Lessons from sleep training #1 and my genius plan to get #2 to sleep through the night sooner (that's working!)

In my last post I shared with you my journey in getting our firstborn to sleep well at night and how ultimately the cry it out (CIO) strategy worked for him and us.  Today's post follows up on the previous one, and is about what I learned from trying CIO the first time, and how I've modified the strategy with baby #2.

(Spoiler: While James didn't sleep for 5 hours consistently at night until he was past 6 months old, Cam slept for 6.5 hours for the first time when he was 12 days old, started consistently sleeping 5-8 hour stretches at night by 4 weeks old, and has never really "cried it out" for more than a few minutes!)

Consistency is key.  Based on what failed to happen after my lack of consistency with James, I learned that if you're not consistent with it, using CIO is basically pointless.  Baby learns nothing except that sometimes waking and crying gets him the attention he wants and sometimes it doesn't, so virtually no progress is made.  Worrisome Mom loses sleep when baby cries and cries and doesn't fall asleep (since he knows that sometimes Mom just gives in).  All it took with James was one night of being drastically consistent (letting him CIO for 2 hours) and both James and I learned our lessons.

I think I actually "taught" James to use nursing as a sleep aid.  While pregnant with Cam I finally got around to reading Bringing up Bebe, and the section on baby sleep in that book blew me away.  According to the author, an American mother who raised her children in Paris and writes about how French parents do things differently, the majority of French babies are "doing their nights" (sleeping through the night) by 4 months old, and often sooner.

After reading that French parents start a very mild version of CIO the author nicknames "the pause" as early as 2 weeks old (basically waiting 5-10 minutes when baby wakes and cries to assess whether he is in fact hungry and needs to nurse or is able to settle back to sleep on his own), I realized that I may have actually taught James to wake up and need to nurse to go back to sleep.  From the very beginning, when James stirred and cried even the littlest bit during the night, I immediately scooped him up and nursed him, hoping to minimize the noise he made for the sake of my sleeping husband right next to us.  As a new mom during those terrifying, confusing, sleepless first few weeks I had no clue that there was even another option-- I just thought that's what I was supposed to do!  But now looking back, it seems like that very behavior (completely brought on by me) probably instilled in him the need to nurse between sleep cycles that I then ended up fighting for months!

CIO taught James he could break the habit of eating after waking at night and fall back asleep without nursing, but I'm beginning to think it was the fix to an avoidable problem that I let get out of hand.  What would have happened if I had paused and let James try to resettle himself to sleep in those early days?  

Starting earlier seems advantageous.   Armed with this new insight about baby sleep, I set out to tackle Cameron's nighttime sleep with a different, preventative approach.  The author of Bringing up Bebe mentions a scientific study in her chapter about sleep that inspired my game plan.  Prior to reading that chapter, I believed what I read all over the internet that breastmilk digests in less than 2 hours, so it's normal for breastfed babies to wake and nurse 2-3 times per night until 4 months old, maybe longer.  But the results of this study call all of that into question.

I'm about to get all science-y/nerdy on you, but stick with me, because I found this incredible and I can't believe I didn't come across it in all my reading about sleep training the first time around.  In the study (which, after some serious detective work googling, I found and read in its entirety) a group of new parents were given the following advice on how to handle their newborns' sleep:

1. Try not to hold, rock, or nurse baby to sleep at night to "accentuate differences in environmental cues for day and nighttime hours (eg, high levels of stimulation during the day but low at night)." 
2. Establish a "focal feed" from the time baby is a few days old, nursing between the hours of 10 PM to 12 AM. 
3. Make sure baby is "really complaining" before picking him up.  Distinguish between crying and whimpering.  (sounds like 'the Pause')
4. Once baby is 3 weeks old (and growing adequately), do not immediately feed the child between 12-5 AM.  Try changing his diaper, re-swaddling, walking/rocking/bouncing to help him go back to sleep, but only feed him if you've tried all that and he is still crying.  The goal is to "stretch nighttime feeding intervals by breaking the association between awakening at night and being fed." 

A different control group of parents were given no instructions.  The results astound me.   Up until 3 weeks old, babies in both groups slept about the same.  But at four weeks of age, 38% of the treatment group babies were sleeping from 12-5 AM, while only 7% of the control group babies were.  And by 8 weeks old, 100% of the treatment group babies were sleeping from 12-5 AM (ONE HUNDRED PERCENT!!!), compared with only 23% in the control group. 
Is that not craaaaaaazzyyy unbelievable?!?!?  100% sleeping through the night (5 hours) at 8 weeks at old!!!
And lest you be concerned that the babies in the treatment group were being starved while not being allowed to nurse between 12-5 AM, the researchers also measured the volume of breastmilk taken in during a 24 hour period and the infants' weight gain.  They found that the "volume of intake per feed, per day, and per kilogram of body weight per day were comparable for infants in the two groups" and "weekly weight and weight gain were not affected by the experimental manipulations."  They discovered that the babies who didn't eat between 12-5 AM took in more milk during the morning feed to make up for the time they didn't eat while they were sleeping. 
The researchers conclude "from birth, parents play an important role in the development of their infants' sleep patterns" and "although breastfeeding is typically associated with frequent and continued night waking and later 'settling,' this research indicates that continued night waking is not a necessary component of breastfeeding."  (Hallelujah!)

How I Sleep Trained Cameron
This study informed my game plan for handling Cameron's sleep from day one-- I basically set out to follow the advice given to the treatment group parents.  During the first 3 weeks I waited for a few minutes when Cam woke up at night instead of immediately nursing him and found to my amazement that sometimes he settled himself back to sleep with the pacifier instead of a belly full of milk.  (I also paid attention to his diapers and weight gain during this time to make sure he was nursing enough and he went from 7 to 10 lbs in the first month, so he was getting plenty of milk.)

I didn't follow the advice to establish the 'focal feed' between 10 PM-12 AM, mostly because I had tried waking James up for a dream feed (another name, same idea) and it never worked so I was kind of jaded.  I also think based on my experience with James that it's better to try to work with and stretch out baby's natural sleep cycles rather than disrupt them by waking them up at odd times.  Cam naturally settled into a pattern during the first 3 weeks where he nursed and fell asleep around 8-9 PM, slept until 2-3 AM when he woke and nursed, and then slept until 6-7 AM, when he woke for the morning and nursed.

So at 3-4 weeks old he wasn't sleeping from 12-5 AM, but he was essentially "sleeping through the night" from bedtime until 2 or 3 AM, and then sleeping another long stretch until morning.  While that one night feeding at 2-3 AM wasn't ideal, it's a heck of a lot better than what I dealt with the first time around.  Because I was super happy with him sleeping a long 5+ hour stretch period, I was kind of afraid to mess things up by trying to wake him and feed him between 10 PM-12 AM so he could *hopefully* sleep from 12-5 AM, so I decided to just go with the schedule he settled into and see what happened.

Within the next few weeks Cam settled into a sleep schedule that he still follows now at almost 3 months old.  Many nights he falls asleep for the night around 7 or 8 PM, wakes and eats around 11, and then sleeps all the way until 6 AM.  Perfection.  Some nights he falls asleep for the night a little later and follows the 4 week old schedule, waking once and eating between 2-3 AM and then sleeping until morning.  It is fairly common for him to sort of wake up at other times during the night, but he settles himself back to sleep quickly sometimes with, sometimes without his pacifier, but not with nursing.  Which is a huge victory in my book.

A note on naps: With James I seriously stressed myself out trying to get him to take naps longer than 45 minutes.  Cam does the 45 minute nap thing too, and frequently.  But this time I really don't care.  My reasoning: I know Cam knows how to connect his sleep cycles.  So if he wakes up after napping 45 minutes because his big brother is being loud in the next room, it doesn't worry me because I'm pretty confident that later in the day he'll take a major nap to make up for it.  Fairly commonly Cam wakes 45 minutes into a nap and I go stick his pacifier back in and then sleeps for an hour or two longer.

Disclaimer: I fully recognize that Cameron is a different baby than James, so comparing their sleep is not really comparing apples to apples.  Cam may just be more of a natural sleeper and James was not.  James was also a significantly smaller baby than Cameron  He was born weighing 5 lbs 13 oz, while Cam weighed 7 lbs at birth, so James may have really actually needed to nurse a lot more frequently to grow at a healthy rate.  (That study actually required babies who participated to have a birth weight over 3 kg/6.6 lb.)  HOWEVER, the vast difference in the groups in the study and between my 2 kids' nighttime sleep tells me that there's something to the idea that what parents do from the beginning makes a difference.

To Summarize
Picking baby up and nursing him each time he makes a peep in the first weeks of life may train him to wake up frequently at night and need to nurse before falling back asleep.  BAD DEAL.

Pausing when baby stirs from sleep and whimpers can allow baby to fall back asleep on his own without nursing which can help baby learn to sleep longer stretches at night without waking.  GOOD DEAL.

After two kids and reading tons of books, blogs, internet articles/forums, and a scientific study I am now an expert at baby sleep.  JUST KIDDING.

Good luck mamas!  Over and out.