Bribery

So...first I bribed Tiny Boy with his 'ninja nardo' (aka Leonardo of the Ninja Turtles) costume.  He earned it if he stayed in bed ALL NIGHT LONG without calling (there is an exception for being REALLY scared).  Success.

Then a few days of absolutely fucking horrible.  Being awake for 2 hrs in the middle of the night again.

Then I went out of town and he slept great for two nights.

Then I started bribing him again.  LG made him a chart.  He chose his own reward (I suggested a book or a small toy).  So far, two great nights again.  And by great, I mean I put him to bed when he ASKS to go to bed around 7:45 and I don't hear a peep out of him for 10+ hours.  I forgot to change his stupid bunny clock with daylight savings time, so the first morning he was up by 6:00.  This morning was 7:00.

I will be interested to see what happens if the sleep clinic pulls him off melatonin.

But today?  wow.  I have a kid who SLEEPS.

Being Scared at Night

An  update on Tiny Boy and all the drugs.

1. He's off singulair, which has known psychological side effects, and on inhaled steroid.  It's something to remember to do in the morning, which is annoying, and it's too early to say if it will keep him off albuterol as well as the singulair.

2. He's also off both prilosec and iron supplements.  He came off prilosec first, and it didn't seem to have much effect on sleep, so the larger issue must have been his low iron level.  Which, after about 3 months of mega-doses, came up to normal.  So now he's just on a 'maintenance' dose of flintstones vits with iron.  He is definitely definitely definitely less restless than when we started this whole process.

3. Melatonin still going, until we see the sleep specialists in a few weeks.  It works so nicely I don't ever want to take him off it.  But I'm guessing we'll wean to a lower dose and then cut.

But the downside of melatonin is that it seems to wear off at ~7-8 hrs, at which point he is AWAKE, sometimes for as long as two hours, and then he goes back to sleep again.  He's getting 10-11 hrs of sleep each night total, and clearly sleeping in longer stretches than waking every 1-2 hrs.  But if he wakes me from 3-5, well, I'm just awake at 3 on.

So we've been working on STAYING IN HIS OWN BED ALL NIGHT LONG.  But he's scared.  And has a zillion and one issues I've tried addressing, including swapping nightlights, new pajamas, giving him the blanket from my bed.  He's gone about every other night lately.  And now I've just flat out bribed him to stay in his room.  5 days in a row, he gets the Halloween costume that I will probably give him anyway, but he doesn't know that.  So something to work toward.  We're talking about it A LOT.  I've told him I will give him a hug if he's scared and tuck him back in.  But what I'd really like, obviously, is for him to be not scared.  Ideas?

Big picture, his sleep is so much better it's like living in a different family with a different child.  But for the moment I'm sleeping worse.  Or at least differently bad.  And I don't like it.

Well, now that's annoying (Singulair)

Well, overall life on melatonin has been AWESOME.  With one exception, Tiny Boy falls asleep within 15 minutes of his head hitting the pillow, and often it is almost immediate.  No rolling.  No kicking.  No calling.  No drama of any kind whatsoever.  This includes when we've been out (like last night LG had a meeting that ended 7:45 which is usually when Tiny Boy is headed to sleep).

The thing where he's awake for 1-2 hrs in the middle of the night is done.  Not sure what that was about, frankly.

He had a cold (not surprisingly) and I restarted his singulair about a week ago.  And I've noticed his nightwaking happens much earlier (like 11-12 instead of 3-5) and then he's more restless.  And crying in a bad dream sort of way.  Turns out night terrors and insomnia are a childhood side effect of singulair.  I'm not sure how this escaped my attention.  It's a good drug for him--means he hasn't really had any major asthma episodes--so I'll need to ask his ped about alternatives.  Because I like his lungs to work.  But I really like him to sleep.

Oy.

On Melatonin (Redux)

This thing where I put Tiny Boy to bed and he's out cold within 5 minutes?  I could get used to that.

It hasn't happened every day...but combined with a decent bedtime and 50-60 minute lead time (like, he takes melatonin at 7:30 and he's in bed at 8:30), WOW.

Tiny Boy's Behavioral Modification Plan

So...now that Tiny Boy is generally sleeping better DURING the night (he's waking up 1-2 times, instead of 2-5, and going back to sleep easily), the drama at bedtime has gone up exponentially.

We went back to the sleep clinic today.  New plan is to keep him on iron (he had a blood draw today), prilosec, and add melatonin an hour before bedtime.  I'm not sure how long they'll keep him on the melatonin (we go back in about a month) but I'm guessing it will work like a charm.

I've used a very tiny amount (about 0.2 mg) with moderate success.  They're putting him on 1 mg.

And if that doesn't work, there's always this book which must work by way of some version of hypnotism.  Either way, I feel fairly certain Tiny Boy at age 4 will be sleeping much better than Tiny Boy ages 1-3.5.

And me?  Knock wood and all that hocus pocus, I'm getting about 8 hours these days, which is simply divine...

Woe the Return of the Old Tiny Boy

Two nights in a row he's woken and come to my bed early and thrashed.

Which is why we stopped co-sleeping a while ago.

He took a long time to go to bed last night, and hten he woke early, and somehow he'd actually pooped in his pullup (he hasn't NOT used the toilet in more than 18 months).  So something was amiss.

I hope to go back to the new Tiny Boy soon...

That Whole Sleep Begets Sleep Thing

So other than one night (when I didn't give him melatonin) that involved a 2 hour bedtime crazy session....Tiny Boy has been doing really well.

He goes to bed within a reasonable time frame.

He wakes generally once, and usually that's coming about 4:00 am.  He does call me, and I can't get him to stop doing that, but as soon as he settles in my bed, we're both back out.

Yesterday he said he was tired around 3:00 in the afternoon....  had an early bedtime of 7:15ish and he wasn't up until 8:00 this morning, when I woke him!!!  Uhh????

Week #2

So it's been more than a week of The Plan, including a trip that required changing time zones and sleeping in a trundle bed.

The Plan, as you'll recall involved a combo of medical and behavioral tinkering:

• iron supplementation (30 mg/daily)
• prilosec
• new sippy cup for night

The upshot of all this is he is eating like a fiend, so I'm not sure if he really wasn't feeling great before or what (he was taking in only 50ish calories/night, so that's not a major loss), and only waking once in the middle of the night, generally in the 3-5 window, at which point he's coming into my bed (he's asking me to sit in the rocking chair, and that is not going to happen).

So this is pretty excellent.  Not perfect, but reasonable.

Night #6

Wow...almost a whole week.

Another nap.  Alas.  Bedtime 9:00ish.  Woke at some point early morning (4:00?) and came in with me, which seems to be the 'baba mulk' alternative.  I'm okay with that for the moment, as long as he's able to go right back to sleep.  Up for the day around 7:00.

So the GOOD is that the most he's woken in a single night since starting prilosec is twice.  Given that he was waking up to five times, that's progress.  On the behavior front, he's drinking much less at the beginning of the night, and not drinking at all through the night.

Now if I would just stop waking on my own, we might be getting somewhere...

Night #5

Well of course it was too easy.

Yesterday he took a nap again.  Fell asleep at 9:00.

Woke up around 2:00.  Cried for 'baba mulk.'  Was awake for a full hour.

I was awake for one more.

He woke up again aroun 5;00.

Up for the day (late) at 7:30.

Night #4

Asleep by 7:45.  One waking at maybe 1:30, minimal fussing.  No request for bottles or drinks of any kind.

Woke up for the day just before 7:00.

Yahoo!

Night #3

He took an unexpected nap at daycare (he's napped maybe three times in the past month?).  This meant I was prepared for a later bedtime.  It went later than I would have liked (I sat in the rocker for 45 minutes) but not completely insane:  9:00.

I woke up at 4:00 and hadn't heard a peep.  He woke up maybe half an hour later, so I spent the 4-5 hour awake.  He came into my bed and up for the day at 6:30.  So not a lot of sleep (that's 10.5 hrs in a 24 hr period, which is more like an older child than a 3 year old).  But only one request for milk, and when I reminded him it had to be in a sippy, he didn't want it.  Definitely getting easier on that score, but I'll give it a few days before I describe this as a TREND.

*

I have a call in to the sleep clinic because one of the totally amateur observations I made is that most of his moments of central apnea (for those of you who don't know, that's not the same as the OSA people have when they snore; it's a brain glitch that doesn't send a signal to breathe) occurred during REM sleep.  And if numbers on the internet are any indication...he gets less REM sleep than most ADULTS.  I sort of unscientifically wonder if that's a self-protective mechanism?  Like, he stops breathing during REM sleep so doesn't get much of it?  Like I said, totally unscientific but I'm going to ask about it.

Night #2

(FWIW, I don't plan on recording our nights until the end of time.  For now, some record keeping...)

Bedtime was later than I would have liked as we were out with friends.  Tiny Boy was fine while we were there (we left at 7:20) but by the time we got home was meltdown boy.  Immediately did an abbreviated night routine (we only did one story) and got him in bed w/melatonin.  I thought he was out by 8:00 and left his bedroom--if I didn't mention this, the doctors encouraged me to sit in the room with him, which we'd been doing for a while, to cut down on bedroom antics--only to be called back.  He was out for good by 8:20.

Observations:  he's definitely squirrely, particularly in the legs.  But as soon as he stops moving he's OUT.  He doesn't spend time with his eyes closed relaxing.

He woke at maybe 3:00.  Cried for his 'baba.'  Maybe this lasted fifteen minutes.  Went to sleep. Repeat around 5:00, though at this point he was more upset, he said his belly hurt, and I said the choices were drink from a cup or come into my bed but I was going back to sleep.  We snuggled up and slept until about 7:30.

I'm guessing he'll keep asking for the bottle for at least a few more days.  But if this continues, I'll definitely call it progress.

And I had to have a talk with myself that the goal here is not to get him to sleep through the night without any interruption (though that would be awesome) but to minimize the wake ups that disrupt both our sleep.  If we can get that down to 1-2, instead of 2-5, I'll be a really happy girl.  The problem is I've been pressured on all sides...can't go to bed early, can't sleep late, woken frequently in the middle of the night.  Last night softened all those pressures to an extent.

Night #1

Last night was the first night to implement the new plan (though we didn't start prilosec until this morning, as timing all these supplements is fairly complicated).  Could have been better, could have been much worse.

LG came home from camp yesterday, so I expected bed time antics.  The biggest problem giving up his night drinking is that it's the delivery system he desires.  I've tried in the past buying all kinds of different cups but what he wants is the bottle (and before you tell me he's three he shouldn't have a bottle, that's sort of pointless...the fact is he does).  Conveniently we have a new baby cousin; I asked Tiny Boy if he wanted to perhaps give the bottles to the baby in exchange for a new stuffed animal to sleep with.  Everything was great with this plan during the day.

At bedtime there was some protesting, but he drank usual rice milk in sippy cup while we read stories.  I gave him melatonin, as the sleep doctor had suggested, to minimize the DRAMA at bedtime.  Sat in the rocking chair, reminded him to close his eyes, etc (he moves around and kicks A LOT in bed, and the doctor seems to think this will stop once his iron is up) and bam, twenty minutes later had a sleeping kid.  Yahoo.

Not a peep out of him until 1:30 in the morning (which was 6 hrs after he went to sleep, so that's great).  But then it was crying and whimpering and crying and begging for the bottle and being scared of the bedroom.  He finally came into my bed and fell asleep around 3:30.  I feel like maybe he woke around 6:00 but I'm not sure and up for the day at 7:00.

If that's the worst of it, we'll be okay.  But this is not something I can continue for more than a few days, and certainly not the month it took when we tried CIO at the beginning of the night when he was an infant.  The only reason I was able to fall asleep at all was self-medicating on top of the lunesta I usually take...and that's not good for me and now I'm both exhausted and druggy.

Clearly coming into my bed is not ideal and might set us up for another habit to break later.  But one step at a time.

What I Learned (And Didn't!)

So the official line from the sleep clinic is that Tiny Boy's sleep study was NORMAL.  His iron level was still characterized as really low...so low that it might take six months or so to get up to normal values.  And they want to try him on prilosec for a minimum of three weeks to see if it makes any difference.  The only behavioral tinkering they want to do at this time is, not surprisngly, change his bedtime drinking.

Of course, they sent me home with the official report, and I can PubMed with the best of them.  What I see is that the index for Central Sleep Apnea is at EXACTLY the cutoff for normal.  And compared to the 'normal' sleep architecture of children he slept less (duh), had a lower sleep efficiency, longer latency to both to sleep in general and REM sleep specifically, low values for stage 1, 2, and REM, and high for stage 3.  I don't know what any of this MEANS because I'm not a sleep specialist, although the numbers seem more typical for kids with ADHD (and they were definitely asking pointed questions in that direction today).  So I'll be calling back or asking about that at our next appointment.


UPDATE in response to reading comments on multiple posts:  I like comments, I really do.  And I value the perspectives of others who have insight into what is a challenging situation.  But, going forward, it's not particularly useful to be told that my kid's issues have been caused by my parenting in various ways, or to minimize the very real effects of 3.5 years of sleep deprivation.  He's seen a team of doctors, and even while they are very clearly working with us to change sleep habits, they're also clearly indicating that the issue is complicated, with some medical factors.  There are behaviors that could benefit from change, but that doesn't mean his sleep problem is "behavioral."  That's really dismissive.

Sleep Deprivation and Me

As I wrote on the other blog, LG's been away this week, and it's been great overall.

Tiny Boy's sleep?  Not so much.  He's been going to bed without drama around 8:00 and waking around 6:30, which is not a whole lot considering he doesn't nap.  And he's been up a minimum of three times overnight.  Last night, he called me three times in the 12-1:30 window alone and yes, I think he'd fallen asleep between calls.  At that point I just put him in my bed until about 4:00 and then kicked him out again.

While I'm certainly willing to consider if there are behavioral issues involved in his waking...wouldn't nights be more consistent if it were purely behavioral?  Why would the same kid occasionally be able to sleep through the night and sometimes have nights he sleeps worse than most newborns?

In the meantime, I'm zonked.  It's been days since I've slept longer than 2 hrs at a time and that makes a huge difference.  I need to get real work* done and I just can't.





* of the revising the book sort.   I can do other things, but not what really needs doing.

Process of Elimination

I received a phone call from the nurse at the sleep clinic, who informed me that Tiny Boy doesn't have obstructive sleep apnea.  This struck me as an odd phone call, because the possibility of his having OSA wasn't even really on the table (among other things, he doesn't really snore).  I'll get more info about the rest of the results on Friday, but I'm guessing it won't reveal much.

We saw the nurse practitioner at the GI's office today...who likewise doesn't think reflux is an issue. She did say we can try prilosec for a few weeks and see what happens.  I might, because this goes in the can't hurt might help category.  More accurate testing for reflux would involve an overnight stay and I'm not really ready to go there without a stronger hunch.

So so far the only conclusive info I have is that he has low iron levels.

And I'm fucking tired.

Training

Last night I woke to the sound of the train.  And Tiny Boy.  I'm not sure which I heard first.

It happened around 1:30 and around 3:30, which are times he often wakes.

I hear the train frequently...hadn't really occurred to me that perhaps it's not a coincidence.  Perhaps the train is waking him?  I'm going to pay more attention.

Tonight's Bedtime

(Tiny Boy woke up at 6:00 this morning and declined to nap.)

At 6:45 we started reading stories.  By 7:30 he was in jammies.  Potty, tooth brushing, etc.  Nice and calm and ready to go to bed.

Then LG got something in her eye that created DRAMA.  Like, holy shit, she was crying and screaming DO something even as she wouldn't let me touch her or look at it.  I don't doubt that it hurt.  But you'd think she was being murdered.  I actually splashed water in her face because it was a good way to start flushing out the eye.  Shit.

By 8:00 the eye problem was resolved.  (No, I never found anything in her eye, but it was red.)  I retucked Tiny Boy.  Sat in the rocker, which has been cutting down on nighttime antics.

He kept talking.  I left.  He called me back.  He kept talking.  I went downstairs.  He was quiet.  Then showed up in LG's room.  I brought him back to his room.  He asked me to sit in the rocker.  He kept talking.  And...

It's now 9:30 and I think he might still be awake.  Or there's a large animal kicking the wall in his room.

I tell you if they made ambien for preschoolers I'd be all over that shit.  THREE HOURS OF BEDTIME.

Our consult to go over the sleep study can't come soon enough.

Back to Normal

And last night had the same bedtime, 8:30ish w/no drama, plus 4 wake ups in the 12-6 timeframe and then up for the day.

We need to reinstitute the bunny clock (no calling in the morning until the clock is orange--7:00).