Sleep Problems

Getting In a Good Night's Rest

Babies, so the saying goes, are nature's way of showing you what the world looks like at 3:00 A.M. They just don't respect the difference between night and day. Whenever they have a crying need for something--which usually means food--they announce it by crying.

Things do get better. ''By the time most babies are three to four months old, they're sleeping for longer stretches--even up to six hours,'' says Dena Hofkosh, M.D., assistant professor of pediatrics at the University of Pittsburgh School of Medicine and coordinator of the Infant Development Program at Children's Hospital of Pittsburgh. But most infants need some help learning to fall asleep by themselves--and to put themselves back to sleep after night wakings. Babies who don't learn this valuable skill may grow up to be children with sleep problems, says Dr. Hofkosh.

Because so many parents lose that precious opportunity to teach good sleep habits early on, some of the techniques that follow are also aimed at older children who have trouble falling or staying asleep.

Put your baby to bed awake, but tired. ''Parents should try to put babies into their cribs while still awake,'' says Dr. Hofkosh. At bedtime, she says, get the baby into her sleeper and feed her. But don't let her fall asleep nursing or taking her bottle. '' You want the child to be tired, but still awake, so she can have the experience of falling asleep on her own. Hopefully, she'll learn to do that when she wakes up in the middle of the night, too.''

Encourage self-comforting behavior. Babies learn to associate certain rituals with the process of going to sleep, according to Ronald Dahl, M.D., director of the Children's Sleep Evaluation Center at Western Psychiatric Institute and Clinic in Pittsburgh, and associate professor of psychiatry and pediatrics at the University of Pittsburgh Medical Center. Often those rituals involve a parent's cuddling, rocking or singing.

''In fact, we're genetically wired to fall asleep only when we feel safe,'' he says. ''For a lot of kids, safety means being in close contact with a parent.'' That's why babies and toddlers who wake in the middle of the night often cry out.

''The child goes into his deep sleep for one to three hours, and has a normal waking-up period after the first sleep cycle,'' Dr. Dahl explains. ''But then the rocking isn't there anymore. So he starts to scream and cry.'' According to Dr. Dahl, the problem is that the child learns to rely on rocking as a comfort--and, of course, no parent can rock a child all night.

Children need to latch on to something that is available, like a thumb or a teddy bear, says Dr. Dahl. ''If the child can begin to associate sucking his thumb or twirling his hair or having his teddy bear with feeling safe, then he's learning self-comforting behavior. Feeling safe, he can go back to sleep.''

Plan daytime practice sessions. You want to teach your baby selfquieting skills--the ability to quiet herself when she gets upset, says Edward Christophersen, Ph.D., clinical psychologist at Children's Mercy Hospital, professor of pediatrics at the University of Missouri­Kansas City School of Medicine and author of Beyond Discipline: Parenting That Lasts a Lifetime.

''If she's fussing, but it's a situation that you know she can deal with, ignore her or leave her alone until she's quiet for a few seconds,'' notes Dr. Christophersen. ''Or if she gets frustrated with a toy or activity, wait until she self-quiets before you redirect her to something else. In a study, we found that half the children who were taught self-quieting skills during the day no longer needed help with nighttime sleep problems.''

Set a regular bedtime. ''Establishing a regular bedtime is really valuable,'' says Dr. Dahl. ''By following a routine, infants and children are much more likely to fall asleep easily.

''That's because there's a biological clock inside each of us that controls when we get drowsy, when we secrete hormones, when body temperature rises and falls--a whole symphony of physiologic regulation. As anyone who has had jet lag knows, if you stretch the normal 24-hour pattern one way or the other, unsettling things occur--including sleep disturbance.''

It's important, though, that in living by the clock you distinguish between bedtime and sleep time. '' You can tell your child to go to bed--and enforce it--but there's nothing you can do to make him sleep,'' says John Herman, Ph.D., director of the Sleep Disorders Center at Children's Medical Center in Dallas, Texas. ''At my house, we have only two rules for bedtime: Don't get out of the bed unless you have to go to the bathroom, and don't make any noise. That seems to work. I'm not saying the child has to sleep; I'm asserting this is bedtime.''

Wean your baby from parental hovering. Most parents find the ''cold turkey approach'' to making their baby sleep through the night is just too painful. The more you try to ignore the crying, the louder it seems to get. '' What's usually more helpful is a gradual weaning from parental assurances,'' says Dr. Hofkosh.

''Choose a period of time when you feel you can stand to listen to the baby cry for a while,'' she advises. ''Start by waiting five minutes. Then you can go in and assure yourself and the baby that everything is okay, maybe give her a pat on the back, and then leave the room. Next time let her cry for ten minutes before going back in. Make the visits less and less frequent.

''The point is, you are reassuring yourself that the baby is okay, and you're letting her know that this is not punishment. In essence, you're saying, 'I'm still here. I still love you, but this is bedtime.' It may take several nights of crying before the baby realizes that she is not going to get picked up or get her bottle, just because she cries.''

Tell yourself you're doing the right thing. That's often hard to remember when you're listening to your baby wail at 2:00 A.M. ''It's akin to the mother bird pushing the baby bird out of the nest,'' says Dr. Herman, ''It looks cruel, but it's actually for the baby bird's own good.''

You need to keep this in mind, so you don't weaken and rush in. Says Dr. Hofkosh: ''Try to remember that rather than punishing your child, you're teaching her something, helping her to develop a skill she's going to need.''

Give early wakers a second chance. If you have an early riser, you might want to let her stay in bed--even if she's crying--until you're ready to get up. In many cases, says Dr. Herman, kids who wake up early fall back to sleep again.

Decide on bedtime etiquette--and stick to it. ''Each family has its own notion of what sleeping arrangements should be,'' says Dr. Herman. ''But whether you believe that everyone should sleep in his or her own bed, or that a child can pile into your bed, make the policy clear and be consistent.''

If you decide that your child must sleep in his own bed--and stay there through the night--you can't give in when he cries and pleads for help getting back to sleep, says Dr. Herman. ''No in-between techniques will work. Letting your child sleep with you sometimes and not other times will just prolong the misery indefinitely. If you decide your child is going to sleep by himself, this is a permanent decision, not a temporary one.''

Have a bedtime ritual. Following a winding-down routine helps a child feel safe in the place where he's going to sleep, says Dr. Dahl. ''The kind of things many families do--reading a bedtime story, having a special time with the child to talk about things in a supportive way, saying prayers, listing all the people who love the child--make sense in helping him feel secure and ready for sleep.''

Don't punish a child by sending him to bed. ''If a child begins to associate going to bed with fighting or being yelled at, that's going to interfere with sleep,'' says Dr. Dahl.

Don't overdo caffeinated beverages. A child who chugs down several caffeine-containing sodas in the course of a day can get a significant dose of this stimulant, says Dr. Dahl. ''That may cause sleep difficulties the same way coffee does for adults.''