I apologize in advance for the really long post. I just really need help trying to find a solution, and I thought that the more information I could give here, the more likely someone who's BTDT might recognize something familiar? I asked for similar help with extremely problematig BFing during our daughter's first 3 months, and it's only because of help from the boards here that we found and treated her posterior tongue-tie, so I thought I'd solicit here for help again in the hopes that the wonderful people here might be able to help us hit on a solution again!
A summary of the problem:
We've tried everything, and while our daughter (7.5m) now can go to sleep on her own reasonably quickly without any sleep aids (pacifier, nursing to sleep, bouncing, rocking, singing, noise machines, etc), she still wakes repeatedly throughout the night (at least once per hour). Sometimes she gradually improves to waking only three times per night, and then suddenly she is back at the old pattern. This has been going on since at least 3m (she slept ok for a newborn, but not fantastically well, usually waking every 2h, and then every hour after 4/5am, but sometimes occasionally going 6h). I would be happy if she'd just limit her wakings to 2 times per night (and I'd take 3 times) as long as she goes back to sleep fairly easily after eating.
What we've tried:
I've read through almost all the sleep books at this point. (I refuse to read Weissbluth or Mindell since I'm offended by some of the excerpts I've read from their books, but I've gone through Pantly, Karp, Kurcinka, Sears, West, Ferber, and am just starting Reichert.) We've done everything in the books except CIO (took away all her sleep associations, made sure she gets enough sleep, put her on a regular schedule, changed her sleeping location, environment, etc), with no luck (and even Ferber wouldn't recommend CIO in our case, since our daughter can fall asleep on her own, and doesn't have any "sleep crutches.")
More details about the problem:
We cosleep/bedshare, and our daughter still breastfeeds three times per night. She seems very happy and well rested during the day. Most of the repeated wakings are concentrated in the middle of her nighttime sleep - she may sleep for 3h at the beginning of the night (or she may wake once per hour from the beginning of the night), but she is definitely always really wakeful between 1-4am, and after 5/6am. She goes to bed at 9pm and gets up around 6-7am, with two naps per day totaling about 3h together (she gave up her third nap about a week ago, and just made her morning nap later and longer).
Here's what it's like when she wakes at night: she starts thrashing her arms and legs a bit, and starts fussing (not really crying, but making unhappy noises). If it's not time for her to eat, she will just make noise and thrash around for a while, and then settle back down to sleep on her own. During this time she often rolls over onto her stomach and pushes herself up as though she wants to crawl. She may smile and open her eyes, or she may writhe around so much that she claws my face and hits me with her arms and legs quite forcefully. (I've tried both just letting her do what she wants without touching her or talking to her, and I've tried holding her tightly so that she can't thrash - I think she actually goes asleep more quickly if I just leave her alone.) At times when she really seems to be crying and upset and getting more and more wild instead of less and less, I feed her, and then she seems to calm down and then go to sleep after I have taken her off the breast.
What I've ruled out?
I don't get the feeling that she is actually in pain, although there may be something that is causing a milder discomfort. Since this has been going on for months and months, I just don't think it can be teething. She doesn't have any signs of GERD other than spitting up some, but I think it is within the realm of normal. I've tried pulling on her ears to see if that causes her to cry out (and signals fluid in ears or ear infection), but there's no reaction to that particularly, so I think that rules that out. She isn't in the midst of any major motor milestones (she's been pulling herself up to standing and crawling for at least a month, and these sleep behaviors didn't come or go with those changes). I don't notice any pattern to when she sleeps well and when she sleeps poorly (the wakings don't come after more stressful periods, or when her schedule has been disrupted, or when she has had more or less sleep - they just seem totally random). In particular, we did a ton of traveling that involved sleeping in strange beds for several nights in a row, interrupting her nap schedule when travel schedules were awkward, and crossing six time zones - none of this made her sleep worse, and she adjusted to the new time zone in 2 days. She's doesn't act underslept, and attempts to get her to sleep more each day result in bedtime battles and no improved sleep.
My current theories - what do you think? Which one is it? Is it something else that is not on my list?
Having just finished the Ferber book (I'm not in favor of his CIO method, but I liked that his book at least talked about all the possible types of sleep problems, so that one can try to actually diagnose why she is waking up), I can come up with the following theories, but they may all be wrong:
1) She won't sleep better until I nightwean her b/c she is waking all the time b/c she wants to nurse. (I'm not sure that nightweaning her now is a good idea, even though doctors say it is fine - she can go for 6-7h without milk during the day voluntarily sometimes, so maybe it is fine, but I just don't know how to tell?) But if this were the case, why doesn't she wake once an hour every night? Why does she sometimes wake only 3 times per night, and sometimes 10+ times? Weaning her from the pacifier and rocking and singing, etc didn't make a difference, so I am skeptical about this one, but I guess I can't rule it out completely. Maybe I should try feeding her a ton during the day and gradually reducing the night nursing?
2) She's having some kind of confusional arousals (like night terrors, only milder), where the thrashing around at night is when she is going from one sleep state to another, but gets sort of stuck between sleeping and waking. Since when she gets really agitated BFing calms her, I'm not sure that this is it (since supposedly you can't calm or interact with or wake a kid in this state). If this is it, though, I guess we need to see a sleep doctor?
3) Her naps are too long or her nighttime sleep is too long, so she is having trouble staying asleep in the middle of the night because she is not sleepy (but when she thrashes around, her eyes are usually closed most of the time as though she is tired but just can't sleep, so I'm not sure that this is it - although she does sometimes open her eyes and seem like she wants to play). She naps about 3h/day and sleeps about 10h per night, which I understand is normal (11-12h is supposed to be normal for her age at this point).
4) She has some kind of medical issue like GERD or itchiness, or twitchy limbs, or whatever, that is causing her discomfort (probably not horrible pain, but maybe just something uncomfortable enough to keep waking her - for example, sometimes I can't sleep because I have achy-twitchy hips and legs, so I have to get up and do stretches). Not sure how to diagnose this, though, since she can't talk!
Thanks for reading my super-long post. If you have any ideas here or BTDT that you want to share, I'd love to hear it! Which one of my theories do you think is most likely? Is there something else I should put on the list of possible causes? Should we try to find a sleep clinic? Any other recommendations?
Thanks again in advance for your help and advice!