Thursday, August 2, 2012

Sleep Update

As I mentioned in my post about our sleeping troubles, we have been working on developing better sleep habits. After reading the No Cry Sleep Solution, we felt like we had a pretty good idea of where we wanted to be, and the steps it would take to slowly get there. It seemed like it would be a long process, but I felt good about it.

The following day, however, we went a little off course after our pediatrician recommended following Kim West's 'Sleep Lady Shuffle' and reading her book, Good Night Sleep Tight.
Our pediatrician described the 'shuffle' as a middle point between a 'cry it out' and a 'no cry' method. She said most of her clients have luck with the method, and is a good method if we wanted her to start sleeping in her crib.

This was a very well meaning and good suggestion, but after reading the book, I felt like I had information overload. Yes, I did learn some helpful tips and think it is great to be informed and have alternatives in case our first course of action doesn't work, but with all the conflicting advice, I felt like I couldn't make the best decision. I felt so confused and uncertain. Was I really ready for November to switch to a crib? Was SHE ready? Would it be better for her? Is sleeping in our bed better for her?

We decided to try the sleep lady shuffle technique in her crib, and lasted about ten minutes. Despite this approach being considered gentler than CIO, November quickly dissolved into hysterics. It was just too hard to watch her sad, scared little face looking at us, wondering why we weren't picking her up. She was back in our bed that night, and after a couple more days obsessing over the best course of action and wondering if we should just let her CIO, I decided to take the new information with a grain of salt, and continue co-sleeping while working on the no cry approach until we possibly become desperate for something more extreme.

To give us a sense of direction, and let some of that overwhelming information overload go, I organized and printed out a sleep plan, along with our ideal daily schedule. I won't share the entire plan here (it's six pages!) but here is a basic summary:

November's Sleep Plan

Acceptable Goal: less night wakings (one or two), regular naps, earlier bedtime, and easier to put to bed
Ultimate Goal: SLEEP THROUGH THE NIGHT!

November's (ideal) Daily Schedule
7:30 wakey time
8:00 changed and dressed
8:30 breakfast, play
9:30-10:00 calm activity, nurse if needed, watch for tiredness, nap
11-11:30 wake, nurse if needed, play
12-12:30 lunch, play
2-3:00 calm activity, nurse if needed, watch for tiredness, nap
3-4:00 wake, nurse if needed, play
4:30-5:00 dinner, play
6-6:30 start pre-bed time routine
7:30 asleep

Naps -November will take two regular naps, one in the morning, one in the early afternoon. We anticipate them to be around 10 and 3.
-We will encourage naps with calm acitivity and watch for tiredness signs starting at 9:30 and 2, and start the nap once she is tired.
-Once we have established more predictible nap times, we will start a regular pre-nap routine (or continue with the calm activity as a routine.)
-We will make naps a priority, and not schedule activity or errands during those times, and we will come home from activities before her naptime if we are out; especially for the first month while we work on these changes.
-Our first priority with naps will be to establish a routine and discover the best naptimes AND encourage her to sleep as long as possible (at LEAST an hour.) This will be done however it takes (she can nurse to sleep, nap in the chair on mom or dad, etc.)
-Once she is taking two long, regular naps, our next goal will be to make sure she takes those naps in bed, even if she falls asleep on mom or dad
-Once naptime has become regular, and she learns to sleep better at night, we will work on putting her down for naps drowsy but awake, and help her learn to put herself to sleep for naps as well

Night
-We will establish an early bedtime. We will let her fall asleep however it takes until she is used to falling asleep early, and then start putting her to bed drowsy but awake at her early bedtime.
-We will follow a bedtime routine beginning 1 hour before bedtime (around 6). It will consist of:
-Dim lighting, calm activity, gentle voice tone
-Lullaby or sleepy time pandora station
-Warm, calm bath
-Slow, gentle coconut oil massage
-Calm playtime with stuffed animals and reading books
-Cuddling, walking, and rocking with her 'lovey'

-We will introduce a 'lovey' (soft owl toy) and keep it with us when we snuggle and nurse before/during naps and sleepytime
-We will keep night sleep different from day naps. Day will have open curtains. Night will be dim, quiet voices, and blackout curtains drawn.
-We will develop keywords, 'Shhh, shhh, sleepy time.'
-Once she is used to sleeping regularly at an earlier time, we will start putting her to sleep at night drowsy but awake. We will go through our sleep routine until she starts to fall asleep. Once she is drowsy, we will move to the bed to finish falling alseep.
-We will gradually remove November's nursing-sleep-association throughout the night by using the gentle removal plan (don't let her fall asleep at the breast. Remove breast or bottle once her eyes start closing and she starts sucking less. If she wakes and roots, give it back and keep trying.) However, I will allow her to trade breast for pacifier after a few tries, and let her fall asleep with the pacifier, and let it be available for her throughout the night. But I will only offer it if she roots for it, or finds it in her sleep (no popping it in just because she moves.)

-While we continue to co-sleep we will do the following:
-If she wakes, I will hold still and let her roll over, move, and see if she really is waking. Try to comfort her with pats and key words first. Only give the pacifier if she roots for it. Only nurse her if she continues to fuss.
-Stay awake during night time wakings/nursings and shorten duration of help so I can practice gentle removal, pull my shirt back up, scoot breast away from her face, and move her back to her spot by the guardrail, if necessary

Summary:
-Phase One: Establish daily routine. Follow schedule and establish regular nap times and early bedtime no matter what it takes. Establish and follow a pre-bed routine. Shorten duration of night waking help to lessen night nursing, and encourage her to fall back to sleep without nursing.
-Phase Two: Continue to follow routine with naps and night time. Have her take naps in bed (even if she falls asleep elsewhere.) Encourage her to fall asleep at night drowsy but awake. Continue to work on the 'removal plan' during night wakings.
-Phase Three: Continue with all of the above. Encourage her to fall asleep drowsy but awake for naps now, too. Try to put her back to sleep at night with key words and pats and continue to lessen night nursing.

I know it's long and ridiculously detailed (I even left some out!), but I really needed it! After about ten days, I reassessed our plan (I didn't exactly do a 'log' like The No Cry Sleep Solution suggests because I'm really in-tune to our current daily schedule, naps, wakings, etc), rejoiced in our successes, and changed what we could improve.

Sleepy time success: It feels like sleepy time success is one step forward one night, and then three steps back the next. But they are still successes nonetheless! We have done a pretty good job at 'phase one' and are now working on phase two. We have the pre-bedtime routine down. Her daily schedule is usually predictable now, and even on days when we get a little thrown off (like when she goes to my moms when I work, or we have plans to go out, or she naps in the car) we do our best to keep the schedule in mind and stay as close as we can, as opposed to just throwing it out the window for the day. We have established an early bedtime; most nights we can get her down between 7 and 8 (sometimes even earlier) but there are still nights (one of those 'three steps back' kinda nights) when we just can't get her down until close to nine. There was even a night when she wouldn't go to bed until 11! She is used to taking two naps a day, and they are usually (but not always) at least an hour long. She is getting better about falling asleep without nursing in the middle of the night; she still wakes frequently most nights, but I can usually get her to trade breast for pacifier (or even nothing at all!) and she falls back to sleep on her own.

What we learned/changed: after watching her 'sleep signals' it became clear that she generally needs a nap two hours after waking time, then three hours after her waking from her first nap, and then bedtime four hours following waking from her second nap. With this knowledge, we learned to adjust her nap times and schedule if she wakes earlier (we try to wake up no later than 7:30, but sometimes she is just ready to wake up at 6!). We have added 'closing the curtains' to her pre-bed routine where we say goodnight to all the windows after her bath. Another change to the pre-bed routine: we listen to the soothing pandora stations during calm time, but once she is clearly tired, we turn off the music, turn on the fan (it's usually muggy at night in our room) and the sleep sheep (to help muffle noises after she falls asleep!)

What we need to improve: She still has a hard time falling asleep without rocking for naps and bedtime. We try putting her down 'drowsy but awake' but most of the time, she just becomes more alert. For now, we are ok with rocking her to sleep, but we are putting her down as soon as she falls asleep (which sometimes gives her the chance to slightly wake and fall back asleep on her own) instead of waiting until she is fully deep asleep. We continue to try to encourage her to fall asleep drowsy (but not stress it too much! It turns out high need babies generally need more help falling asleep!) I am also working on staying awake during night wakings. I try to stay awake so I can pull away from her before she falls asleep at the breast, but sometimes, I am asleep before I know it!

Sigh. One step forward. Three steps back. I feel a lot happier and more at peace about our sleep situation already. These baby steps WILL eventually lead to sleeping through the night!

Also, I should mention that a HUGE weight was lifted off my shoulders when I stumbled upon this blog discussing the '9 month sleep regression.' I didn't even know that was a THING! It turns out November's sleep issues are totally normal, very common, and are just a part of growing and learning. It's so nice to know that there are tons of other parents out there having sleepless nights while their babies try to walk in their sleep! I felt like I was going through 'sleep hell' but now I can accept this stage much easier. Good night!

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