SLEEP PROBLEMS
Another fairly common symptom of Neonatal Abstinence from any substance exposure is sleep disturbance. This is seen when infants have difficulty falling asleep or staying asleep. Often they may sweat or snore in their sleep as well. Babies with sleep difficulties are easily upset (dysregulated) and fussy. Some signs of this sleep disturbance is restlessness, waking in an irritated state, resting only in short bursts, frequent night waking and/or resistance to falling asleep. Not that tremors, startles, or irritability often wake the infant so swaddling can be very helpful with sleep disturbances. However, it is important to determine the root cause of the sleep disturbances as it could be more than one cause and several different interventions may be important.
NOTE: The Following Videos found in this kit under the Parenting Tips from Specialists will provide more information and/or demonstration that might be useful for some of the interventions recommended here.
The SOOTHE Technique
STRATEGIES BY DISCIPLINE
NEURODEVELOPMENT
First consider any physical reasons for sleep disturbance and take steps to address those while you engage in other non-medical strategies.
Establish a bedtime routine
Go from more movement and engagement to less stimulating
For example Bath/Reading/Feed (if appropriate)/infant massage/sing softly or play 1-2 soft songs
Swaddling is a very important and helpful tool in helping a baby fall and stay asleep (the Ollie swaddle was specifically designed with the NAS baby in mind as it offers moisture wicking, and stretch with pliable restriction). Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.
If the baby wakes up distressed use the SOOTHE technique offered here {LINK}
Make sure the baby’s environment dark with no noise and appropriate temperature.
NOTE that screens give off a light that impacts our brain waves and it is very important that no screens be in the baby’s environment at least 90 minutes before sleep. (also important that baby’s don’t watch or look at screens till they are at least 2 years old).
MAKE sure that you rest when your baby is sleeping; you may have more frequent and shorter times for rest/sleep until the baby’s sleep can be more regulated.
MEDICAL
It is important to determine the root cause of sleep disturbance. If you are unsure you need to call your baby’s doctor.
Your baby’s doctor may want to know how long your baby sleeps after feeds
Your baby’s doctor may ask you sleep/wake patterns (when and how long they sleep)
Recommended interventions:
Reduce the stimulation in the environment; dark and no noise is best, and use soft materials, make sure the room in a comfortable temperature (70-72 degrees Fahrenheit).
Swaddle. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.
Comforting techniques (SOOTHE offered in this kit) {LINK}
Your baby may not be getting enough food
Make sure your baby’s suck is productive (they are able to attain breastmilk/formula and swallow it)
If your baby is having trouble with a productive suck - shorten the feeding intervals to not tire the baby out
You may need to put the infant on a schedule with frequent, less amount feeds
NURSING
It is important to determine the root cause of sleep disturbance. If you are unsure or sleep does not get better after interventions offered here you need to call your baby’s doctor office.
Swaddle. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.
Create a sleep routine and very comforting environment
Warm bath and chest to chest contact prior to sleep is helpful
Infant massage
Soft comforting music or singing
Reduce the stimulation in the environment. Limit noise. No lights. Make sure the baby is comfortable (temperature and fabric).
Make sure the baby is not hungry (are they getting enough calories to sleep well; monitor their weight gain)
OCCUPATIONAL THERAPY
Movement, especially if it is jerky and unwanted, can cause sleep disturbance.
Swaddle (helps to limit the movement and provide calming) Make sure it is not too tight (fabric should provide stretch so it doesn’t harm shoulders or hips) but provides flexible restraint. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.
Schedules and routines are very important
Texture of clothing should be soft
Make sure room temperature is between 68-72 Fahrenheit
Evaluate the lighting – best is a dark room – and no screens including TV’s in a baby’s room and not in the baby’s environment for at least 90 minutes before bed time.
SPEECH PATHOLOGY
Use a soft/gentle and calm tone interacting with the baby.
It may be helpful to sing to the baby or play music (5-10 minutes) that is calming.
Swaddle. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.
It will help to teach them to use a pacifier. Sucking is very calming to the nervous system and will help them sleep. You will need to teach them to use a pacifier when they are calmer so they learn to coordinate their sucking rather than just spit it out. “Spitting it out” is due to not being able to coordinate the suck, swallow, breathe (SSB) rhythm resulting in the pacifier fall out and/or frustration.
It can be that they are hungry and strategies for amount and frequency of feeding may be needed in consultation with your baby’s doctor.
Shorter and more frequent feeds may be important to help them with endurance when they have trouble with feeding.
Make sure the baby’s sleep environment is calm and not noisy.
Most importantly, read your babies cues to inform your strategy.