Family Sleep in the Wall Street Journal

By ELIZABETH GARONE

Ah, a blissful night of sleep—until a cry rips through the quiet: Waaah. Mo-ommy! Daddeee!

One sleep consultant’s bedtime rule for 3-year-old Zoe: No talking to Mom or Dad, but whispering to Cat, her favorite stuffed animal, was allowed.

As a sleep-deprived family of four, we were prepared to throw money at this problem to regain our rest (and sanity). Luckily, there is no shortage of businesses designed to collect that money. So we put to the test three consultants with expertise in putting kids to sleep, as well as a do-it-yourself approach based on websites devoted to the subject. The advice included dramatic changes to the bedtime routine, reward stickers, white noise, better daytime naps, even recorded affirmations read by a “Sleep Fairy.”

The challenger in our tests: our 3-year-old daughter Zoe, who we spend hours getting to sleep only for her to awaken in the middle of the night, calling for Mom, disrupting the sleep of her 7-year-old sister.

Kim West, a licensed social worker and mother of two, has worked with families around the country over the past 15 years. Demand for Ms. West, aka the Sleep Lady, is so high, we had to book the appointment a month in advance. That allowed time to read certain chapters in her book, “The Sleep Lady’s Good Night, Sleep Tight,” as well as fill out an extensive history form, prerequisites for a 60-minute phone consult for one child. Parents with two or more kids or who don’t have time to read the book can sign up for a 90-minute session.

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Elizabeth Garone/The Wall Street Journal

The consultants stressed establishing a nighttime routine. For Zoe that means brushing teeth, getting friends ready for bed and a story.

Ms. West recorded the session and emailed a link to it so we didn’t have to take notes. We also appreciated that she didn’t rush us off the phone when our session went over.

We found her approach a little intimidating and labor-intensive. Her sleep plan involved a number of steps as well as dramatic changes to our bedtime routine, such as no talking to Mom and Dad after being tucked in. Zoe had to lie quietly in her bed and only whisper to Cat, her favorite stuffed animal. Still, the plan was easy to follow and having her book to refer to came in handy.

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Elizabeth Garone/The Wall Street Journal

Zoe and friends getting ready for bed.

Ms. West’s plan started with a family meeting where we would introduce a sleep sticker chart, which we would use to reward Zoe on mornings when she followed the rules. From there, we needed to establish a consistent bedtime routine and implement the Sleep Lady Shuffle: For the first three nights, we sat in a chair next to her bed; the next three nights, we moved to a chair just inside the door; then down the hall, and so on until she was supposed to put herself to sleep. She never did.

The plan’s most difficult requirement, at least for us, was that we had to refrain from getting into bed with Zoe at bedtime. She protested every night. It wasn’t long before we were back in bed with her with the plan to try the Shuffle again in a few months.

Deborah Pedrick, the founder of Family Sleep, a consultancy in Stamford, Conn., offers consultations by email. We had the choice of one day or three days’ worth of email; we chose the latter. Ms. Pedrick offers in-person and phone consults, but she says many clients prefer email for convenience and price ($60 for three days versus $295 for a package that includes an hour phone consult).

When she heard we were using music through the night to help Zoe sleep, she told us to switch to the less-disruptive white noise. Of course, Zoe found the change quite disruptive and complained about the “awful sound” coming from the machine.
[CRANKYjp1] Elizabeth Garone/The Wall Street Journal

Zoe choosing a story.

Ms. Pedrick’s most helpful advice: When Zoe doesn’t nap, she needs to go to sleep a lot earlier. Otherwise, she will get overtired, and it will take longer to fall asleep, she said. Zoe was down in unprecedented five minutes the first time.

Sleep expert Kate Daymond in St. Albans, England, offered us the option of Skype or phone, and we chose an hour Skype consult. Upon witnessing her British accent and calm demeanor, images of Mary Poppins swooping in and solving our sleep problems danced in our heads. She asked how “cross we were with the situation at the moment” and whether we were feeling “cheesed” about it. Having two children herself, she wasn’t fazed when our girls peered into the camera and chatted away about themselves.

Her first recommendation was a star-sticker chart to reward Zoe whenever she followed the new sleep rules, such as having minimal physical contact if we were in the bed with her (no snuggling, just lying still). She instructed us to start the rules with Zoe’s naps and get them under control before moving on to the nighttime routine. This proved a little difficult since Zoe doesn’t nap consistently.

Her plan also included going into Zoe’s room and “checking” on her every few minutes to reassure her Mom and Dad were nearby. Ms. Daymond suggested sitting outside the room with a chair and a cup of tea between checks. The moment we tried this, Zoe protested quite loudly and only stopped when we came back in her room—and into her bed.

To address Zoe’s playing and procrastinating when she should be asleep at 9:00 p.m., Ms. Daymond said it was up to us as parents to make the environment as unexciting as possible for her. “Try to be like a bored shop assistant. If you’re there saying, ‘Let’s have another story,’ there’s no reason for her to fall asleep,” she said.

For our D-I-Y plan, we ordered “The Sleep Fairy” CD and “The Floppy Sleep Game” CD from Amazon.com. We also ordered “The Bedtime Beats: The Secrets to Sleep” CD, with classical songs that cycle at 60 to 80 beats per minute to mimic a resting heart beat, and the Marpac SleepMate 980A, a white-noise machine like Ms. Pedrick had suggested. While neither the Bedtime Beats nor the white noise put the girls to sleep faster, they did seem to help calm them faster.

“The Floppy Sleep Game” is about 20 minutes of songs, nature sounds and gentle yoga techniques that can be done lying in bed. The kids liked it but didn’t appear anywhere close to being sleepy afterward.

“The Sleep Fairy” CD offered 30 minutes of positive affirmations and relaxing images read by a woman with a slightly cloying voice. At the end, everyone (except Dad) was awake. Gabby, our 7-year-old, announced, “That was really long, wasn’t it?” Zoe balked at the CD at first, but after a few nights of it, she started asking for it and it became part of her bedtime routine.

While no one approach proved to be the answer for us, Ms. West’s plan and book seemed to give Zoe—and us—the best chance for a good night’s sleep.

Wall Street Journal: 9/27/11 – Cranky Consumer

Literal Interpretation: from Marc Weissbluth’s Blog

By weissbluthmethod

Here is a sentence that might appear in the Blog or my book. “Children begin to develop nap circadian rhythms about 3-4 months of age. The morning nap develops first and occurs around 9am.”
Sometimes, sleep deprivation in parents naturally causes some mental fog and impatience so they might remember this sentence as “4-month old babies take a nap at 9am.”
Obviously, to well-rested parents, this is a too literal interpretation leading to frustration. Clearly, the morning nap might occur earlier than 9am, especially in the younger babies and clearly the morning nap might not be regular until after 4 months of age perhaps in the post-colic baby. Babies develop sleep patterns at different rates because of differences in nature and nurture. Please be patient, don’t compare babies, and develop coping strategies to deal with your own sleep deprivation such as taking breaks, getting help, and indulging in some self-maintenance as a reward for all your hard work. Marc

Catch more of Weissbluth’s Blog Posts Here: http://weissbluthmethod.wordpress.com

A Child’s Nap Is More Complicated Than It Looks

By PERRI KLASS, M.D.
Published: September 12, 2011, Views Section of the New York Times

What makes a child nap? Most parents cherish toddlers’ naps as moments of respite and recharging, for parent and child alike; we are all familiar with the increased crankiness that comes when a nap is unduly delayed or evaded. But napping behavior has been somewhat taken for granted, even by sleep scientists, and napping problems have often been treated by pediatricians as parents’ “limit-setting” problems.

Now, researchers are learning that it is not so simple: napping in children actually is a complex behavior, a mix of individual biology, including neurologic and hormonal development, cultural expectations and family dynamics.

What parents usually want to know is simply how long a child should nap. That concern dates back a little over a hundred years: In the first decade of the 20th century, European experts published the original studies measuring the sleep patterns of children and promptly began worrying they were not getting enough sleep.

Today, researchers believe that very young children take naps because so-called sleep pressure builds rapidly in their brains — that is, the need for sleep accumulates so quickly during waking hours that a nap becomes a biological necessity. It is not just a question of how much total sleep that children need in 24 hours. Possibly because of the intense synaptic activity that goes on in their highly active, highly connected brains, young children are less able to tolerate long periods of time awake.

In the early 1980s, Dr. Alexander A. Borbély, a professor of pharmacology at the University of Zurich, Switzerland, posited a “two-process model of sleep regulation.”

The “circadian process,” which has been localized to a specific place in the brain, works a little like a clock, tying our sleep to schedules and to cycles of light and dark, regardless of how much we have or have not slept. This interacts with the “homeostatic process” which works differently, pushing us harder toward sleep the longer we stay awake and building up sleep pressure, which can be measured via EEG recordings.

Napping happens “because children have a much faster sleep homeostasis — they build up sleep pressure more quickly, they are not so tolerant toward longer waking periods,” said Dr. Oskar Jenni, a pediatrician who is director of the child development project at the University Children’s Hospital Zurich.

Generally, new infants sleep between feedings in short periods both days and nights. As they grow, babies sleep at night (more or less), waking to be active in the early morning and taking morning naps; they wake again for play and food, followed by afternoon naps.

Sometime after the first birthday, the two naps are consolidated into one, usually in the late morning or early afternoon. “The rationale for having your afternoon nap over by 3 p.m. is to build up enough sleep drive so you can fall asleep at night,” said Dr. Judith Owens, a pediatrician who is director of sleep medicine at Children’s National Medical Center in Washington.

As they grow toward school age, most children begin to fight against that remaining nap or just leave it behind. But there is a great deal of individual variation, and many parents struggle with a child who seems too eager to do without a nap.

Sometimes problems arise because relinquishing the nap conflicts with a parent’s daily program or a day care center’s routine. Sometimes the parent sees the tantrums and whining and general negativity that come with fatigue, a sign that the child is not really ready to do without a nap.

“By age 5, about 80 percent of kids have given up a nap — that means one in five still napping,” Dr. Owens said.

Dr. Jenni was one of the authors of a large study, published in 2003 in the journal Pediatrics, which measured sleep duration across childhood. He and his colleagues documented the decrease in daytime napping and the consolidation of nighttime sleep as a group of Swiss children grew up. They also found that individual children’s sleep needs and sleep patterns tended to be consistent through age 10. In other words, children who slept less than their peers as infants grew into older children seemed to need less sleep.

A 2005 study of American children ages 3 to 8 showed distinct differences between black and white children, too. While total sleep duration for the two groups was similar, black children napped more and tended to be older when they gave up their naps.

Despite the intriguing findings, the study of napping patterns is still in its infancy — or perhaps toddlerhood. Experts are just beginning to understand the biological underpinnings.

Dr. Monique LeBourgeois, a sleep scientist at the University of Colorado at Boulder, and her colleagues recently conducted the first study on how napping affects the cortisol awakening response, a burst of hormone secretion known to take place shortly after morning awakening. They showed that children produce this response after short naps in the morning and afternoon, though not in the evening, and it may be adaptive in helping children respond to the stresses of the day.

By experimentally restricting sleep in young children, and then analyzing their behavior in putting puzzles together, Dr. LeBourgeois’ group also is quantifying how napping — or the lack of it — affects the ways that children respond to situations. “Sleepy children are not able to cope with day-to-day challenges in their worlds,” she said. When children skip even a single nap, “We get less positivity, more negativity and decreased cognitive engagement.”

But for parents and scientists alike, there are many unanswered questions: When is it too early to give up a nap? Too late to hold on to a nap? How do domestic patterns and cultural norms affect the circadian and homeostatic processes?

“I think there’s a dire need for adults in general to be in tune with individual children’s physiology,” Dr. LeBourgeois said. “What are the capabilities, and what are the limits?”

This everyday childhood behavior, commonly a source of family struggle, is the product of cultural and familial expectations as well as complicated biology, which changes as the child grows.

“If the child is stopping the napping, that represents a process of neurological maturation,” Dr. Jenni said. “The ability to tolerate wakefulness is an indication that the brain is maturing.”

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