Mothercraft nurse, Chris Minogue answers your top baby sleep questions

Posted in Baby sleep.

From waking in the middle of the night to struggling to self-settle, our little ones can be baffling creatures when it comes to sleep. Luckily, mothercraft nurse Chris Minogue has years of professional experience – and tried and true methods to help your baby (and you!) get a better night’s sleep. Here is her advice: 

Question 1: My toddler is up for two hours in the middle of the night. How can I get her to sleep through the night? 

Niharika asks: “My two-and-a-half-year-old wakes up for extended periods of time during the night. Her bedtime is around 8pm. The evening routine starts with dinner, bath and story time. Putting her to sleep in the first place is not a problem, however, she wakes up in the middle of the night – any time between 12-4am – and once she’s awake, she won’t go back to sleep for at least a couple of hours. She doesn’t necessarily cry or scream when she wakes up, but she’s wide awake and wants to play or read storybooks and wants one parent to stay with her. She also wants to be in our bed once she’s awake. She’s been told to stay in bed when she wakes up, and sometimes she does that, but she won’t go back to sleep. Her nap is about one to one-and-a-half hours; I have tried reducing this and also tried completely stopping the day naps, but that hasn’t made much difference to the night waking. Any advice to get her to sleep through the night would be appreciated.”

Chris says: I think the answer is still going to be reducing the day sleep. The other attempts that you’ve tried before might not have worked because she was a bit young, or dropping her nap might have happened too fast. Right now, I think what we need to do is grade it down and find that sweet spot where she might be able to still have a bit of a nap, but it’s not affecting her nights. Then you can deal with the behaviour that’s happening at night.

For some children, once we wean them off their day sleep – maybe over two to three weeks – their nights just get better, and we don’t have to do anything else; the weaning of the day sleep is the important part of this. Parents get really frustrated when their child’s up for a couple of hours at night, so they just withdraw the whole day sleep and the poor child is so fragile at 4pm, it’s beside itself. So what I would do from this point is regulate her sleep in the day to gently wean her off the nap.

The rule of thumb that I use for this age is that from when they get up, they have five-and-a-half hours awake. And because we’re reducing her sleep, we also need to put her to bed earlier so she doesn’t get overtired – because getting overtired is one of the things that contributes to getting up at night.

For example, for the first week I’d probably put her down at 12:30pm and make sure she’s up by 2pm, then put her down to bed around 7:30pm. Then for the next week, I’d probably only give her an hour’s nap. And then a week after that, I would drop it down to 45 minutes.

Sometimes if you put them in their bed and you wake them up after 45 minutes, what happens is they just get really irritable because they’re in quite a deep sleep. So I tend to do this ad hoc – it could be on the couch so there’s a bit of light and a bit of movement around so they don’t go into such a deep sleep. Or it could be going for a drive on the weekends, and they have that little 40-45 minutes sleep. Either way, they still have to be awake by 2pm.

And the following week, we only do 20 minutes and that nap is very incidental – like a walk in the pram or a drive home from somewhere.

Each time you make that adjustment, you may have to move her nights earlier. So I suspect once you drop her nap altogether, she’ll go to sleep around 7:30pm. And I’d do all that before I would address what’s going on at night because I think what’s going on at night is fed by this nap that she’s having in the day. Once you get through that, if she’s still waking up, then we’d address that behaviour.

Then simply be clear about your expectations, such as saying, “You need to stay in your bed, I’ll give you a kiss and cuddle,” and then return her to her bed. Don’t allow her to engage in a book, get out of bed, or get into your bed; all those little things that are keeping her more and more awake.

So have a think about it, plan it out and see if that might help that night sleep behaviour.

Question 2: How can I get my baby to sleep past 5am?

Erica asks: “Thanks to your previous advice, my eight-month-old is no longer night-waking or being fed through the night. However, she is going through a phase of waking at 5am. We try to resettle with patting and cuddles, but she won’t go back to sleep. We end up taking her out of the cot and quietly playing in the dark and waiting to feed her at 6am. She goes to bed by 7pm with 240ml of formula. Do you have any strategies to get her to sleep till 6am?”

Chris says: I think you’re doing all the right things. It doesn’t help to put them to bed later at night. Some people think if they’re getting up at 5am, pushing their bedtime to 8pm will mean they’ll sleep until 6am – but usually this just makes them overtired.

I think there’s a period, and I see it about two to three times within a baby’s first year of their life, where they just wake up at 5am in the morning. This could be because they’re actually sleeping really well and they just don’t need any more sleep.

I would leave her in her cot for as long as possible, until she’s whinging or complaining. But I think you’re doing a really good thing by just doing really quiet play, not encouraging her to start the day. Then when you feel it’s acceptable, which for you is around that 6am window, the day starts. I think as she becomes more mobile, especially when she’s crawling, pulling herself to stand, that she’ll tire herself a little bit more and then she will be able to sleep through to 6am.

And be careful of not letting her oversleep in the day. I wouldn’t go over three-and-a-half to four hours sleep in the day, because that might be playing a part as well.

Question 3: Do you have any tips for teaching my baby to nap in his bassinet? 

Chrissy asks: “My three-week-old baby will not nap in his bassinet during the day. He will only fall asleep on me or when in the pram for walks. He falls asleep on me, then wakes up as soon as I put him in the bassinet. Nights are no issue and he sleeps fine in the in the bassinet. Should I be encouraging him to take all naps in his bassinet? Do you have any tips to get him to settle in there?”

Chris says: This is actually a really common question that I get asked about three-week-old babies. When you first take a baby home, nobody explains to you that along the line, they began to become more alert and more wakeful. And that means we might have to change some of the things that we’re doing around their sleep.

What I would do is try and find a healthy balance in your day; if you’re feeding about three to four-hourly, you’re going to have about three to four sleep cycles in that day for him. And I would try to get him to sleep in his bassinet for at least half of those sleeps. So for two of those sleeps, you might need to go and do the shopping, or go for a walk – just something to balance that day out, so we’ve got this approach that’s not always about going in the cot or bassinet.

The other thing that happens at three weeks is he has a little bit of an energy surge or a growth spurt. He’s got his eyes wide open, he’s looking around, and so we need to wind him down before we put him into bed. When he has his feed, he should be calm and relaxed. Then he’s a little bit alert after that feed for maybe 10 or 20 minutes. And from that point, as soon as you start to see those very basic tired signs – the kicking of legs, the whinging starting – change his nappy if needed, then pick him up, gently wrap him and calm the whole situation down. 

Bright lights will affect his sleep from about three weeks, so dim the room, draw the curtains, cool the room down, just make it a little bit more conducive to sleep. Then I would rock him till he’s quite calm and relaxed, and when you put him down, don’t withdraw your hands really quickly, because they feel the difference from being held to laying in the bed. Then put your hands on him and just rock. Do a little bit of body rocking just for a few minutes to get him back into that nice calm state, and tuck him in so that he still feels like you’re holding him. You’re giving him lots of comforting cues. Then see if you can tiptoe back out of the room again.

So you’re starting the process of giving him the cues about going to sleep. And if you can try that twice in your day, you’re going to end up setting up some good patterns for sleep behaviour further down the track. Take it gently and just start putting those early cue signs in, and I’m sure he’s going to start sleeping better in the day.

Question 4: How do I teach my 5-month-old baby to self-settle?

Kim asks: “I’m struggling to teach my five-month-old to self-settle. He sleeps through most nights and is fed to sleep. But he has been cat napping during the day. He sleeps 10 – 45 minutes, most of the time. I put him down after one-and-a-half to two hours awake, although the results have not differed when I’ve tried putting him down sooner and later. I am trying to let him put himself to sleep, but it is always hours of crying with me going into reassure. Sometimes five hours with the feed in the middle. I try to settle him in the cot, only picking up when he’s hysterical. It’s really stressful, even though I am trying to stay calm. But I’m getting nowhere. I don’t think he has ever self-settled to sleep. At what point should I stop trying at each attempt? He’s in an arms-out sleeping bag, in a dark room with white noise, but he won’t take the dummy. I would be okay with feeding to sleep if he would stay asleep, but that’s not happening during the day. He’s generally very chilled and happy, except when I’m trying to get him to self-settle.”

Chris says: I think lots of people can empathise with this problem. When babies are sleeping for really short periods, you’re as tired as they are, because you’ve been working all day with this little one. When their arms go out of the sleeping bag, somewhere between the fourth and the fifth month, they’re adjusting to the movement of their bodies, which affects their sleep.

I think he’s tiring faster than you think, so at about the hour-and-a-half mark, give him his sleep cues, which you’re already doing – you’ve got him in a sleeping bag, you’re taking him into his room, you’re dimming the room. If you’ve got white noise, turn it right down, because I have this theory that when they wake up, all they hear is the sound and it actually wakes them up even more. The white noise is meant to be a very soft sound in the room, not a jarring sound. So have a think about that, as that might be affecting him.

And then I’m going to give you this three-step approach.

The first step is to just rock him in your arms till he’s really calm and relaxed, put him in his bed, put your hands on him do a bit of body rocking. So it’s almost like we’re going to go back a step and re-teach him this. If he can manage to become calm and quiet, then try to leave.

He might then start working himself up and start crying again, so you go back in the second time and try settling him in his bed. Mimic the behaviour that you did in the first place; maybe try rolling him on his side, now his arms are free, and body rocking him with little taps on the bottom and a bit of a rock with your hand – get that motion going for him, and stay until he’s sleepy. This could take you anywhere between 10 and 15 minutes to do. Then you cross your fingers and toes, and if he drifts off to sleep for a little bit, you walk out. Then if he starts up again, the third time you stay with him until he is asleep. That whole process might take you between 20 and 30 minutes to do.

If that period of time has gone past and you’ve had no success, then get him up and restart the process. Get him up, keep him in the quiet room for about 10-15 minutes. Look for some tired cues: does he start getting whingy again because he’s really tired? Then repeat the sequence again. We’re seeing if we can just gently bring him back into longer sleep patterns.

Doing this for five hours, as you said, is too long. I would do this three-step process for the length of the sleep that I was expecting him to have. And then I’d move on to the next thing, because otherwise it will do your head in. You have to have an ‘out’ in parenting. You need to be able to say, ‘Okay, that’s enough, let’s just move on to the next thing.’ That will stop that five-hour process and it will give more rhythm to your day.

You’ve got to have a structure to it, because what I see is that when you do it consistently, it does start to work. It takes babies about 15 experiences to learn anything – in a baby’s life, that’s about three to five days. So I think you should pick the morning sleep and an afternoon sleep, and if you’re consistent with this, you should see improvement.

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