Sunday, May 1, 2011

Adopted Kids and Sleep Issues

Probably one of the hardest parts of Conleigh's transition home was related to sleep.  Or lack thereof.  Both her and I spent about 6 months with inadequate sleep.  Which then trickled down into every facet of our lives.  It was like having a newborn at home in a lot of ways; often it was like waking up every 4 hours.

That said, when I tried to sort out what might be going on or what I could do to help the situation, I found very little information out there.  We had tried multiple things like letting her sleep in our bed, letting her sleep in our room, rocking, the cold shoulder during night time wakings, nightlights, music, white noise, melatonin, etc..  Nothing mattered.  She would still wake up multiple times during the middle of the night and be awake for hours on end.  When you are parenting an adopted child, all of those strategies cause your brain to do double the thinking.  "If I expect her to stay in her bed, am I encouraging her to not come to me when she needs me?"  "Maybe she just needs to have the reassurance and closeness of a physical presence so maybe I should just put her in our bed?"  "Am I just expecting too much for this scared little girl?"

At some point, I think the things that stuck out to me where
1.  I had to get some sleep.  I was not functioning well when my nights were continually interrupted.  No deep, REM sleep=a mom who is not able to parent well.
2.  Putting her in our bed only resulted in both of us not sleeping.  She is a crazy sleeper who seemed to be constantly in motion.  And she never slept any better in our bed.  Ditto putting her in our room on the chaise.
3.  I needed to stop worrying about all the adoption stuff and just do what I thought I needed to do so get some sleep so I could function.  We would do our best to work on adoption related issues during the waking hours and not feel guilty about not not having a perfect response for the nighttime.

It can also be helpful to think about some basic questions related to sleep in an adopted child, to see the heart of the problems and not just chalk it up to a child who is pushing your buttons by deliberately sabatoging your sleep.
Why do adopted children struggle with sleep?
Some children struggle with hyper vigilence.  Some adopted children believe that they can trust no one except themselves.  Falling asleep is hard because it means letting their guards down and trusting that they will be safe if they fall asleep.  Falling asleep means that a child is no longer in control of what might happen to himself and that they instead must trust that an adult will take care of them.  Other times, I think it's tied to worry and anxiety.  For some kids, they have difficulty adjusting to sleeping alone, the new noises they hear in their rooms, or just the new bed itself.  For others, it is worry and anxiety over all the change that are happening.  Anxious thoughts fill their minds at bedtime making relaxing very hard.  Are my friends from before okay?  What will happen next in this new family?  That type of thinking, the what if's, makes sleep dificult.  I think Conleigh fit into all of these categories to some degree with the majority of her issues wrapped up in worry and anxiety.

What do sleep issues in adopted children look like?
For us, Conleigh did not stay asleep through the night.  At age 3, she would often fall asleep in a pretty typical way.  But once asleep, she would wake up multiple times throughout the night.  She might fall asleep at 8, wake up at 12, fall back asleep until 2, wake up and be awake until 4, then fall back asleep until 6:30 when she would be awake for the day.  Sometime she would be awake for large chunks of time throughout the night, like 4 hours at a stretch.  She usually did not play or mess with things when she would wake.  Rather, she would come into our room and want to get in bed with us.  If we put her back in her bed, she would stay there for 30 minute or so and then come back in our room.  This type of behavior continued for about 3 months, with her sleeping completely through the night maybe 5-6 days in those 3 months.  At 3 months, she started sleeping more through the night but it would go in spurts.  She might sleep through the night for 2 nights in a row and then be up in the middle of the night for 3 nights.  Conleigh has always taken a nap but despite her nighttime wakings, the naps would always be consistent the same amount of time and relatively short.  When she first came home, she would almost always nap for 45 minute, sit straight up, and want to be done napping.  (It was almost as if she was "startled" awake.)  I always encouraged her to go back to sleep and she would sleep a bit more.  With that additional time, her naps would be about an hour fifteen.  She naps like clockwork, rarely any more than that.  Conleigh also never made up any sleep.  She is/was always up around 7, never sleeping in.  She never took/takes an extra or unplanned nap. 

For some kids, sleep issues can include night terrors or nightmares.  For others, it can mean being so hyper vigilent that they can't even nap on a road trip in the car; they will not let their guards down enough to fall asleep in a setting where most kids seem drawn to sleep.  Startling awake can also be an issue.  Another behavior that adopted kids can have is waking up and then laying in bed and self soothing rather than seeking out an adult.   This can mean rocking, head banging, or just simply laying there and not seeking out an adult to comfort them.  For adopted kids, Post Traumatic Stress Disorder can also be a part of their lives and this disorder can create some of the issues mentioned above.

How might sleep issues affect a child's ability to be his true self?
Disobedience and defiance may actually be not indicative of true issues within a child's personality but may be manifestations of lack of sleep.  Neurologically, sleep and the way our brains fuction are tied together in amazing ways.  As adults, we are all aware of how lack of sleep affects our brain function.  We feel fuzzy.  We can't remember things well.  We get cranky.  For children, lack of sleep does these things and more.  In fact, lack of sleep can actually mimic ADHD symptoms.  (See the WebMD and King articles.)  I also had a college special professor whose daughter was presenting with ADHD and nothing seemed to help.  After taking her in for neurological testing, she was diagnosed with a sleep disorder which was preventing her from sleeping for more than a few hours at a time.  For my daughter, lack of sleep makes her struggle with disobedience and defiance.  She is not out of control but her behavior becomes much harder to manage.  When she first came home, we would spend all day disciplining her.  She could hear a direction and within a minute, do exactly what you told her not to.  She would repeat that pattern of willful disobedience multiple times in a very short time span.  (Like 5 times in 30 minutes.)  Some of it normal toddler/preschool stuff.  Some of it is her personality.  Some of it is related to finding the boundaries in a new situation.  But some of it is not.  With my daughter, it is a pattern related to sleep.  We dealt with sleep issues for 6 months; once the sleep issues were in check, her behavior improved dramatically.  And now that we are on the other side of the sleep issues, if she has times of getting over tired, the discipline problems return, in almost the exact same way as they presented themselves before.  But what I have learned is that, without adequate sleep, my child is a completely different person.

What things can be done to ease sleep issues in an adopted child?
I can only speak from our experience as to what strategies we tried.  We worked hard to eliminate fear and worry by sleeping in Conleigh's room, on an air mattress, for the first 3 weeks or so.  We were immediately available if she needed us.  We then moved back to our bedroom which was right down the hall from Conleigh's room.  When the nighttime wakings continued, I allowed Conleigh to sleep in our bed.  Again, we were looking to establish that we would comfort her if she needed.  However, due to her repeated wakings and due to the fact that she is a very mobile sleeper, I was getting no sleep at all.   And it wasn't seeming to reduce the wakings.  She was still awake regardless of if she was in our bed or not.  It also left us wondering if putting her in our bed was reinforcing the waking behavior.  So we went to putting her back in her own bed.  Since D is working full time and I'm not, I primarily did this job.  We tried stuffed animals, music, white noise, light, dark, you name it we tried it.  It was also recommended time and time again to try melatonin.  I was very hestitant to try the supplement because I was concerned about covering up a potential psychological issue.  Specifically, Conleigh had gone through a pretty traumatic event (major earthquake and then coming to the U.S.).  PTSD was on my radar and I didn't want to just give her melatonin and mask something more serious.  We did eventually try melatonin but didn't see a noticeable difference.  After 6 months home, we discussed it with our pediatrician and got a referral to a child pychologist who specialized in sleep issues.   After keeping several sleep diaries and meeting with us and Conleigh, she had a few suggestions.  She suggested that we needed to get a different night light.  Specifically, she said if you are in bed and can read a book when the lights are out (due to the light from the light house) then the light is too bright.  She also suggested that D be the one to take her back to bed when she woke up.  (ie getting attention from me was reinforcing the negative behavior)  Last she suggested that she be made to walk back to bed instead of having someone carry her.  (ie reducing the positive reinforcement of carrying, touch, etc.)   For us, we followed the suggestions offered.  We did so because we felt like the suggestions would not impede her attachment and because we felt she was showing positive signs of attachment.  If we were concerned about attachment, we might not have followed the suggestions to a t.  I don't know whether it was an issue of time or the suggestions or both, but for whatever reason, almost as soon as we started seeing the doctor, the sleep issues subsided.

My simplistic answers aside, Adoption Learning Partners has a webinar on sleep issues in adopted children if you are struggling with sleep.  


Kathy C. said...

We just used the melatonin drops to keep them asleep. It just took the edge off of all they'd been through. We stopped after about 6 mos. However, our Jasmine has been on melatonin for years and doesn't sleep without it but that is a different issue.

At first ours would wake up at 4:00 and be ready for the day. Ugh. But we didn't face the serious sleep issues you did.

Jolene said...

We've had less sleeping issues and more eating (or lack there of) and defiance issues. Each child has their own challenges and even if we don't have sleep challenges with our 4 current children our future children might. Thanks for the great article!

Lillie Family said...

Thank you for posting this! We have many of the same issues. I cannot tell you how many blogs I read said 'just co sleep and it will be fine'! Seriously, i was getting depressed b.c I felt like a bad mom b/c I could not co sleep. She was still up every 2 hours but now just waking me up too.

We are doing a lot of things your dr. recommneded. My DH gets her when she gets up and makes her walk to a crib mattress on the floor in our room. He won't carry her and she gets no attention. It feels mean but honestly i am so tired I don't care that much, lol.

I am hopeful things get better so we don't end up needing a specialist!! BTW - I will let DD cry a little...tonight it took 10 mins of crying. I think AP's think I should be committed for doing this but my Peditrician told me that if she falls asleep without us in the room s he is more likely to stay asleep.

Thanks again!