Case study: James' amazing progress
Our first chat
When James’* mum and dad contacted us they were exhausted and desperate for help. On the phone they described that James was 13 months old and had never slept well. He would wake up and cry for hours at night. James’ mum explained that he had twice ‘failed’ a 5 night residential program (known to some parents as ‘sleep school’). They tried really hard to follow the advice they received but it just didn’t seem to make much difference.
James’ mum felt unsupported and frustrated by conflicting advice from friends, family and health professionals. She felt depressed, had barely seen her old friends and expressed her concerns that she might just be a ‘crap mum.’
James’ dad felt really frustrated with James, felt at the end of his tether, and wasn’t coping well with spending hours at night trying to rock, pat, or feed James back to sleep. He was worried about James’ mum and had never seen her so flat.
We asked James’ parents to fill in a sleep diary for a week so we could see exactly when and for how long James was sleeping. James was quite often awake for two hours, twice each night (a total of four hours awake at night).
His day sleeps were irregular, starting and stopping at different times each day depending on how he had slept the night before, and often occurring too close to bedtime. He also had a lower than average sleep need, averaging between 8 and 11 hours per 24 hours. We could see in his sleep diary that he wasn’t building up enough sleep pressure before bedtime, meaning that his drive to sleep wasn’t very high. This was causing him to wake up for long stretches during the night.
The appointment
Before we met with James’ parents we confirmed that James was a healthy weight, ruled out any obvious medical causes for his interrupted sleep and checked that James was up to date with his routine health checks. James’ mum was found to have very high symptoms of depression and she had already organised a mental health care plan with her GP and was booked in to see a psychologist.
James was tired and grizzled a lot during the appointment. His parents tried to calm him but he was not easily soothed. When his mother briefly left the room he became very upset.
We spent an hour with the family, discussing what they had tried, how James had reacted and what their goals were moving forward. James’ mum said they had mostly tried strategies like settling him and then leaving him for several minutes to put himself to sleep. She said this never worked because when they left he cried so hard he would become more worked up and even harder to settle again.
Problem identified
It turned out that James had Sleep Onset Association Disorder, which made teaching him to self settle extremely hard. The issue with James’ sleep pressure had also never been identified or treated. This is why other approaches had been unsuccessful. When these difficulties co-occur, a careful plan is needed to correct both issues - without treating both difficulties, James’ sleep was not going to improve.
The plan
We worked up a plan to make James’ days and night more consistent with set times for day naps to help regulate his circadian rhythm. There were a few things in James’ sleep environment that may have been bothering him so we moved some furniture and put some objects away. We also developed some strategies to increase James’ sense of security. James was frightened of his parents leaving him so his settling plan needed to respect this and provide regular reassurance. At the same time we also wanted to encourage James to resettle himself during the night with less help from his parents. We spent time going through the settling routine with James’ parents so they knew exactly what to do. After detailed discussion and demonstration, we left to prepare a comprehensive, gentle sleep plan that was tailored to James’ unique needs.
How did it go?
James made amazing progress during the week after his appointment. During the first few nights he still woke up twice a night but only for around 30 minutes each time. His parents used the settling strategies we taught them to calm and reassure him. They decided to stop giving him a bottle during the night and he didn’t seem too bothered.
By the fourth night James slept from 8pm-7am. His parents could hardly believe it. Everyone was sleeping better and James was ‘like a different baby.’ His parents said he was calm and rested, enjoyed playing with his toys and wasn’t as clingy as before. They were able to enjoy their days so much more.
James’ parents emailed most days to chat about how he was going and to ask questions if they felt unsure. They stopped tracking his sleep in the diary after a week because every night was pretty much the same – he was consistently sleeping for 11 hours without a peep!
James’ parents now
“What a game changer. We didn’t think he would ever sleep. We figured if sleep school didn’t work then nothing would. The difference with this was that we had so much support and new what to do to help James feel safe and secure at bedtime. It actually ended up being easier to fix than we thought.”
How is James?
“He’s a much happier baby. He isn’t so tired anymore so will play with his toys without crying and clinging to us all the time. The whole house is calmer and everyone is happier.”
If James’ story resonates with you then make a time to talk to one of our Sleep Practitioners. We’re highly qualified to work with complex and difficult cases - other sleep professionals often refer their tricky cases to us.
Sleep Practitioner
*name changed to protect privacy, images are not of the baby described in this article.