Sweet Dreams : Scheduled Awakenings: A New Strategy for Solving Babies' Sleep Problems

It's 2 a.m. and 15-month-old Matthew Griffith and the sandman are sorely out of sync.

Wide-eyed and wiggly, according to his mother Nancy, Matthew wants nothing more than to play.

Needless to say, such unscheduled wake-up calls can be a struggle for both babies and groggy parents. While newborns aren't expected to sleep for long nighttime stretches--at least not until age 4 months or so--about 30% of children ages 1 to 4 continue to wake during the night, say child-care specialists.

What can be done about early morning wake-ups?

Traditionally, sleep-deprived parents are advised to ignore nighttime fussiness and crying until baby outgrows them.

Other experts think children should be taught sleep skills at an early age, so they can put themselves to sleep--and back to sleep again should they awaken.

Scheduled Awakenings

Now some researchers believe they have found what may be a better alternative: A technique called scheduled awakenings, in which parents attempt to help the child sleep for increasingly longer periods of time.

Scheduled awakenings worked better than waiting for children to outgrow the problem, found Vaughn I. Rickert, an assistant professor of pediatrics at the University of Arkansas for Medical Sciences, and C. Merle Johnson, professor of psychology at Central Michigan University in Mount Pleasant.

For their study, published in the February, 1988, issue of the monthly journal Pediatrics, the researchers compared three groups of parents, Johnson said in a telephone interview. One used scheduled awakenings. Another practiced "systematic ignoring," in which parents tended to the crying child's needs, ruled out any medical problems underlying the crying, then ignored the child. The control group was told that some children outgrow spontaneous night awakenings and to respond to the crying as they always had.

Systematic ignoring proved most effective in reducing nighttime awakenings, but many parents in the study found the technique objectionable. More acceptable to parents and also effective is the scheduled-awakenings approach, the researchers said.

The technique is based on a simple concept, Rickert explained: Wake the child before the child wakes you. How often the child is awakened depends on the sleep-wake schedule.

It works like this: If a child wakes up at 1:30 a.m., "Wake him up instead at 1 a.m.," Rickert suggested. "Do whatever you'd do during spontaneous awakening (diaper changing, feeding, etc.).

Tricky Situation

"Every three days increase the time 30 minutes," he said. For example, on night three, wake the child at 1:30 a.m.; on night six, 2 a.m., and so on. Then stop when you get to the time you want the child to awaken.

"Gradually," Johnson said, "they learn to sleep through the night."

If the child awakens twice during the night "it gets trickier," Rickert said. "You usually schedule two scheduled awakenings and then fade to one."

Researchers don't know why scheduled awakenings work but speculate that it may reset the child's internal sleep clock. "To say I taught kids to sleep through the night may be incorrect," Rickert said. "What I may have done is teach them not to awaken their parents."

The technique has been discussed in psychological literature for the past eight years. Mel Hovell, a professor of behavioral science at San Diego State University's School of Public Health, believes he was the first to analyze it for children.

But it's still not well-known among pediatricians nor recommended by many of them, according to Rickert.

"I was not familiar with scheduled awakenings (before reading the article)," said Dr. Ronald Rosengart, chief of pediatrics at Kaiser Permanente in Los Angeles, "but we had tended to recommend systematic ignoring. Scheduled awakening may offer something to families who have a lot of trouble listening to the baby cry," he said.

Other child-care experts polled by The Times--including Dr. Benjamin Spock--said they find the scheduled-awakening technique interesting and perhaps worth a try.

"It's an ingenious idea if it works without tiring the parents too much," Spock said in a telephone interview from his office in the Virgin Islands.

"Most important, (Rickert and Vaughn) showed by intervening you can get children to sleep through the night," said Dr. Richard Ferber, director of the Center for Pediatric Sleep Disorders at Children's Hospital in Boston.

In his book, "Solve Your Child's Sleep Problems," Ferber recommends, among other solutions, an ignoring technique called progressive waiting, gradually increasing the time the parents wait before going to a crying child. On day one, for example, a parent waits five minutes before briefly tending to the child and then, if the child continues to cry, waits 10 minutes, then 15 before returning to the child. By day seven, the first wait is 35 minutes, the second 40 and others 45 minutes.

But some child-care specialists have reservations about scheduled awakenings or systematic ignoring. Noting that scheduled awakening "sounds like a good idea," Dr. Loraine Stern, a Newhall pediatrician and American Academy of Pediatrics spokeswoman, said "it's probably too complicated for most parents to do without a lot of support from a pediatrician who really understands it behaviorally."

Rule Out Medical Problem

Parents should be certain that crying doesn't spring from a medical problem, such as an ear infection or colic (crying, apparent abdominal pain and irritability), she emphasized.

Dr. T. Berry Brazelton, professor of pediatrics at Harvard Medical School and author of several child-care books, was critical of systematic ignoring. "Leaving them alone sounds too punitive to me," he said in a telephone interview.

Brazelton and other pediatricians say children can be taught to soothe themselves to sleep at an early age, given half a chance and minimal intervention from parents.

"Learning to sleep at night is an issue of independence," Brazelton writes in his book, "Working and Caring." "No baby is likely to achieve a mature 12-hour sleep unless she is allowed to develop independent patterns of getting into deep sleep again after each REM (rapid eye movement) light sleep cycle," he writes.

In agreement is Edward Christophersen, a professor of pediatrics at the Children's Mercy Hospital in Kansas City, Mo., and author of "The Baby Owner's Manual."

"Put them to bed awake but drowsy," he suggested in a telephone interview, "and put them to bed the same time seven days a week." Giving them an appropriate transitional object--a teddy bear or blanket--is another good idea, he said.

Feeding a baby to sleep is not a good idea, he added, because it establishes the breast or bottle as the bedtime transitional object. "(Then) if the baby wakes up at 3 a.m., the only way he knows how to go back to sleep is at the breast or bottle."

Natural Occurrence

Spock suggested that parents learn to relax a bit about children's nighttime awakenings. "Everybody--children and adults--stirs several times during the night," he said. "When you don't expect anything to happen, you go back to sleep again."

Nancy Griffith, for example, has learned not to "hop right out of bed" when she hears her son Matthew stirring. If his crying persists, she gives him a bottle but does nothing to encourage him to stay awake. After he finishes the bottle, she returns him to bed, allowing him to put himself back to sleep.

Indeed, for some children, noted Dr. J. Michael Cupoli, a Tampa pediatrician and specialist in child development and behavior, crying is a way of putting themselves to sleep. "They take a few minutes to cry and blow off some steam." About age 3 months, he added, many babies discover their thumbs and learn to "self-quiet."

Teaching children sleep skills is a good idea, agreed Rickert and Johnson, who emphasize that scheduled awakenings and systematic ignoring are just two of many options for weary parents.

Providing background noise, for example, is another way parents might help babies get themselves get to sleep, Johnson said. "Babies sleep better with continuous monotonous sound, like (that from) a fan or air conditioner running," he said.

Radio static can also do the trick. "Put an AM radio between stations so you get static," he advised. "Turn it up loud and then gradually fade it out. When you first put it on, (babies) are startled. But then they adapt."

'Anything to Cope'

Curious to learn what other parents do, Johnson asked 230 families to share their strategies.

Among his findings: "Anything to cope" was a common attitude. And many parents used more than one technique to quell nighttime crying.

Two-thirds said they sometimes let their baby cry it out. "But most disliked the procedure," Johnson said.

One-third said they would never consider letting their baby cry it out, he reported. Half said they sometimes took their children to bed with them. Another half said they sometimes put the baby to bed with a bottle and 50% said they used monotonous sound--such as a vacuum cleaner, radio or television--to lull the infant to sleep.

Avoiding bad bedtime habits is important too, pediatricians said. Don't put a baby to bed with a bottle, they cautioned, because it can promote tooth decay and increase the chance of ear infections.

Taking babies into bed with parents is viewed as a bad habit by some experts but not by others. "Once babies start sleeping in the middle of (your) bed, they're hard to get rid of," Rickert said.

Despite debates over the best routes to silent nights, most child-care specialists agree on one point: At 2 a.m., having a plan of action may be more important than what that plan is.

"Just having something to do, that in itself can be therapeutic," Ferber said.

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