Junior, June 2006
Sleep and how to get it

Occasional sleepless nights are an accepted part of parenting, but how do you cope when they start taking over your life?  A sleep clinic could provide the answer…

Sleep deprivation is a well-documented and very effective form of torture, and most parents of young children experience it at some point.  As well as extreme fatigue, sleep deprivation can cause irritability, short-term memory loss and mood swings.  It can also make you emotional, and in extreme cases, can take all the joy out of family life.  The good news is that sleep problems can be resolved.  However, when you are feeling exhausted and can’t think straight, it can be difficult to identify what these solutions are.

Parents who contact Millpond Children’s Sleep Clinic, run by former health visitors Mandy Gurney and Tracey Marshall, are, by their own admission, “desperate”.  They have not simply had the occasional bad night, but have been living a sleepless existence for several years.  These parents, mainly mothers, complain of depression, strained relationships, exhaustion to the point where they can’t make the simplest of decisions and “ruined” lives.  For these parents, the sleep clinic can be a source of instant relief as desperate parents discover that there are other families out there with similar problems.  They also discover that with the right approach, an undisturbed night’s sleep is achievable for the whole family.

The baby who wants to play

Alex, then months, had no trouble getting to sleep at night.  His problem was staying asleep because he kept waking every two hours.

“Alex was always an adorable baby during the day, but at night he was a nightmare.  I’d start his bedtime routine at around 6.30pm and give him a nice warm bath, breastfed him and sing him lullabies.  He would always nod off immediately, but would wake up crying two hours later.

My husband Simon and I would try to second guess what was wrong.  We’d try teething gel, or I’d bring him back into our room for another breastfeed.  This would go on several times a night.  Sometimes, Alex would fall asleep on my breast and I could place him back into his cot, but quite often he would be wide awake after a feed and would babble and gurgle as though he wanted us to play with him.  Then, if we tried putting him back into his cot, he would just cry continuously.  I’d try holding his hand and singing to him, but nothing worked until we eventually relented and picked him up.

Six months without a decent night’s sleep began to take its toll and, with a lively three-year-old daughter to care for at the same time, there was no opportunity to catnap during the day.  I was exhausted – it was like walking around with a permanent hangover every day.  After a while, it began to affect our moods and although Simon and I rarely argue, during that period, we were constantly snapping at each other and bickering over the smallest thing.

When I consulted the sleep clinic, Mandy explained that interrupted sleep means a reduction in Rapid Eye Movement (REM) during sleep – the all-important component that allows you to file away the day’s concerns.  Without this, a person is prone to mood swings, stress and emotional outbursts.  And she explained that being sleep-deprived is equivalent to trying to function with four units of alcohol in your body, but without any of the relaxing or pleasurable feelings.

The specialists at the sleep clinic told me to keep a sleep diary, in which I had to note all the times that Alex woke during the night, and how my husband and I responded to is sleeplessness.  The diary was extremely revealing.  It showed that we were being surprisingly inconsistent with Alex’s bedtime routine.  Sometimes, we attempted leaving him to cry, and on other occasions we would rush in to his room at the first yelp.  And I realised that I was breastfeeding Alex just before putting him into his cot, so that feeding and sleeping had become linked in his mind.

I needed to break the association that Alex made between sleeping and feeding.  I was told to gradually reduce feeds incrementally by a minute each night.  On night one, I fed him for 15 minutes when he woke,, and the next night for just 14 minutes, and so on.  I was also told to space out daytime feeds and naps, so that Alex had a better routine for the whole 24 hours, and not just at night.

Most importantly, Alex had to learn his own sleep cues to put himself back to sleep without depending on us.  Our method of soothing him back to sleep was doomed, because it was too gratifying.  In fact, it was giving Alex more incentive to stay awake then to go back to sleep.  Mandy instructed me to respond to Alex’s night-waking with the firm command: ‘Go back to sleep, Alex’, after which I had to leave the room.  This simple command was sufficient to reassure Alex that he had not been abandoned, but also confirmed that I had no intention to linger and pick him up again.

It was important for us to be steadfast and consistent for the regime to work.  When I first stopped the night feed, Alex protested vociferously.  However, Mandy had warned me to expect a few ‘test nights’, and although these were pretty gruelling, they didn’t last long.  Within three weeks, the new regime was working beautifully and Alex was sleeping through every night.”

Sleep Solutions

• Do not breastfeed immediately before your baby goes to bed, or the minute he wakes up.  Alex’s mother was told to feed him before his bedtime bath, and to wait ten minutes before feeding him when he woke in the morning.  This allowed the association Alex had formed between feeding and sleeping to be broken.

• Use a neutral tone of voice when telling you baby to go back to sleep.  Alex’s parents attempted to soothe him back to sleep with cuddles and songs, but that gave him an incentive to stay awake.  Raised voices are also counter-productive as the baby will perceive this as a response – albeit an angry one.

• Keep a sleep diary and list the times your baby wakes, sleeps and feeds.  This will help you to identify where the problem may lie.  In addition, note how you cope with your child’s night-waking to identify any inconsistencies in your behaviour.

The clingy toddler who never slept

Alice’s birth was traumatic and she spent her first few days fighting for her life in intensive care.  On leaving hospital, Alice refused to sleep unless she was held against her mother’s chest and would let out piercing screams during the night.  Two years later, her parents still hadn’t had a full nights sleep.

“We experienced sleep problems from day one, but I assumed this was because Alice had spent the first two weeks of her life in hospital.  When they finally discharged her, she would only go to sleep if she was close to me.  She was very clingy and I had to carry her everywhere.  I wasn’t used to this, and it was a bit of a shock at first.  My first daughter had been a straightforward sleeper, but Alice would wake at least five times during the night and let out ear-piercing screams that would make you jump out of your skin. I am sure the screams were associated with her traumatic start in life, but I thought they would disappear as she got older.

Over the years, we attempted everything.  We tried letting her cry it out, but she simply let out a high-pitched scream for over an hour and nearly made herself sick.  It was heartbreaking.  We tried putting her into our bed, but she could never get comfortable and kept fidgeting.  We also tried cranial osteopathy, but despite four months of treatment the problem persisted.  When I eventually consulted my doctor she suggested that to combat the tiredness, my partner and I should take it in turns to sleep alone in a hotel room!

The only way I could get Alice to settle at night was to pick her up.  After so long without sleep, I was totally exhausted.  It was a tiredness where I was just functioning, but no longer living.  It felt as thought I had been drugged and it became hard to make decisions.  Martin and I run a children’s theatre company and we used to try sleeping on the dressing-room floor between productions.  It was ridiculous.  I remember thinking it was ruining our lives.  It is only now that things have improved that I realise how tired I was.  By the time I consulted the sleep clinic I assumed that Martin and I had failed as parents. 

When I attended the clinic for a face-to-face consultation I had tears streaming down my face.  The first thing Mandy tackled was the length of Alice’s bedtime routine.  It used to take an hour, during which time we would read her books, give her milk and let her have an energetic bath together with her sister.  It was too stimulating.  Mandy recommended that Alice should have a bath on her own and that the whole bedtime routine should last not more than 30 minutes.  Once we’d established a good regime we were told to introduce a ‘magic fairy-light’ to use in conjunction with a reward system.  This light worked on a timer switch and we set it to come on 12 hours after Alice’s bedtime.  We told Alice that she must stay in bed until the light came on.  She understood the logic from day one.

But we still needed to tackle the calling out and the fact that she would get out of bed and wander around.  Mandy suggested a door-closing method.  When Alice got out of bed, I was to lead her back without any conversation and say: ‘If you do that again, the door will be shut’.  The first time I tried this, Alice leapt out of bed again within ten seconds, so I had to close the door.  She did cry, but I was allowed to reassure her through the door, so it didn’t seem cruel.

Within the first week, the screams got noticeably less and on day four we had no night-waking.  Martin and looked at each other as if to say ‘What’s happened?’  It was extraordinary.  Of course, there have been setbacks, but these days Alice sleeps through the night and if she wakes up, she is able to get herself back to sleep without our help.”

Sleep Solutions

• It is essential for children to have a quiet and calming wind-down period before bedtime.  Alice’s routine was far too stimulating.

• Don’t make empty threats.  First, issue a warning, but if your child gets out of bed or calls out when she’s been told not to, then you must follow through.  For Alice, this meant her mother closed her bedroom door and kept it shut.

• A light on a timer switch can work for children who are old enough to understand the concept, and can curb early rising.  It is particularly successful when used in conjunction with a reward system.

The boy who wants his mummy

Connor, four, had been a good sleeper but a bout of illness threw all his routines off-kilter.  Even when Connor was given a clean bill of health, he wouldn’t sleep unless his mother climbed into bed with him.

“As a baby, Connor was the perfect sleeper, but everything changed when he started teething.  Then he became ill with suspected meningitis and had to spend time in hospital.  After that he would wake up crying anything up to ten times a night.

Because Connor hadn’t been well, I was happy to stay with him while he went to sleep, but he continued expecting me to do this even once he’d fully recovered.  By the time he was two, Connor would only go to sleep if I climbed in next to him and let him hold onto my hair.  However, this didn’t stop him waking up during the night, and on a bad night he would wake every hour.

My husband, Mark works away from home during the week, so the responsibility fell to me to try and soothe Connor until he fell asleep.  After years of this, I was beyond tired and it changed me as a person.  I was permanently close to tears and I walked around with a ‘can’t be bothered’ attitude and a moody demeanour.  The sleeplessness took over my life and became part of my daily routine.

When Connor was four, I consulted my local health visitors because I wanted to get the problem resolved before he started school.  They told me that I would need a referral to see a child psychologist, but I decided I couldn’t wait that long.

I’d heard about Millpond Sleep Clinic from a television programme and plucked up the courage to call.  The clinic is based in London (we live in South Derbyshire) but co-founder Tracey Marshall, and one of the clinic’s sleep advisors were able do do all the consultations over the phone.  The first call was quite emotional and I was both tearful and euphoric.  At last I felt I was speaking to someone sympathetic who really understood what I was going through. ‘You are not unusual,’ Tracey told me.  ‘We can help you to sort it out.’  It was so important for me to realise that I was not the only one going through this. They made Connor sound like a ‘normal’ child, when I’d been starting to think he as abnormal.  I was given much-needed support and reassurance and it was left up to me to decide how quickly any changes should be made and when they should be implemented.  I made the decision that a softly-softly approach would be the best way to deal with our situation and would suit Connor’s behaviour and personality.

The first stage involved getting me out of Connor’s bed.  Tracey recommended a ‘gradual withdrawal’ method together with a reward system.  I told Connor that a sleep fairy would leave him a treat (in his case £1 coin) in a special sparkly box if he let mummy sit beside the bed and not in it.  And I told him that he could hold my hair during the daytime – but not at night.

As the nights progressed, I moved a little further away form him and then onto a bean-bag at the far end of the room.  Tracey explained that Connor might kick up a fuss and I would have to tell him: ‘I’m going to have to leave the room,’ but he took to the system well and I didn’t have to carry out that threat in the end.  After six weeks, I could leave him alone in his bedroom without any problems.

At last, Connor could get to sleep by himself, but he was still waking in the middle of the night, so I called Tracey again.  I was told to move the goalposts a little so that Connor only got rewarded if he didn’t shout out in the night.  These days, Connor sleeps well.  He never calls out and if he wakes up, he always goes back to sleep by himself.  The evenings are my own again and knowing that I have a regime that works means I feel in charge.”

Sleep Solutions

• Recognise that sleep problems are common and that you are not alone.  Connor’s mother found it helpful to realise that his problems were not unique.  Until then, she thought he was a ‘problem child’ whose difficulties could not be resolved.

• Sleep training can involve controlled crying, but this isn’t the only method.  Other options include a gentle retreating approach.  Individuals need to decide what will work best for their family.

• Use a reward system that works on your child’s level.  In Connor’s case, a ‘reward box’ gave him the motivation to change his habits.  Little rewards, such as stickers, work just as well as money.

• For further details of Millpond Children’s Sleep Clinic, tel: 020 8444 0040 or visit: www.mill-pond.co.uk.  The clinic charges £195 for a complete package.  Consultations take place in person or over the phone and by email.

• Teach Your Child To Sleep by Mandy Gurney and Tracey Marshall, £9.99, Hamlyn, is available for £7.99 inc p&p. Tel: 01903 828503, quoting HAM 675

Jo Carlowe