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Why Won't my baby sleep through the night?

10/3/2022

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Let’s be real here. When we get right down to the heart of the matter, this is the question you really need an answer to, am I right? 

Your baby is regularly waking up sometime during the night, and when they do, they start to fuss, they need you to soothe them back to sleep somehow, and the disruptions to everyone’s sleep are leaving the entire family exhausted, baby included.
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Now, I’m not going to tell you there’s a simple “one-size-fits-all” solution to this problem because, after all, I’d have to find a new line of work if there were.
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But I am going to tell you that there’s almost always a single cause for a baby or toddler not being able to sleep through the night, and it’s the same reason in about 90% of the cases I deal with.

Before we get to that, though, let’s rule a couple of things out. 
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  • ​DISCOMFORT
Conditions like acid reflux or indigestion, being too hot or too cold, or just being stuck in an uncomfortable position can all lead to baby waking up at night. If you suspect that your little one is experiencing some kind of discomfort, you’ll want to address the issue before you attempt to get them sleeping through the night.
​● HUNGER
If your little one is less than six months old, there’s a pretty good chance they might still need a nighttime feed to get them through the night. That’s not a hard and fast rule, but on average, six months is around the age when you can expect your baby to sleep a good
11- 12 hours without eating.
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​And that, I’m happy to tell you, pretty much sums it up.
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If your baby’s comfortable and fed, there’s really only one major reason why they can’t sleep through the night. 

Are you ready for it?

It’s because they don’t know how.
Now I know we’ve all heard the sound bites and talking points on social media. “Babies will sleep when they’re ready!” “Sleep is developmental!” “Just ride it out. It won’t last forever.” and so on. I have to admit to a little low-key rage whenever I read comments like that because… 
a) It doesn’t help and
b) It tells people to avoid fixing an issue that absolutely can and should be fixed!

If someone asked how to get a sliver out of their little one’s foot, would anyone respond with, “Just be patient. It’ll work its way out eventually. Hang in there mama! You’re doing great!”

I certainly hope not, although given some of the comments I’ve seen on social media, I wouldn’t say it’s out of the realm of possibility. 
(OK, that’s the end of my rant. Back to the good stuff!)

So what do I mean when I say that babies wake up because they don’t know how to sleep through the night?

All of us, babies and adults alike, sleep in cycles.

When we get to the end of a cycle, we’re no longer in a “deep” sleep. We’re hovering right around the point of waking up, and a lot of the time, we do wake up. Us adults have so much experience falling asleep, we can usually just look at the clock, realize we’ve still got a few more delicious hours before our alarm goes off, and we close our eyes, maybe roll over onto our other side, and go right back to sleep.

Babies haven’t had nearly as much practice, and very often, I mean VERY often, they get a bunch of help when it’s time for a snooze. They get bounced, shushed, cuddled, rocked, serenaded, taken for car rides, rolled around in their stroller, or fed to sleep. 
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So when they wake up after a sleep cycle, which again, is going to happen regularly for their entire lives, they can’t get back to sleep again without that extra help, so mom or dad needs to get up and repeat whatever process baby’s accustomed to.
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​That’s the issue, and like I say, it’s the issue with about 90% of the babies I work with.

How do you address that issue? Well, that’s where things get tricky because the solution varies tremendously depending on the baby and their parent’s compatibility with various approaches to resolving the problem, but the cause is almost always a dependency on some form of sleep assistance from a caregiver.

So when you hear someone saying that babies don’t sleep through the night, or that it’s natural for them to wake up several times, that’s absolutely correct. 

When they tell you that all you can do is wait it out, that’s absurd. 
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You can absolutely teach your little one the skills they need to sleep through the night, and I’d be delighted to show you how. 
Book Your Free Sleep Evaluation

Author

Erin Neri - Pediatric Sleep Consultant and Owner of To The Moon and Back Sleep Consulting since 2016. 

26+ years experience working with children and families including her BA in Applied Psychology, Infant Mental Health Training, Early Childhood Education & Experience. Working to complete an Integrative Feeding Specialist Program in September 2022.

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COPING WITH ANXIETY ABOUT SLEEP TRAINING

9/27/2022

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So you’re on the fence about this whole, “Teaching your baby to sleep,” thing.

On the one hand, you know that sleep is essential for everyone in your family. You’ve read all the literature and have come to agree with the consensus of the pediatric community that sleep is vital to your baby’s development and well-being.

You’re 100 percent positive that your little one needs some help learning how to sleep well, and you’re dedicated to helping them overcome this obstacle.
And on the other hand, you’re nervous as hell about it.

​Almost every parent I’ve worked with has started off absolutely riddled with anxiety. They know there’s a problem that needs fixing and they’re committed to that solution, but even with all of the research and evidence that this is a safe, effective process, they’re still on pins and needles.
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Because there’s a big difference, right? There’s all the babies, and then there’s your baby. And when it comes to your baby, the research and evidence can’t override your concern that you might be doing something wrong. Especially if your baby doesn’t seem to take to the new way of doing things right away.
So, what’s happening here? Is this your maternal instinct kicking in? Are you subconsciously aware of an underlying threat to your baby? Is mother nature trying to tell you not to teach your baby to sleep?

Well, sorry to be ambiguous, but the truth is, it’s complicated.
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Let’s take a few things into consideration here. First of all, you’re probably running on empty at this point when it comes to your own sleep.

If your baby’s not sleeping, it’s almost a guarantee that you’re not sleeping either, and that can wreak havoc on your emotional well-being.

Sleep deprivation stimulates activity in the amygdala, which is a part of the brain that controls several of your immediate emotional reactions.

According to a 2007 joint study between Harvard Medical School and U of C Berkeley, “...a lack of sleep inappropriately modulates the human emotional brain response to negative aversive stimuli.”

Or, in layman’s terms, you’re likely to overreact when things go bad. So when, say, your baby starts to cry, you’re less inclined to think, “I wonder what she needs,” and much more likely to think things like, “I’m a complete failure as a mother.”

This is what happens after one night of sleep deprivation, so you can imagine what chronic lack of sleep over the course of weeks, or even months, can lead to. You may even be experiencing it right now. It leaves you feeling helpless, inadequate, and riddled with anxiety.

Alright, that’s the sleep deprivation part. Let’s look at the other major reason that this process can be so difficult, and the real elephant in the room when it comes to this whole endeavour. - Crying.

Will your child cry when you’re teaching them this skill? Here’s the straight answer. It is extremely likely, bordering on an absolute certainty that, yes, your baby’s going to cry when you implement these new rules around bedtime.

Is your baby also going to cry when they get dropped off on their first day of school? Again, we’re looking at about a 95 out of 100 probability.

Will you baby throw a fit when you turn off their favorite cartoons, or when they get their first taste of asparagus, or when they’re told not to eat dirt?
You betcha. And even though you know they’re not in any danger or genuine distress in those situations, you’re still going to feel your heart explode when you hear your baby crying.

But again, if we look at this objectively, we can see that there’s an actual reason why the sound of a crying baby causes us such distress, and it’s not because of the actual level of urgency. Dr. David Poeppel, Professor Of Psychology & Neural Science at NYU, found that a crying baby differs from other environmental noises in something called the “amplitude modulation rate,” meaning how often the loudness of a sound changes.

Crying babies, along with car alarms and police sirens, have a modulation rate of about 100 times per second, compared to a regular speaking voice, which hovers somewhere between 4 or 5.

Experiments with an MRI to monitor the brains of people while listening to a variety of sounds, Poeppel found that baby screams have a unique ability to trigger activity in… you guessed it, our old friend, the amygdala.
Now, I could walk you through some meditation practice and deep breathing exercises to help calm your nerves before we start teaching your baby these vital sleep skills. In fact, I think that’’s a great idea, but I’m guessing you already know what works for you in those arenas.
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Where I think I can be of the biggest help here is by getting you to realize that your brain, despite having some really noble intentions, is playing tricks on you. It’s making you feel negligent. It’s making you think that your baby is in desperate need of something they’re not. It’s attempting to get you to address an immediate situation because it’s incapable of appreciating the long-term solution that you’re working towards.
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As with most instinctual habits, this one is more easily dealt with when we can appreciate not just what we’re feeling, but the science behind why we feel what we feel, so I wanted to provide you with that vital tool before you take on the challenge of helping your baby sleep through the night.

Now that you know; it's time to take that leap of faith and take the next steps in the journey to helping your little one learn to sleep well independently.
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We can do this together!
​Erin 
Book Your Free Sleep Evaluation

Author

Erin Neri - Pediatric Sleep Consultant and Owner of To The Moon and Back Sleep Consulting since 2016. 

26+ years experience working with children and families including my BA in Applied Psychology, Infant Mental Health Training, Early Childhood Education & Experience. Working to complete Integrative Feeding Specialist Program in September 2022.

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How Iron Affects Sleep

8/17/2022

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Let me just throw a little disclaimer out in front of this post by saying that I’m neither a doctor nor a professional research scientist. I’m a sleep specialist with a fascination for all things sleep-related, and I follow the latest research and studies in the field.

Typically when I write these posts, I like to rely on peer-reviewed studies that have been evaluated, replicated, and borne out conclusive evidence to support them, but today I’m focusing on something that’s a little on the speculative side, since it’s a relatively new theory, and it’s a super interesting one for anyone with a seemingly “restless” baby.

Now, when a parent tells me they have a restless baby, I have a series of questions I tend to ask in order to determine whether it’s due to a “sleep prop.” That’s industry terminology for something that Baby’s grown dependent on in order to get to sleep. Breastfeeding to sleep, rocking to sleep, sucking on a pacifier, stroller rides, are all examples of these “sleep props.”

And most of the time I find that, yes, that’s absolutely the problem, and we address it and things get significantly better in a few nights.
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But every once in a while, I have to admit, there seems to be something beyond the standard prop dependency. There are babies who seem like they’re just more, well, restless than usual. They’re much more animated when they sleep, and they tend to flail around and have a hard time getting into a deep sleep.
I first heard mention of an interesting theory during the 2019 World Sleep Conference and was really interested to hear more about it, but didn’t want to write about it until a little more string had been played out in the research department. And even though it’s still too early to state anything unequivocally, I thought the time might be right to at least share what I’ve learned so far, so here goes...
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So we’re all familiar with iron, right? Everybody knows about iron, the essential mineral that helps red blood cells carry oxygen around the body. That function right there makes iron a  downright essential component of our circulatory system and therefore our overall health.

Iron deficiency, commonly known as anemia, also happens to be the single most common nutritional deficiency worldwide. The vast majority of those cases are in developing countries, but the numbers in North America and Europe are still alarmingly high. In the US alone, there are around 2.8 million visits to physicians annually where anemia is the primary diagnosis.

So, in short, a LOT of people aren’t getting enough iron.

Now, if you follow health news at all, you’ve also probably heard a lot about something called Restless Leg Syndrome (RLS) lately. If you’re not familiar, RLS, also known as Willis-Ekbom Disease, is exactly what it sounds like; a condition that makes your legs feel restless. People with RLS describe the sensation as an irresistible urge to move accompanied by uncomfortable sensations in their lower limbs. Standing up and moving their legs typically remedies the feeling almost instantly, but only temporarily. Symptoms occur more frequently when individuals are sleeping or lying down.

RLS is also a bit of a mystery when it comes to its cause. According to the National Institute of Health, “In most cases, the cause of RLS is unknown. However, RLS has a genetic component and can be found in families where the onset of symptoms is before age 40. Specific gene variants have been associated with RLS. Evidence indicates that low levels of iron in the brain also may be responsible for RLS.”
So now comes the big question… could those restless babies that I was talking about earlier possibly be suffering from some variety of Restless Leg Syndrome due to an iron deficiency?

It’s a bit of a stretch, I know, and that’s why I went on the long preamble at the start of this post about how this was more theory than fact, but there’s a lot more information to work with here.  


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In a 2008 joint study from the Southern Illinois University and Carle Clinic Association, 1.9% and 2% of children and adolescents respectively were shown to have Restless Leg Syndrome. A 2020 study from the BC Children's Hospital Research Institute entitled Iron deficiency and sleep - A scoping review, found that iron supplementation was tremendously effective in treating a number of sleep disorders, including RLS. Sample sizes were small and the data collection process leaves a little to be desired, but it’s still a good indication that iron plays a big role in the quality of sleep.

Unfortunately, diagnosing RLS isn’t an exact science. There are no markers or proteins to test for. It’s done by a doctor’s evaluation of the patient’s description of their symptoms, and for that reason, the only people who have been diagnosed are individuals who are capable of explaining what they’re experiencing.
And guess who that leaves out…
You guessed it; Babies, toddlers, and as theorized in a 2005 study, a significant number of children.
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A 2005 Mayo Clinic study established rates of restless legs syndrome in children, finding that, “almost 6 percent of children seen in Mayo's sleep clinic have the disease. The study also notes that the most common risk factors for the disease in kids are family history of restless legs syndrome and iron deficiency.”
So back we go to the 2019 World Sleep Conference where one of the speakers put forth the theory that either RLS, or a variant of it, might be responsible for some babies being overly restless.

Restless Sleep Disorder, as researchers have described it, hasn’t been thoroughly researched yet, but evidence suggests that it could be an early variant of restless leg syndrome which in some cases could be caused by insufficient iron levels. Or, as they more eloquently put it in their conclusion, “We have characterized clinically and polysomnographically children with RSD and attempted a new diagnostic category. We also have identified an association between RDS and iron deficiency. Future larger studies are needed to confirm these findings and evaluate the natural progression of restless sleepers.”

So again, I’m not trying to offer medical advice here. I just thought this whole line of research and discovery was fascinating and wanted to share it with all of you. If your little one is one of those overly animated sleepers, it might be worth asking your pediatrician to check their iron levels. Even if it’s not the cause of their sleepless nights, anemia is something you’ll want to remedy.

And remember, if your baby fits into the other category, the much more prominent category who have trouble falling asleep because of their dependency on a “prop,” I’m here to help you solve that problem. It may not be as simple as taking an iron supplement, but I can say unreservedly that it’s worth the effort to get your baby sleeping through the night.
Book Your Free Sleep Evaluation

Author

Erin Neri - Pediatric Sleep Consultant and Owner of To The Moon and Back Sleep Consulting since 2016. 
26+ years experience working with children and families including my BA in Applied Psychology, Infant Mental Health Training, Early Childhood Education & Experience. Working to complete Integrative Feeding Specialist Program in September 2022.

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Hiring a Sleep Consultant Versus Buying Sleep Gadgets

1/11/2022

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As a pediatric sleep consultant, there are a few questions I’ve grown accustomed to hearing. People are understandably curious about whether or not their child is going to cry, and if so, for how long. They want to know how long it’s going to take before baby starts sleeping through the night, and when they’ll be able to do the same.

And even though they never come right out and say it in so many words, they want to know if there’s some kind of magical solution that will solve the problem instantaneously without any effort, crying, or protest.

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Maintaining Your Child's Sleep Schedule Over the Holidays

11/27/2019

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With the holidays quickly approaching, parents who have recently gotten their babies, of any age, sleeping on a schedule are often worried that their little ones'  sleep will regress over the Holidays.

I can assure you that those fears could not be more real.

Many 
families struggle with severe sleep deprivation for a very long time due to the "blessing" of having a child (or two like I was) that lacks healthy independent sleep strategies.

So, finally getting your whole family into a routine that works. Finally moving from being severely sleep deprived into a family that is becoming well rested.  Trust me everyone inside that little family unit wants to protect their new found sleep including the little one who is finally able to sleep.
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When little ones finally FEEL what it feels like to have the sleep that is needed for healthy growth and development they don't want their schedule messed with either. 

Between the travel, excitement, and constant attention of family and friends, holidays are the easiest way to throw all of your hard work out with the wrapping paper.

But fortunately, it doesn't have to be that way! With some strategic planning and an iron will, you can keep that carefully orchestrated routine running right on schedule.

There are two major impediments to maintaining your kiddos routine over the holidays. One is travel, and the other is family and friends, so I want to tackle both of those topics individually.

First, we will cover the travel portion...

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Sleep and feeding schedule for your 12- to 18-month-old baby

5/14/2019

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A whole year, really? How did your wee newborn, curled up on your chest, turn into a babbling, active toddler? Somehow, those long days became a short year. Happy birthday, baby! As you move into toddlerhood from 12 to 18 months, get ready for some roller coasters when it comes to food and sleep, including new schedules and routines. The non-stop eating tends to slow down, and toddlers typically only gain a few pounds between the ages of one and two. Continue to offer a variety of healthy foods for meals and snacks, but don’t get too concerned if they’re not that hungry.
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Do babies dream?

5/14/2019

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In adults, we’re most likely to dream during rapid eye movement (REM) sleep, although dreams can happen during other sleep stages, too. This REM sleep may even start before birth: Brain waves that closely resemble those found in REM sleep have been measured inside the womb between 25 and 28 weeks. Since babies spend about half of their sleeping time in REM sleep, some researchers think it only makes sense that they are having some form of dreams. On the other hand, some scientists say that babies are not developmentally capable of the kind of abstract thinking (including the ability to imagine things visually and self-awareness) you need to have dreams.  

If babies do dream, their dreams probably won’t have the rich visuals and interactions with other characters that adults have when they dream, says Zadra. “Their dreams are probably very similar to what they experience when they’re awake because they have a preverbal form of consciousness,” he says. “It may be a collection of sensations, whether it’s warmth, suckling on a breast or images of a close-up face.” Just as an adult processes the previous day when they sleep, so does an infant’s brain—it’s just not as advanced yet.

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Four- to five-month-old schedule: Sleep, naps and feeding

5/14/2019

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Now that you’ve made it through the “fourth trimester” and all the ups and downs that come with it—welcome to months four and five! When your baby is around five months old, you will probably see more of a schedule with dedicated nap times—usually two naps a day. Many parents also find that on-the-go napping comes to an end around five months, as your kiddo needs their own quiet, dark space to settle down to snooze. Sleeping for 12 hours a night is becoming a possibility, even if you’re not there yet. “A four-month-old or five-month-old often needs a feeding at night, but around six months, if they’re growing on their curve and everything is fine health wise, then there absolutely is that ability to sleep 12 hours,” says Erin Neri, a certified pediatric sleep consultant in Sherwood Park, Alta.
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Is Melatonin Use for Babies Safe?

2/14/2019

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Is melatonin use for babies safe?
For overtired parents who can’t seem to get their kids on a healthy
sleep schedule, the promise of a magic pill can be pretty enticing.

However, it seems that more and more doctors and parents are turning to melatonin as a Band-Aid for sleep issues for their children.

​​I get emails all the time from people telling me they are giving their babies melatonin to help them fall asleep at night, and I have serious concerns about this. 


​An article titled  Too many children being prescribed melatonin to aid sleep, experts warn ...  via www.theguardian.com - shares my concerns plus the concerns of even more medical experts. 
 
"After a surge in the number of children under 14 being admitted to hospital with sleep disorders over the last decade, specialists are concerned that it [melatonin] is being given to children “off label” – with little knowledge of the long-term safety or side-effects."
 
Dr. Neil Stanley, an independent sleep expert and former director of sleep research at the University of Surrey.  "Unless a child has a diagnosed condition such as autism that has been scientifically proven to be helped by melatonin, there is no medical rationale for a child to be given it,” he said. “Most paediatricians know little about sleep or melatonin. For non-autistic children, it is a fashionable treatment for parents wanting ‘perfect' children.”
 
"Dr Liz Bragg of the Royal College of Paediatrics and Child Health, said: “I don’t want to criticise fellow practitioners by saying it is being overprescribed, but I wouldn’t like to prescribe it unless work has been done to make sure the right sleep advice has been given and ... the right bedtime routine to wind down to sleep is put in place."-Sarah Marsh; TheGuardian.com.

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Well, I don't agree that "parents (are) wanting perfect children"; I do think many parents and pediatricians are looking for solutions when things get desperate with their little ones lack of sleep. 
 
Being sleep deprived as a child or as a parent is not an easy thing to cope with. When you have a baby that doesn't sleep for more than a couple of hours at a time (if you're lucky), or a toddler/preschooler that takes hours to get to sleep, only to have them wake up in a few hours and you have to start all over again; it's exhausting, to say the least. Not only are parents dealing with the mental and physical consequences of sleep deprivation; but the situation can cause a lot of anger and frustration, even resentment towards your child.
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However, here's the deal: 
 
Melatonin is a hormone that is naturally secreted by your brain and is present in every person’s body. Taking synthetic Melatonin is NOT a long-term solution to poor sleep habits. 
 
Healthy sleep habits need to be taught at a young age to set kids up for a lifetime of healthy sleep habits.
 
As Dana Obleman says SleepSense Magazine; ".. giving {Melatonin} to kids who aren't sleeping well is the equivalent to giving Tylenol to someone who has a broken leg. You may alleviate the symptoms, but you're NOT fixing the problem."
 
“Bad sleeping habits.. won't just go away with time." While some studies have shown that melatonin can be helpful with children with autism or children with ADHD, most babies and children do not need melatonin; they need to be given the opportunities to develop their sleep strategies and develop good sleep hygiene.

Here's why:

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