Reflux and Sleep

This article should probably be titled ‘Reflux and Lack of Sleep’, as many refluxers experience both day and night time sleeping problems. Indeed lack of sleep is one of the main causes of distress for parents of refluxers and can put immense strain on your relationship with your child, partner, family and friends. It is helpful to start by clarifying what is ‘normal’ sleep behaviour and I use that term quite loosely, as every child is very different.

General Practitioner Dr Renee Shilkin details in her book Crying Babies & Beyond (2010), that it is common for healthy babies to wake every three or four hours in their first few months and then from four months to have a five to six hour stretch of sleep at some part of the night. She also states that day time sleeping is variable in healthy babies and the sign of enough sleep, is if the baby wakes happy (Shilkin 2010). If your baby wakes happy from a day time nap or night sleep, then the length of sleep they had was adequate (Shilkin 2010).

Anne Gethin and Psychologist Beth Macgregor detail in their book (Helping Your Baby to Sleep, 2007) the sleep habits of healthy infants, and the below table shows how the average hours of sleep can vary significantly! The range of sleep for babies in their first month differs dramatically, with some infants sleeping as little as 9 hours over a 24 hour period and some as much as 19 hours (Gethin & Macgregor 2007).

Age

Average hours of sleep 50% of babies Range of nearly all babies
 1 month 14-15 13-16 9-19
 3 months 14-15 13-16 10-19
 6 months 14 13-15.5 10.5-18
 9 months 14 13-15 10.5-17.5
 12 months 14 13-15 11.5-16.5
 18 months 13.5 13-14.5 11-16
 24 months 13 12.5-14 11-15.5

Figure 1  Sleep hours by age: 24-hour period (including naps) (Gethin & Macgregor, 2007, p. 6)

It is important to know that night time sleeping problems are very common in refluxing infants. Research shows that 13 percent of infants over 3 months of age wake their parents three or more times a night, however a study completed on infants with Gastro-Oesophageal Reflux Disease (GORD) found that 50 to 60 percent of infants over 3 months of age suffering from GORD woke their parents frequently at night (Ghaem, et al. 1998).

Dr Shilkin advises that adults need a four to five hour period of uninterrupted sleep. This four to five hour period of uninterrupted sleep is so important as it is a deep sleep phase, and without it you are tired, forgetful, unmotivated and over a longer period of time will show many signs of depression (Shilkin 2010).

Unsettled baby

Sleep issues that can be due to reflux include:

  • waking in the middle of the night with a burst of crying (Pantley 2002);
  • waking frequently overnight (Blanch 2010), your child may initially sleep for three or four hours, but then will wake every one or two hours for the rest of the night and be difficult to resettle (Shilkin 2010);
  • infants and children may be more comfortable in a fully upright position and may object or cry when you go to lie them down (Blanch 2010);
  • trouble self-settling and they can be restless sleepers who are easily disturbed from sleep (Blanch 2010);
  • day time sleeping tends to be for short periods and usually are cat naps for 10 to 40 minutes with the child waking distressed (Shilkin 2010);
  • older children with reflux can be restless during sleep and may cry, moan or swallow even when asleep (Blanch 2010);
  • older children with reflux may ask for drinks of water overnight and/or want water immediately upon waking (Blanch 2010).

Tips for coping with lack of sleep and a child or infant who is overtired include:

  • sleep or rest if possible when your baby sleeps, even if it is just for 20 minutes. Make sure you switch off the phone and ask friends/family to ring before coming over (Blanch 2010);
  • consider baby wearing, it may help you to get things done around the house while your baby sleeps upright (Blanch 2010), even if it means your baby gets an extra 10 or 15 minutes sleep, this can make a significant difference to their mood;
  • organise family or friends to babysit for an hour or two so you can have a break (Blanch 2010);
  • recognise that you are tired and don’t feel guilty to spend at least one day a week in your PJ’s (I like to call them pyjama days) where you don’t do any housework, buy takeaway for lunch and dinner and just give yourself some time-out;
  • put a day bed or mattress in your child’s room and lie down near their cot/bed so you both can get some sleep;
  • have a small mattress or sleeping bag next to your bed that your older child can get into if they wake in the early hours of the morning;
  • Pinky McKay suggests making a list of five-minute breaks for you and putting it on the fridge (McKay 2002) and making a promise to yourself to do one each day. She suggests breaks such as

- reading an article;

- calling a friend;

- meditating;

- putting on a CD;

- sending an email.

  • Pinky McKay also suggests trying to simplify your life by hiring help. Her advice is that even if money is tight, just one thorough house-clean or one basket of ironing outsourced could relieve some pressure (McKay 2002);
  • Another suggestion is online shopping, by having groceries, fruit and vegetables and even pharmacy products home delivered, reduces the need for shopping excursions (McKay 2002). We all know how difficult it can be with a reflux baby that hates traveling in the car and also being out at the shops with an upset baby is not enjoyable for anyone!

 Download printable version Reflux and Sleep

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Written by Bianca Willis RISA Inc member/volunteer

Additional information on gastro-oesophageal reflux and sleep are provided in RISA Inc’s book “Reflux Reality: A Guide for Families” by Glenda Blanch.

The books and articles referenced in this article can be accessed for free by RISA Inc members through the library. Become a RISA Inc member here.

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References

1. Shilkin, R 2010, Crying Babies & Beyond – the ins and outs & ups and downs. KHL Printing Co Pte Ltd Printers, Singapore.

2. Ghaem, M, Armstrong, KL, Trocki, O, Cleghorn, GJ, Patrick, MK, & Shepherd, RW (1998), ‘The sleep patterns of infants and young children with gastro-oesophageal reflux’. Journal of Paediatrics and Child Health, vol. 34, no. 2, pp. 160-163.

3. Pantley, E (2002), The No-cry Sleep Solution. McGraw Hill, Sydney.

4. Gethin, A & Macgregor, B (2007), Helping Your Baby to Sleep: Why gentle techniques work best. Finch Publishing, Sydney.

5. Blanch, G, 2010, Reflux Reality: A Guide For Families. Michelle Anderson Publishing, Melbourne.

6. McKay, P, 2002, 100 Ways to Calm the Crying, Griffin Press, Melbourne.

 

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