A GOOD proportion of mothers who come to Anne O'Connor, a psychologist who runs a sleep clinic, for advice are holding down full time jobs as well as pacing the floor into the wee small hours. "By the time they come to me, most parents are very, very tired. They talk about being on auto pilot. They know their work is suffering, they are just holding on".
It is very easy, she says, for parents to fall unknowingly into poor bed routines with baby. "It's a chicken and egg situation. You may get a baby who is a poor sleeper, they begin to accommodate that, and before you know it, you re in to a habit".
This could include staying with the baby until she falls asleep then creeping from the room, breast or bottle feeding the baby to sleep, rocking the cot until he nods off and so on.
What this is doing, says O'Connor, is setting up sleep associations for the infant, so when he wakes up and they are missing, he will look for them. So if a baby who always goes to sleep being rocked, wakes up later and the rocking has stopped, he will want to replicate the circumstances he associates with sleep. So he cries, they come running and this can go on all night.
Given today's small families, many young mothers, she says, are unfamiliar with new babies. "Often they will say the first tiny baby they held was their own . . . In fact, I am constantly struck at how patient they are, how they don't lose the head with the baby. But they will talk their feelings, feeling angry towards their baby, they know the strain the situation is putting on their marriage, of the effect on other children. You find one partner going to bed early to try and get some sleep before they're on duty. I normally ask couples what outcome they want, and one woman whose husband had moved out to the spare room said `I'd like my husband back'."
Ideally at about six months, a couple should be into a regular routine with their baby, based on the child's need for sleep which can vary a little from child to child.
"You establish a bedtime routine by doing the same things every evening at around the same time," says O'Connor. "Everything should become a bit quieter. You begin a winding down process. So you might wash and change the baby, put her in night clothes, there might be a little chat, or a story, then you bring the baby upstairs put her in her cot, say goodnight and leave."
Some babies will cry a little at that point, others won't. "If the baby cries, you don't allow it go on, you go back into the room, reassure, then leave again. And you may have to do this a number of times. But don't pick up, don't turn on the light again. If you stick to this approach, a pattern should be established."
Issues such as landing light on or off, a bedroom door open or closed are personal ones, she says, taken within your needs and those of your baby. People should not have to tiptoe, a baby will sleep through normal household noise.
WHEN parents first come to the sleep clinic they are usually in a chronic situation and need more dramatic interventions to break the sleepless chain. The most dramatic choice is systematic ignoring.
"This is leaving the child to cry" says O'Connor. "It involves going in to make sure that he is all right, but not lifting him and leaving him again. It can go on all night the first night, less the second night. Many parents don't go for it, and again, it depends on their knowledge of their child and what he could cope with. Some are so desperate that they opt for it, and it is usually successful."
The second option is around putting the child to sleep and if he doesn't settle, or wakes and cries, going into the room, reassuring, talking, but not necessarily lifting or touching and lessening the amount of sensory contact each time.
"This can take longer," says O'Connor, "and it can be more difficult to be precise in limiting the amount and type of contact each time. But again, it works.
"Whatever programme we decide on, I write it out. Also, parents keep a sleep diary so that they can see change." Where the baby is in day care, the creche or minder will be asked to follow the written guidelines also.
An option that some parents choose is to bring the children into bed with them. Anne knows one couple who have had a larger bed made to accommodate two adults and two children.
In a number of cases, O'Connor will counsel no action at all: "Sometimes when we take a detailed sleep history and I learn more about the child, I realise that the sleep patterns are normal, that the parents are expecting too much for this stage. But they find this helpful as well, and go away knowing that as the baby gets older, she will sleep more".
