Desperately seeking sleep

Up all night

For the first two years of her life, my daughter Marley awoke screaming, up to 10 times every night. My husband, Austin, and I would take turns comforting her, but Marley’s constant wakeups were starting to wear us all down. Each day, she had two loud meltdowns and, at night, she’d take an hour and a half to fall asleep. Surgery to remove Marley’s adenoids at age two eliminated her sleep apnea, but she was still waking about four times a night. At first, this was a heavenly reprieve, but with our new baby, Pierce, thrown into the mix, we couldn’t keep up.

Austin and I hadn’t slept in the same bed for more than two hours since Marley was born; we were constantly snapping at each other for petty reasons. I walked around in a trance, showing up to mom-and-baby yoga on the wrong day and crossing the street on a red light. “Exhausted” was no longer a strong enough word to describe how we felt. So, in an effort to save our sanity and our marriage, we shelled out almost $2,000 for the help of a sleep expert.

I never intended to raise a bad sleeper. But when Marley was born at 36 weeks, she weighed just four pounds, 13 ounces. For the first three weeks, our time was devoted to helping her gain weight. I nursed her for 30 minutes every two hours, and then pumped while Austin fed her my breastmilk from a medicine cup. After 20 minutes of burping, we put her down, only to wake her up half an hour later to start the whole process over again.

By 14 weeks, she’d gained several pounds and was eating like a champ. So I decided it was time for sleep training. The first day, I let Marley cry for 20 minutes before her first nap. She was so loud that our neighbours came to check on us. We tried again two weeks later, putting Marley to bed and crying ourselves while listening to her scream for an hour. When we went in, we found her tiny leg stuck through the side of the crib.

We moved from Toronto to Manhattan when Marley was seven months old. I spent hours exploring, pushing Marley in a stroller through Central Park. But no matter how long we were out, she never fell asleep. I looked with envy at other moms sipping lattes on park benches, their children snoozing in the shade beside them.

While Marley now fell asleep on her own, she still awoke six to 10 times each night and would never return to sleep without help. Sometimes she cried because she was wet — her newest trick was to take off her diaper. We tried duct-taping it, but she pulled that off too. Finally I cut the feet off her PJs and zipped them up backward. Success. Other times she screamed for no apparent reason, sometimes to the point of vomiting. Often it took 40 minutes to calm her enough to sleep.

Meanwhile, Marley had developed chronic ear infections and snored so loudly, we could hear her from our room upstairs. Some nights, she stopped breathing for a few seconds, gasping for air afterward and crying out. It was time to find help.

An ear, nose and throat (ENT) specialist told us that enlarged adenoids (lymphoid tissue) at the back of Marley’s nose were contributing to her breathing problems, ear infections and sleep apnea. When they were removed, the difference was amazing: She breathed better, enunciated better, ate better and, most importantly, slept better. With fewer night wakings, all we had to do was lie down with her and she’d fall back to sleep almost instantly. We were so happy to be rid of the evening screaming fits, we didn’t mind cuddling with her a few times every night.

As the months passed, though, I grew more and more exhausted. During the day, Marley was a kind, funny and imaginative kid. But at night, everything changed. Pierce was a good sleeper, but he still needed to be fed every four hours. Austin was travelling two weeks out of every month and worked long hours when he was home. I started to avoid other mothers who bragged about their solid sleepers. Austin and I would fight about which of us deserved a nap on the weekend. Our whole family needed sleep and lots of it. So we turned to an expert.

Seeking professional help

Our first 90-minute session with Neil Kavey, a psychiatrist and director of The Sleep Disorders Center at New York’s Columbia-Presbyterian Medical Center, cost $650. Sounds crazy, but it was worth every penny. After interviewing Marley and us, and looking at our record of her sleep over two weeks, Kavey gave us his assessment.

While she most likely had breathing issues and was definitely having night terrors (made worse by her exhaustion), the most important issue was Marley’s inability to fall back to sleep on her own. Austin and I were catering to her every desire — from a different pyjama shirt to a glass of water, no request was too small if it meant she’d stop crying. But our attention was making things worse. Marley was a bright and energetic child, Kavey said, but she was in charge. “And it’s very disruptive to a three-year-old to rule the world. It’s disruptive to her feelings of stability.” By taking back control, we would give her the security she needed.

The plan: to utterly exhaust Marley in hopes of teaching her to fall asleep on her own. We were to wake her at 7 a.m., skip her afternoon nap and put her to bed at 9:30 p.m. The goal: She’d be so tired that she’d fall asleep quickly and easily, learning how to do it on her own. There were to be no cuddles, no compromises and no lying with her in bed.

Marley could have her blue blanket, toys and books in her bed. She could have a night light on, but she was not allowed to leave her room. And how would we get her to co-operate? Bribes. We made a sticker chart and taped it to her closet door. If she stayed in her bed for the whole night and didn’t call out for us, she’d get three stickers. If she called for us but remained in her bed, she got one sticker. If she got out of bed, nothing. Once she accumulated 10 stickers, we’d buy her a small present.

The first night started off so easily, we thought we’d wasted our money. After running Marley ragged during the day, we read her the new rules: Sleep in your bed all night; if there’s an emergency, call out for Mom or Dad; no getting out of bed or else the door shuts until you get back in. She went straight to sleep on her own.

At 3:17 a.m., we woke to her screaming from a night terror. It was hard, but Kavey had told us never to wake a child from a terror — it will scare her even more — so we didn’t go in. She woke up five minutes later, crying for me. I went in, kissed her, told her I loved her and left. Screaming ensued. She wouldn’t stay in her bed, so I had to keep shutting the door until she got back in. More screaming. At one point she cried so hard, she choked on her spit. Then, she resorted to banging on the door with her shoe, screaming for us to bring her a blue cup of water, a shirt to cuddle, a tissue.

More than 40 minutes in, Austin emerged from our bedroom, ready to open Marley’s door to console her. “I will divorce you before I let you go in there,” I said sternly. He backed off, knowing that I meant business. When we finally went in, there was Marley, standing on her rug, face flushed, hair matted to her tear-soaked cheeks. She eventually fell asleep on her own at 4:33.

Luckily, each night got progressively easier. Although Marley tried to get us to lie with her by doing everything from guilting us (“Why won’t anybody cuddle me?”) to wetting her pants, she learned after a week that we weren’t going to cave in. Then, to our great relief, she started calling for us from her bed instead of coming to get us. And that happened only about once a night, a huge improvement. After a week and a half, Marley slept through the night. I don’t know that I’ve ever felt such elation.

Sleep lab

Although Marley slept through the night about three times a week for the next two months, she was still crying out, snoring loudly and getting tired during the day. Concerned that her tonsils were causing breathing problems, Kavey booked her into a sleep lab (another $1,250). I was nauseous with fear when we entered the surprisingly homey-looking basement room at 8:30 that night. Would she be scared? How would we get her to co-operate? Marley was so excited over the prospect of watching a movie and sharing a bed with me that she wasn’t fazed at all. It took 45 minutes to hook her up to all of the wires after she fell asleep.

There were seven wires connected to pads on her scalp to monitor brain activity, five on her face, a microphone taped to her neck to record snoring, two electrode pads on her chest, bands across her chest and abdomen to measure her breathing, four wires on her legs to test for restless leg syndrome and a blood oxygen monitor taped to her toe. Above us were a video camera and microphone to help record her sleep.

Marley lasted for three hours and 20 minutes before waking up terrified, pulling off as many wires as she could. When she asked me, through tears, to take her home, I couldn’t say no. So we hopped in a cab at 3 a.m. and I prayed that the doctor would have enough data to give us an answer.

Thankfully, Kavey concluded that Marley’s sleep problems are no longer serious. The lab data told him her sleep stages were normal, her breathing was fine and, although he didn’t hear Marley’s snoring (the microphone didn’t work), he thinks she’ll likely outgrow it. We still have to keep an eye on her tonsils and ear infections with our ENT specialist but, hopefully, we won’t have to subject her to another surgery. So far, he’s been right. In the six months since the study, Marley’s snoring has diminished, her night terrors have decreased and her awakenings have dropped to about two a week. We have no idea what the future holds, but for now, we’re all happy — and rested (most of the time).

Looking for a sleep clinic near you?

First, get a referral from your family doctor, then visit the Canadian Sleep Society at css.to and click on Canadian Sleep Facilities.

Here are a few clinics recommended for children.

All offer a consultation with a sleep specialist, follow-up visits and sleep studies. Fees, unless noted, are covered by provincial health care.

Northern Alberta Pediatric Sleep Program Edmonton albertahealthservices.ca Age Infant+ Wait Six to nine months for consultation, one to three months more for a basic screening study

Canadian Sleep Institute Calgary 300-295 Midpark Way SE Calgary, AB T2X 2A8

Age 6+ Wait Four to six weeks

Centre for Sleep and Human Performance Calgary
centreforsleep.com
Age 13+ Wait Two to three weeks; initial visit covered by Alberta Health Care, $800 for a night in the sleep lab

Children’s Hospital of Eastern Ontario Ottawa
cheo.on.ca
Age Infant+ Wait Three to four months for a consultation, over a year for a sleep study. Note: Deals exclusively with respiratory sleep problems, not behavioural issues

Oshawa Clinic Centre for Sleep Medicine Oshawa, Ont. oshawaclinic.com
Age 5+ Wait Two weeks for an appointment, three weeks for a sleep study

Paediatric Sleep Disorders Clinic at The Hospital for Sick Children Toronto
sickkids.ca (search “sleep clinic”) Age Infant+ Wait Nine to 10 months (unless the case is deemed urgent)

Tri-Hospital Sleep Laboratory West Mississauga, Ont.
sleeplab.ca
Age 12+; they will occasionally see children over 5 Wait Less than a month

Windsor Sleep Disorders Clinic Windsor, Ont.
jennichealth.com
Age 2+ Wait Four weeks

Youthdale Child and Adolescent Sleep Centre Toronto
youthdalesleep.com
Age 3+ Wait Two weeks