Complicated 20 Month Old (sigh) still waking after 30 minutes at nighttime.

[Lumukanda]

Hi All - it's been a while since I've posted about my touchy little 20 month old. Since she was 3 months old, she's woken after 30 minutes (approximately) after falling to sleep for both naps and nighttime. She had a wonderful 8-month streak when we overcame the problem by a wake-to-sleep technique, but it's cropped again in the past three months.

She always, always wakes after the 30 minutes, but when she was doing well she would just roll over and go back to sleep. The other times, she immediately stands up, and screams for the next hour or two (can't be calmed; is still blery-eyed), eventually calms down, and finally falls asleep three hours after her initial waking. However, if she just rolls over and goes back to sleep, she will sleep soundly the whole night without problems or other wakings. So, that 30 minute waking makes a HUGE difference in her sleep.

(One note: my daughter has complex medical needs involving her growth, digestion and GI system, so I'm not including meal times, etc. She is tube-fed and vomits frequently. However, she is neuro-typical and we do not believe her sleep difficulties are related to her GI problems.)

Schedule:

Wakes at 6:45am or 7am. (This morning after not falling asleep until 10:30pm, however, we finally woke her to eat at 8:30 am. We were hoping to break the over-tired cycle, but we can't do this most mornings unfortunately.)
Naps from 11:30 until 12:30 - 2:30. Usually, about 1.5 hours.
Nighttime: if she took a good nap, goes down at 7pm after routine. If a poor nap, we put her to bed at 6:30pm.

My gut feeling is that she is overtired. But, it's become much more extreme than that. We've tried waking-to-sleep, PU/PD (modified for toddler), etc. She gags herself to try to get us to come in (which we have to do since calories are of UTMOST importance due to her medical issues), throws out her lovey (saying, "Oops! I dropped it!" right before she does), screams "Up please? I love you!" etc.

Due to scheduling issues with her feedings, we don't have a whole lot of wiggle room in her routine. Her naptime is early because it is much longer when I do it at this time - when I tried to gradually move it up to around 12:00pm, the nap was only an hour maximum.

I think I am looking for some support as to how to handle her nighttime behavior, and how to prevent her from creating such miserable habits again.

I feel lost. We have so many other stresses in our life (she also has a twin), and this is enough to break me down. We thought we had finally solved this problem last year.

Thank you so very much for any input or insight you may give! I appreciate it so very much.

[katie80]

Hi hon, (((hugs))) that sounds no fun esp after everything else you are dealing with.

Upon first read through, the behavior does sound somewhat OT and a waking 30min into sleep often indicates OT.  However, because it happens so regularly and has happened for so long, I think we need to take other factors into consideration.  I also don't think her routine is that far off to contribute to major OT issues.  If I'm reading right, she sleeps for about 1.5hr from 11:30-1pm and without the NW, is in bed about 12hr overnight? As far as the nap goes, when was the last time you tried to gently move it to 12pm?  If she is indeed OT, getting the afternoon A to be a bit shorter may help.  Some touchy LOs even of this age, need things to move in only 5min increments, so you might have to do it really slowly.

Is she an independent sleeper going down for naps and BT?  What do you do during the NWs?  Do you take her out of the crib or pick her up at all? I'm assuming you've tried wake-to-sleep recently?

As far as the GI stuff, if you truly believe it isn't a factor, then you're probably right.  My only question is if the waking is somehow related due to any discomfort.  I know there are lots of LOs with food allergies and intolerances which don't sound as severe as what you are dealing with, that struggle with sleep for a long time because their tummies just don't feel right.  The length of time she's awake and her disposition just make me wonder if she isn't in some kind of discomfort.  I'm assuming her naps and BT have always come within a certain amount of time after eating?  Is it possible that she transitions in her sleep and realizes there is some digestive discomfort and then can't get back to sleep?

[Lumukanda]

Thank you so much for your thoughtful reply! I so appreciate your input!

-No, I hadn't tried moving her nap a bit later in a while ... I think that is a good suggestion; I will give it a (very gradual) try!

-Yes, she is an independent napper and sleeper, other than the dreaded NWs. We have a consistent routine, and she seems to like bed ... even asking, "nap?" when she is really tired.

-However, where we've gotten sloppy is the NWs. Honestly, we have not been consistent in this at all (in part because her behavior keeps changing, too). Initially when she did it as a younger baby, when the literal wake-to-sleep method didn't seem to work, my husband would go in there after about 25 minutes of sleep and would put his hand on her back and keep it there until she stirred at 30 minutes, and having his hand there helped her to stay still and not roll over and wake up. She never woke up when he did this; it was all while she stayed asleep. Gradually he would do it shorter and shorter, and eventually she learned to put herself back to sleep on her own.

-When we tried this recently, she was very aware of his presence and would keep her eyes open, watching him, making sure he was there, etc. In other words, we created bad habits, so we stopped. We've tried taking her out and rocking her (I know! Naughty of us!! We thought it was going to be a quick phase that would pass - famous last words), but didn't want to keep that up. We've tried various things, such as going in and lying her down and walking out, repeat, repeat, repeat but she gets so worked up that it seems to make things worse (that's really when she gets desperate and gags herself, throws out her lovey, etc.). I got that idea from Tracey's book, "BW Solves All Your Problems."

-As far as the GI issues, I appreciate your kindness and concern. Truly thoughtful, and you may be right, although I desperately hope that is not the case. Hers are long-term GI issues, so it's hard to know what is "normal" for her. She's also on heavy steroids right now, which can affect sleep negatively. Initially, that is what we thought was making everything so much worse, but as we're gradually tapering off of the steroids (takes a month to do), there haven't been any positive changes in sleep, which makes me think the steroids can't be too much to blame. They do maybe make her more restless, which could exasperate everything else, too.

-I really am stumped as to what to try next (and next is coming up so soon - it's the next day already! ha:)). When we went through this before, she was not mobile so it was a really different game!

Thank you so very much for reading about our special little girl! We welcome any input! Thank you sincerely!!!!!

[katie80]

(((Hugs))), it definitely sounds stressful.  Interesting about your DH's w2s method, that is what I would've suggested.  But, I'm sure it is not the same with a 20mo old as a 6mo old, so that makes a lot of sense.

As for next steps, I would definitely start moving the nap later, by 5/10/15min every couple days; whatever you think she can handle. She's at the age where she should be able to make it to 12pm on her wake up, even maybe 12:15/30.

When you settle at the NWs, I wonder if taking a gradual withdrawal approach might work best for her.  It sounds like your going in and out and putting down is a bit too stimulating for her at this point and just making her more upset.  What if you just went in, stayed in and either sat or lied down on the floor next to her (or a little ways away if that is better)?  You could then say your sleepy phrase, reassuring her that she needs to go back to sleep and then gradually work your way back out of the room.  If she starts throwing her lovey, only give it back randomly, so that it doesn't become a game.  At this age, consistency is really important, so I'd start doing something that you think you can stick with.  Here is a good link on GW: Walk In/Walk Out vs. The Gradual Withdrawal Method (HOW TO CHOOSE)

I hope too that she is not in discomfort from her GI issues.  Poor thing sounds like she's been through more than enough. It will be interesting to see if continuing to reduce the steroids has as effect.  Do you think it could be like a food allergy where it takes longer to come out of her system, than on the exact time table they're being reduced? Even if they're not a main cause, I'm sure they can exacerbate it, as you've said.

[Lumukanda]

This was very helpful!! Thanks so much for your thoughts - great ideas. The random lovey-replacing sounds downright mean, haha. But effective, which is what I am going for!! So you'd better believe I will be trying it tonight!

After reading the link you attached, I think you're right ... the gradual withdrawal method is probably the best idea for us to try. Nervous as I am, I will try it tonight. Thank you!!

I do have one more question if you don't mind! Do you think this method might help her fall asleep more quickly? Even once she's calmed, it normally takes her several hours (2 - 3) to finally fall asleep. My thinking is that she's somewhat satisfied from the 30 minute "power-nap" she's taken before waking, so it's difficult for her to fall back asleep once she's awoken. Thanks again for everything!!

[katie80]

The random lovey-replacing sounds downright mean, haha. But effective, which is what I am going for!!

I wouldn't say mean, necessarily, but effective yes. She just needs to learn that you won't replace it every time, so she shouldn't try.  I had to do the same with my DD around this age while doing WIWO.  She would purposely throw her lovey out to get me to go in there more often, so I stopped picking it up every time. She stopped throwing it put pretty quick!

Do you think this method might help her fall asleep more quickly? Even once she's calmed, it normally takes her several hours (2 - 3) to finally fall asleep.

Ideally, yes.  The goal is that with consistency she will know that there is no real reason to be awake at that time as you will only keep doing what you are in getting her to go back to sleep, so she should just roll over and do that.  But, if the reason that she's waking has to do with some discomfort or something other than OT/needing to transition on her own, it likely won't stop the waking.

[Buttonbobs]

Hi lumukanda, you are getting some fabulous advice from Katie and I can see a plan is forming. Just wanted to add in that we had similar waking problems with E when she was smaller and used a similar approach to you. Now she is 21 months old a hand on the back and our presence in the room makes her stimulated and she wants to play. I have found in addition to the techniques you have been discussing above, I can often reassure E using sleepy words from the doorway. You might find it helpful to introduce a sleepy phrase as you start the GW technique so that as you progress you can use this at the door to calm her and not have to go in at all.

Hth xx

[Lumukanda]

Thank you both so much for your replies! All of your comments make tons of sense! The comments about the sleepy phrase are wise, too ... definitely something I will incorporate. Thank you both so much!

Last night I (fortunately) did not have the chance to implement any of these good suggestions, because my little girl decided to sleep wonderfully and undisturbed for the first time in a week. I shouldn't complain, although I was all ready to begin my new plan. She took a good nap yesterday and was put down right at 6:30, so maybe that aided the situation.

I will also be trying Katie's suggestions of the later nap, along with everything else. I will give an update when I have something more to share - thank you so VERY much for helping out a mother at the end of her rope!! Hoping I will have some successes to share. Thanks again.

[katie80]

Yay for the good night!  Sometimes I think these LOs know when we're posting about them.

You do have a good plan, so be confident if you need to use it.  And please keep us posted.

[Buttonbobs]

^^^ this. Xx

[Lumukanda]

We're in the throes of it ... she must have been able to tell I wasn't posting much about her today. Eek. I am crossing my fingers! Thanks for all the good advice; who knows WHAT I would be doing right now without it. My husband texted and said, "This method is SO much better." Thanks all:)

[katie80]

Sorry to hear she woke, but glad DH thinks it's working better. Keep encouraging each other and stay consistent and hopefully it will go quicker soon. (((Hugs))) and FX for you all!

[Lumukanda]

You're sweet to keep cheerleading! It's been a bit rough - made herself vomit once he got the door shut! It's been about an hour so far. Thanks for the support!!!!!

[Lumukanda]

It's been about an hour and a half, and while she's not asleep (I'm sure she won't until 10:30pm, like usual), but she's finally calm and my husband came back downstairs - I would call it a success overall. I expect it will get shorter with time, too, as she realizes the drill. She was quite confused tonight - couldn't tell what was up. Hopefully once she realizes what's going on, she will respond well. Thank you VERY much. And because I can't help myself, I'm sure I'll update again another day and say how we're getting on by then. Thanks for everything.

[Lumukanda]

She didn't fall asleep till 11pm last night (no more crying after we finally left at 8:30pm), and she woke up at 6:45am this morning. She's been yelling, "Nap? Nap?" already this morning by 7:30, because she's so tired. She's absolutely hysterical and a sobbing mess. Do I change her naps and nighttimes around? This is torture and I don't know how to help her:(