Wednesday, January 7, 2009

Sleep Training My Triplets

Sleep Training My Triplets

This past year has been an amazing one filled with many milestones for us and for the babies. One of the things that stands out in my mind is the whole "sleeping through the night" thing. It is one of the top ten things I have been asked about when I am out with the babies.

"Do they sleep through the night?"

Technically sleeping through the night is sleeping five hours or more during the night. Tell that to an exhausted set of parents and they'll tell you, "NO WAY" does that feel even remotely close to sleeping through the night. But its certainly better than the hour here and there in the beginning. It was this seemingly unnatainable goal to me, in the beginning. I dreamed of the day that they would finally sleep through the night. And my interpretatation of sleeping throught the night was NOT five hours - but more like twelve. During the most exhausting first weeks of having them home, twelve hours seemed like an impossibility. A dream.

I have finally gotten around to writing another post about our experience with sleep and scheduling since promising you to do so almost six months ago. This one addresses sleep training, Weissbluth style - A HOT topic for sure. I must preface this by saying that I believe that parents all choose to do what they feel is best for their family. In no way do I believe that I know what's best for you and your family. Every family is different and the great thing is that there are so many choices out there. For our family, sleep training was a good choice.

For now, I want to start by just clarifying what I know sleep training to mean, for me. I think there is a misconception among the anti-sleep training folks that "sleep training" equals "abandoning your baby and letting them cry and scream all night long no matter what". While I type that half jokingly, I do know people who are very strongly against all baby-training whose perception of sleep training may be just that - a form of abandonment. However, this is not what I know sleep training to be. Or at least, not the version of sleep training that we implemented. I think many people are referring to the Ferber method when referring to sleep training, which is also informally known as the cry-it-out method. While we did not choose to “Ferber-ize” our children, I do not feel it would have necessarily been a bad thing if we had. I tend to think that the Ferber method is often misrepresented and misunderstood. I believe it has been unfairly characterized as a “shut the door and ignore” or “let ‘em cry all night” type of thing, which it isn’t really. Maybe that’s how some people choose to interpret and implement it, I don’t know. But I’m not here to talk about Ferber since, like I said, its not the philosophy that we used to sleep train our babies. I happened to chose Weissbluth - and I am so glad that I did.

One thing about the Weissbluth method is that it focuses not just on night-time but also on day/wake-time - more specifically, the duration of wake-time (this is KEY), and the activity/stimulation level during wake-time. So, rather than spending all night “sleep-training” your baby, its more like you spend all day focusing on creating a perfect rhythm, which helps lead to healthy sleep. Its pretty simple if you think about it.

Take our own adult lives, for example. To put it very simply, if we have a healthy daytime routine that includes the right amount and balance of activity and rest, it is likely that we will sleep well. It is likely that if we develop a good daily routine – one which includes regular cycles of eating, activity, resting, exercise, etc. – we may also develop healthy sleep habits. Healthy daytime encourages healthy nighttime.

When you think of it that way, it makes lots of sense. Its almost a no-brainer, except for the fact that some people (ME ME ME) are NOT really always living an optimally healthy daytime routine – at least not CONSISTENTLY, and thus are also not really healthy in their sleep habits. If this resonates with you, don’t feel bad. I learned a LOT about MY OWN terrible daytime habits, which lead to pretty crappy sleep habits.

I have NEVER been a good sleeper. I believe this to likely be a combination of A) being born with a certain personality that seems to resist sleep (One of my children is also like this) AND B) by design – or simply not having LEARNED healthy sleep habits. I knew that while I could not control factor A, I could control factor B. I could teach my children how to sleep. This includes daytime sleep - or naps - Which is another HUGE key according to Weissbluth.

According to Weissbluth, daytime sleep is just as important as nighttime sleep. It has its own unique restorative value, different from – but just as important as - nighttime sleep. It is NOT just optional nuggets of sleep that you can consistently skip based on social calendar, convenience or any other potential interruption, without paying a price. And the price isn’t just cranky babies or fussy bedtimes. According to Weissbluth, the price is MUCH greater.

Weissbluth claims that inconsistent sleep and sleep deprivation in babies (and in all children for that matter) can lead to long term issues including problems with learning, behavior, hyperactivity and other health issues. He claims that sleep-deficiency may harm neurological development. Without going into that stuff too much, I will just say that I found this to be alarming! I tend to agree that sleep-deprivation can be harmful.

The thing is, I think there is an expectation that a baby knows how much sleep he/she needs. While I agree with that expectation somewhat, I believe it to be only HALF true. It is missing the important fact that babies need to learn a healthy process of falling (and staying) asleep. It’s true that without interference, the natural process would likely develop. HOWEVER, this is unrealistic given our daily lives. Realistically, our days are usually not perfect for building a good sleep routine and circadian rhythm for babies. People have busy lives and like it or not, babies don’t always benefit from the adult schedules.

Brian and I believed it was crucial to build a foundation of consistent sleep. This was a huge commitment – one that I didn’t realize we would be making until after the babies were born. In fact, I didn’t even buy Weissbluth’s book until the babies were about three months old. As you may know, I had already been using some of what I read in Baby Wise to create a structure and general schedule in my day. It was crucial for me to do so, given the fact that I was alone with all three of them for most of the time. I was encouraged by my game-plan with Baby Wise. Baby Wise was what helped me created a great routine and get all three babies on the same schedule. Before then, they all came home from the hospital on different schedules - which was not ideal. For me, using Baby Wise was great.

However, I saw some holes in my plan. I was sold on Baby Wise’s “Feed/Wake/Sleep” cycle but I was left wondering about their wake and sleep time. How long should they be awake? Until Weissbluth, I was keeping them up WAY TOO LONG and didn’t know it. In my mind, if I kept them up longer, they would be more likely to fall asleep and stay asleep for the “Sleep” part of each feeding cycle. When I read Weissbluth and learned that I should be shortening their wake time to ensure better sleep, I was confused. It seemed counter-intuitive to put them down sooner in order to get them to fall sleep faster and for longer periods. Basically, his advice was to shorten their wake-time to help them go to sleep better. Although I was confused, I was open-minded.

Let me tell you, it was TRULY an instant difference. And by instant, I mean the very first day that I decide to commit to it, there was an immediate difference. Not only in their sleep but in their wake-time moods and in how well they ate/nursed. ESPECIALLY in Alexis. If you remember, she was diagnosed COLIC (this is in CAPS because OHMYGOSH it was AWFUL) by several of the neonatologists in the NICU. After about a month of having her home, I had just resigned myself to having a colicky baby and figured we would have to wait it out - that eventually, she would grow out of it. This was an exhausting and frustrating thing. She cried ALL THE TIME. ALL THE TIME. I’m sorry, am I repeating myself? That’s right. ALL THE TIME.

Anyway, what seemed to really help her symptoms (not all of them because remember -she was also on medications for her digestive issues) was MORE SLEEP, MORE OFTEN. Each daytime 3-hour cycle (feed/wake/sleep) would basically include a bottle & burp, LESS THAN one hour wake time, and then nap – for almost two whole hours. The nighttime cycle remained the same "feed and then right back to sleep" cycle. The change in daytime wake-time was a huge departure from the almost two hours wake-time that we had previously been doing. All three babies seemed to fall right into it. They were happier. I couldn’t believe that first time when I went to put all three of them down for a nap after less than an hour of being awake, that they all went down without the screaming that I was used to. They were not over-stimulated. They were not over-tired. They were just right.

I cried. I was shocked. I was still confused. But mostly, I was exhausted, so I rushed my butt into my own bed (after pumping) for a real nap. I actually slept for more than an hour, which was monumental for me during that period. It was bizarre and new and heavenly. Mind you, this wasn’t every single time. It took some time and some tweaking but there was definitely overall improvement.

Over time, this “wake-time” eventually stretched out to an hour and then an hour-and-a half and then two hours and then to now which is about two-and-a-half to three hours wake-time. Basically, as they got older they were able to tolerate longer wake time. I adjusted accordingly, as I read their cues. I don’t want to go into too many details of their sleep but I want to still get across to you how important of a nugget it was for me to learn - the importance of appropriate wake-time and how it benefited everything we did. Including the quality of the naps.

As I have previously touched upon, the best naps were created by finding that sweet spot of optimal wake time AND by being consistent. REALLY consistent. That meant that NO MATTER WHAT, I made it a priority to be absolutely consistent with their routine and to deviate as little as possible, especially in the first year. I was fierce about their naps and sleep in general. Weissbluth calls it “Protecting your child’s sleep” and I consider it a vital part of the process of teaching a child healthy sleep. It is, however, the area in which I received a LOT of slack. People would say, “You make them sleep too much.” Or “Just bring them…you need to live your life.” Thing is, we were living our life. We waited so long to have these babies and this is the life we wanted to be living. We felt that this was the best thing for our children. Not anyone else’s children, but ours.

I remembered reading in the book that we would be criticized and misunderstood for our inflexibility when it came to the babies’ sleep. I didn’t keep them awake for visitors or for family or anyone - just so people could play with them longer. I didn't force them to stay awake for social convenience. When it was time to sleep, I put them down. Even my own family was miffed at first (NOW they are supportive and are actually HUGE fans of our method). I was fiercely protective of their sleep. People misinterpreted that as being overscheduled. I knew better.

Here’s the thing. Before having children of my own, I saw myself as a “go go go” Mom and taking my baby along for the ride. I saw us as changing very little of our lifestyle to accommodate a baby. I didn’t have a clue then about how much and how often a baby needs to be sleeping. To my surprise, it was A LOT more than I had expected. Once having my own child(ren), I had done a lot of research on sleep – since it is one my most favorite things in the whole wide world EVER – and I changed my thinking and my focus. I came to believe that sleep is as important as food and that just as I would NOT deprive my child of food to accommodate my schedule, neither would I deprive my child of sleep for the same reason. Both were equally important, especially to a tiny baby.

I could go on and on and on but instead of continuing to bore you with more details of my zealous philosophy on sleep training, Let me share with you some things that I found especially important in my own experience in successfuly sleep training OUR trio:

-I always put the babies to bed AWAKE.

-I always put them to sleep in their crib(s). I never (EVER EVER EVER) put them to sleep in the swing, in the bouncy chair, on someone, in the car-seat…This isn’t because I am a mean awful Mommy. It’s because I felt that it was important for me to be consistent and to do things that I could actually maintain in caring for my trio. For example, I didn’t want to HAVE TO put my baby to sleep in the swing in order to get them to fall asleep because that is something I would not be able to actually maintain (for many reasons but one important reason is that I had only ONE swing and THREE babies!). I didn’t want them to become dependent on anything to fall asleep. There was no way I was going to load all three of them in the truck and go for a drive whenever naptime came around. I was being realistic. Their crib was ideal because its what I could maintain.

-I came to believe that motionless sleep was actually better quality sleep. Per Weissbluth, motionless sleep was important in learning to stay asleep and that motion sleep (e.g in a swing or in the car) was not as restorative as motionless sleep. I found that for my babies, this was absolutely true. I stopped using the swing for sleep as soon as I learned this.

-A baby’s biological need for sleep is always changing so I was especially aware of following their cues and knowing their signs to make sure I was on top of shifts in sleep requirements. This proved to be especially challenging at first since they are three very different babies! As all mother’s do, however, I got to know them very well and reading each of them became easier and easier. As much as I was a huge fan of schedules (still am), I was not focused on watching the clock as much as I was on watching the baby(ies).

-Consistent sleep routine is important. More specifically, I had a routine for each sleep period. For example, for naps I would consistently follow the same ritual of decreasing stimulation, diaper change, back “pat pat” and leaving the room while the babies were still awake. For nighttime, we had (and still do) a solid nighttime routine that included bath, bottle (NOT ANYMORE - WOO HOO!), snuggle, diaper, music, lights off. Every night. Brian and I know our roles in each routine which has made it even easier since we know what to do and what to expect.

-I always encouraged their attempts to self-soothe. For example, for a while Alexis had a habit of putting her fingers in her mouth and humming just before falling asleep. I never discouraged it because it was not only her way of self-soothing, but also her way of learning how to go to sleep on her own.

-I formed their schedule around a 7am-ish wake time and 7pm-ish bedtime. Some people said this is too early (WHAT???) but I believe it is based on a natural and healthy cycle that will benefit them as they develop their own internal clock and continue to grow.

We have tried to follow the “Weissbluthian” rules of early bedtimes and regular naptimes. Consistency is key. I found that when I deviated, so did they. I believe that in order to get something to work, you have to actually DO IT and do it consistently. No excuses.

Now that they are older babies, things are much more flexible. But the bottom line issues still remains for us:
1. We still do NOT skip naps unless we must for important things like doctor’s appointments and for special occasions.

2. They still have a consistent bedtime, although we have gotten much more flexible with this when we have stuff going on. We just try not to schedule too many things too many days in a row so that they don't fall out of routine.

3. We still have a consistent bedtime routine that we all really enjoy together. It has evolved as time has passed but we still both put them down after a period of snuggle time together. It’s a nice way to end the day. And trust me, sometimes the end of the day cannot come fast enough!

There are times when they will fuss when we put them down, but its almost always when we have people over and I think the babies want to stay awake and play! Either that or we’ve kept them up too late and they are overly-tired. No matter what, we have built what we consider to be a good foundation of healthy sleep habits that we feel will benefit them as they continue to grow.
This process was never easy, but I believe we are all reaping the benefits now and it has surely been more than worth it!