's like a little red flag going up where your brain is saying to you, you need to check and make sure the environment is still safe and okay. And that's what happens to babies. If they,
Dr Laura (13:18)
Mm -hmm.
Mm -hmm.
Dr Fallon (13:28)
you know, common one is they fall asleep feeding and then they're transferred to the cot. They come up into light sleep and they spring awake with a bit of a shock. Like, how did I get here? How very dare you move me here? Their systems check has happened and their brain has gone, hang on, you need to check the environment. Something's changed here. It could be dangerous. We better check out, you know, what it is. Obviously there's no danger, but as humans, that's how we've survived. As long as we have, we, you know, we wake up and do that check. So that's why it's so important.
Dr Laura (13:37)
Yeah.
Mm -hmm.
Dr Fallon (13:57)
And I think a lot of the families who listen in and say, well, that's not a problem for us. Our baby or toddler is cuddled to sleep or fed to sleep and they still sleep pretty well. And that's fine. There are children who, you know, won't care where they fall asleep. It's all just totally fine. But they tend to be in the minority. Like it's for the majority of babies and toddlers. They will wake up if big things are changing in their sleep environment during sleep. And
Dr Laura (14:13)
Yeah.
Yeah.
Dr Fallon (14:24)
I think you had a great explanation for this before Laura about how sometimes even if they do feed to sleep, they will have some longer stretches of sleep and parents go, why is it that they do a three hour stretch before they wake up? And you have a great explanation for that.
Dr Laura (14:37)
Yes. Yeah, so this is where the sleep pressure works in combination with the how babies go to sleep and how they link their cycles during the night. So if we think about your baby going off to sleep, we know that their system checkers are going off to sleep is they're fed, they're comfortable, they're with mum or dad, and off they go to sleep. When they come up into light sleep,
after a sleep cycle, their body will do that systems check. Am I still satiated? Am I still comfortable? Has anything changed since I went to sleep? Now, if they had, using your example, Fallon, if they have gone to sleep whilst feeding and they're now in their cot, the flag, that red flag might come up and the system is saying, Oh, hang on, something has changed. Now,
If their sleep pressure is high, the sleep pressure can sometimes push that flag back down and your baby will go into the next sleep cycle. So that's why sometimes we see babies doing big long stretches of sleep, even when they have been held to sleep, rocked to sleep, fed to sleep, and then they're being transferred to their cot afterwards. But what we see often is that in the second half of the night when that sleep pressure is getting a bit lower,
Your baby's coming up into light sleep doing that systems check. Am I comfortable? Am I hungry? Has anything changed since I went to sleep? Bang, the flag comes up, where's mum? And the sleep pressure isn't there to push that flag back down. And then they're like, Oh, no, something has changed. And where are you? And then there's that startle and parents will describe that their baby wakes up in the night. Frantic, hysterical. You know, those are the types of words that are used.
Dr Fallon (16:18)
Hmm.
Hmm. Can't put them back down no matter what I do. Yeah. Really common.
Dr Laura (16:34)
Yes, yeah. Because your baby had the sleep pressure hasn't been able to push the flag back down. And then they have woken up somewhere unexpected and they are startled. And then yes, they are upset. Of course, they're upset. And then of course, they need support from you to help them calm down. And we expect that so it's a very common presentation in the clinic. And yeah, of course, then it's really important that you go and give them a cuddle.
Dr Fallon (16:51)
Hmm.
Yes.
Dr Laura (17:04)
to calm them down. Now with then the sleep pressure being a bit lower, it's very unlikely that you will be able to put them down into the cot for them to go back to sleep without using that sleep association that they have, be it rocking, bouncing, cuddling, feeding.
Dr Fallon (17:18)
Hmm.
Yeah, absolutely. I think that's the number one thing that is missed. And my number one wish for parents is that we need to have more people working in the sleep space who are looking, it sounds crazy, they're not looking at the circadian rhythm and they work in sleep, but it happens. We need more people who are considering sleep pressure and the circadian rhythm and a baby's unique sleep needs alongside how they're falling asleep. What's happening when they do their systems check.
Dr Laura (17:46)
Mm.
Dr Fallon (17:49)
because when we work on those two things together, that is where magic happens. And there is almost not a single case that comes through our clinic doors where we aren't looking at having to look at both of those things. It's a rare appointment when it's only one or the other that is actually the problem. There's usually something we need to do about both. And that's how they've come to us because they've tried all the things, nothing stuck. And then we work on them together and we finally figure it out. So yeah, if you felt like you've been walking that kind of pathway.
Dr Laura (17:54)
Hmm.
Yes.
Mmm.
Dr Fallon (18:19)
it's going to be a case of looking at both in combination.
Dr Laura (18:23)
Yeah, and going working through the chapters in Sombell, that's going to help you work out what sleep associations your baby or toddler may have. And if the way that your baby is going off to sleep with those sleep associations may be contributing to the overnight wakes. And then you'll be able to look at the range of approaches that we describe in detail in Sombell to see which one is going to be most suitable for you, your baby or your toddler.
Dr Fallon (18:31)
Hmm.
Dr Laura (18:51)
so that you can begin to help them fall asleep in a way that isn't dependent on you, should that be something that you're ready to work on.
Dr Fallon (18:59)
Yeah, a hundred percent. And I think it's worth reiterating. I know a lot of parents have a lot of fear about changing how their baby or toddler falls asleep. Um, it is a hundred percent possible to do it in a way that is respectful, that is loving, caring, kind. You know, there are so many strategies we can use to make sure that you as a parent feel like you're supported well enough and you're confident in what you're doing, but that also fits your child's unique temperament. Don't.
Dr Laura (19:16)
Yeah.
Mm.
Dr Fallon (19:28)
fall for the views out there that are very polarized saying you can't possibly, you know, change these things without being a horrible parent. It's such nonsense. It really is. And I think it does a lot of harm. So if you need support with this, you can absolutely do it in a way that, that fits your family well. And that final factor that can really, you know, cause night waking contribute to night waking is potentially one I think that, that influences toddlers a little bit more than babies, but.
Dr Laura (19:35)
Yeah.
Yeah.
Yes.
Dr Fallon (19:58)
It's motivation. So you could have a baby or a toddler who knows how to put themselves off to sleep in their cot. They've got a great daily rhythm. You know, they've got nice high sleep pressure, but they know that if they do wake up and call out, or if they wake up really early in the morning and call out, there's likely to be something really nice happening. Like maybe it's, um,
Dr Laura (20:19)
Yes.
Dr Fallon (20:21)
You know, I get to have a big long cuddle with dad in the middle of the night. If I call out, I don't really, you know, I've got plenty of sleep pressure and I know how to get back to sleep, but I want to see my dad or, you know, for a lot of, um, very tired parents, if you, um, are letting your toddler have some TV time or screen time, or maybe it's a warm cup of milk, um, you know, at 6 AM in the morning, they're going to keep waking up at 6 AM because it's lovely. And it's, so you kind of like rewarding that wake up in a way. And often they'll start to wake a little earlier and a little earlier.
Dr Laura (20:29)
Yes.
Yes.
Yes.
Dr Fallon (20:50)
And if you're like, I've totally would have done this. If you're offering more screen time thinking, I just need an extra few minutes, you know, here's a screen, please don't hurt me. Then, you know, it does become a bit of a spiral where they can start to wake really early. And I've certainly seen families where they're so worried. The toddler keeps saying at 2am, I'm really hungry. I need a sandwich or I need to, you know, some kind of snack.
Dr Laura (20:57)
You
Yeah.
Dr Fallon (21:16)
And they're not actually hungry, but they just know that if they ask, it will be offered. And then I get this lovely quiet time with mum or dad. Um, so yeah, think about, is there something motivating your child to wake a lot at night or wake very early? Um, and start to think about reducing any kind of rewards that might be kind of encouraging that behavior to
Dr Laura (21:26)
Mm -hmm.
Yeah.
Mm -hmm.
And on that note, if you do have a toddler who is experiencing separation anxiety, then one of the reasons that they may be waking up overnight is because they've gone to sleep with you present, and then you've gone to sleep in your own bed, and they've woken up and you're not there and then they are actually anxious and scared. So in those instances, it will be really important to use a respectful method.
of just very slowly reducing your presence at bedtime, slowly building their confidence to fall asleep without you by their side, so that when they do wake up overnight, they're not then having that shock and fear of finding themselves alone. Then we generally find that those overnight wakes, where they come to find you or call out, waking up very upset, do then tend to fall away.
Dr Fallon (22:22)
Yes.
Dr Laura (22:31)
So some of those wakes in toddlers are because they want to watch Bluey on the iPad at 5 .30 in the morning in bed with you whilst you get that extra half hour in bed. And some of the other wakes that are happening overnight for toddlers can be because they have separation anxiety. And we do have to be really respectful of that and treat it as the real fear that it is and not be thinking that your toddler is being naughty or...
Dr Fallon (22:38)
Hehehehehe
Yes.
Dr Laura (23:01)
you know, just trying to worm their way into your bed. We do need to actually take that seriously and understand that separation anxiety does impact sleep and toddlers.
Dr Fallon (23:01)
Mmm.
Yeah.
Yeah, definitely. And there's a great approach in the toddler's program called parental fading, which helps to build their confidence settling alone at night, which is a really good one to look at. So really, I suppose to summarize, we've probably got sort of five main causes there of night waking that you can be thinking about if it's a problem for you. So think, is it a physiological cause for it? So are they just too young to drop night feeds? Is there pain or illness? We can't do much about those things. Is it something to do with their circadian rhythm?
Thinking about that nighttime sleep pressure, are they running out of sleep drive at night? Is it something to do with how they fall asleep, their sleep associations? Are they, you know, very dependent on your help to fall asleep? And is that something you need to dial back? Are they motivated? So thinking about those things that they might be wanting to wake up for and separation anxiety, particularly in toddlerhood is a big one to look out for. So hopefully if you've got a baby or toddler who's waking up a lot, that's going to give you some clues about, yeah, what
Dr Laura (23:45)
Mm -hmm.
Dr Fallon (24:09)
what factors to consider. And hopefully that helps. Laura, we've had some great questions come through this week that of course we usually have something about night waking and these ones do really tie into to night wakes and early rising. Do you want to start maybe by reading out the first one from Michaela and Ulf?
Dr Laura (24:20)
Mm -hmm.
Mm -hmm.
Yes. So Michaela and Ulf have written, we have recently night weaned our 14 and a half month old and transitioned her to the cot from our bed. Well done. That's great. She is now sleeping largely uninterrupted through the night. She's going to sleep at about 9pm each night and was sleeping through until 6am with one to two wakes, which was a great outcome for us as she had been waking 15 or more times a night. Wow.
Dr Fallon (24:38)
Yeah.
Oh goodness.
Dr Laura (24:56)
Gosh, and sometimes for an extended period. Wow. So Michaela and Ulf were really getting the double whammy of their frequent wakes plus the extended wakes. So well, definitely. Now they say she has a sleep need of 11 hours a day, according to two weeks of tracking sleep patterns. So that means that she is a low sleep needs toddler. We have recently been capping her day naps at two hours a day.
Dr Fallon (25:01)
Mmm.
Yes.
Well done, you've come a long way.
Dr Laura (25:24)
They sometimes have to wake her from her naps in order to keep it capped at two hours and then they aim for nine hours overnight. Recently, however, she started waking earlier and earlier, five or 5 .30. And there are two things we feel may be motivating this. One is breastfeeding in the morning as she wakes. And yes, so when she wakes, she wants to have a feed and the other is independent settling as we still settle her in our arms.
We're wanting to address the early waking and wonder where the best place is to start. I .e. should we work on the independent settling or should we try to push the morning breastfeed to 6am? Do you have any specific suggestions related to pushing the morning breastfeeding?
Dr Fallon (26:11)
Mmm, it's a really good question. And there was something when you were reading that out Laura that jumped out at me. And I wonder if it could even be something else that needs to change. And they mentioned they're capping her day naps with an S on the end and she's 14 and a half months old. So if she is having two naps per day, I would definitely suggest dropping to one nap because two naps at that age often does result in really early rising. They kind of, you know, having
Dr Laura (26:17)
Mm.
Oh, yes.
Mm.
Dr Fallon (26:40)
They're just basically left with less sleep overnight that they can do. So I'd be thinking about that. And then I don't know, what do you think, Laura, in terms of, you know, alongside dropping to one nap, it could be, yeah, definitely working on, I suppose it's the night wears on and you get closer to morning. It's sleep pressure is getting lower. So that reliance on the help to fall asleep is going to increase towards morning.
Dr Laura (27:00)
Hmm.
Mmm.
Dr Fallon (27:08)
I would probably work on, on the independent settling first, but what do you think, Laura? I think it could go either way.
Dr Laura (27:12)
Yes. Yeah, it could go either way. If you're feeding her at five or 530. And she is then managing to do another half hour to an hour in the morning. And that is just what's holding you together, Michaela and Althea, that's holding your sanity. Then I would probably keep that and work on the...
Dr Fallon (27:31)
Hmm.
Dr Laura (27:38)
independent settling at the start of the night, which combined with moving to one day nap is then likely to result in her maintaining her sleep until closer to 6am when you can then give her that feed. But I think this is one of those cases where there isn't a right or wrong Fallon. Sometimes if parents have been struggling for a long time, I would just say let's just pull the bandaid off and what we're going to do is
Dr Fallon (27:59)
Hmm.
Dr Laura (28:08)
work on the independent settling at the start of the night, and then just be really strict and firm, make the decision that there isn't going to be a breastfeed on offer until 6am. And for a couple of mornings, just work really hard on that settling approach that you've decided to use when she wakes early in the morning and just get as close to 6am as you can and then offer the feed. But if you are feeling that no, I'm just hanging by a thread.
Dr Fallon (28:21)
Mmm.
Mmm.
Dr Laura (28:37)
then I would say keep that early morning feed for the time being and just work on the nap and the independent settling at the start of the night first.
Dr Fallon (28:48)
when you do go to push that feed to 6am, there's two things you can do that can help. Offer a sippy cup of water and you might even make it warm water and just make sure you're saying she's old enough that she can understand if you say no milk until morning, we're just having water. She's probably going to get a bit cranky with you, but that's okay. Lots of cuddles and reassurance and you can carry on with that. And then you might even start to use something like a grow clock or
It could even be your own alarm clock or something to signal that at 6am so that you can say to her, the clock hasn't turned green yet, or we haven't heard the beeper go off yet. So it's not time to have our morning feed because for toddlers and she's just entering toddlerhood, they like kind of knowing what to expect. So if they know that when the clock turns green or whatever else it is, that's when they have their feed. Then if they wake up and see it hasn't happened yet and they think, well, all I'm really going to have is water.
Dr Laura (29:32)
Hmm.
Dr Fallon (29:41)
then they're a bit more likely to go, oh, well, I'll just kind of doze off again. Yeah. And look, I think working on the independent settling first is probably going to be the easier road just because then when you're not offering that feed, there are some skills in resettling without a feed. So that could help things. So that's probably a lot to digest, Michaela and Ulf, but give us some things to have a think about and good luck. Do let us know how you go.
Dr Laura (29:41)
Yeah.
Yeah.
Yeah, definitely. So shall I read the next
Dr Fallon (30:09)
Yeah.
Dr Laura (30:11)
So Mwasi's baby is now seven months old and has a 12 and a half hour sleep need. She goes to sleep at 7 .30 and wakes at 6 .30 and she has one night time feed. Then during the day she has two naps, totaling a maximum of two hours.
The problem is she's screaming at nap time. Mwasi says if she pushes nap times a little later, it makes no difference and just makes it harder to fit in the second nap before bedtime. Mwasi says, excuse me, she's having to do naps in the pram in order to get her to take a nap. Otherwise she just won't settle. Mwasi wonders if her sleep needs have dropped lower or is something else going on?
Dr Fallon (30:58)
Hmm. Yeah, it's a really good question. And I think for a lot of parents, they hit this exact hurdle and it feels like the sky's falling down because suddenly, you know, sleep's been going well and then suddenly they're really, really resisting naps. Um, but we know Mwasi that at seven months old, two naps is perfectly reasonable. There's not a chance that she's ready to drop to one nap yet. Um, I mean, it could be that sleep needs are dropping a little bit lower, but my
Dr Laura (31:08)
Yes.
Hmm.
Dr Fallon (31:26)
thought when hearing this question is that I think this is just one of those rough patches. Even the very best sleepers will every now and then have a couple of weeks where it's just everything's a bit off and everything's a bit tricky. But Mwasi you're doing the perfect thing. You're popping her in the pram for an easy settle. It's good for you. It's good for her because she gets her nap and it keeps the day on track. So look, before making any big changes, I would probably stay the course. Don't worry if you're having to do a nap.
Dr Laura (31:36)
Hmm.
Mm.
Dr Fallon (31:55)
in the pram to survive, go for it. I reckon there's a really good chance in a week or two you'll go back to, you know, finding that she's settling more easily for naps. And I definitely want you to try that out before we go and tinker with something that's been working really well previously. And on the other flip side of that, I would say that, you know, she's probably getting a bit older and just thinking, I don't want to go, I don't want to have a nap. I've got stuff to do. I don't want to do this.
Dr Laura (31:56)
Mm -hmm.
Hmm.
Yeah.
Dr Fallon (32:22)
But naps are important. So if you thought, no, I can't be out walking around with a pram all the time, or you just don't want to, it's totally fine to just stick to the approach that you've chosen for settling her at nap time. You know, you might try it for 30 minutes if you can manage it, or if you can only manage 20 minutes, that's fine. But try it every nap time to show her that, well, you know, this is where we sleep. I'm here to support you, but this is where we're going to have this nap. And if after that 20 or 30 minutes, you think, no, it's not working and it's just too hard, then you resort to the pram nap at that point.
Dr Laura (32:36)
Mm -hmm.
Mm -hmm.
Yeah.
Dr Fallon (32:52)
Um, so hang in NYC. It is really hard when they do this, but just know that even the best sleepers will have a week or two every now and then where it's just hard. We don't know why. And then suddenly it'll just get back on track again.
Dr Laura (33:02)
Mm -hmm.
Yeah and if Mwasi things don't get back on track I would be looking at just shaving a little bit of sleep because she's having the 12 and a half hour sleep need, she's having 11 hours overnight and then two hours during the day so it might be that you look at shortening the second nap perhaps so that maybe she's having an hour and a half total during the day.
or you move bedtime a little bit later or you move her wake up till six. So we'd just be looking at shaving half an hour off either from one of the naps or at the start of the day. But that would only be, as Fallon has said, after you've just ridded it out, ensure that it's a persisting problem that isn't changing when you just stick to that one consistent settling approach. At that point, you can say, oh, I will do a little bit of a shuffle of the daily rhythm.
And then you should be sorted until she's much closer to, you know, over 12 months of age. And that's when the big change will happen when she drops down to one nap, but definitely a bit soon just yet.
Dr Fallon (34:18)
Excellent, I think that's good advice Laura. We have a question from another Michaela now, it must be the name of the week. Michaela has a 10 month old girl who's been sleeping really consistently through the night, but over the last few weeks she started waking up for a few hours into the night and then won't return to sleep for around three hours. So this is the classic biphasic nights we were talking about earlier.
Dr Laura (34:31)
Mm -hmm.
Mmm.
Yes.
Dr Fallon (34:43)
Michaela says, I thought maybe she was getting too much day sleep. However, I kept a sleep diary and it seems her sleep need is 13 hours. She sleeps for 10 and a half to 11 hours overnight, one and a half hours for her morning nap and then has a 30 to 45 minute afternoon nap. And Michaela says these split nights don't happen every night. It can be as infrequently as every 10 days and as frequently as every three nights.
On days when she's been up overnight, she tends to be really tired the next day, usually sleeps in and would take longer naps, but Michaela tries to keep the naps on track, even if the night was bad. She says, most of the time when she wakes up, I cannot get her back into the cot and I cannot settle her in the cot at all. She screams and there is no way of settling her, but she will settle if I pick her up, even if I successfully get her straight back to sleep.
Dr Laura (35:22)
Hmm.
Hmm.
Dr Fallon (35:38)
Michaela says she will scream if I try lowering her into the cot. So Michaela has resorted to sleeping on a mattress next to the cot with her baby on the mattress beside her on those nights. And Michaela's also saying a typical sort of day is that her daughter's up at 6 a .m. You have those two naps we described and then at 7 p .m. bedtime. So it's a bit to digest there, Laura, but what jumps out at you?
Dr Laura (35:51)
Mm.
Mmm.
The first thing that jumps out is the extended overnight wakes. So being awake for three hours overnight is telling me that there's a circadian rhythm disruption there. And I would be wondering whether the roller coaster that the Kayle is describing, where it can be every few days that she has that three hour wake overnight and the other time she can go a bit longer before she then has an extended overnight wake.
just suggestive that her sleep needs have changed a little bit and maybe she actually isn't needing the 13 hours. It may be that she is having 13 hours on so -called good days or good nights, but then her body is doing like an overcorrection every few days. It may be Michaela that your baby has slightly lower sleep need, it might only like be 12 and a half hours perhaps.
Dr Fallon (36:51)
Hmm.
Dr Laura (37:05)
Um, and what's happening is that every few days she's doing, she's oversleeping. If you're not coining a new phrase here, but she's having really good sleep. And then her body does the sleep pressure is just a bit low at bedtime after a few days. And then she does a bit of a, uh, over correction where she's then awake for that three hours overnight. That's the first thing I'd be thinking about Michaela is just logging her sleep and perhaps doing it for about two weeks.
Dr Fallon (37:14)
Mmm.
Mmm.
Dr Laura (37:33)
and working out the average across two weeks, since it sounds like that roller coaster that she's on sometimes is a little bit longer. We do often see that three days, three days of good sleep, one night of bad sleep, three days of good sleep. But for some babies, it does extend over a longer timeframe. So I'd probably log her sleep for two weeks and just double check that sleep need and then make some adjustments to...
Dr Fallon (37:42)
Hmm.
Mmm.
Dr Laura (38:01)
Probably moving bedtime a little bit later, because it does sound like those naps are working quite nicely. What else would you suggest, Fallon?
Dr Fallon (38:09)
Yeah. Yeah. What jumped out at me is that Michaela describes that after a split night, she's really tired. So she has a sleep in and then the day naps stay on track. And that for me is like, aha, when we let them have a sleep in after a split night, we're telling this circadian rhythm, sure, go ahead and do that whenever you like. You can have a three hour night. Wake. That's not a problem. We'll just let you have a sleep in.
Dr Laura (38:21)
Yeah.
Yes.
Dr Fallon (38:37)
So you've got to think about what it's teaching the circadian rhythm. So as hard as it is, and I appreciate it's excruciatingly hard, get her up on time in the morning, even after a horrible night, get on with the day and you're doing a great job of sticking to the naps, which is perfect, but make sure she's up on time. Because when you get her up on time, it's really directly saying to the circadian rhythm, you cannot do a three hour night wake up because we've got to get up. We've got things to do. We're not going to adjust the rest of the daily rhythm.
Dr Laura (38:47)
Yeah.
Mmm.
Dr Fallon (39:06)
to allow for overnight wakes or the overnight wakes will just keep continuing. So definitely like what you've said, Laura, check that total sleep need. If it's more like 12 and a half hours, just tweak it a little bit and then stick to it really predictably. So there's no opportunity, no option really to have this extended weight. Once you've done that for a week or two, that sleep pressure is going to be higher again at nighttime and that drive to sleep will be very, very strong. And then when you work on settling her in the cot, you won't get that.
Dr Laura (39:08)
Yeah.
Mm -hmm.
Mm.
Dr Fallon (39:36)
phenomenally hard resistance. And I don't doubt that it's an absolute nightmare, Michaela, you know, from what you describe. During split nights, babies often know that they're supposed to go back to sleep, but they understand that's what you're trying to do. They simply can't do it. They just don't have the sleep drive there to do it. So they get very frustrated when we do try to settle them in the cot, because they know, you know, the best they can really do is doze in your arms or just stay awake until that sleep pressure is higher again.
Dr Laura (39:41)
Yeah.
Yeah.
Yeah.
Dr Fallon (40:05)
So for now, I wouldn't worry too much how you're settling her overnight. Just focus on that timing difficulty after a week or two, then start to just use one approach and really persist with the cot settling. When you know that that sleep pressure is definitely high enough, it's okay to just persist with resettling in the cot. So she realizes, okay, the old shenanigans aren't happening anymore. And her biology and her sleep drive is really going to be on your side at that point.
Dr Laura (40:10)
Hmm.
Yeah.
Yeah, yeah, that sounds like really great advice, Fallon. So good luck, Michaela. Work on that timing for the next week or so and then pick that one settling approach and stick with it. And you'll find that it's much more likely to be successful with them, as Fallon says, with the sleep pressure on your side. All right, and we have a email from Jodie
Dr Fallon (40:55)
Mmm.
Dr Laura (41:01)
And Jodie would like to know for babies with low sleep needs, how flexible can we be with the schedule during illness? She says that we are scared to change the schedule, but no sick babies need more sleep. Yeah, absolutely, Jodie. When you do have a sick baby or toddler, it is really important that we allow them to get all of the sleep that they need to fight that illness that they have.
Dr Fallon (41:16)
you
Dr Laura (41:30)
the body needs to rest. And the last thing we want to do is to stop them from having all the rest that they need to recover. It is a little bit harder when you do have a baby who has low sleep needs. Because we know that when a baby is well, if they have a low sleep need, even if that you're only giving them an extra half hour during the day for a nap, you can really see the impact overnight.
I think that the kindest thing to do is to, you know, if your baby was having a one hour day nap and they're unwell, you might say, well, let's give them double the amount of daytime sleep and see how they're going and just looking at how they're functioning during their wake window. If they're waking up after a bit of a longer nap and they're still just really miserable, then...
The kindest thing is to let them have a little bit more sleep and know that the sleep that night may be really
But once they are better, you know that you have got the skills in place to get them back on track and use that one consistent settling approach that you had used before they became unwell. That said, if they're just a...
Dr Fallon (42:36)
you.
Dr Laura (42:55)
It's a tiny bit of a sniffily nose and nothing really major. You might find that you don't have to offer them a whole lot of extra daytime sleep and it might just be an extra 15, 20 minutes.
But if they're really unwell, then it's just not appropriate to restrict that daytime sleep. Do you have anything else to add, Fallon?
Dr Fallon (43:16)
Yeah, I think there's lots of factors parents can consider when their babies are unwell. So one is going to be how severe the illnesses, if it's a mild cold, you know, it might be that you can stick pretty close to schedule. If it's a really major illness, then throw the schedule out the window and give them whatever rest they need. And, you know, particularly with older babies and toddlers too, some parents will let them sleep longer.
Dr Laura (43:34)
Yeah.
Dr Fallon (43:43)
but they'll still have some limit to it, particularly if you've got a two or three year old and you know that if they nap for three hours in the day, the nights are going to be a disaster. It might be that you say, okay, well, we'll let them nap a little bit longer. Maybe it's two hours total day sleep instead of their usual one hour, for example. So yeah, be thinking about your child's age and how unwell they are. And that will determine how much extra sleep you might offer at those times.
Dr Laura (44:01)
Yes.
Mm -hmm.
Yeah, good. All
So Louise would like some advice on reducing early wakeups and establishing a daily rhythm that fits in around the school run for her older children. Oh gosh, that's such a juggle Louise, I feel for you. Louise's baby is gaining weight well, and she's been advised she can drop the single overnight feed that's currently being offered, which she feels ready to do. So that's great.
Dr Fallon (44:23)
Yep.
Dr Laura (44:36)
So her baby is seven months old and having three meals a day. Louise has started to work towards a more predictable daily rhythm based off the 13 hours her baby tends to average. Louise offers a maximum of three hours day sleep and her baby goes to bed at 6 .45. So Louise is free to help her older children get ready for bed. Louise reduced the third nap of the day to just 10 or 15 minutes and it's helped out.
but there are still mornings that start at 5 a .m. Louise would like to know if this schedule sounds appropriate, how she can reduce the 5 a .m. wakeups and also how to fit in day naps around the school run.
Okay, so.
My first thought on reading your email Louise is that your baby is seven months old and you've worked hard on reducing the length of that third nap to just a power nap. Basically, it's not a whole sleep cycle. And I would say it is time for that third nap to go. So that would be my first piece of advice. The second thing that jumps out at me is that your baby has a 13 hour sleep need. And when your baby is having three hours of daytime sleep,
that would mean that there's 10 hours left in the bank for the nighttime sleep, particularly now since you're dropping that last feed, so you don't need to factor in time for overnight feed. So if you do put your baby to bed at 6 .45, then they are gonna be waking up at around 5 a .m. I think if I've done my maths correctly there, Fallon. Yeah, yeah, probably quarter to five.
Dr Fallon (46:13)
Yeah, yup, even slightly before 5am.
Dr Laura (46:19)
And so on that current timing that you've described, your baby, if they're able to go to sleep themselves and sleep all the way through the night, is just going to get that 10 hours in one red hot go and is going to be ready to start the day early. And if we don't make some adjustments to the daily schedule, to that bedtime or the duration of the daytime naps, that 5am wake is not going to go away.
Dr Fallon (46:39)
Mm.
Yeah, absolutely, I agree. I think dropping to two naps and you know, if you want to get a longer window overnight, so Louise mentioned that she likes the 6 .45 p .m. bedtime so that she can attend to her older children, you're going to need more sleep to be happening overnight. So reducing the total day sleep, it might be that you try to shave it down to just two hours maximum day sleep across the two naps.
Dr Laura (47:13)
Hmm.
Dr Fallon (47:15)
And that's going to give you around about 11 hours that your baby needs overnight. So that could be 6 .45 PM bedtime. And you know, they're going to be waking up about 5 .45 AM, kind of ready to go 11 hours later. That might be close enough to six that you're happy with that. For some families that works really well. But if it doesn't, then really the only thing you can do is start to shuffle bedtime later to get that longer sleep in. And Laura, you and I have talked about this sometimes.
Dr Laura (47:39)
Yeah.
Dr Fallon (47:44)
parents want to settle their baby before the older children because the baby needs so much hands -on support. They really need time to do that with the baby before they settle older children. So have a think about how your baby's settling to sleep and this is for any parent who's facing this struggle. It might be that you'll find once your baby is able to put themselves off to sleep in their cot really easily, it's then you know their bedtime is so quick and easy you say good night you leave the room.
Dr Laura (47:49)
Hmm.
Mm.
Dr Fallon (48:11)
That kind of settling is a lot easier to fit in around older children than if you need to breastfeed for 45 minutes just to get your baby to fall asleep. So yeah, think about how you settle your baby because if you can get them settling pretty quickly in their cot, then that's easy to slot in around the older children. Even if the older children are halfway through their bedtime routine, often you can say to them, hey, just keep going with your school reader or go and brush your teeth. I'm just going to pop the baby down. And that's when we start to get.
Dr Laura (48:14)
Hmm.
Yes.
Mm -hmm. Yeah.
Dr Fallon (48:39)
um yeah, baby sleep kind of optimized with that overnight window of sleep that the family wants to achieve. Um. Hmm.
Dr Laura (48:42)
Mm -hmm.
Yeah. And Louise also asked about fitting those naps in around the school run. If you have managed to reduce the overall nap duration to about two hours, Louise, that tends to then get a little bit easier to fit in around school run because you're not trying to get at least one really long sleep in. And you might be able to, depending on whether you're walking or driving.
your older kids to school, you might be able to have one of the naps in the pram or even both of them, one in the pram on the way to or from school drop off and one on the way back. Although having said that, given that your baby is seven months old, school in Australia generally finishes around 3 .30. If you're aiming for around 7pm bedtime, you probably want your baby to have
Look around about four hours awake before bed on that, the sleep needs that you've described Louise. So it's starting to get a little bit later, a little bit too late to be doing that second nap at pickup or just after pickup. So you might want to have that nap just before school pickup perhaps, or finishing off the nap in the pram or the car on the way to school pickup.
Dr Fallon (50:00)
Hmm.
Yeah, it can be a bit of a juggle, but I think it's easier to manage when they're just on two naps. Often parents will do the first nap in the cot at home at around 9am when they've done the school drop off. And then the other nap might be at two or two thirty. So they're waking up around the time you've got to get on the move and you can keep them awake in the pram or the car, maybe with a new toy they haven't seen before or something like that to kind of keep them going.
Dr Laura (50:14)
Hmm.
Yeah.
Dr Fallon (50:35)
but you're doing a great job and all the parents who have emailed in are doing a fantastic job. The fact that you're asking these questions, you know, you've hit a little hurdle and you're thinking about what to do next is fantastic and it tells us that all these parents are really thinking about their own well -being and their baby or toddler's sleep health as well, which is just absolutely brilliant. So well done everybody. Next week is going to be our
Dr Laura (50:56)
Yes.
Dr Fallon (51:00)
50th episode of this podcast. I cannot believe it, Laura. I think back to that very first one we recorded, we were so nervous.
Dr Laura (51:05)
Oh my god.
You were! We were so nervous. I think it took us a few run -ups as well where we were like, okay, let's press record. Oh God, no, we messed that up.
Dr Fallon (51:14)
Yep. Like, yeah, wait, hang on. I just need to cough again and deep breath. Okay, we can do this. Yeah. Now we're just like, yep, let's hit record. Oh, good to go. Yeah. So we've definitely grown with our confidence with this sort of thing. Um, and it's been so much fun putting it together. So episode 50 next week, we actually have a big surprise planned for Sombelle members that we're going to be announcing next week for episode 50. So.
Dr Laura (51:25)
Yeah.
Dr Fallon (51:43)
be sure to tune in for that episode. There's something really exciting that I can't wait to tell you all about. It's going to be fantastic and that's all I'm going to say. Laura you're going to be at this fantastic picnic that's coming up on Saturday so if you're a parent in Melbourne please come along say hello to Laura. It's the Parents You've Got This family picnic. If you don't follow Parents You've Got This on social media you are missing out.
Dr Laura (51:48)
Mm -hmm.
Yeah.
Dr Fallon (52:11)
They are fantastic. It's run by lovely ladies Freya and Christy. And they have gone out there and collated the best experts on every possible early parenting topic you're going to want more info about. And they're running master classes all the time. I think most of it's free. There's a few paid bits and pieces. But it's just a fantastic way to get across who are the experts in these different areas. And then if you do need more support, you know where to go.
Dr Laura (52:36)
Hmm.
Dr Fallon (52:39)
But yeah, lots of free advice available there. So they're hosting this picnic on Saturday, the 11th of May from 9am to 1pm at St Vincent's Garden in Albert Park. There's got so much cool stuff planned. It is really going to be fun. There's going to be activities for the kids, show bags, all sorts of cool stuff and just a great way to build more members into your parenting community, which is so important for looking after your own wellbeing as well.
Um, if you've got sleep and settling questions, this is your chance to grab Laura and say, Hey, this is what's happening for me. You'll have your own little private, almost like a podcast episode. That's not, not ever going to air. So if you need some support, do go along and say, g'day to Laura. Um, yeah.
Dr Laura (53:10)
Hahaha!
Yes, come and say hello. I might wear this jumper for anyone who's watching or who's seen the reels. So look out for me. I'll be in green. And do come over and say hello, because I love meeting families in real life who are using Sombelle
Dr Fallon (53:28)
Heheheheh!
screen.
Yes. And make sure you tell Laura your name, especially if she's ever seen you in the clinic. Cause I'll tell you what, that's my biggest fear, Laura, that you're going to have someone come up to you in the street and go, Oh, hi, you know, I've seen you in the clinic and you're just thinking, Oh my gosh, what's their name?
Dr Laura (53:54)
Yes, it happened to my mum all the time. My mum was a midwife in a big town in England when I was growing up and she was a midwife for 30 years. And she she finished up after she was delivering babies of babies that she had delivered years before. She was like, that's it, I'm done. And people used to come up to her all the time in the town centre. Hi, Sue and my mum.
Dr Fallon (54:05)
Hmm.
Hehehehe
Dr Laura (54:20)
clueless, no idea. And I was just used to find it mortifying. And now I'm just getting a taste of it myself. So yes, do come and say hello and tell me your name and a piece of information about your child's name. And then I'll be like, yes, of course. Yeah.
Dr Fallon (54:21)
Heheheheh
Yes.
You
Excellent. It's going to be such a great day. I can't wait to see some photos from that one and you've got to take lots of pictures Laura so I can have a look at all of everything that goes on. Yes, definitely, definitely. And Mother's Day is coming up before we will record our next episode. So a very happy Mother's Day to all of those who celebrate.
Dr Laura (54:52)
Yeah, let me have a cuddle of any of those cute babies or toddlers.
Dr Fallon (55:07)
Take it as a chance to, you know, you can't always put your feet up. We know that that's the case, but to reflect on your journey as a mother and how far you have come. Motherhood is one heck of a ride and we don't celebrate the little successes. There are thousands of them, especially in the first year or two. Take a moment just to think about the incredible job you're doing and the sacrifices you've made and how you've had to change who you are and how you do things.
to help grow your little people and know that you do get those little pieces of yourself back again, that the older your children get, the more those little pieces of yourself come back home again and you do remember who you are. Because I think that's in those first couple of years, it's an exercise in almost forgetting your own needs as you focus so much on your children. So just take the day to really think about how wonderful you are. And of course, if you've been thinking about...
Dr Laura (55:56)
Yeah.
Dr Fallon (56:04)
getting support for sleep and settling. You know where we are, you know who we are. You can even go harass Laura at the park. But if you need support, we run a clinic, we've got the Sombelle program and there's options there for you if you need that help. So thank you everyone for tuning in and listening for your fantastic questions and for your beautiful feedback. We see those five star reviews coming in.
Dr Laura (56:09)
Hahaha!
Dr Fallon (56:27)
And we absolutely love them. It makes everything we do worthwhile. So thank you so much for making our day -to -day work just such a pleasure. And yeah, we will see you or hear you next week for episode 50. Woohoo!
Dr Laura (56:40)
Yay! Thanks everyone, bye bye!
