Sleep Training Infant on Bipap

[JPMama]

I'm hoping there are a few parents on this list that have children on either CPAP or BiPAP. Does anyone have experience with sleep training an infant who's on BiPAP? We have an 11 month old who's been on bipap now for almost 4 months. Once he's asleep, he usually does well. He doesn't fight putting the mask on (most nights) and will eventually fall asleep. We did a modified cry it out with our oldest around this age and after spending nearly 45 minutes standing over him last night while he settled in, I realize this can't continue. If he wasn't a medically complicated child, he would have cried it out long before now. I worry about him playing with the mask and rolling around in his crib once the mask is on. He is also on a pulse ox during sleep. Any tips for us?

[Julie]

"We did a modified cry it out with our oldest around this age and after spending nearly 45 minutes standing over him last night while he settled in, I realize this can't continue. If he wasn't a medically complicated child, he would have cried it out long before now."

Maybe I'm missing something, but that was a bit confusing - the last part. Are you saying you think he'd have had one crying session 'long before now' and that would have been it - never to occur again?

And it's hard to be sure you're talking about an 11 mo. old vs your oldest (of what age?).

In any case, have you tried soft music that he might like, in the background? Have you asked the pediatrician what others have done? Is there anything at all he might recommend as a very short term med til the baby gets used to the mask - something that wouldn't interfere with the Cpap?

What about rocking him (in a rocker) til he falls asleep and can be put back in the crib?

I realize those might seem obvious, but it's a bit hard to get the whole picture from here.

[JPMama]

Sorry for the confusing post. This is for our 11 month old. We currently use white noise and have tried music, but that's been distracting to him. We're trying to get him to fall asleep on his own, so rocking until he falls asleep isn't what we're hoping to do at this point (plus we've tried that and he will rock for hours before actually falling asleep). He's not having trouble adjusting to the mask, it's really more of a question of leaving him unattended to wiggle around with the mask on. Our pediatrician didn't have much in this department as we are the only patient he has on bipap.

[BlackSpinner]

Some just do not fall asleep quickly. I never did. My mother complained I would play for an hour in my crib.

I still can't understand people who fall asleep as soon as they lay their head down.

[Morchella]

Helping parents with kids ages 0-5 solve their parenting challenges is my day job, but this particular medical issue is one I've never encountered before! But off the cuff, here are my two top suggestions, one *to* do and one *not* to do.

To do: Come up with the most relaxing bedtime routine you can imagine (whatever is relaxing for your particular child) and stick with it, in the same order, every night. Possible elements might include a bath, baby massage, rocking and reading a story, etc. (I have a really good link for infant massage saved somewhere at work.) If putting on the mask is at all distracting or disruptive for your child, have him wear the mask with a comfortable pressure during part of the relaxation routine so that when you set him down in his crib, he really is ready to just close his eyes and drop off to sleep.

What mask is he wearing? I haven't tested a lot of different models in person, but it seems like on a lot of them the straps wouldn't be very operable by a baby. I would definitely peek at him every few minutes until he's out, but I don't think you need to watch him *constantly* until he's out, unless your doctor has recommended that.

What I would NOT do: don't ever let him cry with the mask on. First, masks just aren't designed well for the kind of breathing that goes with crying or coughing or sneezing. Second, if he needs that mask to keep him breathing at night, you definitely don't want him to form negative associations with it.

Another consideration: is there a neurological component to the health problem that is necessitating the BiPAP? Kids with neurological issues often have sleep difficulties that overwhelm the sleep strategies that work for normal kids. For example, my oldest daughter finally had to start taking melatonin (teeny tiny doses) when she was three because her brain simply would not make the sleep/wake transition unassisted.

I know that many parents have a lot of philosophical and emotional considerations all tied up in the issue of how and when kids fall asleep. Unfortunately, special needs kids often have special needs at bedtime, too, and sometimes they do need to be actively "parented" to sleep at night, even when a healthy kid of the same age would be encouraged to sleep on their own. But I think there's a lot of room to try different relaxation strategies here before worrying about that option.

(Oh, also, is he supposed to use BiPAP during daytime naps as well? Does he take good naps? Kids who are overtired at bedtime often have a *harder* time falling asleep.)

[Julie]

Have you tried an overhead hose holder (loose of course) that will keep the hose from irritating so much?

[Michelle-OH]

Nothing to offer other than in regards to leaving him awake in the crib with the mask on, I would invest in a video monitor and watch/listen till the baby was sleeping and listen for any wake-ups during the night. They didn't have video monitors when my kids were little, but I still used a sound monitor all night long cause I felt better knowing I would hear any issues during the night.

[Jane Jetson]

I realize I am not on the cutting edge of parenting but I didn't like crying it out. My daughter slept with us and that is what worked for us. I understand that is unappealing and unusual for Americans but it did work. My daughter slept in the middle but if you have a cpap machine, your child could sleep on the side or you could build a little bed that is close enough to you that you could touch him. My husband and I both worked full time and it was nice to have time together. Your child will not sleep with you or by your did forever so don't worry about that. Sometimes it may seem that way but you may miss the time you had together. We generally went to bed and got up at the same time. The baby napped at daycare (my mom!) If you aren't able to do that, let the baby go to sleep with you and take him to bed when he is sound asleep. That works too but you would also need to move the equipment.

I can't imagine how hard this is for you. You must be exhausted. Even if you are a SAHM, you still must get tired if you don't get a good nights sleep.

I now have the full mask cpap set up but when my daughter was a baby I slept like a normal person with untreated sleep apnea. The mask would truly have scared her.

As a parent, especially with a special needs kid, you need to do whatever works for you and your family.

Good Luck!