School of Parenting
Course: Sleep Management 101
“Sleep Baby Sleep” – Case Study #1: The Butler Family Corporation
The Butler Family Corporation is a medium sized group located in a fairly small community. The corporation is headed by the co-CEOs, Mr and Mrs. Butler. They have three young boys ranging in age from almost 2 to eight years old. The company’s main job is to provide clothing, food, shelter, unconditional love and guidance to the three boys to help create new valuable members of society.
Sleep has been an issue for the Butler Corporation almost since its first member joined a little over eight years ago. The first child, Gerry, was a terrible sleeper. While originally thought to be caused by the use of cloth diapers (Mrs. Butler thought that using them made Gerry wake up every time he was wet), the main reason for the child’s sleep issues were that he liked being with someone when sleeping. Gerry took his naps on or next to Mr. and Mrs. Butler until he was 20 months old, until Mrs. Butler finally developed a good nap time routine. Night times were more difficult, and while Gerry started out in his crib at night eventually he made his way into Mr. and Mrs. Butler’s bed. Mrs. Butler was quite ashamed of this behavior, since all her friends had their kids sleeping in their own beds. She never talked about it with anyone outside of the corporate inner circle. It wasn’t until Gerry was over 4 years old that he stayed in his bed all night long. He has been there ever since.
About that time, the next member of the corporation arrived. Howie’s bedtime struggles were worse. Howie was colicky and woke up every 45 minutes to nurse. He would only sleep if touching someone, and even then was up all the time. Nap times were worse – every nap was on someone’s lap and even those naps were usually cat naps. The problems were compounded by the fact that Mrs. Butler was also trying to take care of Gerry’s needs, so Gerry ended up watching a lot of TV and playing on his own while Howie slept. Howie’s sleep issues became such a problem that Mrs. Butler took him to see many experts, including Dr. Ferber’s sleep clinic at Children’s Hospital at age 2. Howie (and Mrs. Butler) endured one overnight sleep study and one 24 hour EEG. The results showed abnormal brain “blips” that were diagnosed by Dr. Ferber’s colleague as “rolandic benign epilepsy”. Mrs. Butler was told to basically ignore this – there had been no evidence of seizures and if none were observed by the time Howie was 11 or 12 years old, then he had outgrown the diagnosis. Mrs. Butler was sent home with instructions to leave Howie in his crib screaming, and if he threw up, she was to clean it up and leave him in there, basically telling her that the sleep problems were a result of poor parenting routines. Mrs. Butler was beside herself with this, and after a few nights of Mr. Butler trying the technique, Howie was back in the bed with them.
Mrs. Butler began to look for other reasons why Howie wasn’t sleeping, including reflux or allergies. Howie went through more testing to rule out anything physiological. Mrs. Butler had also found out around this time that another member would be joining the corporation in nine months, and the search for answers became desperate. Mr. and Mrs. Butler knew that Howie had to get out of their bed with another baby on the way. Mrs. Butler spent several months of her pregnancy sleeping on the floor next to Howie’s mattress, as well as sleeping in Howie’s big boy bed with him. Early Intervention had been called in at this point, and Howie had been given the diagnosis of Sensory Processing Disorder by their occupational therapist (and later at age 3 1/2 his autism spectrum diagnosis). He started working with the OT on his sensory issues and that was leading to some success at the sleep level.
In the fall of 2008, the final member of the corporation arrived. Lewis was a better sleeper from the start. However, he still started out in the bed with Mrs. Butler to ease with feeding as she recovered from her third C-section and almost 3 years of sleep deprivation. Determined not to make the same mistake a third time, Mr. Butler made it his mission to get Lewis to sleep in his crib as soon as possible, especially since Howie was still having several night wakings per night. Mr. Butler successfully achieved his goal on Christmas Day 2009, and from that moment on Lewis napped and slept in his crib through the night.
There was a period of time when sleep was going quite well for the members of the corporation. Gerry was continuing to sleep fine on his own. Thanks to weighted blankets, melatonin and a better understanding of sensory issues, Howie was sleeping through the night in his own bed at least 75% of the week. He still needed someone to lay next to him while falling asleep, but was usually able to stay there all night long. Lewis would go to bed in his crib at the same time as everyone else, and would stay asleep until the morning. Mr. Butler was finally getting some sleep.
Mrs. Butler on the other hand, was having trouble. She would wake up every few hours waiting for the shoe to drop. After over 4 years of not sleeping, she was having trouble training herself to sleep soundly again. Every noise she heard on the monitor or from the boys’ rooms in the middle of the night sent her out of bed quickly, trying to manage the situation before the whole house woke up. If Lewis cried a bit, she would run into his room and pop his pacifier back in. If Howie moaned or shuffled in his bed while sleeping, she quickly fixed his covers and weighted blanket so he would settle back down again. Mrs. Butler knew that the alternative might be hours of screaming and crying, causing everyone in the house to be awake. She was willing to sacrifice her sleep to make sure everyone else was getting the rest they needed.
This has been an ongoing issue for Mrs. Butler and the whole Butler corporation. Recently, things have changed back to old sleeping patterns. Gerry, while sleeping through the night, is having a hard time falling asleep. Howie’s night wakings have returned, and increasing the melatonin dosage has not helped. And Lewis, previously the best sleeper in the house, is fighting naps and bedtime, and is up two or three times during the night.
The challenges for the Butler Corporation regarding sleep are many. The lack of sleep causes irritability and quick-tempered behavior from everyone, but especially Mrs. Butler. This is especially hard for her because she has never considered herself a “yeller”. The Butler Corporation is at their wits end, and would do anything for one good night’s rest.
The Case Questions: As special counsel to the Butler Corporation, please identify and evaluate one or two strategies that you think would help keep this company afloat. Consider the solutions that they have already tried, and analyze where they might have chosen a different path. Recommend a specific action plan to help them more efficiently manage sleep in their house.
And if you can’t do that, just let them know that this happens in your house too, and that they are not alone in their sleep misery.
“Sleep, baby, sleep
Your father tends the sheep
Your mother shakes the dreamland tree
And from it fall sweet dreams for thee
Sleep, baby, sleep
Sleep, baby, sleep” – Sleep Baby Sleep, A Lullaby