Monday, October 31, 2011

Transitioning Naps to Crib (i.e. a Tome on Sleep)

This is my first post on sleep. Ever. That is because it has just recently become interesting to me.

My 3-year old took his naps in the carrier (Moby then Ergo and occasionally Mei Tai) until he got too heavy to carry (around 20 months). Then we tried to get him to nap in bed and he didn't know how to fall asleep on his own. Since then, he has been falling asleep in a stroller (we love our BOB Revolution on the trail which is a quarter mile from the house) or in the car and being transferred to the bed. Three years in, I am thinking it would be awfully nice if he knew how to let go during the day and fall asleep for a nap. I remember asking various people (ahem, like our pediatrician) how long babies nap. I was told they stop between 18 months and 3 years or so. Now that we are at 3, it is quite clear they are mostly needed, and most of his buddies nap daily. Heck, preschools all nap the kids, and they are 3 and 4 years old. So I wish that someone would have told me then that kids usually nap until kindergarten. I like to think that this bit of information would have inspired me to help the little guy learn how to fall asleep on his own for naps. One can never be sure, but I did stand my ground on him falling asleep at night in bed, knowing he would always need to fall asleep at night while laying flat.

I mention this because I now have a 4-month old baby. In hopes of improving his chances at napping at home without a struggle for the next five years, I am researching sleep. I did love having the first baby nap on me. I really think it helped us bond, plus I didn't have to stay home all the time, and I always knew he was ok (the threat of SIDS freaked me out and I had read that babies are less vulnerable if they sleep next to an adult because they regulate their breathing using the other's breath). I had also just read The Continuum Concept and Our Babies, Ourselves and was feeling like American babies could use more cuddling. Because of this, I never put him down "drowsy but awake." Plus, the sound of him crying made me physically ache. I couldn't stand it at all.

In my sleep research thus far, there seems to be a continuum of methods. They seem to trade crying for length of time it takes to reach the end goal of having your baby sleep through the night (not just the technical definition of 5 hours). They all get there by teaching the baby to fall asleep on their own ("self-soothe"), then when the baby wakes up briefly between sleep cycles, as we all do, they won't need whatever intervention we used to get them to sleep to get them to fall back asleep. The idea is that once they know how to fall asleep, they will know how to fall back to sleep. They all also pull this through to naps as a matter of course. In our experience with our toddler, naps were totally different than nighttime sleep. But maybe that was our problem.

I haven't read any of the "cry it out" books, but I did read one handout. It said you do a  specific bed (or naptime) routine, then put the baby in bed and kiss them goodbye then check on them in 5 minutes then 10 minutes then 15 minute intervals until they are asleep or an hour has passed. You try again for the nap if they didn't fall asleep in that hour. The stricter cry it out skips the check-ins. Ferber is less strict and Weisbluth is more strict, as far as I know. I would like to avoid this method because I want to believe that if my baby is crying then something is wrong. I also don't want him crying alone.

In the middle is the Baby Whisperer and the Sleep Lady. The baby whisperer says a lot of things I disagree with (like wanting your figure back is a contraindication to breastfeeding), but she says that, for sleep, babies need to be given a chance to learn to sleep on their own. She recommends a naptime routine, then putting a tired baby in the crib. She says to pick up the baby if he gets upset (not necessarily immediately), calm him, then put him back down. And then to repeat this over and over again.  At night, she advocates a "dream feed" before mom goes to sleep.  The sleep lady lays out a progressive plan which inches you in a chair towards the door away from the crib in about a fortnight. Each of these have a few tears, but the babies are accompanied through their transition.

At the attachment parenting side of the continuum is The No-Cry Sleep Solution. Pantley recommends a few solutions to helping your baby sleep longer. She urges you to keep a log, but only every 10 days because any more often would be too frustrating to see any results. She says the results will come in time, with persistence. Her solutions include having a specific naptime routine, which ends in a drowsy baby if you started when the baby was tired. She gives phases for comforting a baby in a crib, beginning with keeping you nestled around him in the crib patting and shhhhh-ing then slowly moving further away until all baby needs is "shhhh" from the doorway. She also encourages co-sleeping (as none of the other books do), but says to make sure baby is really awake in the middle of the night before rushing to comfort, and to try to pat and shhhh before nursing. She also says to stay awake while nursing so that baby doesn't get used to sucking to sleep, and so that you can gradually shorten each feeding session time until it is too short to be worth baby's while to wake up for. This is similar to what our new pediatrician said, actually. I asked her how to get the baby to nurse less at night. She said not to feed him at night, and then he wouldn't get hungry at night. Her tip for getting baby to stop falling asleep nursing is to pull baby off while patting and shhhh-ing, then gently hold baby's jaw closed with one finger under the chin. And to re-attach baby if he complained, then to let him suck and repeat the pulling off over and over. She also recommends co-sleepers to scoot away from baby so the milk smell doesn't wake him. Another recommendation is to introduce a lovey.

Of these methods, the no-cry is most appealing. I have been trying some of the nighttime methods and was down to 2 night wakings a couple of (nonconsecutive) times this week.  I have been trying the crib tactics for naps and am amazed that they seem to be working. I had always thought that the advice to lay baby down tired but awake meant to do this then leave them there. I have learned that it means to do a naptime routine to get them tired, then lay them down drowsy, then by all means you can stay to comfort them to sleep. I think this comforting is a transitioning stage to eventually saying goodnight and leaving them to fall asleep alone, but I am not sure.

The challenge for napping a baby routinely in the crib is when you aren't home for naps. Figuring out the balance of how often you need to be home versus out for naps, and how to nap the baby while out is another question. With my first, it was simple. He would sleep on the go easily in a carrier, stroller, or car seat. This new baby used to sleep in the Moby and now refuses it. He has yet to fall asleep in the car seat. I tried putting him in the car seat and swinging it, and I tried the same thing with him swaddled in a friend's Moses Basket. Both times he got close, but didn't make it to dream land. He can fall asleep in a baby swing, but he cries for 5-10 minutes (whimpering). I have put him to sleep once then set him into the car seat (with a friend's help) and tried to replicate that and failed. I finally tried a New Native sling, and he will reliably sleep in it on the go if I hold him in it horizontally and sway, pat, and shhh like I do when calming him for naps in the crib. Then I can release it to its intended position when his eyes close.

Our current nap routine now, two weeks out from when he refused to sleep in the Moby, has morphed a bit over this time.

I first was swaddling then nursing him to sleep. I didn't like this because it made him poop and threw off our routine of nursing upon waking (or soon after). It also seems like it wakes him up a little, and always takes 20 minutes. My toddler is not always that patient, either, especially with my back to him and laying down. And if he wants to also lay down, he likes to talk, and then I think it is hard for the baby to fall asleep.

Then I tried standing and swaying while patting and shhh-ing (after swaddling and putting on the white noise machine). I would let him fall asleep in my arms then gently lower him and sneak away. The problem with this was the escape. It is hard to lower the baby onto the bed or crib (which we got last weekend) without waking him. Then it is hard to extract oneself without waking him. This is, of course, made more difficult with a little talking companion. We sorted out that the baby could fall asleep with the toddler around, though, but the toddler had to go in the other room for the lowering into bed and escape. Then, of course, the baby would wake up at times and we would need to start again.

Then I started some of the no-cry crib ideas. For three days now I have been doing an actual nap routine. First we potty. Then we read a book in the rocking chair. Then we put on a diaper and swaddle blanket or sleep sack. Then I turn on the sound machine. Then I sway and pat and shhh like before but when his eyes start to close I take my leap of faith and keep swaying and shhh-ing but move downwards and gently place him in the crib, continuing my sounds and pats. If he cries, I count to ten five times and usually by then he has started sucking on his hands. I don't remember where I read that hand sucking, rolling to one side, and whimpering are how they self-soothe. As his eyes close, I stay there. I am trying to pat in a non-routine pattern so that he doesn't start to rely on them to fall asleep. If he gets mad, I pick him up to quiet him and set him down again.  I look at the clock to watch one minute pass after I think he is asleep. Then I gently release pressure or extract myself or just raise myself from my cribside position. 

After another day or two of this, I intend to lay him down when his eyes start to blink longer instead of when they close on and off.

After a few days of that, I hope to be able to shorten the swaying and patting and shhh-ing.

After a few days of that, I would like to drop the swaying and patting and shhh-ing.

After a few days of that, I will shorten the patting and shh-ing in the crib.

Perhaps eventually he won't need that at all; the theory is that you can comfort with a shhh from across the room (Pantley calls this a cue sound- just like in doing EC) or from the doorway.

I also want to drop the swaddle soon (but use a sleep sack) and maybe drop the white noise machine. We have a little pull toy that sings a lullaby and attaches to the side of the crib. I am thinking of inserting that into the routine- maybe at the point when he is set in the crib. I don't want to complicate matters unnecessarily, though. The idea is that we will start his naptime routine 15 minutes before sleeping time and the toddler can stay through books.
To achieve this timing, I am trying to watch the clock and the baby for sleepy cues, which he is good about giving. He yawns and cries when he is tired, and his awake amount of time from waking to sleeping again is fairly consistent (about 1.5 hours to 2 hours, depending on the time of day).

Currently, I am also trying to lengthen his naps from 45 minutes in the crib by coming in right when he makes a noise and shhh-ing and patting. When I try and nurse then, it ends up waking him up to go potty because there is plenty of milk to push his digestion through. The other way to lengthen naps I may try is to wait when I hear him, and see if he can sort it out in a couple of minutes without getting upset. Another way I read you can lengthen naps is to go in about 10 minutes before you think baby will awaken. You touch them or move something just enough for them to stir; the idea is that they will stir then resettle into another 45 minute sleep cycle. When he was sleeping in the carrier, he would take one 2 hour nap per day and the rest would be 45 minutes. I need to sort out when he is tired enough to take that long nap- maybe when I go in and he isn't cheery...

In conclusion, there is a lot of "coaching" that it seems like babies are capable of being molded by. It is amazing and counterintuitive that babies need to learn to sleep. I want to help my baby learn to sleep so that he will enjoy taking naps and sleeping at night, and feel good and grow strong and smart.

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