Thursday, May 15, 2014

Rocking/Singing/No Cry/Cry it Out/Co-sleeping and Everything Else: Part I

When you're a 1st time mom, particularly if you breastfeed, you can be expected to have many interrupted nights for the first few months after your baby is born. A breastfed newborn is expected to eat every 2-3 hours, and even if your baby does give you a nice chunk of sleep, you're instructed to wake him up to eat again after 4 hours at the most. As difficult as it was to deal with these sleepless nights, particularly since my baby completely refused to nurse with me in bed, we found the sleep troubles he encountered between 4 and 7 months to be significantly worse. There were times I found myself longing for the newborn nights of only being woken up every 2-3 hours. At least then I knew in advance how many times a night I would need to wake up, approximately when those wake ups would be, and what the issue was and how I could take care of it.

Around 4 months old, Tyler started having extremely inconsistent nighttime sleep. He could sleep 8 hours through the night or he could wake up multiple times throughout the night for no particular reason. Random wake ups unrelated to hunger or any other discernible reason had actually begun as early as 6 weeks old, but 4 months was when it became truly unbearable. It was rarely difficult to get to Ty to fall asleep initially, but we had lots of problems transferring him from arms to crib and keeping him asleep through the night. Even if we transferred him to the crib successfully, it could be anywhere between 5 minutes and 5 hours before he would inexplicably wake up again. At first I assumed he was just extra hungry from growth spurts, so I always nursed him back to sleep, but I soon learned my 4 month, 18.5 pound chunky monkey didn't need nearly as many nighttime feedings as he was asking for.

Even Tyler's good nights offered me little relief. On the rare occasion he did sleep a 5-8 hour chunk, I struggled to sleep due to breast engorgement. Usually I'd have to go downstairs to pump and relieve the pressure, which would often wake me up completely and make me ravenously hungry. There were days that I'd pump, clean out the bottles and such, store the milk in the freezer, get myself a bowl of cereal and finally feel ready to lay down again right as Ty would start waking up. After the few minutes it took him to empty me, he'd still be upset and I'd have to find other ways to soothe him back to sleep or tide him over with a bottle until my milk supply was replenished. Ty really just wanted the bonding aspects that accompany nursing, so a bottle of pumped milk rarely made him happy in the middle of the night.

I always nursed Ty to bed at the beginning of bedtime, and we could typically expect to enjoy a good 2-5 hour chunk before his first wake up (the average was about 3 hours). After that my husband and I would sleep in shifts to keep our sanity. One of us would sleep in the guest bedroom next to Ty where we could hear him easily if he cried while the other would sleep in the master bedroom down the hall with a fan turned on high. For his first 7 months, one of us was always there for him every time he cried. He would usually calm back down easily once he was in our arms, but because he wouldn't transfer from our arms to the crib well, it could be up to 2 hours at a time of rocking, singing, walking, and other soothing techniques. Usually it took at least 3 attempts of putting him back in the crib before he would stay there asleep. Although I'm not a big advocate of co-sleeping, we resorted to it a few times, but Tyler was never interested in sleeping in bed with me. Occasionally he would do it for Oscar, but even that wasn't something we could always rely on. Sometimes Ty would fall asleep nursing on me in the recliner, and I was able to get a little sleep that way, but I found the maximum my body would sleep in that position was about 2 hours (if I fell asleep at all). I'd then wake up, take him up to his room, and pray he stayed asleep when I put him in the crib.

My mom and several other veteran parents recommended I leave Ty to cry it out, and even his pediatrician's office sent home a packet encouraging we teach him to fall asleep on his own drowsy but awake. However, 4-6 months was also when Ty was having the world's worst spit up. We had to use receiving blankets and baby bath towels as burp cloths, and we'd wash our extremely large supply of them at least twice a week. We joked that Ty was the only baby that could spit up more than he took in yet somehow still put on the weight for all of it. I attempted drowsy but awake with him several times, but even when I had Ty so drowsy he was falling asleep sitting up in one of his toys, he'd throw a huge tantrum as soon as we put him down in the crib. Within about 30 seconds there would be massive amounts of spit up all over himself and all over the crib. He learned how to roll to his tummy several weeks before he could flip himself back over, so letting him cry it out would essentially mean leaving him alone swimming helplessly in a pool of his own vomit. There were times it was so bad that I'd have to change his diaper, his clothes, his blanket, and his sheets, and pad down his mattress before I could put him back down again. Several sleep training books gave good ideas for keeping a baby calm without removing him from the crib, but at 4 months they were completely ineffective on Ty, The only advice I got for spit up was completely useless to me - "just wipe them off quickly and let them continue to self soothe." Obviously the babies they're referring to weren't spitting up the vast quantities that Tyler was. The soothing techniques did no good since being able to see us from his crib only made Ty more upset and more likely to spew out everything he'd eaten, even if it'd been 3-4 hours since his last feeding. Over time he responded a bit more to the soothing techniques when waking up in the middle of the night, but he never responded well enough to be able to put himself to sleep from beginning.

Most of the people I talked to were puzzled by Ty's sleep problems. Most had never heard of a baby who woke at night that wasn't hungry, in pain, or needing a quick fix (diaper change, binky popped back in, swaddle tightened, etc). When I'd post about it on Facebook or look up what to do online, I'd often get lots of advice from well-meaning, concerned people. The main suggestion was to swaddle him. Ty never cared much for swaddling, and at 4-6 months when his real sleep problems began, most parents are encouraged to start weaning the baby out of his swaddle so he can strengthen his little muscles and have access to his hands for self soothing. 

I was also asked if he used a pacifier, if we played soothing music, or if there'd been any changes to his sleeping environment or loud noises to startle him. Ty would take a pacifier, but he wouldn't stay glued to one like Maggie Simpson does. He might suck on one to fall asleep, but he rarely took one to bed with him. The pacifier falling out of his mouth was actually our biggest sign that he was ready to be put down in the crib. Recorded music only stimulates Tyler, though we do turn on white noise to help trigger "bedtime" for him. There were no changes in his sleep environment and any noise the cats made during the night would get drowned out by his white noise. 

Some friends advised giving him a bath to relax him right before bedtime (which I tried but it was more trouble than it was worth) while others suggested putting him in a sleeper next to our bed where I could rock him when he'd wake up. Though rocking him in his snugamonkey had worked wonderfully as a newborn, by that age it was taking so long to rock him back to sleep that most of the time we'd end up taking him out to the rocking chair where it was more comfortable for us. Some people asked if we used a swing or other automatic motion sleeper. These would usually help Ty fall asleep, but they wouldn't help him stay asleep. Even while the swing was in motion he would still wake up frequently. It really wasn't very useful to me for anything more than a brief snooze. The more advice I got from people, the more it seemed my baby was the only one with sleep difficulties without easy solutions.

Since none of these popular soothing methods did much good, most people insisted the problem must be due to teething or an ear infection. I was repeatedly advised that Tylenol or other medication would do the trick. However, I was resistant to even try Tylenol because A) I didn't believe Ty was teething or had an ear infection, B) I've consumed so much Tylenol throughout my life that it's now almost useless on me due to building up an immunity to it and C) this was a constant problem that had been going on for weeks. Even if Tylenol did relax Ty enough to help him sleep better, I didn't want it to be a crutch he needed to use every single night and every single nap.

In the end I was right to trust my instincts that medicine would not help him. I didn't believe he was crying from pain since he did not have typical ear infection symptoms, and as he was generally cheerful throughout the day and rarely drooled, I figured it couldn't be teething either. I'd been told that teething babies feel more pressure on their gums while they're lying down, but if teething were causing his nighttime difficulties, he'd likely also complain whenever he was on his back throughout the day too. Though I held out on giving Ty medicine for a few weeks for those very reasons, I did resort to trying Tylenol and Orajel a couple times on particularly bad nights. Unfortunately it never helped him sleep any better, and it was difficult to keep him from spitting the Tylenol out and swallowing the Orajel before I could spread it on his gums. In the end time itself ultimately proved that Ty's sleep problems had never been caused by teething. He didn't even cut his 1st tooth until after 10 months, so it's unlikely he was even having pre-teething pain between 4 and 6 months. And now at nearly 12 months when he definitely is teething and will be for awhile, he really doesn't make much of a fuss over it, and it doesn't affect his sleep in the slightest. His only real symptom is drooling, chomping, and sucking on anything he can shove in his mouth, and only on rare occasion has he complained about it enough to make us medicate him.

Many of the books I read encouraged me to take notes and make a log of Ty's sleep pattern. I did start doing this, and I have a lot of notes written, but trying to keep track of every single wake up, every soothing technique, every failed attempt to put him down, and how long he slept before waking again was simply taking too much out of me. I couldn't remember it all unless I wrote it down right after it happened, but trying to make detailed accounts in the middle of the night was making it even more difficult for me to sleep. I couldn't keep up with it, so I'm missing a lot of what happened. However, I did still record quite a bit of it. In the next post you can read about Ty's sleep struggles and improvements all detailed in chronological form. Some of the books I read made me think Ty's difficulties must be my fault in some way; I wasn't giving him enough self soothing opportunities, I was being manipulated by him, I wasn't identifying his sleep cycle well enough, I was overstimulating him, etc. But there were plenty of times that I know I was doing everything right and Ty still struggled to go down. Sometimes babies are just weird. I hope Ty's story can encourage other parents that their babies aren't the only ones with difficult to fix sleep problems.

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