Day sleep

iStock_000019690870XSmallAchieving good sleep during the day can be just as difficult as the night for parents with a tired infant. The advice about daytime sleep is similar to that for the night but with a couple of minor variations.

While the vast majority of parents come to see me about nightime sleep problems, quite often day time sleep problems are harder to solve. This is not such a great problem for the parents in that once the child’s night sleep has improved and they the parents are sleeping well overnight it is possible to be far more patient and forgiving during the day. When night sleep is terrible it is very hard to cope with some of the normal frustrations of the day.

I divide sleep periods into three groups.

  1. Night
  2. Morning
  3. Afternoon

Interestingly while the night is usually the biggest problem for families it is the one area which improves most rapidly. The morning is next to improve. The most difficult time of day to achieve good control of an infants sleep performance is the afternoon. Remember that while this is generally true, some babies will be different. They may not have all read this book.

DAY TIME ADVICE

The key to day time success is a concept which I call the Happy Wake Time (HWT) It will be worth reading this section a couple of times as the HWT is a simple yet powerful and useful tool in your understanding and management of daytime sleep disorders.

Imagine your child having slept well overnight. He or she wakes in a good mood. (It will happen I promise.) They are usually hungry and then once fed are happy. They are in a happy wake time. The key to a happy wake time is that it has a beginning, a middle and an end. The end of the happy wake time is announced by changes in the child’s behaviour. They begin to rub at their eyes, to whimper, to seek out your company for support or to become grizzly in the number of little ways which you will come to recognise rapidly and quite accurately.

This is the time to put them down. This is the time when they are best able to achieve sleep. With every half hour which passes beyond that point the child is going deeper into overtired time. The more overtired the child becomes the more difficult to get to sleep. Remember that sleep achievement is a learned skill. Learned skills are more difficult to perform as we become more tired. The more overtired the infant the more trouble it will have in achieving sleep efficiently.

Many parents who I see are missing the end of the happy wake time and allowing the child to become overtired. The child then has trouble achieving sleep and cries vigorously. The parents then loose confidence in their decision that the child was tired and needed to go down. The baby is then lifted up, settled in the mother’s arms but becomes increasingly tired and grizzly and less able to achieve sleep efficiently. A common time for this can be the afternoons. One of my patients described five pm as suicide hour.

The key advice here is as follows. When you know that the baby is well, has had enough to eat and has reached the end of its happy wake time, then put him or her down and allow them the chance to achieve sleep alone. If you pick the time accurately then sleep will be achieved efficiently. The more tired the child becomes, the more they need sleep, the more tearful they may become while sleep is being achieved. A common mistake is to miss the beginning of the end of the happy wake time and to allow overtiredness to occur. Remember it is only appropriate to ignore the crying baby when it is well, gaining weight correctly and no other cause for distress exists.

How long are happy wake times?

This question is often asked and unfortunately it has multiple answers. Generally they are shorter than most people expect. For example a baby of 12 weeks who is sleeping well overnight may be tired and ready for another sleep of two or three hours after only one to one and a half hours of being awake. The shortest happy wake times tend to be early in the day. This appears illogical as they have just had their longest sleep. Despite the lack of logic that is how they work. The babies own behaviour is the best indicator of the length of the HWT. A baby who is sleeping well and receiving adequate food is generally in a good mood. As they become tired their mood deteriorates. They become more tearful, seek out parental care more, are less emotionally independent, play for shorter times with one object and are more likely to be destructive in their play. Use your child’s behaviour as the guide to the length of waking time which is appropriate.

BLENDED BEHAVIOUR

This is a concept which I find helpful for parents whose children are behaving in such a way that they feel confused. If you are feeling that this is ‘all the time’ then relax help is on the way.

Imagine that a child’s behaviour is divided into two styles only. This is simplistic but it works. The two styles of functioning are:

1. Happy and well

2. Tired and ’scratchy.’

As the child becomes more overtired these two patterns of behaviour blend together. They become harder to ‘read.’ You think that they are tired and then they give you a big smile. At another time you believe that they are well and happy but their smile will suddenly change to loud inconsolable crying for no obvious reason. This is ‘blended behaviour.’ It is a catch for the unwary. It can leave you confused and desperate in trying to understand your baby. Once recognised for what it is then you are a long way towards getting control of the situation. Blended behaviour is most commonly a result of fatigue. The child wants to be cheerful and loving but is just too tired to put it together consistently. The solution is obvious. More sleep.

SLEEP ACHIEVEMENT IN THE DAY

Sleep achievement has been discussed extensively in a couple of areas. The rules for the day are similar but a little different. At night I advocate a program of minimal reassurance. In that program the baby or child is left with gradually less and less contact with parents as sleep is achieved. As the parents gain confidence the child is left alone to achieve sleep for longer and longer periods. During the day the advice is similar but slightly different.

Once you have decided that it is time for sleep go through your normal pre-sleep pattern. The child is then placed in his or her cot or bed and settled as you normally would. You leave the child to achieve sleep alone to the best of your ability. If the child protests then depending upon their age leave them alone for between five and 15 minutes. For this discussion let’s assume that you leave the child to protest for ten minutes. After ten minutes you return and reassure the baby with a little touch perhaps resupply the dummy a few kind words and then leave. Please avoid patting, rocking, holding or other styles of reassurance which include prolonged parental care. If the protests continue then you return after 15 minutes and repeat the short reassurance. This may be repeated again after another 20 minutes. If this has failed then the child has been protesting for at least 45 minutes. At night I advocate that you just continue. During the day the advice is different. During daylight hours I set an upper limit of 45 minutes of crying. The reason for this is that it is too harsh on the parent who is listening to the childs cries. Some children will cry for a couple of hours particularly if they have become overtired. If I ask a mother or father to listen to this crying for hours it becomes distressing and can lead to a loss of confidence. Because of this I allow the baby to be lifted after 45 minutes. This time is approximately equal to one sleep cycle. The child is lifted and fed, reassured and settled. Despite this compromise it is important to recognise that the mother was almost definitely correct that the baby needed sleep 45 minutes previously. The child is now tired plus 45 minutes of protest. The childs ability to be usefully awake is thus limited. Allow the baby to settle but as soon as you see the signs of tiredness appearing return them to their place of sleep and repeat the process. The baby may only be up for 30 to 60 minutes before you are deciding that it is time for sleep again. Keep on cycling in this way until sleep is achieved. Remember that the morning sleeps will improve before the afternoon sleeps in most children.

CONCLUSION

Daytime sleep requires just as much attention as night sleep. It can be a little confusing when the child is overtired. The pearls of wisdom can be distilled down to the following few points.

1. Use the concept of the Happy Wake Time to choose when the child is ready for sleep.

2. Avoid the child becoming overtired. Increasing levels of fatigue will interfere with his or her ability to achieve sleep. Put the child down sooner rather than later.

3. Once you know that the child is ready for sleep go through your normal preparations for bed time and then leave the child alone to achieve sleep. During the day I generally recommend a maximum of one sleep cycle of protest and then allow the child to come out of the cot and to be settled in the parents company.

4. If the baby is demonstrating ‘blended behaviour’ then there is almost definitely a need for more sleep to be achieved.

5. Do not be discouraged if you have good control at night and that it takes longer to achieve satisfactory control of the day. That is normal.

Check out our day and night routines for 0-6 weeks, 6-12 weeks and 4-9 months.

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