Nurturing Sleep

Nightmares are frightening dreams that wake children up. We don’t know exactly when little ones start to experience nightmares because until they have the language ability to communicate their fears and experiences we can’t be sure if their reason for waking is a frightening dream. However, there are specific characteristics associated with nightmares – so here is what we do know.

During the second part of the night there is more REM – or dreaming – sleep, so this is when nightmares mostly occur. Nightmares are common in healthy, happy children and are considered normal reactions to the experiences of growing up. The occurrence of nightmares is linked to a child’s growth and development of imagination, curiosity and understanding. In early childhood for example, children don’t always understand the difference between what is real and what is imaginary, and they begin to understand that there are things that can hurt them. So this is why nightmares are most common in children between the ages of 3 and 6 years, however younger children can experience them, and of course older children and even adults experience nightmares.

After experiencing a nightmare a child will wake, and although anxious she can be comforted and reassured by your presence and her familiar surroundings. Usually children remember their dream vividly and will explain the content of the bad dream clearly. Often the dream’s theme or content is related to the child’s age and/or experiences. The theme for young children’s nightmares for example maybe associated with images such as monsters or very large animals; older children may describe events of a TV programme, film or something seen on television, or new experiences like moving house. Why nightmares occur is a mystery; often they occur spontaneously, however there are known factors that may trigger them such as anxiety, stress, illness, and even sleep deprivation.

Providing comfort and reassurance to a child who has had a nightmare is important, as well as staying with them until they are feeling relaxed and safe to sleep again or if necessary, staying until they are asleep. In most cases nightmares are harmless and on the whole become less frequent as a child grows older. However, if your child experiences major episodes, becomes overly disturbed by her experiences, and/or her daily life becomes disturbed by them then it’s advisable to seek medical help and advice.

Disclaimer: The purpose of this article is to inform and not for medical diagnoses or treatment. Please contact a health care professional if you have concerns about your child’s health.

One of the easiest ways to help your little one sleep well is by establishing a relaxing bedtime routine. Babies and toddlers naturally enjoy routines – and establishing a consistent bedtime routine from about 3 months of age can have huge benefits for you and your baby throughout her childhood!

A well planned, relaxing bedtime routine ‘sets the scene’ for sleep. Research by Jodi Mindell (et al, 2009)  suggests that establishing a consistent bedtime routine can reduce the time it takes for babies to fall asleep and decrease night wakings. But that’s not all - a routine can help prevent bedtime battles later in childhood because once established, it provides valuable wind-down time and clear, predictable steps to bedtime which communicate that it’s nearly time to sleep.

Top bedtime routine tips:

• Reduce activity levels and lighting after tea and before the bedtime routine starts. Older babies and children benefit from quality connection play before bedtime to boost co-operation and connection.

• Plan a routine that works for you; one that you know you can manage and maintain consistently.

• Keep it simple, about 30-45 minutes; for example bath, massage, into comfy nightwear, feed/drink, picture book/story, cuddles, lullaby....

• Include massage; massage is relaxing and calming. It prepares your baby for sleep and it will help her associate her feelings of calmness and relaxation with sleep and her cot.

• Think about context; start your routine in the bathroom and complete it in the bedroom, keep lighting low. Low lighting and darkness triggers the release of oxytocin and the sleepy hormone melatonin that helps to calm the brain.

• Avoid feeding your baby to sleep; ensure feeding isn’t the last stage of your routine. Put your baby into the cot drowsy, relaxed and calm ready to fall asleep by herself. As your baby matures, I suggest the last feed is before the bedtime routine.

• Use a shorter version of your bedtime routine for daytime naps; nappy change, into sleep clothes (comfy sleepwear = comfy sleep!) drink/feed, book, cuddle and into the cot to settle to sleep.

• Consistency is key! Little ones thrive on familiar, predictable routines, because routines communicate to them what it’s time to do and what’s happening next. So, your relaxing bedtime routine will help your little one feel emotionally safe and secure; feelings of emotional wellbeing at bedtime is the foundation of happy, sound sleep!

Further Reading:

Mindell, J, Telofski, L., Wiegand, B and Kurtz, E. A Nightly Bedtime Routine: Impact on Sleep in Young Children and Maternal Mood. Sleep Vol 32; No 5. 2009.  Research available in PDF form here http://www.journalsleep.org/ViewAbstract.aspx?pid=27454

One of the many first aims of new parents after establishing feeding is to get more sleep and to help their baby distinguish between night and day – sleep time and wake time. Key to achieving this aim is how the biological clock functions and the related role of light and dark.

Our periods of sleep and wakefulness are regulated by our internal biological clock. Without the influence of external cues such as light, dark and social cues like mealtimes (known as zeitgebers), it is suggested that our biological clocks would function to a 25 hour day. The most important and influential zeitgeber that keeps us on our 24 hour daily cycle is natural light; when light fades and darkness falls the pineal gland secrets the sleepy hormone melatonin which naturally prepares our bodies for sleep and keeps us sleepy. Daylight suppresses melatonin secretion, so helps us stay awake.

William Dement in his wonderful book ‘the promise of sleep’ provides a fascinating history of the role of light in regulating sleep. In a nutshell though - throughout history and until fairly recently, our internal clocks and our daily lives were regulated by natural light – the rising and setting of the sun; so we worked in daylight and slept in darkness. A fire or oil lamp may have served to lengthen the day a little, but the red/orange glow of these light sources was not enough to suppress melatonin secretion and interfere with our biological clocks. However, the structure of our days changed with the invention of electric light bulbs - our days can stretch well into the night now with the influence of artificial light! Lights, computers, televisions used in the evening can all delay the production of melatonin, and so delay the onset of sleepiness.

All this is relevant when establishing baby sleep. A baby’s biological clock starts to develop at around 2-3 months and is working pretty well by 4-5 months of age. By exposing their babies to natural daylight in those early weeks and months parents can support and encourage the development of the biological clock and its associated role in regulating the sleepy hormone melatonin.

Some practical tips for using light and dark to encourage your baby or child to sleep well:

• Studies suggest that exposing babies (between 6 - 12 weeks) to natural daylight between 12 and 4pm helps establish good night sleep.

• Support the wind down to sleep by keeping the lighting low an hour before your child’s bedtime.

• Use blackout blinds to keep the bedroom dark and prevent street lights, car lights or light summer mornings stopping the flow of melatonin!

• If you need to use a night light, keep it very dim or consider using a red/yellow tinted bulb (remember the red/orange glow of the fire?)

• Expose your child to natural light first thing in the morning to trigger wakefulness and to help him keep his biological clock ticking efficiently.

• Finally – Televisions and computers are best kept out of children’s bedrooms – far too stimulating and can prevent the secretion of the wonderful sleepy hormone melatonin!

Further Reading:

Dement, W; (2000). The Promise of Sleep. London: McMillan

Karp, H. (2012). The Happiest Baby Guide to Great Sleep. New York: Harper Collins.

I went to Ann at the stage when i was desperate for help. My little one was 1 year old and had been having sleep problems ever since she was 4mo. This had become a huge problem within our household for one main reason: I didn't want to follow the cry-it-out method whilst my partner was more inclined to do so.

I decided that before giving in to the 'cry it out' method, I would go to Ann as a last resort hoping that she would help me through this ordeal and get our baby girl to start having better sleep patterns.

I was still breastfeeding at the time and she was waking up 5 times a night and had to be on the breast every single time. Putting her to bed sometimes took over an hour on a daily basis. I was so tired that my little one would fall asleep on me while I was breastfeeding her. I would wake up 2 or 3 hours later barely realising the time that had passed.

From the minute I talked to Ann, I felt that she had a deep understanding of everything I was going through. She showed every bit of empathy and genuinely set out on helping us. She always carefully listened to what I was saying which allowed her to identify the problems in L's sleep situation the way we had been dealing with it all along. Accordingly, she put together a tailored plan to our very situation and circumstances.

All I can say is that Ann was some kind of a horse whisperer. Although she never set foot in our house as all conversations were done via phone or Skype, she helped me understand what L was going through and slowly empowered me to follow my instincts in teaching L how to fall asleep on her own, and how to appreciate sleep. She taught us a helpful sleep time routine and explained the importance of expressing emotions through play and the importance for Leila to feel safe in crying in front of us. Most importantly, Ann helped realise that babies are nothing but tiny human beings with a very limited communication ability.

Throughout the sleep training, Ann always put L's health and well being above all. She kindly suggested to stop the sleep training until L recovered from a virus that was weighing her down so that she's in tip top shape and ready to go further in her training, every time pushing new limits.

Eventually, L weaned herself off on practically on her own and I got more and more into the habit of talking to Leila, explaining to her the situation and comforting her. Believe it or not, I think Leila was getting the gist of my messages and was progressing at the pace she set for herself. By the end of the training, Leila was sleeping through the night on her own.

Now, even if we do go through bad sleep days, I feel confident and well equipped to get Leila back on track as long as she's ready for it. It's a constant process of encouragement, support and empowerment.

I recommend Ann without reservation.

The story of a family of an early waking toddler.... written by Saul's mother.

 Helping your baby to sleep through the night does not have to mean the end of breastfeeding.

 For 6 months Saul would wake up, on average at 4.30am. and he was awake! there was not a change that he was going back to sleep. My husband and I tried everything: earlier bedtimes, later bedtimes. Nursing, then breaking the latch, putting him into his cot awake, and shush patting him to sleep. White noise. Blackout blinds. A sleep training clock. Bringing him to bed with us in the early morning. And at the age of 2 ½, a rewards chart. Occasionally Saul would generously allow us to sleep until 5, or 5.30am. Any parent who has endured these early wakings can tell you that they are a special circle of hell worthy of Dente.

 When I reached the point that all fellow suffers reach, that pinnacle of losing one's sanity, I realised I needed help. And fast.

 A dear friend recommended Ann, so I made the call. A warm, understanding, empathetic and encouraging coach and expert greeted me on the other end of the phone and later via our Skype session. Ann theorised that although Saul had some good sleep skills, he needed help to develop the skills that would enable him to put himself back to sleep at his naturally occurring wake cycle between 4 - 5 am.

 Ann also understood that I cherished my nursing relationship with Saul, especially the morning and evening times. So we slowly moved ourselves from bedtime nursing to nursing before Saul's bath. After Saul's bath, we would read and tell him a story. We would put him to bed, and then he would put himself to sleep. This was the single biggest change.

After a week of loving consistency, bolstered by the many emotional tools that Ann advised we implement, out new routine was set and Saul began to wake past 6am. After a few more days he played quietly in his cot until his sleep clock told him he could call for us at 6.30am.

 In the months following our sleep work with Ann, Saul's early wakings have stopped and he rarely wakes in the middle of the night. He also transitioned easily into his big boy bed and plays quietly in his room until he knows he can wake us. My husband and I have enjoyed our first 8 hours of uninterrupted, blissful sleep in 2 ½ years.

 As Saul's 3rd birthday approaches, our nursing relationship continues. For any mother who is told she must give up nursing in order for her baby or toddler to sleep through the night, I say nonsense.

 First make that call to Ann....

by Saul's mother, September 2014.