Monday, June 2, 2008

I know you want to know

I know you want an update from the sleep clinic. But I've been too tired (yawn) to write about it.

So, we had to wait a long time, like 30-45 minutes once we got into the exam room. That was okay though since the doctor spent a lot of time with us. I know that during that time she was reviewing Madeleine's file as she had a lot of question.

First, Dr. Kifle is a woman! And a very good doctor, at that. She came into the room with a lot of great questions about Madeleine's surgery, our day to day life, our nighttime routine and such.
Did I mention that the paperwork we did ahead of time was extensive? They asked about what Madeleine ate (at dinner time), what our bed time routine was, what activities she did and what the sleep problems were.

In a nutshell the doctor told me that we were doing a lot of things right but we were doing some things that are not recommended. With that she said that she didn't blame me for doing some of the not so good things as I was a concerned parent and it was my job to do these things. She never specifically said what things I didn't do right but I can guess. She liked our bedtime routine and the time that the kids go to bed. She didn't seem concerned that Max shared a room.
Here's the routine:
  • About a half hour to forty-five minutes before the bed the kids will sometimes nurse (Yes.... we are still doing that...)
  • We will read books for 15-20 minutes and sometimes sing songs
  • We will discuss the day we had or what the plans for tomorrow are
  • The kids brush teeth and have a drink of water
  • tuck in, nigh-night, kiss kiss
  • If they cry, ask for something etc., we go in and comfort and then put them back down
  • They have always been put to bed awake

So that is what we are doing right, thank you very much.

What we are not doing so right is that when the kids, namely Madeleine, wake up we don't try to soothe them back to sleep in there crib or try to tell them to go back to sleep. Instead, we scoop them up and bring them (Madeleine) to bed with us because, frankly, Michael and I are too freaking tired to do anything else.

The doctor said that at one year of age when kids are learning to soothe themselves back to sleep we responded to every peep that Madeleine made and that 'trained' her into relying on us to get her back to sleep to some extent. Okay, okay, I know we did that but for heaven's sake my daughter just had MAJOR surgery at that time and was in a God-forsaken body cast that went up to her armpits, so no shit I'm going to respond to her. I was worried that she was in pain (phantom or real), that she had an itch, that she needed to be turned, that she was hungry (remember, she wasn't eating much then). Of course, Dr. Kifle being the Sleep Goddess that she is said that 'of course I did that, that was the right thing to do...' but then she diagnosed Madeleine with Behavioral Insomnia of Childhood.

She recommended that we make some behavioral changes this summer and see if that works out okay and if it doesn't she wants to see us in September for a sleep study, where you spend the night and they observe her throughout the night and monitor breathing and sleep activity.

The behavioral changes are to try to get her to stay in her own bed and help her to try to get herself back to sleep. Along with continuing to follow a strong bedtime routine, not eating before bed and not nursing in the bedroom prior to sleep. The doctor told Madeleine that she needed to stay in her crib throughout the night. We have been using this for the past few days saying, "remember, the doctor said you have to stay in your nigh-night bed allllll night long." I'll keep ya'll posted....

The other part of this which isn't quite as straight forward is that Dr. Kifle has some concerns that Madeleine might be experiencing some sleep apnea. Here's why...

  • Her most restless times of the night are between 2-5 when an individual experiences the most REM or lightest sleep
  • She tosses and turns, talks in her sleep, cries, thrashes around but only during this time of the night
  • She is prone to having apnea because she was premature and on a c-pap machine for 12 hours to help her lungs work as there wasn't enough surfactant in them
  • She has RSV when she was two years old
  • It might run in the family

For these reasons we will most likely do the sleep study in September.

Last night Madeleine woke up at 3:30 am. Not bad. That is a longer night than usual. I went into her room as she was screaming and crying and calling for me, as if she had had a nightmare. I went in and rubbed her back and told her that the doctor said she had to stay in her bed. She asked for "rocky-roo" which means that I will pick her up and rock her in my arms or rock her in the rocking chair. She fell back asleep and I put her back in her crib until morning. Success.

Here's the thing: I want to respond to my children's cries. I want them to know that if they wake up in the middle of the night for whatever reason their mommy and their daddy will be there. They will be welcome in our bed. We will help them get through rough nights. I recognize that there are boundaries but I will always be open to listening to their needs.


Sarah said...

I stopped freaking out about sleep "rules" so much when I ran into my doctor one morning in the grocery store buying her kid a donut for stayign in his room all night! Even doctors resort to bribery and other methods that us "mere mortals" use, so... You know, it is what it is!

That said, I'm glad that you got some feedback, both positive and constructive. I think it would have been easier under different circumstances to play by the "rules" - i.e. comfort the kiddo in bed, etc... but you are right when you say that you had far too many other variables in place - how could you know that her cry wasn't one because there was something wrong, rather than a habitual one. I'da done the same thing.

Good luck moving forward :)

AnnaK said...

Okay - I am one of those readers who has been anxiously awaiting the results of Madeleine's sleep evaluation. I have been hoping that the doctor would have some sort of theoretical "magic bullet" that would do the trick, but it sounds like she is saying leave her in her bed??? Like you, I have a hard time with this as I actually remember being a small child who had terrible nightmares and crying in my bed and no one would come. I don't want my kids to experience that so when Finn cries, we pick him up and he sleeps with me (Pat moves to the guest room - three's a crowd...). We've reached the point where Finn pretty much sleeps with me all night - and he does sleep for the most part. It's a pain, yes, but is it wrong? I mean, he's not going to do this when he is 10 years old, right??? I don't know what to do. Thanks for sharing Madeleine's story -- it is so comforting to know that I am not the only one wondering what can be done...

Niki said...

Thanks Sarah, I'm glad to know that it is okay to give my kids a donut too! :)

Anna, she didn't necessarily say to leave her in her bed. She said we can take her out and comfort etc because she understands at this point, but to return her to her bed so that the place where she sleeps in consistent.
But like you, we were/are doing the same thing in that I sleep with Madeleine and Michael sleeps elsewhere. I don't think it is 'wrong' but the problem was that Madeleine still wasn't staying asleep no matter where she was. I'm glad you said that you remember having nightmares and no one coming to see you- not that I'm glad that happened to you but it validates my feelings about cry it out.

Call me if you want more details.

Winbrooke said...

I just had to crack up that you have rocky-roo as a label. tegan would be the one to search that keyword and find this information. he loves that word too.

Niki said...

Brooke, ha ha. I figured that one day we might want to look up all references to rocky-roo. It really does deserve its own post, dontcha think?