Not sure which way to go...

[krispifsu]

We are dealing with the dreaded 5 AM LONG NW and can't seem to find the "fix" 

Our typical day looks like this:

A 7:30
E 7:40 BF
E 8:30 solids
E 10:30 BF/bottle of EBM
S 10:30/10:45 (S time of about 1-1.5 hours)
A 11:30/12:00
E 12:30 solids
E 2:00 BF/bottle of EBM
S 2:30/3:00 (S time of about 1-1.5 hours)
A 4/4:15 - I always wake up by 4/4:15 to keep a reasonable BT
E 5:00 BF
E 6:30 solids
Bath/BT Routine/ 6:30/7:00
E 7:15/7:30 BF
BT 7:30
First NW sometime between 10:30 and 2:30 - BF and back to sleep pretty easily
If first NW is early we get another one sometime between 1:30 and 3:30
NW 4:30 and 5:30

I try to keep A times to around 3-3.5 hours and total daytime sleep to no more than about 2.5 hours. 

I usually send hubby in to try to settle for all NW's after the first one.  If he can't get him to settle within 30 minutes of so, I will go in and feed. Sometimes he falls back to sleep but will wake right back up and wants to play.  He screams if I leave the room, but is happily gurgling and chatting away in my arms or if I am with him. I'm embarassed to even say it - but I have resorted to climbing into his crib with him. I'll lay down and (for lack of a better way to describe it) I "ignore" him. He'll crawl around and cruise around the crib happy as can be and then eventually curl up next to me and fall asleep.  I have to be up for work around 6:30 so these long NW at 4:30/5 AM are killing me because he will typically fall back to sleep around 6/6:30 right when I need to be getting up for the day 

So I'm not sure whether we need a routine tweak or what is going on. He has been cutting his first tooth for the past 2 weeks -we have used IB Profen or Tylenol at BT with mixed results. We do the short times between feeds because we're still working on his reflux and the smaller/closer feeds seem to settle better in his tummy. Reflux doesn't seem totally under control to me because we're having lots of wet burps and LOTS of coughing.  So it's hard to figure out whether we need to focus on sleep training (hubby fears we'll be sleep deprived until he goes to college) or if we need to tweak the routine to get the nights as best as we can.  I don't mind getting up 2 x's a night to feed so long as he goes back to bed.  The playing at 5 AM is what's killing me more than anything.  He is clearly still tired because once he goes back to sleep at 6/6:30 - he is sleeping until 7:30 or later if I let him. 

Help!     

[ZacsMumme]

Hi there,

Few thing are jumping out at me Hun, first is that it definitely sounds like the reflux may be flaring, teething does this, as does new mobility (crawling) and sometimes solids. What is your LO on for the reflux? Do you think he needs a med increase?

As he is napping well, but waking a bit at night I doubt the NW are UT. I would offer 2 x 1.5 hr naps rather than capping them at 2.5 hrs, and give a bit more A time. You day may be closer to 12.5-13 hrs over time but he may sleep better at night as a result and will be rested throughout the day.

You can't sleep train while your LO is poorly so lots of cuddles and you can do shh/pat if your LO will let you. do you find the pain meds if given at 4.30am help him sleep longer?

[krispifsu]

Thanks so much for the advice. 

Jane - the link you sent sounds like my little guy. He has been harder and harder to put down and his naps have gotten shorter and shorter.  It used to take him less than 5 minutes to nod off comfortably. Now he wiggles and flops around for 20 minutes before he finally falls asleep. 

ZacsMumme - I definitely agree that we are having reflux issues.  He is currently on 2.5 mls of Rantidine twice daily.  This was his max dose when we went to the doctor about a month and a half ago and he hasn't put on much weight since then so I don't think he needs a med increase.  I personally would hate to try the meds at 4:30 AM. After an initial fight, he was taking his meds like a champ without hardly a complaint - but has been fighting us tooth and nail the last 2 weeks to get his meds down.  We did change pharmacies - but I can't imagine that their Rantidine is any different than the one we were getting at our old pharm.   

How far out should I stretch his A times?  Right now he seems to do about 3-3.5 hours.  Should I aim for 3.5 hour A times all around.  Something like this? 


A 7:30
S 11:00
A 12:30
S 4:00
A 5:30
BT 8:30

This would give him a consistent A time of 3.5 hours and 2 S times of 1.5 hours.  I just don't know how to extend the A time much more without having a very late BT.  My daughter goes to bed at 8:30 though and it's been nice having him down by 7:30/8:00 to give her some alone time with hubby and I. I suppose I could get him up at 7 and adjust the schedule from there. 

 

[krispifsu]

I also meant to ask - what do I do during the EW's?

A 7:45
S 10:40
A 11:30
S 3:00
A 4:00
BT 8:00
NF 12:45 - finally settled back in crib around 2
NW 4:45 chatting away in crib
5:00 real crying so hubby went in to try to settle
5:45 still up so I went in to BF to see if he would go back to sleep
FINALLY asleep at 6:50
I woke him at 7:30 to keep on schedule for day. 

So exhausting - we keep the lights off and interactions to a minimum in the hopes that he associates this that it's still sleep time (yea right     )  but he just chatters away, cruises around the edge of the crib and seems content.   

I am working in the office today so I told his caregivers to aim for this schedule:

A 7:30
S 11:00/11:15
A 12:30
S 4:00
A 5:30

And I plan for bedtime around 8:30. 

Sound ok?

[ZacsMumme]

Hun I meant pain meds at 4 sorry I wasn't very clear.
You may want to consider changing meds from ranitidine to losec if your Dr agrees and you feel the reflux is getting worse.

Mmmm maybe you do need to cap that nap like OU were doing with just the increased A time. Those NW do seem UT don't they?

[krispifsu]

My mistake on the meds - I may try a dose in the middle of the night and see if that helps.  If he does a late first NW I might go ahead and give them then and see if we can't just avoid the 4AM/5AM wake-up all together.  Wishful thinking and all...   

He wakes very happy - so to me he does seem UT. Typically if he wake OT, he will let you know it. 

Today has been wonky.  I called to see how the 11 AM nap went and he only napped 30 minutes     so not sure if it is UT or OT or what with that nap because they said he seemed content.

The Dr. said that if the max dose of the Zantac didn't work - we would look at switching to a PPI.  My fear with the PPI is that it will be harder to wean him from it and he does seem like (in general) the major pain of the reflux is gone.  He is still having lots of coughing and wet burps though so I know he's still dealing with some of the symptoms of reflux though.   

So - should I continue with a 3.5 hours A time?  even with getting the 30 min nap today after 3.5 hours? 

[ZacsMumme]

If you get a short nap you bring the next A time forward as he will get tired quicker. I would watch him to see how much he can do - For us Z could do ~2hrs after a 30min nap.

HUGS re the reflux, its hard to know. Teething does flare it up so maybe its that causing the flare. How long has he been doing the wet burps etc? Are you giving probiotics - I found these helped Z a lot with all his tummy issues.

[krispifsu]

Ugh - despite their best efforts we only got a 40 minute nap for the second nap from 3:00-3:40 so only 1 hour 10 minutes of total sleep today    I intended for an early BT - but failed.  Just hard to get home from the office, get some quality time with both kids, dinner made, and bath and bedtimes.   

The reflux symptoms seemed to flare right around the time that his first little tooth started showing through about 2-3 weeks ago. We started probiotics around the time we started the reflux meds @ 5 months old and he gets the daily dose recommended on the bottle. 

Now I'm just keeping my fingers crossed that tonight isn't a total meldown from being OT.  We already had one wake-up an hour after he went to sleep but he settle back down pretty quickly. 

Thanks for the advice    Sleep deprivation makes it harder to see things clearly!

[ZacsMumme]

It does sound like maybe the teething is causing a flare up. ... Can you see if the tooth is cutting yet? With teething I always pain medicated before naps and BT if my LO was in a lot of pain

[krispifsu]

I can feel it just at the gum - but it's been just sitting there for 2 weeks and hasn't cut through yet

Last night was a handful - I ended up just APOP to get him sleep and he slept fairly well from about 11-6:30 this morning with one quick NF. 

I'll try pain meds through the day today and see if we can't get some better naps. 

[ZacsMumme]

gross...teeth can be evil! Good luck today

[krispifsu]

Yes - that tooth is driving me crazy because it just seems to be stalled. 

Last night went well - BT @ 7:20, one NF @ 2:00 and Awake @ 6:30.  Confusing though because I forgot pain meds @ BT and that's the best night we've had in a while! 

Today I pushed him to a 4 hr A time and I got a 1 hr 20 minute nap - also best nap we've had in a while!

I think my son is messing with my head to see how many times I'll try to adjust his schedule only for him to adjust it himself!

[ZacsMumme]

They are really had to read at this age. Glad you had a good night and nap