May 25, 2020

Why Isn’t My Baby Sleeping?

As the late afternoon intense fatigue sets in, I walk into the office and smile as I see my four month old patient and her family. 


“Hello!” I greet them cheerily. “How are you? What’s the update?” Despite my lively outward appearance, the parent within me has to remind me over and over again in my head. “Keep smiling, don’t let on that you are as tired as she is.” 


The baby’s mother is quick to respond. “We are great! Our baby is doing well. But you know – the four month sleep regression has definitely kicked in. She’s not sleeping well, and it’s seriously affecting our sleep. We need help to fix her sleep schedule, Dr. Hoffman.” 


My doctor persona is silenced in my head for a moment as my inner parent gets a thought in again. “Am I familiar with the four month sleep regression? Of course I am. How about the four year sleep regression… or the fact that I haven’t slept since my child was born…” I think sarcastically to myself.


“Oh yes, that can be so hard.” I respond sympathetically to the mother. “Tell me more about the bedtime routine, schedule and what exactly is going on with naps and night time sleep.” 


The father of the baby explains: “Well we read ‘Happy Baby Healthy Sleep Habits’ and ‘12 Weeks to 12 Hours’ and are so confused. We are trying to extend the times between feedings but our baby is just miserable. We rock her to sleep at 6:30pm every night but she wakes up without fail at 8:30pm to eat. She cries, then we fight, then my wife cries, then I cry, and we end up going in and giving her a bottle so we can get some sleep.”


Hearing such stories all the time, I am not surprised. 


At least I’m not the only one crying on the regular due to my child’s sleep. But my kid is five and yours is four months. Is there something wrong with me? Is my child a sociopath?” I think again. But I silence that voice in my head, and get to solving the issue.


“Okay,” I respond, “let’s start with talking about a routine around bedtime and self soothing,” and we start discussing solutions.


How to Fix Your Baby’s Sleep Problems

I am not sharing this to give you too much of a window into my own sleep struggles with my child, but rather to stress the fact that even those of us giving the advice have difficult times with sleep. It is on the top of everyone’s list when they come into the office, and one of the more interesting parts of my job. Unfortunately, there isn’t a one-size-fits-all solution to sleep struggles with children. 


However, here are a few things that generally prove to be helpful:


  1. Start a routine for bedtime once the baby is around 2-3 months of age. Sometime between 7-8 PM is the right bedtime; however, some babies need to go to bed later until they’re about 3-4 months old. Either way, try to do the same thing every night. Dim the lights, play a song, read a book, feed, rock. Whatever it is, keep it consistent in time and routine.                                                                                                                                                    
  2. Really try to put the baby down “drowsy but not asleep.” It’s tough at first, but if you can avoid the two hour rocking-transferring-repeat scenario you will be much happier. The baby will likely cry at first. You can stand by them and pat their tummy or back. Or leave and come back. (Or leave and don’t come back.) Any way you do it, try to teach them to soothe themselves to sleep around 3-4 months. It makes life so much easier.                        
  3. Try to decide early if sleeping in the same bed or the same room as your baby, also called “co-sleeping”, is for you. If so, figure out a safe way to do it. Co-sleeping does not necessarily mean bad sleep: many families feel it is the only way they can get a good night’s sleep.                                                                                                                    

  4. Some babies are just naturally good sleepers — their parents are probably good sleepers too! However, most babies need to be taught how to sleep at some point. It is hard, but sleep is no different than most parenting issues – we, as parents, have to guide them on how to do it well. Many parents ask, “How do I know he/she doesn’t need me?” or come to conclusions like, “If they wake up, they must need me.” In the early days that is likely true, but if your child is growing well, has a dry diaper, is not sick, and does not have any physical discomfort, night time waking does not necessarily imply that they need something. They just don’t know how to go back to sleep without you there. Part of growing up is learning to do that.                                                             
  5. Most babies do not abide to a strict nap routine until after six months. But they still need to nap. Ideally their bed-time should be about three to four hours after they wake up from their last nap. When they are younger this gap can be much shorter, often as little as two-three hours.                                                                                         

  6. Cooler is better. Keep the temperature down in the baby’s room.                                                                                       
  7. If you have a bad nap day, compensate with an early bed-time.                                                                                          
  8. Share the responsibility of dealing with night wakings. Figure out a system (if you are a two parent home) to avoid the habit of one parent being solely responsible for dealing with the night wakings. We all need sleep and night after night of interrupted sleep can make the best of us irrational. 

All of this being said. I’m really looking forward to getting to bed early tonight! 

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