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Sleep Clinic Visit- What do you think?

post #1 of 19
Thread Starter 
We visited the sleep clinic today for my son, Sid (4 1/2). He was referred by our pedi, for sleep issues.

Sid goes to bed around 8 pm, and wakes several times a night. He usually wakes up about 5:30am, sometimes as early as 4am. His behavior is clearly related to his lack of sleep.

In the afternoons, he goes from exhaustion, to hyper activity, tantrums, oppositional behavior-- and makes for difficult times.

He won't nap, but does have a rest time.

We met with the director of Texas Children's Hospital Pediatric Sleep Center- he was referred for a sleep study to r/o apnea or something else medical. He seems to think that Sid's lack of sleep is due to us- and not setting limits. I somewhat agree, because part of the routine is for DH to lay with Sid for 10 min. listening to his music box before bed. Sid ususally falls asleep within these 10 minutes. So, Dr. concluded that Sid relates falling asleep with being with dad or mom. I understand this. We are ready to change this tonight.... and have Sid go to bed on his own, and also put him straight back to his room after his night wakings.

But what I don't understand, is why the Dr. would tell us to move his bedtime from 8 to 9 pm, and make sure he stays in his room until 6am. This is only 9 hours of sleep--- 30 min. less than Sid is getting now! How does that make sense? I think the Dr. may be thinking that we are being inconvienced by Sid's early waking, and this would help. It's not the time he wakes up that is the problem, it's the fact that the kid sleeps at the MOST 9 1/2 hr a night--- and is so cranky, aggressive, oppositional and emotional every afternoon!

He is an older doc, with lots of experience and very "mr roger's like" in one way, but also had a tone of authority in his voice. We are supposed to start this new routine tonight and report back to him in a week. I cannot envision us keeping this kid up till 9pm. Partly, because by 8:30 i am in bed reading and relaxing till I go to sleep around 9pm.

i don't want to lie to him, but i also don't want to seem like I am not going with the plan to help Sid---

What do you think about this situation?
post #2 of 19
Is it possible he just thinks your son will stay asleep better if he goes to sleep later, and that fewer wakings will make up for the less total sleep?

I would just call and ask him to clarify his reasons for you and where the ultimate goal is (like is the 9pm bedtime just to get him sleeping a little later and then you can adjust back again, or is he aiming for a permanent 9pm bedtime?) or just try it for this week and see if it helps. One week is a pretty short time, but If you are an early to bed family and you can't make it through the week or don't want to try that, I'd just tell him that and see if he can offer an alternative suggestion that doesn't involve keeping your son up later than is comfortable for your family.
post #3 of 19
does light come threw his window? if there is any light coming threw i would say put up a thick blanket to block it out. i know mine 2 will wake up many times a night. it is just how they are (dd 6 ds 21m). if there is any light coming threw the window they will get up at the crack of dawn because they see the light change and think its time to get up. i would say change his bedtime to 9. set a alarm and say you have to lie in your bed untill it goes off with the hope that he will fall back asleep.
post #4 of 19
In my completely un-professional opinion, your ds needs more parental contact not less. I think it is perfectly normal and reasonable for a 4 1/2 yo to associate going to sleep with being with a parent. Would you possibly consider encouraging your child to quietly get into bed with you when he wakes in the middle of the night? Children (and adults) wake up during the night. Your goal should be an easy transition back to sleep. If your ds can get into bed with you, you would not even need to wake up (eventually) and I bet all of you will start getting more and higher quality sleep.

I think it is a really good idea to see the professionals and rule out medical causes for sleep problems, but once physical causes have been ruled out, I would give anything the doctors say about behavior changes the same credence I would give a random neighbor - no more and no less. They are medical doctors, not parenting experts. You are under no obligation to follow their parenting advice.

Dr. Sears' Nighttime Parenting book has lots of helpful advice with an AP slant.

Good luck!
post #5 of 19
Hmmmm...I think the sleep clinic is a good idea to rule out apnea.

Until very, very recently (as in the last 6 weeks), we sat by our kids as they fell asleep.

Ds (7) falls asleep and stay asleep the entire night unless he's had a nightmare.

Dd (4) was a frequent night nurser as an infant, and would wake up and come into our bed and nurse. I stopped night nursing when she was 3 (but nursed in the AM), and she'd come into our bed, snuggle and nurse when it got light. I weaned her at age 4. Now, she comes into our bed, snuggles up to us and falls asleep, and sleeps until morning. She only wakes if she has to go to the bathroom. I often don't wake when she comes in with us. More than once I've rolled over thinking, "Wow, she slept all night in her own bed!" only to find her lying next to me!

Two kids, two different waking patterns. (Ones, I might add that they've more or less had from birth. Ds slept 4-5 hours a stretch the first night after his birth - it FREAKED me out!)

I suspect my frequent waker (dd) has a bit of sleep apnea that she's outgrowing. She has night sweats sometimes (and had them frequently as a toddler). And when she was an infant in our bed, she would seem to pause breathing more than I think ds did, but never long enough for me to freak out. (But long enough to make me very glad we co-slept!)

Your ultimate goal is to get your son more sleep, right? What's the best way to do that? Is it for him to come in with you? For him to learn to sleep in his own bed? (For our ds, he does NOT sleep well when he co-sleeps. He needs his space. Dd on the other hand sleeps best with full physical contact!)

You might also think about gradually withdrawing support for him, rather than cold turkey, should you decide to go that route. So, for example, your dh could stay until he falls asleep for 2-3 days, then he can move halfway between the bed and the door, then to the door, then into the hallway. Or you can do what we do - set the kitchen timer for 5 minute intervals. When it beeps, go in and check on him. (So first it's 5 minutes, then 10, then 15, then 20.)

I find the advice to keep him up LATER very odd. I would actually ask the sleep doc about that.

What I would do is focus on making one change at a time. Which one is most consistent with your parenting philosophies? Make that change first. If the doctor asks how it's going, you can say "We're taking things one step at a time." That's not lying to them, but it is being more gentle in your implementation.
post #6 of 19

I think Lynn's answer is way more helpful than mine.
post #7 of 19
I guess I'm a bit surprised that he wants to cut his sleep to 9 hours. Maybe he meant make sure he stays in his room until at least 6 AM but you don't have to go in and wake him up at 6 AM if he is actually asleep?
I'd ask him to clarify.

When my dd was 4 1/2 she was sleeping 12 hours and I thought that was a normal amount. She would have been horrible on 9 or 9 1/2 hors. As she got a bit older she switched to 10 hours and that is what she gets at age 8.
post #8 of 19
I would guess that the 9pm bedtime is more about making sure he is really tired so he gets the night started with a good sleep. If he has less or at least shorter waking periods throughout the night then he would end up with more sleep not less. Plus it would be better quality sleep.
post #9 of 19
My DD, just turned 5, sleeps 9 hrs. a night. She goes to bed at 9 and wakes up around 6. And always seems well rested! In fact, I wish she slept more! She also doesn't nap. I think the amount of sleep needed varies per child. When she does nap at school, she's up until after 10! (In bed, playing with her stuffed animals...) Only you can gauge how much sleep your child needs - it's too individual and varies too much for anyone not close to the child to make that determination.
post #10 of 19
I think he is saying by forcing a 6am rule, it is encouraging him to stay in his room and possibly, um, sleep. I have heard of this tecnique...kid gets up too early, but has a time where he has to stay in his room until(usually a clock or some tool is used to show time) eventually, kid realises nothing is happening until that time, starts sleeping a bit later. It actually works in MOST cases, but not all. Every child is different, of course. Your son is not sleeping WELL, so he is not getting the full 9 hours of sleep, he is getting interrupted sleep which is crappy sleep. My 4 1/2 year old went through a period of this too, I think it was some food he was eating too close to bedtime though. I am actually very strict bedtime parent. I put him to bed, read a story and its night nights. He sleeps from now(its 7 30 and he just went to bed) to 8am. He wakes still, occasionally, which is expected of all humans. When he wakes I sort the problem(hunger, bathroom, scary dream, thirst)then he is returned to bed. Kisses and night nighted, and I go back to bed myself. Sleep is very important to me as a mom, I NEED it, and am nasty if I dont have it, so I have to be this way for bedtimes.
I would look to finding out WHY your son is waking rather than anything else. And no, IMO its not your*support* that is waking him. HE is waking for a reason, stop the waking, and then he will sleep well. Of course people are going to wake occasionally but this should not be a regular occurance and there has to be a reason. It may be developmental, it could be diet related, who knows??? Good luck!
post #11 of 19
I agree that ruling out medical issues is good. Beyond that, I think there are lots of options and your ped. is only presenting one. So before you start changing things, make sure you are moving in a direction that agrees with your overall parenting philosophy and that will work for your whole family.

It wouldn't, frankly, work for me. For one, I believe that children need parents and there is nothing wrong with them needing parents at night. I also, honestly, have never wanted to get up in the middle of the night and deal with sleep issues as a "discipline" problem -- which is what your ped. is turning it into. You can't force someone to sleep. You can force them to stay in their rooms, and be quiet, but you can't force sleep. Unfortunately, for many children staying quietly in their rooms is also forcing them to be lonely and unhappy. And getting to the point where they follow the rules can be long and ugly. Not what I want to deal with at 2 AM, given that my alarm goes off at 5:30 and I'm already more sleep deprived than my kids.

For us, the answer has always been to snuggle them to sleep, then leave. If they wake in the middle of the night and need a parent, they are welcome in our bed. They come in quietly and don't wake anyone up as they snuggle in. Over time, my older child (almost 9) has virtually stopped coming in at night. When he does come in, it means he is upset about something happening in his life and I know to explore things with him (during the day). 5 YO DD still comes in about 75% of the time, but its starting to taper off. I expect she'll stop coming in so much soon. They go to bed peaceful and happy. They sleep on their own and with us, content. They are rested in the AM and don't wake me up at night. For that, I am more than happy to share my bed with them for part of the night.
post #12 of 19
The more over-tired my child is the earlier he wakes..the more tired he is then and wakes even earlier and on and on. The only way to "fix" that is to get him rested.

What we did for him (at the suggestion of two doctors--a geneticist and neurologist) is use a small amount of melatonin to help him settle to sleep. He goes to bed at 7 pm. And in your case I'd move bedtime up instead of later.

Melatonin won't keep a kid asleep and you want to use the smallest effective dose if you decide to do that. My son uses .25 mg. And work on the things he needs to stay asleep--whatever that is. I actually explained to my son that when he wakes up if he still has "sleep in him" he should stay quiet and keep his eyes closed and listen to his white noise and try to go back to sleep. That helps here when he is rested enough to follow through.

Why I mention the melatonin is when we get into big messes like you describe (last week my son woke at 6 am one day, then 5:30, then 5, then before 5...he normally wakes between 7 and 7:30) is give him a good dose (like 1 mg.) of melatonin for a nap. I wake him after a couple of hours or a bit more depending on my instincts. Then melatonin a good dose again for bed that night. Often that "re-sets" him.

Melatonin may not be where you want to go. I didn't I know. But the doctors suggested it (independently) and I knew that his being so tired was horrible for his health.

However you do it getting your son rested is what you need to do and then don't turn his bedtime to later.
The average four year old is getting about 12 hours of sleep. Has your son always got less than average sleep or is this pattern new?
post #13 of 19
Thread Starter 
thank you everyone for your ideas. I have thought of using melatonin before, but I hesitated because of my own reaction to it. It would indeed help me to fall asleep easily, but I would wake up sometime in the middle of the night and be wide awake.

our issues with sid are night wakings and early wakings which leads to sleep deprivation.

Last night he fell asleep by himself, by a few minutes after 8 pm, and stayed in bed all night, until 5:40 am. This is close to my goal of 10 hours, but it is clear he is still not rested. We are discussing a sticker chart today, with each sticker earned by staying in his room until 6am.

I wish he could be happy with 9-10 hours, but I don't feel this is enough. His behavior in the afternoons is so difficult to deal with. If feel that it is so unfair to him to not be able to enjoy his childhood the way he should, but I don't know what else I can do.

This week or so , I will focus on sleeping by himself, and staying in his room until 6 am. The next step perhaps is to move bedtime up by a few minutes at a time, and hopefully, he will maintain the 6am stay in your room component.
post #14 of 19
Me? I'd ignore the doc and read "Sleepless in America" by Coloroso. Lots of great ideas.
post #15 of 19
Originally Posted by sidandspencersmom View Post
Sid goes to bed around 8 pm, and wakes several times a night. He usually wakes up about 5:30am, sometimes as early as 4am.
My oldest doesn't wake at night, but usually sleeps from 8pm-5:30/6am. It's plenty of sleep for him and he has been sleeping this way for a year or two.

I guess the problem sounds to me like the night wakings--How long are they? How easily does he go back to sleep? Is he happy or sad when he wakes up? What is your approach to the night wakings?
post #16 of 19
My ds never could stay in bed more than 9 hours, either, which meant he needed naps desperately to get his overall hours up to 11 or 12 when he was a toddler and preschooler. But he wouldn't just go take a nap. I had to parent him to sleep as I did at night. Had to lie down with him the entire nap, essentially. His day sleepy time did not stay the same but slowly got later (so he took a nap at 3 or 4 instead of 1). And that meant his bedtime got a little later. Sometimes, I timed outings so we had a nice long car ride home in the afternoon and he'd usually catch an hour's sleep.

Overtired people are more prone to sleep disturbances, insomnia, night terrors, nightmares, etc. So step one is just getting more sleep anyway, anyhow, anytime.

What is happening with my ds is that he is slowly growing out of his sleep need so that 9 hours is usually enough. Once in a great while he will sleep 10 or have a short nap. But he never did start sleeping longer at night. He still stirs a lot at night but if he feels me, he goes right back to sleep.
post #17 of 19
I find that if I get my five year old into bed earlier, he sleeps later.

Same with my one year old.

Being overtired from staying up late seems to mess up their sleep. A double whammy that leaves them cranky and tired the next day.

So the priority is first to increase his # of hours of sleep. When he wakes at night, is it taking a long time to get him back to sleep? Because if it's not then I'd personally put the nightwakings at second priority under increasing sleep time. Getting a greater # of hours of sleep might actually help him sleep longer stretches, thus decreasing the nightwakings. At least that has been my experience of how more sleep affects my own kids.

I hope you find a solution that works, I know it's so tough to have a kid that is unhappy and acting out.

Do you think the sleep is the only issue, or do you think you might come at the daytime behavior from another angle as well - I know how constant opposition, tantrums and hyperness can wear a mom down, and getting some tools to deal with them while you suss out the source, might help you cope in the meantime.
post #18 of 19
We (my 2 kids, daughter now 4.5yo and son now 2.5yo) used to have sleep problems (trouble falling asleep, occasional (not every night) nightwakings, and early wake-up times) and the best solutions for us have been health-related. Magnesium in the evenings (made falling asleep much quicker), eliminating food allergens (gluten for us), and eventually I added melatonin (that was what was needed for my son's nightwakings). Good ideas on the behavior side already, so I thought I'd share our health-related ones.
post #19 of 19
Sleep issues are sooo hard. to you.

I'm not sure what to say about what the Doc suggested. Frankly, I feel like parents are usually the best judge of what to do because they know their child so very well. Doc's have a lot of advice, but people are so individual. It's hard to say what would work for one's child without really "knowing" them. I'm also wary of the "make sure he stays in his room" bit. It sounds like something that could cause stress for you both and create a negative sleep association. Also, anytime advice steers toward less parental connection, I'm uncomfortable. When we did things [out of desperation usually--sleep deprived] in those rough sleep days, tried to get DS to be by himself or whatever, it usually fueled DS's anxiety and made things a whole lot worse. It undermined our attachment, and not only did we still have the original problem, we had much healing to do by the trauma caused by distancing ourselves from him.

I find the pushing back of bedtime rather odd. We've had our share of sleep problems over the years and one thing I consistently found, particularly when DS was in a night wake/early wake phase, was that putting him to bed EARLIER rather than later then his usual bedtime would help in getting him to sleep before he was overly tired which tended to cause restlessness and more night waking. DS has gone through many periods of this through the years and when I saw it, I would get him to bed an hour (or sometimes 1 1/2 or 2!), earlier than normal and it almost always ended up in a much better night's rest. If DS goes to bed over-tired, he wakes more and ends up in an early waking pattern as well, almost as if he has an alarm inside him. And well, as the days go on... he starts to unravel which I'm sure you understand very well. In addition, in putting him to bed earlier, he usually slept LATER than normal because his sleep was better qualit7, much more restful.

My .02 for whatever that's worth.

The best and hang in there. Best of luck in whatever you decide. Hope you're all getting some Zzzzz's before too long. If it helps, DS over the years has become a really good sleeper. At 4 1/2 - 5 or so, things started to work themselves out nicely. We still co-sleep (he sleeps in our bed with DH the first part of the night and when I come to bed, I move him to his own mattress on the floor). He falls asleep easily and most nights (99.9% of the time) sleeps through beautifully.

This too shall pass.

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