Baby Won’t Sleep: Here’s Why

HELP! MY BABY WON’T SLEEP!!!

You’re not alone. I know someone else who said that a few years back… ME.

Our first little one arrived 2 weeks early. But he fed well. He gained terrific weight. He hit all his milestones. There’s just one thing he didn’t do. LO did. not. sleep.

We tried everything (or rather, we thought we tried everything!) We rocked him in our laps for what seemed like days at a time. We walked the floor with him at 2 AM night after night. We tried leaving him to cry (against all recommendations). We used pacifiers, white noise machines, bouncy seats and baby swings. Everything worked… for about 10 minutes.

We asked friends with babies for advice. We even borrowed a copy of Ferber (and read it!)

Reading Ferber for me was the proverbial light at the end of the tunnel. In this book I first encountered the concept of “sleep associations“. It was a kind of epiphany for me. And my journey began. I started reading more about sleep and infant development. Then it all fell into place. I had planted the germ of and idea that was to evolve into my sleep coaching business.

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Don’t wanna sleep right now

I discovered that a powerful potential for normal sleep resides in every human being. The trick is to unlock it. There are no ‘sleep problems’ per se. There are only barriers that stand in the way of a baby or child and a restful night’s sleep!

Over the years, I’ve heard the cries of “Help! My baby won’t sleep!” hundreds, maybe thousands of times. Each story is unique. Each child and family has their own set of issues that contributes to a sleep problem.

But very often, each of these unique cases can be classified in its own group. I’ve made a catalog to share with you here. I’ll explain the broad sleep issue, then explain the elements of the fix. The key thing to remember is that each child is unique, so your story may be different, as will the remedy. The underlying elements, however, are the same.

Why Your Baby Won’t Sleep

1. She’s Not Tired

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I will sleep later

It’s 9:00 PM. You’ve been up since 4 AM with your 2-month old. You’ve fed and changed her what feels like a dozen times. You’ve gone shopping. You’ve done four loads of laundry. Oh yeah, and you cooked dinner for your husband, who strolls in at 6 PM looking fresh as a daisy. You look like you’ve been in a fight gone bad. You can barely keep your eyes open. So why is it the baby won’t sleep?

It could be that she’s already slept 16 hours in the last 24, and she just got up from a 3 hour nap at 7:00 PM! She’s just not tired enough to go to sleep yet!

Babies develop sleep-wake cycles just like we do. When they are very young, their stomachs usually set the clock. After a few weeks, they begin to respond to the structure imposed by the sun. That is, they learn that day is light and night is dark! They also respond to the structure imposed on the day by their parents: the day tends to start at the same time. She eats at the same time. She plays at the same time. And she naps at the same time.

The Fix

For a baby like this, I first make sure she’s healthy and getting enough to eat. Then we talk about her sleep patterns. We talk about a typical day for her. In this case, when she’s just had a huge nap in the afternoon, I recommend some tinkering with the nap schedule. It may involve moving the afternoon nap earlier in small steps, say 15 minutes at a time. Again, the fix when the baby won’t sleep because of the recent long nap is only an example. There are always little tweaks that I recommend for families.

2. She’s Overstimulated

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But I kinda LIKE stimulation!

Overstimulation is a real thing. It really can rev a baby’s motor so high that she cannot calm down enough to go to sleep. Maybe there’s been too much activity. There was a party in the morning. You listened to a rock station on the radio on the way home. You played all afternoon when she wasn’t napping. By the end of the day the poor baby is wired up!

Newborns and some young babies are able to protect themselves from overstimulation. They do this by ‘shutting it down’, and going to sleep. I call this “The Tilt Function“. As they develop, babies lose the Tilt Function and expose themselves to the risk of overstimulation on those really busy days. Some babies can handle a lot of stimulation, but some cannot!

Sometimes the baby becomes overstimulated because she has lost one of her naps that she really needs. Sometimes this happens ‘accidentally’ and sometimes it happens by design – at day care.

The Fix

The best way to fix overstimulation is to avoid it to begin with! If the baby’s day is too much for her senses, try cutting back on activities. If she needs that third nap and isn’t taking it, I can teach you some tricks to get that nap back!

On the day that the baby won’t sleep because she really is overstimulated, you may need to bend a few rules. That means, you may need to sit or rock with her for a while. Do this in a dark, calm place. You can run a white noise machine or hum quietly to her. It may be a bad night. But you’ll know how to avoid such nights in the future!

3. She’s Hungry

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I’m a kitten. I’m always hungry

This one is more common than I thought it would be. Babies are growing faster in their first year of life than they will ever grow later. They need a lot of calories. Some exclusively breastfeeding moms worry that their babies aren’t eating enough. This is natural because it’s hard to know how much the baby is eating if you can’t measure it! But sometimes a baby won’t sleep who is exclusively bottle fed! Rarely, a baby who has started taking solids is still not getting enough calories during the day.

In all these cases, the baby won’t sleep because her stomach keeps her awake. It’s a good thing, in a way. A baby needs to grow!

The Fix

The first step is to consult the pediatrician. You want to know if they baby is getting enough calories for her weight during the day. You want to know if she is gaining weight along her growth curve appropriately. If she is not getting enough calories, work with your pediatrician, or perhaps a nutritionist, to figure out ways to feed her up. A baby who eats well, sleeps well (and vice versa!)

4. She’s Over-Fed

This is the opposite of #3. Sometimes a baby won’t sleep at night because she’s eaten too much, not too little. Their stomachs are working double time to try and digest all the formula (and solids?). These babies are gassy and colicky. Often they are constipated. In that case, the baby won’t sleep because she needs to poop and cannot. Or sometimes she poops to much, and her full diaper won’t let her rest.

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Too much?

I see this a lot in babies who drink “spiked bottles”. These are bottles of formula or pumped breast milk that you’ve added cereal to. There is no reason to spike bottles, people (see below).

The Fix

Just as in #3, the first step is to consult the pediatrician. You want to know if the baby has a good weight for her age. You want to count up the calories she’s eating per 24 hours. This number varies, but she should get around 50 calories per pound of body weight per day. If she’s eating substantially more than this, this could be the reason baby won’t sleep. You should discuss it with your pediatrician. He/She will probably recommend that you cut back on calories. One thing is pretty certain, however. The pediatrician will recommend you stop spiking the bottle if that is what you are doing! Formula or breast milk are perfect by themselves!

5. She’s Got Bad Sleep Associations

This is a major cause of “baby won’t sleep”. It may be the major reason. Sleep associations are, very simply, those things that your baby associates with going to sleep. Some typical ones are darkness, swaddling, sucking on a pacifier, being rocked.

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But she won’t sleep without her binky!

What’s the difference between a “good” sleep association and a “bad” one? A good sleep association is something that will stay with the baby all night. Baby sleep cycles from shallow to deep, just like ours does. A bad sleep association is something that disappears, or is taken away, after we fall asleep. When we get to shallow sleep, we ‘take an inventory’ of all the things around us (our sleep associations), make sure they are all there, then we roll over and fall back asleep. We don’t even remember these partial awakenings.

A baby does this too. What if one of her sleep associations is being held by you? Unless you plan to hold her all night, she’s going to awaken partially at midnight and wonder where you went! That’s why being held is a bad sleep association.

Very often, the baby won’t sleep because the binky (pacifier) has become a bad sleep association for her. When the binky falls out of her mouth, as it surely will, she’ll ‘look around’ for it in the dark. Then she’ll get ticked off and become fully-awake. Then you have a crying baby!

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The Fix

Pay close attention to the events that surround the moment of sleep. Is she surrounded by all the things that will be there in 90-120 minutes when she partially wakes up? Do you hold her or rock her until she falls asleep? If so, she may associate holding and rocking with being asleep. No holding? No rocking? Baby won’t sleep!

Each case is different, but in general parents and I work on ways to put some time between the bad sleep association and the moment of sleep. First a few minutes, then more minutes. It’s essential to dis-associate these things in order to allow the baby to master her natural self-soothing technique.

6. She’s Got Colic

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No. That’s “cow lick”

I call this the “C” word. I hate colic. Everybody hates colic. By definition, no one knows what colic really is. The incessant crying for hours at a time, every night, at the same time, is enough to drive any parent nuts! I’m talking about babies who eat well and nap perfectly throughout the day. Then they turn into little devil-babies at night. It begins at 3 weeks of age and continues until 12 weeks.

Colic is a “diagnosis of exclusion”. That means, once you exclude all the other reasons why baby won’t sleep, you can call it colic. Some of these reasons are reflux (see below), over-feeding (see above), or under-feeding (also above).

The Fix

Parents hate this answer. You have to wait it out. If you and your pediatrician figure out that there’s no other reason why baby won’t sleep, then you have to wait. At 12 weeks of age, it will stop. These may be the longest 8 weeks of your life. But you will survive it. We all did.

7. She’s Got an Inconsistent Schedule

Again, this reason why baby won’t sleep turns out to be a lot more common than I imagined. It turns out that some (many?) babies are creatures of habit. They like having a regular day. They like things predictable. They don’t like change. They don’t like inconsistency. Having said all that, there are many babies who don’t mind chaos at all! But if the baby won’t sleep because she needs consistency and her day is chaos, you may have a difficult problem on your hands!baby won't sleep 9

Sometimes the schedule is fairly consistent except for one part of the day. I’ve had many clients who believe the baby won’t sleep because Dad comes home late and the baby wants to play with him! They’re right! She probably does want to play with him. The problem is her regular sleep-wake cycle wants her to be going to sleep at 9 PM, not to be playing with Dad.

The Fix

Easier said than done. For many families, chaos is more or less a way of life.  It would be great if every day were more or less the same, but the reality is that this just doesn’t happen for some families. But in every family, there are some ways that the day can be made as regular and as predictable as possible. For example, there may be a four-hour stretch at the beginning of the day when mom and baby are alone together. This is a good time to try and establish a routine of eating, playing, and sleeping. If you can succeed in introducing order in one part of the day, then you can work on other parts of the day as well.

8. She’s Got Reflux

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Wrong way. Should be down

Sometimes the baby won’t sleep because food comes up instead of going down. That’s reflux in a nutshell. Milk or food that is supposed to pass into the baby’s intestines comes back up toward her mouth instead. Sometimes acid from the stomach irritates the baby’s esophagus. These babies seem to be in pain. They make funny faces. Many, but not all, of these babies also spit up. Not every baby who spits up has the painful symptoms of reflux.

Some parents tell me that the baby won’t sleep unless she’s being held upright. Or she won’t sleep unless she’s in the bouncy chair. This is a clue. Other parents tell me that the baby always seems fussiest right after eating, especially if they put her down right away.

The Fix

The first step, once again, is to discuss the possibility of reflux with your baby’s doctor. While you are doing this, there are some things you can try. I call these “anti-gravity methods”. The point here is to let gravity be the baby’s friend, not her enemy. If food is supposed to travel down, let gravity help it go down. I recommend keeping these babies up on an angle virtually all the time, except when changing their diapers. An angle of 30 degrees is possible, but you may have to buy more than one wedge at the baby store. When I say “angle” I mean the entire body, not just one part of it. You don’t want the baby to do an “abdominal crunch’; this might only make the reflux worse. You wan’t her entire body ‘planked’ up at an angle of 30 degrees.

Sometimes doing smaller feeds more frequently can cut down on reflux. If anti-gravity alone doesn’t work, I sometimes recommend adding this technique.

If neither trick works, your pediatrician and you can try some other methods. There may be dietary changes she can make. Sometimes medications can help. The good news is that practically every baby with symptomatic reflux gets better by her first birthday.

9. She’s Sick

Sometimes the baby won’t sleep because there’s something wrong. She’s coming down with something. Or she’s already caught something. Usually you can tell this reason from the other reasons because the baby won’t be right throughout the day, not only at sleep times. She may or may not have a fever. Sometimes, the best way to tell if a baby is sick or not is to ask how well she is feeding. A baby who is feeding well may be sick, but she’s not SICK, if you know what I mean. I worry a whole lot less about about when a baby won’t sleep but continues to eat well, than I do about a baby who won’t sleep and won’t eat!

The Fix

If you have any concerns or question at all that the baby may have an illness, consult your pediatrician. The overwhelming majority of the time, when the medical problem is fixed, the baby will go back to sleeping well again!

10. She is Hypersensitive

Finally, the baby might be more sensitive to the sensations of her world than other babies. For example, the baby won’t sleep because she hears every toilet flush in the house and it wakes her up. Or if you go in her room to check on her and you ever-so-slightly jostle the crib and it wakes her up! Or the baby won’t sleep if there is too much light in the room.

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So I’m sensitive, so what? I’m also cute!

These are real example from families I’ve helped. On further questioning, I often learn that one or both the parents were “just like this” when they were babies. Grandparents can be a helpful resource when trying to figure out why the baby won’t sleep.

The Fix

Create a “sensory deprivation space” in the baby’s room. Install black-out shades and carpeting to muffle footsteps. The exception may be a white noise machine. Sometimes, but not always, these devices can help filter out noises from around the house that might wake the baby. It sounds gross, but sometimes I recommend that the parents wait until the baby is awake to flush the toilets. I’ve actually seen this work at least once.

Sleep, Baby! is Here for You

If these ideas don’t work for you, or if the reason your baby won’t sleep doesn’t appear on the list, contact me. I can help!

 

 

How To Treat Bedwetting

Since the dawn of recorded history, bedwetting has been seen as a problem requiring the help of a specialist. The indispensable Dick Ferber documents “cures” for bedwetting from as early as A.D. 77. But bedwetting is unusual among maladies with long histories. Ancient remedies for such common problems as colic and constipation have given way to prescription medications. Not so for bedwetting. “Boiled mice” and “hedgehog testicles” have not been replaced by “modern” medicines. Instead, in the 21st century we treat bedwetting primarily with behavior modification. In other words, you no longer need a specialist, you treat bedwetting yourself!

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Hedgehog LOVES behavior modification!

Four Major Methods to Treat Bedwetting

Virtually all treatments for bedwetting fall into four categories: reinforcement and responsibility training; bladder training; conditioning; and medication. But all of these methods, including medication, require that parents and the child all cooperate to solve the problem together. If the child is not “with the program”, you have very little chance of success. Likewise for parents: all the child’s caregivers must agree to be patient, persistent, and above all, prepared to deal with many setbacks along the way.

Before you begin any such plan, it’s important to see the child’s doctor to rule out any medical reasons for bedwetting.

Reinforcement and Responsibility Training

Reinforcement and responsibility training is based on the theory that a child who feels responsible for taking care of her general needs during the day is more likely to take care of herself at night as well.

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Everyone loves a gold star

You begin by sitting down with the child and coming up with a (short!) list of things the child can take responsibility for in the house: washing dishes, walking the dog, etc. But the one item that absolutely is on the list is taking responsibility for the bedwetting episodes themselves. This is not punishment, it’s giving the child ownership of the problem. It can be explained as a privilege that “big kids” are able to do and, most importantly, will be rewarded for doing. People respond much better to positive reinforcement for good behavior than they do to punishment for bad behavior.

So yes, you involve the child in changing the sheets and doing the laundry, but mostly, reinforcement and responsibility is about the rewards. And since the second half of the 20th century, this has meant sticker charts.

The sticker chart concept sounds easy. And in theory, it is easy. You set clear and achievable goals, chart progress, and provide a reasonable (not extravagant) reward for success. Easier said than done. If you’re going to do reinforcement and responsibility training, you need to have a very solid sticker chart plan in place and never deviate from it! This is an area where a sleep coach can really help you get it right. There are a lot of pitfalls to avoid, so get help before you put up that chart!

Bladder Training

Some parents do bladder training at the same time as reinforcement and responsibility training. I recommend doing one at a time. Any of these methods, done right, is a lot for a child. Any one of the methods might work, so there’s no need to do them together.

I don’t recommend restricting fluids either. That method doesn’t seem to work, and it’s difficult for children. It’s difficult for people! Instead, have the child drink normally throughout the day, but avoid large amounts of fluid at bedtime.

Once a day, encourage the child to hold her pee for as long as possible, and then have her pee in a container that allows you to measure volume.  Try to go for the record every day. Also, once a day, have the child practice stopping and starting the flow of urine. These exercises help increase tolerable bladder capacity and bladder control.

When she’s dry for a few nights in a row, try increasing the amount she drinks during the day! This will help “train” her bladder to get even better at holding urine.

Conditioning

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Yup. Kinda like THIS

This is the type of solution that involves gadgets. The child might enjoy the idea of wearing a little device to bed. There are many on the market and I’ll be discussing some of them in a future post. Most of these gadgets have two parts: one that detects wetness, and a really loud alarm.

The detector usually gets clipped to the child’s underwear. As soon as the child pees in bed, the electrical circuit is closed and now the alarm is powered to set off. Don’t worry, no child has ever been shocked by her “potty alarm”!

There’s some kind of connector, with or without a wire, to an alarm, which is sometimes designed to clip to the child’s shirt. Once the circuit is switched on, the alarm rings and makes a loud screech that could wake the dead!

What happens next: The brain talks to the bladder and says something like this: “Don’t ever do anything like that to me again!” With time, usually a short period of time, the brain and the bladder become friends and child learns to hold in the stream of urine before it starts.

Just like with bladder training, once the child becomes dry at night, increase her fluids during the day to “overtrain” the bladder.

The brain talks to the bladder and says something like this: “Don’t ever do anything like that to me again!”

As with any of these techniques, the key to success is consistency. Don’t deviate from the plan and don’t give up too soon!

Medication

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The last resort

If you’ve given all these methods a good shot; if you’ve been consistent, stuck to a plan, given it a good few weeks and you’ve still made no headway, it may be time to head back to the doctor. Medication should be seen as a last resort only. Too many parents believe that medication is a “quick fix” for a problem that was medical to begin with. Neither thing is true. All medications have side-effects. These should be explained thoroughly to you before you give them to your child. If the doctor doesn’t do it, I encourage you to look up the side-effects on the internet.

Medications for bedwetting work best in low doses, and for brief periods. They are most useful in situations where the child is going to need to be dry for one night, or a few nights at most. For example, the child may be invited to a sleep-over, or a weekend away. As a long-term solution, medications are not the answer. The benefits wear off fairly quickly, but the side-effects do not.

Lifting

This term refers to picking your child up at 11 PM or so, carrying her to the bathroom, and placing her on the potty. Sometimes lifting can be the only technique you need to treat bedwetting, especially if the child wets once per night at a predictable time. Ferber believes that lifting can actually prevent your child from learning to train her own bladder, since she is not getting up on her own to go to the bathroom!

Dietary Changes

Despite what you may have heard, there are no changes to diet, special foods, etc., that successfully treat bedwetting. However, I firmly believe that good diet works together with healthy exercise to make sleep better, just as good sleep helps you exercise better! We will address the effects of diet on sleep in future posts.

 

Troubleshooting Sleep Problems

If parents have followed my sleep method and it’s still not working, there are a number of ways of troubleshooting sleep problems that we pursue until we solve the problem.

Overstimulation

Troubleshooting 101:
I start by asking parents to describe their bedtime routine. I think of the bedtime routine as a series of highly predictable events that begins at your baby’s dinner time and ends when she falls asleep. The time frame we are talking about may be anywhere from 30 to 60 minutes in length. I listen particularly for indications that the baby may be overstimulated during this period. For example, is the lighting bright and harsh? Is the television on, even softly? Is there music playing? Are there a lot of people talking loudly? Is everybody passing the baby back and forth among themselves? If it turns out that there are too many stimuli, I discuss ways to reduce them, which sometimes is more easily said than done. In some homes there are simply too many people and too much surrounding chaos to reduce stimulation. Dr. Spock would argue that this is not necessarily a bad thing and that babies will get used to it, but Dr. Weissbluth and I would not agree with him. In general, less stimulation is better than more, and the empiric research seems to corroborate this. The trick is finding a way to reduce stimuli. The solution may be to find a quiet but well-ventilated corner of the house or apartment where light, sound, and tactile stimulation can be kept to a minimum.

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Teething

Teething pain often interrupts the process of getting a baby to learn to go to sleep. At around four months of age, give or take, a baby may start drooling much more than before and may start grinding her fist into her mouth. This is likely the start of the teething process, though actual teeth may not appear for eight months.

Colic

Colic almost always happens when babies and their parents want to be sleeping. Once all the other causes of crying have been ruled out (baby just ate so she can’t be hungry, diaper is clean, she’s not constipated, and so on), you might settle on colic as the cause. Troubleshooting colic is a subject unto itself, and beyond my scope in this post!

Constipation

This is actually a subcategory of colic. Many babies wake up crying because they have to poop and they can’t. There are many easy ways to help a baby through constipation problems. Your pediatrician can help you with these

Need for more calories?

Many of my mom-clients are so successful that their babies outgrow their supply! A healthy baby that is born to a healthy mother and grows as fast a human being can grow eventually reaches the point where 20-calorie-per-ounce breast milk or formula is no longer sufficient for her needs throughout the entire day. Sometimes the baby will signal this change by waking up in the night at times when she used to sleep. This phenomenon is real but is often short-lived because feeding is so often a self-regulated phenomenon. Breast-fed babies will stimulate their mothers to make more milk during the day, and formula-fed babies will drink larger or more frequent bottles. Sometimes it works, sometimes not.