Bedtime intervention

When Chole Campbell gave birth to her son, Benjamin, in April 2008, the Ottawa pharmacist relished the thought of spending her maternity leave with her new baby, enjoying lazy days in neighbourhood coffee shops, hanging with other moms on playdates, and snuggling with her son during leisurely sleeps in the family bed. But reality didn’t quite measure up.

From day one, Benny was a fitful sleeper, barely napping, and waking every hour or two at night, screaming until Chole nursed him back to sleep. It took so long to get him settled at bedtime that Chole and her husband, Tim, a policy analyst, were terrified of waking him, spending most evenings tensely whispering and avoiding anything as noisy as watching TV or washing dishes. During the day, Chole was so zonked she couldn’t muster the energy for outings. “I was too tired to get dressed, and Benny was so overtired he’d scream when we went out, so it just wasn’t worth it.”

As Chole geared up to return to work last March in her zombie state, a friend suggested that she enter a Today’s Parent contest to win a sleep-coaching consultation. In her 250-word submission, Chole wrote: “I’m afraid I wasted my maternity leave — what I was hoping would be one of the best years of my life. Instead I’m bleary-eyed, exhausted and resentful.”

Chosen as the contest runner-up from about 200 entrants, Chole won a consultation with Tracey Ruiz (sleepdoula.com) of Brampton, Ont. A regular doula for 10 years, providing support during birth and postpartum, Ruiz started offering sleep-training services four years ago to help parents lull their little ones to sleep. As the Sleep Doula, her trademarked name, Ruiz creates a sleep plan tailored to the child’s personality and sleep issues, as well as mom’s and dad’s parenting style. Once parents are ready to begin, she shows up at bedtime and stays overnight. “I sleep in a lot of crazy spots: under cribs, in closets and on bathroom floors,” says Ruiz, whose calm demeanour and soothing voice would put the weariest parent at ease. For families like the Campbells, who live too far for a home visit, the Sleep Doula provides 24-hour support with phone calls and text messaging.

Ruiz started the process with a 90-minute phone consultation, asking about Benny’s birth, his health, the bedtime routine and the Campbells’ parenting approach. “I’m basically a detective, searching for clues to figure out why Benny isn’t sleeping well and which sleep method might best suit the parents,” says Ruiz. During this conversation, Chole told Ruiz her hopes for sleep training: to get Benny to sleep without prolonged crying or repeated nursing and to continue some co-sleeping, if possible. Read on for what happened.

The sleep plan

Break the link between food and sleep Benny’s bedtime routine included being nursed to sleep, which the Sleep Doula discouraged. “When you’re nursing your baby to sleep or until he’s drowsy, it’s the last thing he remembers. And when he wakes up, it’s what he expects,” she explained. Ruiz suggested breastfeeding Benny somewhere other than his bedroom and before his bath and story, rather than after.

Ruiz also recommended nixing the night-nursing sessions; at a year old, Benny no longer needed the top-up. “If you want to do one feed during the night, do it as a dream feed. Pick him up when he’s in a dream state so he’s not awake, and then put him right back into the crib asleep.”

Co-sleep on a schedule Chole and Tim were committed to sharing the family bed with their son, but it clearly wasn’t helping anyone get any sleep. Benny woke hourly and had trouble getting back to sleep even with the help of back rubs and breastfeeding. Ruiz recommended putting Benny to sleep in his crib and restricting co-sleeping to the early morning. “Wait until it’s light out at 5:30 or 6 a.m., and when you go into his room to bring him into your bed, make a big production of it,” she suggested. “Say good morning and show him the sun. He’ll probably fall asleep with you so you still get to co-sleep, but on your terms.”

Find the right sleep-training method Ruiz and Chole discussed the range of possible sleep-training methods, including extinction — putting the baby to bed and not going in until morning; and the Ferber technique or controlled crying — leaving the baby to cry in bed for gradually longer periods. (For some interesting new research on sleep training, see Sleep Training) Keeping Benny’s intense temperament in mind plus Chole’s desire to comfort him during the night, Ruiz recommended a method she calls Sleep Doula Shush: You put the baby to bed awake and then hide inside or outside the bedroom, close enough for him to hear but not see you. On the first night, when the baby cries or calls out, stay out of sight, but shush in a soothing voice, saying things like “Nighty-night. You’re OK. Go back to sleep.” The second night, eliminate the talking and just shush; same for any waking the third night.

Stick with it When the Campbells tried sleep training in the past, Chole’s resolve would crumble in the wee hours. “By the time the third wake-up came along, I’d be so tired and desperate for sleep that I’d do anything to get him to stop crying and just shove my breast in his mouth.”

Inconsistency is a common pitfall in sleep training, says Ruiz. “Sometimes parents don’t give enough time for the process to work or they don’t feel good about it, so they don’t follow through.” After helping about 1,000 families get their kids to sleep, Ruiz has found it usually takes only three days to see a change: one day to break bad habits, a second day to create healthier new habits, and a third day to foster them.

The results

Chole was apprehensive, but she and Tim decided to give the Sleep Doula Shush a try. On the first night, they camped outside Benny’s room, talking and shushing him when he awoke eight times, each time crying for 20 minutes. “It was the worst night ever,” says Tim. “It was kind of surreal because we were so exhausted and only half awake, and both doing the shushing.” Throughout the ordeal, they exchanged about a dozen text messages with Ruiz. “When she’d tell us he was doing better than she expected, it was really helpful, so we stuck with it,” says Chole.

The second night, Benny screamed for 45 minutes at bedtime, but woke only five times, for 10 to 15 minutes. On night three, things improved: He cried for five minutes at bedtime and woke three times for just five minutes. By night five, to Tim and Chole’s delight, Benny slept through. “That was the first night since he was born that we didn’t have to get out of bed to deal with him in some way,” says Chole. “It was amazing.”

But after a week of blissful slumber, Benny started waking again between 3 and 5 a.m. and crying for long periods. Ruiz told Chole this is typical of toddlers who may be less tired by the middle of the night. She recommended a return to talking and shushing whenever Benny wakes in the night. “Once he’s gotten into a trend of sleeping independently, it’s better to go to his room and lie on the floor and shush him to stay consistent, rather than bring him into your room,” says Ruiz.

Despite the setbacks, Chole was pleased with the outcome of her family’s sleep-training experience. “We have a peaceful bedtime and evening now, and a little boy who can put himself to sleep,” she says. “It’s not perfect yet, but we have our nights back.”