On Night “Wakings” That Actually…Aren’t

Hi Amy,

I know you have answered a million questions about infant sleep before, but you seem to be privy to some special info that the rest of us mere mortals cannot find.

Anyway, this is about my (just turned) 1 year old. He sleeps like a newborn at night! He is up every 2 hours (sometimes more frequently). This has been happening since he was 4 months old, although it has gotten progressively worse.

At 4 months, he had his sleep regression at the same time as my return to work and his first daycare cold. The only way most (but not all) of the time to get him back down is to nurse him. Daddy usually doesn’t help out at night because he is in school and working and can’t miss out on too much sleep. I left my job when my son was about 6 months old, so I get the nighttime duties because I’m home with him all day. The problem is, I haven’t gotten more than 3 consecutive hours of sleep in almost 8 months now!

I’m exhausted and not interested in weaning (and he is teething, so if he honestly needs nursing for comfort, I don’t want to deprive him of that). I’ve read the The No-Cry Sleep Solution, but a lot of the stuff either doesn’t apply or didn’t work. He falls asleep without issue, it is just the waking up. We’ve tried earlier bedtime – he actually sleeps longer if we put him to bed later (ie: if he goes to sleep at 8, he’s up by 9, but if he goes to sleep at 9:30, he’s not up until after midnight… and forget about 7pm!). He is also a good napper when given the opportunity (sometimes he misses or has a shortened one if we are out somewhere, but he’s good about sleeping in the car at least). I’ve even seen him wake up and go back to sleep on his own for naps, so I know he can put himself to sleep.

He never wants to wake up – he’s very angry when it happens and his eyes are usually still closed. I give him an opportunity to go back himself, but usually it doesn’t work. If I go in and just try to pat him or rub his belly or something, he gets mad and pushes my hand away and cries until I pick him up. We tried CIO once; after 3 minutes, he was screaming bloody murder, so my husband went in, which caused him to get even angrier. By the time I went in at 5 minutes, he was hysterical and about ready to throw up. He was so wound up the rest of the night he had to come into bed with us.

He starts out the night in his crib, but usually by 3am or so, he ends up in bed with us if he keeps waking up more frequently than every hour or won’t go back to sleep. He still cries in bed with us, so it isn’t separation anxiety. Even though I’m a believer in co-sleeping, it really isn’t feasible in our tiny queen sized bed with my 23-pounder that likes to kick me in the stomach and poke daddy in the eyes. My back is in so much pain from accommodating him in our bed. I wouldn’t care as much if it solved the problem and he slept, but it doesn’t. I just get too tired to walk down the hall to get to him.

We’ve tried white noise, lullabies, light projector, sleeping in the pack ‘n play (where he takes his naps), sleeping with a soft blanket (also what he does for naps), introducing a lovey, tiring him out before bed (riles him up more), bath time, reading a book, warmer pajamas, cooler pajamas, and any other advice I’ve probably heard. What am I missing? The sleep deprivation is really starting to affect me.

(Also, we just found out that he is anemic, so I have no idea how this kid isn’t tired! I remember how it felt to have low iron – I couldn’t stay awake!)

Thank you Amy,
Sleepless in South Florida (sorry, that was pretty cheesy)

Okay. So. Imma write a column here, but be forewarned that it’s almost 100% culled from the book I am going to recommend you get ahold of. In fact, if you want to skip my blabberings altogether and just go straight to the bookstore or library right this instant, my feelings will not be hurt. Go buy/borrow a copy of Richard Ferber’s Solve Your Child’s Sleep Problems.

“But wait!” you say. “Isn’t Ferber and Ferberizing just a cry-it-out (CIO) system? Which we tried already? With disastrous results? Did you not READ my question, woman?”

I did! I promise I did. And it’s kind of a shame Ferber and his book have gotten so pigeonholed as being All CIO, All The Time. I mean, my copy is 440 pages long, and I assure you, there’s SO MUCH MORE to it than simply: List sleep problem. Solution: Cry. The End.

There’s a chapter in this book that describes what your son is going through to a tee. It’s called a “confusional arousal.” He’s not waking up completely — and like you said, he’s pissed as hell that he’s not still fully asleep — but it just keeps happening. He’s on the verge of moving from Stage IV (deep sleep) to Stage V (REM sleep). He’s waking up partially in a confusional event and since he’s young and still kind of figuring this whole “sleep” thing out, he’s unable to balance out the drive to sleep with the drive to wake, and the entire sleep cycle (and yours, too) is getting derailed from there. Ferber’s book actually plots these “partial wakings” on a spectrum, and what’s happening to your son is basically one step below a night terror.

A night terror will feature screaming and panic, a child who is literally standing up or jumping out of bed while still asleep and who will have no memory of the event once it passes. These can be terrifying to witness the first time, and the temptation to fully wake the child up is strong…but it’s best to let the event run its course (as long as the child isn’t in danger of hurting him or herself). A confusional arousal is an extended period of crying, fussing, yelling, kicking, rolling around and general upset. It’s at this stage in the sleep cycle that older kids will sleepwalk, or talk in their sleep. Your son is basically going through something similar — and getting stuck there, and then fully interrupted by you. Like a night terror, a child experiencing confusional arousals is not fully awake and the event will pass on its own, provided we parents mind our own business and resist going in there and waking them up the rest of way, thus pulling them completely out of the night’s sleep cycle and dooming them to zero REM sleep.

Because your son is likely not actually “waking up every night.” He doesn’t really need or even want you. (You mentioned even going in to pat his back seems to make him angry.) It is very, very likely that if given proper time and space, the event will pass and he will go back to sleep. As in, longer than three minutes. I wonder if, that time he was screaming bloody murder if he was even awake, or if he had simply moved a step down the spectrum and was having a night terror? Once again, by going in and waking him up fully, you’ve interrupted the sleep cycle EVEN MORE and then yes, he’s then going to be awake and confused and tired and be COMPLETELY incapable of resuming his night’s rest.

So why do these partial wakings happen? Well, the number-one reason is usually that the child is overtired. An overtired toddler will wake up more and have more difficulty getting back to sleep. This would make sense given the anemia — possibly once you get his iron levels up the problem will pass on it’s own. You mentioned that he is a good napper but occasionally does miss a full nap, and his bedtime is definitely a tad on the late side. I understand you’re trying to do a ballet of “if he goes to bed at X, he wakes up by Y, but if we try Z” and we’ve ALL BEEN THERE.

But just spitballing here: Experimentation with the “right” bedtime has led to a feeling (for him) of inconsistency. You do an early bedtime on a day he missed a nap, but then push it back to 9:30 the next night…not realizing that thanks to a partial waking the night before he’s STILL behind in sleep from the missed nap, compounded with shaving an hour or so off his night’s sleep — confusional events happen pre-REM, which only comes at night, hence his ability to put himself back to sleep during a nap’s day sleep cycle — and well, you get the idea. A super overtired, anemic kid who is behind in his sleep, screaming at the sleep gods multiple times a night because he’s struggling to make it through the sleep cycle hump. Multiple nights in a row without ever entering REM sleep, and BAM. That’s a toddler who is going to keep having the same sleep issues every night.

So. Get his iron levels back up. Pick a bedtime once and for all and stick with it — for kids with sleep issues, it should be one that is just late enough to allow him to fall asleep QUICKLY but not so late that he’s yawning, putting his head down, etc. Try to get him through a solid week or so with full, real naps in the crib and no car-snoozing and see if you notice a decrease in the night wakings.

The other big reason for confusional events (according to Ferber) is the idea of the child having a “job” to do. Basically some external factor that he’s come to depend on to get back to sleep, like a pacifier, musical toy or even just looking for your presence in the room. (Even though he doesn’t necessarily WANT you there during the midnight freak out.) You nurse him back to sleep (not all the time, but most nights), so his brain thinks it “needs” you (even though he’s not waking from hunger) and the needle is getting stuck. “Uh oh, waking up, where’s boob where’s boob I DON’T WANT BOOB, I WANT TO SLEEP, aaaarrrrrrgggghhhh Hulk Smash.”

You certainly don’t need to wean him completely, but closing the boobs after bedtime might be a wise choice at this juncture. Don’t let him fall asleep while nursing, brush his teeth afterward and/or read a story so he’s fully awake when you put him in the crib. Resist swapping night nursing with another “job” like waiting for a butt pat or to be picked up. (Which, as you’ve obviously noticed, HE DOESN’T EVEN WANT.) You can do this as gradually as you feel comfortable with, but focus on eliminating anything external that his brain might be feeling like it “needs” before it can go back to sleep — especially something that he can’t provide for himself (like rolling over, grabbing a blankie, etc.) and requires YOU to provide. We all do that when they’re tiny, obviously, but at some point it’s OKAY to admit that you’re tired and are done being the Human Nighttime Pacifier.

When you say “I give him an opportunity to go back himself, but usually it doesn’t work,” how long of an opportunity are you giving him? If three minutes is the maximum you’ve let him cry, well…yeah. You’re going to hate me and I’m sure I’ll get an ear full of it from the commenters, but that might just not be enough time. Especially since I really don’t think he’s even awake and aware that he’s crying!! If you were describing a child who was standing up in the crib, eyes open, arms out, and who immediately settled down with a contented sigh when you pick him up, my advice would be completely different. (In that case, I’d probably say try the 3/5/10 minute incremental approach, and try to ease him off needing to be picked up by offering back pats or a lovey instead, then work on making yourself eventually extinct from the whole process.)

If he’s really going through a confusional arousal, he’s not fully awake. Full stop. Science! He might never be fully awake most nights, even if he’s moving around or acting possessed or pissed as all get out. It might take him five, 10 or even 15 minutes to work through it enough to lie back down and sleep. I would only recommend intervening if you can tell for SURE that he’s fully awake and crying FOR YOU and not just bleating out to the void. (Video monitor, maybe?) (Followed by ear plugs, if you do determine that you’re dealing with a shrieking-in-his-sleep/work-it-out-yourself-son kind of situation.) By not going in after three minutes I bet it will highly unlikely that he’ll be hysterical and vomiting by minute five — that probably happened because he’d been fully awakened, mid-confusional event. (Or night terror. Lots of kids experience both. Wouldn’t it just SO FIGURE that the one time you tried to let him cry would be the night he’d escalate to a full-on bloody murder terror?)

Crying sucks, ooooohhhh how I know it sucks to listen to a crying kid in the middle of the night, but remember that — if he’s truly having a Stage IV event — he’s riiiiight on the verge of crucial, super-important and healthy REM sleep. He probably needs that way, way more than a back pat or more milk.

But anyway, get a copy of Solve Your Child’s Sleep Problems. It’ll make a lot more sense than I have here. It really taught me so much about the science behind sleep and why certain things happen at certain points in the night. And why it’s important to take our children’s sleep issues seriously and not just sort of shrug and hope it all works out because we’re fine being a martyr who doesn’t get enough sleep either.

And it’s also quick to note that children sleep problems are not because of bad parenting, or from doing things “wrong.” Some kids have these issues, others don’t. Some kids magically “fix” everything the night they cut a tooth and others require sleep training to move past it. Some kids wean from night nursing themselves and other kids don’t, and it can then only cause sleep problems for half of those kids, while the others co-sleep like rocks and never wake Mom up with their constant thrashing and gaaaaahhhhhh this isn’t going to work out I NEED TO SLEEP.  But I don’t think your son isn’t crying at night because he feels abandoned or hungry or unloved by the understandably sleep-deprived parents down the hall. He’s crying because the human brain and sleep patterns are strange and mysterious things that rule our bodies like a couple of drunk dictators.