Healthy Sleep Habits, Happy Child

by Marc Weissbluth, M. D.

  Overall, we have simply had to revise our expectations of how much time we have available and what we can accomplish. Adhering to a schedule that dictates the amount of time the children will be awake has circumscribed our activities. This would be true for anyone who chooses to abide by Dr. Weissbluth's approach to sleep. But with twins, it's even more pronounced: Since the multiplied tasks of child care place a greater demand on our time, there's even less time left for the extras. We had adjusted to this in various ways, but the sacrifices we've had to make during these months have very clearly been worthwhile. We never cease to hear people comment when we go out: “Oh, look, twins!” and “They're so cute” (which I, of course, can confirm). More than that, we constantly hear remarks to the effect that the boys are so well behaved and remarkably calm.

  Raising “multiples” requires an extra degree of forethought, communication, planning, and sheer work. Two parents for whom sleep is an enchanting memory have to struggle to find the energy it takes to do all the work, mental and physical, necessary to take care of twins. Having had this experience, it's clear to me that training a child to sleep well is an extraordinarily crucial component to child rearing, especially when you're having more than one.

  Here is an account from a family where the twins initially were overtired.

  NIKOLAI AND ALEKSANDER

  Nikolai and Aleksander, our identical twin boys, were born six weeks early. For the first few weeks, the boys slept soundly and cozily together in their crib. We had been instructed by the hospital to wake them at night for feedings, which we did happily. As they gained weight and their actual due date neared, they became more and more alert, much to our delight. Perhaps due to their early sleepiness, it didn't even occur to Mike and me to put the boys on any kind of schedule, or to protect the sleep. We both just assumed they would fall asleep when they were tired. When Nik or Aleks started to cry after two or three hours of wakefulness, we chalked it up to fussiness. When they took only a few very brief naps a day, we assumed they weren't sleepy children, and that most babies were like that. We told our friends and family that the boys could barely sleep an hour or two at a time at night, and they advised us to keep them up during the day so they would be tired at night. When that didn't work, we relied on reports that things would improve when they hit the three-month mark. We took the nights in shifts—I would sleep from 8:00 P.M. to 1:30 A.M., and then take over so Mike could get some rest—and gritted our teeth, waiting for the day they would be three months old, at which time they would embrace naps and bedtimes with sweet smiles and contented sighs.

  Not only did that day never come, but the older Aleks and Nik got, the worse their sleep patterns became. They could manage to sleep a couple of hours if they were cuddled up on Mike or me, but they did not sleep in their crib for longer than twenty minutes at a time. When I asked their pediatrician about it at their four-month checkup, he told me it was normal for infants to have such short, erratic sleep. When I left his office, I knew he was wrong. I sought out Dr. Weissbluth and his book, and was amazed by what I read! I had been doing all the wrong things with my children—keeping them awake for several hours at a time, rushing in to rescue them from their beds at the slightest peep, allowing them to “snack” on poor-quality stroller, swing, or car seat sleep all day! Was it possible that my kids did need sleep, and I just hadn't been providing the right conditions for it? I felt horribly guilty for torturing my poor boys!

  We began trying to help Nik and Aleks improve their sleep habits immediately. It seemed logical to attempt to get the boys on the same sleep schedule. We decided to temporarily have the boys sleep in separate rooms, which was a difficult decision for me to make. I had very strong feelings about keeping the boys together from the time they were born. I felt they would feel safer, more secure, and comfortable if they could sleep together. I think I wanted them to continue what I considered to be an idyllic, symbiotic existence inside the womb. I still feel strongly about sleeping twins together, and wish that our circumstances hadn't forced our hand in this matter.

  Our boys were incredibly overtired when we began to employ Dr. Weissbluth's ideas and, as a result, they were overly sensitive to outside stimuli. The slightest floorboard creak would wake them from sleep with a jolt, and they would scream at the top of their lungs. As one can imagine, if small household sounds woke them so easily, the ear-piercing wails of their brother would do the same. Having two screaming babies was inordinately stressful, and made it virtually impossible for them to settle down and fall back asleep. We didn't have much room in our apartment, so we chose to let Nik, who slept more soundly, sleep in our room in his crib, while Aleks stayed in his own room.

  Mike and I continued our nightly “shifts” as we instituted Dr. Weissbluth's plan and set out to improve our children's sleep habits. I spent many difficult nights questioning myself and feeling bad for “making” my children cry. Although we saw improvement immediately, it took several weeks before Aleks and Nik had completely adjusted to the new sleep routine. I believe it really took them months to get over those first months of so little sleep. The transformation was slow, but nearly miraculous. Our sweet, dear boys, who had probably been getting no more than eight to nine hours of irregular sleep a day, were now sleeping up to sixteen and eighteen hours a day! I often wonder if I ever would have figured out on my own that my sons, who initially seemed to need so little sleep, were actually in need of the absolute opposite.

  As the months passed, I began to see that Nik and Aleks were way at one end of the sleep continuum—they needed, and continue to need, a lot more sleep than the average child. Around the time they were a year old, they were actually falling asleep at around 4:30 or 5:00 in the afternoon, and sleeping until about 6:30 in the morning! Then they would take a nap at around 8:30 for one to two hours, and a nap at noon for another one to two hours. They didn't give up their third nap until just before their first birthday. Our realization that they required so much sleep was a revelation—we had finally found the “key” to unlock their sunny, curious, exuberant personalities. Having kids with such high sleep needs, however, hasn't been easy. On the contrary, it's been a real pain in the neck to protect their sleep so vigilantly. Before they were about two and a half years old, missing one nap would send our family into a tailspin—three to four days of fragmented nighttime sleep, resistance to their regular naps, crabbiness, et cetera. I can count on my hands the number of times we allowed them to miss a nap or stay up late before they turned three. The cost of such a move was so great that few things were worth the price.

  When Aleks and Nik were thirty months old, Michael and I were preparing for the birth of our youngest son. My in-laws purchased two beautiful “big boy” beds for the twins, and we excitedly set them up and let them loose. The twins had escaped from their cribs on a couple of occasions, but had responded well to reprimanding. They were capable of sleeping safely in the twin beds, but did not seem able to follow instructions to stay in them. Looking back, I realize that attempting to make the move so early was a mistake. Bedtime became a circus, complete with two wild monkeys, jumping and running around their rooms each night. After two months of little improvement, one night they fell silent almost immediately after their bedtime routine. I was hopeful that all the bribes, cajoling, and scolding had finally worked, but I went in to check on them anyway. I walked in to find Nik standing on his bed, snapping the wood blinds from his window in half, carefully sliding them out of their frames and handing them over to Aleks. Aleks was sitting quietly, stacking my broken blinds on his bed. We dismantled the beds and put their cribs back up the next day.

  We set the twin beds up again soon after the boys turned three. The first few nights were successful, but things began to deteriorate soon after. Even in their pitch-dark room, Aleks and Nik would run around their room, empty their dressers, jump on their beds, and stay up one to two hours past their normal bedtime. Within a few weeks they were engaging in the same kind of behavior at nap time, a
nd Mike and I knew we had to make a change. This time, it was easy for me to make the decision to separate them. The difficulty was where to put them! We settled on putting Aleks to bed in our room. After their bedtime stories, Nik stays in his room, and we take Aleks to our bed where he sleeps until we're ready to go to bed. At that time, we carry Aleks back into his room. While the situation is not ideal, it has been very successful for us. At three years of age, the boys fall asleep between 7:00 and 7:30, wake up around 7:00 A.M., and take one nap a day from 1:00 to 3:00 P.M. Aleks is incredibly cuddly and happy to return to his bed each night, and it doesn't seem to affect his overall sleep habits. After feeling so strongly about keeping the twins in the same bedroom, I would be the first to give them their own rooms now if our house provided it. At this stage in their lives, I think it would be healthy for them to have a few hours to themselves after playing together all day. In addition, the separation relieves them of the pressure to perform for each other.

  Tomas arrived when the twins were thirty-two months old. I never realized how difficult it was to have twins until he arrived! It's such a relief not to panic at every cry, for fear of waking the “other” baby. Of course, I have to admit that Tomas has made it really easy on us. He is even-tempered, sweet, and happy. He was practically sleeping through the night within a week of coming home from the hospital. In the first few months, we could tell when he was sleepy, as it would be the only time he'd cry. Now that he's nearly six months old, he continues to be patient and calm. I'm careful to maintain his nap schedule and to put him to bed early at night, and he wakes up happy and content, cooing and smiling. His sweet, gentle demeanor makes me wonder what Nikolai and Aleksander would have been like at his age if I had incorporated Dr. Weissbluth's ideas immediately after they were born!

  There is ample evidence that genetics contribute significantly to shaping our sleep patterns. Identical twins sleep more like each other than fraternal twins. So there are limits on what we can do to modify their schedules if we attempt to synchronize them. As discussed previously, the regularity of the mother's activity/rest cycles and her sleeping and eating patterns before the babies are born may substantially contribute to the regularity or irregularity of her babies.

  With twins, triplets, or more, the major principle is to start sleep training early.

  Early sleep training means starting around the time the babies are born, or around the time of their due date for children born early (many twins or triples arrive before their due date). The first principle is to avoid the overtired state. Try to put your babies down for a nap, using Method A (see page 235), after a wakeful period of one or two hours. If they get overtired, it is harder for them to fall asleep. The more rested they are, the more adaptable they become later, and the more successful you will be in synchronizing their sleep schedules when they are older. Because the clock machinery is not really well developed during these first few weeks, you can't set their clocks to the same “time.”

  Counting from the due date, over the next six weeks, you will notice more and more fussiness and wakefulness; by six weeks of age, it is mostly concentrated in the evening hours, about 7:00 to 10:00 P.M. During these increasing spells of agitated or fussy wakefulness, do whatever you can to calm and comfort your babies. Remember, you can't spoil your babies, so during these spells do all the holding, hugging, nursing, or whatever works to keep your infants comfortable.

  The next step in early sleep training, at about six weeks after the due date, means trying to control the wake-up time in the morning with the goal of partially synchronizing the babies’ sleep/wake cycles. The earlier we start the process and the more rested our children are, the more likely it is we will succeed.

  So, around six weeks after the due date, when one baby awakes in the morning, you declare that the day is starting and night sleep has ended. This will usually occur between 5:00 and 8:00 A.M. At that time, awaken the other baby or babies. Remember, we are doing this at a few weeks of age to help synchronize their sleep schedules, but this maneuver of controlling the wake-up time may also be applied to older twins and triplets. If you are experienced parents, you might want to try to control the wake-up time when the children are much younger. If you are good at reading the babies’ cues and you have identical twins, then you might be able to synchronize their schedules when they are very young.

  After both children are up in the morning, the next step is to keep the following interval of wakefulness ultra-short. We are going to try to put both children down for the first nap—together, in the same room or crib—after only one hour of wakefulness. Try as best you can to change, feed, and soothe them back to sleep within a total time of one hour. This means that you will probably have no time to play with them during this brief morning wakeful period. During this hour of wakefulness, if there is bright natural sunlight, open all your shades and expose them to this light, because exposure to bright morning light helps to set the sleep/wake clock.

  Let's stop for a quick review: start early, avoid the overtired state, use Method A, control the wake-up time, allow a very brief interval (only one hour) of wakefulness, and exposure to bright light.

  Now comes the hard part, especially if you are an inexperienced parent. Our hope is that your children will be able to learn some self-soothing skills even at this very young age. The most important point is to put your babies down to sleep after several minutes of soothing whether or not they are in a deep sleep state. This simply means that your children may be fully asleep, completely awake, or in a state between wakefulness and sleep at the time when you put them down.

  If one or both babies cry as you walk away, leave them alone—but look at a clock so that you will know when they have been alone for five to ten minutes. Here are two common scenarios: Your babies cry very hard for a few minutes, then cry quietly for several minutes, and then fall asleep. Or possibly your babies cry hard for several minutes and do not appear to be able to fall asleep. Of course, one child may go one way and the other child another way. Your goal is to get and protect the morning nap for one or both children.

  If your baby does fall asleep, don't be surprised if the duration of the nap is brief; naps tend to lengthen only at twelve to sixteen weeks of age, counting from the due date. Within any subsequent two-hour interval, try to put both children back down for a nap. This is because most young babies do not comfortably tolerate more than two hours of wakefulness.

  If your baby does not fall asleep, rescue your baby or babies. You now have two choices. First, you may sense that after several minutes of hard crying your baby will now be able to fall asleep, so you repeat the process of soothing back to sleep. Or else the crying was so stressful for all of you that you will quickly go out for a walk, enjoy playing with and comforting your baby, and try this maneuver again another day. Remember, you want to give your babies the opportunity to learn how to soothe themselves to sleep. You are practicing consistency in how you soothe the baby to sleep and timing to avoid the overtired state.

  If you had only one child, you might decide to always hold or nurse that child until he or she was in a deep sleep state and then either put the baby down alone or sleep with the baby in your bed or sofa (Method B, see page 236). The simple truth is that you cannot be consistent with Method B if you have twins or triplets. So stick with Method A. Because the process of falling asleep is learned behavior, your babies will learn faster if you are consistent in how you soothe them to sleep.

  At night, an early bedtime is helpful because it regularizes and lengthens naps. Here, too, consistency in the style of soothing to sleep is helpful.

  If you have older twins or triplets, between four and fifteen months of age, control the wake-up time, expose them to bright light in the period after they wake up, and practice consistency in how you soothe your babies to sleep. Now your goal is to put them down for naps at about 9:00 A.M. and 1:00 P.M., and not to let them sleep at other times during the day. Expect your babies at fifteen to twenty-one months of age to
need a single nap between noon and 2:00 P.M.

  Here is the story of one mother who started sleep training her twins at eleven months of age.

  CAROLINE AND LAURA

  As a new mom, I was very reluctant to let my babies cry when they reached the four-month mark. Although my rational side (smaller every day, due to sleep deprivation) believed that children would sleep better if they learned to soothe themselves to sleep, I was filled with anxiety that I might be doing the wrong thing … they would be emotionally scarred, feel abandoned, or at a minimum be in pain and need our care. My husband, convinced that life must get better, had to force me to stay in our bedroom while the girls learned to soothe themselves to sleep. They cried for only about fifteen minutes, but it seemed like days.

  They cried less each day for three or four days and rarely cried at nap time after they learned to soothe themselves to sleep. I no longer spent hours every day rocking them to sleep. What a relief. We also found that sleep begets sleep … the better they napped, the better they slept at night.

  I now have six-month-old Peter, who has been a joy in every way, starting with the fact that he was not part of a set. With two “guinea pigs” before him, I don't need to try all the tried-and-true sleep remedies. I now know what works and what doesn't. When he was fourteen weeks old, I started him on a 9:00 A.M. and 1:00 P.M. nap schedule with a 6:00 P.M. bedtime. Starting a predictable schedule at fourteen weeks was much better than waiting for eleven months for some organization in my chaotic household. When he was four months old, I let him learn to soothe himself to sleep. He cried on only four different occasions, for no more than ten minutes each time. Starting a schedule and self-soothing are proving much easier at such a young age.