Sleep

I've been thinking for a while about a post about sleep, but it's such a long story I had not written it yet. Sleep is actually going much better than it once was, but it is still a challenge and sometimes I wonder if there are things I could have done differently along the way.

I don't consider myself a full-blown proponent of "attachment parenting" per se, but I do believe that little babies need their parents to be there for them and meet their needs in order to form a secure attachment. I do believe a secure attachment is important. I am not a cry-it-out mom. But I also have a kid who really doesn't sleep well, so I'm not so sure I'm qualified to give anybody any advice about sleep theories and techniques.

Many of you know that Nathan was a preemie. Preemies really just sleep. That is what they do. You wake them up every 3 hours for feeding and diaper change, and that's about it. I can't remember when exactly this phase of spending most of his life asleep stopped, but once it stopped, Nathan was never again a good sleeper. He'd be wide awake for hours in the middle of the night. I'd get so tired of seeing those big blue eyes! I don't know how many miles we put on the rocking chair, or how many laps I walked around the dining room table with Nathan in a sling trying to get that child to sleep. At some point, he began to become a gassy, fussy baby. We didn't yet know, but he was developing an intolerance to the formula we added to his breast milk to give him extra calories. We figured he had reflux, tried to elevate the crib, tried to hold him upright for a long time after feeding, tried Zantac (that seemed worse). When he was over a year old and we'd been trying all sorts of new solid foods, we began to figure out that a lot of foods were making him sick. Some foods made him vomit violently, but others simply made him cry and writhe every 15 minutes all night long. We got the food thing figured out (a protein intolerance which he thankfully outgrew before age 3), but sleep problems persisted.

Initially, I did not want to co-sleep. I didn't think it would be safe for a little preemie, and I didn't want to start the habit of having a child in my bed. For 5 months or so, he was in a co-sleeper next to our bed, and then we moved him to his crib in his room. We'd rock him to sleep and put him down. There have been a few nights in his life where he stayed down for 8 hours, but you can count them on one hand, and he is 4. He'd sleep 2-3 hours and wake up, or cry. We discovered that if we could get to him quickly, before he woke all the way up, sometimes we could keep him asleep. I'd rock him and then try to put him back down in the crib, gently, gently, without waking him up. Lots of times he'd wake up, and just be up for hours. For about the first 2 years, we divided up the night-- dad took the first half and mom took the second half. This meant I got 5 hours of solid sleep plus whatever dribs and drabs of sleep I could pick up in between all this awakening and fussiness. Oh, yeah, and I was pumping too-- exclusively pumping for 2 years, and initially pumping every 3 hours. I can remember the anger, the frustration, waking up my also-sleep-deprived husband to take him because this wide-awake child was driving me nuts.

The first winter of Nathan's life, he was pretty healthy. He was home with a parent at all times, not in childcare yet. The second winter (after he started at a daycare center 2 days a week) was a different story. He had numerous respiratory illnesses with wheezing, including pneumonia and RSV within a couple months of each other. We learned about breathing treatments. We learned what kinds of symptoms really alarm our pediatrician. We also learned that his sleep became even worse when he was sick. One night we ended up in the ER because while asleep Nathan seemed to be gasping for breath. Of course he woke up in the car, and didn't repeat the behavior at all for the nice doctor. We ended up in the ER and then the hospital with the pneumonia. With the RSV, a hospitalization was averted, but just barely. We determined that he had sleep apnea (the pauses and gasping) which got worse when he was sick. Nathan saw a pulmonologist. We had an at-home sleep study. Eventually we had a full sleep study in the sleep clinic, except it wasn't so full (the tech could not get the electrodes on his head, and he also woke up in the middle of the night and stayed awake. I took him home because the study was supposed to end early in the AM and I didn't think I could get him back to sleep. It turned out the bigger issue was the lack of electrodes on the head, but the whole thing was a giant mess). We saw an ENT who was willing to take out the tonsils and adenoids, but pretty much left the decision up to us. We did not go forward because heart surgery was looming on the horizon and took precedence, and after the second sleep study the pulmonologist thought the apnea was not severe enough to warrant it.

Somehow, sleep has never worked quite right for this kid. The pulmonologist suspected that we'd see something about his phases of sleep if we'd been able to get electrodes on his head. He has trouble falling asleep, and sleeps deeply for only a few hours, and after that any little thing bothers him. If he has a mosquito bite, he can be restless from midnight on-- kicking, thrashing, crying, needing to be soothed. And then he wakes up fine, perky, unbothered by the mosquito bite during the day. If I am sick or have a headache, sleep takes it away temporarily. If Nathan has some little thing bothering him, sleep seems to magnify it.

We tried melatonin, which seemed to work initially, to make him drowsy. The one and only time I've ever been able to "put him down drowsy" and have him fall asleep independently in his own bed happened on melatonin. I was hopeful that with the combo of melatonin and Elizabeth Pantley's "No Cry Sleep Solution", I could get the child to fall asleep in his own bed. I blamed his dad for "letting" him stay up too late and rocking him to sleep every night. I thought I could do a better job. I thought if we could get him to fall asleep more independently, maybe he could stay asleep more independently, or learn to put himself back to sleep if he awoke in the night. I thought I could teach this. I thought wrong. It was good for me to experience this for myself, though, because in the end I came to quit blaming my husband for Nathan's trouble going to bed. I still feel bad about blaming him. Sorry, honey.

Eventually, melatonin stopped working well, and in consultation with the pulmonologist we raised the dose. We still had nighttime awakening, but now we got long naps during the day, from which Nathan would awaken screaming. It was hard to awaken him from nap, but long naps didn't translate into long sleep at night. We ended up discontinuing the melatonin. I did try benedryl, and I learned that while benedryl does make Nathan very calm, he is calm and wide-eyed awake, laying in my lap but not sleeping. Not helpful. We also learned during his hospitalization for heart surgery that narcotics make him unable to sleep, not that I planned to try narcotics at home, but obviously he has atypical responses to some meds.

At some point I started to be able to leave him in his room with music on once he woke up in the middle of the night, and I'd put in earplugs and get a little more sleep, come back in an hour and try again to get him to sleep. Usually if he was up in the middle of the night, he'd be up between 1 1/2 and 3 hours. If I left him in his room he did not go back to sleep. Maybe twice total he's rocked himself back to sleep in the rocking chair.

After he was discharged from the hospital during the winter of respiratory illness hell, I decided to try co-sleeping. Since he needed to be propped up in order to breathe, I thought that maybe I could find a way to prop us both up with pillows and we could both sleep. And it worked. After that point, we'd put him to sleep in his bed but when he started fussing at night, I'd try to keep him asleep, rock him a while, and then take him with me to the futon to sleep. Many nights he'd start to awaken as soon as I laid down, and I'd have to repeat the rocking, and repeat. But eventually we'd get to lay down and sleep.
At some point, I decided that the futon was Nathan's bed. I lay down in it and put him to bed in it, go sleep in my bed, and then come back when he fusses. I don't have to get up and rock him anymore. If he wakes up, much of the time now I am able to tell him to keep sleeping and he will be able to snuggle up and go back to sleep. It's progress. We are sleeping at night.

This week it's not going so well. It's hard to get him to sleep at night, and then he's fussy and agitated in his sleep. It's nowhere near as bad as it used to be. Writing this down reminds me of how awful it was. Before I sat down to write this all out, I was blaming myself a bit for not teaching this kid how to go to sleep and stay asleep more independently. Now as I think back, I'm not sure when in the world I could have done that, and I do see the slow progress. Someday I'd like him to fall asleep and remain that way for at least 8 hours without bugging me. I know I'm not going to be getting up at midnight to snuggle with him when he's 18! I don't know how to progress further along the path to better sleep.

One thing I know is that I have a very snuggly, loving child. He likes to snuggle when he falls asleep, and he likes to snuggle when he wakes up in the morning and when he gets up from his nap. He is able to play independently, but when he is scared or sick he is clingy and wants to be held.
I love my snuggly kid. Maybe that's my trade-off; I have this sweet kid who wants all kinds of support and comfort around this thing that's hard for him. I do wish he could make it through the night without needing so much support and comfort, though. I'd be much happier to snuggle in the morning after a good night's sleep!