Mental health articles

Relationship-based disturbances and disorders
When there is no evidence of regulatory involvement in the infant, and
information on development and support has not changed the sleep problem, it is important to consider underlying factors in the infant–parent relationship.
Unconscious feelings or past experiences of the parents may be influencing
separation at sleep times. For example, has this mother experienced recent loss, or abandonment in her own childhood? Does separating from her child for sleep
awaken embedded anxiety about abandonment?
Stern (1995) speaks of internal models, ‘schema-of-being-with’ another, which are the template in the mind of oneself in interaction with a primary
caregiver. These templates are laid down in the neural development of the brain in early infancy. The internal model determines how the individual interacts
with others as he grows into adulthood, and remains as the preferred option of relationship unless other pathways are laid down as a consequence of different
relationships through therapy, religious experiences or choice of partner. Thus, the model in the adult’s head will largely determine that adult’s interaction with her infant.
Intrapsychic factors in the mother
Several factors may make it difficult for the primary carer to allow the infant to
work on getting to sleep by managing a little negative emotion or fussing from
the baby. Possible causes may include:
• the death of a previous baby
• past terminations and associated feelings related to ‘putting the baby down’ to sleep
• how the parent was parented
• the parent’s experience of abandonment.
Effect of the present and the past
Aspects of the parents’ current situation have been associated with infant sleep
problems: perinatal adversity, including caesarean section, neurotic symptoms,
difficulties between parents, depressed mood and ambivalence towards their
infant (Minde, 1997). Although the relationship between the mother’s psychological difficulties and her infant’s irregular sleep patterns is sometimes
unclear, Minde found that the parents’ contact with mental health clinicians
preceded the sleeping problems of the infant. In fact, parents with insecure
attachment to their own mothers were significantly more likely to have children
with sleep problems (see Minde, 1997, for studies).
Possible effects on infant sleep
Fear of separation underlies some sleep problems. Being able to go to sleep and
feel safe to stay asleep depends on feeling safe to be separate. Separation issues
can become apparent at sleep onset and through night-time waking. Sleep-onset
problems may include refusal to go to bed, crying and anxiety. These in turn
may lead to angry bedtimes, punishment at bedtime, or tantrums, which of
course increases anxiety in both infant and parent.
Night waking occurs when infants are unable to resettle to sleep on waking,
call out for parents, cry on separations or are awake for long periods seeking
parental comfort.
Parents and caregivers may have difficulty allowing their infant to fuss and
settle himself to sleep alone (when it is developmentally appropriate to do so) out
of concern that their infant may feel rejected, or may be harmed even though
they have reassured the infant they are close by. Parents may be striving to
overcome their own experiences of rejection as an infant by overcompensating
with their own infant, or, alternatively, may be repeating their own experiences
unconsciously.

Tags: disorders, disturbances