i’m sleeping at last evelyne martello …my parents too€¦ · initiated by parents of children...

I’m Sleeping at Last …my Parents Too

Evelyne Martello

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Both children and parents need a good night’s sleep. What can we do to allow the whole family to benefit from a restful sleep?

This book is the outcome of more than 10 years of intervention with thousands of parents. It presents notional elements, measures to be used to facilitate bedtime routine, various techniques that will help children fall asleep on their own and various methods to make bedtime calm and enjoyable. The author also suggests ways for parents to face certain specific situations such as night terrors, nightmares, teething and otitis.

I’m Sleeping at Last… my Parents Too, a guide to a good night’s sleep… for the whole family!

Evelyne Martello, clinical nurse and sleep specialist, has been working since 2008 at the Sleep Clinic at Hôpital Rivière-des-Prairies.

ISBN-978-2-89619-696-8

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Couv.I'm sleeping at last.indd 1 2014-10-31 10:35

Fil des jours 1/8/02 4:00 AM Page 96

I’m Sleeping at Last! …my Parents Too

Enfin_je_dors_ang.indd 1 2014-10-31 10:41

I’m Sleeping at Last! …my Parents Too

Evelyne Martello


Bibliothèque et Archives nationales du Québec and Library and Archives Canada cataloguing in publication

Martello, Évelyne[Enfin, je dors… et mes parents aussi. English]I’m sleeping at last… and my parents too

(Collection du CHU Sainte-Justine pour les parents)Translation of : Enfin, je dors… et mes parents aussi.Includes bibliographical references.Electronic monograph.ISBN 978-2-89619-696-8 (PDF)ISBN 978-2-89619-697-5 (ePub)

1. Sleep disorders in children - Popular works. 2. Children - Sleep - Popular works. I. Title. II. Title : Enfin, je dors... et mes parents aussi. English. III. Series : Collection du CHU Sainte-Justine pour les parents.

RJ506.S55M3713 2014 618.92’8498 C2014-941332-7

Cover : Marie-Claude FavreauGraphic design : Nicole Tétreault

Circulation and distribution:

in Québec : Prologue inc. in France : CEDIF (diffusion) – Daudin (distribution) in Belgium and in Luxembourg: SDL Caravelle in Switzerland: Servidis S.A.

Éditions du CHU Sainte-Justine 3175, chemin de la Côte-Sainte-Catherine Montreal (Québec) H3T 1C5 Telephone : (514) 345-4671 Fax : (514) 345-4631 www.editions-chu-sainte-justine.org© Éditions du CHU Sainte-Justine 2014 All rights reserved ISBN 978-2-89619-696-8 (pdf) ISBN 978-2-89619-697-5 (ePub)

Legal Deposit : Bibliothèque et Archives nationales du Québec, 2014 Library and Archive Canada, 2014

Member of Association nationale des éditeurs de livres


My sincere thanks to the following people:

◗ Dr. Céline Belhumeur, developmental pediatrician and sleep disorder specialist at CHU Sainte-Justine. She has greatly helped me develop my knowledge and clinical experience. Special thanks for her trust and support over the past ten years, for her advice as I was writing this book, and for agreeing to write the preface;

◗ Dr. Dominique Cousineau, developmental pedia-trician, who entrusted me with the responsibility of writing this book;

◗ My spouse, Sylvain, who read my texts, my children Béatrice and Jean-Christophe, who allowed me to apply the tips and possible solutions presented in this book. Special thanks to Béatrice, whose sleeping problems prompt ed my discovery of the benefits of certain herbal pro ducts discussed in this book;

◗ Francine O’Leary, speech therapist and a mom at the Centre montérégien de réadap tation, for her con-structive comments;

◗ Luc Bégin and Marise Labrecque, the publishing team at CHU Sainte-Justine, for their support for the writing of this book;

Acknowledgements


6 I’m SleepIng at laSt! … my parentS too

◗ Dominica Labasi, social worker at the CLSC Saint-Louis du Parc, who shared her considerable expertise, and advised me on the adoption section ;

◗ Jean-Guy Moreau, comic and composer, who gave me permission to use the words of a lullaby he composed, which I’m sure will inspire and delight you as much as it did me;

◗ Finally, all the parents who confided their difficulties and who inspired me to look for ways of helping their children and themselves sleep better at night...


PrefAce

Many children have trouble sleeping. Their parents can get the feeling that every other child in the neighbour-hood sleeps soundly all night long... and what could be more natural, because night is for sleeping!

However, nearly one in five visits to pediatricians are initiated by parents of children with sleep problems. Though these may not seem too serious, children’s sleep problems often cause great upheaval in families. Excessive parental fatigue can lead to marital conflict, family ten-sions, absenteeism, problems at school, and psychological disorders, with impacts that can be considerable.

Good sleep hygiene is necessary to establish a regular sleep cycle, but it is not innate in children. As in all other areas of development, it needs to be guided and supervised. Parents, as in so many other areas, are the first to be confronted with this delicate task, but when they look for support they are inundated by facts, figures and pieces of advice that are sometimes irrelevant, or even contradictory... How does one find information that is both reliable and effective?

With a decade of experience as a sleep clinic con-sultant, lecturer and parent, the author offers a variety of tips, strategies and concrete measures that have proven effective in helping babies sleep well... and parents too.



The author discusses theoretical concepts for under-standing the origins of sleep disorders, helps parents to establish good sleep hygiene and recognize certain medical or individual conditions that may be impeding a child’s sleep.

With the help of clinical examples, she guides parents towards finding the right solution for their situation.

Parents, the author has written this book to share her expertise with you, developed from working with other parents and children… who now sleep well, right through until morning!

Céline Belhumeur, developmental pediatrician


tAble of contents

IntroductIon .............................................................. 13

Chapter 1Sleep ........................................................................... 15

Some Facts ..................................................................... 15

Basics Aspects of Sleep ..................................................18Sleep Architecture .........................................................18The Stages of Sleep .................................................... 19

Prevention ..................................................................... 23

Psychological Factors .................................................... 26

Aggravating and Precipitating Factors ........................ 27Medical Conditions .................................................... 27Emotional and Difficult Temperament ....................... 28Development Problems ................................................ 28

Chapter 2Bedtime ..................................................................... 31

Importance of Routines, Sleep Associations and Sleep Hygiene ..................................................... 31

Bedtime Routine ...........................................................31Environment ................................................................ 32Biorhythms .................................................................. 33Napping ....................................................................... 34Some Practical Advice on Sleep Associations .............. 35



Promoting a Good Pre-Sleep Routine ......................... 36The Importance of the Bath in Bedtime Routine ........ 38

Bedtime Resistance ....................................................... 39The Bedtime Waltz .................................................... 40

The Transition from Crib to Bed ................................. 41Those Difficult Time Changes ..................................... 42

Chapter 3Management or Treatment ...................................... 45

Weaning of Parental Presence ...................................... 45Gradual Extinction(the 5-10-15 or Ferber Method) ... 45

Tips for Special Situations .............................................51Weaning from Night Feedings ......................................51

If Mom is Breastfeeding ............................................... 53

Fading of Adult Interventions ...................................... 60

Reinforcement Strategies and Reward System ............ 64The Barter System ....................................................... 64Sticker Charts .............................................................. 66

Complementary Suggestions ....................................... 66Over the Counter Medecine and Herbal Preparations .................................................... 67Relaxation Technique .................................................. 69Sleep and Medication .................................................. 69

Success or Failure? ........................................................ 72

Chapter 4Special Situations and Sleep Problems ................... 75

Special Situations .......................................................... 75


Table of Contents 11

Night Terrors ............................................................... 75Confusional Arousals .................................................. 78Sleepwalking and Sleep Talking .................................. 78Nightmares ...................................................................81Obstructive Sleep Apnea Syndrome ........................... 84Bruxism ....................................................................... 86Sleep-Related Rhythmic Movement Disorder ............. 86

Circadian Rhythm Sleep-Wake Disorder .................... 88Advanced Sleep-Wake Phases ..................................... 88Delayed Sleep Phases ................................................... 89

Restless Legs Syndrome (Periodic Limb Movement Disorder) ....................................................94

Sleep Problems Related to Medical Conditions .......... 95Teething ....................................................................... 95Colds, Ear Infections, Asthma ..................................... 97Infantile Colic, Gastroeosophageal Reflux Disease (GERD), Cow Milk Protein Intolerance or Food Allergies .............................................................. 98Hyperactivity Disorder ..............................................101Frontal Lobe Epilepsy and Myoclonus ...................... 106Children with Neuro-Developmental Disabilities (Encephalopathy, Epilepsy, Autism Spectrum Disorders and Genetic Syndromes) ........................... 106

Sleep and Premature Babies ........................................110

Sleep and Adoption......................................................113

concluSIon ................................................................117BIBlIographIc referenceS ...........................................119reSourceS ...................................................................121


IntroductIon

Parents often sleep poorly at night. This is their most common complaint when they visit the pediatrician. In addition of their daily obligations, their nights are often interrupted by their young children calling out for them. It is not uncommon for parents to be greatly affected in their professional life, family life and relationship. Intervention is required because in this situation, at least one member of the family will suffer... and it is rarely the child.

Moreover, in young children, poor quality sleep and too few hours of sleep can cause health problems, attitude and mood disturbances (these can eventually affect the rest of the family). In the long run, daytime behavioural problems may develop, at school or elsewhere.

This book is the result of over ten years of consultations and interventions with thousands of parents with whom we’ve developed different strategies to ensure that their children sleep well. We offer a few approaches that have proved effective. Although we’ve taken our inspiration from some of the tried and true techniques, we’ve adapted them according to our experience and each family’s special conditions to achieve better results.



In the following pages, you will find a brief overview of theories relating to sleep, information on bedtime routine, as well as different techniques allowing to promote the gradual withdrawal of parents. You will also find many tips for helping parents deal with specific situations or difficulties related and unrelated to health problems. Throughout the book, practical examples will be provided. This will make it easier for parents to choose the right solution for their own situation. Each child is unique, but in most cases the actions we propose apply to several types of situation. Moreover, it is you, the parents, who are the best judges of when to take the first steps towards better sleep... for the whole family.


chAPter 1

Sleep

Some Facts

Sleep problems frequently occur in young children and even more so in babies. In fact, 20-30% of children have sleep problems. This number increases if the child pre-sents other disorders. In particular, we note the following:

◗ There is a high proportion of problems in children under five;

◗ If an eight-month-old baby has trouble sleeping, he will continue to do so at the age of three if no action is taken;

◗ When a child has sleeping problems at the age of two, he will still have them at five, which means that the earlier action is taken, the better;

◗ From 4 to 6 months to 3 years, children exhibit many sleep association problems (see the Importance of Rou-tines, Sleep Associations and Sleep Hygiene, page 31).

Feeding children to put them to sleep can lead to wakings and feedings until the age of three, if the problem is not resolved at night.



◗ It is easier to solve sleep problems as soon as they appear, and before the age of 12 months.

◗ The most difficult period for solving problems is between 18 months and 2½ years, although it is not impossible.

◗ During the period between 2½ and 5 years, when children understand relatively well, it is easier for parents to improve sleep patterns without too much difficulty.

◗ Between 0 and 2 years, there is more bedtime resist-ance and more prolonged night wakings. It is around 18-24 months that fear of the dark and nightmares may start. In fact, over 50% of children have nightmares between 3 and 6 years of age. In this age group, night wakings are less prolonged, but the child is more likely to get up and join the parents in their bed.

◗ About 15% of children have at least one sleepwalking episode in their lives, while only 6% have more regular episodes.

◗ In the case of night terrors, about 6% of children experi-ence them, and the proportion is higher among boys.

◗ Reports show that 5% to 20% of children grind their teeth (bruxism) during the night, but few corrective treatments exist. This can be controlled with good sleep hygiene, and solutions can be found to prevent dental complications.


Sleep 17

◗ Among children who show bedtime resistance or older ones who go to bed late and get up late in the morning, we see a delayed sleep phase resulting from a shift in the sleep-wake pattern. This is very common among teenagers because their social lives and various physiological and environmental factors disrupt their sleep hygiene.

◗ In addition, certain problems may occur when the parent has unreasonable expectations of their chil-dren’s sleep. For example, if parents want children to go to bed early when they’ve taken a two-hour nap in the afternoon, resistance behaviour may develop at bedtime and it may take some time before children fall asleep. This problem can easily be avoided by reducing nap length or putting children to bed later. Parents should also keep a close watch on children’s sleep needs, which vary according to age.

Left: age. Right: average duration of sleep by age (differential from the average is about two hours). White: waking state. Black: night sleep. Grey: day sleep (naps). According to Challamel and Thirion. Mon enfant dort mal.

6 p.m. Midnight 6 a.m. Noon

Sleep Average According to Age

17 hours

15 hours

15 hours

15 hours

14 hours

12 hours

10 hours

8 hours

1 week

1 month

3 months

6 months

1 year

3-5 years

10-12 years

Adult

6 p.m.



Basics Aspects of Sleep

Sleep Architecture

Sleep cycles last approximately 50 minutes in infants. Around the age of 3, the cycles increase to 90 to 120 min-utes, which corresponds to the length of the stages of sleep in adults. Already, in utero, there is an organi zation of the stages of sleep. The REM (rapid eye movement) stage, the stage of dreams, develops around the sixth or seventh month of pregnancy, and the others develop around the seventh or eighth month. After birth, sleep organization is largely influenced by daylight, feed ing schedules and the day’s activities. These elements (called “time-givers”) develop circadian ryhthms and regulate sleep cycles, so they must be regular and stable. There are also hormonal releases that help regulate the body clock. Changes in body temperature also have an effect on sleep cycles.

When we go to bed at the same time every night, fatigue is primarily manifested by the sensation of coldness and decreased activity or mental alertness. This will help chil-dren sleep if you put them to bed as soon as they exhibit these signs. Overtired children may become restless, which compromises their sleep. Several hours later, the body temperature increases toward the end of the night, and children can wake up ready to start the day.

On average, the natural biological clock is spread over 25 hours. In the absence of external stimuli, the cycle


Resources 123

Healthy Sleep Habits, Happy Child:

A step-by-step program for a good night’s sleep Marc Weissbluth New York: Ballantine Books, 2005. 506 p.

Sleep Training for Your Child

Melissa Burnham Indianapolis: Alpha, 2006. 304 p.

Sleeping Through the Night:

How infants, toddlers, and their parents can get a good night’s sleep Jodi A. Mindell New York: HarperResource, 2005. 360 p.

Solve your Child’s Sleep Problems

Richard Ferber New York: Fireside Book, 2006. 440 p.

The No-Cry Sleep Solution for Toddlers and Preschoolers: Gentle ways to stop bedtime battles and improve your child’s sleep

Elisabeth Pantley New York: McGraw-Hill, 2005. 396 p.


I’m Sleeping at Last …my Parents Too

Evelyne Martello

Éd

itio

ns d

u C

Hu

sa

int

e-J

us

tin

eEv

elyn

e M

arte

llo

Both children and parents need a good night’s sleep. What can we do to allow the whole family to benefit from a restful sleep?

This book is the outcome of more than 10 years of intervention with thousands of parents. It presents notional elements, measures to be used to facilitate bedtime routine, various techniques that will help children fall asleep on their own and various methods to make bedtime calm and enjoyable. The author also suggests ways for parents to face certain specific situations such as night terrors, nightmares, teething and otitis.

I’m Sleeping at Last… my Parents Too, a guide to a good night’s sleep… for the whole family!

Evelyne Martello, clinical nurse and sleep specialist, has been working since 2008 at the Sleep Clinic at Hôpital Rivière-des-Prairies.

ISBN-978-2-89619-696-8

I’ sl

eepi

ng a

t la

st!

…m

y pa

rent

s to

Couv.I'm sleeping at last.indd 1 2014-10-31 10:35

i’m sleeping at last evelyne martello …my parents too€¦ · initiated by parents of children...

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