Wednesday, September 23, 2009

The No-Cry Sleep Solution: When Your Baby Wakes Frequently

By Elizabeth Pantley
Author,
The No-Cry Sleep Solution: Gentle Ways to Help Your Baby Sleep Through the Night and related No-Cry book series. Excerpted with permission. Learn more from Pantley at her homepage: Pantley.com and join her on Facebook here.


When Your Baby Wakes Frequently To Eat

If your baby is waking up every hour or two to breastfeed, bottle-feed, or locate his pacifier, you may be wondering just what it is that causes him to wake up so often. The reality is that brief nighttime awakenings are a normal part of human sleep, regardless of age. All babies experience these. The difference with your baby, who requires nighttime care every hour or two, is that you are involved in all his brief awakening periods.

Your baby makes a “sleep association,” wherein he associates certain things with falling asleep and believes he needs these things to fall asleep. My baby, Coleton, spent much time in his early months in my arms, his little head bobbing to the tune of my computer keyboard. From the very moment he was born, he slept beside me, nursing to sleep for every nap and every bedtime. By the time I looked up, he was 12 months old, firmly and totally entrenched in a breastfeeding-to-sleep association.

Your baby, like my Coleton, has learned to associate sucking (having your nipple or his bottle or pacifier in his mouth) with sleeping. I have heard a number of sleep experts refer to this as a “negative sleep association.” I certainly disagree, and so would my baby! It is probably the most positive, natural, pleasant sleep association a baby can have. The problem with this association is not the association itself, but our busy lives. If you had nothing whatsoever to do besides take care of your baby, this would be a very pleasant way to pass your days and nights until he naturally outgrew the need. After all, this is natural. You may not even see this as a problem, in which case it is not. It's all a matter of your perception and your personal needs.

However, in our world, few parents have the luxury of putting everything else on hold until their baby gets older. With this in mind, I will give you a number of ideas so that you can gradually, and lovingly, help your baby learn to fall asleep without this very powerful sleep aid.

To take the steps to change your baby's sleep association, you must complicate night wakings for a while, but in the long run you can wean your baby from using his pacifier, bottle, or your breast as his only nighttime association. In other words, be prepared to disrupt your own nights for a while to make some important, worthwhile long-term changes.

When your baby wakes, go ahead and pop his pacifier or his bottle in his mouth, or nurse him. But, instead of leaving him there and going back to bed, or letting him fall asleep at the breast, let him suck for a few minutes until his sucking slows and he is relaxed and sleepy. Then break the seal with your finger and gently remove the pacifier or nipple.

Often, especially at first, your baby then will startle and root for the nipple. Try to very gently hold his mouth closed with your finger under his chin, or apply pressure to his chin, just under his lip, at the same time rocking or swaying with him. If he struggles against this and fusses or roots for you or his bottle or pacifier, go ahead and replace the nipple, but repeat the removal process as often as necessary until he falls asleep.

How long between removals? Every baby is different, but about ten to sixty seconds between removals usually works. You also should watch your baby's sucking action. If a baby is sucking strongly or swallowing regularly when feeding, wait a few minutes until he slows his pace. Usually, after the initial burst of activity, your baby will slow to a more relaxed, “fluttery” pace; this is a good time to begin your removal attempts.

It may take two to five (or even more) attempts, but eventually your baby will fall asleep without the pacifier or nipple in her mouth. When she has done this a number of times over a period of days, you will notice the removals are much easier, and her awakenings are less frequent.

Pantley's gentle removal plan
“We got to calling this the Big PPO (Pantley-Pull-Off). At first Joshua would see it coming and grab my nipple tighter in anticipation — ouch! But you said to stick with it, and I did. Now he anticipates the PPO and actually lets go and turns and rolls over on his side to go to sleep! I am truly amazed.” --Shannon, mother of 16-month-old Joshua
If your baby doesn't nap well, don't trouble yourself with trying to use the removal technique during the day for naps. Remember that good naps mean better nighttime sleep — and better nighttime sleep means better naps. Once you get your baby sleeping better at night, you can then work on the naptime sleep.

The most important time to use Pantley's gentle removal plan is the first falling asleep of the night. Often the way your baby falls asleep will affect the rest of his awakenings for the night. I suspect that this because of the sleep-association affect that I explained earlier. It seems that the way in which your baby falls asleep for the night is how he expects to remain all night long.

Feeding a sleeping baby

I am a follower of the “never let your baby cry” rule, and I took it very seriously. What I didn't understand, though, is that babies make sounds in their sleep. And these sounds do not mean that baby needs you. Babies moan, grunt, snuffle, whimper, and even cry in their sleep. Babies can even nurse in their sleep.

The next step to helping your baby sleep longer is to determine the difference between sleeping noises and awake noises. When she makes a noise: Stop. Listen. Wait. Peek. As you listen attentively to her noises, and watch her, you will learn the difference between sleeping snorts and “I'm waking up and I need you now” noises.
"Last night he was nursing and I pulled him off and put my finger under his chin. I was thinking, “This will never work; he'll be mad!” — but it worked, he went to sleep! The other trick is working too. When I take him off and then roll over, he thinks I'm asleep, then he goes to sleep, too!” --Carol, mother of nine-month-old Ben
Changing your routine

Very often we have a routine we have followed with our babies since birth. The final step before sleep is always nursing or having a bottle. Some babies can continue this pattern and still sleep through the night. Others, though, need to have the final step in their routine changed before they begin to sleep all night.

What you'll want to do is take an objective look at your final steps in putting your baby to sleep and make some changes if necessary. You may want to use massaging, cuddling, or sleepy-time music to help get your baby to fall asleep. Eventually these steps will take over for nursing or bottle-feeding, and then they too will fade away, and your baby will be sleeping longer.
“I have changed the way I'm putting Carlene to sleep, and it's working! Instead of nursing her down, I just feed her until she is relaxed and then I let her do whatever she wants in the very dim room with me. When she rubs her eyes and looks sleepy, I put her in her crib. I stay there and stand next to the crib, and encourage her to sleep. I say, 'Shhh, it's night-night time, close your eyes, sleepy girl,' and I tell her that it's okay to go to sleep. I rub her head or her tummy. She shuts her eyes right when I do this. It's been a major breakthrough.” --Rene, mother of seven-month-old Carlene
Patience, patience, and just a little more patience

Take a deep breath and repeat after me: “This too shall pass.” You’re in the middle of it all right now, and it’s hard. Keep in mind that your baby’s seeming inability to fall asleep on his own is not his fault. He’s done things this way since the day he was born, and he’d be perfectly happy to keep things as they are. Your goals of helping him feel loved and secure while discovering ways to fall asleep without you — without your succumbing to the temptation of letting him cry it out — are admirable. You have his best interests at heart. Be patient, take your cues from your baby, and in no time at all, your baby will be sleeping. And so will you. Then your concerns will turn to the next phase in this magnificent, challenging, and ultimately rewarding experience we call parenthood.

Parents sharing sleep with their little ones
photo collage published in Mothering, Issue 152


16 comments:

  1. I really like this. Although as Elizabeth said, I don't see it as a problem, it's good for when I need to start going back to work or for dad to try when I'm too tired.

    I'm EBF though. So what would happen if I didn't feed him at night anymore? Would I need to pump, or would my breasts just start making less at night? My son is 6 months. I don't want to ruin my supply and we bedshare, so I don't mind feeding him as I just nurse him laying down.

    But after his long stretch of sleep from 7:30-11:30, he starts waking up every 2 hours, then every hour. It is tiring, but not unmanageable. Thanks for any advice. :)

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  2. Toni,
    I went back to work when my daughter was 6 weeks old. It was her nursing through the night that kept my milk supply up. I found it much easier to continue breastfeeding over getting up to fix a bottle in the night and all that goes with that. My husband watched her when I was at work, and he only fed her when she asked, so he usually only fed her an hour before I got home. Looking back on it, it worked perfectly. I would only pump before I went to work and then when I got home so that kept things fairly simple.

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  3. Our son was waking up *at least* 2-4x/night by 14mo, and we had to rock him completely to sleep and then put him in the crib. (All-night co-sleeping usually doesn't work well with us - he's very very restless!) We took a lot of Elizabeth's suggestions, some from like-minded friends, and figured out some of our own, and we've made progress. He did cry some when we put him down awake, but we never left him alone until he was completely asleep. It only took 3-4 nights (again, at 14mo, different than when they're younger) for him to get used to falling asleep in his crib. So now he still tends to wake up 1-3x/night, but it's much easier to put him to sleep at night, and he goes back to sleep much more easily (as long as his teeth aren't bothering him!). So it's progress. CIO is NOT NOT NOT the only way!

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  4. My 17 month son will wake 1-2 times a night to nurse. I do it happily, at times I've tired just cuddling him back to sleep. Most times that does not work, he wants to nurse. I am very happy to be nursing but some nights it does get tiring, I just remind myself its what's best for him.

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  5. I have been using this book since my bedsharing nursling was 10 months old. He nursed literally 8-10 times per night back then, and I was starting to sleep less and less when I needed more and more energy to chase my crawling boy! Pratley shared something in the book that deeply touched me, and that is that we are often not really ready for our little ones to STTN (sleep through the night). I fit that, I LOVE night nursing, those quiet moments are some of my favoirtes! As a doula I work out of my home roughly 10-20 hours per week, and those sweet times are just such a blessing. We sometimes go out and sit in the moonlight and just enjoy this brief time.
    But alas, I decided I wanted to still night nurse, but only 2-4x a night vs the 8-10 as before.
    It worked so well for me to gently transition, and now we all sleep better, and other (my mom and husband) can also get my now 14 month old to sleep. We do still wake to night nurse, but it is more gentle and restful. Last night we woke 3x, friday night only 2. 2-5 is pretty typical. And he goes to sleep now easily, and will unlatch and even roll over to go to sleep. He also doesn't cry every time I get out of bed, in fact he and daddy are still sleeping right now. :)
    LOVE LOVE the book, and highly recommend it to anyone needing improved nighttime sleep with their little one.

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  6. Nightweaning is generally not recommending before 12 months of age for breastfeeding babies. Up until then, they really do still need to be nourished during the night.

    That being said, you can encourage less waking using Pantley's techniques and by following your infant's lead. During those early morning hours when babies are in a lighter stage of sleep and wake more frequently, you can slowly lengthen the amount of time between those feedings to encourage less waking times. For us, it worked nicely and while my little one(s) still woke a few times during the night to nurse, they would sleep a lot better from the 2 am mark on which seems to be the magic number in my kiddos as far as once the frequent wakings start.

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  7. This works for "normal" babies who somewhat fit the general idea, but not for babies with problems like reflux like my son. I tried every trick under the sun, read every article I could get my hands on, went to many doctors and nothing worked except running to him every time he cried and nursing him back to sleep. We coslept as well. I, unfortunately, have no desire to revisit the first 8 or 9 months of his life. I had to wean him at 8 months old (cold turkey I might add--very difficult for both of us) because the medication I was on was bothering his tummy.
    Nothing has really worked and we have good days and bad days. Good days are when he only wakes maybe once, bad days are when he might wake as many as 10 times. Luckily I don't work, so I can handle a few wakings.

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  8. A quick note on reflux because it was mentioned - If a mother has not cut out cow's milk and all nuts/soy from her diet, this is the first step and usually eliminates the reflux problem. Infant humans simply cannot digest the proteins in cow's milk or nuts/soy and they pass through mother's milk easily. It may take several days for them to be cleared from milk, but it is by far the #1 culprit for reflux and other digestive issues in newborns. More information on this specific topic can be found in the book, "The Baby Bond"

    http://astore.amazon.com/peacefparent-20/detail/1402226578

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  9. I have been working Pantley's method for about two weeks now...with results! :) My son is almost a year old; I really wish I had found this book sooner--especially with all the pressures around me to use CIO! I knew it wasn't right, and I knew I couldn't do it, but when even your partner starts to doubt your mama-instincts, what do you do? I am so happy to put in the time and effort that this no-cry solution requires..and I'll be recommending the book to every new mama I meet!

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  10. I really like this book because it offers so much support to desperate, sleep-deprived parents. My husband ran out for it late one night (thank heavens for Barnes and Noble's late hours!) when we were at a loss what to do. The book has so much more to offer. I never night weaned until Charlie weaned entirely (which was in the last couple weeks--this is the first I've written anything about it, it's still such a soft emotional spot for me) because I work and the night nursing was so special to us, but we did use this technique to decrease our night nursings a little so I could get more sleep. We mostly used the bazillion other ideas she has for improving baby's sleep. When we got completely messed up with the time change last November, my patient hubby made another late-night run for the sequel for toddlers and preschoolers. So helpful!

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  11. Great insight here :) Thanks for your post, as well as the subsequent comments.

    I'm here with an 11 week old, our handsome son, who has yet to sleep outside of our arms during the day and is cosleeping with me at night and seems to nurse every 1-3 hours throughout.

    At this age, how can I help him learn to nap in his rock n play (or mamaRoo or crib)? Currently he begins crying so hard within 30 seconds or less of lying him down. We just bought a house, so I need to be able to use nap times to start packing ;)

    Thanks for listening!

    Jessica

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    Replies
    1. You may want to get a good wrap or carrier so you can wear your baby while packing. :) He will be content and snooze while wrapped on your back (or front) and you'll be able to get things done with a happy baby. We loved our Moby at this early stage - but I know others also like woven wraps or an Ergo with newborn insert. :)

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  12. This would be wonderful, except my 9 month old breastfed daughter falls RIGHT back to sleep as soon as she latches. It's literally 2 minutes, from the moment I pick her up, stumble back to bed, lift my shirt, and latch her, then she's knocked out! I've tried just giving her a bink instead of picking her up, or even just rocking her...but nope, she HAS to latch.

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  13. Thanks, I will try this with my 9 months old. For me, I do actually have the time to just be with my baby, but waking and feeding her all night is very tiring and makes me resent feeding and much less patient with her, which is horrible. It sometimes makes me wonder if that really is the right thing to do, sleeping next to her and respond to her always, but at the same time I don't see any other way, can't imagine letting her cry alone.
    I have done what is described here before but I think I have to be more persistent and remember its a process. Hope it will work!

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  14. Am I still on time to change my 21-month old to change sleep pattern??? I'm still nursing and we co-sleep. Some good nights I think she nurse 3X but many other times she wakes up many more times. Also, she's been really fighting for not going to sleep and has often skipped the daily nap. I've been instinctively using the finger/chin technique but not consistently. I'm a bit tired of reading books at this stage but still need help!!!

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  15. This is great advice. I'm not a mom yet, but I've always wondered how long it takes for children to grow out of waking up in the middle of the night. Now I realize you can actually help them along with the process. Great advice.

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