Tips for a Good Night’s Sleep
Bruce Hewett, M.D., is anything but boring, yet he can help put your kids to sleep, if you give him a chance.
That’s because the Vacaville pediatrician has made it his mission to help children—and frazzled parents alike—get a good night’s sleep.
His advice is best shared via video. Several installments are available online at northbay.org/sleepdoc. The videos are geared to help parents of children in specific age ranges.
As a father who learned a lot in dealing with his own children (now fully grown and sleeping just fine, thank you) he draws from real-life challenges. Here is a collection of case studies from Dr. Hewett’s files. The patients’ names have been changed to protect their privacy.
Case No. 1
Problem: A mom recently asked my advice regarding her 8-month-old daughter, Maggie. She was waking up every two hours to breastfeed from midnight to 7 a.m. Despite mom’s attempts to let her “cry it out” for up to 90 minutes, Maggie would not quiet down unless she was picked up and latched onto mom’s breast. Within four to five minutes, she would fall asleep without really swallowing much milk.
Maggie was in a crib in her own room, but mom placed a mattress on the floor next to the crib so she could tend to her without waking up the rest of the family. Interestingly, Maggie was taking four naps during the day, up to two hours long. She was being offered solid food in small amounts twice a day, the rest of her meals consisted of nursing at various times during the day. Her bedtime routine started around 9 p.m. and consisted of a 4-ounce bottle of formula that dad gave to her. Mom was exhausted and desperate, her other two children were also young and required a substantial amount of attention during the day.
Solution: To fix the demanding night schedule, I explained to mom the best strategy is to increase the amount of calories Maggie was consuming during the day. The baby should be offered solids three times a day in amounts that provide complete satiety. Also, I encouraged her to begin to break the “sleep-suck” association by taking Maggie off the breast when she is drowsy but still awake, then place her on her back and massage her feet till she falls asleep. Mom needed to adjust the daytime naps to two hours two or three times a day so Maggie would require more sleep at night.
Finally, and most importantly, the hardest advice was asking mom not to pick her up or feed her between midnight and 7 a.m. When the baby wakes during this time, I advised mom to replace the breastfeeding with a foot massage and a lullaby; gradually decreasing the amount of time she attended to Maggie during the night. Within two days Maggie was no longer demanding to nurse during the night and only required brief reassuring visits.
Case No. 2
Problem: Jeremy is a 3-year-old who falls asleep on the couch while his parents watch TV each night. His dad developed the habit of carrying Jeremy to his bedroom and gently laying him into his bed without waking him up. When Jeremy woke up during the night, he immediately left his room and crawled into his parents’ bed. Dad finally gave up taking Jeremy back to his room and decided to move his mattress into the boy’s room.
Solution: There are many possible solutions, depending on the parenting style. It is important that the parents understand that Jeremy needs to get comfortable falling asleep in his own bedroom. The nightly bedtime ritual must be very consistent since children are always more relaxed if they know what’s coming next. Making a bedtime poster with pictures demonstrating each step of the routine will reinforce the importance of following the bedtime plan. The ritual must always end with Jeremy being placed in his own bed when he is drowsy but still awake.
The poster should have pictures showing what Jeremy should do if he wakes during the night. If he crawls into his parents’ bed, they can refer to the poster that shows a picture of Jeremy returning to his own room. This strategy might need to be combined with a method to confine Jeremy in his own room if he repeatedly defies the bedtime plan.
The parents can reassure their toddler by sitting with him briefly when they take him back to his room. It is important to slowly decrease the amount of time spent with him each night. Some crying is expected and no matter how chaotic the night goes, the wake-up time should stay the same.
Rewards for success work well for toddlers. Although the first few nights can be rough, this method has a high success rate in three to five nights.
Case No. 3
Problem: David is a 12-year-old who is difficult to wake up on school mornings. His weekday routine consists of getting out of bed with difficulty at 6:45 a.m. He is generally tired when he gets home from school, so he takes a one-hour nap. His bedtime is 9:30 p.m. but he isn’t drowsy so he watches TV in bed and typically falls asleep around midnight. The parents are worried because the falling asleep time has been trending later and later. The parents have allowed David to sleep late into the morning on weekends, hoping he would get caught up on his sleep and be more energetic during the upcoming school week, but the problem is getting worse.
Solution: David has a common problem referred to as Circadian Rhythm Sleep Disorder, caused by persistently poor sleep habits. Rather than having a consistent daily sleep routine, David’s sleep is reduced during the week and extended on the weekends. This disorder can be extremely difficult to treat because it requires a lot of motivation by David and support by his family.
The treatment is focused on restoring a normal bedtime and most importantly a wake-up time that is adhered to seven days a week. Naps must be eliminated. Exercising daily and outside exposure to sunlight is very important and will help ensure David is tired at bedtime.
Parents must limit the TV/video games, especially watching from bed because the wavelength of light from the TV causes the brain to stay awake long after the TV is turned off. David’s pattern can be readjusted in seven days if he follows the plan closely.