In which I throw in the towel

So, yeah, the sleep thing. Not so good. Squeaker was up 6 times the other night, and something in me snapped. I got to work that morning, picked up the phone, and called our HMO's advice nurse. After listening to my long sad tale of 2+ years of sleeplessness, she promptly patched me over to the pediatrician's advice nurse, who read the first nurse's notes, asked a few follow-up questions, then promptly got us a "long" appointment with the pediatrician -- the very next morning. Apparently, we are an urgent case.

I had been planning to take the day off to pull together our tax stuff anyway, so instead of burying myself in paper all morning, I dragged Squeaker and our incredibly patient Nanny off to the doctor. It was good having Nanny J there, because she could attest to Squeaker's behavior during the weekdays, when she has him on a pretty good schedule -- his naps are regular, deeper sleep than nighttime, but still problematic in that he wakes halfway through sometimes and won't go back to sleep unless she's holding him. It sounds like she still holds him all the way to sleep, which is the opposite of what the Mister and I have been trying to do at bedtime, so we may need to have her stop that. But that's only the tip of a very big iceberg. Squeaker has never been a good sleeper, and now that he's not teething or sick or, well, a baby anymore, we've got to get to the bottom of it.

Unlike the Mister and me, Nanny J gets regular sleep at night, so she could fill in the blanks when I forgot words, and she could also attest to how horrible and tricky it was a year ago, when it took an hour or more of very complicated rocking, bouncing, walking, and swaddling to get Squeaker down for his naps, how even that ritual often didn't work, and how he quickly moved to a single nap, long before his peers. I spoke about nighttime -- how he still gets up multiple times every night, how he's not scared or wet or lonely -- he's just awake, at least halfway, and comes looking for us. Sure, he'll go back to bed with a minimal fight, but he's gonna be up again in 15 minutes. And even when he doesn't get up again, I lay there awake, not wanting to fall asleep, because the chances are so good that I'll just get yanked out of a deep dream. I spoke about how it takes up to 2 hours to get him to sleep Every Single Night. Yes, there are exceptions, nights when he only gets up once or when he falls asleep by 9pm, and I always get excited and blog about them or brag on FB that we're finally out of the dark tunnel, only to be smacked upside the head a day or two or a week later when he again reverts to his old ways. He's not growing out of it. And it's reached the point of being Really Not Okay.

The night after I talked with the advice nurse was a bad one in that it took until past 10pm to get him to sleep, but he only got up once during the night. In the morning, he came into our bed at about 6:30 am and fell back asleep. He often does this, sleeping until 8am -- this usually means he's had a particularly restless night. This was true that morning. He was incredibly congested, snoring like a drunken sailor, and ugh! grinding his teeth, scrape scrape griiiind scrape. Nails on a chalkboard, shudder. He thrashed and turned, trying to get comfortable, trying to get into a position where he could breathe. I watched his breathing stop, hover, start again. I've often thought that he has a mild case of sleep apnea, and it was really obvious that morning that he does. We took a video of him "sleeping" and I showed it to the pediatrician. "It's a good thing you brought him in," she said. "There's definitely something going on here."

So we're now in a step-by-step process to diagnose and treat whatever physical problem it is that's interfering with his sleep. We started with melatonin, which is a relatively natural and noninvasive way to supposedly help regulate his natural sleep cycle. HA! Ha hahahahahahaha! Ha! Some sleep aid that was. The first night, he was up 6 times. The next day, he was noticably more hyper than usual -- a sure indication that he's tired. The second night, which was last night, he fell asleep by 8:30pm (woo-hoo!) but then was up 10 times during the night. We were all miserable this morning. I called the pediatrician -- she was out, but her nurse got her to call me -- I told her we were stopping the melatonin right this minute, and she agreed. Today, it was like someone had spiked his coffee with adrenaline. Nonstop hyperactivity beyond anything we've ever seen. Major meltdowns during the day, and complete exhaustion in his eyes as he spun and jumped and yelled and ran. He couldn't stop talking long enough to eat his dinner. Tonight, I insisted on an earlier than usual bedtime. Two hours later, the Mister is still up there trying to get him to stay in bed. I know melatonin works for a lot of kids, but for Squeaker, it was like shooting up with speed. Not helpful.

Step 2 is to try to figure out whether he has allergies that are causing the congestion that seems to be waking him up. I haven't noticed a seasonal difference in his congestion, and neither has Nanny J. The doc ordered a round of blood tests (including one for anemia, which apparently can cause sleep problems). Have you ever watched a phlebotomist botch a blood draw on a shrieking 2-year-old? It's not a pretty sight. I nearly throttled the woman with my bare hands. Poke, poke, poke, went the needle, I sat there watching her drag it around under his skin, and when she finally found the vein, they couldn't get any blood from it. WTF!? When I told the doc about it today, she said the woman might have actually gone right through the vein (ew!!), which is apparently something that happens when they're not used to drawing blood from kids. Whatever it was, I sure as hell didn't let her try again. We packed up our howling, red-faced, snot-covered toddler and took him home. Enough torture for one day. Today, I demanded that the doc get me someone who could do it right the first time, so now we have the name of a pediatric phlebotomist. The Mister is going to take Squeaker in tomorrow, poor kid. If that doesn't work, the doc suggested a nurse she knows who was a NICU nurse. Now that is a credential I would trust!

So. IF we are able to get the blood drawn, we'll hopefully find out that he's allergic to something like dust mites or cats and work on remedying the source of the allergy. Then we'll see if that affects his sleep at all. In the meantime, we're going to try a steroid nasal spray to shrink the tissues and hopefully let him get more comfortable in his sleep. If none of this works, then we're off to an ENT, who will probably order a sleep study. I mentioned this to my mom, and she burst out laughing, as did I when the topic came up at the doc's office. None of us who know him can imagine Squeaker letting anyone hook him up to a bunch of tubes and wires, and we certainly can't imagine him sleeping in that state. Ha! The poor researcher. They'd need a shot or two of whiskey after that night.

On a related note, another mom at work overheard me whining in the bathroom about all of this. She grabbed me and told me all about her daughter, who had the exact same issues. The only difference was that her child's exhaustion manifested in tiredness and bad behavior, rather than hyperactivity and bad behavior. Except for that, she could have been describing Squeaker. She told me that they tried all of the things that our doc has suggested, and nothing worked. It wasn't until the sleep study showed her daughter had severe sleep apnea that her docs agreed to take out her tonsils. And she's been basically sleeping through the night ever since. She's almost 4 years old. That woman didn't sleep through the night for nearly four years. Shoot me now.

The tonsil stuff jives with what our doc has said. Squeaker's tonsils are big in relation to his airway, which is apparently quite common from about age 3-6, and usually isn't a problem. Some kids, however, get an obstructed airway and have sleep issues. Our doc also said the ENT docs won't even consider a tonsilectomy until he's at least 3. Which means we have some time to work all the rest of these issues through, but it also means we may have to be sleepless for another year or so. Awesome.

The idea of being Sleepless in the Pacific Northwest for another year makes me want to cry. But at least now we've got someone besides ourselves working on the problem. It's about the only time in my life I've cried "Uncle!" and I'm glad I did. Each and every medical person I've talked in the past few days has said, with very sincere pity in their voice, "Oh, you must be SO tired!" Why yes, thank you. That I am.

As Squeaker would say, in his remarkably precise grammatical way: I. Am. Very. Tired. And ready to be done with this now.

Comments

[Jacquie]

Squeaker sounds like my daughter who, at almost 4, still doesn't sleep through the night. Her pediatrician and a pediatric ENT thought she was a very clear case of sleep apnea that would improve if she had her tonsils & adenoids removed--which we had done last summer. Her sleep has improved NOT ONE BIT. True, she doesn't snore anymore, but she still wakes frequently.

So, now we're back at it, having a formal sleep study done in a few weeks (something we skipped last time because all concerned thought she had textbook apnea) and then we're having her evaluated by a pediatric pulmonologist to ascertain the extent to which asthma/allergies is complicating her sleep. And mine.

I wish you luck. Please don't hesitate to email me if you want to compare notes.

[SassyMama]

Ugh!
I'm glad you took him in and have a physician that is committed to helping you find a solution. One of my sons had a sleep study and although it was a little crazy at first, they got him hooked up and got the info they needed.

I just sincerely hope you find something that helps soon!

[Almamay]

You poor thing. I think you have been more than patient and loving. I hope there is something they can do. Sending lots of love to you all xoxo

[Sue]

You must be incredibly exhausted. I hope all the tests provide some answers and you don't have to wait another year to get some good sleep.

[Rachel]

I'm so glad that you are getting help! While we don't have the repeat waking up, my daughter is routinely awake until 10 pm (in her crib from 7:30 but keeping herself awake talking/singing/whining) and it drives me crazy. Thankfully she's way too lazy to make the effort to get out of her crib, but when she does we are going to be in much bigger trouble.

If your ENT won't take Squeaker's tonsils out until age 3 I'd suggest getting a second consult or hoping on a plane to NYC - they do it all the time here at age 2 (2 of our friends just had their consults for tonsils last week at a few weeks before their second birthdays).

[Mrs. X]

I don't remember where or when, but I was recently having a conversation with a woman who told me that it turned out that her son had apnea - they determined this when he was EIGHTEEN! You are so far ahead of the curve here.

Personally, I think you should skip the blood test and go straight to the apnea test. My gut tells me that this is not an allergy issue but an apnea issue.

Good luck!

[niobe]

Good luck!

and if you're looking for encouraging anecdotes, my oldest (now in college) had sleep apnea and ENORMOUS tonsils. The doctor said that, on a scale of one to ten, they were an eleven.

Anyway, he had them out when he was almost three and it made all the difference in the world.

[fiddle1]

crap...thought i posted, but didn't enter that code thingy. anyway, i'm late on this, but I'd push for the ENT and the sleep study NOW. why wait? i've heard of this so many times. I actually went to a sleep doc with lizzy back when she was one, and he laughed, but ordered a pule ox monitor at night. the home health company came to deliver it. I attached the sensor to her toe with medical tape and then tucked it all into her sock. She was younger than squeaker, I know..but she left it alone. Then after we got her to sleep, I sneaked back in and attached the monitor to the sensor. they only need a few hours worth of data to know if he's got apnea. if so, out come those adenoids and tonsils, and hello sleep! I've heard it so many times. It works like magic. Don't wait!!! Good luck!!! (Lizzy was fine..no apnea, btw, just multiple sleep crutches that we were able to loose using the sleep lady shuffle).

[fiddle1]

Gah! That was supposed to be "pulse."