Episode 10: Mailbag Episode

Episode Transcript
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Craig Canapari MD (00:02):
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(00:27):
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(00:50):
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Enjoy the show.
Welcome back to the Sleep edit.

(01:10):
I'm Dr.
Craig Canapari
and.

Arielle Greenleaf (01:12):
And I'm Arielle
Greenleaf.

So this week we have a mailbag episode of questions.
So I thought we'd just get into it.
We have a lot of good questions.
Our first segment is on infantsleep patterns and challenges.
Here I'll say the first one Laurenasks, when do babies start dreaming?

That's a really good question and I was gonna Yeah,
I I was gonna ask you that one.

REM sleep, which is what we think of as the predominant
stage of sleep that happens withdreaming, actually is the most
prominent phase of sleep from birth.
So as far as we can tell,babies are actually dreaming.
Even in the womb
though, it would be very difficult toverify that for sure, but they are,

(01:58):
even if they're born early at thetime of birth, having active sleep,
which is the equivalent of REM sleep.
It happens usually in the, I.
Last trimester of pregnancy on,
so cool.
Otherwise they're probably getting prettybored until if someone figures out how
to insert a tiny iPhone into the womb.

I guess, And some of the questions I get when do they start
having bad you know, aren't dealingwith fears the way we think of fears.
So bad dreams, nightmares don'toccur until later in toddlerhood
when , the imaginary comes to life,

Yeah, you need a you need a certain amount
of abstraction for nighttime.
Nighttime fears.
And it's usually, I'd say really concreteones or, ages four or five, sometimes
in earlier ones, like worrying aboutsomeone breaking into the house, et
But hey, let's take the, I, letme read this next one, Arielle.
'cause I think this mightbe a good one for you.
Susan, who is a pediatric sleep fellowand mom of a five month old, God bless.

(03:01):
I have a question about why baby's wake.
My little one naps between 45 minutes to1.5 hours and sleeps four to five hours
stretches at night, starting at 7:30PM Sometimes I think he wakes to feed.
Other times I feel like he wakesbetween sleep cycles and needs
help getting back to sleep.
Do you have any tips fordifferentiating between waking to

(03:22):
feed and just needing more sleep?
I'd say maybe needingsoothing to go back to

Sure.
The place I would start is talk toyour pediatrician about night feeds.
Is your baby gaining weight?
How much are they getting during the day?
It's really important to look atthat because sometimes parents don't
realize that their baby's not gettingEspecially I've seen that when someone
is transitioning from breastfeeding toformula, it's not a one-to-one conversion.

(03:50):
And so babies need more formula, in order to say, stay full.
So , I've seen it where parentsjust don't know that they're they're
not feeding their baby enough.
So I think that is a really trickyquestion because it's very unique to the
individual as far as, know, if your, ifyour pediatrician says that they feel

(04:13):
like your child could sleep throughthe night, or they feel that your child
could have one night feeding, then youwanna really have a, the first stretch of
sleep to be like the most uninterruptedportion of the night, if possible.
So I generally use 11 or 11:00 PM or12:00 AM as like a cutoff for feeding.

(04:34):
, Especially if the child was fed rightat bedtime, , by five or six months that
they should be able to go four or five,six hours before needing another feeding
at that first stretch , of the night.
However, again, we have to look atwhat does daytime feeding look like.
It's really important.

I, I would add the extra layer of mom probably had three
or four months off for maternity leave.
Now back to work maybe nursing, maybeformula, maybe doing a little bit of both.
Certainly can be a challenging time forfor moms when they've returned to work
as well to try to balance quality timewith the baby and getting enough sleep.

(05:15):
I, yeah, I think it's always theanswers to questions like this
have to be very specific, but Ithink looking the feeding's a good
idea.

I also think it's important to.
Recognize how you're putting your babyto sleep at the start of the night.
So if your baby can go to sleep at thestart of the night independently, then
they should be able, if they're nothungry or they're not sick, they should
be able to put themselves back to sleepin the middle of the night as well.

(05:42):
And sometimes you have to givethem a little nudge and remind them
that they can do it themselves.
, And choose sort of a, asleep training method.
At the start of the night orthroughout the night, regardless
of, you know, wherever you arein that , sleep training journey.
But if your child is falling asleepindependently and, waking throughout
the night, you should be looking atwhether you're, are you continuing that

(06:05):
sleep training throughout the night?

Yeah, you're definitely getting in the window where
you could think about trying to worktowards independent sleep at bedtime.

Andrea asks, how can I sleep train at night when my 11 month olds
barely sleeps at nursery during the day?
The first days or weeks of sleeptraining mean no restful sleep during
the day or night, and it's overwhelming.

Yeah, I'm not sure I quite understand this.
Um,

I do, yeah.
I think what she's saying is she'svery concerned because her child
doesn't sleep well at nursery daycare.
, And then she's concerned aboutsleep training at night because
she's concern concerned that,
the child won't get any sleepif she's sleep training.

(06:51):
And it sounds like she's concernedthat the child is going to be
losing tons of sleep while sleeptraining overnight and then not
sleeping during the day at nursery.
So how do you handle that?
, And I guess what I would say is itreally doesn't take, well, your child
should not be awake overnight uh, fordays and weeks if you're sleep training,

(07:13):
that that's not really, um, and I'venever seen that as an issue where
it's like such long amount of time.
that that you know, thatthe child is so crazy tired.
So I would say just go for it.
If they're tired during the day, youknow, maybe back up bedtime a little bit.

(07:33):
If they're extra tiredand not sleeping at all.
But I would go for it, especially ifthey're not sleeping during the day.
Let's get them to sleep overnight.

Yeah, no, I would agree with that.
Okay, so
Here's another one, Chelsea.
Our 6.5 month old has been sleep trainedFerber for about a month and sleeps from
7:00 PM to 5:00 AM I would celebrate thatwin first of all, Chelsea, but how do
we avoid these early morning awakenings?
Should we just accept that he'sa 10 hour overnight sleeper?

You want me to tackle that or you want that?

I'd say that a lot of this depends on how
much he's napping during the day.
I'd say that 5:00 AM is in the low endof normal, the early end of normal.
For a young child and it is painful.
What do you think?

Well, I think one of the biggest things that
I do is look at overall sleep.
So like you said, let's look at naps.
How much does, how much sleep doesthis child need in a 24 hour period?
Because it's possiblethat they're maxing out.

(08:44):
And so a 7:00 PM bedtime yields a 5:00 AM.
Wake up at perhaps an an8:00 PM bedtime would not.
However, it could also beif you start capping naps.
And move, try to shift some of thatoverall sleep into the nighttime.
You could perhaps get rid ofthat 5:00 AM waking, but it
really depends on the child.

(09:06):
Because some babies just really lovewaking up early, just like some adults.
So for me, it's a matter of, again,it's, it is looking at that daytime
sleep and the timing of everything.
And I also like to look at thefact, like, I always ask the
question, have they always woken at5:00 AM or is this something new?

(09:28):
Because if they've always wokenat 5:00 AM it's more likely
that they're just early birds.
But if it's something new, it's it'sprobably something that you can shift
around a little bit with scheduling.
But I would say early wake up are probablyone of the hardest things to solve.

Yeah, absolutely.
Yeah.
And the basic stuff.
Make sure the room's dark, though.
If you're in the Northern hemisphere, itprobably is dark at five in the morning.
Currently.
Make sure there's no a, is theretrash pickup going on when this child
wakes up at five in the morning?
Something like a soundmachine could be helpful.
It's tough though.
It's a tough problem.

(10:06):
You wanna read the next one?

Sure.
Okay, Caitlin asks, I have a seven monthold who has just started sleeping better.
This will be our first daylightsavings time, and I'm terrified.
How can I preserve the progresswe've made with his sleep?

I can speak to this.
Yeah, the falling back is thetough one for for parents of young
kids who are getting up early.
Because if your kid was getting upat six in the morning, guess what?
On, I think it's November 4th this year.
All of a sudden that'sfive in the morning.
And it'll feel like six in themorning because you won't have
adjusted the new schedule, but therest of your life probably will.

(10:46):
Not so often.
Often I just tell parents, justkeep your kid on the clock schedule.
You can maybe move them 30 minuteslater for bedtime for a few nights
before, but most kids reallydon't need a huge adjustment here.
It's not gonna, for a seven month old,it's not typically gonna result in a

(11:07):
lot of middle of the night awakenings.
I think it's just your baby's gonna haveto ship their sleep schedule an hour later
just to be in sync with everything else.
So I don't think that'sa huge lift though.

No, I agree.
And I think some babies arejust sensitive to any change.
It just is who they are.
But I generally prefer not to do any sortof shifting of schedules unless a parent
is really, really nervous about it andit makes them feel better to do that.
In which case I'll say, push wake uptime, nap time, bedtime, about 10 to

(11:43):
15 minutes later for , you know, sevendays leading up to the time change.
And then, the goal is you're puttingthe baby to bed an hour later for
everything so that when you wake up onSunday, the baby's already on schedule,
but shifting a baby's schedule.
By that much can be really challengingand may backfire in a way that

(12:09):
even just following the clock,like you said, wouldn't backfire.
The other thing is that I just say if youknow for a few days you may have to put
baby to bed actually a little bit later.
Isn't it later, 30

Well, it'll
'Arielle Greenleaf: cause they need more sleep drive or
the

am I getting my

a, here it's like
jet lag.
The clock's gonna shift, and thebaby's natural biology is not gonna
So the schedule is actually,since we're falling back, the
clock time is ratcheting earlier.
So if the child was used, was sleepingfrom seven to five, like the previous
example, all of a sudden the child'ssleep schedule is gonna be six to four

right,

don't
make any changes, right.
So for most for teenagers it's greatbecause all of a sudden school feels
like it's starting an hour later.
But for kids who are waking their parentsup, falling back is more difficult.
But I wouldn't overcomplicate itunless your child has special needs.
I think if you're gonna do anything,try to shift the afternoon nap and

(13:11):
the bedtime a little bit later.
But it, it's your first rodeo.
I would just maybe just go with theclock time and recognize your baby's
gonna be a little bit irritable.
That first night.
Maybe the first night after the shift,you, your child stays up 30 minutes.
You keep them up 30 minutes laterand then they get used to it.
But just try to stick withthe clock schedule which is

(13:34):
gonna feel later to the baby.
Let me just make this simple.
Okay?
'cause this, it is areally confusing topic.
If you want to prepare in advance,you could have your baby stay up 15 to
20 minutes later for a night or two.
Otherwise, I would just try tostick to the clock schedule.
So in the Sunday after the daylightsavings time shift, you could

(13:54):
just try to keep your baby up tothe clock time, which will be an
hour later if you don't make it.
That's okay.
So if your kid's usualsleep time was seven 30.
And they're irritable atseven because seven feels like
8:00 PM used to, that's okay.
You can put them to bed.
They're gonna adjust pretty quickly,

Yeah Yeah, I I think it's just get them outside in
the sun um, and know that it'll takea couple days, but it should be fine.

Okay.
Kaley asks my nine month old wakesin the middle of the night, babbles
for a while, and then cries.
I end up going in to resettle him,which gives me more sleep than
waiting for him to cry it out.
How do I break this cycle?

Oh boy.
It comes back to how do you even knowthat the baby is babbling and moving
around in their crib and not crying?
is a, this is a big problem I'mfinding with a lot of clients right
in that you know, there's some reallygreat technology out there and it

(14:59):
gives us lots of information, but ifwe didn't have those smart monitors,
we'd have no idea that baby wasawake and babbling and moving around.
As far as the crying mean, this,it's nine month old, is that right?

Yeah.

Nine mean, Generally speaking, nine month
olds can sleep through the night.
Um, But again, I think you have to goback and look at how are they falling
asleep in the middle of the night?
Are they getting theright number of feeds?
Could they be hungry?
Speak to the doctor about If if thechild is healthy and they're getting all
the nutrients that they need throughoutthe day, then the best bet is to,

(15:38):
choose a method and and stick with it.
Start with bedtime.
You have to start with bedtime and thenfollow through throughout the night.
Um, But I think it's important toremember, I know, I understand the
idea of, you know, maximizing sleep.
I think a lot of people, and, andsome of the questions we've heard
already assume that sleep trainingis gonna take like and and weeks of

(16:03):
prolonged crying and sleepless nights,and it's just really not that bad.
And in the majority of cases,parents are like, why did I wait
so long and why was I so nervous?

Yeah, I think in this case, baby needs to be falling
asleep independently at bedtime.
If that is not the case, do notstop, go, just do some sort of sleep
training technique at bedtime to havethe child fall asleep independently.
And Arielle, I think you textedme that you wished everyone
would throw their Nanette out
the

I sure did.

sponsor of the

Oh gosh.
I feel know?
yeah.

or sponsor me, not Arielle.

you know,

I think I think that it is a, it does sound like in
this example, the baby is crying.
But I do think that it,that, and sometimes you
in inadvertently power this habitbecause you're anticipating crying.
So when you hear the baby battle, yougo in, put in the pacifier, pat them.
So then they, when they have anatural awakening, they're gonna cry.

(17:07):
'cause that's what they're used to.
So again, if your baby's falling asleepindependently at bedtime, you may
need to ignore them and let them crya little bit if they're not falling
That's what I would do.

Craig, I didn't put these in our questions, um, but I got
two different sleep coaches asked toasked to discuss how it's normal for
babies to wake throughout the nightand, um, and that, you know, sometimes
they're just kicking around and they'replaying with their fingers or their feet

(17:44):
know, babbling like this this baby, and.
I've noticed that people are so concernedabout these awakenings and sometimes
the baby's awake for, you know, anhour, but they're so concerned in
the morning and they see it as theirbaby didn't sleep through the night.
Even if they're not signaling, youknow, they're not crying out, they're
not hysterical, they're just awake.

(18:05):
So what are your thoughts on that?

Yeah, I think it's perfectly natural for people
to awaken during the night.
And it's true of babies,it's true of grownups.
And if your child doesn'tseem to need anything, you
don't need to worry about it.
If the monitor says they're havingbroken sleep at night and you don't
hear from the middle of the night,it's not cause for concern to me.

(18:29):
We've, I think that as people as babiesgo through the night, they go through
non-REM sleep, then they go through REMsleep, and then they wake up and they go
back to sleep and it's totally natural.
So just it, it take pleasure inwatching your baby practice rolling
or putting their fingers in theirmouth or babbling to themselves.
This is just normal development andI think it's a wonderful thing if

(18:52):
a child can entertain themselvesin their crib or their bassinet and
actually not have you present for that.

I mean, I think that's one of the goals we
have when we are helping parentsthrough these sleep challenges.
We want our, the babies to feelcomfortable and know, have it be
a safe space for them to I agree.

Okay.
We are on section two, early morningawakenings and sleep regressions.
So we did cover this a little bit.
But yeah, we, let's get, we can gorapid fire for these they're related.
Brittany asks, once a childis sleep trained, how should
nighttime awakenings be handledto avoid reversing the progress?

Stay consistent.
mean, as long as you know your childum, healthy and otherwise, well
cared for it, you can see on themonitor probably whether they're
they vomited or something like that.
Um, Then the most important thingis to stay consistent because one
of the biggest things I see withregressions is it they can happen

(19:53):
out of nowhere and you can suddenlyhave these wakings and parents are so
confused because baby has been sleepingwell and this is outta the ordinary.
And so they go in and then the ball ofyarns starts to unravel and six weeks
later they're coming to me saying,I just, I don't know what happened.
And now we're in a horrible spot.

(20:13):
So as long as your baby is healthy andotherwise fine, I would stay consistent
with whatever method you chose.
If you feel like you needto go in for a quick check.
Make it quick, brief, don't make,you know, no fanfare and uh, and be
outta there as quickly as you can.

I agree and look, sometimes your kid are gonna have an
ear infection and wake up at night,and that doesn't mean that they're not
sleep trained anymore if they've got acold or you're traveling and something
comes up.

Yeah, I think that's a really important point.
I've, I often see um, parentssaying, you know, I've had to
sleep train, I sleep trained andI keep having to ResSleep train.
And I, and I, you know, you'renot really ResSleep training.
What you're do is redoing is recalibrating.
If you go on vacation,your own sleep gets.

(21:02):
Outta whack.
You come home, you have toget back into the schedule.
You probably have to wake up a littleearlier, go to bed a little earlier,
and it's the same as true for your baby.
So illness, like you said, um,travel, those things are probably
going to affect baby's sleep.
And you just, I just look at itas getting back into routine.

Agreed.
So let's see.
I've actually got a couple of,let's let this compare and contrast.
So these are three early morning awakening
questions.

Okay.

Chelsea asks about a 6.5 month old who's been
sleep trained but wakes up atfive in the morning consistently.
How do we troubleshootearly morning awakenings?
We talked about that a littlebit in a child this age.
Again, some of it you might haveto subtract a little bit from the
daytime naps if they're excessive,but I think that, it is early.

(21:58):
Let me let's read these others as well.
'cause I think they're, it's a little
bit of compare and

Okay.
Yeah,

Hunter asks our two daughters ages six and nearly four wake up
extremely early with the youngest regulargetting up at four 20 in the morning.
We've tried adjusting bedtimesbut nothing seems to help.
What strategies do you recommendfor handling early risers?
Four 20.
A cool time to wake up,but not for parents.
Is pretty early.

(22:23):
And Pauline asks, can you suggeststrategies for children with a SD who take
melatonin to fall asleep but waken theearly morning and won't return to sleep?
We've considered various factors suchas pain, consistency, and routine and
family response, but nothing has helped.
So Chelsea, I think we talkedabout a little bit earlier.
I have an idea about Hunter, but I.

Yeah, go ahead with your Hunter and and if I have anything to.

So sometimes I've had situations like this where we have
a 6-year-old and a 4-year-old, or a6-year-old and a 3-year-old say who
are sharing a room and the 4-year-oldis napping and the 6-year-old is not.
And the result can be sometimes thatthe 4-year-old is either needs to
go to bed later or get up earlierbecause they're getting more sleep

(23:14):
than they need with their sleep
opportunity.

drop their nap.

So dropping the nap can be helpful again and listener kind
listeners, I always appreciate these andwe don't always include all the details.
Sometimes you need a kind ofbespoke solution with a schedule.
But I'd say that certainly if the4-year-old was napping, I would
definitely get rid of the nap.
Adjusting bedtimes sometimes needs to takea little bit longer than a few nights.

(23:42):
So a later bedtime, doing it for a nightor two is not necessarily gonna work.
You almost have togenerate some sleep debt.
And I think also some childrenjust need less sleep than others.
If your child is well rested, makes itthrough the day without napping, you may
want to transition to some strategies likean okay to wait clock or like a morning
light kind of protocol which I can linkto in the show notes to say your child

(24:07):
can quietly stay in their room and play aslong as they don't wake up other people.
But the key is makingsure they have enough
sleep

Yeah.
And I also think though, that you need tolook at what is happening when they wake
up are, what is your response to them?
Um, what do do they get to watch atablet so that you can keep sleeping?
Do they get to watch tv?
Do they get something?

to cuddle

Do they get to
Yeah.
Do they go into bed?
Um, Because I find that a lot of times.
At that age, they're waking, notbecause they're not tired um, but it's
more that there's an anticipation thatthey get to do something and then they
probably are on the the other end.
Uh, Because that's really early,that's exceptionally Um, And so
have to, I I would start withwhat is the response right now?

(24:54):
I absolutely would be looking atthe schedule for the 4-year-old.
Um, But also what is the responsethat these children are getting
when they wake up that early?
And are you getting them up?
Are you taking them outside?
Are you feeding them breakfast?
You know, Looking at all that andthen deciding like, you know, what
what is the start of the day for you?
Because 4:00 AM to me, isthe middle of the night.

Yeah.
Hunter, I feel your
pain.
Definitely.
Shoot us an email follow up.
'cause I'm curious.
It is exceptionally early.
Pauline's question is a child witha autism spectrum disorder waking up
in the early morning with melatonin,and I would say that first of
all, I look at the melatonin dose.
So typically for kids that areless than 80, around 90 pounds, the

(25:38):
recommended dose is three milligrams.
And for kids that are over that weight forthe European is the 40 kilogram cut up.
The me five milligramsis the maximum dose.
If it is higher than that, sometimesthat can cause middle of the
night awakenings or nightmares.
So certainly sometimes the lowerdose can be more effective.

(25:58):
They've looked for pain, they've lookedat consistency and routine and how
they respond and nothing has helped.
This is we're gonna have Beth Mayo on.
This is a very common issue inautism spectrum disorder and it can
be quite challenging to address.
But similar to the last example,what happens with this child when
they get up early in the morning?
Tired parents often inadvertentlyoffer reinforcement and I've seen

(26:24):
many parents of autistic childrenletting 'em have some screen time.
And if that doesn't compromisethe functioning of the household
and allows the parent to sleep, itmay be something that's necessary.
Certainly I have seen a lot of kids havesome better luck if they're getting a lot
of physical activity during the day, butit often is a lot of physical activity.

(26:46):
Like parents will say that they go onvacation and their kid's swimming all day
at the beach and then they sleep in later.
That isn't really practical.
In October when your is gonna school.
For them to exercise for eight hours.
Sometimes looking at the sensoryenvironment trying something like a
Lycra sheet or working with occupationaltherapy can help for sensory issues.

(27:07):
And certainly a BA therapyfor autism can help sometimes.
But it's a, these are early morningawakenings I think are, we've alluded to
some of the most challenging problems.

Absolutely.

Okay.
Now co-sleeping and sleep transitions.
Arielle, I'm, this is a good one for
Holly asks My 2-year-old andI have co-slept since birth.
How can I transition him tosleep on his own without me
needing to sleep in his room?

yeah.

You're making her feel good with
your response.

sorry.
I'm not trying to, no, I, I think,I think it's I, I always hate
this because it's like everything.
I always, I always say it depends.
It depends because everysituation is so different.
I think a method like camping out canbe really I think you can't just your
your presence in a situation like thisbecause the child is so used to your

(28:08):
presence all the time overnight, thatI, it just completely removing pre your
parent presence would not be helpful.
So I think a method likecamping out would be useful.
It's going to take time andconsistency to get there.
But I think that that would be my, my,you know, my number one option for this

(28:31):
and this what I've used in the past.
I wonder,

Arielle, why don't you just expand just explain what you
mean by

Yeah, sure.
So camping out, basically we startwith the parent sitting right
next to the the bed or the crib.
Um, And they are sitting thereuntil the child falls asleep.
And that can be really tiring, but itcan also be reassuring to the child.
The o the bigger thing that becomestiring is you have to stay consistent

(29:01):
with that throughout the night.
So he falls asleep, he sleeps for threehours, he wakes up, it's 1:00 or you know,
it's midnight or something like that.
You have to go ahead and go back inthere and sit until he falls back asleep.
Um, There's gotta be a lot ofreassurance with that because they're
alone for the first time ever in a bed.

(29:22):
So you've gotta followthrough with that, that.
I just always tell parents, we're gonnaput our body armor on and we're gonna
get through it, and it's, you willget there, you just stay consistent.
It's hard to know, you know,how far into two is this child?
Because, um, there could certainly be somesome other tools um, that you could use.

(29:45):
I, you know, I'm justthinking about your puppy.
What is it?
The huggy puppy.

Huggy
puppy.

I mean, I at two, that's probably too young, but it
depends on are they closer to three, youknow, where are they developmentally?
Um, because sometimes things like that arelike a, an article of the child, of the
parents' clothing that smells like them orsomething like that can be really helpful.
But yeah, so camping out, essentially the,the the goal is that you're slowly moving

(30:12):
yourself away from the bed or the crib.
Um.
Over the course of, usually it's morelike two weeks and, and then the ultimate
goal is you're, you're out in the halland they, the doors, you know, slightly
open a jar and then eventually you'renot having to sit there with them at all.

So yeah, two's a tough age.
My first foray, I might be like,okay, I think you, no matter
the age you have to sell it.
Be like, oh my God, you're such a big kid.
Now you're ready to go inyour room and really, do a lot
of salesmanship about this.
Make it exciting.
Have your child spend some time inthe room by themselves during the day.
Maybe start with a nap.
And I might just say, okay, I'mgonna, I'm gonna stay with you for a

(30:57):
couple of nights and we're gonna havea sleep fun sleepover in your room.
And then mommy needsto go back to her room.
And then 'cause campingout is labor intensive.
I might just see.
You know this, some kids this might go
fine,

Absolutely.
Yeah.

be like, oh, okay, this is how it
is.
So be optimistic thatit could go smoothly.
But if it's more difficult, you mightneed to do more, be more gradually

Yeah.
I like a like a be right back methodwhere you put the child to bed and you
promise to come back um, you have toactually go back because you have to gain
their trust that you're gonna go back.
But just starting with little, you know,little steps like that can be helpful.
Um, New stuffed animals, thingslike that can can be useful.

So here's another one from Ashley.
I co-sleep with my three-year-oldin his room, but I need some more
support in my bed and back pain reliefif I leave after he falls asleep,
he eventually comes to my room.
Any suggestions on how to transitionhim to sleeping independently?
I.

I'm gonna leave that one to you.

I would say that, first of all, Ashley, good
for you for prioritizing self-care.
And I think what your childneeds is to learn to fall
There's lots of different ways to do it.
We mentioned camping out.
Taking a break is when you're comingin you leave the room and you come
in and you check and you build thatmuscle towards independent sleep.
But I think working towardsindependent sleep at bedtime is

(32:24):
your point of maximum leverage.
The nighttime awakening should improve.
Why don't leave it at that?

Yeah, I would agree with that.
'cause if the child ex, I mean, theexpectation right now is that mom
is gonna sleep in the room and ofcourse if he wakes in the night and
mom's not there, that's upsetting.
So starting at the Yeah, I totally agree.

I'm also a big fan of saying this is a three-year-old.
This child can honestly be
like, you know what, mommy's backhurts and I can't sleep in this
bed anymore.
And just, that is totally legitimatething to say to your child.
They can respond how they like, butyou can control your own body and
you can make a choice not to laydown with your 3-year-old anymore.
And I would encourage you to do thatbecause if it's causing you pain, you

(33:06):
shouldn't do it.

Yeah.
And I would say, I mean, I'vedone that with my own child.
I've had to um, well, it'snot, it's not a lie either.
I, I, when I don't sleep,I literally feel sick.
And she went through some crazyregression when the threes, somewhere
in the threes, and I literally justsaid to her, when you do this, mommy

(33:29):
doesn't feel good, and I wanna feelgood so I can have fun with you.
And that actually made all the difference.
I'm like, why didn't Ithink of this sooner?
It's sometimes it's the simple things andyou forget how kids learn quickly and
they can pick up on things very quickly.

Yeah, I think modeling self-care and expressing
what you need there's been a real Ithink since attachment parenting in,
it had its heyday in the nineties andthe early two thousands of this idea
that we have to do everything to.
For our children, they can never beuncomfortable or upset even at the expense

(34:06):
of our own mental or physical health.
And I would empower you parents tosay, it doesn't have to be that way.
And it's okay to say yourparents, you know what?
That's uncomfortable for me.
I'm not doing this.
You know that we're not doingthis way anymore because I

well, It's really just setting healthy boundaries, honestly.

Okay.
Here's another one.
Katie asks, my nearly 3-year-olddaughter has her own room for the
first time after her recent move.
First of all, Katie, that'swonderful and it's a cause for
celebration that your new move,
hopefully she wakes during thenight and asks my su husband to
sleep next to her in her crib.
Any advice for breaking the habit?
First of all, I would ask,how large is your husband?

(34:51):
Can he get into a crib?

maybe he is not actually in the crib.
He is next to the crib.

He is just got his hand in
there.
I'm just imagining like a little tiny man.
Katie hear
me?

I've definitely seen people and heard of people

Oh, I, I was too tall to get in my kid's
crib, but I've definitely seen
parents do it.
I think that I think this is one of thosethings that's just first of all, just have
a be like, oh my God, it's so exciting.
You're in your big, you'rein your big girl room.
Daddy can stay a little bitnext to you here, but he, he
can't really lay down here.
It's not comfortable anymore.

I am a big big fan of timers, so daddy
will lay next to you for you.
Choose the time.
I mean, I prefer shorter amounts of time.
You might have to start with alittle bit of a longer amount
of time and slowly back it up.
But again, this is about settinghealthy limits, not just for.

(35:45):
Him, but for her, because it'llbe, it ultimately benefits
everybody to have everyonesleeping in their own sleep space.
So timers can be really helpful, alongwith, I'll come back and check on you,
or a bedtime pass might be useful there.
Um, calling out after bedtime forone, you know, glass of water or
hug or whatever that might be.

(36:07):
But basically you just have to setthe boundaries and stick to them.
And I know every, everybody thinksit's gonna take forever for them to
figure it out, but I promise you,if you're consistent, she should
be okay in a couple few nights.

Yeah.
And I would say to any parent thatwants to break a habit, you can
just decide to stop doing something.
Your child will adapt, maybe unpleasantfor a night or two, and some people
want to do a gentler approach.
But again, if something doesn'twork for you, it's okay to stop it.
Here's one.
Kimberly asks, our 3-year-oldwakes multiple times during

(36:43):
the night screaming for hugs.
This is such a great description.
He will vomit if we let him cry.
So we end up waiting for him to fall backasleep, which can take 10 to 30 minutes.
What consistent strategy canhelp us break this cycle without
going back into his room?
This is I'd say the vomiting with cryingis up there with the dreaded sleep

(37:04):
deuce as a move that it's difficult for
parents to

can't, you can't, go in and be like, sorry
you pooped in your diaper.
I'm not you.
I mean, that's not, that's just notsomething, and they definitely learn it.
I, it's just working withsomeone recently, a return client
who's this is the latest yeah.

Unstoppable.

Yeah, so I, I actually said put her in the pull up earlier.
Maybe put her into bed earlier sothat she's doing, you know, going
to the bathroom earlier and thenactually going to sleep time.
And, And that did start to work.
So, um, I think the vomitingthing is a little tricky.
I know with younger babies and toddlers,um, generally recommend that they go in,

(37:55):
clean them up without much a attentionand put them back into bed or, you
know, continue on with the method.
However, I know that wouldn't be,would be uncomfortable for some people.
Um, Who would you say about that?

I think I, first off, I'd say, yeah, make sure your kid
gets checked out by your pediatricianthat he doesn't have acid reflux.
'cause certainly some kids thatvomit easily could have acid reflux.
Again.
He probably doesn't.
You may have already thought of that.
Often there's a lot of anxietyhere with kids that do this.
I think that if your child, one placethat might be a little bit safer is to

(38:32):
work on some separation during the day.
If separation is also a problem duringthe day, working with a mental health
provider to work on separation anxiety.
'cause this has a realseparation anxiety flavor to me.
I'm often in this age group a big fanof building that separation muscle,
but not quite getting to the pointwhere your child is hysterical because

(38:53):
they're not, they can't think, right?
Like when they're, yourchild doesn't enjoy
vomiting.
So they're getting, he's gettingso jacked up that he's throwing up.
I think you're you're he'slost the capacity to reason,
and three year olds are onlyselectively reasonable as we know.
I think working on seeing if you couldincentivize some time with him again,

(39:17):
work towards independent sleep at bedtime.
If you are not there start graduallyscaling back your intervention.
I don't know it.
If he's really struggling all the timewith separating during the day, you
probably wanna work with a professional onseparation anxiety, which is very common.
If it's just a nighttime thing, I thinkthat really start gradually, work towards

(39:39):
dependent sleep at bedtime, start scalingback your interventions at bedtime.
And I, as Ariellele says, he getsto the point where he vomits.
Then I think you do clean 'emup and put 'em back to bed, but
not really dwell on it too much.
But yeah I, yeah I'd make sureany anxiety component, this is
addressed.

yeah, definitely.

I think the next one, the, another another,
Holly is asking about a 3-year-oldtra who co-sleep and want to
transition to independent sleeping.
I think at age three, that's agreat opportunity to get pumped.
Be like, oh my God you're sucha big, you're such a big kid.
You're totally ready for this.
This is amazing.
We'll have a couple of sleepovers in yourroom and then you are gonna be sleeping in

(40:22):
a big, like in a big boy bed by yourself.
It's great.
And just sell it like
that.

Totally agree.

big,
terrible

Yeah, no, I actually, sometimes if I'm dealing with a
three-year-old, or a four-year-old, 'causeI still, I mean, some people keep their
kids in cribs for as long as possible,but, um, if I'm dealing with a child that
age who's still in a crib, I often willtransition them to a bed and it's like
new rules because new big kid, you know,so, like, I find it can be exciting.

(40:54):
You can make it exciting and offer alittle bit of reassurance like, Craig
said, but don't, I mean, I wouldn't, I.
Linger on with sleeping in theirbedroom for long periods of time.
And you might even trynot even doing that.
Maybe you, Maybe you start with sittingnext to the bed and saying, well,

(41:14):
you know, new, new exciting things.
I will sit next.
I'll read you a book andthen we're gonna do this.
And then, you know, I'llsometimes guided meditations.
You could listen to a guidedmeditation in the dark.
But make it exciting.
I would definitely make it exciting.

Yeah.
Not like the moment ofbedtime, but just sell it.
Be like, let's pick up some sheets.
This is gonna be great.
When my kids were little, theywere, my older son really liked
the Wiggles, which are like, it'slike really over the top cheesy.
Who's the guy who's the guy onYouTube that all the kids like now?
Where's the
weird

there was blippy.

Blippy.
Yeah, like Blippy.
It's
like you, when you're trying tosell something to your kid, be
embarrass yourself a little bit.
Like not at bedtime, but beep, bepumped, make it exciting, make them
feel good about this transition.

Absolutely.

Okay, she's another section, a question on
travel and disruptions in routine.
Abby asks, our 10 month old sleeps well athome, but struggles to sleep through the
night when we travel, we try to keep thebedtime routine as consistent as possible.
Do you have any advice formaking sleep during trips easier?

I really wish I had like some wonderful advice for this
other than, you know, eventually she willstart to sleep better while traveling.
Um, try to keep her well rested.
Try.
You said you're doing the bedtime routine.
That's great.
Um, Trying to recreate the environment.
So if you've got blackoutshades and a white noise

(42:44):
machine at home, it it can help.
There's.
You know, Plenty of um, disposableblackout shades you can use
or even black trash bags.
Um, you know, anything to sortof recreate the environment.
But honestly, travel forchildren can be difficult.
It's not uncommon for travel to bedifficult for a baby or a toddler.

I am a big, they didn't have 'em when my kids were little,
but those sleep pods that they have,they're like, it's like a little tent,
uh, that your baby sleeps in.
Yeah.
I'm a big fan of those actually.
I think it's great.
It's especially black.
They can't see you, especially ifthey're after six months of age.
If you have them sleeping in a differentroom something like that can be helpful.
But this too shall pass.

Yeah, I know.
I wish there was something like wonderfulbecause I went through it myself
and it know, I'd called them trips,not vacations for quite some time.

yet.
Vacations
are over.

It.
No, that's not true.
No.
Your child will be okay but it it,it, you know, some children are
just more sensitive than others andI was part of that camp, so I feel

Okay, here's a section on nighttime anxiety and sleep fears.
Andrea asks, my 4-year-old neverstays asleep in his room and comes
to sleep in my room every night.
He's scared to sleep alone and alsofears being by himself even when awake.
How can I help him feel comfortablesleeping alone in his own space?

I think that goes back to what you were saying.
It sounds like there's someseparation anxiety going on there.
If he fears being alone.
Even.

in show notes that Eli Lebowitz book on anxiety, which is very
good has a detailed plans on howto deal with separation anxiety.
Also my website, there's, he has somethingin his book one of his books called
The Yale Plan for Independent Sleep atBedtime for Kids with Separation Anxiety.
I'll link to it.

(44:40):
But I'd say the key is basicallyworking for kids that are very anxious.
You wanna work on independence, butvery gradually if he is struggling with.
Separation or being alone when awake.
Honestly, working with a behavioralspecialist during the day is
often the least threatening.
'cause if your kid can't, being alonein his room for five minutes during

(45:01):
the day, nighttime is a lot scarier.
I'd say if you could work with someone onthat, again, it doesn't mean that there's
anything terribly wrong with your kid.
This is incredibly common.
But working up on building thatmuscle of independent sleep,

Or just independence,

yeah.

you know?
cause that's tricky.
It's hard to, like you said, it's hardto do that overnight if they can't.
Feel comfortable during the day?

Let's see.
Here's one , Stephanie, ask whatis appropriate to go in and help
your child fall back asleep?
My 2-year-old wakes up and when wego on, go in, it turns into a party.
How do we know when it'sreally necessary to intervene?

Well, I mean at two, I would say it's probably
unnecessary the majority of the time.
Unless the child has health issuesand needs to be fed overnight, but
that's very unusual at that age.
It

This
is sometimes where thesetwo-way monitors can be helpful.
Where you can just say,oh, you gotta go back to
bed.
Goodnight.

but some kids are scared of that.
you know, the great and powerful oz comesout and they're, that freaks 'em out.
I'm serious.

attention.
the
man behind the

Um, I mean, if if it's consistent that the
child just wants to party, thenyou know, you've gotta work again.
We gotta look at bedtime.
How is bedtime, how arethey falling asleep?
And that's, that's where we start.
I know we sound like brokenrecords when we say that, but
that's where you have to start.
And and then you have to followthrough um, with that consistency

(46:33):
so that they understand the theboundary in the way that it works and
that they feel comfortable when theywake up in the middle of the night.
They definitely don'tneed you for a party.
They can party by themselves in the crib.

Totally.
Leslie asks, my 7-year-old grandsonwakes up around three to four in the
morning when he stays overnight with us,even though he wakes up later at home.
I think he wakes up earlyto spend more time here.
Any strategies to help him sleep later?

Yeah, don't get up with him if you, if you're, I mean, it
sounds like he's being incentivized, so

yeah, I would agree.
Leslie, first of all, Ilove a grandparent question.
Grandparents are the best.
I used to spend a lot of time atmy grandma's when I was a kid.
I think there may be two layers to it.
Some of it is just sleepingin an unfamiliar environment.
But think about how you maybe reinforcing this behavior.
I'm sure you really enjoy having himcome to visit, but if you're getting up

(47:26):
with him, if you're getting him a snack,if you're letting him play with a toy
or something like that, I think the ex,if he sleeps well at home and this is
at your house I think the expectationneeds to be that, you don't see him
in the morning till his wait time.
He's seven years old.
He should be able to
do that.

Might be helpful to get an okay to wait clock or
something at grandma's house.
Um, Something so that it signalsto him that it's okay to get up.
Um, But I would, if you're getting him upyou know, offering a snack or something
like that, the way to make it stop is to

I don't think a

of new.

likely read a clock.

no.
no.
But an okay to wake likea, something visual.
They can read a clock a 7-year-old

No, I'm saying I don't think an okay.
Okay.
To wait clock is a clock thatchanges color based on whether or
not the child can get up or not.
I think for, I don't think you need itfor a 7-year-old, just get a digital
clock and be like, okay, if you'reawake in the middle of the night if
it's an emergency you can come get me.
Otherwise I'll see you at six in the
morning and just
sort of stick to your

don't know.
I just think wake okayto wake clocks are fun oh

you invented the okay
to wait clock.

did not invent the okay to

you
invented it.
Okay.
To wait clock.
If you wanna sponsor us,
Leave our email at the bottom of the

I mean, I did work for Hatch a long time ago, so

Yeah.
No it's great stuff.
Okay, Dr.
Ula, believe as a pediatrician, asks My19 month old used to sleep through the
night, but has recently started waking upmultiple times and crying for reassurance.
He won't go back to sleep unless wehold his hand through the crib bars.
It's very
touching, touching image.
What can we do to help himsleep through the night again?

I'm sure it's not touching in the middle of the night.
It's exhausting.
I mean, if The child used to sleepwell previously, I would think how did
they, how did you go about teachingyour child to sleep independently?
Initially, and then sometimes youjust have to go back to basics.
I would also say look at daytime sleep.

(49:27):
I don't know if they've transitioned toone nap um, at this point, I would assume
so, but sometimes you know, sometimeschildren hold onto two naps for a while
it's time to to transition to one nap.
Uh, I also say that that's likea very common age for language
development and there just happensto be a lot of nighttime awakenings.

(49:48):
One language is exploding.
So It's so tricky 'cause it soundsso It's like, well if you don't want
that to happen, then stop doing it.
But it's so hard as parents tojust stop doing something if you
feel like your child needs you.
So.

And we don't know the timeframe of this.
Maybe when I sent this emailout to my email list, it
happened for a night or two.
Maybe it's been goingon for a week or two.
Certainly if something's happening fora couple of nights, I'm not that worried
about it, but it's be, it's becoming thenew norm, that's when it's a problem.
I think the looking at the naps isdefinitely a money, if there's two

(50:25):
naps, I'd go to one make sure there'snot something medical going on.
And, think if there's anything thatchanged in your routine or your child's
life, that might be a factor here.

Yeah, all of that.

Okay, so here, sleep disorders and medical concerns.
This is one probably for me,though it's not a disorder I treat.
Sarah asks if it's possible for someonewith REM sleep behavior disorder
to perform complex movements likegetting outta bed and opening a door.
My father-in-Law, who has all therisk factors for REM sleep behavior
disorder, was hurt in the earlymorning after a supposedly waking up.

(51:01):
Could he still have been asleep?
In short, the answer is is yes.
REM behavior disorder is where someoneloses atonia, which is muscle, which
is the suppression of muscle activityexcept in the, during REM sleep, your
diaphragm and your eyes, muscles can move.
Everything else is paralyzed.

(51:21):
That is specifically to keepyou from acting out your dreams.
So patients with rem REM behaviordisorder can act out their dreams and
the dreams often have violent content.
So that is a possibility.
Another possibility is he justcould have been sleepwalking.
Even a sleepwalker and sleepwalkingis a non-REM parasomnia that can
get outta bed, open a door, leavethe house, turn on the oven,

(51:44):
et cetera.
Certainly I'd say one episode, weirdthings happen sometimes, but if this is a
pattern, I definitely think he should beevaluated by an adult sleep specialist if
he is wandering the house in his sleep.
There are forms of nocturnal epilepsythat can look a little bit like this
too, though, that would be less common.
So
yeah, that's an interesting one.

(52:06):
It is scary.
People are interested.
Mike Bur Bigley, who's a comment,a comedian, has a special
called Sleeve walk with me.
He was diagnosed with his disorderand actually because of a dream,
he jumped out to the window of his
hotel.
Fortunately, he was on the secondfloor, so he just pretty banged
up and had to walk in the frontentrance of the hotel in his

(52:28):
underpants

Oh my gosh.
Oh Lord.

yeah, here's another one.
Whinging asks.
My seven month old has been diagnosed withscience silent reflux, so we had to hold
him up where upright to sleep for months.
Now that we're trying to transitionhim to the crib, he won't fall
asleep unless we hold him.
Should we just keep trying orare there more tips you can offer
to help him sleep independently?
It's a tough
situation.

Very tough.
I've worked with many really intensereflux situations and one of the biggest
issues is that, you know, sleep training,usually there's some crying in the
beginning and crying often results in.
Saliva, more saliva and that saliva can,you know, cause reflux to flare up a bit.

(53:18):
So it can be challenging um,to to work with, with families
like this, I would definitelyget clearance from the GI doctor.
I'm assuming that you have one'cause you have that diagnosis.
But then I would consider what feelsright for you for a sleep training method.
And perhaps it's a more hands-onmethod and slowly removing

(53:42):
yourself from, , the situation.
You may have to have, you know, literallyhave your hands on him for a little bit
or you do some sort of a check-in methodwhere you go in and you lay hands on him.
Um, But I mean.
unfortunately, the only way throughit is through it, and it can be done
even with children who have reflux,reflux, severe, you know, gerd.

(54:05):
But again, I would definitelyspeak with the pediatrician or
the, the the specialist beforemoving forward with anything that
may include some sort of crying.

Yeah, it sounds like they've been receiving
medical care in the line.
I mean, I would ask yourself tooif this also feels like the right
time for you to do it, I'm assumingit is that you're tired of dealing
with the nighttime awakenings.
I think you just have to goreally gradually and maybe you
lay down next to the baby andyou hold him for a little bit.
Maybe you're just patting him tosleep and you're really gradually

(54:35):
ratcheting back your involvement.
But best of luck, again, this isnot gonna last forever, it probably
will be a little bit of a rocky
transition.
Okay, now last question from Amelia Juanand baby to, and they sent a picture of
the baby,

Oh, yes.

We followed the CIO sleep training method with our six month
old, but even at nine months, he stillcries himself to sleep every night.
Though briefly, how canwe help him stop crying at

And you might have a different answer, but for me, some
babies just do that and sort of, it'slike a, it's like a normal way for them
to decompress and they get it out infive minutes and then they're asleep
and sometimes it's even for naps.
Um, And I just find thatit's, it's pretty common.

(55:24):
Not, I wouldn't say common,but it's it's normal.
Uh, And nothing of concern.
And that he willeventually grow out of it.

I would compliment you guys as successfully sleep training your
child, And also staying the course eventhough he is crying slightly every night.
I remember my one of our friend'skids did this for a year and he
is now a junior in high school.
He is doing great.
You baby Tonio is gonna be fine.

Yeah.
And and that's actually somethingI've been hearing a lot from
um, other consultants that Ispeak with, is that exact issue.
You know, I think sometimes we get thisimpression and perhaps I blame every,
I blame social media for everything,but um, I did that And the, and smart

kid, we didn't have social
media and it was
great.

smart technology and social media are my, you know, I have
a beef with both of those things, I, Ijust think that there's this, this, um.
unrealistic picture that when you sleep,train your baby is gonna, and your child
is never gonna hit any bumps in the road.
They're never gonna cryagain in their sleep.
They're never gonna cry to fall asleep.

(56:31):
it's, you know, they're,they're not robots.
And, , staying consistent , is key.
If you're ever worried about your childfor whatever reason, go to the doctor.
, crying a little bit at the start of thenight is just really, it's pretty common.

Yeah, it's common.
It's not cause for concern.
You are doing a
great

Yes.
Oh, that, that's a, that'sanother big important piece.
You are doing Nothing wrong.

Yeah.
Feel good about where you're at.
So that's it, that's ourquestions for this week.
Arielle, what's our email address?
I can never remember.

The Sleep Edit show@gmail.com.

Okay.
. go ahead.

I'd love to hear from, was it Hunter?
I'd love to hear from Hunter the youknow, the six and four year olds the
the waking at 4:00 AM or whatever.
Um, So if you could email,that would be great.

that seemed yeah, a little bit outta range.
I'll send him an email back as well.
So well, thanks for your attention.
Hope everybody gets some good sleepespecially as we're heading into daylight
savings time or the end of daylight
savings time, I should say.
So about.
So hopefully this will comeup before that happens.

Yes.

We'll see.
got a busy couple of weeks.
Okay, good.
Thanks so much forlistening to the Sleep edit.
You can find transcripts atthe web address Sleeped show.
You can also find video of theepisodes at that address as
well as in my YouTube channel.

(57:59):
You can find me at Dr.
Craig canna perry.com and on allsocial media at D-R-C-A-N-A-P-A-R-I.
You can find Ariel atInstagram at Ariel Greenleaf.
That's A-R-I-E-L-L-E-G-R-E-E-N-L-E-A.

(58:21):
If you like the flavor of the advice here.
Please check out my book.
It's Never Too Late to Sleep.
Train the Low Stress Way to high QualitySleep for babies, kids, and parents.
It's available whereverfine books are sold.
If you found this useful, pleasesubscribe at Spotify or Apple Podcast
and share it with your friends.
It really helps as we're tryingto get the show off the ground.

(58:42):
Thanks.

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.css-15opob5{left:0;position:absolute;top:0.8rem;} All Episodes

.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Episode 10: Mailbag Episode