Night time awakenings are THE most common reason that parents bring their child to a sleep physician or consultant. Dr. Craig Canapari and expert sleep consultant Arielle Greenleaf join forces to give advice on the most common reasons that kids wake up at night. The first step to getting your child to sleep through the night is understanding why they are waking up. They address the concept of sleep regressions, the impact of medical conditions such as asthma, acid reflux, and ear infections on sleep, and the importance of consulting a professional when these issues arise. Greenleaf discusses her own journey from a sleep-deprived mother to a pediatric sleep consultant, highlighting the valuable role of sleep consultants in helping families achieve better sleep. Canapari reminds listeners that the goal isn’t about achieving “perfect” sleep but about achieving sleep that enables everyone in the family to feel good and function well in the morning. (Note that this is such a big topic we split it in two– here is part 2).
- 00:00 Introduction and Disclaimer
- 01:06 Meet the Host and Guest
- 01:41 Arielle’s Journey into Sleep Consultancy
- 03:15 The Impact of Nighttime Awakenings
- 05:37 Defining ‘Sleeping Through the Night’
- 09:34 Understanding Nighttime Awakenings
- 09:49 Addressing Early Evening Awakenings
- 16:06 Understanding Sleep Cycles and Stages
- 18:35 The Importance of Independent Sleep
- 24:07 Understanding Your Child’s Sleep Patterns
- 24:27 The Role of Sleep Consultants and Pediatricians
- 25:04 The Importance of Independent Sleep
- 26:21 The Misconceptions Around Sleep Training
- 28:06 The Impact of Developmental Milestones on Sleep
- 30:19 The Effects of Travel and Illness on Sleep
- 31:35 Addressing Nighttime Awakenings
- 37:11 The Role of Medical Issues in Sleep Disruptions
- 40:34 The Importance of Addressing Health Before Behavior
- 42:35 Preview of the Next Episode
- 43:18 Closing Remarks and Contact Information
- Sleep training won’t hurt your child
- How much sleep do kids need?
- What to do about sleep regressions
- How to stop night feedings
- Things that go bump in the night: Night terrors, sleep walking, etc.
- Craig’s Book: It’s Never Too Late To Sleep Train: The Low Stress Way to High Quality Sleep for Babies Kids and Parents
- Why you should ignore annoying things your kids do
- Toddler night wakenings: what causes them, what you can do about them
Questions or feedback? Email us here. We are collecting questions for future Q&A shows!
Video of both parts 1 and 2: (if you prefer video)
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[00:00:00] Welcome to the sleep edit. where I gather together the best sleep advice for kids and parents focusing on actionable. Evidence-based easy to implement strategies to help tired kids. And parents sleep better.
Now a quick disclaimer. This podcast is for general informational purposes only, and does not constitute the practice of medicine, nursing, or other professional healthcare services. Including the giving of medical advice.
No doctor patientAriellelationship is formed.
The use of this information and the materials linked to this podcast. And video are at the user’s own risk. The content on this show is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay obtaining medical advice. For any medical condition they have, or that their children may have. And they should seek the assistance of their healthcare professionals for any such conditions. Nothing stated. hereArielleflects the views of my employers [00:01:00] or the employers of my guests. Enjoy the show.
Craig Canapari MD: /
Let’s kick this off. Welcome to the sleep edit with Dr. Canapari.
I’m Craig Canapari. I’m a pediatric sleep doctor and author, and I’m here to explore one of the most mysterious and sometimes troubling aspects of being a parent.
How to make sure your child sleeps well, so that you can sleep well, so everybody in the family can sleep well. My goal is to provide practical and evidence-based informations for parents, pediatricians, educators, sleep consultants, and anyone who’s interested in this topic on today’s inaugural episode, I am so excited to have my friend Arielle Greenleaf to come and talk to us today.
Before we get in the topic, Arielle, do you wanna just introduce yourself and t talk a little bit about your expertise in sleep?
Arielle Greenleaf: Sure. I’m Arielle Greenleaf. I’m a former, formerly sleep deprived, mom turned pediatric sleep consultant. I’ve been in the industry for the last eight years and it has changed quite a bit [00:02:00] since I started in 2016. Gosh, is it 2016? Yeah. And I’ve trained more than 60 pediatric sleep consultants to help others, other families get the sleep that they need as well.
I became a sleep consultant because a sleep consultant changed my life when my daughter was five months old and I had not slept a regular night in I say five months, but more like. Probably two months prior to having her too. So I probably hadn’t slept in about seven months. And hiring a sleep consultant and working with her for two weeks truly changed my life.
And so from that point forward, I dedicated my life to helping others in that same situation.
Craig Canapari MD: That’s great. That’s one of the things I like about working in the sleep field because I wear two hats. I’m a sleep doctor and I’m also a pulmonologist, and I’ve clearly are important, right? Breathing is also very important. But I feel like in, in sleep often just by providing good information to people,
Can make [00:03:00] impactful changes like I your child’s asthma. may still need some flovent, right? But sometimes not always sleep issues can be addressed or at least improved with just uh, good information and good support.
Arielle Greenleaf: absolutely.
Craig Canapari MD: So today I, we are gonna talk about one of the most burning questions that parents have, which is specifically, how do I get my child to sleep through the night?
The thing is, struggles at bedtime are annoying, but middle of the night awakenings and their close cousin, early morning awakenings, they’re soul destroying.Arielle ally that is what impacts parents so much. If you’re arguing with your toddler for two hours a night, you can still go to bed and sleep for seven or eight hours, but if your child is waking up multiple times during the night, even if you get them back to sleep quickly, you are gonna still be up awake, wanting when they’re gonna get up again. What Ariel would you say this is the most common thing that people [00:04:00] would come to you with?
Absolutely. The majority of the families that come to me are waking multiple times a night. And I think, the biggest thing we talk about, how I was personally, it was the disrupted sleep more than anything. Because even if, for instance, my daughter had only woken twice overnight, it was disturbing my sleep enough that then two, it took time for me to fall back asleep.
And so I think absolutely the number one problem that people come to me with is multiple night wakings and or difficulty falling asleep at bedtime or early morning wake. I think all of those kind of go together.
IAriellemember being a pediatric resident and where I would, I. They don’t,Ariellesidents don’t do this anymore do work a 36 hour shift. And there was no guarantee of sleep whatsoever then. And I still felt more tired when my first [00:05:00] son was a couple months of age than I did as a resident.
Because the thing is, as a resident, there were, I was on call every third or fourth night. So those other nights I was footloose and fancy free and could catch up. But as a parent you don’t usually have that luxury. It, hopefully parents have a partner that, that actually participates in dealing with nighttime awakenings.
Not everybody is that fortunate. Whether or not they have a partner or another adult in the house can help or not. But the fact is if your kid is crying and your partner is going to get them, you still wake up. It, it does take a toll. So I think we should start with a definition of what, how do we even define sleeping through the night, which is surprisingly less straightforward than it seems
Arielle Greenleaf: Yeah, absolutely. I think it would be helpful to hear the definition from a medical perspective because Sure.
Craig Canapari MD: like you mean like me?
Arielle Greenleaf: yeah someone [00:06:00] who went to med school and not just anecdotally and there are plenty of definitions out there for, and on social media and in mom groups and things like that.
And I think that many of the clients that come to me believe that sleeping through the night will mean that even their two month old is going to sleep 12 hours through the night. So I think it’s important to hear from your perspective what isAriellealistic and what is sleeping through the night.
Craig Canapari MD: It’s funny, I was rushing right before this to text a colleague who doesAriellesearch in sleep in young children. ’cause I had, I was going back through books and articles and I could not find actually uniform definition, which I immediately attributed to my ignorance and stupidity. One, and what she said to me is look, practically it means if your kid goes to sleep. Then you don’t hear from them till the morning that’s sleeping through the night. They may even [00:07:00] wake up and be quiet. So that’s one definition. But I think sometimes you make an important point, comes down to what is aArielleasonable expectation at different ages, because this change is so rapidly in the first year of a child’s life and just going back and forth with my colleague, Monica Ordway, who I’m sure I’m gonna have on the show, for an infant, if you could get ten eight hours of sleep, I think that’s pretty good for, so for young infants, we might talk about putting them to bed on the early side, but then they get up and have, say, a dream feed at 10 o’clock at night, and then if they sleep to six in the morning, I think most of us, at least people working in the field, would be pretty happy with that as an outcome. I’d say that biologically most infants have the physical capacity to sleep through the night by six months of age. It’s more likely to happen younger for infants that have some formula feeding because it takes them longer to digest it. But obviously there’s a lot of benefits to breastfeeding as well.
I’d say six to nine [00:08:00] months is a pretty reasonable expectation but I wanna say is, I don’t wanna get hung up on the definition because the fact is. If you’re tired and your child is waking up three or four times a night, what we’re gonna talk about today is how youArielleduce that number, right?
It may not be perfect, and we’re not gonna go from four awakenings a night to no awakenings a night in one step, but we can start moving that needle to fewer and fewer disruptions because it’s hugely impactful to start peeling back some of those nighttime awakenings. So I’d say that for parents in general, if you’ve got a one month old, they’re gonna be waking up at night.
Once you get halfway through your child’s first year, . It’s a reasonable expectation by six months that you’re gonna get a pretty good night of sleep there. And certainly by a year of age, absolutely.
And then sometimes people will come to see me. They’ve got like a three-year-old that’s taking three bottles of milk a night. I’m like, yeah that, you should want to fix that. [00:09:00] The other thing I would say is if you feel like you’re doing well and your child is doing well and your child’s waking up once or twice a night, you also don’t have to make a change if you feel good and your child is doing well.
That’s the other side of it. But I imagine most people listening to this probably aren’t that excited about how their child is sleeping.
Arielle Greenleaf: Yeah.
Craig Canapari MD: But I do want to validate is if you’re happy with how things are going, you feel good in the morning. Everybody in the house feels good in the morning.
Your child’s growing well, developing well, it doesn’t have to be perfect.
Arielle Greenleaf: I totally agree with that. Totally.
Craig Canapari MD: So the next thing I wanted to talk about is the timing and the nature of these nighttime awakenings, because I think often there are clues baked into this that help us figure out exactly what’s going on. And Ariel, when we’ve talked about this in the past, I just wanted to start with those early evening awakenings because you’ve said something to me that is so interesting and [00:10:00] useful that I wanted toAriellevisit this.
So what I’m talking about here is when parents say, I put my baby down at seven o’clock or eight o’clock, and they wake up within 30 or 45 minutes and they’re crying and they’re, it’s difficult to console and I’m never quite sure what to do with that. But you, I have someArielleal insight into this.
Arielle Greenleaf: Yeah, in my experience, it depends on the age. I know I, I’ve shared that with you before because I think a lot of times as newborns are becoming infants, so if we’re looking at three months, four months, maybe even into five months, sometimes as we begin working with ’em, we’re experiencing this, what some people call false starts.
I don’t personally look at it as a false start because in my, again, in my experience, what it generally means is the bed timing is off. So in most instances with the people that I’m working with, it means that bedtime is too [00:11:00] late. And when we start to pull bedtime back a little bit, even if it’s 15 or 20 minutes earlier, we can start to see some big changes inAriellectifying the.
That 30 that early waking the quick waking. That almost seems like a nap. And I will say though, going back to that 3, 4, 5 month age group sometimes they are still maturing and sometimes it is it appears to be, I used to be like, oh no, they’re not, they don’t think it’s a nap.
That’s not what this is. But I’ve seen it enough that I do think that sometimes their bodies just aren’tArielleady for bedtime at whatever time it may be, 6 37, 7 30. But eventually it does start to pull back earlier, give them, you can even check in with one of these people, one of these families two weeks later, and the baby is going to bed much earlier.
But I would say with beyond five months, six months, usually the situation is that bedtime has gotten too late. The child’s overtired going to bed. [00:12:00] And then this also goes in with other things that we’re gonna talk about, which would be what are they doing? What do you need to do to help your child fall asleep?
Are they waking up because they fell asleep in your arms and they woke up and they’re in their crib and you’re no longer there in their crib and you’re not there, you’re not rocking ’em, you’re not feeding them or whatever. So that they’re not falling asleep independently. But I think in the two in conjunction.
So if you’re working on eliminating something like that, you wanna be looking at the schedule and you wanna be looking at helping your child learn to fall asleep independently. And one other thing that I would say too is that ensuring that your child is getting fedAriellegularly throughout the day and is taking full feedings throughout the day.
Which can be tricky because a lot of the families that I work with are, both parents are working, so the child is in the care of someone else. They’re taking bottles. In some cases, if it’s a breastfed baby, they may not want to take a bottle. They, they’re just, they [00:13:00] wanna breastfeed and so their bottles are much smaller and then they may actually be waking up of hunger.
But I would say the topArielleasons together would be the schedule com combined with that dependency on someone or something to fall asleep and back to sleep.
Craig Canapari MD: So let’s tease this out a little bit. Let’s say I’m a parent, be like my three month old. We’ve been making progress in the sleep I’m putting to bed at eight 30. He wakes up at nine o’clock and he’s inconsolable for 30
Tell me what to do to fix this.
Arielle Greenleaf: So for my first go-to, and I think you and I have discussed this a little bit because I have. Originally, way back when I studied a lot of Weissbluth and he is the biggest, like propo, he is all about early bedtime. So I have always been a big fan of early bedtime, and I have seen, I would say more times than not, that backing up bedtime solves a [00:14:00] lot of problems.
And that is true for a lot of children, but it’s not true for all children. However, in a situation like this one that you’re explaining, I would wanna know how is the baby falling asleep? I wanna see their feedings throughout the day. And then IArielleally wanna see let’s back up the schedule.
What time is this baby waking for the day and then going to bed at nine o’clock? A lot of times a parent will say she was up at five 30 and took. Six 30 minute naps throughout the day, and then I couldn’t get her to go to bed until nine o’clock. But a lot of times, because they’re not getting a resorative nap or they’re taking really short naps, they’re just growing more and more overtired, and that makes ’em fight sleep even more and can lead to those false starts like we’re talking about.
Craig Canapari MD: I struggle a little bit with the term overtired ’cause I know what you mean, but I don’t think there’s a good definition for it. Sometimes, and I think in the future we can talk about bedtime battles. There, there is that sort of circadian second wind that people get where and this is more com [00:15:00] really common in parents, right?
You lie down with your toddler, you fall asleep with them in their bed at eight o’clock at night and you’re like, oh my God, I’m so tired, I could go to bed right now. And then you wake up and you’re awake till 11:00 PM watching TV or reading a book or something. And some of what’s going on there is that there are definitely circadian windows where it’s easier to fall asleep and there are windows where you have the surge of wakefulness.
And it’s pretty common in someone with a mature circadian system, which really is not an infant, right? The mature, the maturation of the circadian system happens over the first year of life. But having that sort of second wind is pretty common. I always joke with my kids is they have to be in bed by a certain time or they’re gonna be out for an hour and a half when they’re younger. aNd the other thing is if the bedtime slips a little bit later bad stuff is gonna happen When they’re trying to, you get, trying to get them to rush to sleep, brush their teeth. I have two boys. They’d be slapping each other running around with their pants off. It’s [00:16:00] just chaos. So we wouldArielleally do everything we can to just get them into bed at that time.
I think another thing to talk about is sleep, stages of sleep, right? There’s a circadian cycle, that’s the timing of your sleep and wake over a 24 hour period. Then there’s what we call the ultradian cycle, and that is the cycle through different stages of sleep. So the way this manifests in in adults is we will go to, we will go to bed and we will have our biggest chunk of slow wave sleep.
If we’re lucky, about two hours shortly after we fall asleep. And then during the night, we will cycle through lighter stages of sleep, which is like stage one, stage two in REM, and then deeper stages of sleep, stage three or slow wave sleep with a cycle length of about, about two hours. So we’re children, those cycles are shorter and they happen more quickly.
And the reason this is germane to nighttime awakenings [00:17:00] is that long period of slow wave sleep. If you’ve ever. It’s the holidays, you’re driving home, your kid falls asleep in the car seat, you transfer them to the crib. You feel like a parenting genius. They’re in slow wave sleep. Nothing was going to wake them up.
alSo sometimes for older children, if they’re waking up during that time and they’re absolutely inconsolable or they’re wandering the house acting weird, that is a parasomnia, right? What we call a non-REM parasomnia. The most common are night terrors or sleep terrors which can be 30 to 45 minutes of screaming and inconsolable being inconsolable.
Children are sweating, they’re crying, nothing you do works and they don’tAriellemember them the next day. It’s hard to interrogate like a nine month old, but like a, an older child can’tArielleally tell you what happened. Sleepwalking is pretty easy to get right ’cause they’re actually leaving the bed and walking around the house.
My older son does this once in a while and [00:18:00] I’m a little bit concerned when he goes to college that, ’cause it does happen when he’s stressed. And then there’s a confusional arousals, which are, they’re not quite a night terror, but someone may sit up, talk in a nonsensical way, go back to sleep.
These are all nonArielleM parasomnias, most likely in that couple of hours after sleep onset. And then the sort of REM related phenomenon. So there’s nightmares, right? Like nightmares have a narrative. If your child wakes up and says, the mouse was chasing me and he had a big hammer and I was just trying to get some cheese.
That’s a nightmare that came out of REM sleep. ’cause it has a clear story to it. But the other thing that is so common in, in kids are what we call sleep onset association disorder. Ariel, I don’t know if you wanna explain this a little bit here, this is such a common cause of nighttime awakenings and it’s an.
It’sArielleally when we’re talking about sleep training, we’re talking about addressing this problem
Arielle Greenleaf: sure. I think that’s probably in [00:19:00] when I’m thinking about working with a client again, it’s, let’s look at the schedule and then let’s figure out how is your child falling asleep? So what did you call it? ’cause I, ’cause you, you have like more of the medical term for it.
Craig Canapari MD: It’s it. So the it, it used to be called, I’m not gonna get into the international classification of sleep Disorders version two, version three, but the common term Sleep Onset Association
Arielle Greenleaf: Okay. Yeah,
Craig Canapari MD: was a subset of behavioral insomnia of childhood. All of these have been lumped under the rubric of chronic insomnia.
Now, whether you’re like age three or like 93, you had three months of sleep difficulties. You’re meeting that definition, but I still think it’s a useful term because it’s explains a little bit what’s going on.
Arielle Greenleaf: That’sArielleally interesting that would even be classified as insomnia, but I suppose, it’s a dependency on something. [00:20:00] And it’s disrupting that dependency is disrupt disrupting your, either your ability to fall asleep or your ability to fall back asleep. So essentially what that means is what we’re trying to do is teach babies and children to fall asleep independently.
So without any sort of sleep onset dependency really rocking. Walking, bouncing, driving in the car feeding to sleep. We want to help the child or baby feel safe and comfortable in their own sleep space. So whether that be a bassinet or a play yard or a their crib, helping them to learn that they don’t need to.
One of the biggest things, and I’m sure you’ve heard this, is my baby falls asleep so easily in my arms. I place her down in her crib and she just screams and she’s up for hours. And it’s we need to teach baby how to fall asleep comfortably in her own space. And that doesn’t mean you have to place her in there, let her scream and walk away.
It can be a slow progression out of the room. You [00:21:00] slowly get her in there while she’s drowsy and then she might get a little upset and you can put your hand on her or maybe even pick her up and put her back down again. It could take a little bit of time, but, eventually they do learn, okay, I am comfortable here and I can, and I’m safe and I can fall asleep without you.
And I can also wake up in the middle of the night as we all do and turn around,Ariellealize where I am, and then fall back asleep without having to say mom, come save me, dad, come save me. So that’s really, in my opinion, that’s really the definition of sleep training is let’s get rid of the dependency on someone or something.
It could be a pacifier. It doesn’t even have to be a parent. It could be pacifier falls out, the baby freaks out. You have to go back in and plug it back, replug the baby. And so that’s, yeah, right? Boop. But there’s so many people that play what we call passy pong all night long, and it’s disrupting the parent’s [00:22:00] sleep, and it’s disrupting the child’s sleep.
So ultimately the goal is to help the child fall asleep independently, feel safe and secure in their own sleep. Sleep space. And that leads to, in, in general, at least, to better sleep, both during the day and overnight.
Craig Canapari MD: Yeah, I think that it is so important and I just want to tease out a few parts of what you brought forward. The fir. The first is that these are the, what we’re talking about are circumstances. Your child needs to fall asleep that are absent in the middle of the night. So if you rock your child to fall asleep, unless you are rocking them all night long, they are going to wake up and want to be rocked again.
And the timing of this is with those bouts ofArielleM sleep becauseArielleM sleep is actually a pretty light stage of sleep. If you look at the EEG, like the brainwave pattern, it looks a lot like wakefulness. And if you’ve ever been woken up from a dream, you actually feel pretty awake, like you’re lucid. You can tell the story of what happened in that [00:23:00] dream.
Whereas if you wake up out of slow wave sleep, you feel very groggy. And there’s a lot of what we call sleep inertia. So the timing of these events is usually parents get their child to fall asleep. They may even, there might be some struggles around it. They might be arguing with their toddler eventually, say they rock them to sleep, they lay down with them, they give them a bottle, then the child has that nice bout of slow wave sleep for an hour and a half, two hours.
Then when the parents are getting into bed. The children cry out for them, right? Like they call for them and then the parents have to go and do it again. They have to rock them or feed them or what have you. And that can happen anytime there’s an episode of REM sleep, which is again, after that first part of the night can happen every one to two hours.
It doesn’t have to happen every time, right? Like we’ve all seen those parents who are like, just, they’re dying ’cause their kid’s waking up every hour. But more common, it’s a couple of times and it may also manifest as an early morning awakening with that last REM period of the morning. There’s a, again, the second [00:24:00] half of the night is weighted with moreAriellem and then the parents get in the habit of bringing the child into bed with them.
And guess what? Your 2-year-old is not gonna raise their hand and be like, mom, I seemArielleally tired since I’m getting up at four 30 every morning. And then as my younger son used to do, would stick his whole hand into my mouth. If he was trying to sleep next to me we called it mouth hands.
They’re not gonna stop doing that on their own. So I think thatArielleally, and this is where it can be so helpful, working with a sleep consultant, working with your pediatrician, you actually need to go through the story of what you’re doing at bedtime. Usually these things are obvious, but occasionally they’re not.
It might be something like oh, I, back when people used to have CD players or something, right? They’d play their dream time cd, their baby Einstein or whatever, and thatAriellecording was 30 minutes long. The kid falls asleep when it’s on and the parents have to go in and turn this on multiple times during the night.
So anything that you don’t wanna have to do in the middle of the [00:25:00] night, you shouldArielleally try to avoid doing that in your child’s bedtime. When they’re infantsArielleally aged three to four months of age, you try to put your child down drowsy, but awake so they can start to learn, fall asleep independently. If it doesn’t work, you can just then soo them back to sleep and try again a couple of weeks later. They develop so quickly. And I would say that in general just ’cause we want to go through all the other causes when we talk about sleep training, we are talking aboutAriellemoving the dependency on a of a child for their parents or caregivers at bedtime and in the middle of the night.
And a lot of times where my mentor, Judy Owens is like, people are tired in the middle of the night. So you just have to teach them to do their, whatever they’re doing for sleep training and it’s not necessarily cry it out, it’s a behavioral plan to get them to fall asleep independently and then in the middle of the night they can just do what they need you to soothe their child.
Because if they establish independent sleep at bedtime, often, not always, but often, [00:26:00] those middle of the night awakenings drop out. Over the course of four to six weeks. Because the fact is, we live in a country where parents don’t have a lot of parental leave. ThereArielleally aren’t a lot of great supports.
People don’t have family members living in their house who can help them. A lot of parents have to go to work, with when they’ve got a six week old at home and they just need to survive during the night. So I think in the future we can talk about different sleep training techniques.
’cause there’s a million of them, right? It’s not just cry it out. And this always bothers me, right? My book’s called Never, it’s never Too Late to Sleep Train. And I didn’t want the term sleep training in the title. Like it has a certain valence to it. Like I don’t have a problem with it. A lot of people do.
And the fact is, well, my agent was like, nobody’s gonna know what you’re talking about if you don’t have sleep training
They were they were right about that. But that it has a, in some circles it has a sort of a negative
Arielle Greenleaf: Oh, absolutely. And I feel like that’s part of the mommy wars it’s this dividing conversation. And it doesn’t [00:27:00] need to be, I don’t think it, I just don’t think it needs to be
Craig Canapari MD: aNd to come back to the definition of insomnia, a component of insomnia is not just what your sleep pattern is. It can be problems falling asleep, problems staying asleep. It’s also IT impairment or unhappiness the next day. So for an adult, if an adult came in to, I don’t see adults, but I see 22 year olds, they came in, they’re like I sleep six hours a night. I have no problems getting outta bed. I’m not sleepy during the day. I’m a straight A student in school. But someone told me this, there’s a problem here. I’m like, there’s not a problem. That’s not insomnia. Insomnia has the definition of being unhappy with how things are going, and the way that manifests in young children is usually not, the kids are fine the next day, right?
They can sleep in the car, they can sleep in the crib. The, they’re not like driving minivans or giving presentations at work. They’re just like, they can catch up, but it’s the parents that are unhappy, and that’s included in the definition of insomnia and childhood. If the [00:28:00] parents are struggling as aAriellesult, that gets you to that insomnia definition.
Arielle Greenleaf: Very interesting.
Craig Canapari MD: sO let’s talk about, let’s talk about other causes of nighttime awakenings. And I know this is one of your favorite topics, Ariel, I think maybe we are gonna just name this after you. And that’s it’s sleep regressions.
Arielle Greenleaf: Ugh.
Craig Canapari MD: So that’s a reaction to, but I would love you to explain why, because we’re on the same page
Arielle Greenleaf: So I’m in, I’m a mom, so I’m in mom groups and I’m in parenting groups and I’m on social media. And anytime a child suddenly has some sort of a sleep disruption, is there an 11 month sleepAriellegression? Is there a 10 and a half month sleepAriellegression? Is there a 13 month? 50 every month Apparently has a sleepAriellegression.
But the truth of the matter is that [00:29:00] in many cases when a child is developing, so progressing, notAriellegressing sleep might be disturbed. So for instance, there is science to sh that shows that learning to crawl, it affects particularly naps. And babies might be practicing their new skill in their crib, gross motor developments also learning cognitive developments.
So it’s language development often. A lot of times people talk about their 21 month old, their 22 month old, what is going on. And in many I’ll ask, I ask lots of questions. You have to ask lots of questions to get to the root cause of things and they’ll say, yeah, suddenly the child is speaking a full sentence.
And it just started happening last week. And I’m like, when did the sleep disruption start? And they’re like, two weeks ago. And so it’s okay, a lot of times when they’reAriellegressing in the sleep department, they’re progressing in other ways. And also anytime a child gets sick [00:30:00] and you’re, of course you should be attending to them if they’re waking in the night.
Rules go out the window. If your child has a fever or they’re throwing up or they’re sick, they’re not comfortable you’re going in there a lot. And they may get used to that. And when they’re better they’re like, wait, I liked it when he used to come in here and rub my back all night long.
And then travel, we’ve got these. Progressions. We’ve got sickness. Travel is a huge one. Parents go away, they come back and they’re like, I don’t get it. My kid was sleeping so well and now we’re home and I’m trying to get back on track. And the child is just not falling into place.
Things are all over the place. Those are probably the top three things that I see with regard to sleep falling off the rails. But the problem becomes, you might have a bad night or two, and then as a parent you start second guessing yourself and you’re like maybe what I was doing is not working anymore and my child is upset.
They’re not feeling well. Or they’re sad. Or they’re [00:31:00] scared, or they’re this or they’re that. and really what it is the child has grown accustomed to whatever new thing you’ve done to help them fall back asleep when they’re having these arousals that they haven’t had previously. So you might. Suddenly start going in and rocking again.
Or they were waking up at four 30 in the morning all of a sudden and you’re like, oh, you are tired. So you’re like, come to bed with me. And then you’re like, why is he still waking? I thought this would be one thing. And it in my experience, it starts to spiral. You do one thing and then all the other parts start to fall to the wayside and nobody’s sleeping.
So sleep disturbance can happen at any age, depending on when a child is going through anything. And it can happen after sickness and travel. Those are the top things that I see the most.
Craig Canapari MD: Yeah, travel is one. And I’m definitely seeing the kids where sleep was great and then we took a trip, shared a shared a room or shared a bed with our [00:32:00] 15 month old and then they come back and they justAriellefuse to sleep in another situation. I wanna say also to you, it’s funny ’cause yeah.
The, I agree with you. What bothers me about the term sleepAriellegression is that yeah, if you Google the 3.17 year born in Mercury in retrograde sleep regression, you’re going to find it online. And this is just not how it works. Another thing is a lot of parents who had children that were, theyArielleally struggled with their child’s sleep.
They worked hard. They, they read a book, they went to see you, they went to see me, they fixed their kid’s sleep. Six months later, their kid gets a cold or or. Stubs their toe at school or nothing happens and they’re awake for one or two nights and the parents are panicking. They are it’s like PTSD.
They’re like, I didn’t sleep for three years. Now we’ve had six good months and I can’t go back to the way that it [00:33:00] was. And it’s almost like you can’t hold on too tightly, right? Like you can’t white knuckle it too much because it’s just gonna make things worse. And the other thing is sometimes with time we do get a little bit sloppy as parents, right?
Like we’re so we’re very regimented. And our kids, it’s the holidays. Our kids stay up a little bit later, we lie down with them ’cause it’s sweet and it’s nice when they do that. And then just you just need to tighten up your bedtime routine like a tiny bit. And you can get back to where you were.
Arielle Greenleaf: Yeah, tightening it up and then staying consistent with it. I’m just thinking about it. I justAriellecently had aArielleturning client and I worked with her older son and he did great. And then she had a second child. And it’s funny, parents are like, oh, I, this is my third kid and I should know how to do this.
And every kid is so different from the next. And second child, first child could travelArielleally easily and now second child is a toddler. And they went and they traveled and. Quite literally, this child was like just not sleeping at [00:34:00] all when theyArielleturned. And mom was just so desperate. And she knows what to do, right?
She knows what’s right. She knows. She knows what’s worked. And you’re just so tired. At some point you start forgetting like, who’s in charge? Is it the kid that’s in charge or is it me? And like you’re, you start listening to this 22 month old who’s no, we’re gonna walk around the house from one in the morning till five in the morning, and I want some snacks and I want a bottle.
And then mom is like the next day like, what am I doing wrong? And sometimes you just need to step back and have someone say okay. I know it’s scary, but what’s scarier? Or getting up all night with your kid or staying consistent for a few nights, she might get upset, but. If you don’t do this, then you’reArielleally gonna be stuck in a bad place.
But it, it happens a lot. And I agree with you about the PTSD because I certainly had that anytime. ’cause my daughter, sure. I [00:35:00] got her sleeping well at five months, but I would say at least once a year until she was about four, we would have maybe a six week period that I would just let things fall apart.
And I’m going, what do I do? What do I do? And then I finally talked to a colleague and they’re like what would you tell your client to do? And I’m like, fine. And two. And then, it takes two days. I get it done and I’m like, why did I get myself to this place for six weeks of like newborn sleep, but it’s just, it’s hard to be a parent, period.
Craig Canapari MD: It is. And you know what do we call it? You, as I learned in medical school, the definition of a phase is when a patient is doing, when a child is doing something annoying, and we don’t know why, but it’s probably gonna go away. Kids. That’s not theArielleal medical definition, but I feel as a parent and as a doc, sometimes if I’m like, sometimes your child is gonna do something annoying for a finite period of time and you’re not gonna know why.
Here’s, I wrote on my website about how my [00:36:00] we have a guest bedroom and my younger son who at the time was like 11 or how old was he? He was like 10 or 11. He just started going to bed and sleeping the other night in the guest room. WhIch is a little, it was a little bit annoying to me because I was like we have, it’s another bed to make or what have you ’cause he’s not gonna do it.
But it really irked my older son because he felt like. The his younger brother was getting over on something. And I can tell you as an older sibling, it is absolutely intolerable. Intolerable if you feel like your younger sibling is getting away with something. Still, it bugs me with my brother.
I’m looking at you Matthew. yoU know what you did. I think sometimes also we get annoyed by little things that kids do. And then you have to ask yourself like, would an impartial observer find this annoying? And is thisArielleally causing a problem? Do they wanna sleep with 10 stuffed animals, let them sleep with 10 stuffed animals?
Like it’s, even if it’s annoying [00:37:00] to you, if it’s not really causing a reall problem, if you explain to your friends, be like, they’re doing this is so annoying, and they’re like, what’s the big deal? Maybe you can let some things go.
Arielle Greenleaf: Yeah, definitely.
Craig Canapari MD: So I wanted to turn to something else you mentioned, which is our medical issues, which is is. Something that, again, we’re not usually talking about serious medical issues, but sometimes parents come in and they think they’ve got a behavioral problem, but what they really have is a medical problem. And the problem, and a lot of common problems will manifest at night. Just to go through the list obviously ear infections are very painful when you lie down, but there are also kids who have chronic otitis.
They have just persistent fluid in their ears. Often that if that’s treated with ear tubes, the sleep will get better. Acid reflux, if your child is spinning up a lot at night, treatment of the reflux may improve things. Eczema is actually a big one. And they shown even in older kids with eczema who are itching a lot at [00:38:00] night, their sleep is disrupted to the point that they are impaired.
Like some, a child with a ADHD is impaired in terms of being able toAriellegulate their own mood, behavior, and attention. Yeah, no, it’s it’s and it’s worth knowing that this can actually, anything that when you, we all wake up during the night, right? Usually we roll over, go back to sleep. But any, anything that triggers more awakenings from your child may trigger them calling out to you. Asthma’s one as well, a child with poorly controlled it’s asthma will be coughing during the night and wheezing. And a lot of times kids come to see me for sleep problems and I’m like, this kid does not, I.
Has occult or they have hidden asthma. I treat the asthma, the sleep gets better. And the final thing I want to cover there is actually snoring. Snoring is, we all know what snoring is, right? Because if somebody else is doing it around you, it’s really annoying. And but the irony is that if you ask anyone, [00:39:00] they will never tell you that they snore. But. Snoring is not normal. Like snoring once in a while is fine, but children who snore loudly and regularly really deserve an evaluation with their pediatrician. They could have a condition called obstructive sleep apnea, which is where the airway, which is the tube that goes from the nose and the mouth down in the throat gets closed periodically during the night.
Oxygen levels can drop, et cetera. And I always tell the parents, this is not, the danger here is not that your child is gonna just stop breathing in the middle of the night. The problem is that every time your child stops breathing, their brain has to turn on and wake them up a little bit so they breathe normally again.
So it’s not really dangerous in the short term, but it is dangerous in the long term to development and sleep quality. Lots of different treatments for it. Some kids need an overnight sleep test. A lot of kids just need to have their tonsils evaluated. But it’s funny, during the pandemic we saw no sleep apnea, right?
Because one of the things that was driving kids [00:40:00] tonsils and adenoids. The most common cause of sleep apnea in young children are when their tonsils, which are the tissue in the back of their throat or the adenoid, which is similar in the back of the nose, would get big and they get big withAriellecurrentAriellespiratory infections and then they tend to stay big.
When kids weren’t having any breathing illnesses, nobody was having sleep apnea. But now it’s picked up again. And that’s probably a whole other topic for a thing. But I’d say don’t take, don’t ignore snoring. That’s happening more than a couple times a week, and especially infants infant snoringAriellegularly is not normal.
Worth talking with your pediatrician about.
Arielle Greenleaf: I think it’s so important for me to ask those questions right at the beginning before I even start working with somebody because it’s, so I, I try to explain to them also. cHildren who are struggling to gain weight, I would say that’s another one that can cause sleep problems. Only because in those cases, many times a parent is, [00:41:00] has to wake the child up to eat because they can, they only are taking two ounces every few hours.
Or failure to thrive, those sort of things. That’s something else that I always screen for, but I try to explain to the parent, I can’t do anything behaviorally if the child isn’t if the child’s ears are hurting, I, you’re not going to leave them to be alone. And we always need to make sure that health is addressed before doing any sort of behavioral work, because it just won’t, it’s not gonna work.
That’s why it’s don’t waste your money with me because it’s definitely not gonna work unless you have that everything’s cleared.
Craig Canapari MD: I think there’s a couple of really good points here. The first is your child has to be screened for a medical problem before you start with a significant behavioral plan. And globally, if they’re not developing normally, if they’re not growing normally , you’re not looking at a behavioral problem, you’re looking at a medical [00:42:00] problem first.
And I would say the other part of this is to me. If a child is falling asleep on their own and waking up in the middle of the night, I’m taking a hard look at them for a medical problem. It isn’t always a medical problem, but I’m ruling those things out because that’s a really common manifestation of a medical disruptor of sleep is nighttime awakenings.
When the parents have everything dialed in with their bedtime, they’re doing everything perfectly at bedtime, the child’s falling asleep independently. The kid’s waking up at night and they don’t know why.
Well at this point, We’re actually going to take a little bit of a break because Arielle and I had so much to talk about on the topic of sleeping through the night. That we ran long. So I really want his podcast, not to be too long because you are probably a tired parent, if you were listening to this. So just tune in for our next episode, where we will be covering nighttime feeding [00:43:00] issues. Adjustment insomnia, such as what happens to your older child when you walk, when new baby home. Issues with your child’s sleep environment that can wake him or her up at night and the dreaded too much time in bed syndrome.
Thanks so much for listening to The Sleep Edit, you can find show notes at the web address, sleep edit.show. Where we’ll have a lightly edited transcript as well as links to everything we discussed during the show. You can find me at drcraigcanapari.com. And on all social media @Drcanapari. You can findArielle at Instagram at arielle_greenleaf If you like the flavor of the advice here, please check out my book. It’s never too late to sleep.
Train the low stress guy to high quality sleep for babies, kids, and parents it’s available. Wherever fine books are sold. If you found this useful, please subscribe at Spotify or apple podcasts and share with your [00:44:00] friends.I ltrealy Helps as we’re trying to get the show off the ground. Thanks.