Sleeping FAQ: 18-24 Months – Night Waking

What can we do to stop our 21-month-old waking for two hours in the night?

We are both doctors with regular night shifts and are just not getting any sleep at home either.

My daughter was a total contented baby right from day 1 – I followed all the routines and she learnt to go off to sleep by herself in her cot from the start. She’s my 2nd baby and I know the routines very well. Until 9 months everything went well, but after 9 months she started waking at night despite feeding very well and not sleeping too much during the day. Unfortunately she wasn’t very well – she’s has numerous diarrhoea/vomiting infections, chest infections, coughs, colds etc, to the degree that we’ve seen various consultants – and I think she may have a mild immune deficiency – but she seems to be getting much better now ; she’s 21 months and we’ve been discharged from clinic. She needs no treatment, and in fact I haven’t taken her to the GP now for over 6 months.

However, I think maybe this is, at least in part, the cause of her sleeping problems, although these infections started when I stopped breastfeeding at 3 months and her sleep was great until 9 months. At the moment she wakes approx 50% of nights, usually at 1am, and is usually awake for 2 hours. I’m not sure why she wakes: she’s still in a grobag which she’s been in since the early days, we have a digital thermometer on our baby alarm so we can keep a close eye on the temperature in her room, she’s eating and growing well so I’m sure that’s not the problem, we have blackout lining and blinds in her room and her room is quiet. She has got teeth coming through, but this doesn’t seem to bother her during the day and I don’t think we can put her problems down to this. When she wakes she’s often crying, sometimes screaming, sometimes just whimpering. We’ve never cuddled her to sleep and never given her milk at night since being a tiny baby – she slept through at 10 weeks I think, and goes to sleep each night at 7pm herself (she goes into her cot awake and settles herself off to sleep.) She hasn’t had a lunchtime nap for 6 months, as it seemed to be the cause of her not going to sleep in the evenings, and she doesn’t really struggle without a sleep in the day.

When she wakes, we’ve tried all approaches. We’ve been doing controlled crying for 3 months now – completely by the book – and it doesn’t seem to be working. We go in at 5, 10, 15 minutes etc, don’t get her out of bed, stroke her head, say: “night night”, and leave. We never turn the light on. Despite this she still screams for 1-2 hours and sometimes makes herself sick. More recently my husband has tried the sitting in the room approach, which has worked on occasions but not last night. We’ve also tried just letting her cry which doesn’t work either.

I kept a sleep diary for 2 weeks – the odd thing is that it’s not every night, as I said about 50% of the time. It did seem to be that if my daughter had no daytime sleep at all (or max 5 minutes) and loads of daytime activity that she’d sleep, but it hasn’t been the answer. For example, yesterday she had no daytime sleep at all, she ate well as always, we went to Tesco’s in the morning where she walked round most of the way, rather than going in the trolley and in the afternoon she ran round the garden as we had the paddling pool out. She went off to sleep at 7pm very tired, but woke at 1am crying – when my husband went in she started laughing and playing, he did controlled crying for 1 1/2 hours and eventually she went to sleep after another 30 minutes of whimpering on and off.

We’re exhausted; she wakes our 3 yr old (who sleeps very well), so is making her tired too, and we don’t know where to turn. I’ve asked our health visitors for advice on various occasions but they’re stuck too.

The reasons why your daughter is waking for a length of time could be overtiredness, habit, attention seeking or due to some part of her day which is disturbing her.

How to deal with it could be equally difficult, as you have already found. As your daughter has given up her daytime sleep, it seems she may need a really low key and long wind down at bedtime. Have you noticed any relationship between the nights she wakes and how bedtime has been that day? Is she allowed to watch a video with her older sibling which may be too old for her? Or listen to stories which may result in unpleasant dreams? Are there a lot of fun and games, and general running around after bath time? Try to make the time between tea and bath very quiet and unrushed. Generally tidy up and take the children up with plenty of time to get undressed and into the bath. Fun and games in the bath can sometimes get out of hand with two children. It is better to try to work towards having it as quiet and calm time. Once out and dressed, try to get her to her room and into her cot well within half an hour so she does not rush round and get her “second wind”. Using dim lights, drawing the blinds and curtains even playing calming music in the childrens’ bedrooms can all help bedtime to go smoothly. Without any daytime sleep she will be exhausted, so needs to be in bed well before 7pm if possible. Research has shown that an earlier bedtime helps towards better sleep and less waking either early or in the night. On the days when your daughter has not slept at all try to get her to bed earlier than when she has had a nap.

Although she appears not to need any daytime sleep, keeping her active and busy all day could be causing her to be overtired and unable to settle back to sleep when she comes into a light sleep. Try to build quieter times into her day, looking at books together, quietly doing a jigsaw, listening to a story or song tape together. It is very easy for a child of this age to always be on the go and they do not always know themselves when they need to calm down and recharge a little. They need your help and guidance in this.

Decide between your husband and yourself how you are going to deal with night wakings. Decide on a plan, whether controlled crying, “cold turkey” or gradual withdrawal and both agree to stick with it. Whatever you decide to do, keeping yourselves distant and firm will in the end make her see she is getting nowhere no matter how long she cries. It must be said that with a sleep problem as long standing as this, there will be some crying to resolve it. When you use controlled crying do you increase the time day by day, or go back to 5 minutes, 10 minutes, 15 minutes etc if there have two or three days when she hasn’t woken at night between the wakings? It would be better to make the first visit at least 10-15 minutes after she begins to cry now, as at her age she has learnt that you will come into her room pretty quickly when she first cries. This is understandable as you do not wish to wake her sibling up as well. With her history of illness it is very easy to go in straight away to see if she is unwell, but as the past months have been better it may be the time to leave her for a while before going in. Rushing in at the first sound means she has no time to settle back down into deeper sleep, waking as she does when obviously in a light sleep.

If you decide to stay with her and use the gradual withdrawal method, make sure there is no interaction with her after your initial soothing. Gradually move your chair further and further away from the cot. This method can take some time to work successfully, especially with a toddler who has been waking in the night for so many months. This is why you do need to decide to stick with whatever method you choose and both treat her in the same detached way with the minimum of interaction. Returning to sleep unassisted is a skill she needs to learn. Until she is able to do this, without your help she will have problems when she wakes from her light sleep in the night.

Would it be possible for your three-year-old to stay with relatives or friends for two or three nights whilst you try to crack your daughters problem? If you are less worried about her sibling being woken you may find it easier to remain away from her room for progressively longer and continue with this night after night (if she happens to wake!).
Finally, although you are both working and time must be precious in your home life make sure she is receiving enough one-to-one time in the day. By being awake in the night she gets your attention- even if only in short bursts when resettling her with controlled crying. By taking some special times with her in the day, away from her sibling she may settle more easily. During her times of illness she was no doubt used to this, and this could be a cry for attention, of whatever kind, now that she is better.