Every child is unique. Every family is different and does things in its own way. So in talking about sleep problems and teaching sleep skills, there is always the danger of generalising in a way that is inappropriate for some or even many families. Despite this, it never ceases to impress me how predictable some things are. Changes that occur in children as their sleep improves are remarkably consistent. While recognising that details vary from family to family, I will outline below events which occur commonly.
Having decided to regain control of the child’s sleep routine for the sanity or even possibly the survival of the family, you begin to implement the plan as described elsewhere.
There are three phases in the improvement that are worth describing:
As explained elsewhere, the aim of this program is to enable the child to learn independent skills of sleep achievement. Almost always this involves removing the parents from the actual time of sleep transition. Now as far as the child is concerned, mum is the most attractive, most needed woman in the world. (Hopefully there will be two people in the house with that opinion.) When she is removed from the moment of sleep achievement, the child will quite logically have an opinion. As you leave the bedroom, they will almost certainly protest loudly. This is logical and easily understood. I generally suggest to my patients that the child is complaining about the wicked doctor, that they, the child and the parent, had a much better system and that mum should return at once and keep on doing what has been normal for months.
Your child’s protest is logical, understandable and loud. It tugs at your heart. It needs to be ignored in a way that helps to develop sleep skills. I won’t repeat the program of decreased handling here. Please see Chapter 4 on Sleep Problems for a full description.
The good news is that the protests will decrease in a fairly predictable way. I say fairly, because there is a big range in the way children respond to the program.
About 10% of children will cry briefly for 10 to 15 minutes, and then sleep for the rest of the night. I well remember a young lady who saw me after 18 months of badly disrupted sleep. She applied this program and, on the first night, her child cried for 15 minutes and then slept for twelve hours. He then just slept each night thereafter. To my surprise, the mother was moderately annoyed by all this. ‘Why hadn’t someone told her about this before?’ I think she did smile at me a little as she left.
To return to the main story, a small minority of children will improve very quickly. A small minority will improve very slowly. (For more information on this group, check the section on Failure.) The majority of children will be in the middle, and their protests will decrease fairly rapidly.
If your child can’t speak yet, then please jump now to the next section. If your child is old enough to talk and negotiate, then read on. They have some interesting little tricks.
When the child was very young, he or she could only cry. The talkative toddler can do more than cry. The child can now imagine, make excuses, and negotiate. They often have fertile imaginations and, despite your best intentions, will always be one step ahead. Remember the child has only one objective during the night and that is to maximise contact time with mum or dad. Whatever you do to meet one of their needs and let them return to sleep, will therefore never be quite right. If mum is present, they ask for dad. If dad is present, they want mum. The range of requests is never ending. ‘I want a drink.’ ‘I want to eat.’ ‘I need to go to the toilet.’ ‘I’m cold.’ ‘I’m hot.’ As rapidly as you meet one need, another will appear. The most worrying are anxieties and terrors. Please see a longer discussion about this in the section on Dreams and Nightmares.
The rule to remember is that your child, whom you love and who loves you, is simply protesting at a new style of sleep achievement which excludes parental contact. Independent sleep carries so many advantages for the whole family that every endeavour must be made to ignore these attempts at negotiation. If your child is well, properly fed and clothed, and if the time is appropriate for sleep, then politely but firmly decline to become embroiled in these efforts at negotiation. You need to be in charge of the night, not your offspring. They will protest, but trust me, the future is bright. Read on.
Once a program of teaching independent sleep skills is commenced, progress is usually rapid. (Please do not read ‘always rapid’.) There are variations from child to child and family to family.
The two major variables that affect the rate of improvement are fatigue and consistency.
Remember that we are teaching a skill. In this setting it is the skill of making the transition from wakefulness to sleep independently of parental contact. Like any new skill, this is harder to learn if the child is severely overtired. The more severe the sleep problem, the slower the improvement. This is an area of parental confusion because, as adults, we think of sleep achievement as being driven by tiredness. It is only when we regard sleep achievement as a learned process that the negative impact of fatigue becomes logical.
Once begun, the training program must be consistent. There are major problems with an inconsistent approach, such as teaching ‘persistent crying behaviour’. This is discussed at length in Chapter 13.
With a loving but consistent approach, children will achieve more hours of sleep. As they achieve more rest, their ability to learn the new skills of sleep achievement, and putting them into practice, rapidly improves.
Many families report at their second visit, ‘If only we had known how effective it would be, we would have done this months ago’.
Rapid improvement needs further explanation. While I have approached this cautiously and explained the highs and the lows, I will now give greater detail.
Children will protest vigorously at the removal of a parent figure from the time of their sleep achievement. It is difficult to predict how much crying or calling out a specific child will produce, but its rate of improvement has a degree of predictability. The child’s protests will often decrease at a rate of about 50% per night or better. There will be variation depending upon specific circumstances, but the crying on the second night is often 50% less than the first. The third night is often 50% better again, or 25% of the first night’s effort. It is not unusual for long blocks of sleep to be achieved by the third, fourth, or fifth night. For parents who have been up many times a night for months, this may seem like rapid improvement. A full night’s sleep for mum and dad is a very rewarding experience.
Having said all this, there is a trap which I will call negotiation. The phase of negotiation is a trap for the unwary and unprepared.
It is one of life’s little axioms that if you are really having a nice day, something will try to trip you up. In our case, if you have started to enjoy a full nights sleep, you may find there will be an attempt to return to the previous poor sleep behaviour.
In the sleep literature, where academics talk to academics, there is an event called the post-extinction reaction burst. To change that into normal language, the infant has had a sleep problem, the parents start a program to improve sleep, the sleep does begin to improve, and then it seems to go wrong. The child who has begun to sleep for long blocks at night begins to awaken again. This can be a major setback for the parents, and for some it marks the point of final surrender. ‘We tried so hard for seven nights. It seemed to be working. Now listen to that cry. I’ve got to sleep or I’ll be useless at work tomorrow. Let’s get him up, bring him to our bed, and get some sleep.’
This phase is significant and I call it the negotiation phase. What appears to happen is that the child who has been using the parent as a major cue for sleep achievement begins to sleep through after a period of decreasing protest. He or she achieves reasonable blocks of sleep and then something occurs in the child’s subconscious to ‘try it again’. I describe it to families as a final effort to see if mum and dad really mean it, and are quite certain that they wouldn’t like to come back for a cuddle at say two or three in the morning. This is the child’s last subconscious effort to modify your behaviour back to that style of sleep which you saw as a problem in the first case. The rational response to this phase of negotiation is to see it for what it is. The baby or infant is asking, in its own way, ‘Could you please come in and visit me now. I like it when you do’.
To comply with this request simply reinstates parent dependent cues of sleep and so undoes the work of the preceding days and nights.
The parents’ response needs to be along these lines: ‘Sorry darling, I feel much better when I’ve had a whole night’s sleep. In fact, you were a much happier child today after last night’s good sleep. I love you dearly, but night is for sleeping, I’m not coming’.
To the best of your ability, stay in bed. Ignore this attempt to negotiate and allow the child to return to sleep alone. You may choose to check that the baby is well and safe, after you believe that they are asleep again.
The negotiation phase is difficult to predict, because of its randomness. I cannot say on which night it will occur, or at what times the child will cry out. Simply recognise it for what it is, and don’t become involved. Once successfully ignored, the child has completed the three usual phases of improvement and has now developed independent skills of sleep achievement and maintenance.
Once good sleep is achieved, there are a number of areas that many parents report as improved. We know as parents that when we become overtired, there are consequences we don’t like in our own behaviour. Many of us become short-tempered, forgetful, confused, and unaffectionate. Children also reflect the consequences of tiredness in many ways. Often their play is too boisterous or destructive, their concentration span may be poor, and their frustration tolerance may not exist. They become increasingly emotionally dependent, but at the same time less loving. Having said all this, there are certainly many children who cope very admirably with broken sleep, and who are loving, cheerful, and a joy to be with during the day. In these families, it is usually mum and dad who benefit from the improved sleep. Despite this, the majority of sleep-deprived children will be affected in some way that family or friends recognise. Signs of improvement will often include the following:
Happiness: A child who has slept well overnight will usually wake happy. They may be hungry, but they are content. I generally expect children who have achieved the amount of sleep they need, to awake quietly, patiently wait for mum or dad to come, and then greet them with obvious happiness and enthusiasm. This improved happiness will continue throughout the day until they start to become tired.
Calmness: A well-rested child is calm. Their play tends to be less intrusive and more constructive. They are more enjoyable.
Concentration Span: Once the child’s mind and body are rested, parents will often report that he or she plays for longer periods with specific toys, or shows signs of being able to be more focused on a task. Any adults who have been severely overtired will be able to relate to this improved ability to concentrate.
Frustration Tolerance: Overtired children who are not getting their own way will often give an impressive display of temper. They throw themselves down on the ground, kick and scream. Older infants may turn on others and kick or bite or throw things. Attempts at negotiating with these children are useless, as they are usually past the point of responding to a ‘reasonable approach’ from the care giver. Many of you will have seen such children in the shopping mall giving their tired mothers a terrible time, yelling and screaming. They are generally regarded as naughty or poorly behaved, but almost always it is simply fatigue. They have become too tired and are unable to accept not getting their own way.
The reverse occurs when sleep improves. Within a few days, behaviour becomes more logical, tolerance of frustration improves, and it becomes easier to talk them into an alternative activity without screams of temper. Having said this, beware of the end of the day. Even the child who is sleeping well still gets tired and may become ‘testing’ before bedtime.
Affection: Another interesting behaviour affected by fatigue is the giving of affection. Giving and receiving appropriate affection are the true rewards of parenthood. There are few feelings more satisfying than to be holding an infant who is loving and thriving. It is wonderful to receive unconditional love from your child. This is often shared by touching and holding. The overtired child has trouble being affectionate. They are often dependent. They look for your company, seeking contact, but when you hold them it is often a relationship of dependency. The child needs you and takes affection from you. Being in mum’s arms is safe. There are many occasions where this is totally appropriate, but when it is too frequent it becomes wearing. As children improve their sleep, the relationship with care-givers and parents often becomes richer. As mentioned below, as the child becomes more rested with improved sleep, the confidence radius increases. At the same time, the quality and style of physical interaction improves. When the child is in your arms, they not only take love, but give it in return. It is heart-warming and strengthening to feel your child snuggle into your body and give affection to you. It may be a wet and clumsy kiss, but it’s a kiss. This two-way emotional traffic is no longer draining and tiresome, but strengthening. If your sleep has improved as well, your chance of returning that affection is greater. When it begins to happen, particularly if you are coming from a background of months of tiredness and broken nights, you will know that you are heading in the right direction.
Confidence Radius: In recent years, I have developed the concept of a ‘confidence radius’ which has proven to be a useful idea. Like so much in this book, it is simple, but fairly widely applicable. The ‘confidence radius’ is a distance measured in metres or yards or whatever units you like. It is the distance between the adult and the child. In fact, I never ‘measure’ it as such, because it is not necessary. However, think of it as the distance between the carer and the child.
As children become tired, their ability to function away from a parental figure decreases. At the most extreme, the child will only be content resting in the parent’s arms. As soon as an attempt is made to put the child down, they cry and become distressed. Slightly older children who are mobile will cry and follow you around the house. Their ability to feel confident alone is severely limited.
As children’s sleep improves, so does their confidence. Once children are sleeping well, they become more comfortable in their own company. The general picture here is of a child who has slept well overnight, eaten breakfast of either milk or solids, depending upon age, and is now happily awake. This child generally can be expected to enjoy the company of the care giver but will not become distressed if left alone. It should be possible to leave the room to attend to other responsibilities and for the child to be able to entertain himself or herself with toys or mobiles or other appropriate activities.
The value of this concept is in it being useful marker of fatigue. If your child is usually confident in a room alone, and over a day or two you notice that you are being called back more and more rapidly, then the child is possibly becoming overtired. Conversely, if your child becomes less tired, you will notice an increase in his or her confidence radius.
Emotional independence and the ability to give affection are complementary. In some ways they may appear to be opposites, but they are in fact two sides of the one coin.
Readability: The concept of readability connects with that of ‘blended behaviour’ mentioned elsewhere. Overtired children can be difficult to read or interpret. Are they happy or sad? It is confusing for parents caring for an overtired child.
This concept needs further explanation and can be simplified into behaviour patterns of two types. The first is that of overtiredness often associated with difficult behaviour. Rested behaviour is usually the reverse. The rested child is usually pleasant to be with, their play is not intrusive, their appetite tends to be good, they are more logical and consistent. Looking after them is a pleasure.
I often see children where the continual presence of significant tiredness leads to a blending of these two styles of behaviour. Minutes of laughing and happy behaviour are mixed with minutes of unhappiness and difficult behaviour. In this setting, the parent may have trouble judging their child. The child may become difficult to ‘read’. ‘Is my child tired or not?’.
Improved sleep leads to improved readability. The rested child is far more likely to be content. As normal tiredness develops during the day, it declares itself as a change in behaviour. Common signs include yawning, heavy blinking, rubbing at eyes, pulling an ear, or crying and whimpering. The child is tired but not overtired. If this tiredness is recognised quickly, and the child is put down for the next sleep, it is far more likely to achieve sleep efficiently.
One of the benefits of improved ‘readability’ is enhanced confidence that you understand what is happening and can take control. For those of you who just thought ‘I’ve never been in control’ take heart, things should improve soon.
Sleep Seeking Behaviour: There is a sign which parents have reported to me and it appears to be the final sign of success in teaching sleep skills. It only applies to the toddler and older child, and you will quickly understand why.
What I refer to is ‘Sleep Seeking Behaviour’. Recognising our own tiredness is one of the functions of the mind that we take for granted as adults. Some of you may feel that you are living in a permanent state of tiredness. Feeling exhausted is not fun, but understanding and recognising that you are tired is important. It is a function of self care that we recognise our tiredness and take the necessary steps to fix the problem. To the best of our ability we plan and seek sleep. It is a sign of maturity to assume responsibility for our sleep.
Young children do not have an ability to recognise fatigue or make a decision to go to sleep. As the child matures they will at some stage begin to monitor themselves and recognise tiredness. The magic moment for parents is when the child takes that extra step of development and recognises the solution. ‘I’m tired. I need to sleep.’
When your toddler begins to report to you that he or she is tired, the battle is almost won. Once both you and your child recognise fatigue for what it is and that the solution to these feelings is sleep, then you are finally working together.
When we began our consultations, our 19 month old son was not sleeping in the evening until 9.00 pm, and then only after a lot of difficulty. Occasionally he would be awake until 9.30 – 10.00 pm. He would wake up regularly during the night and usually ended up in bed with us. He would then wake at 6.00 am. He would not sleep in the afternoon unless he was rocked in our arms, with the duration of his nap being 40 minutes.
We followed ‘The Plan’. Within days we achieved a more reasonable sleep time in the evening. The nightly waking ceased a few days after we settled his evening routine. The afternoon nap was the most difficult routine to achieve, as our son had always been rocked in our arms and was very determined not to let go of this. We had to persevere, knowing it was to our son’s benefit to achieve sleep by himself, at all times of the day or night.
Our son is now in bed at around 7.00 pm and content to go to sleep. He no longer wakes during the night and his day continues to start between 6.00 – 6.30 am. We are able to put him down for an afternoon nap, without any rocking, when he sleeps, on average, two hours. He is now a happier, less stress and less stressful little boy.