Saturday, October 31, 2009

Sleepless in NJ and the Parent-Killer

“Ten percent of the babies I see are parent-killers,” my doctor said, looking at my red eyes and worn body. “You need to hire a baby sitter and go to a friend’s house to nap. You can’t keep this up.”
Our pediatrician had diagnosed the issue: Ava was killing me. Our fifteen month old was apparently a low-sleep need, high energy kind of kid who was going to suck the life force from her mother’s teat and torture her with sleep deprivation. It was not just that Ava did not sleep; she cried, screamed and banged her head for hours when we tried to get her to sleep.
Before you say that I should try Ferber or Weissbulth, let me say that we did. And, I believe those methods do work; my oldest daughter Heidi cried it out for two nights and was a regular nap taker and nighttime sleeper from six months.
Ava was different.
At four months I had started searching for a solution. I took her to the pediatrician, the dentist, the dermatologist, an allergist. We looked at food allergies, eczema, teeth eruptions. What was keeping this kid from sleeping?
That was the first question. But, it soon turned into: What will get this kid to sleep?
We slept on Ava’s floor, we rubbed her back, we tried letting her cry it out again—another four hours of screaming---we tried adding more toys to her crib, adding music, changing the bedtime routine, we tried and tried and tried until the question then became: How can we live like this?
Certainly, many parents live with harder challenges. Many parents endure and then thrive in much, much more difficult situations.
But, knowing that others faced bigger heartache and difficulty did not erase our own. My husband and I were at the end of our ability to function—we had not slept in more than a year and the past few months were worse than ever before. There were some nights when Ava was awake more than asleep—not just one off night, but several nights---seven hours of being awake and five intermittent hours of sleep. It was not sustainable. How could I drive a car? How could I relate to our four year old? I was so tired my entire body hurt. I hoped I’d finally just collapse and wake up in a hospital. At least then, I’d get some rest.
“You need to hire a baby sitter and go to a friend’s house and nap.” The doctor’s advice hit a chord. But, it was when a long-time friend came to visit that I realized I needed help. I’d known her for seventeen years and all it took was one look and a few honest words. She had never seen me so depleted. Find a sleep consultant, she said. Her friends in Chicago had.
That night I googled a few phrases and found a message board for Berkeley moms. There were a few mentions of a pediatric nurse named Meg who had helped with sleep issues.
Did I want references? Did I want to know her credentials? Did I want to know how much she charged? No. She was from Berkeley, California, and at that particular moment of desperation, that was just about all I needed to know.
Meg would correspond through email and telephone calls. She asked me to keep a journal for two or three days detailing everything Ava ate and her sleep patterns. Before our first phone call, I was to send her this journal and a photo of our family.
The first phone call was an hour and a half. My husband sat on the couch with one phone, while I paced with another. . .What was my pregnancy like, how was my labor, how did we spend our weekends, what was the nightly routine. Meg was specific and kind, and I had the sense that the clues she was searching for were not hidden, but indistinguishable to my husband and me because of habit.
She’d pick at something we said, and tug a little more, getting to know our Ava from a thousand miles away.
Finally, as the call came to end she said had a plan.
Hours before bedtime, I was to sit with Ava and enact a story with stuffed bears or ducks or whatever I had, in which the family has a busy day and, finally, mama bear gets baby bear ready for bed. When mama bear puts baby bear in the crib, baby bear cries. But, mama bear reassures baby bear, and then baby bear learns that it’s ok to sleep. Yes, that sounded insane. And, believe me, when I tried this, Ava quickly grabbed all the bears and my four year old started barking like a dog. I decided to modify this, and tell the story when I nursed Ava—no props, just words.
The other things I was to do: move Ava’s crib to a cozy corner of the room and eliminate any book or toy from the crib. The crib should be a place for sleeping, an almost boring environment. Meg’s theory was that Ava was being over stimulated, and confused by the array of books and toys we’d tossed into the crib in our effort to distract her from loneliness.
Also, and most important, I was to make sure Ava was awake when I put her in the crib. A simple “night-night” and “time for sleep,” is fine, but then leave the room promptly.
If Ava cried, I was to wait fifteen minutes, and then return briefly to say, “night-night. Go to sleep.”
If the crying continued, I was to wait another fifteen, and so on.
In the middle of the night, I was to wait thirty minutes before going to her.
Finally, we had a solid plan. Permission to let Ava cry, but a limit to how long.
You might say the things Meg advised us to do were ideas we’d already heard or read. Nothing was novel. But, the little modifications at this moment in Ava’s life, and at this state of our exhaustion, taken together, added up to something.
The first night we tried the plan in earnest, Ava went down after a few minutes of crying. The next night, even fewer. Finally, she went down without any crying at all. I left a voice message for Meg that we had made great progress. The only problem now was Ava woke up in the middle of each night and stayed awake for three or four hours. Still, compared to where we had started, this was wonderful!
Meg had higher expectations. I won’t go into the details of the minor tweaks we made, a back and forth of little adjustments to the bedtime routine. In the end, we moved to new ground. Ava now sleeps. And, so do we.
What did I learn? Of course I wished we’d arrived at these ideas long ago, but I no longer blame myself for that. Meg said something about Ava that gave me a different understanding of her. It was not that Ava had missed the cues we’d given her for bedtime. In fact, Meg said children like Ava are often more perceptive than their easy-going counterparts. They pick up on cues their parents might not even realize they are sending.
With our older daughter, Heidi, and others like her, the basic routines leading to bedtime work and if there are minor changes, the larger agenda is still understood. Little Ava was confused by the array of signals she was getting. I think the crib full of toys and books was probably the most confusing to her. How could she sleep, when she had all those books to read and no one to read them to her? The more she cried the more distractions I offered. I was doing the opposite of what she needed.
I used to think that if only Ava could talk, we’d be able to figure out what was keeping her from sleeping. But, now I am glad we faced this problem before she’d mastered verbal expression. Words would have obscured the core issues. Even the most self-aware three year old would probably not have said, “Mom and Dad, you’ve over stimulated me with books and toys in my crib and offered conflicting cues about your expectations for bedtime. Oh, and by the way, please stop treating me like my older sister.” As hard as it’s been, I think we’ve gotten to know Ava more deeply precisely because we could not negotiate with words. The proof is in the sleeping.