19 week old still not sleeping through the night

[chryals]

If anyone out there can help me, I would be ever so grateful.  My 19 week old has acid reflux and slept through the night for three days on week eight (he was strapped down (literally) to an incline pillow where he couldn't move his arms like a tight swaddle, but as he got bigger it is really not meant for sleeping so we have his crib propped up and he is taking medication.  I don't think the reflux is a problem anymore at night.
Right now we are switching from a 3 hour routine to a four hour routine.  I breast feed one side only at each feed and he is satisfied (usually 15 minutes..he is a fast eater..but sometimes at the dream feed we mix half EBM and half formula.
E:7AM
A:7:15 play with Mommy, toys, every A time is this way
S:8:30-45 (he starts getting cranky after an hour and a half) cereal feed (1-2 tablespoons if he takes it)
Y:not much Y time he's a 45 minute napper.  I usuallly go back in there and use the pacifier or soothe in the crib for 45 minutes and if I'm lucky he'll go down for 45 more minutes
El:11AM
A:11:15
S:12:30-12:45 (really depending on when he woke up from the 1st nap)
Y: once again..40 minute naps..same routine as the first nap
E:2:45 (we are working on stretching it out to 3)
A:3:00
S:3:45 (this is the hardest nap of all, he's normally pretty wired at this point and won't go to sleep till after maybe an hour of soothing or will sleep 30 minutes and I do P.U.P.D but does not work yet
Y:
E:5:30 (we are working on going to 6 and eventually 7)
A: bath. cereal (1-2 tablespoons if he takes it, quiet play time, book, cluster feed and bed by 7:3o

Will sometimes wake up once or twice before dream feed, has been having a hard time going down at night

He normally wakes for his dream feed around 10:15.

The night wakings are unpredictable.  He would wake up 1-2 times a night before we started moving him to a four hour schedule, once to feed and once to be readjusted, but since he is 18.5 lbs, we have been trying to use the paci to stop the night feedings.  He wakes up around 4 times a night at unpredictable times, where we can put the paci in. Sometimes he sucks and spits iit out and is satisfied for another hour, sometimes he sucks and as soon as it falls out he is up again (the latter normally happens around 5ish if it happens).  When he wakes it starts as a mantra cry but escalates to a full blown cry.
I am so sleep deprived with short naps and not good sleep at night.  Please help if you can.  I have had my baby on EASY since birth.

[Colin Macs Mom]

Sorry to hear that you're having a tough time    I see a few things going on so I hope that my suggestions will be helpful for you.

My DS also had reflux, and he didn't sleep through until he was 7.5 mo.    Refluxers will often have a much harder time with sleep and take longer to sleep through, I suppose because they have such a tough time in the early days and get into the habit of waking. I'm not saying that he will never sleep through or anything like that, but at 19 weeks it's not unusual for him to still be waking. Do you feed at all again after the dreamfeed and before the 7:00am? At 19 weeks he could still very well need a night feed in addition to the DF.

You already seem to know that those 45 minute naps are no good and need to be extended. Keep it up with the PU/PD, it can take some time but it will pay off! And definitely check out the PU/PD forum if you haven't already. He's likely having a hard time going down at night and staying asleep because he's overtired from poor naps.

One more thing, that cereal feed at the very end of the day might be contributing as well. Cereal can cause gas and stomach upset/cramping. If you really want to do two solid meals you might consider doing the second at noon.

[chryals]

Thank you so much for the suggestions.  I will try some of them out.

I was feeding him once or twice a night after the dream feed, but since he is so big, I wasn't sure if it was just habit or hunger so we have been using the pacifier instead and he takes it and doesn't spit it out like he would before when he was hungry so I don't think that hunger is the issue but I would almost just wake up and feed him instead of him waking up many many times a night.  Let's see, last night he woke up at 2:30, 2:50, 3:30, 4:30, and 4:50, then I woke him up at 7 to keep him on schedule.  I hope that was the right thing to do.  Today I could only get 30 minute naps out of him and he was livid by the end of the day.  I'm just at such a loss right now.  I know it could be worse and there could be many more months of this..I absolutely feel for those who have been going through this much longer.  I actually look up to them.  I just don't feel like I can be the best mommy that I can be without sleep. 

[Colin Macs Mom]

Don't worry, you're doing fine. I know what you mean about being a better parent when you're rested - that's soooo true! Is there someone who can give you a break for a few hours so you can catch up a little?

[chryals]

Thanks for the encouragement.  My neighbor is back in town so I think she is going to help me tomorrow at least listen to me cry and my baby crying.   We fed him once last night at 4:15.  He woke up however at 12:45, 2:30, 3:45-4:15 when we fed him then 6:00 talking till 6:20 and started crying so we got him back down but had to wake him at 7:00.  I absolutely hated doing that, but I want to get him on a better schedule. 
P.U.P.D. is so tough.  I have visited the boards on there to get more info and read success stories but I just don't know if I have it in me with little sleep and not much help.  I want to do it, and am still trying it, but I'm getting weary and I know for it to be successful I have to give it everything I've got.    I still use a pacifier at this time (I don't feel like it's a prop yet, but I didn't know if I should be using one with P.U.P.D).  Any suggestions?
Once again, thanks so much for responding.  It reallly means the world to me right now. 

[Colin Macs Mom]

You're right, PU/PD really is hard. Actually pretty much everything about EASY is - as we say EASY is not always easy! And like you said, to be successful you have to give it your all. Problem with that is when you're so tired and spent that you have little to give. I know, I was there myself at one point. I'm glad that you have a neighbor who can be with you though, I hope that you can catch up a bit.

Waking him at 7 to start the day is definitely the right thing to do IMO even though it's not fun. But if you don't he will only interpret that he can play in the night and sleep until he feels like getting up. If you consistently start the day at the same time even if you have to wake him, he'll learn sooo much sooner that that's the way things will be and he needs to sleep at night because he'll be getting up!

As for the paci, I don't see a problem with using it with PU/PD. The only thing is that eventually you will need to decide if you want to run the risk of it becoming a prop (which it usually does) and dealing with that, or not going down that road.