It’s a common phenomenon. When babies have immature or poor sleep skills, they wake a lot and need a lot of help to resettle. This means you’re also waking a lot. Once sleep stabilizes for your baby, either as an organic process or with guidance and help, often parents are still waking up frequently or have difficulty going to sleep.
This is called insomnia and its happening because your body has been trained to wake up at certain times. And, if your bed has been a place of stress and anxiety over when your baby will wake and need you next, your sleep environment may not be supporting you to get the sleep you need.
Here are seven tips to get your sleep back on track. After all, if your baby is now sleeping well, shouldn’t you be sleeping well too?
Limit or cut out any caffeine (beverages and chocolate are big ones here) after noon. Caffeine’s half life is 4-6 hours so you may still be feeling the effects when it’s time for you to go to bed. If you’re opting for a warm drink before bed, ensure it’s got zero caffeine in it.
Limit your screen time before bed and don’t bring screens into bed with you. It’s tempting. WE get it. But staring at your tablet or phone before dozing off can really affect your ability to get to sleep. That blue light that comes out of your device signals your body to alert, not settle.
Set up your room for best sleep. If you’ve worked with us you know that we prescribe specific environmental changes for your baby to get his/her best sleep. This applies for you too. Think dark, quiet and cool. Consider covering up lights on electronics (phones, alarm clocks, etc) as this can even rouse you out of a sleepy state.
Be disciplined about going to bed and getting up at the same hour. While the getting up part may not be dictated by what you’d like, if your child wakes at 6am, work it backward from there and set your to-bed time. This is in your control. It is sometimes hard to get to bed at a decent hour if you want to squeeze in a bit of “grown up” time, but it’s worth it to get your body set and into a regular rhythm of wakefulness and sleepiness.
If you cannot fall asleep or wake in the night, try to get back to sleep but if this fails after about 10-15 minutes, get out of bed and do something enjoyable but a bit boring (or relaxing). Avoid screens and keep the environment dimmed and “night like”. Reading or knitting are good choices. Once you feel sleepy again, head back to bed. Staying in your bed and getting anxious about not returning or getting to sleep will not serve you well.
Get active. Get outside. Activity builds your natural drive to sleep. Daylight sets you up for your wake/sleep cycle. And it’s good for your mental health too.
Brain dump. If you find that you are going over to-do lists or have great ideas pop into your head as you are trying to wind down, write it out. Keep a note pad on your bedside table, write it down so you don’t worry about forgetting. Because we all know that pregnancy and baby brain don’t really go away!
Sleep well parents! The world is a much more pleasant place with a few good hours of sleep under your belt.
As Occupational Therapists, we consider many components of a child’s development when assessing their current sleep patterns and making a plan to move towards their sleep goals.
A significant piece of information about a child’s makeup is their sensory profile. This is the way in which each unique child processes the sensory information around (and inside) them. Processing is taking the sensory information in and the neurological system’s response to this information. Children can under- or over-respond to sensory information or can have an adaptive/positive response which serves them well in whatever occupation (activity) that they are engaging in.
Let’s look at an example. Nicky, a 2 week old infant has been awake for about 30 minutes. She is laying on her mom’s lap while her mom sings her “the wheels on the bus” while bouncing her along and moving her arms. Her mom is looking into her eyes. Nicky begins to avert her gaze and then starts to fuss. She’s got too much going on from a sensory perspective and her behaviours are telling us to take a step back, reduce the amount of inputs we are providing and then determine if she needs help to calm and re-focus.
Sensory overload is when a child’s thresholds have been exceeded and they are no longer able to adaptively and positively respond to sensory input. This effect can accumulate in a defined period or over the course of a day. A child who is in overload may have difficulty calming their bodies down and have very limited ability to cope with any more sensory inputs.
So, what does this have to do with sleep? In order for our children to settle into sleep, they must be able to calm their bodies. If they are in a state of sensory overload, they will likely have difficulty calming down independently and will require parent assistance and more time to settle down to sleep. They may also more have difficulty maintaining sleep.
What to do?
Provide different kinds of sensory stimulation at different times during the day. For example, swinging (vestibular), fast paced songs (auditory) and new foods (taste) are all inputs that may be alerting to the nervous system. Do these kind of things after your child is well rested, during an active time of the day. Deep hugs (Proprioception), dim lighting (visual), firm massage (tactile/touch) are calming inputs that can be put in place closer to sleeping time.
Watch your child’s cues for sensory overload. Children can go both ways; either escalating or shutting down. If you notice a sharp change in your child’s behaviour, step back and consider what you/the environment are asking him to process and see if the inputs need to be dialled down or if you need to infuse some calming inputs to balance the situation out.
Newborns and infants can easily become over stimulated and this can affect their ability to settle off to sleep. Understanding that the world around them can hold both the “just right” and “too much” stimulation is key to helping them regulate themselves during the day and to get quality sleep at night.
Karen Randall, BsC(OT) Registered Occupational Therapist
White Noise Machines and Auditory Development are in the News Today
Many news outlets are sharing their take on an article released today (March 3, 2014) from Pediatrics which studied the upper limits of 14 commercially available white noise machines. White noise machines are a common choice on the list of “baby gear” that new parents obtain to help their baby obtain better sleep. Based on the news stories today, we’ve had a lot of concerned parents contacting us to ask us our opinions based on our professional health care training in Occupational Therapy.
What are the news articles and the research paper really telling us?
1.We know that noise levels and certain lengths of exposure for adults can produce damage to the ear.
2.Animal studies were cited to demonstrate that completely replacing the varied natural sounds of an animal’s environment with white noise can be detrimental to their auditory pathway development and it’s postulated that this could also occur with infants affecting their development of speech and language.
3.Hospital nurseries (Neonatal Intensive Care Units – NICUs) that serve critically ill and premature infants have recommended policies to decrease ambient noise to 50 decibels to both decrease the stress of environmental stimuli for these sensitive babies, to protect their sleep by decreasing disruptive noises and to protect their sensory development (the brain of infants born at 24 weeks gestation – 4 months early – will increase in volume 4x by term). This ambient noise is constant day and night in NICUs.
4.Many commercially available white noise machines can exceed the upper limits of noise safety for adults when turned to full volume. The loudness is amplified when the machine is closer to the baby/person.
5.Babies require many auditory inputs like singing and conversation with their caregivers to optimize their development. It is best to not use white noise all day long.
What we know as Occupational Therapists:
1.Infants, children and adults that have sensory processing differences, particularly those that are hyper sensitive to stimuli can have difficulty filtering out extraneous noises at any time of the day, and specifically while in light sleep or REM sleep phases. An infant or child that is sensory sensitive will respond to noises more frequently and with greater intensity to their peers making sound masking more critical as when roused, they may have a difficult time re-settling.
2.White noise has a sound masking effect due to its broad range of sounds. This effect decreases the risk of unpredictable environmental sounds rousing an infant or child from sleep.
3.Decreased overall sleep or disrupted night and day sleep can have significant implications on development and general health of infants and babies. Increasing an infant or child’s ability to fall asleep and stay asleep is important to an infant and child’s overall health.
What you need to know as a parent:
1.If you have a baby that has difficulty settling to sleep and is sensitive to sounds, the noise dampening effects of white noise may assist your baby to get the sleep that he/she needs to maintain good health and promote optimal development
2.Because there are no definitive studies available at present that document long term outcomes of white noise and development in infants and children (particularly auditory), the most conservative approach that is presented in robust literature is what we can form our parenting practices around. This is the research that is being applied in the hospital NICUs to aim for a noise level no higher than 50 decibels.
3.There are decibel readers available to parents, easily accessed by downloading an app on a smart phone. This meter can be used to calibrate the level of noise.
4.Based on the recommendations from this study, you can also place the white noise machine a minimum of 2m away from your baby and then use your meter to calibrate the noise level.
5.If you want to further decrease exposure, you can use the white noise machine in the later part of the night when your baby has a greater amount of REM sleep and is more vulnerable to environmental stimulus and to waking.
If you are interested in learning more about sensory sensitivity and your baby’s unique profile as it relates to promoting healthy sleep, our Registered Occupational Therapists can work with you to assess your child and provide a unique sleep plan which includes strategies to address sensory differences and sleep.
As a follow up to our blog post titled White Noise Machines and Auditory Development, we’ve been in contact with some experts in our own community to ask a few more questions to help parents with understanding their child’s needs related to auditory, speech and language development. Below is a Q&A session with Carla Monteleone, Speech-Language Pathologist and Fred Matta, Audiologist. Both clinicians specialize in pediatric services.
Question 1: From the article in Pediatrics published on March 3rd, we learned that white noise should not be played continuously (24/7) as it can affect speech and language development. If parents are using white noise at night as a means to improve their child’s sleep, what can they do during the day to help with speech and language development when the white noise is off?
The auditory system is constantly active, even during sleep, and although speech and language development is a process that takes place during waking hours, the fine tuning of the cochlea (organ of hearing) and the laying down of the auditory pathways occurs in response to sound stimulation. An infant’s auditory system requires exposure to a variety of complex sounds such as speech and music in order to develop the proper auditory pathways needed to be able to discriminate and recognize meaningful sounds. White noise may be a helpful way to lull or sustain an infant’s sleep state, but should be used sparingly because it does not vary in pitch and loudness across pitches.
Question 2: During the day, parents can help with their child’s speech and language development in many different ways including:
Talk to your child as you change, dress, feed and bathe your him/her. You can talk about what you are doing, what you are seeing.
Add gestures with words when you communicate (e.g. waving bye while saying bye, throwing kisses and making a kissing noise)
Respond to your child by imitating your child’s smiles, laughter, vocalizations, babbling sounds and/or word attempts
Sing songs especially action songs (e.g. itsy bitsy spider, pat-a-cake, the wheels on the bus)
Play people games (e.g. peek-a-boo, row row row your boat)
Read to your child. Children seem to enjoy lift the flap books and books with different texture. These add the opportunity for my language input.
The more your child sees non-verbal language (facial expressions, gestures) and hears verbal language (sounds and words), the more his/her language skills will develop.
Question 3: Can you give us a brief description of auditory development in a baby? For example are all the auditory pathways laid down before birth or do they continue to develop in the first year(s)?
The human cochlea (organ responsible for hearing) is fully formed and functional by the end of the second trimester (weeks 24 – 26 gestation). The period of time from the end of the second trimester to about 6 months of age is critical. This is when the fine-tuning of the cochlea or in other words, its ability to discriminate between different pitches of sound develops. This is why the recommendation for babies born with hearing loss is to provide them with suitable amplification before or by 6 months to maximize communication development and learning. The auditory pathway continues to develop over the next several years as the child begins to acquire speech and language. Chronic hearing loss in the early years can negatively affect normal auditory development and delay speech and language acquisition and learning.
Question 4: We talked about what to do to support speech and language development during the day, do you have any recommendations about protecting hearing?
Four ways to protect hearing include:
ONE: Learn to recognize sources that generate harmful noise and avoid or limit exposure when possible. Hearing damage caused by noise is primarily due to two things: A) Loudness of noise source and B) Exposure time. The louder the sound, the shorter the time before permanent hearing damage may occur. Some examples of potential sources of loud noises a child may be exposed to include: IPODs, car stereos, vacuum cleaners, power tools, lawn mower, TV, blender. Events such as weddings, concerts, movie theatres and sporting events are other examples.
TWO: Avoid competing noise sources in the same area (e.g. don’t try watching TV while vacuuming). You will simply end up turning the volume of the TV higher to overcome the noise of the vacuum cleaner and inevitably risk overexposure to loud noise.
THREE: Avoid purchasing very noisy toys. In Canada, The Hazardous Products Act prohibits the sale of toys that emit sound exceeding 100 decibels. However, even this level of sound can cause hearing damage in a child. Read the label on the toy to check its noise rating. If there is no noise rating, listen to the toy and if you have to raise your voice to be heard over the toy or if it sounds uncomfortably loud, don’t buy it.
FOUR: Wear hearing protection. When it’s not possible to avoid the potentially harmful noise source, hearing protection may be the next best alternative.
Question 5: From a sound and noise perspective, what are the ranges in loudness that a baby experiences in a day? For example, how loud are the sounds around the house and the community?
For a baby, the primary place in which he or she spends the majority of time is in the home. The sound environment will differ depending on the location, for example, a noisy main street versus a quiet cul de sac. Generally, sounds around the house can range from the hum of a refrigerator (around 50 decibel) to a food processor (80 – 90 decibel). Average conversational speech is at around 60 – 65 decibel). A vacuum cleaner, traffic noise and a dog barking are about 70 decibel. A hair dryer is around 90dB and inside a concert space can be as lout as 110dB.
Thank you to Fred and Carla for sharing some great insights and tips on speech, language and hearing development and ways to protect our little one’s ears.
Fred Matta, MClinAud, R.AUD., R.HIP is a Vancouver-based Audiologist involved in the diagnosis and management of childhood and adult hearing disorders as well as having a keen interest in hearing conservation and auditory processing disorders.
Carla Monteleone. MSLP RSLP SLP(C) is a Speech-Language Pathologist primarily working in the Lower Mainland. Carla primiarily works with preschool and school-aged children. Her interests are in the areas of children with apraxia of speech and fluency disorders.
As Registered Occupational Therapists specializing in sleep for infants and children, many extended health care plans recognize and cover the cost of our services. Sleep is an activity of daily living and falls within the scope of practice of Registered OT's. Ask your extended health care provider if they cover Occupational Therapy services. If your health care coverage includes an expense account then OT services should be covered within that umbrella of registered health care providers. Our OT's are registered health care providers and specialists in sleep.