Case study: how mismanaged nap transition wreaked havoc during the night
Updated: Feb 17
(Published with the permission of the parents)
One day, I got a phone call from a mom who needed help with her 14-month-old son’s sleep. The boy had never been a good sleeper, she explained, and now, at the age of 14 months, he still kept waking up multiple times a night. I suggested we looked into it and sent the parents my standard child sleep questionnaire. I also asked them to track the boy’s sleep for at least three days.
Frequent night awakenings are more often than not due to unsustainable sleep associations. The child will wake up between sleep cycles (just like we adults do, we just don’t remember it) and look for the same conditions that were present when he or she fell asleep. If they fell asleep while nursing or being rocked, they will be asking for that again in the middle of the night (this is explained in more detail here).
But I wanted to be thorough and not miss anything. Before we tackle sleep associations, I always make sure that sleep hygiene is in order and that the schedule is age-appropriate.
When I looked at the boy’s sleep chart, I noticed something interesting. He was waking up every hour, sometimes more often, before midnight, but then would sleep a solid stretch, possibly until morning. When we deal with unsustainable sleep associations, the pattern is usually reverse: the child will be sound asleep for the first three or four hours of the night but start waking up every 1-2 hours, once the parents go to bed. Normally, the first three-four hours of the night is when most of deep sleep takes place, a state from which children (nor adults) are not easily aroused, whereas, in the second half of the night, sleep is lighter.
Frequent wake-ups in the first half of the night suggested to me that something was preventing deep sleep from happening. What could it be? I had two hypotheses. One, there was not enough sleep pressure. In order to fall into deep sleep, we need to be awake for an appropriate amount of time to create enough sleep pressure. For example, if you, an adult take a long nap at 6 pm, there might not be enough sleep pressure for you to go into deep sleep when you decide to go to bed at 10 pm. For small children, sleep pressure and tiredness accumulate much faster, but even for them, sleeping too much or too late during the day can “steal” sleep from the nighttime.
The boy was already on one nap, and the parents told me he had been on one nap for two months. Daycare encouraged one nap because it was easier for them to manage. The boy was clearly tired when he had just switched, but by now seemed to be doing ok with one nap and had energy in the evening. The average age of transition to one nap is 14 months, but it varies quite a bit. At first, it sounded to me that the boy had already adjusted to the new schedule. I noticed, though, that sometimes he slept as long as 3,5 hours during the day and that looked like a bit too much. I suggested capping naps at two hours, hoping that some of that sleep will move to nighttime, resulting in deeper and longer sleep at night. I also asked the parents to make sure to monitor for the signs of over-tiredness, which we always need to do when we wake children up rather than let them sleep as much as they will.
This is where the interesting part starts. About a week went by and the mom wrote to me that we needed another plan. The situation got worse. The boy started waking up every 20 minutes, got up early for the day. He was also falling asleep for his nap very early (around 10 am). It was when the holiday season started and the mom said: “I don’t understand how they manage to keep him awake longer at daycare! He is exhausted by 10:30!”
All of this suggested to me that my first hypothesis was wrong and confirmed my second hypothesis. The frequent awakenings were due to over-tiredness, a reason which is often overlooked. And by the way, early mornings can be a sign of over-tiredness, too. Sounds counter-intuitive? Well, think about the time when you are either very stressed or exhausted beyond measure. Have you ever had trouble falling asleep in such a state?
This is exactly what happens to kids when they stay awake for longer than what their nervous system is capable of. Being awake for too long triggers a stress response in the body. The levels of stress hormones go up, which interferes with relaxation and deep sleep. (The evolutionary purpose of the stress response system is to keep us away from danger, and if you are in danger, you should not be sleeping, otherwise, you will die!)
The key to finding the solution was realizing that the boy had been pushed to transition to one nap before he was ready. Staying awake for 4-5 hours in the morning was too much for him, and this created over-tiredness and poor sleep in the first half of the night. We switched the strategy and let the boy have an earlier nap, making it as long as he needed. I encouraged the parents to offer a second nap in the late afternoon, thinking of it more as a little pause, a power nap, which would help the boy to make it to bedtime without getting overtired in case he woke up form the first nap early.
The results were immediate. Already on the first night, after the boy was allowed to nap early and long, he slept through the night. Not a single wake-up. It was on Christmas eve. The exhausted parents got a full night's sleep as a Christmas present that year.
The moral of the story is, don’t try to fit your child into somebody else's schedule. Not everyone is able to transition to one nap at 12 months. Some kids won’t be ready until they are 16 months or even older. It is very unfortunate that institutional daycare does not always allow for these individual differences.