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SUCCESSFUL SLEEP

COACHING ROADMAP

© Copyright 2019 - Holistic Sleep Coaching . All rights reserved

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How does the parent define their sleep problem?

How is the sleep problem affecting:

a. the parents

b. the child

c. any siblings

Is it a new problem or has it been steadily worsening?

What is the age of the child?

Any known underlying health problems for child or parent

Other siblings needs:

a. age

b. nursery, school or playgroup

c. behaviour, neurodevelopmental or special needs

What are the parent’s goals?

How urgent is the problem?

Is anything driving the need to address the problem?

What have they heard about sleep from other people/sources?

What is the parents capacity for change?

Complete a sleep diary for 3-5 days/nights

1. UNDERSTANDING THE CONTEXT

Do expectations match reality?

What are the biological and developmental norms, and how do

these compare with what the parent is describing?

Night feeds

Developmental milestones

2. DEVELOPMENTALLY APPROPRIATE

a) Genetics

i. parental history of poor sleep

ii. circadian rhythm extremes

iii. insomnia

b) Feeding problems

i. feeding comfort

- wind

- feeding stress

- position for feeding

- overfeeding

ii. feeding relationship

iii. faltering growth

iv. reflux

v. colic

vi. allergy and intolerance

c) Developmental problems

i. bed-wetting

ii. separation anxiety

iii. gross and fine motor milestones

iv. developmental delay

v. loss of developmental progress

d) Health problems

i. chronic health problems

ii. acute health problems

iii. inflammatory conditions

iv. skin disorders

v. pain

vi. frequent hospital admission

vii. medications

viii. congenital problems

ix. prematurity

e) Anatomical problems

i. oral anatomy and tongue function

ii. torticollis

iii. plagiocephaly

iv. head, back, neck and torso misalignment or tension

f) Sleep pathology

i. sleep disordered breathing

- snoring

- mouth breathing

ii. sleep apnoea

iii. restless leg

iv. periodic limb movement disorder

v. night terrors

vi. confusional arousals

vii. nightmares

viii. night sweats

g) Mental health problems

i. depression

ii. anxiety

iii. trauma, including birth trauma

iv. eating disorders/difficulty

h) Neurodevelopmental disorders

i. autism spectrum disorder

ii. attention deficit hyperactivity disorder

iii. communication disorder

i) Special needs

i. down syndrome

ii. dyslexia

iii. dyspraxia

iv. global developmental delay

v. epilepsy

vi. cerebral palsy

j) Sensory problems

i. sensory impairment

- blind

- deaf

ii. sensory processing disorder

iii. brain injury

iv. lack of emotional regulation or co-regulation by parent

3. RULE OUT UNDERLYING TRIGGERS

FOR POOR SLEEP UNRELATED TO SLEEP

BIOLOGY OR BEHAVIOURAL CAUSE

Age appropriate total sleep time in 24 hours

- proportion of daytime sleep

- proportion of night time sleep

- sleep debt?

Age appropriate bedtime

Age appropriate nap opportunities

- consider location of nap

- lighting during nap

- avoiding compensatory long early morning naps as a result

of poor night sleep

- avoiding long naps just before bedtime

Observation of individual tired cues

Optimal and individual awake windows

- age appropriate

- responsive to infant/child cues

- adaptive as sleep deprivation lessens

- increasing with age

Sleep latency

- indicative of sleep deprivation

- optimal

- indicative of low sleep pressure, poor sleep timing, or anxiety

Pattern of night waking

- Frequency

any long stretches of sleep?

does frequency increase over the night?

every sleep cycle?

how often do they wake?

- Timing

before midnight (Predominantly deep NREM sleep)

after midnight (Predominantly REM sleep)

any long periods awake in the night?

predictable time?

early rising?

- Wake after sleep onset

- Easy to re-settle?

- Any obvious cause for night waking

- Behaviour during waking?

confused

groggy

alert

upset

screaming

crying

4. SLEEP BIOLOGY

5. LIFESTYLE, DIET AND WELLNESS

Nutritional deficit

- anaemia

- vitamin D

- other micro or macro-nutrient deficiency

Opportunity for age-appropriate exercise

Outdoor and nature time

Avoidance of processed foods, artificial colours/flavours/GM

ingredients

Emotional needs

- sensory and social stimulation

- secure attachment

- loving, age appropriate boundaries

- emotional regulation

- emotional availability of caregiver

- involve child

- child temperament

level and extent of motor activity

regularity of basic functions such as feeding, elimination and

sleep

response to new people

sensitivity to stimuli

intensity of response

distractibility

adaptability

general mood and disposition

persistence

6. SLEEP HYGIENE

Bedtime routine

- consistent

- 30-45 minutes long (may be shorter in younger babies)

- nurturing

- choose activities that facilitate calm

- consider a background noise such as pink or white noise, or

nature sounds

Positive association with sleep environment

- no time spent in sleep environment as a punishment

- spend time in bedroom doing calming, positive, nurturing

activities

- avoid stressful activities such as revision in bedroom for older

children

- uncluttered environment

- watch out for scary shadows caused by mobile, toys etc

Right temperature

- cooler in evening when core body temperature is higher

- room may cool in early morning when core body temperature is

lower

- bedding thickness and material

Dim light in the evening

- warm, red light, avoid blue light

- avoid clocks, monitors and light projectors that emit blue light

- black out blinds

Calm down period before bedtime

- reduced noise

- calmer play

- emotional availability, warmth and connection

Avoidance of screens 2 hours before bed

- tv

- games consoles

- laptops

- handheld screens

- apps/iPhones/iPads

Avoid going to bed full, or hungry

Right level of stimulation during the day

- exposure to social variability

- age-appropriate stimulation

Parent sleep hygiene and wellbeing

- opportunities for self care

- opportunities to have a break

- stress management

- mental health

- sleep latency

- bedroom environment

7. SAFE SLEEP CHECKLIST

Baby in parents bedroom for at least the first 6 months

Sleep on back

Check whether bed-sharing is done as safely as possible

Room temperature 16-20

o

C

No smoking in pregnancy or around children

Breastfeed if you can, for as long as you can

Avoid sleeping products such as positioners, cushions and other

devices

Choose a firm, clean mattress with waterproof cover

Avoid articles such as teddies, loose blankets or cushions/pillows

in the bed

8. EASY THINGS FIRST

Naps

- timing

- location

- length

- behaviour before and after

Avoiding overtiredness in day

Stress reduction and emotional and mental health

Nutrition

Opportunities for fun family time, connectedness and bonding

Lifestyle, exercise and wellness

Address underlying causes

Bedtime routine adjustments

9. NIGHT TIME STRATEGIES

Change the bedtime routine

- change order

- make shorter or longer

- bring the feed earlier in the routine

- leave out bath if causing excitement or stress

- ensure sibling needs are accounted for

- support families with multiples

Change the location of sleep

- from falling asleep feeding to falling asleep in arms

- from rocking to still holding

- from holding to sleep to lying down beside child to sleep

- from beside child to lying next to cot or bed

- from lying next to cot to sitting

Change the person

- switch parents

- alternate parents

- additional support

Change the response

- add in additional sleep cues

- overlap additional sleep cues

- delay sleep cue

- schedule the sleep cue

- remove the sleep cue

10. FORMULATING A PLAN

What have they previously tried?

Solution focused approach

Is there anything they are unwilling to do?

Is there anything they need to put in place before embarking on

the plan?

Is this the right time?

- holiday

- availability of both parents

- support from other family

- other events within the family

- house moves

Set SMART goals

- specific

- measurable

- achievable

- realistic

- within a given timeframe

Offer a small range of choices

- easy things first

- quick vs slow

- intense vs very gentle

- pros and cons

Make compromises and adaptations to strategies to help the

family succeed

Discuss speed of progress with each step

Discuss and prepare for predictable stumbling blocks or set backs

Check family fully happy with the plan

Check understanding

Provide written summary and plan

Plan follow up