There is reason why sleep deprivation has been historically a method of torture (1.) and there is an abundance of scientific studies that shows the correlation between sleep & mental health (2,3.).

The concept of having children and how we, as parents, have to accept, that sleep becomes a “nice to have”, (because once you have children, being tired is just a given - especially for mums) is unfortunately deeply engrained in the society we live in right now: and if you prioritise your own sleep, surely your being “unrealistic & selfish”.

But the impacts of not getting enough sleep & having a child that’s dependant on the parent’s help to sleep well, is much bigger & more complex, than “just” being tired.

When not sleeping impacts your whole life

A while ago I had the privilege to meet a family that was impacted by their child’s sleep to the point, where the ability of mum going back to work, as well as realizing the couple’s dream of a future with more than 1 child was seriously jeopardized.

Susan & Ben* had a 9 months old baby boy, who was their whole pride & love, but when it came to sleeping (day & night) it was impossible to have anyone but Susan take over to get little Jack* to sleep: feeding, rocking & holding was the only way to make sure that anyone in the family could catch some desperately needed rest. Well, everyone, but Susan. Her whole day & night revolved around being there for her son, making it impossible to look after her own needs, especially when planning on going back to her job. And while going back to paid work was non-negotiable to make sure that the whole family was financially secure, Susan broke out in tears, when she told me how much she loved her job and how much she longed to re-connect with her colleagues & how vital she felt it was, for her own well-being.

Susan & Ben always dreamed about having a big family and they wanted to have at least 1 or 2 siblings for their first born son. But faced with the impacts of consistently broken sleep since Ben was born, Susan going back to work was simply not realistic with the current energy levels and the dream of having multiple children, was on the cusp of dying. Especially Susan felt like she was “failing” as a mother & partner. And while talking to friends/other mothers and browsing the internet showed her that she wasn’t the only one struggling, she started to think there were basically 2 options:

• Adjust & accept that not sleeping enough was something to “suck up”: It seems like sleep deprivation is like a “batch” to proudly display & to live with, once you have children and surely, one day it has to get better!
• Or use “cry it out” for a few nights as the only alternative, because ultimately the 1^st option felt already unbearable…at the same time this felt like going against their values & the kind of parents they wanted to be: responsive, gentle & present.

When feeding & sleeping becomes inseparable

Apart from needing to achieve more independent & consolidated day and night sleep, Susan was worried about her son’s dependence on breastfeeding for sleep: how would that be possible to keep up, once she was back at work all day? Jack wouldn’t take a bottle, neither expressed breast milk nor formula. And while he was a great eater & enjoyed his solids, simply weaning him off the boob wasn’t on the cards, as this would have meant taking the only thing away that made him (most of the time) go (back) to sleep eventually.

Susan felt stuck and was at the stage where she resented having to breastfeed & therefore having the sole responsibility when it came to making sure that Jack got the sleep he needed to develop and grow and to be the happy boy he was. This had as well an effect on her and Ben’s relationship, with Susan feeling a lot of pressure & Ben like he couldn’t really support his wife to the extend he wanted.

Taking the plunge

Eventually Susan & Ben got in touch with us at BSC and I am so glad they did, as meeting them & supporting them along the way was such a great example when it comes to the power of establishing a great sleep for the whole family! The first thing they told me, was that this was their last hope…and that they were sceptical, but they needed to at least try.

When we started our journey together Jack was a serial cat napper and could only do so with the constant presence of mum Susan and sometimes dad Ben. When he woke after 15-45min she had to go back into his room (if she managed to transfer him into his cot, otherwise contact napping was the only solution), then hold, pat, rock and/or feed him back to sleep, which was getting harder and harder as he got older. At bedtime & for night wakes (3-8 times) this routine repeated itself every 1-2 hours and Jack would usually wake up for the day as early as 5am, which meant every single day started with Susan & Jack feeling utterly exhausted. This was their reality since Jack was about 4 months old (previously a good sleeper, especially at night) and the only way dad Ben was able to keep going to work (day & night shifts) was to sleep in separate room.

While this seems a sensible solution and is the reality for many families with babies/young children, this added to Susan’s feeling of overwhelm: at night she was in charge, so her husband could sleep in order to work. In the day she was in charge, because it was hard to have someone else looking after Jack, as getting him to sleep was closely connected to her presence & breast feeding. She felt she was constantly behind on housework, because there was hardly any time without her son being either on her or awake - and even if he slept in his cot the odd time: how can the occasional 40min window be enough to look after a household and – more importantly- yourself? If there was any time & energy left Susan would take Jack to baby classes, where he could spend time with other babies and she could meet other mums. But even there she would avoid talking about how she struggled with the lack of sleep, as everyone else seemed to simply cope better and sleep training a topic rather not to be discussed.

Fast forward and here we were during our daytime home consultation, talking about how life in their family looks like, not focussing on sleep only, but the routines & lifestyle that influence it (day & night) and are all part of what needed to be considered to write up the perfect sleep plan for little Jack.  We put tweaks & changes into place to set him and his parents up for success: from the room Jack slept in, to the timings of his naps & milk/solid feeds- all important parts of the change we wanted to encourage and when it came to what settling approach to choose, Jack’s temperament and Susan’s & Ben’s were in the centre of this decision.

In their case, we had plenty of options: either an in or out of the room approach was on the cards and while Susan had heard terrible things about “CIO”, after a conversation about the ins & outs of the spaced soothing method (inspired by Ferber), she felt that the balance of space & comfort it provided was probably a good fit. And while a more gradual approach was what she initially thought she wanted, she felt committing to being in the room at all times would overwhelm her even more: she was at breaking point and needed fast results. Still, I saw how she still felt torn, so I told her that we could give spaced soothing a try and if it was too much, we could always pivot and use the gradual withdrawal method: no plan is written in stone.

Starting the change is always the hardest

Jack was of course confused & frustrated about the change that he was too young to have explained with words and communicated that by crying. But while certainly upset, he wasn’t hysterical and from my and Ben’s point of view he was actually doing ok and as expected.

Susan though was in pieces within seconds and after 1 check in and overall less than 5 minutes I looked at her and decided that we had to change course. There was no way she would be able carry on & to be consistent with this approach, especially not when by herself, which would have caused only tears, but most likely no real progress. And if so, at a cost that wasn’t necessary.

A method that pushes parents close (or over) the edge several times a day/night only achieves that they feel like they are doing this horrible thing to their baby- and themselves.

Susan had Jack in her arms and in tears she declared that she had enough, that she wasn’t strong enough and didn’t want to do it anymore. For a while we just sat there, taking the time for both of them to calm, to take a breath and to just give some space, while I made a tea. After a few minutes little Jack was happy again and all smiles and with a hot drink in our hands we started talking about what had happened and where to from here. Susan was desperate for change, while doubting her own capabilities, apologizing to me & Ben about wasting all this time & money.

So I asked her, if she could trust me & give this 1 more chance. 1 more round with the in-room approach we had talked about and if this still didn’t feel right, nobody would push her any further. And Jack had to go to sleep anyway (he was so tired by now), so all I would like to do was to watch her how she usually tries to put him to sleep in his cot and I would guide her from there. Susan agreed, so we went together into Jack’s room and put him into his cot, with mum right beside him and me a bit more in the background, guiding Susan through the cycle of giving Jack the hands on support he needed to feel calm in his own sleep space, while practicing with him on how to go from calm to asleep with less and less help. The turnaround was quick & with minimal upset. Within less than 15min we had achieved what used to seem impossible without hours of patting, holding or feeding: Jack was asleep in his own bed and neither Susan, Ben nor Jack had to be pushed right to the edge. While I could see the surprise on Susan’s face, I knew she was sceptical- this was too good to be true and when he woke again after 20 minutes, the anxiety came back. But she wasn’t alone, I was there to guide & reassure her and within a few minutes of us in the room, repeating the cycle of giving Jack the support & space he needed, Susan achieved the previously unthinkable: a re-settle in the cot, within a shorter amount of time & with less upset than usual. 

From total desperation to utter relief: absolutely priceless!

Gradual, but consistent

When it gets to choose the right approach for a family, I always explain that we have options to choose from, based on their individual situation and often the method itself isn’t the most important- What is crucial, is that the parent(s) feel comfortable enough to be consistent and to take the lead, so their child can follow. That takes time & repetition so the “unknown” can transition into the “new” and feels comforting rather than overwhelming.

Over the next 1-2 weeks we:

• established an age-appropriate nap & feeding routine that worked with the family dynamic
• reduced overall milk feeds, which then were replaced by bottles of formula and more solids
• this enabled us to transition from multiple night feeds to initially 2 confidentially, then 1 and by the time our journey together came to an end, Jack had started to sleep through the night on occasion

The freedom and flexibility that came with this change was so much more than “only” getting a good night’s sleep: it meant that Susan could go back to the job she loved and that meant financial security for the whole family – and another baby was back on the cards…although both parents wanted to enjoy a little more sleep together, before daring round 2 ;)  

References:

1.Cakal E. "Befogging reason, undermining will: Understanding the prohibition of sleep deprivation as torture and ill-treatment in international law. Torture. 2019;29(2):11-22. doi: 10.7146/torture.v29i2.109620. PMID: 31670701.

2. Iranpour S, Kheirabadi GR, Esmaillzadeh A, Heidari-Beni M, Maracy MR. Association between sleep quality and postpartum depression. J Res Med Sci. 2016 Nov 7;21:110. doi: 10.4103/1735-1995.193500. PMID: 28250787; PMCID: PMC5322694.

3. Palagini L, Hertenstein E, Riemann D, Nissen C. Sleep, insomnia and mental health. J Sleep Res. 2022 Aug;31(4):e13628. doi: 10.1111/jsr.13628. Epub 2022 May 4. PMID: 35506356.

4. Burnham MM, Goodlin-Jones BL, Gaylor EE, Anders TF. Nighttime sleep-wake patterns and self-soothing from birth to one year of age: a longitudinal intervention study. J Child Psychol Psychiatry. 2002 Sep;43(6):713-25. doi: 10.1111/1469-7610.00076. PMID: 12236607; PMCID: PMC1201415.