"Sleepless Nights"

My 14-month-old daughter is still waking between two and five times a night. We have tried letting her cry, but she screams for 45 minutes and I can't bear listening to her. A few times, she cried so hard, she even threw up. I feel like I'm abandoning her, but I'm so exhausted I can't function anymore. I feel like a zombie during the day. I'm desperate. What can I do?

-- exhausted in Ketchikan

Many parents of young children join you in this sleep or, more accurately, sleepless struggle. Dealing with sleep brings us right to the core of some of our most important issues as parents, "How do I meet my child's physical and emotional needs?" "What is my child capable of doing on her own and what does she need help with?" And we find often ourselves grappling with these questions when we can hardly function due to sleep deprivation.
      When children first join our families, everything shifts to accommodate them. Their cries bring us running any time of the day or night. But as they get older, our expectations change, and we may discover that the strategies we used previously don't work anymore -- or don't work for us anymore.
      In your situation, it is clear that you can't go on with the system you've been using because it is interfering with your ability to function. Once you realize this, it is important to take steps to change the situation. Here are several important factors to consider when trying to make such a major change:
. Work on developing clarity. The only thing that really works in making changes in sleep patterns is your clear conviction that the change will be better for everyone involved. Often when we are making the change because of "our" needs, we don't see the ways it can be helpful to our child. Let's look at some of the ways your child stands to gain from making this change: 1) She will have a more rested, resourceful parent. 2) She will have less interrupted sleep. 3) She will have a chance to learn about putting herself back to sleep.
. Talk to your partner or to other people who are caring for your child to develop a consistent plan. It is important to get the support, input and agreement of the other people who will be helping your child with this change. The discussion about how to make the change should happen during the day when you are able to think most clearly. As you plan, think about what part each of you will play in helping your child. Some people divide up the night, others each take a whole night and alternate. How you divide up the night duties will depend on work schedules and other demands during the day, as well as individual temperaments.
. Make change gradually. What we want for our child is to learn some new strategies for putting herself to sleep. It will be difficult for her to learn these in one night. If we make changes gradually, there is enough of the familiar system in place to help her feel secure while she is learning new ways of doing things. If you have been going to pick her up every time she cries, a first step might be to go and talk to her quietly for a short time (she may continue to cry or even cry louder when you don't do what she expects you to). Or, you could pick her up for a minute or two and then put her back in her crib, even if she hasn't yet fallen asleep. There are many individual ways to begin the process. It is important to think about what makes the most sense in your situation. Even with a gradual change, children may be very upset, crying or even throwing up. If your child does throw up, you can go in and quietly clean her up, reminding her that it is time for her to sleep and that you will see her in the morning.
. Talk to your child about what is going to happen. Even if your child is too young to understand all of your words, it is useful to tell her in simple language about the change you want to make and what she can expect if she wakes during the night: "We are going to help you learn to put yourself back to sleep when you wake up during the night. Tonight, if you wake up, I will come and talk to you and pat your back, but I'm not going to pick you up until morning."
. Set a timeline. Your child will begin to learn a new system if she has the opportunity to experience it repeatedly and consistently. Sometimes, when we start a new plan, we realize the first or second night that our family is not ready for this struggle and we back off. And that's fine. But if you're sure that now is really the time, set a goal of four to six days. Commit to your system for four days, and re-evaluate at the end of that time. If nothing has changed, you can make a decision about whether to continue. And if there has been progress, even if things aren't "fixed" yet, you may decide it's worthwhile to try for a few more nights.
. Make time to spend with your child during the day. In order for you to feel better about setting limits with your child at night, it is important that you feel you've have had a good connection with your child during the day. This will help with those ambivalent feelings we all get during the night: "Gee, we've hardly had any time together today, maybe she is really missing me."
. Listen to feelings. You and your child are both likely to have strong feelings during this kind of transition. It is important to acknowledge, respect and give expression to your child's feelings, as well as your own. Children may experience confusion and frustration when we ask them to give up familiar patterns. Some parents prefer to stay in the room with their child who is crying about not being picked up during the night. Others stay in another room and check in every five minutes or so to let the child know they are still there. You may find that it works better to acknowledge your child's feelings during the day if you are trying to minimize contact during the night: "I heard you crying last night. It sounded like you were frustrated and having a hard time going back to sleep. I know you can learn how to do it, but it is hard sometimes." You also need recognition of the feelings you are having. Do you have a friend you can cry with or a therapist who you can talk to? Even when there is not a lot to be "done" about your feelings, it can help just to voice them.
. Develop ways to nurture yourself during the transition. Ironically, while you are helping your child sleep more independently, you may be getting even less sleep than you were getting before. If you can simplify your life during the day, make time for a nap, arrange child care so that you can get a break, or take a half-day off from work, it will help rejuvenate you for the challenging night you may have ahead of you. Remember, these are temporary measures. You won't be needing to do this forever.
. Eventually we all find sleep. Sleep is one of the most difficult issues parents of young children face. Parents have come up with a complexity of solutions that range from having a family bed to helping children sleep independently from an early age. One of the most important things to remember is that there is no one right way to handle sleep issues, there is only the way that is right for your family. For more on sleep, click here. If you're considering a family bed, click here.