Read an Excerpt
Chapter 1 "Help, my baby won't sleep!"
An Introduction to Sleep and Sleep Problems
Susan's daughter, Elisa, has never slept through the night. She falls asleep sometime between 7:30 and 10:00, sleeps for a few hours, then wakes up and begins crying. In order to fall back asleep, Elisa needs Susan to rock her. This pattern has been repeated every single night at least twice a night since Elisa came home, nineteen months ago. One Tuesday night a few weeks ago Elisa slept from 10:00 p.m. until 5:30 a.m. According to Susan, "It was a miracle." Susan and her husband are both at their wit's end. They have fought frequently about this problem, and at this point they are both too tired to function, let alone enjoy being parents.
Right after "Is it a boy or a girl?" and "What is her name?" the next question that veteran parents ask is "Is she sleeping through the night?" The above scenario describes the situation faced by many parents of infants and toddlers. Study after study has shown that approximately 25 percent of all young children experience some type of sleep problem. Most of the time these problems are related to getting to sleep and then sleeping through the night.
Sleep, or the lack thereof, is a critical aspect of childrearing. Good babies sleep. Most babies don't. As long as you get enough sleep, a parent can deal with just about anything during the day. However, when it is 4:00 in the morning and you have just been awakened for the third time and are facing a screaming baby, all sanity goes out the window. It would try anybody's patience. What parents resort to is even more incredible. Many parents, as they are circling the block in theircar at 3:30 in the morning wearing only their pajamas and mismatching socks, with their baby sleeping peacefully in the car seat, try to imagine how they are going to explain this behavior if pulled over by a police officer.
Sleep--What Is It? Everyone sleeps. Humans sleep, toads sleep, monkeys sleep, dogs sleep, and whales sleep. Perhaps all species sleep. But, surprisingly, we know very little about sleep. Although sleep researchers understand the mechanisms of sleep and what happens to the brain and body when we do sleep, we still do not know why we sleep. What is sleep's function? No one knows. Some believe it is a restorative function. Others believe that it is for energy conservation. And even others believe that it is adaptive, that it enhances survival. We do know that everyone has to sleep. People cannot function without it. The body craves sleep if too much time has gone by without it. People also don't feel like themselves if they haven't gotten enough sleep. So while we are not exactly sure what it is, we know that we all need to sleep.
One aspect of sleep that is well understood is that many people have sleep disorders. Approximately 25 percent to 30 percent of adults have some type of sleep problem, whether it is insomnia, sleepwalking, or just too little sleep. Babies and toddlers also have sleep problems. Some are quite serious, such as sleep apnea, whereas most are just difficult to deal with, such as bedtime problems or frequent night wakings.
Since sleep is a natural process, we must all know how to sleep. However, good sleeping habits must be developed. And sleep, especially falling asleep, involves a number of behaviors. These behaviors are what become problematic for many babies and toddlers. Babies learn to fall asleep in specific circumstances, such as being rocked, lying in a crib, or being pushed in a carriage. It is these specific circumstances that may or may not lead to a baby's sleep problems; that is, many babies develop good sleep habits, whereas other babies develop poor sleep habits. These issues will be addressed more thoroughly throughout this book.
Why Doesn't My Baby Sleep? As discussed above, sleep problems in young children are much more common than you may think. Every study has consistently shown that between 25 percent and 30 percent of infants and toddlers have some type of sleep disturbance. That is a large number of children. If you put ten infants in a room, three or four of them will have some difficulty sleeping, which means that you are certainly not alone if you have problems with your baby's sleep.
Of course, if the other six or seven babies in the room sleep fine, then you may ask yourself, Why does my child have a problem? First of all, and most important, it seems there is a biological predisposition to having sleep problems. This means that some babies are more susceptible to sleep problems. Some babies start sleeping through the night within weeks of coming home from the hospital and never have a sleep problem. Others never seem to get a good night's sleep. Thus, some babies seem to be "sleepers" and some babies are not. Some babies have more difficulty learning to fall asleep, are more easily aroused from sleep, and are more sensitive to changes in routines that affect their sleep patterns. I once heard a parent joke that when she ordered her next baby, she was going to check the "sleeper" box. Many parents feel that way.
Some parents blame themselves for their child's sleep problems. Some believe that if they just hadn't rocked him to sleep as an infant, he would be fine. Others feel that they let their child sleep in bed with them for too long, and that is what caused all their baby's problems. And, unfortunately, the truth is that parents often do play a role in their child's sleep problems. They may have inadvertently maintained the poor sleep habits that contributed to their child's sleep problems. But a baby's sleep problems are not entirely the parents' fault. The baby also contributes. Many babies are rocked or nursed to sleep, and sleep fine. They go to sleep quickly and don't wake during the night. It is apparent, then, that the same parenting behavior can lead to sleep problems in some babies and not in others. Parents therefore need to change their behavior only if their baby has a problem sleeping through the night.
Predictors of Sleep Problems In addition to a biological predisposition, there are certain things that make a child at risk for sleep problems. Being "at risk" means that a higher percent of these children will develop a sleep problem. Below are a number of things that can contribute to a baby having a sleep problem.
Firstborn. Firstborns are more at risk for sleep problems. Why? Probably because parents are more anxious with their first child. This is their first time at parenting, and they are usually more concerned about whether they are doing it right or wrong. They tend to be much less tolerant of their child's cries and have more time to devote to their first child. They also find it easier to take the time to get up and rock the baby back to sleep in the middle of the night. Later, when the family is larger, it seems more important to set a definitive bedtime. When it is bedtime, everyone goes to bed. There are no ifs, ands, or buts about it. And it is rare to have the luxury of rocking later-born children to sleep or nursing them to sleep when you are trying to get everyone into pajamas with teeth brushed and so on.
Sex. Boys are more likely to develop a sleep problem than girls. We do not know exactly why that is, but overall boys are more at risk for many things. For example, boys are more at risk to die of SIDS (sudden infant death syndrome), are more at risk to be hyperactive, and are more likely to develop some illnesses. It also seems that parents treat boys differently. Studies show that parents are less likely to be consistent in the way they treat boys. While parents are likely to respond to a girl baby the same way every time, they are more likely to change their responses to a boy baby. For example, when Mark's baby, Adam, cries after falling down, sometimes he picks him up but other times he ignores him and lets him try to stand up again on his own. If Adam was a girl, studies show that Mark would be more likely to always pick her up or to always ignore her. No one knows why parents differ in their behavior in this way, but this type of inconsistency can lead to sleep problems.
Colic or ear infections. Children with colic or frequent ear infections are much more likely to have sleep problems. These babies have sleep problems primarily because they get into the bad habit of waking during the night when they aren't feeling well. Then, even when they are feeling better, they may still wake during the night and have difficulty returning to sleep without parental intervention. For the parents, it is difficult to determine whether their baby is still in pain from an ear infection or is just having problems sleeping.
Same bed or room. Studies have shown that almost all children who sleep in the same bed or in the same room as their parents wake during the night. Chapter 5 explains why this happens.
Breast-feeding. Breast-fed babies are also more likely to take longer to sleep through the night. One study found that 52 percent of breast-fed infants, but only 20 percent of bottle-fed infants, wake during the night. A complete discussion on breast-feeding and sleep can be found in Chapter 7.
