February 3, 2015

The BEST Thing I've Ever Done to Help My Baby Sleep - Behavioral Insomnia & Sleep Compression


Halle's an angel. Really. But there's something wrong with her at night. Terribly wrong. For the past 5 months she has waken up anywhere from 3-8 times a night, screaming, and we have no idea what's up. We chalked it up to EVERYTHING - teething, earache, tummy ache, gas, hunger, too much food, sleep regression, growth spurt, etc. We tried EVERYTHING - feeding her more, feeding her less, ibuprofen, co-sleeping, letting her Cry It Out (Ferber Method), rocking her to sleep, even driving her around in the car at 3am and letting her sleep in her car seat. We had no idea what was going on. We average 3-5 good hours of sleep a night, are exhausted, and frustrated. We also had different views on what to do about it. I wanted to comfort her, convinced something was wrong. Joey wanted to let her cry, convinced nothing was wrong. After trying the Ferber Method over 3 times, with no success, I just knew that something was up.

Enter this morning. Finally, with a referral from our normal pediatrician, Halle had an appointment with a sleep specialist at the Children's Sleep Center. Let me tell you. That was the single best thing I've ever done to help Halle.

We were told to keep a sleep log last week, and also had to fill out an intensive packet full of questions on everything and anything you can imagine about Halle's life, sleep, and family. After an hour long interview with the specialist, a review of the packet, and a study of the sleep log it was confirmed that Baby Halle has behavioral insomnia. This means she wakes up a the end of each 60 minute cycle of sleep and doesn't know how to go back to sleep on her own. She associates sleep with a bottle/boob because that's how I put her down for naps and bedtime, plus I used to nurse her back to sleep when she was younger - pretty much as much as she needed. So now she needs this every single time (yes every single hour) she wakes up.

I finally understood why the Ferber method didn't work on her, because it doesn't work on kids who have behavioral insomnia. The explanation is that she's crying because she is so exhausted and cannot settle herself down. Babies with this issue cry harder and more with time, not less. They simply cannot soothe themselves. This explains so much for me and makes me feel better since everyone around me kept insisting that Halle needed to cry it out, and I just knew it wasn't going to work with her. (The longest she cried was 2 hours before I got her, because I simply could not let her scream longer.)


This morning at the Sleep Center.


You're going, behavioral insomnia? Seriously? Is this a real thing? Yes! Not only is it real, but it is so common that it has a name! It's normally know as BIC, which stands for Behavior Insomnia in Childhood. It usually occurs in young children (less than 5 years old) and left untreated, will not resolve itself, and even results in behavior problems and affects academic performance!

Here are the symptoms of BIC:
  • Child has difficulty sleeping - very restless throughout the night.
  • Bedtime is an extended process that is only resolved with certain demands (in Halle's case, to be nursed or fed a bottle, in an older child it can be a favorite book, or needs mom to lay with her).
  • The child wakes up frequently throughout the night. Anywhere up to 6x a night.
  • When the child wakes up, parent intervention is needed to get back to sleep.
  • In babies, Crying it Out/Ferber Method does not work. Crying becomes longer, harder, and does not lessen over time. Parent intervention is needed.
  • Sleep difficulty in getting to sleep, staying asleep with each awakening.
  • There are no other issues going on. Examples are pain, reflux, GI problems, apnea, etc.
There are two types of BIC, either Sleep Onset Association (SOA) or Limit-Setting (in older children). Halle has the SOA type, so that will be the one I'll be talking about.

SOA is frequent and/or prolonged night wakings and is a condition that needs an association like parent intervention to return to sleep. These associations include patting a baby to sleep, rocking, nursing, bottles, TV, etc. Whatever is required for that child to get to sleep, is needed every single time the child wakes up. (That explains why Halle woke up every hour wanting to nurse!) The child is unable to self soothe and cannot fall asleep on their own, which prevents them from remaining asleep through the night.

Consequences of untreated BIC:
  • Shortened sleep times.
  • Irritability.
  • Increased temper tantrums.
  • Behavioral problems.
  • Poor academic performance.
  • Hyperactivity when overtired.

Treatment of BIC:
The treatment is set by the Standards of Practice Committee of the American Academy of Sleep Medicine and it is divided into 3 parts.
  1. Setting a consistent sleep schedule.
  2. Implementing a consistent bedtime routine.
  3. Teaching the child to fall asleep independently.

For us personally (treatment as chosen by our sleep specialist), we are setting a strict sleep plan that deprives her of sleep initially during the day so that she falls asleep easier at night on her own. No matter how fussy she is or tired, we have been advised to keep her up until 10pm. Then she is to be waken up each morning no later than 6:30am. She is allowed to take naps between 8:30-10, and from 1:30-4. This way she is deprived of rest after 4, and her sleep is condensed at night. This plan is called The Sleep Deprivation Plan or Sleep Compression, and our sleep specialist said that all her patients who had this issue had it resolved by using this plan for 2 weeks! (Using the "sleep compression" increases the child's homeostatic need for sleep so that by the 3rd or 4th night the struggle to fall asleep and to remain asleep is decreased.)

Currently she has been nursing before bed, which has created the SOA that she has. So to eliminate this we have been told that she is no longer allowed any type of bottle/boob in the bedroom at all. The bedroom is strictly for sleep. She is allowed to only have milk outside of the bedroom, and in light.

During this process it is to be expected that she will be waking up very often, and very mad for the first week. However we cannot wander from this plan. We have been told to adhere to it 100%. We are not to let her cry it out, in any way. She is to comforted by a simple hug and "it's bedtime" every single time she wakes up, then put back down. We need to do this repeatedly all night until she gives up. No lights, no walking/pacing, no rocking, no lullabies, no patting, nothing - because she cannot develop a new SOA. (So, looks like no sleeping for anyone!)

After the first week, it is expected that things will click, and we will return the following week for a follow up. By that time it is expected that she will be following this schedule on her own without needing us at night. From that point on we will gradually move her bedtime earlier, and her wake up time later.

Of course, this plan sounds exhausting for us, but it also sounds like a miracle. I am just so happy to know what is going on FINALLY!!! I'm so excited to have an action plan. I'm also so glad to have found the Sleep Center - finally I have a wonderful place to go where the people specialize in children and sleep and have ANSWERS!! For the longest time we were on our own, and at 10 months of age, enough was enough. We couldn't have her do this past age 1.

I pray this works and am excited to start the plan tonight. We will be very, very tied and busy doing this sleep training for the next 14 days so I apologize now if we are MIA. We need this to work for our sanity, sleep, health, and even our moods!

Here's the link to the Sleep Center if your story sounds like mine and you need help! Children's Sleep Center - St. Paul

All of the above information has been collected from sleepswfl.com

2 comments:

  1. Wow! So glad you went and got her diagnosis. I hope the next couple weeks go well for you all. I will be praying!!!

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  2. I also want to encourage you to not feel sad/bad or feel like you are harming her by giving her 'tough love' through this action plan, even if its hard. I have done the the feed-awake-then sleep and non-rocking/soothing, instead just put down and walk away since Myla was born, even when I felt like I was a meanie for it (especially when she was getting up more again at night around 8-11 months) because I had heard of BIC and how common it is for kids who are nursed/rocked before bed. Halle will transition, and better now than later on!! She will learn how to settle back to sleep on her own and you'll both be grateful! XO

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