There’s nothing like parenthood to give you an insight into why sleep deprivation is an effective method of torture: after a while you get to the point where you feel you would do almost anything for an undisturbed night.
With a newborn in the house, night-time waking is part of the deal and you muddle on. But a common crisis point is when the mother has to return to full-time work or another baby is on the way.
Sleep issues have a draining effect on the whole family. Parents may feel they are the victims and the child the “villain”, but interrupted sleep is detrimental to both sides.
Very desperate couples turn to sleep trainers – usually having tried the advice of books, friends and family, but nothing has worked. They feel like complete failures and believe their child is the worst in the world.
Lucy Wolfe can identify with this, although initially she thought she had done everything right when her first baby was sleeping through the night from about six weeks. Then, "at about eight or nine months, everything went to pot and I didn't understand it".
She recalls asking her GP for a referral to a paediatric sleep expert, only to be told there was no such thing. A decade later, Wolfe is one herself.
Now a mother of four children, ranging in age from 11 to three, the former chartered surveyor had become the “go to” person for sleep problems among family and friends.
When one father confided he would have paid her any money for the help she gave them, she saw the potential and went off to be trained before setting up her own business, Sleep Matters in Cork, three years ago.
In consultation with clients, she draws up an individual, step-by-step plan and supports the parents with follow-up phone calls, at a cost of €300 per child.
“Modern life has compromised sleep,” she says. “Corporate hours are dictating that maybe we’re picking up our kids when we should be putting them to bed.”
Sleep problems are usually a combination of factors, such as a parent assisting sleep, too-late bedtimes, lack of naps and, she says, children whose biological clocks are not in sync with the optimum times to sleep through the 24-hour cycle.
Wolfe’s method does not involve leaving a child to cry and she feels very strongly about that.
“There seems to be a perception that if you want your child to sleep, then you have to cry it out. It is not really the way.”
She advocates gradual retreat where parents stay with their children and respond appropriately, then the intervention is scaled back.
Like all experts, Edel Gargan of the Baby Sleep Academy in Sandyford, Dublin, advocates a calm bedtime routine but she doesn't think a bath is an essential part.
“They’re a pain – you’re coming in from work and the last thing you want to be doing is running the bath every single night.”
But avoid stimulating play in the wind-down. Give them their last feed down stairs, she suggests, and then use the ritual of putting on pyjamas, washing face and teeth as sleep cues; read a story or sing a song and put the child into bed.
“The child will know, following a certain pattern, that sleep is coming,” she explains. Try to keep the routine the same each night and one that anyone, eg a babysitter, could do.
Sleep trainers tailor plans to individual families and no one solution fits all. But there are common issues at different ages:
Under six months
You can't expect a baby to sleep through the night consistently before starting to be weaned onto solid food, which is not recommended until six months. However you can start trying to establish a framework for healthy sleep habits, says Wolfe.
Very young children will need to go back to sleep within 45 minutes and an hour-and-a-half of the last nap. If you try to get into that rhythm and never let them become over tired, she advises, then you can start teaching them the skills they are going to need to settle themselves.
Gargan recommends a set time for waking in the morning and going down in the evening. She believes it helps them if they get used to eating and napping at the same time.
HSE guidelines don’t recommend co-sleeping for the first three months but after that it can work very well for families says Gargan, who also warns on its drawbacks – such as when one parent, usually the father, doesn’t want to do it, or when it is only used as a last resort in the middle of the night.
Six months to five years
This is the period you really hope to get any sleep issues sorted, the younger the better. The aim is to teach children to put themselves to sleep, so when they "surface" during the cycles of sleep they are not alarmed by the absence of assistance, such as a parent, rocking movement or soother.
Devise a good bedtime routine, one that it is possible to repeat every night. A consistent approach to daytime naps is also recommended and while you would expect to phase these out before the age of three, children starting pre-school may need a "power nap" afterwards, but keep this to half an hour, advises sleep trainer Nuala Reddy (see sidebar).
Over-tiredness is often a root cause of sleep issues but a surprising symptom of this is hyper-activity, so a boisterous child may need an earlier bedtime rather than being kept up to tire him out. With children over three, beware the vicious cycle of night-time problems leading to daytime naps leading to night-time problems.
Six upwards
A therapist rather than a sleep trainer may be required if problems persist at this age. But first address the child's "sleep hygiene", suggests Colman Noctor, a psychotherapist at St Patrick's University Hospital in Dublin. This includes keeping TVs and handheld devices, such as phones and tablets, out of the bedroom and making sure there is still a calm routine before bedtime.
Specific sleep disturbances such as “night terrors” and sleep walking can occur at this age in what’s known as the “latency period”, he says.
It is difficult for children this young to explain how they feel but their behaviour can indicate issues. Finding it hard to fall asleep and frequent nightmares may be a sign of stress.
He believes some parents opt too quickly to try herbal remedies with their children, when they would better off looking at sleep hygiene and routine.
Teenagers
Adolescents, who need between seven and nine hours a night minimum, tend to have poor patterns of sleep. Late-night online gaming or cramming for exams plays havoc with the body clock.
However, sleep problems in teenagers can indicate underlying issues of anxiety or depression, stress or bullying.
Early morning waking, for instance, is a biological feature of depression, Noctor explains, while teenagers not able to get to sleep, or who experience broken sleep, may be constantly going over things in their head.
His tips for sleep hygiene at this age include staying off energy drinks; avoiding any sugary drinks after 6.30pm and an 8.30pm curfew for stimulating screen activity such as gaming and participating in social media.
If asking teenagers to leave hand-held devices out of the bedroom is going to be a constant battle, encouraging them to make their own choices might be a better approach.
“Get them to see the benefit of their own sleep,” Noctor says. And they could use technology to be part of the solution, he adds, because there are apps that promote sleep, such as dolphin music or the sound of waves.
For more information see: sleepmatters.ie; babysleepacademy.com; colmannoctor.com.
swayman@irishtimes.com
