Thursday, February 1, 2007

Scientific Obsession

Last night I took a step back and redefined Wren's "sleep problem". The problem is not that he wakes too often but this:

Wren sleeps in the wedge. He has Zantac at bedtime. Firstly he has 2 or 3 periods of 2 hour peaceful sleep starting around 8 to 11pm. Then, around 3-5am he enters a very disturbed period of sleep lasting 3 hours. He thrashes, grunts and half cries, strains, flails arms and legs (kicking of swaddling blanket) then settles for a few minutes then repeats the grunting, snorting and flailing. I turned the light on and watched him... his eyes are flicking under this eyelids and he looks like he is about to wake but doesn't. He falls asleep for a short period and repeats.

If I interupt this by nursing he usually latches and nurses for 5 minutes and then falls into a better sleep for about 20 minutes before staritng again. He naturally rouses himself every 45 minutes to and hour.

This is the behaviour that is most disruptive to my sleep because I can't sleep through it and worry about him. I have some theses I will type in later. Any ideas?

8 comments:

Anonymous said...

Hi Shannon,

Tracy here. You sound exhausted and worried. The fear is how much of Wren's sleep is normal baby stuff and how much is caused by his heart? I've got a long post that I'm copying from Elizabeth Pantley's book "No-Cry Sleep Solution." It can at least give you a yardstick for "normal."

A baby is not born with an adult circadian rhythm. A newborn baby's sleep-wake cycles are spread throughout day and night, gradually settling into a pattern of defined naps and nighttime sleep.

A baby's biological clock begins maturing at about six to nine weeks of age and does not work smoothly until about four to five months. As the biological cycle matures, a baby reaches a point when she is mostly awake during the day and mostly asleep during the night. At about nine to ten months, a baby's sleep periods consolidate so that she wakes up and goes to sleep at about the same times every day, and her sleep spans are longer.

Because the biological clock is the primary regulator of daily sleep and wakefulness patterns, it is easy to see why a baby does not sleep through the night - and why this pattern so adversely affects new parents!

Babies move through the same sleep cycles as adults do, but their cycles are shorter and more numerous. Babies also spend much more time in light sleep than adults do, and they have many more of those in-between stages of brief awakenings.

A typical baby's night-time sleep cycle looks something like this:

Drowsy; falling asleep
Light sleep
Deep sleep for about an hour
Brief awakening
Deep sleep for about one to two hours
Light sleep
Brief awakening
Rapid eye movement (REM); dreaming sleep
Brief awakening
Light sleep
Brief awakening
REM (dreaming sleep)
Brief awakening
Toward morning: another period of deep sleep
Brief awakening
REM (dreaming sleep)
Brief awakening
Light sleep
Awake for the day.

Tracy here. I wonder if the REM sleep is causing the thrashing about. I know even some adults do not lie still in REM sleep. My take from the Elizabeth Pantley book was that early habits pay off hansomely in the future. In other words, unless Wren is actually hungry, you may set up a hard pattern to break by breastfeeding during those thrashing times or times of brief awakenings. I wonder if you are so worried, rightly so, about Wren's health that you are sleeping lighter and therefore cannot sleep through his sleep. Is there a way you can train your brain to listen for his cries, but let him dream? I don't know. I know I was so scared about SIDS that I listened to Annadora's breathing for the first year of her life. I felt like I could, and needed to, will her to live through the night. I remember waking up panicked the first time I slept soundly through the night.

Don't know if it helps to know that the sleep biology will smooth out in a few months. Hopefully you find some comfort in this post.

--
Tracy

Shannon said...

Hi Tracy
Thanks for that info.

Actually I am not so much worried as exhausted. This is not the little grunting sounds you hear from a baby... he is full on vocalizing and thrashing about so much he kicks off everything and while I was watching he hit himself on the head twice and opened bleary eyes before sleeping again.

You can ask Josh - its not the kind of thing I could sleep through without earplugs and that doesn't feel safe.

I don't think this is heart related. The only way that could be is if his breathing slowed to the point he was desaturating and then needed to flail to self-rouse. At the time his breathing is often only slightly slower than "normal" for him so I don't think that is it. He breathes slower in his normal deep sleep. Also, at the hospital he did this on the monitors and his sats didn't alter at all.

I agree I shouldn't nurse him too much through this but oh my god, that half hour of quiet sleep is so good. Even with a pillow on my head the whingeing is too noisy.

Anonymous said...

Swaddle him up tight with his arms (here is the key) at his sides. If his hands are across his chest, near his face, etc. he will get them loose and tear everything off and wake up. If he is swaddled snugly with his arms at his sides then he will be less likely to startle and wake up. Babies who are swaddled this way tend to sleep more like 3 hour stretches on average. It also helps with soothing fusiness - babies like the comfort of being wrapped snugly (reminds them of the womb) and that is one of the reasons he like the sling so well.

Here is the technique I teach:
Spread out the blanket in a diamond shape and fold the top corner down. Lay your baby on top, with her neck at the fold. Fold one top corner down and across her body, holding baby’s arm straight at her side, and tuck it under her. Fold the bottom corner on the same side up. Now fold the other top corner down, holding her second arm at her side, and pull it snugly to about the middle of baby’s chest. Bring the bottom of the blanket up and across your baby’s body, wrapping it snugly. Notice that your baby’s legs can still flex and move, but her arms are held still.

Here is a link to a video demonstration: www.todaysparent.com/baby/healthsafety/article.jsp?content=20030807_121003_2224&page=1

Instead of nursing him down when he wakes, try swaddling him up again, holding him on his side while he sucks on his binky and shushing right next to his ear while you gently jiggle him. It's worth a try.

Sarah

Anonymous said...

Hi Shannon,
I will add my brief 2c as you already have lots of great ideas posted. Unless he is truly awake, no matter what amount of noise he is making, you are not obligated to do anything for him. It would be best to leave him be. He does not need to be fed during that time and feeding him is likely to set up habits that will be harder to break later and also interfere with his current sleep cycle. Try to sleep yourself when he is napping at other times (I know that is easier said than done when you have so much going on). Good luck! - Josephine

Anonymous said...

Shannon--
I am wondering again if it is related to his reflux. How long is the half life of the zantac??? Ian would often awake early morning and have trouble getting back to sleep-- hence the swing. Why not try the other med??? Are there any down sides to trying it??? Or, what about putting him in the swing during this fussy time to see if this might help. I know nothing about cardiac issues with sleeping, but I so remember Ian and having those early morning bleary eyed wake times. I'm not sure if all this feedback helps or not, but know you are not alone.... suzie

Anonymous said...

Shannon,

I do think that if nothing else is working that maybe he could be hungry/need comforting and you could try nursing. He is still young to be going the whole night through without any nursing (as are most exclusively breastfed newborns...) But you certainly don't have to do it every time and you should allow yourself to stay asleep. Try to find a happy medium and ask Josh to help. Wren needs to learn to be soothed by Josh too.

Sarah

Shannon said...

Thanks for the ideas. I shall swaddle more tightly in future (was doing arms bent not at sides as he likes it better like that but it gives more wiggle room). I shall also resist nursing him until he actually opens his eyes and cries. that may be hard as he is really really noisy in the half waking state. I wonder whether my camera can record in the half light - if so I will do a little video of him so you see what I mean.

Suzie, I am going to discuss this with our pediatrician on Monday and see whether seh thinks prevacid is warranted. She said that she would tend to stick to Zantac unless he had trouble gaining weight but if she thinks this may be reflux related (I wonder, myself) it might be worth a try. He does gulp and wince then cry fairly often so that may be reflux bugging him.

Ariel said...

Zantac is amazing... relieves my lil cupcakes heartburn, hope I can also take it to relieve my heartache! LOL Got it online at www.medsheaven.com