Help with frequent NW and EW

[aidenmc]

I'm hoping someone can have a look at our sleep situation and offer some suggestions to help improve it. DH will be going away for 9 days in March and I am so worried about how I am going to cope with the nights and early mornings (especially with my two other boys home for March Break). We have a bunch of issues, but I am not certain I can tackle them all before he goes.

He is 7 months 3 weeks, has had problems with reflux (pretty well controlled now, but flares with teething) and gas (better since going off milk but worsens with constipation which we sometimes struggle with due to solids). He wakes and cries when having to pass gas or burp - can't seem to handle it himself at night. More recently he has been teething, just had 2 pop out (this was a miserable time with over a dozen nws for a few nights) and now he has a pretty bad cold and cough (I am doing whatever he need to be comfortable).

He does not settle independently, but has a consistent nap routine which involves a swaddle (we are in the process of weaning) feed (this is entrenched in his routine now, was recommended by the lc due to reflux related trouble feeding - this improved it), burps, more feed if nec and then paci and patting his bum in my arms. We also have soft music and white noise. Once he's asleep or close to it he goes down in his crib. Sometimes if he's not quite asleep I will have to try again, other times he just takes a little pat and is off.

Naps are okay, generally unless we are in a major OT cycle. But, I am still having to go in an httj from 30 minutes to the 1 hr mark almost all naps. When he's feeling good and things are on track the first nap he doesn't need this. If he wakes fully before about an hour and I can't turn him give the paci and pat him back to sleep (this is rare for a nap) then I hold him in my arms, often for the rest of the nap.

Nights are awful to terrible. 6 NWs are pretty common. We have had as many as 16. I have often been up hourly.  They can start as early as 35 minutes after going to sleep if OT and/or uncomfortable. To resettle we give paci put him on his side and give a pat. Works better in the early hours and dh is having good success with this. If this doesn't work we pick up and try to settle in our arms. He gets a bottle of ebm between 10 and 11 and another full feed sometime thereafter (it might be broken amongst nws on bad nights). He doesn't require the boob to get back to sleep, but will want it for comfort when gassy/constipated. He doesn't usually scream when he wakes (unless bad gas constipation - but really this is better now) but his cry escalates if we leave him for more than a couple of minutes.

He is fairly consistently waking at 5:30 for the day regardless of bedtime.

Our routine is generally like this:

W 5:30
S8:30 - 10:00 - sometimes less than 1.5 hrs (thinking of trying to push this towards 9 to see if we can either remove the catnap or shift his bedtime)
S12:30-2:00 (may vary depending on how tired and previous nap)
S catnap at about 4:30/45, earlier if previous naps were bad. if previous nap ends after 2:10 or so the catnap may not happen
S 7ish or a bit before. 6-6:30 if no catnap.

Then nws all through the night. Generally I can count on them at least hourly after midnight. Sometimes we get an extended nw (1.5hrs). If a good night we get one or two 1.5 to two hour stretches.

So that's about it. Right now DH is taking the evening shift till midnight or so then I have the darkest hours. He will get up about 6 with ds so I can get another hour or two (which I count on) I don't get to bed too early as ds1 isn't in bed till 9 ish.

Sorry this was so long. Hoping for anything that might improve things so I have a better chance of managing when dh is gone. Don't think i can jump into sleep training as he is currently quite sick and I believe he's teething at the same time. I fear we may never get a window...and I really dread the endless crying it will entail.

Thanks for any suggestions.

[mmom]

(((HUGS))) Becky.  Are you sure the reflux is controlled?  Are you sure there isn't another tooth looming?  I ask because your routine looks fine.  But still needing to HTTJ just seems like there is more going on.

A 5:30 wake up isn't an EW with a 6/6:30 bedtime.  I think with the 7 pm bedtime you get it because of the cat nap.  You would almost be better off with an earlier bedtime and try to work in eliminating NWs, then trying to push the whole day back slowly.

How are you settling those NWs?

As for props, what do you want to try and wean?

[my3girlsjde]

I agree with Kara, the routine looks great but there does seem to be something 'up'.

I 'just' sleep trained my 9 month old when her reflux was finally under control. We went through exactly what you're going through right now and I'm wondering if his reflux is under control causing an OT cycle and the extended NW's.

Is he medicated for the reflux? Is the head of his crib elevated? Did he just go through a growth spurt? (The reason I ask that one is that some meds are very weight sensitive and I found that after a growth spurt things would get pretty wonky with sleep).

I found when E was going through this I would hold her up after every feed for aboiut 20 mins and then it was a lot easier trying to get her to sleep.

Hope that helps

[aidenmc]

Thanks for your replies! I am pretty sure it`s controlled right now, although it does get worse with teething. There could be more teeth as he`s been drooling like a faucet, but I don`t see any about to break through. He has never been a great sleeper. He was best as a newborn when he woke every 3 hours. It has progressively gotten worse since then, I suspect initially because of reflux. He`s currently on zantac 2x15ml and prevacid (15mg). The zantac was recently increased. His crib is elevated. DH was thinking that it may have something to do with his feed - he would sometimes wake at odd intervals after the feed. Right now, although he`s very uncomfortable with this cold, the reflux do

The httj is partly habit for me, and I was getting to the point of not going in for the first nap but he got OT and teething and constipation now his cold has made him uncomfortable. I would say he wakes 50% of the time, but again it all depends on what else is going on.

I see what you mean about the bedtime and EW (or not) issue. It sounds like the key is getting that second nap to end as late as possible. If DS were more rested I would feel better about pushing things. Maybe once he`s over this cold...

When he wakes we first try resettling in the crib - give the soother, help him turn onto his side then a pat on his back. If he doesn`t settle then it is into our arms and patting bum. Sometimes he can go back down awake (especially with dh) and we continue patting to sleep, or just lay our hands on him. He is pretty clear when he wants the boob - some nights a lot, others hardly at all. I am not really feeling like it is a prop as yet although we have been doing more nursing to sleep in the last couple of weeks

Props: we are slowly getting rid of the swaddle. Am very ambivalent about weaning the paci. And, I guess ultimately, getting him out of our arms for the initial falling asleep (which i guess is the biggest task).

[mmom]

It may not be a good time to do any sleep training if he is not well.

Have you tried a thickener for the reflux?  I see you are in Canada and I think there is one there that is available to you.
http://babywhispererforums.com/index.php?topic=175036.0  I really think there is some element of discomfort here still.

I would start by weaning the holding to sleep.  You can try Gentle Removal and see if that helps.  http://babywhispererforums.com/index.php?topic=52857.0

Also, if you are going to wean the NFs, you must be consistent in not giving in and offering the boob.  Is that something you want to tackle?

[EloysH]

Hey Becky,

hi again 

Understanding everything you have been through it does sounds like there is an element of pain there and that is what's hindering his progress in the independent sleep dept and constant waking.  But having said that I think that he is old enough for  to try a bit of gentle sleep training to see where it gets you and if he's just waking just the sameafter a couple of days, then revists meds and food intolerances.

Becky I forgot you are dairy AND soy free too right?  I do suspect further food intolerances too, since your meds doses are within the adequate range,  (although there is still room to move upwards) and his symptoms sound like discomfort at the bottom end.  It sounds like you are really wanting to push for the sleeping training  angle right now rather than the meds angle, so I guess what's required is coming up with a plan that you are comfortable with   

I think you are getting close to getting him to sleep independently, especially when he is comfortable you are saying he just needs a little pat and is off to sleep.  But what is stopping this is the waking, and that has nothing to do with independent sleeping.  (Do you agree?).

 If you have got him off to sleep by placing him in the crib sleepy, then given him a gentle pat so send him off, he will have awareness of falling asleep in the crib.  So if he wakes after 35 mins I would not be thinking its because he realiseds he's in the cot and not your arms and hates it.  I would think more along the lines of genuine discomfort. KWIM?

So again,  if you want some results fast, the best results might be to up his meds... if he has further food intolerances, sometimes the symptoms can be masked by a higher does of meds...  if the food intolerances flare up his reflux.  I don;t knoeif you are up for cutting further foods.

As for as the sleep training plan is concerned, one idea is to place him in the cot sleepy for all sleeps, and pat him off the rest.  If he loses it, do a modified PUP/PD where you pick him up and hold him all the way to sleepy again... the place back in cot. After doing this several times he will eventually wear himself out and accept falling asleep in the cot.   My DS2 is spirited and doesn't accept being held much when tired now, he settles quicker by rolling around in the cot and losing it in there as opposed to me arms.   It will be trial and error! 
 and just fall as Then only feed 1-2 times a night as you are doing now.  Then you can see where it gets you.

Just my few thoughts.

[aidenmc]

Sorry it's taken a while to reply - am on too many threads with too little time  .

Kara, thanks for those links. We are still dealing with a bad cough that wakes him from naps and at night. I do feel better with a gradual approach to sleep training and sort of have a plan but am struggling with OT right now because of the illness and EWs.

I'm not sure if we have a thickener here. Have not seen it and the doctor has never mentioned it.

Eloys - it does feel as though we take one step forward and two steps back. I go back and forth between thinking his reflux is controlled and thinking its not. He had loads of spitting up a couple of weeks ago when his teeth were pushing through. Strange thing is that lately, in spit of his rotten cold, he almost never spits up and I don't hear that swallowing sound in his throat either. Really not sure what has made the difference, but we haven't had constipation in the last week and I also changed when I give the prevacid and zantac. So...I am thinking more and more that it is controlled.
I did do sort of a test dairy - dh bought me some chocolate I couldn't refuse night before last and, worse, yesterday morning we had run out of rice milk so I had cream in my coffee instead. He seemed gassier than normal. At this point, I don't think I can face removing any other foods. The issue of increasing meds is mostly because I feel like a fraud going in with ds to the doctor. He is such a sociable baby. Wherever we go he is looking at people waiting to be noticed. So he is obviously at his very best at the doctors!

I do like your approach to sleep training. I will try that approach once he is a bit better. Biggest problem I have is that he seems to be quite OT due to our EW's. I am trying to drop the catnap in effort to improve the EWs but i can't get him napping late enough (especially as our EWs are getting earlier - 5am this morning, 4:45  yesterday!  Even our naps have gone to pot today!

[my3girlsjde]

{{{HUGS}}} Becky

Yes they do have a thickener here in Canada, though I have no idea what it's called. Your doctor would know.

I 'get you' on feeling like a fraud going in to the doctor. The thing is, with reflux is it gets worse at night, teething really makes it worse for some and they love being distracted. My girls would scream the whole time at home and totally 'ham it up' for the doctor. I felt like a neurotic mother who just looked overwhelmed with twins.

My advice? Write everything down. Doctors seem to pay much more attention when you go in with a list and you're not trying to remember things on the spot and convince them that the 'little ham' in your lap really is uncomfortable. Kwim?

I just spent the last week being consistent with withholding the night feeds and it's made such a huge difference. Not sure if you're there yet, but I'll be there to hold your hand when you're ready to try.

More {{{HUGS}}} hun. You'll get there

[mmom]

It looks like you have 2 options: Simply Thick (I use this) and Thicken Up.

I am getting ready for work, so in a hurry, but what if you try what I am going for with setting the first nap time at a reasonable hour.  It has been less than a week for me, but we haven't had a waking that early since.  Having said that, if your LO is uncomfortable, nothing is going to help until you get it under control.  I know this from experience.   I have to get DS#1 on a HAF and clear all intolerances from his system in order to get sleep.  BTW, he was the happiest guy around too.  But he wasn't sleeping and it effected everything in the long run.

[aidenmc]

Not so glad to hear I'm not alone, Vicki, in feeling like a fraud at the doctors  . I will take you up on your offer for support when we start to wean the feeds. Don't know why I am hesitant - partly because he's not having a huge amount of solids yet, but also I guess because I feel like the feeds are the least of our problem iykwim - although I do remember ling ago thinking, geez, if only I didn't feed him at night, he would probably be better. AND, funny thing is that last night he could have gone with only one.

We had a weird night after our severely bad nap day. Yesterday he slept from 8:35-10:15 (with help) then only 30 minutes for his second nap, then refused the catnap. Was asleep by 6:15 (with a fight) then up screaming (OT) at 6:45. Had a very brief wake at about 8:30, cried out and then coughed off and on until 11:20! That is a very good stretch for us. DH gave the bottle, had to resettle briefly at about 1. Then he slept till 3:15. I went in an figured he was hungry but took after a half a side and conked. I put him back down by 3:30. up again by 4 - stayed up till 5:15!! But then slept till 6:40 (good!).

So this morning decided I would aim for a 9am nap. Well he was fussing earlier, yawned as we went into his room, didn't nurse well then fought me till 9:20ish. Woke 30 minutes later. Then again 15 minutes later as I tried to put him back down. Refused to sleep any more. He's still keeping me guessing! Was that UT, OT? Was hoping to have a better schedule today and have a decent bedtime without a catnap, but not sure if that will happen now...

[my3girlsjde]

E had a horrific day yesterday with a single 20 min nap . She's never done this either. Bt was 645 and she was up every hour until 150am and then she screamed until 530   I let her sleep in until 830 as she's usually up at 730 and started her nap at 1115. She didn't go down until 1140 and that was shush/patted the whole way down. My view is when they're in an OT cycle - do whatever you have to to get them caught up and you can start fresh again without combatting the OT monster also.

I'm all for APOP'ing those naps until they get caught up enough to work with.

[aidenmc]

Just want to check in again. We are still having rough nights (although some early parts have been a bit better) and today was our 3rd day with 5am wakings for the day. It is seriously doing my head in! Yesterday was strange. Managed to extend ds' 1st and second naps to 1hr40 so we went without the catnap. But after his 2nd nap he developed a fever and was miserable and yawning constantly. He was asleep by 6 but up about every hour all night and for an extended nw around midnight, which I think lasted about 1.5hrs. I had hoped with no catnap and the early bedtime we'd have a longer night but, nope, another 10hr night. His fever didn't really develop into anything. He has just gotten over a cold (still has a bit of a cough) and I though t he was getting another one, but you know what? I think it is all teething! His finger is in there constantly, and it's all bumpy, he's not feeding well, etc.

Naps today were so rough. He's so tired by 8 that he falls asleep while feeding. If I try to push him to finish nursing, burp etc., he ends up a crying mess. Waking 20 minutes after I get him down. I feel like I am holding him all the time these days. Am slightly scared about when dh goes away this friday. With my other 2 boys at home for march break and these awful nights and early mornings, it is going to be so hard...I feel i have so little time to myself right now.

Okay enough of my whining. I am really stuck about two things. I am trying to stretch him to 8:30 but after waking at 5 he conks before then. There is no way I could get him to 9, which is what i need to do to get through the day without the catnap. But I fear the catnap robs him of sleep in the morning (although I haven't seen a difference on days he gets 2 or 3 naps). And usually catnap days don't actually have him sleeping more overall time in the day. I had been thinking i should try to stretch him and drop force the catnap drop but it is really not possible some days. And I think he has fewer wakings in the evening after the catnap. So, how will we ever get there?

[EloysH]

You will get there as soon as he stops teething.   Remember how tired it makes them?  Pretty hard to extend that morning A time when they are under the weather.  We did have a stage like that. It sucked.

Last of all ((hugs))  c'mon tooth!

[mmom]

More ((HUGS)).  I don't think you can push A's while teething either.  You just have to ride it out.

[aidenmc]

Thanks that totally refocused me. Even though he woke at 5 on the dot again I am going to stick with the 3 naps right now. He slept from 7 to 12:30 last night. That is amazing for him! He only took 2 oz from his bottle then woke at 2, then 2:30 for a while. Gave teething meds and tried giving the boob, but I think his gums were sore. Eventually he took a little. Anyway, he then slept from 3:20 till 5. All things considered, a decent night for him.