Friday, March 26, 2010

Day 65: Trying to find the sweet spot between not tired and too tired

Sometimes my insights seem blinding in their obviousness... after I have them. But it has come to me that perhaps Mari has been having trouble falling and staying asleep because she's not really tired when I try to get her down for a nap.

I once again experimented with letting Mari set her own schedule today, to see what's changed. And clearly, some things have. Mari can happily stay awake longer than ever, and I've finally decided she's given up on her third nap for good -- it's been a couple of weeks since she's taken one and she hasn't even seemed close lately.

I didn't set out to let Mari set her own schedule when I woke up this morning, but when I was trying to get her down for her first nap at about 9:15 it became clear she was nowhere near the point of sleep. So I decided I'd let her stay up for another hour or until she started showing signs of fatigue, whichever came first. Well, the hour mark came first and she wasn't sleeping until 10:30. However, she napped without waking for nearly an hour and a half.

The afternoon worked less well. I decided to do it purely on sleepy signs. But Mari has never been very consistent or clear about showing signs of fatigue until she's already overtired, and that's what happened. The screechiness of overtiredness came on suddenly, without so much as a warning yawn. She didn't go down for her afternoon nap until close to 4 PM and she was up again 35 minutes later. I suspect short naps are likely to happen when she's either overtired or undertired, and I think we've been having plenty of both lately.

So the conclusion I'm coming to is that Mari's schedule needs to change to reflect her only having two naps a day and greater comfort with being up three to four hours at a stretch. But she clearly does need to have a schedule, because she's not old enough to know what's best for her.

Another thing I've been thinking about is moving Mari's bedtime slightly later, in hopes of getting her to sleep a little later in the morning -- she's been waking up before 7:00 most of the time, and 7:00 is just barely tolerate for me. Last night she went to bed early (7 PM) because she hadn't napped well, then she was up and wanted to play at 5:30 AM this morning, though I eventually managed to get her back down for awhile before she woke up for good at 6:50.

Perhaps a new (ideal) schedule might look like this (not including feedings), with half an hour of flexibility on either side for naps:

7:00 - Up and play
9:30 - Naptime routine
10:00-11:30 - Nap
2:30 - Naptime routine
3:00-4:30 - Nap
7:00 - Bedtime routine including bath
8:00 - Asleep

If she really follows this, she should be getting about 14 hours total sleep a day, about ideal for a baby her age, and she would never be up more than three and a half hours at a stretch. Anyway, I'll give this a try for the next few days and re-evaluate.

Wednesday, March 24, 2010

Day 63: A near-perfect day and rethinking night weaning

Mari had a great day today. A morning and an afternoon nap of an hour and a half each, and hardly a moment of fussing all day, none at all at naptime or bedtime. Of course, I can't count on every day being like this, but I want to celebrate the good days. I did have to put her back down when she woke up from her morning nap, but at least she let me put her back down. And she slept all the way through her afternoon nap. Though she cried out a bit in the middle, when I went to check on her she was still asleep.

I am, however, reconsidering if I should try to limit her to one night feeding. I had been thinking I ought to because that's what our doctor said. I like our doctor; I think she's a very reasonable woman. However, Mari isn't a big eater during the day. I have been trying to feed her at least once every three hours lately but until recently she was often going four hours between breastfeeds -- I was more or less feeding on demand, but she didn't demand feedings often. Even with the effort now to feed her more often, I really don't think she's eating any more even when she does take the breast. She often stops before my breasts feel really drained, or really feeds properly off only one breast. And her weight gain has been slow lately.

Doctors seem to say a lot of different things about when a baby should night wean. Some say they're ready at three months; other say it's OK to night nurse well into toddlerhood. That tells me there's no definitive answer.

Mari hasn't demanded feeding more than twice at night in a long time. Sometimes she wants to nurse only once; rarely, not at all. But twice a night, considering she's sleeping an average of 11 to 11.5 hours in total, isn't too much to ask. I don't want her to get into a habit of nursing at night unnecessarily. But for now I will continue letting her nurse twice a night, though I will still limit it to 5 hours after she goes to bed, then 3 hours after the first night feeding. I will offer both breasts at both feedings.

Sunday, March 21, 2010

Day 62: The new, hopefully permanent sleep plan (draft)

(Published on Tuesday, Mar. 23, despite the incorrect date stamp above.)

Over the past two months, I've tried all sorts of things to get Mari to sleep better. Some have worked better than others. I thought they were worthy experiments, but consistency has been a problem. Also, it has taken me some time to work out exactly what I'm comfortable with in terms of crying. This plan is not a strictly no-cry plan, since it allows for up to five minutes of crying or 20 minutes of mild fussing between us going in. (For a discussion of the difference between fussing and crying, see It isn't a cry-it-out plan either, since we will respond to crying fairly promptly, without trying to stretch out time between responses. However, it does have as a central feature the idea that we will no longer put her to sleep -- she is responsible for falling asleep on her own. So this plan is something of a hybrid between the No-Cry Sleep Solution and Ferberizing, though some elements have been taken from Healthy Sleep Habits, Happy Child and others I've simply made up based on what has worked with Mari so far.

This plan is subject to change after Jon has a close look at it. Feedback from other people is also more than welcome. Once I have that feedback and made changes if necessary, I hope to keep this plan in place more or less permanently, though of course we will change the schedule as Mari grows and her sleep needs change -- and if something really isn't working out, we'll change it. Anyway, here's the draft plan.

1.  Schedule: I will impose a schedule of nap times, bedtime and wake times, but with flexibility of up to half an hour on either side for naps, depending on how tired (or not) she seems and how long she slept the last time. I will try my best to maintain a more consistent bedtime, starting the bedtime routine as close to 6:30 as possible every night. If I absolutely have to break the schedule, I will try to get Mari back on track as soon as possible, but I will never wake her up from a nap, except in the unlikely event she naps later than 6:00 PM. The schedule will look like this:

7:00 AM: Up (See point #2)
9:00: Start naptime routine, set down by about 9:20 (see point #3)
9:30(ish): Asleep/quiet time (see point #6)
10:30: Active play time
1:00 PM: Start naptime routine, set down by about 1:20
1:30(ish): Asleep/quiet time
3:00: Active play time
(See point #7 for a discussion of the third nap)
6:30: Start bedtime routine, set down by about 7:20 (see point #4)
7:30(ish): Asleep

2. Morning wake-up time
  • If Mari wakes up before 5:30 AM, I will treat it as a night waking. (See point #10)
  • If Mari wakes up between 5:30 and 6:30, she's vulnerable to not being able to get back to sleep. So at this special time, I will do whatever it takes to get her back down, including nursing (if she hasn't yet had a second night feeding; see point #11) and rocking all the way to sleep.
  • If Mari wakes up between 6:30 and 7:00 AM, I will ignore her even if she fusses mildly, keeping her in her crib with the blinds down and lights off, until 7:00. If she starts to full-on cry, I will use the procedures outlined in point #5.
  • If Mari wakes up between 7:00 and 8:00, that's fine.
  • If by some freak chance Mari hasn't woken up by 8:00, I will wake her up to protect her schedule.
3. The naptime routine will consist of:
  • Trip to potty/change
  • Two stories, one in Japanese and one in English (with the option to cut it off at one if she seems really tired)
  • Blinds closed, white noise machine on
  • Two lullabies while rocking if she lets me rock her, one in Japanese and one in English (with the option to cut it off at one or even part of one if she starts looking like she's going to fall asleep.)
  • Put down in crib still awake but drowsy (with the option of putting her down while I'm still singing lullabies)
  • Good"night" kiss and leave the room
4. The bedtime routine will consist of:
  • Bath
  • Massage
  • Put on pajamas and disposable diaper
  • One to three stories, the last of which is always Goodnight Moon
  • Breastfeed (no trip to potty unless she obviously needs to poo or actually does so)
  • Up to two lullabies while rocking (see note above)
  • Put down in crib still awake but drowsy (with the option of putting her down while I'm still singing lullabies)
  • Goodnight kiss and leave the room
5. Procedures if Mari fusses or cries once she has been put down for a nap or night sleep:
  • If Mari mildly fusses, I will wait five minutes, then go in for her first check and soothe. This first soothing happens quickly because I want to let her know I haven't abandoned her just because I left the room. However, if it sounds like she's right on the point of falling asleep, I will wait up to five more minutes to see if she can fall asleep on her own.
  • When soothing her, I will pick her up, shush her, rock her, stroke her hair, pat her bum -- whatever feels right. However, I will not do any of these things until she falls asleep. If she starts to close her eyes in my arms, I'll put her down immediately. I will avoid talking to her or turning on the light, as I don't want to stimulate her. I will strictly limit time in her room to no more than two minutes and will put her down still fully awake but hopefully calmer. If she doesn't calm down within two minutes, I'll still put her down and leave the room.
  • If Mari continues to fuss, not full-on cry, I will check on her at 20-minute intervals, unless it sounds like she is very close to falling asleep at the 20-minute mark, in which case I will wait five more minutes. If the fussing turns into crying, see below.
  • For naptime, if an hour has passed since I put her down and she has not fallen asleep, I will let her get up. If she seems really tired and hasn't slept at all, I will take her for a walk, weather permitting, and see if she falls asleep in the stroller or carrier. If the weather is bad, I may or may not take her for a car ride.If she falls asleep in the stroller/carrier/carseat, I will try to maintain the same environment until she wakes up on her own, but I won't try to put her back to sleep again until it's time for her next nap. If I decide not to take her for a car ride but I think she still might fall asleep soon, I will let her play quietly in her crib. If she doesn't want to be in her crib, I'll get her up fully. If she doesn't fall asleep, I'll let her stay up until the early end of the range for her next nap or bedtime.
  • At bedtime, I will continue checking on her every 20 minutes indefinitely, as long as she's still fussing, not full-on crying. It's unlikely to ever come to this, though.
  • If Mari starts to really cry or scream, sounding very upset, I will still not go in right away, since I don't want her to learn that we'll come running if she screams louder or longer. I will wait two minutes, then go in and soothe her as outlined above. I will still limit time in her room to two minutes. 
  • If she continues to really cry, I will perform the check and soothe routine at five-minutes intervals. I don't think I'm rewarding her for being louder by going in more often, because my response is still not immediate and because my response will remain the same -- i.e. no rocking all the way to sleep. Also, if she continues to full-on cry despite my best efforts at soothing, I will still put her down after two minutes in her room and let her cry for up to five more minutes. See point #11 for a discussion of if I will nurse her at night.
  • If at any point there is a real problem causing her to cry (i.e. she has vomited), I will fix it, even if it takes longer than two minutes and even if I have to turn on a dim light at night. However, once the problem has been fixed and she has calmed down, I will leave the room. I will still avoid rocking her all the way to sleep, though I may have to make temporary exceptions if she's sick or in pain.
  •  Because there is a continuum between mild fussing and crying, if I'm unsure about which category it falls into, I'll treat it as crying. The point is not to ignore an upset baby -- I want her to know we're here and we will always respond to her quite promptly if she's upset. On the other hand, Mari often seems to need to "talk" or mildly fuss a bit to put herself to sleep, and I don't want to rob her of the opportunity to do so.
6. Quiet time: Procedures if Mari wakes up from a morning or early afternoon nap of less than an hour
  • I will go in right away and do anything I can to get her back down, though that will include nursing only if it's an appropriate time to nurse (see point #8) or if she's showing signs of hunger. If she starts to fall asleep in my arms, I will gently put her down. If putting her down upsets her and she doesn't seem to be trying to fall back asleep, I will pick her up again rock her all the way to sleep before trying to put her down. If she wakes up a second time, I will rock her to sleep again. If she wakes up a third time, I'll let her stay up for quiet time.
  • If after 10 minutes of soothing, it seems like there's no way she'll go back down, or if I have tried and failed twice to put her down, I'll give her some toys and let her play quietly alone in the crib. I will keep the blinds down and white noise machine on until the end of quiet time as per the schedule in point #1. 
  • If I started the naptime routine earlier or later than usual, quiet time is to last an hour from the time I put her down. 
    • It appears Mari has pretty much given up her late afternoon nap. However, if she seems really tired around when she used to have her third nap (between 4:00 and 5:30), I will take her upstairs and perform the naptime routine as fast as possible.
    • If she falls asleep, great. If she fusses, I will do a check and soothe at the five-minute mark, then again if necessary after another 10 minutes, not 20 (five minutes, as always, if she full-on cries). If at that point she doesn't seem likely to fall asleep, I will give her quiet time in her crib, with toys, for another 15 minutes, for a total of 30 minutes of quiet time. If she doesn't fall asleep but doesn't fuss either, I'll let her be for a total of 30 minutes of quiet time.
    • If she never seems tired enough to go down for a third nap, I won't worry about it and won't try to institute a late-afternoon quiet time.
    • If she does fall asleep, I will limit the third nap to a maximum of one hour, or until 6:00 PM, whichever comes first.
    • If she starts to seem really tired between 5:30 and 6:30 PM, I'll start her bedtime routine a little early instead of trying to give her a third nap.
    8. Daytime breastfeeding: Since Mari is now usually having only two naps, feedings will no longer be tied to naptimes or bedtimes.
    • I will feed her soon after she wakes up in the morning, then every three hours or so thereafter during the day, sooner if she shows signs of hunger. 
    • If she refuses to nurse on the three-hour mark, I will wait half an hour and offer the boob again. If she shows signs of hunger before that, I will offer the boob sooner. 
    • If it has been more than two hours since she last ate and she's about to go for an outing or down for a nap, I will offer her the boob before the outing or nap. 
    • If she refuses to nurse before a nap, I won't worry about it and will put her down for the nap regardless. 
    • I will try to avoid lengthy outings if she hasn't eaten beforehand (a short outing is OK) because she's too easily distracted these days to nurse in public.
    9. Solid food: Mari will be offered fruit or cereal when we're having breakfast and some of whatever we're having at lunch and dinner. She may sometimes skip solids at lunch, but she should always be offered solids at breakfast and dinner. Breakfast will usually start between 7:30 and 8 AM, lunch between 12:00 and 12:30 PM and dinner between 5:30 and 6:00.

    10. Night wakings and night feedings:
    • If Mari starts to mildly fuss (not cry) at night, I will let her fuss alone for up to 10 (not five) minutes or until fussing turns into crying. If necessary, I will encourage Jon to put in his earplugs and shut the door while I go to the guest room with the door open so I can accurately gauge the quality of her cries. 
    • After 10 minutes of fussing, I will do a check and soothe as outlined in point #5 OR feed her as outlined in point #11.
    • If it isn't an appropriate time for a feeding, I will let her mildly fuss for 20 minutes before doing another check and soothe if necessary.
    • If she starts to really cry, I will wait two minutes the first time, then do a check and soothe OR feed her as outlined in point #11.
    • If she continues to full-on cry and it isn't an appropriate time for a feeding, I will check and soothe once every five minutes. 
    • If she has been full-on crying for a total of 15 minutes, despite two soothing sessions in the middle, and it's within an hour of a normally acceptable time for a feed (i.e. four hours since she was put down or two hours since her last night feeding), I will feed her.
    11. Night feedings:
    • I will feed her no more than twice at night. Her first feeding can be a full one and can occur anytime after she has been down for a minimum of five hours. Her second feeding can occur anytime after she has been down for a minimum of three hours after her first feeding. 
    • I will make exceptions to the above if she has been crying hard for 15 minutes as outlined above, or if she is going through a growth spurt or teething. In those cases, I will feed up to three times a night. However, after the growth spurt or teething is over, I will return to a maximum of two night feedings.
    • I AM RESCINDING ALL POINTS FROM HERE ON DOWN: I am spending this month (from seven to eight months old) trying to wean her from the second night feeding, on the following schedule:
    • Mar. 20-27: I will offer only one breast at the second night feeding. If she fusses for more than 10 minutes after I put her down or wakes up again within 30 minutes of getting the first breast, I will offer the second breast.
    • Mar. 27-Apr. 3: I will offer only one breast at the second night feeding. If she fusses for more than 10 minutes after I put her down or wakes up again within 30 minutes after getting the first breast, I will offer the second breast, but I will limit her time on it to seven minutes the first night, six the second night, five the third night, etc.
    • Apr. 3-10: I will offer only one breast at the second night feeding. If she fusses or wakes up again I will use only my check and soothe techniques to try to get her back to sleep.
    • Apr. 10-20: I will start to limit time on the first breast to 10 minutes the first night, nine minutes the second night, and so on.
    • I will try to wean her from the first (and hopefully by then only) night feeding in a similar way between the eight-month mark and the nine-month mark.

    Day 60: Taking stock

    Wow, it has been 60 days since I started the No-Cry Sleep Solution. While I don't consider Mari's sleep issues 100% "solved," her sleep habits have improved out of sight. Two months ago:
    • She was waking up about a dozen times a night
    • Her longest sleep stretch was typically about two hours
    • She had to be rocked (or occasionally nursed) to sleep each and every time
    • She rarely napped outside her sling; if she did, she had to co-nap snuggled up to me or Jon. At night she slept in our bed. (Please note I don't consider co-sleeping necessarily a problem for everyone at all times -- we loved it when Mari was younger. But it was becoming a problem for both us and her.)
    • She typically wakes up just once a night to feed. Sometimes we hear her "talking" or fussing a bit other than for that one feeding, but she usually manages to put herself back to sleep within a few minutes.
    • Her longest sleep stretch typically ranges from about five to nine hours; occasionally we have had up to 11.
    • She sleeps and naps alone in her crib and doesn't seem to have a problem with it
    • She no longer has to be rocked to sleep; after a relaxing bedtime/naptime routine (including brief rocking but not all the way to sleep) she goes into her crib awake and usually falls asleep fairly quickly (though that still varies, especially for naptime).
    We have accomplished most of the goals I set out when we started this journey. However, there are still areas for improvement:
    • I still think Mari generally needs to nap more. She's often tired and cranky in the late afternoon, but it seems like she's really and truly giving up the late-afternoon nap because she just will not take that nap anymore (though for now I will continue to try to get her down if she does seem tired, on the off chance she actually manages to fall asleep). On days when she has good morning and early-afternoon naps, she isn't cranky, or not until it's pretty much bedtime anyway. But if one of those naps is short, or worse, both are, watch out!
    • Lately the morning nap has been the biggest problem. She really does best when she naps at least an hour, preferably an hour and a half, in both the morning and early afternoon. But she often wakes up from her morning nap after not much more than 30 minutes, and she won't go back down.
    • Sometimes, particularly in the afternoon, I still rock her back to sleep after a premature nap waking. I am somewhat torn on this. I don't want to continue this practice, but I do it if I go in and she still seems obviously sleepy. If she doesn't fall back asleep quickly or seems to be waking up good and proper I abandon the attempt. Maybe I need to have more faith in her ability to put herself back to sleep, even from naps. But my fear is that if she wakes herself up completely she won't be able to go back to sleep even though she needs the sleep, and she'll be a mess.
    • She's still highly unpredictable in terms of when she will nap and for how long. However, her morning wake-up time and night going-to-bed time have become more consistent.
    • Occasionally, though, she wakes up really early and won't go back to sleep. I don't really know what to do about that.
    • Our doctor says Mari doesn't really need night feedings anymore. She wants Mari completely weaned from them by the time she's nine months, which is also the age Healthy Sleep Habits, Happy Child author Marc Weissbluth says is the limit for needing night feedings. I am now trying to restrict her to one night feeding, usually successfully, and will continue to do so. But I'm not going to start trying to night wean her completely until she's eight months. 
    Despite the above issues, in the past two months I feel I've learned a fair bit about baby sleep in general and quite a lot about Mari's sleep in particular. So I will spend the next week or so writing down various aspects of what I've learned and creating a new hybrid plan with elements that work for us taken from various books. I hope other parents will find my experience useful.