Overtired with Nightwakings and Short Naps

[elsasmom]

First off, I apologize for how long this is….!

I wasn’t very sure where to post this, since it falls into props, nightwakings, naps and pu/pd.  I feel I’m in a bit of a nightmare, and am hoping to get some feedback on if what I’m doing is correct and to continue as I am, or if I need to do some tweaking.

Our DD is an Angel baby (5 months old) with horrendous nightwakings and 30-40 minute naps.  About a month ago I realized her dummy had become a prop.  I debated about taking it away for a long time…thinking somehow we could work through it, plus she has mild reflux and we admittedly used it as a crutch for calming her while we were out of the house.  I quit giving it to her during her awake time almost immediately.  I already had her on a 4 hour feed routine, and she quite easily adapted to the 4 hour EASY.  Over the course of the last month she went from waking maybe 3 to 5 times a night for the dummy, to every hour, and sometimes even more than that.  At naptime she happily stayed in her cot for the full two hours, but always woke every 40 min for the dummy.  Last Thursday it actually clicked that she was tortured by the dummy.  It wasn’t helping her sleep.  In fact she was hideously overtired because of it.  At that moment, I knew that the best thing I could do for her was to take it away and do pu/pd and shh/pat. I’m glad I waited for that light bulb moment because it made the process so easy for me, knowing that I was actually helping her…and after the first bout of pu/pd and I had to abort a nap in order to move to a feed, she looked up at me with a red face and puffy eyes, and smiled at me.  (Lovely!)

Anyway, I really had to do very little pu/pd with her, and she seemed to get over the dummy very, very quickly.  However, I have to sit in her room during naps to catch her at the 30 min mark to hold down her arms and legs.  She quite often goes down for naps and bed easily…but, sometimes I have to hold the arms and legs then as well.  Her first night w/o the dummy had maybe 4-5 wakings, but she was easy to settle by shhing and again holding arms and legs.  The next night was better with 2-3 wakings.  Sunday was pretty bad.  My husband was on duty and I guess the wheels fell off around 1:30 and she had a lot of waking from 1 an hour to every 10 minutes.  Last night was so terrible.  Beginning at 9:30 she woke every hour.  Then around 3:30 it increased, and continued until she woke at 6:30.  The whole time all that is required is to hold her arms and legs.  There is no crying, and she turns her head and falls asleep again.  I can olny figure the arm and leg jerking is due to being overtired...

I guess I don’t know what else to do for her to help her get well rested.  I don’t have her swaddled since we took it away when she was 3 months, and she happily transitioned to a grobag.  (She was constantly kicking her way out of it, so we were concerned for her safety.)  It seems logical to start reswaddling again…however; only after looking at these boards did I realize the swaddle could become a prop!  Should I continue to keep her A time low key as to not over stimulate, take her up for naps early to compensate for the settling/resettling time and continue to help her settle by holding the arms and legs?

I currently have her napping, swaddled with one arm out, and she’s gone over an hour!  I don’t want to have another prop issue, and is this safe??  I’m near the end of my tether….

[elmarie]

It does sound as if you really have a hard time at the moment with a very OT baby .  My first thoughts are that you may want to have her checked out by your doctor to make sure there is not something medically wrong, maybe reflux, ear infection-my lo used have terrible NW when she had ear infections (not that I'm saying that is what is wrong).

Would you also mind posting your routine.  If she is having short naps it may well be that her A time is too long..

 

[*Nicola*]

(((Hugs)))

Just wanted to add that we have a 5 month old who is also going through lots of NW's .. but more up talking/shouting for 2 hours at a time     It was having a horrendous effect on next day naps being short, then bedtime, nighttime, naps etc as OT increased.   We reswaddled 2 nights ago and have continued to do so for days and nights and she is much better. 

IMO, I wouldn't be worried about the swaddle as a prop.  It's probably more of a help than a hinderance right now.

 

[elsasmom]

Thank you so much for replying so quickly. 

The thought had crossed my mind this morning that maybe it was time to go see her doctor.  She doesn't show any signs of being in pain so I was a bit torn on that...  We spent the best part of December thinking she had a cold.  Her sinuses were so conjested...we had her bed elevated, the humidifier going, baby vicks and cleared her nose several times a night.  We finally took her to the dr and he said her chest was clear, and he assumed it was reflux.  She's never shown any other signs of discomfort so he didn't prescribe medication.  He did however suggest we add rice cereal to her formula, and that seemed to help.  (That seems to be what triggered the dummy issues.)  Your advise was very reassuring, and I will go ahead and book an appointment.  (My DS never, ever shows signs of pain with ear infections which always stuns his dr, since he normally has two at a time.)

Listed below is her routine.  This is what she does on an ideal day.  Lately, her naps have moved forward a half an hour, to an hour.  She is always shattered by her catnap.  Rarely ever sleeps at the catnap.  Then cries or is restless until I can get her up to bed.  Also, she stopped night feeds in December.  I tried doing a dream feed twice in the last couple of weeks, but that made no difference, and she only drank about an ounce.

6:30am Wake (lately earlier, but I try to keep her in bed)
7:00am Eat finishes w/in 15 min
7:15am Activity observes older brother and plays on playmat until we take older brother to preschool at 8:00
8:30/9:00ish am Sleep She almost always falls asleep before I can get her back home, wakes every 40 min

11:00am Eat
11:15am Activity playmat or tummy-time
12:30/1:00ish pm Sleep wakes every 40 min

3:00pm Eat
3:15pm Activity run to store, p/u brother from school, normally fussing by the time we get home
4:30/5:00ish pm Catnap fusses throughout, hardly ever sleeps
5:30-6:30 pm sits with family for tea, normally fussing

6:30pm Bedtime bath, massage/music, pjs
6:45pm Eat
7:00pm Asleep

Thank you so much for your help!

[elsasmom]

Hi Nicola,

Sorry to hear you're battling with this as well, but it is good to know I'm not alone with an OT babie.  (Not fun!!)

Thanks for your advice.  I will go ahead with the swaddle and see if it makes a difference.  I can only assume it will help control those little arms and legs!  We took it away once, so hopefully we can again.  I dug out my DS's old swaddle blanket.  Its one of those that has velcro closures, so it should give me peace of mind that she is safe.

I hope things continue to get better on your end.  Please let me know how it goes. 

[elmarie]

I do think she is OT.  Her A time shouldn't be longer than about 2h at her age.   You also need to start working on extending her naps to at least 1.5h.   A 40 min nap is not restorative and she will just get more tired as the day goes on.  You can use pu/pd to try and extend those naps.  The A time between the catnap and bedtime is also too long-maybe push the catnap to between 4.30-5.30 for 40 min or so.  On days she has had bad naps I will also bring bedtime forward so that she can catch up on some sleep during the night. 

Here is an sample routine for her age:

7am wake
9am  sleep (1.5-2h)
1pm sleep (1.5-2h)
Between 5-6 catnap of 40ish min to get through supper and bath time
7.30pm bed
11.00pm dreamfeed (until 7-8 months or when solid food is firmly established

Let us know what the doctor says.

E X

[elsasmom]

Hi elmarie,

Thanks for looking at our routine.  It might not have been clear by the way I wrote it out...but I do have DD in her cot from the beginning of naptime until the next feed.  If she wakes early, I keep trying to get her to fall asleep again with shh/pat or pu/pd.  Given how tried she is, I normally take her up for her morning nap between 8:30 and 9:00....and then try to nap until the 11:00 feed.  The afternoon nap then starts anywhere between 12:00pm and 1:00pm (depending on how the am sleep went)....until the 3:00 feed.  The catnap lasts 30min to an hour, starting around 4:30pm.

Lately we've been spending nearly 7 hours in her room during the day, just to extend the naps, and get caught up on sleep.  I was telling my DH that I feel like I never see my DD anymore because she's always in her cot.  I feel as though I'm doing everything I can to help encourage her to sleep.  As the saying goes....you can lead a horse to water, but you can't make them drink.

I'm happy to say that DD did have a very good night last night.  I had her swaddled, and elevated her mattress...and she only woke once at 3am, went back to sleep quite easily, then woke at 5:30 and I struggled with her to extend it to 6:45am.

Her doctor's appt is tomorrow morning so I'll let you know how that goes.  (We were scheduled to go in today, but my DS (3yrs) woke at 3:30am having thrown up in his bed!  Given his condition I had to reschedule. )

Thanks!

[elmarie]

I know it is hard now but it really will get better  .  I'm glad that she had a good night though.  Let us know what the dr says and ~~~sleeping vibes ~~~~~ coming your way {{hugs}}

[elsasmom]

I think we may have now stumbled upon the cause of the sleep issues.  We saw her pediatrician this morning and he was quite concerned.  He listened to her chest and there was a slight wheezing, and she still has a rattling sound in her nasal passages due to reflux.  So, she's been given perscriptions for a nebulizer to open and clear her lungs.  We are also going to start giving her medication to treat the reflux.  He also suggested that I go ahead and start her on solids since she's 23 weeks, which should help with the reflux.

Its a bit heartbreaking to think that the poor wee lass has been in pain and we didn't realize it.  Not once has she woken crying.  In fact, she always wakes with a smile....after a 30 min nap and at 3:00am.  At least we should be well on our way to making her feel better and improving her sleep.

Thanks for listening, and for your support...!

[*Nicola*]

(((Hugs)))

Glad you got an answer  Hope she is much better soon x

[elmarie]

Keep us updated 

[sputnik1123]

Hi elsasmom,

Just had a few questions for you since my DD has very similar issues.  How did you originally determine your DD had reflux?  Does she spit up a lot?  My DD had very bad reflux which cleared up when she was around 3 months (she is now 7 months) but she still spits up quite a bit.  Our doctor is not concerned, as she describes her as a "happy spitter" (it's not causing her pain, so it's only a "laundry" issue at this point).  She also seems congested, she seems to generate quite a bit of mucus.  I also noticed one night that she was breathing quite loudly, and rubbing her nose a lot (which she does quite a bit as well).  Your nightwaking issue sounded so similar to mine, I'm wondering if my DD has the same problem...

[elsasmom]

I'd be happy to answer any questions you have...  I find the whole thing so confusing, and hope that our experience might be able to help.  (I also posted 'Reflux w/ no signs of discomfort' and 'Reflux and EASY' on the Reflux/Colic board if you want to have a look.)

My DD seemed like a very content baby for her first 9 weeks.  She ate well, slept well and hardly ever cried.  She spit-up, but so did my DS (now 3yrs) and he's what I would call a 'happy spitter'...he continued to spit-up until after we started solids, but rarely cried, ate well, never woke at night and was overall healthy.  That's what I thought Elsa was until she got what we thought was a cold at 9 weeks.  The best I can describe it, is as a rattling sound.  She would wake often at night and we would try to clear her nose (we would get stuff out, but never enough to sound clear) then give her the dummy and she was back to sleep.  After 3 weeks we knew that it must not be a virus, and took her to the dr.  He said her chest was clear w/ no signs of being sick.  He did hear the rattling (its very noisy), and said it must be reflux.  We then added rice cereal to her feeds and that definitely helped her sleep.  At her 4 mo checkup we discussed it again, and since she showed no signs of pain (crying or pulling legs up) we decided not to medicate her, and assumed it was just a mild case.

Over the next month we started having nightwakings and 40 min naps. and since she relied on the dummy to get her through the cold/reflux wakings, we figured this was what was causing her to wake.  Last Thursday (7 March) I took away the dummy, and things went down hill, but I could tell it wasn't b/c of the dummy.  Then as you can see from my above posts, I decided to take her to the pediatrician again to rule out that she didn't have any medical issues to cause the nightwakings.  That's when we discovered she had developed respiratory problems (wheezing in her chest).  She was tested for the RSV virus (I think) and it was neg, so our dr thinks its her reflux.  If we didn't treat it, it could develop in to asthma.

Given that you know your DD has/had reflux, I would take her in to see the pediatrician.  It will give you peace of mind one way or the other.  If its a cold you know it will pass, and if its reflux you can treat it and hopefully get back on schedule.

We're now seeing great improvements in Elsa's sleep (day and night).  We still have a ways to go, but are still waiting for the Provacid to fully kick in.  (I still don't get how she could have developed some pretty serious conditions due to reflux and show no signs of pain.)

Please let me know if you have any other questions.  And please let me know how things work out.  (Fingers crossed its just a cold!)