Navigating the Exhausting Journey of Hourly Wakes: A Parent’s Guide

Embarking on the journey of parenthood is filled with boundless joy, but it also comes with its fair share of challenges. For many parents, one of the most taxing challenges is dealing with a baby or toddler who consistently wakes up every hour at night. In this blog post, we’ll delve into the perplexing world of hourly wakes, exploring the reasons behind this common yet often overlooked sleep pattern. Furthermore, we’ll discuss practical strategies for understanding and addressing the root causes, providing exhausted parents with the insights they need for a more restful night.

Understanding the Prevalence of Hourly Wakes:

Before we dive into the potential reasons for hourly wakes, it’s essential to acknowledge that while this sleep pattern may be common, it is not normal and needs to be investigated. Hourly wakes do not resolve on their own unless the root of the wakes is addressed. Many parents find themselves in a cycle of exhaustion, desperately seeking solutions to help their little ones with these frequent wakes and often resort to cry-it-out sleep training (only teaching the baby to stop signalling) so that they can get some rest.

It is important to note that there will be times when your little one might wake hourly for a week or two (growth spurts, sleep regressions (progressions), teething, etc.) but this should not be something that is happening for longer than a few weeks.

Some of the more common causes of hourly wakes and how to deal with them…

1. Discomfort:
   • The cornerstone of addressing hourly wakes lies in identifying and mitigating discomfort. If your baby is consistently waking up every hour, they are unable to complete a full sleep cycle which is often due to underlying discomfort. This could manifest as gas (we will talk about this below), itchiness, reflux or an overall sense of unease. Anything that would wake you up in pain will also wake them up. Trust your instincts as a parent – if you sense that your baby is in pain, seek the guidance of a healthcare professional who will take your concerns seriously.
2. Mouth Breathing:
   • It is universally recognized that optimal sleep involves maintaining a sealed-lip posture with the tongue gently pressed against the roof of the mouth. Exceptions to this guideline are only in the event of illness (temporary congestion – if it is lasting longer than a cold, it needs to be investigated). If your baby/toddler is sleeping with their mouth open, they are not breathing properly. Rather than using their nose to breath, they are relying on mouth breathing. This deviation from the norm can trigger disturbances in deeper stages of sleep, particularly for infants aged four months and older.
   • Mouth breathing may happen along with snoring, a phenomenon attributed to the suboptimal positioning of the tongue. Snoring occurs when the tongue is not in its ideal placement against the roof of the mouth (you cannot snore when the tongue is pressed against the roof of the mouth). If your baby is sleeping with an open mouth, I recommend seeking consultation from professionals specializing in airway health. You could also ask for a referral to an Ear, Nose, and Throat (ENT) specialist or speak to a qualified pediatric dentist with knowledge in airway health.
   • These healthcare professionals will conduct a thorough examination, specifically assessing for the presence of enlarged tonsils and adenoids, as well as evaluating the positioning of the tongue.
3. Tongue Ties:
   • The ongoing debate surrounding tongue ties has brought attention to their potential impact on sleep. While overdiagnosing may be a concern, a legitimate tongue tie can significantly affect a baby’s sleep. How? We just spoke about the impact of tongue placement on snoring and breathing. If the tongue is not pressed against the roof of the mouth it may be because it is being restricted by a tongue tie. In addition to the tongue placement, if the movement of the tongue is restricted, your baby may be doing a lot of gagging, choking or taking in air and this can lead to an excessive amount of gas (which would again lead to waking). For more information on tongue ties and breathing, see this resource.
   • If you suspect this is happening for your little one, consider reaching out to an IBCLC for support.
4. Low Ferritin (Iron Stores):
   • An often overlooked factor contributing to frequent wakes is low ferritin levels, indicating insufficient iron stores. Recognizing signs of restlessness and difficulty falling asleep in your baby may prompt further investigation. If you have ever been told that you had low iron levels in pregnancy or postpartum, there is a chance your baby may be low as well. Bloodwork is the most accurate method for checking ferritin levels. Even if results fall within the “normal” range, lower levels can still impact sleep quality. When speaking about the levels that impact sleep, Dr. Beth Malow chief of the sleep disorders division at Vanderbilt University Medical Center says, “I will try to check a ferritin level in kids with restless sleep. It is not always doable because often the kids are afraid of having their blood drawn…but if they have a family history, if they have a parent who says that their ferritin levels were low, or that they had restless sleep, I am always more inclined to check. The other thing to realize is that ferritin levels, which is iron stores and is related to restless sleep and restless legs, normally it is 20 and above but what we found in sleep is that we want that level to be 50 and above. It is 50 micrograms per millilitre: 20–50 is what we call low-normal and you can still have symptoms of restless legs and restless sleep in the 20–50 range.”
5. Food Allergies and Sensitivities:
   • Digestive issues, including food allergies or sensitivities, can wreak havoc on your baby’s sleep. If you suspect such issues, consult with your pediatrician and consider seeking guidance from a Naturopathic doctor. An elimination diet, conducted under professional supervision, can help identify and manage potential triggers, ensuring your baby’s digestive comfort and a more peaceful night’s sleep.

Conclusion:

Hourly wakes, though challenging, can be understood and addressed with a thoughtful and holistic approach. While sleep training may offer temporary relief, it’s imperative to delve into the root causes to provide sustainable solutions. Trust your parental instincts, advocate for your baby’s well-being, and explore various healthcare professionals to find the support you need.