Diagnosing reflux-disturbed sleep- agh!

[lbandrb]

DS is 14 weeks and had silent reflux diagnosed at 8 weeks. From 6 weeks, when the symptoms first showed, he has had unsettled sleep. Now on Ranitidine and am doing all I can to manage the reflux otherwise. The sleep issues vary, get worse, improve...

At present nights are unbearable. Days are better than before, and reflux symptoms largely improved, so I am really confused as to what is going on. I know reflux equals disturbed sleep, but how? Can anyone tell me the key symptoms so I can work out what to do?

Watching with interest as I could have written your post although our DS is on omeprazole!

He is now much happier by day that only sleeping for up to 90 minutes at night, having previously managed up to 6 or seven hours. He seems to be writhing about And constantly uncomfortable in his sleep.

It is so horrible to see him like this I just want him to be happy day and night for us all to get some sleep!!!

What happens at night?

Dts had severe silent reflux, they were FF so fed them upright, balanced on my knees, the first one to be fed got propped up on an assortment of cushions and the second held upright for at least half an hour after feeding. We had cot wedges and the top of the cots raised too so when they did go back in they still had their heads higher.

During the day they were also fed upright in bouncy chairs and never had a nap lying down, they were always propped up somehow.

Always give the ranitidine about 45mins before a feed as it needs time to work.

Sorry, not really helpful if you are bf!

It's really strange as it used to be daytime that he was uncomfortable and his naps were disrupted, but his night sleep was good. Then he went on Ranitidine and days quickly got better, but nights didn't improve, even though I keep him upright for a good while after a feed and have his cot propped up (do have a wedge but found it was too severe an incline). His reflux symptoms have disappeared with taking Ranitidine and being held totally or semi upright during and after feeds, so my constant debate with myself is how much of this is emotional / behavioural and how much is reflux.

Basically what happens is:

At night seems to sleep very lightly for some of the time - wriggles around a lot, easily disturbed. Particularly after his first night feed, even if he is held upright for a good while afterwards.

Wakes up an hour pretty much to the minute after he goes to sleep at night.

Keeps waking up, often every 90 minutes; sometimes more often, sometimes he can go for longer.

It's not hunger - he can go for quite a while without needing a feed, and he doesn't seem uncomfortable or upset. He just keeps waking up.

This period of bad night sleep started when we did a trip away from home 4 weeks ago, which was also the time he seemed to be having a growth spurt. Coincidentally his reflux got worse the day our trip started (at home, so it wasn't triggered by the trip).

So... it's really hard for me to know what's causing this - i.e. reflux or emotional? I've been treating it as reflux but I'm not convinced that's the issue as his reflux does seem broadly under control, he's sleeping pretty well during the day, and he's still sleeping like this at night. Plus if I put him in bed with me - on the rare occasions I relent - he sleeps a lot better.

I've only just started trying to get him to settle at night and day as far as possible in his cot (which is working), and if this is an emotional issue I know persisting with this should help. BUT if it is reflux, then that's really hard to do because of the keeping-upright issue - it's often unavoidable that he falls asleep on me after a feed.

At a real loss, and totally exhausted...

silverangel, I've heard elsewhere that Ranitidine needs to be administered around 20 mins before a feed, and in many places (including my pharmacist's instructions) that it doesn't matter as long as it's evenly spaced throughout the day, so that's what I've been doing. Interesting you were operating on 45 mins beforehand... Could be somewhere I am going wrong...

sounds more to me like he wakes when he comes to the end of a sleep cycle, rather than drifting into the next cycle, and he doesn't know how to put himself back to sleep.

is there any chance he is overtired? that will contribute to him waking at the end of every sleep cycle. as will any reflux pain, but it does sound like you have that sorted. (do make sure you keep upping the dose in line with his weight).

to help him transition between sleep cycles (ie drift into the next one rather than waking up) there are a few things you could try - for example go in just before you think he's due to wake up, and when he stirs, stroke and shhh him back to sleep...

to help him learn to put himself back to sleep without requiring you, there are various forms of "sleep training" to teach self settling - he's too little for controlled crying but you could look at the No Cry Sleep Solution, gradual retreat, or pick up/put down (personally I'm not a fan of pick up put down but believe it has worked for others). bedtime is generally the best time to work on self settling, but if he learns to self settle at bedtime it may well mean he can do it in the night too.