My Sleep Bible (Part II)

I have a few things that I get very passionate about. Kids and sleeping is one of them. I feel like I have had good success in the sleep department and truly want all mothers to feel as rested as I do. (Which of course is still not as rested as I dream of being.)

Many of you read my "Sleep Bible" post where I give the details of our success in getting our children to sleep on their own, through the night, by 8-12 weeks of age. If you haven't, you can access it here. 

I recently came across another fantastic sleep article online which is now going to be Part II of my Sleep Bible. This article was taken from a book and adapted for Parents magazine.* You can read it in its entirety below (or you can click here).

HAVE A GREAT SLEEPER
Over the past 20 years, more sleep manuals have come and gone than any other type of parenting book. Yet some of these guides actually misguide parents and can make things even more confusing. My hope is to replace the many mistaken ideas about sleep with new insights. Here's my promise: Your child's sleep problems can be prevented or solved, quickly and lovingly, probably without "crying it out." thousands of parents have gotten more sleep with the methods you're about to learn, and I'm confident you will too.

Try This Crazy But Smart Technique
I'll start with one key suggestion. It may make you think I've lost my marbles, but humor me. This method is key to improving the sleep of everyone in the family. It's called "wake-and-sleep."
Many sleep experts warn that moms who lull their baby to sleep in their arms or while nursing are setting themselves up for misery. They caution that these babies won't learn to self-soothe and will scream for Mama's help every time they pop awake. The advice may sound logical, but it puts parents in a terrible bind because it's totally impossible to keep a baby from zonking out when she's in a cozy cuddle with a stomach full of milk. And it's just wrong to tell parents and caregivers not to cuddle their baby to sleep. You're not spoiling your baby when you do this -- you're teaching her that you love her and that she can depend on you.

But rocking and nursing your baby to sleep can sometimes create a problem; she won't learn to self-soothe to sleep. To solve this, turn on a track of white noise when you're ready to settle your baby for the night (rumbly sound is better than hissy sound). Then feed her, with lots of rocking. After the feeding, swaddle and rock her some more.

As you place your munchkin in the crib, swaddled and with the sound playing, jiggle her or lightly scratch her feet to wake her up a tiny bit. After a good feed, babies act kind of drunk from the milk. So when you rouse your child, her eyes will open -- maybe even roll around in a blurry stare -- but then she'll probably fall right back asleep.

If she starts crying when you wake her, pat her back (like a tom-tom drum) before putting her down, or place her in the crib and give it a fast jiggle for 30 seconds. If she keeps fussing, pick her up to calm her ... but be sure to wake her again when you put her back down.

You're probably thinking, "There's no way I'm going to wake my sleeping baby!" But this is one of the most important tips I can teach you. These few seconds of drowsy rousing are the essential first step in teaching your baby to self-soothe. Practice this now, and I promise you that within a few weeks you'll get a huge reward: Your little one will become much better at getting herself back to sleep (as long as she's not hungry or uncomfortable).

Help Breastfed Babies to Sleep a Bit Longer
It's a fact that infants who nurse wake up their mom more often. And as the months pass, they continue to wake a couple of times at night, unlike formula-fed babies, who sleep for increasingly longer stretches. It's not that your nursing baby can't go longer -- he can, but only if you make an effort to teach him how.

This point was underscored by a fascinating study from the University of Illinois. The researchers told 13 first-time moms to wake their baby between 10 p.m. and midnight and offer him a feeding (a so-called "dream feed"). Then they were also told to respond to their baby's nighttime cries with one minute of loving care (re-swaddling, diapering, a quick walk-and-pat) before offering him the breast. The results were striking: The infants ate less at night but more during the day. Plus, they soon began sleeping longer -- and by eight weeks, all of them were sleeping from 12 a.m. to 5 a.m. (compared with only 23 percent of the babies whose mom nursed them as usual).

So if you're nursing, here's what I recommend for the first month:

• Swaddle your baby and play the right type of white noise all night long.
• Have him sleep next to your bed.
• Practice the wake-and-sleep method every time you put your baby to sleep.
• Nurse him every 1 1/2 hours or so during the day. (If he's napping, try not to let him go longer than two hours.)
• Feed five minutes on one side and then finish on the other side. This may run counter to what you have been told to do, but it'll stimulate both breasts and still make sure your baby gets plenty of your rich hindmilk.**
• Wake him for a dream feed around 11 p.m. to fill up his tummy.

During the first weeks, don't let your breastfeeding baby sleep more than five hours straight, counting from the end of one feeding to the beginning of the next. (Most won't go any longer than three to four hours anyway, but some babies get so comfy they forget to wake and don't get enough milk.)

For Months 2 and 3, follow the same steps, but at night let your baby sleep longer (he'll probably go at least six hours). If he continues to wake at, say, 3:30 a.m. in spite of the dream feed and strong, rumbly white noise, try setting your alarm to give one more dream feed at 3 a.m. You want to wake him before he wakes you so you're giving him the nourishment he needs but you're not rewarding him for waking and crying.

You'll know that your baby is getting enough to eat when your breasts feel full at feeding time and much softer at the end; your baby is happy after a feeding and not hungry again for one or two hours; he has five to eight heavy, wet diapers each day; and his stools are runny, seedy, and yellow or green. (By 6 to 12 weeks, his poops may become thicker and golden brown.)

Help Toddlers to Fall Asleep Faster Bedtime was frustrating for a dad I know named Aaron because his 2-year-old, Emma, would make him sing "Twinkle, Twinkle Little Star" over and over, until she fell asleep. "She insists that I sing 'Twinkle' to her about 10 gazillion times!" he said. "Sometimes she seems to be asleep and I'll try to ease myself off her bed, but if I make any sound, she'll immediately stir and demand, 'Twinkle!!' Then I'm stuck there for another 20 minutes."

To save Aaron's sanity, I taught him a simple trick that I called Twinkle Interruptus. For a week, I had him use a white-noise CD for all of Emma's naps and night sleep. About an hour before bedtime, he quietly played a rain track and continued it from lights-out until morning, increasing the sound night by night until it was as loud as a shower.

Five times a day, Aaron also practiced patience-stretching, which means when Emma asked for something he'd almost give it to her, but had her wait for brief (and increasingly longer) periods of time before he gave it to her. She was soon able to wait a whole minute without complaining. Now Aaron was ready to start. On the first night, he put on the white noise, snuggled with Emma, and sang to her for a few minutes. Then he shot a finger into the air as if he'd just remembered something important, and said, "Wait! I forgot to kiss Mommy. Here, hold your teddy bear. I'll be right back." He left the room for five seconds. Emma's practice with patience-stretching during the week gave her the confidence to wait. Soon he came back in, whispering, "Good waiting!" He cuddled up with her and started singing again. After a few more minutes, he did the same "Wait!" routine, but this time he left for 15 seconds. Again, Emma tolerated it fine, and when he returned, he said, "Good waiting!" and sang to her until she fell asleep.

The next night, Aaron repeated the same actions -- but his first exit lasted for 30 seconds and his second for a full minute. When he tiptoed in at the end of the second time, Emma was fast asleep. And she stayed asleep!

If you try this with your child and she cries when you leave, immediately return to comfort her -- she may be experiencing some particular stress or fear. Over the next few days, continue patience-stretching during the day, use white noise for sleeping, and make sure she has a lovey to hold when you go away. But when you do Twinkle Interruptus, don't leave the room. After saying, "Wait!" simply go to the other side of the room and pretend to search for something. Then return to the bed and say, "Good waiting!" Gradually increase the amount of time you spend on the other side of the room. If she tolerates that well after a couple of days, try briefly leaving the room again.

You'll actually have fun with this approach. I've seen it work about 75 percent of the time with kids older than 18 months. I've even had parents report success using it to help sleep-train their 12-month-old without tears!

My Take on Bedsharing Forty-two percent of families in the U.S. bedshare when their baby is 2 weeks and 34 percent bedshare at 3 months, according to research from the University of Virginia. However, many reported cases of tragic deaths have been associated with bedsharing. For that reason, scientists have spent a great deal of effort over the past 20 years evaluating if -- and how -- babies can safely bedshare. And the results are worrisome.

In a study by British researchers, a third of sleeping moms accidentally rested an arm or a leg on their baby. Infant-sleep experts in New Zealand videotaped 80 infants -- 40 in cribs and 40 bedsharing -- and found that the faces of the bedsharing babies were covered for a total of nearly one hour per night. Typically, the mom or the baby cleared the blanket away. But five still had their head covered when they awoke in the morning.

On the other hand, it gets a little confusing because bedsharing babies in Japan don't have a higher SIDS risk (possibly because they're sleeping on hard futons). And studies in England, Canada, and the U.S. have found no increased risk with bedsharing as long as the parents are sober, attentive, and nonsmoking.

Still, after considering all the current studies, most respected medical groups, including the American Academy of Pediatrics, recommended against bedsharing with babies under 1 year.

While I see the benefits of bedsharing with older babies, I am too nervous to suggest it during an infant's first four to six months -- or first year, if you smoke or are obese, profoundly tired, or using alcohol or drugs (even antihistamines). Why take even a small risk? I believe the best approach is to have your baby sleep right next to your bed in a bassinet or a crib, but not in your bed. You can easily nurse and comfort her, and you'll sleep better knowing you've done everything possible to keep your baby safe.

*Originally published in the July 2012 issue of Parents magazine.
From the book The Happiest Baby Guide to Great Sleep: Simple Solutions for Kids From Birth to 5 Years, by Harvey Karp, M.D. Copyright © 2012 by Harvey Karp, M.D. Published on June 12, 2012, by William Morrow, an imprint of HarperCollins Publishers.

**Not sure I completely agree with the whole hind milk section. This is a fairly inconsequential point in my opinion.

P.S. This post is not intended to cause a debate about bed-sharing. I have many friends who bed-share. It is simply providing the recommendation of the American Academy of Pediatrics. It is a very small suggestion compared to the rest of what is in the article.