In this mailbag episode, Dr. Canapari and Arielle respond to listener questions covering infant sleep, early waking, transitioning from co-sleeping, travel disruptions, nighttime fears, sleep disorders, and more. From “first daylight savings” tips to strategies for toddlers with anxiety, each answer offers practical insights for a wide range of pediatric sleep challenges.
Links
- Daylight savings time: Avoiding problems when Falling Back
- Early morning awakenings: What to do about them
- How to stop night feedings
- How to stop cosleeping
Chapters:
[00:01:09] Intro
[00:01:14] Infant Sleep Patterns and Challenges
• [00:01:33] Lauren: When do babies start dreaming?
• [00:03:00] Susan: Tips for differentiating between waking to feed and needing sleep in a 5-month-old?
• [00:06:26] Andrea: How to sleep train at night when daycare sleep is limited?
• [00:08:07] Chelsea: Avoiding early wakings for a sleep-trained 6.5-month-old.
• [00:10:25] Kaitlin: Daylight savings time tips for a 7-month-old.
• [00:14:37] Kayleigh: Breaking the cycle of middle-of-the-night babbling and crying in a 9-month-old.
• [00:18:07] Francia: How to sleep train an 8-month-old.
[00:19:30] Early Morning Waking and Sleep Regressions
• [00:19:30] Brittany: How to handle nighttime wakings to maintain sleep progress.
• [00:21:34] Chelsea: Troubleshooting early morning wakings for a sleep-trained 6.5-month-old.
• [00:22:02] Hunter: Strategies for a 6- and 4-year-old who wake very early.
• [00:23:00] Pauline: Addressing early waking for kids with ASD who take melatonin.
[00:28:00] Co-Sleeping and Sleep Transitions
• [00:28:00] Holly: Transitioning a 2-year-old from co-sleeping to independent sleeping.
• [00:31:57] Ashley: Transitioning from co-sleeping with a 3-year-old for better parent comfort.
• [00:34:34] Katy: Encouraging a 3-year-old to stay in her own bed at night.
• [00:35:00] Kimberly: Addressing frequent night wakings and crying in a 3-year-old.
• [00:40:00] Holly: How to get a 3-year-old to stop using a parent as part of their sleep routine.
[00:42:20] Travel and Disruptions in Routine
• [00:42:20] Abby: Helping a 10-month-old sleep better while traveling.
[00:44:10] Nighttime Anxiety and Sleep Fears
• [00:44:10] Andrea: Supporting a 4-year-old who is afraid to sleep alone.
• [00:45:39] Stephanie: Determining when it’s necessary to help a 2-year-old fall back asleep.
• [00:46:59] Lesley: Strategies for helping a 7-year-old grandchild stay asleep until morning.
• [00:48:39] Dr. Ula: Assisting a 19-month-old who needs comfort to sleep through the night.
[00:51:00] Sleep Disorders and Medical Concerns
• [00:51:00] Sarah: Can REM Sleep Behavior Disorder lead to complex sleep actions like opening doors?
• [00:52:53] Wenjing: Tips for transitioning a 7-month-old with reflux to crib sleep.
[00:55:00] Sleep Training Questions
• [00:55:00] Amelia, Juan, and Baby Tonio: Ending bedtime crying after sleep training.
[00:00:00] Craig Canapari MD: Welcome to the Sleep Edit, a podcast devoted to helping tired kids and parents sleep better. We focus on actionable evidence-based sleep advice, so everyone in your home can sleep through the night. 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.
[00:00:27] No doctor patient relationship is formed. The use of this information and the materials linked to this podcast and any associated video content are at the user’s own risk. The content on the show is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay obtaining medical help for any medical condition they have.
[00:00:52] Or that their children may have, they should seek the assistance of their healthcare professionals for any such conditions. Nothing stated here [00:01:00] reflects the views of our employers or the employees of our guests. Enjoy the show.
[00:01:09] Welcome back to the Sleep edit. I’m Dr. Craig Canapari
[00:01:12] and. And I’m Arielle
[00:01:13] Arielle Greenleaf: Greenleaf.
[00:01:14] Craig Canapari MD: So this week we have a mailbag episode of questions. So I thought we’d just get into it. We have a lot of good questions. Our first segment is on infant sleep patterns and challenges. Here I’ll say the first one Lauren asks, when do babies start dreaming?
[00:01:33] Arielle Greenleaf: That’s a really good question and I was gonna Yeah, I I was gonna ask you that one.
[00:01:37] Craig Canapari MD: REM sleep, which is what we think of as the predominant stage of sleep that happens with dreaming, actually is the most prominent phase of sleep from birth. So as far as we can tell, babies are actually dreaming.
[00:01:53] Even in the womb
[00:01:54] though, it would be very difficult to verify that for sure, but they are, even if they’re born early at [00:02:00] the time of birth, having active sleep, which is the equivalent of REM sleep.
[00:02:05] It happens usually in the, I. Last trimester of pregnancy on,
[00:02:11] so cool. Otherwise they’re probably getting pretty bored until if someone figures out how to insert a tiny iPhone into the womb.
[00:02:20] Arielle Greenleaf: I guess, And some of the questions I get when do they start having bad you know, aren’t dealing with fears the way we think of fears. So bad dreams, nightmares don’t occur until later in toddlerhood when , the imaginary comes to life,
[00:02:37] Craig Canapari MD: Yeah, you need a you need a certain amount of abstraction for nighttime. Nighttime fears. And it’s usually, I’d say really concrete ones or, ages four or five, sometimes in earlier ones, like worrying about someone breaking into the house, et
[00:02:50] But hey, let’s take the, I, let me read this next one, Arielle. ’cause I think this might be a good one for you. Susan, who is a pediatric sleep fellow and mom of a five month old, God [00:03:00] bless. I have a question about why baby’s wake. My little one naps between 45 minutes to 1.5 hours and sleeps four to five hours stretches at night, starting at 7:30 PM Sometimes I think he wakes to feed.
[00:03:14] Other times I feel like he wakes between sleep cycles and needs help getting back to sleep. Do you have any tips for differentiating between waking to feed and just needing more sleep? I’d say maybe needing soothing to go back to
[00:03:27] Arielle Greenleaf: Sure. The place I would start is talk to your pediatrician about night feeds. Is your baby gaining weight? How much are they getting during the day? It’s really important to look at that because sometimes parents don’t realize that their baby’s not getting Especially I’ve seen that when someone is transitioning from breastfeeding to formula, it’s not a one-to-one conversion.
[00:03:50] And so babies need more formula , in order to say, stay full. So , I’ve seen it where parents just don’t know that they’re they’re not feeding [00:04:00] their baby enough. So I think that is a really tricky question because it’s very unique to the individual as far as, know, if your, if your pediatrician says that they feel like your child could sleep through the night, or they feel that your child could have one night feeding, then you wanna really have a, the first stretch of sleep to be like the most uninterrupted portion of the night, if possible.
[00:04:27] So I generally use 11 or 11:00 PM or 12:00 AM as like a cutoff for feeding. , Especially if the child was fed right at bedtime, , by five or six months that they should be able to go four or five, six hours before needing another feeding at that first stretch , of the night.
[00:04:45] However, again, we have to look at what does daytime feeding look like. It’s really important.
[00:04:51] Craig Canapari MD: I, I would add the extra layer of mom probably had three or four months off for maternity [00:05:00] leave. Now back to work maybe nursing, maybe formula, maybe doing a little bit of both. Certainly can be a challenging time for for moms when they’ve returned to work as well to try to balance quality time with the baby and getting enough sleep.
[00:05:15] I, yeah, I think it’s always the answers to questions like this have to be very specific, but I think looking the feeding’s a good
[00:05:21] idea.
[00:05:22] Arielle Greenleaf: I also think it’s important to. Recognize how you’re putting your baby to sleep at the start of the night. So if your baby can go to sleep at the start of the night independently, then they should be able, if they’re not hungry or they’re not sick, they should be able to put themselves back to sleep in the middle of the night as well.
[00:05:42] And sometimes you have to give them a little nudge and remind them that they can do it themselves. , And choose sort of a, a sleep training method. At the start of the night or throughout the night, regardless of, you know, wherever you are in that , sleep training journey. But if your child is falling asleep independently [00:06:00] and, waking throughout the night, you should be looking at whether you’re, are you continuing that sleep training throughout the night?
[00:06:06] Craig Canapari MD: Yeah, you’re definitely getting in the window where you could think about trying to work towards independent sleep at bedtime.
[00:06:13] Arielle Greenleaf: Andrea asks, how can I sleep train at night when my 11 month olds barely sleeps at nursery during the day? The first days or weeks of sleep training mean no restful sleep during the day or night, and it’s overwhelming.
[00:06:26] Craig Canapari MD: Yeah, I’m not sure I quite understand this.
[00:06:28] Um,
[00:06:29] Arielle Greenleaf: I do, yeah. I think what she’s saying is she’s very concerned because her child doesn’t sleep well at nursery daycare. , And then she’s concerned about sleep training at night because she’s concern concerned that, the child won’t get any sleep if she’s sleep training. And it sounds like she’s concerned that the child is going to be losing tons of sleep while sleep training overnight and then not sleeping [00:07:00] during the day at nursery.
[00:07:01] So how do you handle that? , And I guess what I would say is it really doesn’t take, well, your child should not be awake overnight uh, for days and weeks if you’re sleep training, that that’s not really, um, and I’ve never seen that as an issue where it’s like such long amount of time. that that you know, that the child is so crazy tired.
[00:07:26] So I would say just go for it. If they’re tired during the day, you know, maybe back up bedtime a little bit. If they’re extra tired and not sleeping at all. But I would go for it, especially if they’re not sleeping during the day. Let’s get them to sleep overnight.
[00:07:43] Craig Canapari MD: Yeah, no, I would agree with that. Okay, so
[00:07:46] Here’s another one, Chelsea. Our 6.5 month old has been sleep trained Ferber for about a month and sleeps from 7:00 PM to 5:00 AM I would celebrate that win first of all, Chelsea, [00:08:00] but how do we avoid these early morning awakenings? Should we just accept that he’s a 10 hour overnight sleeper?
[00:08:07] Arielle Greenleaf: You want me to tackle that or you want that?
[00:08:10] Craig Canapari MD: I’d say that a lot of this depends on how much he’s napping during the day. I’d say that 5:00 AM is in the low end of normal, the early end of normal. For a young child and it is painful. What do you think?
[00:08:23] Arielle Greenleaf: Well, I think one of the biggest things that I do is look at overall sleep. So like you said, let’s look at naps. How much does, how much sleep does this child need in a 24 hour period? Because it’s possible that they’re maxing out. And so a 7:00 PM bedtime yields a 5:00 AM. Wake up at perhaps an an 8:00 PM bedtime would not.
[00:08:52] However, it could also be if you start capping naps. And move, try to shift some of that overall sleep into the [00:09:00] nighttime. You could perhaps get rid of that 5:00 AM waking, but it really depends on the child. Because some babies just really love waking up early, just like some adults. So for me, it’s a matter of, again, it’s, it is looking at that daytime sleep and the timing of everything.
[00:09:20] And I also like to look at the fact, like, I always ask the question, have they always woken at 5:00 AM or is this something new? Because if they’ve always woken at 5:00 AM it’s more likely that they’re just early birds. But if it’s something new, it’s it’s probably something that you can shift around a little bit with scheduling.
[00:09:40] But I would say early wake up are probably one of the hardest things to solve.
[00:09:44] Craig Canapari MD: Yeah, absolutely. Yeah. And the basic stuff. Make sure the room’s dark, though. If you’re in the Northern hemisphere, it probably is dark at five in the morning. Currently. Make sure there’s no a, is there trash pickup going on when this child wakes up at five in the morning? [00:10:00] Something like a sound machine could be helpful. It’s tough though. It’s a tough problem. You wanna read the next one?
[00:10:08] Arielle Greenleaf: Sure. Okay, Caitlin asks, I have a seven month old who has just started sleeping better. This will be our first daylight savings time, and I’m terrified. How can I preserve the progress we’ve made with his sleep?
[00:10:25] Craig Canapari MD: I can speak to this. Yeah, the falling back is the tough one for for parents of young kids who are getting up early. Because if your kid was getting up at six in the morning, guess what? On, I think it’s November 4th this year. All of a sudden that’s five in the morning. And it’ll feel like six in the morning because you won’t have adjusted the new schedule, but the rest of your life probably will.
[00:10:46] Not so often. Often I just tell parents, just keep your kid on the clock schedule. You can maybe move them 30 minutes later for bedtime for a few nights before, but [00:11:00] most kids really don’t need a huge adjustment here. It’s not gonna, for a seven month old, it’s not typically gonna result in a lot of middle of the night awakenings. I think it’s just your baby’s gonna have to ship their sleep schedule an hour later just to be in sync with everything else. So I don’t think that’s a huge lift though.
[00:11:19] Arielle Greenleaf: No, I agree. And I think some babies are just sensitive to any change. It just is who they are. But I generally prefer not to do any sort of shifting of schedules unless a parent is really, really nervous about it and it makes them feel better to do that. In which case I’ll say, push wake up time, nap time, bedtime, about 10 to 15 minutes later for , you know, seven days leading up to the time change.
[00:11:49] And then, the goal is you’re putting the baby to bed an hour later for everything so that when you wake up on Sunday, the baby’s already on schedule, but [00:12:00] shifting a baby’s schedule. By that much can be really challenging and may backfire in a way that even just following the clock, like you said, wouldn’t backfire.
[00:12:12] The other thing is that I just say if you know for a few days you may have to put baby to bed actually a little bit later. Isn’t it later, 30
[00:12:24] Craig Canapari MD: Well, it’ll ‘
[00:12:24] Arielle Greenleaf: cause they need more sleep drive or
[00:12:27] Craig Canapari MD: the
[00:12:28] Arielle Greenleaf: am I getting my
[00:12:29] Craig Canapari MD: a, here it’s like
[00:12:30] jet lag. The clock’s gonna shift, and the baby’s natural biology is not gonna
[00:12:35] So the schedule is actually, since we’re falling back, the clock time is ratcheting earlier. So if the child was used, was sleeping from seven to five, like the previous example, all of a sudden the child’s sleep schedule is gonna be six to four
[00:12:51] Arielle Greenleaf: right,
[00:12:51] Craig Canapari MD: don’t
[00:12:51] make any changes, right. So for most for teenagers it’s great because all of a sudden school feels like it’s starting an hour later. [00:13:00] But for kids who are waking their parents up, falling back is more difficult. But I wouldn’t overcomplicate it unless your child has special needs. I think if you’re gonna do anything, try to shift the afternoon nap and the bedtime a little bit later. But it, it’s your first rodeo. I would just maybe just go with the clock time and recognize your baby’s gonna be a little bit irritable. That first night. Maybe the first night after the shift, you, your child stays up 30 minutes. You keep them up 30 minutes later and then they get used to it.
[00:13:30] But just try to stick with the clock schedule which is gonna feel later to the baby. Let me just make this simple. Okay? ’cause this, it is a really confusing topic. If you want to prepare in advance, you could have your baby stay up 15 to 20 minutes later for a night or two. Otherwise, I would just try to stick to the clock schedule.
[00:13:51] So in the Sunday after the daylight savings time shift, you could just try to keep your baby up to the clock time, which will be an hour later [00:14:00] if you don’t make it. That’s okay. So if your kid’s usual sleep time was seven 30. And they’re irritable at seven because seven feels like 8:00 PM used to, that’s okay.
[00:14:12] You can put them to bed. They’re gonna adjust pretty quickly,
[00:14:14] Arielle Greenleaf: Yeah Yeah, I I think it’s just get them outside in the sun um, and know that it’ll take a couple days, but it should be fine.
[00:14:24] Craig Canapari MD: Okay. Kaley asks my nine month old wakes in the middle of the night, babbles for a while, and then cries. I end up going in to resettle him, which gives me more sleep than waiting for him to cry it out. How do I break this cycle?
[00:14:37] Arielle Greenleaf: Oh boy. It comes back to how do you even know that the baby is babbling and moving around in their crib and not crying? is a, this is a big problem I’m finding with a lot of clients right in that you know, there’s some really great technology out there and it gives [00:15:00] us lots of information, but if we didn’t have those smart monitors, we’d have no idea that baby was awake and babbling and moving around.
[00:15:08] As far as the crying mean, this, it’s nine month old, is that right?
[00:15:15] Craig Canapari MD: Yeah.
[00:15:15] Arielle Greenleaf: Nine mean, Generally speaking, nine month olds can sleep through the night. Um, But again, I think you have to go back and look at how are they falling asleep in the middle of the night? Are they getting the right number of feeds?
[00:15:27] Could they be hungry? Speak to the doctor about If if the child is healthy and they’re getting all the nutrients that they need throughout the day, then the best bet is to, choose a method and and stick with it. Start with bedtime. You have to start with bedtime and then follow through throughout the night.
[00:15:46] Um, But I think it’s important to remember, I know, I understand the idea of, you know, maximizing sleep. I think a lot of people, and, and some of the questions we’ve heard already assume that sleep training is gonna take [00:16:00] like and and weeks of prolonged crying and sleepless nights, and it’s just really not that bad.
[00:16:09] And in the majority of cases, parents are like, why did I wait so long and why was I so nervous?
[00:16:15] Craig Canapari MD: Yeah, I think in this case, baby needs to be falling asleep independently at bedtime. If that is not the case, do not stop, go, just do some sort of sleep training technique at bedtime to have the child fall asleep independently. And Arielle, I think you texted me that you wished everyone would throw their Nanette out
[00:16:35] the
[00:16:35] Arielle Greenleaf: I sure did.
[00:16:36] Craig Canapari MD: sponsor of the
[00:16:38] Arielle Greenleaf: Oh gosh. I feel know? yeah.
[00:16:41] Craig Canapari MD: or sponsor me, not Arielle.
[00:16:43] Arielle Greenleaf: you know,
[00:16:44] Craig Canapari MD: I think I think that it is a, it does sound like in this example, the baby is crying. But I do think that it, that, and sometimes you
[00:16:51] in inadvertently power this habit because you’re anticipating crying.
[00:16:57] So when you hear the baby battle, you go [00:17:00] in, put in the pacifier, pat them. So then they, when they have a natural awakening, they’re gonna cry. ’cause that’s what they’re used to. So again, if your baby’s falling asleep independently at bedtime, you may need to ignore them and let them cry a little bit if they’re not falling asleep independently at bedtime.
[00:17:18] That’s what I would do.
[00:17:20] Arielle Greenleaf: Craig, I didn’t put these in our questions, um, but I got two different sleep coaches asked to asked to discuss how it’s normal for babies to wake throughout the night and, um, and that, you know, sometimes they’re just kicking around and they’re playing with their fingers or their feet know, babbling like this this baby, and.
[00:17:48] I’ve noticed that people are so concerned about these awakenings and sometimes the baby’s awake for, you know, an hour, but they’re so concerned in the morning and they see it as their baby didn’t sleep through [00:18:00] the night. Even if they’re not signaling, you know, they’re not crying out, they’re not hysterical, they’re just awake.
[00:18:05] So what are your thoughts on that?
[00:18:07] Craig Canapari MD: Yeah, I think it’s perfectly natural for people to awaken during the night. And it’s true of babies, it’s true of grownups. And if your child doesn’t seem to need anything, you don’t need to worry about it. If the monitor says they’re having broken sleep at night and you don’t hear from the middle of the night, it’s not cause for concern to me. We’ve, I think that as people as babies go through the night, they go through non-REM sleep, then they go through REM sleep, and then they wake up and they go back to sleep and it’s totally natural. So just it, it take pleasure in watching your baby practice rolling or putting their fingers in their mouth or babbling to themselves.
[00:18:48] This is just normal development and I think it’s a wonderful thing if a child can entertain themselves in their crib or their bassinet and actually not have you present for that. [00:19:00]
[00:19:00] Arielle Greenleaf: I mean, I think that’s one of the goals we have when we are helping parents through these sleep challenges. We want our, the babies to feel comfortable and know, have it be a safe space for them to I agree.
[00:19:13] Craig Canapari MD: Okay. We are on section two, early morning awakenings and sleep regressions. So we did cover this a little bit. But yeah, we, let’s get, we can go rapid fire for these they’re related. Brittany asks, once a child is sleep trained, how should nighttime awakenings be handled to avoid reversing the progress?
[00:19:30] Arielle Greenleaf: Stay consistent. mean, as long as you know your child um, healthy and otherwise, well cared for it, you can see on the monitor probably whether they’re they vomited or something like that. Um, Then the most important thing is to stay consistent because one of the biggest things I see with regressions is it they can happen out of nowhere and you can suddenly have these wakings and parents are so confused because baby has been sleeping well and this is [00:20:00] outta the ordinary.
[00:20:00] And so they go in and then the ball of yarns starts to unravel and six weeks later they’re coming to me saying, I just, I don’t know what happened. And now we’re in a horrible spot. So as long as your baby is healthy and otherwise fine, I would stay consistent with whatever method you chose. If you feel like you need to go in for a quick check.
[00:20:23] Make it quick, brief, don’t make, you know, no fanfare and uh, and be outta there as quickly as you can.
[00:20:31] Craig Canapari MD: I agree and look, sometimes your kid are gonna have an ear infection and wake up at night, and that doesn’t mean that they’re not sleep trained anymore if they’ve got a cold or you’re traveling and something
[00:20:40] comes up.
[00:20:41] Arielle Greenleaf: Yeah, I think that’s a really important point. I’ve, I often see um, parents saying, you know, I’ve had to sleep train, I sleep trained and I keep having to ResSleep train. And I, and I, you know, you’re not really ResSleep training. What you’re do is re doing is recalibrating. If you go on vacation, [00:21:00] your own sleep gets.
[00:21:02] Outta whack. You come home, you have to get back into the schedule. You probably have to wake up a little earlier, go to bed a little earlier, and it’s the same as true for your baby. So illness, like you said, um, travel, those things are probably going to affect baby’s sleep. And you just, I just look at it as getting back into routine.
[00:21:22] Craig Canapari MD: Agreed. So let’s see. I’ve actually got a couple of, let’s let this compare and contrast. So these are three early morning awakening
[00:21:34] questions.
[00:21:34] Arielle Greenleaf: Okay.
[00:21:36] Craig Canapari MD: Chelsea asks about a 6.5 month old who’s been sleep trained but wakes up at five in the morning consistently. How do we troubleshoot early morning awakenings? We talked about that a little bit in a child this age. Again, some of it you might have to subtract a little bit from the daytime naps if they’re excessive, but I think that, it is early. Let me let’s read these [00:22:00] others as well. ’cause I think they’re, it’s a little
[00:22:01] bit of compare and
[00:22:02] Arielle Greenleaf: Okay. Yeah,
[00:22:03] Craig Canapari MD: Hunter asks our two daughters ages six and nearly four wake up extremely early with the youngest regular getting up at four 20 in the morning. We’ve tried adjusting bedtimes but nothing seems to help. What strategies do you recommend for handling early risers? Four 20. A cool time to wake up, but not for parents. Is pretty early. And Pauline asks, can you suggest strategies for children with a SD who take melatonin to fall asleep but waken the early morning and won’t return to sleep? We’ve considered various factors such as pain, consistency, and routine and family response, but nothing has helped. So Chelsea, I think we talked about a little bit earlier. I have an idea about Hunter, but I.
[00:22:45] Arielle Greenleaf: Yeah, go ahead with your Hunter and and if I have anything to.
[00:22:49] Craig Canapari MD: So sometimes I’ve had situations like this where we have a 6-year-old and a 4-year-old, or a 6-year-old and a 3-year-old say who are sharing a room and [00:23:00] the 4-year-old is napping and the 6-year-old is not. And the result can be sometimes that the 4-year-old is either needs to go to bed later or get up earlier because they’re getting more sleep than they need with their sleep
[00:23:15] opportunity.
[00:23:16] Arielle Greenleaf: drop their nap.
[00:23:17] Craig Canapari MD: So dropping the nap can be helpful again and listener kind listeners, I always appreciate these and we don’t always include all the details. Sometimes you need a kind of bespoke solution with a schedule. But I’d say that certainly if the 4-year-old was napping, I would definitely get rid of the nap. Adjusting bedtimes sometimes needs to take a little bit longer than a few nights. So a later bedtime, doing it for a night or two is not necessarily gonna work. You almost have to generate some sleep debt. And I think also some children just need less sleep than others. If your child is well rested, makes it through the day without napping, you may want to transition to some strategies [00:24:00] like an okay to wait clock or like a morning light kind of protocol which I can link to in the show notes to say your child can quietly stay in their room and play as long as they don’t wake up other people. But the key is making sure they have enough
[00:24:13] sleep
[00:24:14] Arielle Greenleaf: Yeah. And I also think though, that you need to look at what is happening when they wake up are, what is your response to them? Um, what do do they get to watch a tablet so that you can keep sleeping? Do they get to watch tv? Do they get something?
[00:24:30] Craig Canapari MD: to cuddle
[00:24:30] Arielle Greenleaf: Do they get to
[00:24:31] Yeah. Do they go into bed? Um, Because I find that a lot of times.
[00:24:35] At that age, they’re waking, not because they’re not tired um, but it’s more that there’s an anticipation that they get to do something and then they probably are on the the other end. Uh, Because that’s really early, that’s exceptionally Um, And so have to, I I would start with what is the response right now?
[00:24:54] I absolutely would be looking at the schedule for the 4-year-old. Um, But also what is the [00:25:00] response that these children are getting when they wake up that early? And are you getting them up? Are you taking them outside? Are you feeding them breakfast? You know, Looking at all that and then deciding like, you know, what what is the start of the day for you?
[00:25:14] Because 4:00 AM to me, is the middle of the night.
[00:25:16] Craig Canapari MD: Yeah. Hunter, I feel your
[00:25:18] pain. Definitely. Shoot us an email follow up. ’cause I’m curious. It is exceptionally early. Pauline’s question is a child with a autism spectrum disorder waking up in the early morning with melatonin, and I would say that first of all, I look at the melatonin dose.
[00:25:34] So typically for kids that are less than 80, around 90 pounds, the recommended dose is three milligrams. And for kids that are over that weight for the European is the 40 kilogram cut up. The me five milligrams is the maximum dose. If it is higher than that, sometimes that can cause middle of the night awakenings or nightmares.
[00:25:54] So certainly sometimes the lower dose can be more effective. They’ve looked for pain, they’ve looked [00:26:00] at consistency and routine and how they respond and nothing has helped. This is we’re gonna have Beth Mayo on. This is a very common issue in autism spectrum disorder and it can be quite challenging to address. But similar to the last example, what happens with this child when they get up early in the morning? Tired parents often inadvertently offer reinforcement and I’ve seen many parents of autistic children letting ’em have some screen time. And if that doesn’t compromise the functioning of the household and allows the parent to sleep, it may be something that’s necessary.
[00:26:35] Certainly I have seen a lot of kids have some better luck if they’re getting a lot of physical activity during the day, but it often is a lot of physical activity. Like parents will say that they go on vacation and their kid’s swimming all day at the beach and then they sleep in later. That isn’t really practical.
[00:26:54] In October when your is gonna school. For them to exercise for eight hours. [00:27:00] Sometimes looking at the sensory environment trying something like a Lycra sheet or working with occupational therapy can help for sensory issues. And certainly a BA therapy for autism can help sometimes. But it’s a, these are early morning awakenings I think are, we’ve alluded to some of the most challenging problems.
[00:27:19] Arielle Greenleaf: Absolutely.
[00:27:21] Craig Canapari MD: Okay. Now co-sleeping and sleep transitions. Arielle, I’m, this is a good one for
[00:27:27] Holly asks My 2-year-old and I have co-slept since birth. How can I transition him to sleep on his own without me needing to sleep in his room?
[00:27:38] Arielle Greenleaf: yeah.
[00:27:40] Craig Canapari MD: You’re making her feel good with
[00:27:43] your response.
[00:27:44] Arielle Greenleaf: sorry. I’m not trying to, no, I, I think, I think it’s I, I always hate this because it’s like everything. I always, I always say it depends. It depends because every situation is so different. I think a method like [00:28:00] camping out can be really I think you can’t just your your presence in a situation like this because the child is so used to your presence all the time overnight, that I, it just completely removing pre your parent presence would not be helpful.
[00:28:17] So I think a method like camping out would be useful. It’s going to take time and consistency to get there. But I think that that would be my, my, you know, my number one option for this and this what I’ve used in the past. I wonder,
[00:28:34] Craig Canapari MD: Arielle, why don’t you just expand just explain what you
[00:28:37] mean by
[00:28:38] Arielle Greenleaf: Yeah, sure. So camping out, basically we start with the parent sitting right next to the the bed or the crib. Um, And they are sitting there until the child falls asleep. And that can be really tiring, but it can also be reassuring to the child. The o the bigger thing that becomes tiring is [00:29:00] you have to stay consistent with that throughout the night.
[00:29:02] So he falls asleep, he sleeps for three hours, he wakes up, it’s 1:00 or you know, it’s midnight or something like that. You have to go ahead and go back in there and sit until he falls back asleep. Um, There’s gotta be a lot of reassurance with that because they’re alone for the first time ever in a bed.
[00:29:22] So you’ve gotta follow through with that, that. I just always tell parents, we’re gonna put our body armor on and we’re gonna get through it, and it’s, you will get there, you just stay consistent. It’s hard to know, you know, how far into two is this child? Because, um, there could certainly be some some other tools um, that you could use.
[00:29:45] I, you know, I’m just thinking about your puppy. What is it? The huggy puppy.
[00:29:50] Craig Canapari MD: Huggy
[00:29:51] puppy.
[00:29:51] Arielle Greenleaf: I mean, I at two, that’s probably too young, but it depends on are they closer to three, you know, where are they developmentally?
[00:29:58] Um, because sometimes things like [00:30:00] that are like a, an article of the child, of the parents’ clothing that smells like them or something like that can be really helpful.
[00:30:07] But yeah, so camping out, essentially the, the the goal is that you’re slowly moving yourself away from the bed or the crib. Um. Over the course of, usually it’s more like two weeks and, and then the ultimate goal is you’re, you’re out in the hall and they, the doors, you know, slightly open a jar and then eventually you’re not having to sit there with them at all.
[00:30:33] Craig Canapari MD: So yeah, two’s a tough age. My first foray, I might be like, okay, I think you, no matter the age you have to sell it. Be like, oh my God, you’re such a big kid. Now you’re ready to go in your room and really, do a lot of salesmanship about this. Make it exciting. Have your child spend some time in the room by themselves during the day.
[00:30:51] Maybe start with a nap. And I might just say, okay, I’m gonna, I’m gonna stay with you for a couple of nights and we’re gonna have a sleep fun sleepover in your [00:31:00] room. And then mommy needs to go back to her room. And then ’cause camping out is labor intensive. I might just see. You know this, some kids this might go
[00:31:08] fine,
[00:31:09] Arielle Greenleaf: Absolutely. Yeah.
[00:31:10] Craig Canapari MD: be like, oh, okay, this is how it
[00:31:12] is. So be optimistic that it could go smoothly. But if it’s more difficult, you might need to do more, be more gradually
[00:31:19] Arielle Greenleaf: Yeah. I like a like a be right back method where you put the child to bed and you promise to come back um, you have to actually go back because you have to gain their trust that you’re gonna go back. But just starting with little, you know, little steps like that can be helpful. Um, New stuffed animals, things like that can can be useful.
[00:31:41] Craig Canapari MD: So here’s another one from Ashley. I co-sleep with my three-year-old in his room, but I need some more support in my bed and back pain relief if I leave after he falls asleep, he eventually comes to my room. Any suggestions on how to transition him to sleeping independently? I.
[00:31:57] Arielle Greenleaf: I’m gonna leave that one [00:32:00] to you.
[00:32:00] Craig Canapari MD: I would say that, first of all, Ashley, good for you for prioritizing self-care. And I think what your child needs is to learn to fall asleep independently at bedtime. There’s lots of different ways to do it. We mentioned camping out. Taking a break is when you’re coming in you leave the room and you come in and you check and you build that muscle towards independent sleep.
[00:32:20] But I think working towards independent sleep at bedtime is your point of maximum leverage. The nighttime awakening should improve. Why don’t leave it at that?
[00:32:29] Arielle Greenleaf: Yeah, I would agree with that. ’cause if the child ex, I mean, the expectation right now is that mom is gonna sleep in the room and of course if he wakes in the night and mom’s not there, that’s upsetting. So starting at the Yeah, I totally agree.
[00:32:44] Craig Canapari MD: I’m also a big fan of saying this is a three-year-old. This child can honestly be
[00:32:47] like, you know what, mommy’s back hurts and I can’t sleep in this
[00:32:51] bed anymore. And just, that is totally legitimate thing to say to your child. They can respond how they like, but you can control your own [00:33:00] body and you can make a choice not to lay down with your 3-year-old anymore.
[00:33:03] And I would encourage you to do that because if it’s causing you pain, you
[00:33:06] shouldn’t do it.
[00:33:07] Arielle Greenleaf: Yeah. And I would say, I mean, I’ve done that with my own child. I’ve had to um, well, it’s not, it’s not a lie either. I, I, when I don’t sleep, I literally feel sick. And she went through some crazy regression when the threes, somewhere in the threes, and I literally just said to her, when you do this, mommy doesn’t feel good, and I wanna feel good so I can have fun with you.
[00:33:34] And that actually made all the difference. I’m like, why didn’t I think of this sooner? It’s sometimes it’s the simple things and you forget how kids learn quickly and they can pick up on things very quickly.
[00:33:45] Craig Canapari MD: Yeah, I think modeling self-care and expressing what you need there’s been a real I think since attachment parenting in, it had its heyday in the nineties and the early two thousands of this idea that we have to do [00:34:00] everything to. For our children, they can never be uncomfortable or upset even at the expense of our own mental or physical health.
[00:34:09] And I would empower you parents to say, it doesn’t have to be that way. And it’s okay to say your parents, you know what? That’s uncomfortable for me. I’m not doing this.
[00:34:19] You know that we’re not doing this way anymore because I
[00:34:22] Arielle Greenleaf: well, It’s really just setting healthy boundaries, honestly.
[00:34:27] Craig Canapari MD: Okay. Here’s another one. Katie asks, my nearly 3-year-old daughter has her own room for the first time after her recent move.
[00:34:34] First of all, Katie, that’s wonderful and it’s a cause for celebration that your new move,
[00:34:39] hopefully she wakes during the night and asks my su husband to sleep next to her in her crib. Any advice for breaking the habit? First of all, I would ask, how large is your husband? Can he get into a crib?
[00:34:53] Arielle Greenleaf: maybe he is not actually in the crib. He is next to the crib.
[00:34:56] Craig Canapari MD: He is just got his hand in
[00:34:58] there. I’m just imagining like a [00:35:00] little tiny man. Katie hear
[00:35:01] me?
[00:35:02] Arielle Greenleaf: I’ve definitely seen people and heard of people
[00:35:05] Craig Canapari MD: Oh, I, I was too tall to get in my kid’s crib, but I’ve definitely seen
[00:35:08] parents do it. I think that I think this is one of those things that’s just first of all, just have a be like, oh my God, it’s so exciting. You’re in your big, you’re in your big girl room. Daddy can stay a little bit next to you here, but he, he can’t really lay down here.
[00:35:22] It’s not comfortable anymore.
[00:35:25] Arielle Greenleaf: I am a big big fan of timers, so daddy will lay next to you for you. Choose the time. I mean, I prefer shorter amounts of time. You might have to start with a little bit of a longer amount of time and slowly back it up. But again, this is about setting healthy limits, not just for. Him, but for her, because it’ll be, it ultimately benefits everybody to have everyone sleeping in their own sleep space.
[00:35:53] So timers can be really helpful, along with, I’ll come back and check on you, or a bedtime pass [00:36:00] might be useful there. Um, calling out after bedtime for one, you know, glass of water or hug or whatever that might be. But basically you just have to set the boundaries and stick to them. And I know every, everybody thinks it’s gonna take forever for them to figure it out, but I promise you, if you’re consistent, she should be okay in a couple few nights.
[00:36:22] Craig Canapari MD: Yeah. And I would say to any parent that wants to break a habit, you can just decide to stop doing something. Your child will adapt, maybe unpleasant for a night or two, and some people want to do a gentler approach. But again, if something doesn’t work for you, it’s okay to stop it. Here’s one. Kimberly asks, our 3-year-old wakes multiple times during the night screaming for hugs. This is such a great description. He will vomit if we let him cry. So we end up waiting for him to fall back asleep, which can take 10 to 30 minutes. What consistent strategy can help us break this cycle without going back into his room? [00:37:00] This is I’d say the vomiting with crying is up there with the dreaded sleep deuce as a move that it’s difficult for
[00:37:07] parents to
[00:37:08] Arielle Greenleaf: can’t, you can’t, go in and be like, sorry you pooped in your diaper. I’m not you. I mean, that’s not, that’s just not something, and they definitely learn it. I, it’s just working with someone recently, a return client who’s this is the latest yeah.
[00:37:26] Craig Canapari MD: Unstoppable.
[00:37:28] Arielle Greenleaf: Yeah, so I, I actually said put her in the pull up earlier.
[00:37:32] Maybe put her into bed earlier so that she’s doing, you know, going to the bathroom earlier and then actually going to sleep time. And, And that did start to work. So, um, I think the vomiting thing is a little tricky. I know with younger babies and toddlers, um, generally recommend that they go in, clean them up without much a attention and put them back into bed [00:38:00] or, you know, continue on with the method.
[00:38:02] However, I know that wouldn’t be, would be uncomfortable for some people. Um, Who would you say about that?
[00:38:09] Craig Canapari MD: I think I, first off, I’d say, yeah, make sure your kid gets checked out by your pediatrician that he doesn’t have acid reflux. ’cause certainly some kids that vomit easily could have acid reflux. Again. He probably doesn’t. You may have already thought of that. Often there’s a lot of anxiety here with kids that do this. I think that if your child, one place that might be a little bit safer is to work on some separation during the day. If separation is also a problem during the day, working with a mental health provider to work on separation anxiety. ’cause this has a real separation anxiety flavor to me. I’m often in this age group a big fan of building that separation muscle, but not quite getting to the point where your child is hysterical because they’re not, they can’t think, right? Like when they’re, your child doesn’t enjoy
[00:38:58] vomiting. So they’re getting, [00:39:00] he’s getting so jacked up that he’s throwing up.
[00:39:04] I think you’re you’re he’s lost the capacity to reason, and three year olds are only selectively reasonable as we know. I think working on seeing if you could incentivize some time with him again, work towards independent sleep at bedtime. If you are not there start gradually scaling back your intervention.
[00:39:24] I don’t know it. If he’s really struggling all the time with separating during the day, you probably wanna work with a professional on separation anxiety, which is very common. If it’s just a nighttime thing, I think that really start gradually, work towards dependent sleep at bedtime, start scaling back your interventions at bedtime.
[00:39:42] And I, as Ariellele says, he gets to the point where he vomits. Then I think you do clean ’em up and put ’em back to bed, but not really dwell on it too much. But yeah I, yeah I’d make sure any anxiety component, this is
[00:39:57] addressed.
[00:39:58] Arielle Greenleaf: yeah, [00:40:00] definitely.
[00:40:00] Craig Canapari MD: I think the next one, the, another another, Holly is asking about a 3-year-old tra who co-sleep and want to transition to independent sleeping. I think at age three, that’s a great opportunity to get pumped. Be like, oh my God you’re such a big, you’re such a big kid. You’re totally ready for this.
[00:40:17] This is amazing. We’ll have a couple of sleepovers in your room and then you are gonna be sleeping in a big, like in a big boy bed by yourself. It’s great. And just sell it like
[00:40:26] that.
[00:40:26] Arielle Greenleaf: Totally agree.
[00:40:28] Craig Canapari MD: big,
[00:40:28] terrible
[00:40:28] Arielle Greenleaf: Yeah, no, I actually, sometimes if I’m dealing with a three-year-old, or a four-year-old, ’cause I still, I mean, some people keep their kids in cribs for as long as possible, but, um, if I’m dealing with a child that age who’s still in a crib, I often will transition them to a bed and it’s like new rules because new big kid, you know, so, like, I find it can be exciting.
[00:40:54] You can make it exciting and offer a little bit of reassurance like, Craig [00:41:00] said, but don’t, I mean, I wouldn’t, I. Linger on with sleeping in their bedroom for long periods of time. And you might even try not even doing that. Maybe you, Maybe you start with sitting next to the bed and saying, well, you know, new, new exciting things.
[00:41:16] I will sit next. I’ll read you a book and then we’re gonna do this. And then, you know, I’ll sometimes guided meditations. You could listen to a guided meditation in the dark. But make it exciting. I would definitely make it exciting.
[00:41:27] Craig Canapari MD: Yeah. Not like the moment of bedtime, but just sell it. Be like, let’s pick up some sheets. This is gonna be great. When my kids were little, they were, my older son really liked the Wiggles, which are like, it’s like really over the top cheesy. Who’s the guy who’s the guy on YouTube that all the kids like now?
[00:41:45] Where’s the
[00:41:46] weird there was blippy.
[00:41:48] Blippy. Yeah, like Blippy.
[00:41:49] It’s
[00:41:49] like you, when you’re trying to sell something to your kid, be embarrass yourself a little bit. Like not at bedtime, but beep, be pumped, make it exciting, make them feel good about this [00:42:00] transition.
[00:42:00] Arielle Greenleaf: Absolutely.
[00:42:02] Craig Canapari MD: Okay, she’s another section, a question on travel and disruptions in routine. Abby asks, our 10 month old sleeps well at home, but struggles to sleep through the night when we travel, we try to keep the bedtime routine as consistent as possible. Do you have any advice for making sleep during trips easier?
[00:42:20] Arielle Greenleaf: I really wish I had like some wonderful advice for this other than, you know, eventually she will start to sleep better while traveling. Um, try to keep her well rested. Try. You said you’re doing the bedtime routine. That’s great. Um, Trying to recreate the environment. So if you’ve got blackout shades and a white noise machine at home, it it can help.
[00:42:45] There’s. You know, Plenty of um, disposable blackout shades you can use or even black trash bags. Um, you know, anything to sort of recreate the environment. But honestly, travel for children [00:43:00] can be difficult. It’s not uncommon for travel to be difficult for a baby or a toddler.
[00:43:07] Craig Canapari MD: I am a big, they didn’t have ’em when my kids were little, but those sleep pods that they have, they’re like, it’s like a little tent,
[00:43:14] uh, that your baby sleeps in. Yeah. I’m a big fan of those actually. I think it’s great. It’s especially black. They can’t see you, especially if they’re after six months of age.
[00:43:24] If you have them sleeping in a different room something like that can be helpful. But this too shall pass.
[00:43:30] Arielle Greenleaf: Yeah, I know. I wish there was something like wonderful because I went through it myself and it know, I’d called them trips, not vacations for quite some time.
[00:43:40] Craig Canapari MD: yet. Vacations
[00:43:40] are over.
[00:43:41] Arielle Greenleaf: It. No, that’s not true. No. Your child will be okay but it it, it, you know, some children are just more sensitive than others and I was part of that camp, so I feel
[00:43:52] Craig Canapari MD: Okay, here’s a section on nighttime anxiety and sleep fears. Andrea asks, my 4-year-old never stays asleep in his room and [00:44:00] comes to sleep in my room every night. He’s scared to sleep alone and also fears being by himself even when awake. How can I help him feel comfortable sleeping alone in his own space?
[00:44:10] Arielle Greenleaf: I think that goes back to what you were saying. It sounds like there’s some separation anxiety going on there. If he fears being alone. Even.
[00:44:20] Craig Canapari MD: in show notes that Eli Lebowitz book on anxiety, which is very
[00:44:23] good has a detailed plans on how to deal with separation anxiety. Also my website, there’s, he has something in his book one of his books called The Yale Plan for Independent Sleep at Bedtime for Kids with Separation Anxiety.
[00:44:38] I’ll link to it. But I’d say the key is basically working for kids that are very anxious. You wanna work on independence, but very gradually if he is struggling with. Separation or being alone when awake. Honestly, working with a behavioral specialist during the day is often the least threatening. ’cause if your kid can’t, being alone [00:45:00] in his room for five minutes during the day, nighttime is a lot scarier. I’d say if you could work with someone on that, again, it doesn’t mean that there’s anything terribly wrong with your kid. This is incredibly common. But working up on building that muscle of independent sleep,
[00:45:14] Arielle Greenleaf: Or just independence,
[00:45:16] Craig Canapari MD: yeah.
[00:45:17] Arielle Greenleaf: you know? cause that’s tricky. It’s hard to, like you said, it’s hard to do that overnight if they can’t. Feel comfortable during the day?
[00:45:25] Craig Canapari MD: Let’s see. Here’s one , Stephanie, ask what is appropriate to go in and help your child fall back asleep? My 2-year-old wakes up and when we go on, go in, it turns into a party. How do we know when it’s really necessary to intervene?
[00:45:39] Arielle Greenleaf: Well, I mean at two, I would say it’s probably unnecessary the majority of the time. Unless the child has health issues and needs to be fed overnight, but that’s very unusual at that age. It
[00:45:54] Craig Canapari MD: This
[00:45:54] is sometimes where these two-way monitors can be helpful. Where you can just say, oh, you gotta go back to
[00:45:59] bed. Goodnight.
[00:45:59] Arielle Greenleaf: [00:46:00] but some kids are scared of that. you know, the great and powerful oz comes out and they’re, that freaks ’em out. I’m serious.
[00:46:06] Craig Canapari MD: attention. the
[00:46:07] man behind the
[00:46:08] Arielle Greenleaf: Um, I mean, if if it’s consistent that the child just wants to party, then you know, you’ve gotta work again. We gotta look at bedtime. How is bedtime, how are they falling asleep?
[00:46:21] And that’s, that’s where we start. I know we sound like broken records when we say that, but that’s where you have to start. And and then you have to follow through um, with that consistency so that they understand the the boundary in the way that it works and that they feel comfortable when they wake up in the middle of the night.
[00:46:38] They definitely don’t need you for a party. They can party by themselves in the crib.
[00:46:42] Craig Canapari MD: Totally. Leslie asks, my 7-year-old grandson wakes up around three to four in the morning when he stays overnight with us, even though he wakes up later at home. I think he wakes up early to spend more time here. Any strategies to help him sleep later?
[00:46:59] Arielle Greenleaf: [00:47:00] Yeah, don’t get up with him if you, if you’re, I mean, it sounds like he’s being incentivized, so
[00:47:05] Craig Canapari MD: yeah, I would agree. Leslie, first of all, I love a grandparent question.
[00:47:10] Grandparents are the best. I used to spend a lot of time at my grandma’s when I was a kid. I think there may be two layers to it. Some of it is just sleeping in an unfamiliar environment. But think about how you may be reinforcing this behavior. I’m sure you really enjoy having him come to visit, but if you’re getting up with him, if you’re getting him a snack, if you’re letting him play with a toy or something like that, I think the ex, if he sleeps well at home and this is at your house I think the expectation needs to be that, you don’t see him in the morning till his wait time.
[00:47:40] He’s seven years old. He should be able to
[00:47:42] do that.
[00:47:43] Arielle Greenleaf: Might be helpful to get an okay to wait clock or something at grandma’s house. Um, Something so that it signals to him that it’s okay to get up. Um, But I would, if you’re getting him up you know, offering a snack or something like that, [00:48:00] the way to make it stop is to
[00:48:01] Craig Canapari MD: I don’t think a
[00:48:02] Arielle Greenleaf: of new.
[00:48:03] Craig Canapari MD: likely read a clock.
[00:48:05] Arielle Greenleaf: no.
[00:48:05] no. But an okay to wake like a, something visual. They can read a clock a 7-year-old
[00:48:09] Craig Canapari MD: No, I’m saying I don’t think an okay. Okay. To wait clock is a clock that changes color based on whether or not the child can get up or not. I think for, I don’t think you need it for a 7-year-old, just get a digital clock and be like, okay, if you’re awake in the middle of the night if it’s an emergency you can come get me.
[00:48:25] Otherwise I’ll see you at six in the
[00:48:27] morning and just
[00:48:28] sort of stick to your
[00:48:29] Arielle Greenleaf: don’t know. I just think wake okay to wake clocks are fun oh
[00:48:33] Craig Canapari MD: you invented the okay
[00:48:34] to wait clock.
[00:48:35] Arielle Greenleaf: did not invent the okay to
[00:48:36] Craig Canapari MD: you
[00:48:36] invented it. Okay. To wait clock. If you wanna sponsor us,
[00:48:40] Leave our email at the bottom of the
[00:48:41] Arielle Greenleaf: I mean, I did work for Hatch a long time ago, so
[00:48:45] Craig Canapari MD: Yeah. No it’s great stuff. Okay, Dr. Ula, believe as a pediatrician, asks My 19 month old used to sleep through the night, but has recently started waking up multiple times and crying for reassurance. He won’t go back to sleep unless we hold his [00:49:00] hand through the crib bars. It’s very
[00:49:02] touching, touching image.
[00:49:04] What can we do to help him sleep through the night again?
[00:49:06] Arielle Greenleaf: I’m sure it’s not touching in the middle of the night. It’s exhausting. I mean, if The child used to sleep well previously, I would think how did they, how did you go about teaching your child to sleep independently? Initially, and then sometimes you just have to go back to basics.
[00:49:25] I would also say look at daytime sleep. I don’t know if they’ve transitioned to one nap um, at this point, I would assume so, but sometimes you know, sometimes children hold onto two naps for a while it’s time to to transition to one nap. Uh, I also say that that’s like a very common age for language development and there just happens to be a lot of nighttime awakenings.
[00:49:48] One language is exploding. So It’s so tricky ’cause it sounds so It’s like, well if you don’t want that to happen, then stop doing it. But it’s so hard as [00:50:00] parents to just stop doing something if you feel like your child needs you. So.
[00:50:05] Craig Canapari MD: And we don’t know the timeframe of this. Maybe when I sent this email out to my email list, it happened for a night or two. Maybe it’s been going on for a week or two. Certainly if something’s happening for a couple of nights, I’m not that worried about it, but it’s be, it’s becoming the new norm, that’s when it’s a problem. I think the looking at the naps is definitely a money, if there’s two naps, I’d go to one make sure there’s not something medical going on. And, think if there’s anything that changed in your routine or your child’s life, that might be a factor here.
[00:50:35] Arielle Greenleaf: Yeah, all of that.
[00:50:39] Craig Canapari MD: Okay, so here, sleep disorders and medical concerns. This is one probably for me, though it’s not a disorder I treat. Sarah asks if it’s possible for someone with REM sleep behavior disorder to perform complex movements like getting outta bed and opening a door. My father-in-Law, who has all the risk factors for REM sleep behavior disorder, was hurt in the early morning after a [00:51:00] supposedly waking up. Could he still have been asleep? In short, the answer is is yes. REM behavior disorder is where someone loses atonia, which is muscle, which is the suppression of muscle activity except in the, during REM sleep, your diaphragm and your eyes, muscles can move. Everything else is paralyzed. That is specifically to keep you from acting out your dreams. So patients with rem REM behavior disorder can act out their dreams and the dreams often have violent content. So that is a possibility. Another possibility is he just could have been sleepwalking. Even a sleepwalker and sleepwalking is a non-REM parasomnia that can get outta bed, open a door, leave the house, turn on the oven,
[00:51:44] et cetera. Certainly I’d say one episode, weird things happen sometimes, but if this is a pattern, I definitely think he should be evaluated by an adult sleep specialist if he is wandering the house in his sleep. There are forms of nocturnal [00:52:00] epilepsy that can look a little bit like this too, though, that would be less common. So
[00:52:03] yeah, that’s an interesting one. It is scary. People are interested. Mike Bur Bigley, who’s a comment, a comedian, has a special called Sleeve walk with me. He was diagnosed with his disorder and actually because of a dream, he jumped out to the window of his
[00:52:19] hotel. Fortunately, he was on the second floor, so he just pretty banged up and had to walk in the front entrance of the hotel in his
[00:52:28] underpants
[00:52:28] Arielle Greenleaf: Oh my gosh.
[00:52:31] Oh Lord.
[00:52:32] Craig Canapari MD: yeah, here’s another one. Whinging asks. My seven month old has been diagnosed with science silent reflux, so we had to hold him up where upright to sleep for months. Now that we’re trying to transition him to the crib, he won’t fall asleep unless we hold him. Should we just keep trying or are there more tips you can offer to help him sleep independently? It’s a tough
[00:52:52] situation.
[00:52:53] Arielle Greenleaf: Very tough. I’ve worked with many really intense reflux [00:53:00] situations and one of the biggest issues is that, you know, sleep training, usually there’s some crying in the beginning and crying often results in. Saliva, more saliva and that saliva can, you know, cause reflux to flare up a bit. So it can be challenging um, to to work with, with families like this, I would definitely get clearance from the GI doctor.
[00:53:29] I’m assuming that you have one ’cause you have that diagnosis. But then I would consider what feels right for you for a sleep training method. And perhaps it’s a more hands-on method and slowly removing yourself from, , the situation. You may have to have, you know, literally have your hands on him for a little bit or you do some sort of a check-in method where you go in and you lay hands on him.
[00:53:54] Um, But I mean. unfortunately, the only way through it is through it, [00:54:00] and it can be done even with children who have reflux, reflux, severe, you know, gerd. But again, I would definitely speak with the pediatrician or the, the the specialist before moving forward with anything that may include some sort of crying.
[00:54:14] Craig Canapari MD: Yeah, it sounds like they’ve been receiving medical care in the line. I mean, I would ask yourself too if this also feels like the right time for you to do it, I’m assuming it is that you’re tired of dealing with the nighttime awakenings. I think you just have to go really gradually and maybe you lay down next to the baby and you hold him for a little bit.
[00:54:31] Maybe you’re just patting him to sleep and you’re really gradually ratcheting back your involvement. But best of luck, again, this is not gonna last forever, it probably will be a little bit of a rocky
[00:54:41] transition. Okay, now last question from Amelia Juan and baby to, and they sent a picture of
[00:54:48] the baby,
[00:54:49] Arielle Greenleaf: Oh, yes.
[00:54:52] Craig Canapari MD: We followed the CIO sleep training method with our six month old, but even at nine months, he still cries himself to sleep every night. Though briefly, [00:55:00] how can we help him stop crying at
[00:55:02] Arielle Greenleaf: And you might have a different answer, but for me, some babies just do that and sort of, it’s like a, it’s like a normal way for them to decompress and they get it out in five minutes and then they’re asleep and sometimes it’s even for naps. Um, And I just find that it’s, it’s pretty common. Not, I wouldn’t say common, but it’s it’s normal.
[00:55:27] Uh, And nothing of concern. And that he will eventually grow out of it.
[00:55:31] Craig Canapari MD: I would compliment you guys as successfully sleep training your
[00:55:34] child, And also staying the course even though he is crying slightly every night. I remember my one of our friend’s kids did this for a year and he is now a junior in high school. He is doing great.
[00:55:46] You baby Tonio is gonna be fine.
[00:55:48] Arielle Greenleaf: Yeah. And and that’s actually something I’ve been hearing a lot from um, other consultants that I speak with, is that exact issue. You know, I think sometimes we get this impression and [00:56:00] perhaps I blame every, I blame social media for everything, but um, I did that And the, and smart
[00:56:07] Craig Canapari MD: kid, we didn’t have social
[00:56:08] media and it was
[00:56:09] great.
[00:56:10] Arielle Greenleaf: smart technology and social media are my, you know, I have a beef with both of those things, I, I just think that there’s this, this, um. unrealistic picture that when you sleep, train your baby is gonna, and your child is never gonna hit any bumps in the road. They’re never gonna cry again in their sleep.
[00:56:29] They’re never gonna cry to fall asleep. it’s, you know, they’re, they’re not robots. And, , staying consistent , is key. If you’re ever worried about your child for whatever reason, go to the doctor. , crying a little bit at the start of the night is just really, it’s pretty common.
[00:56:45] Craig Canapari MD: Yeah, it’s common. It’s not cause for concern. You are doing a
[00:56:48] great
[00:56:49] Arielle Greenleaf: Yes. Oh, that, that’s a, that’s another big important piece. You are doing Nothing wrong.
[00:56:54] Craig Canapari MD: Yeah. Feel good about where you’re at. So that’s it, that’s our questions [00:57:00] for this week. Arielle, what’s our email address? I can never remember.
[00:57:05] Arielle Greenleaf: The Sleep Edit show@gmail.com.
[00:57:09] Craig Canapari MD: Okay.
[00:57:10] . go ahead.
[00:57:11] Arielle Greenleaf: I’d love to hear from, was it Hunter? I’d love to hear from Hunter the you know, the six and four year olds the the waking at 4:00 AM or whatever. Um, So if you could email, that would be great.
[00:57:22] Craig Canapari MD: that seemed yeah, a little bit outta range. I’ll send him an email back as well. So well, thanks for your attention. Hope everybody gets some good sleep especially as we’re heading into daylight
[00:57:32] savings time or the end of daylight
[00:57:34] savings time, I should say. So about.
[00:57:35] So hopefully this will come up before that happens.
[00:57:38] Arielle Greenleaf: Yes.
[00:57:39] Craig Canapari MD: We’ll see. got a busy couple of weeks. Okay, good.
[00:57:43] Thanks so much for listening to the Sleep edit. You can find transcripts at the web address Sleeped show. You can also find video of the episodes at that address as well as in my YouTube channel. You can [00:58:00] find me at Dr. Craig canna perry.com and on all social media at D-R-C-A-N-A-P-A-R-I. You can find Ariel at Instagram at Ariel Greenleaf.
[00:58:13] That’s A-R-I-E-L-L-E-G-R-E-E-N-L-E-A. 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 Way 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 Podcast and share it with your friends.
[00:58:39] It really helps as we’re trying to get the show off the ground. Thanks.
[00:58:47]
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