My daughter will be 19 months next month. From the time she was about 3 months old, she's always slept through the night. She usually goes down around 7:30. My husband reads her a book and then tucks her in. She usually protests for a few minutes and then goes down until around 8am.

She's never been a good napper, but since my dad started watching her, she has her afternoon naps with him on the couch and sleeps for about 2 hours.

When I started a new job at the beginning of April, my daugther started waking up at around 6am. She still fights when its time to go down in the evening as well (sometimes crying for about 30 minutes until she falls asleep).

I don't know what to do anymore. She's waking up between 5:30 and 6am on weekends and we've tried putting her down at 8pm but that hasn't helped. She always has a bit of warm milk before she goes down and we make sure her room is a good temperature and that she's dressed appropriately. On the weekends, she won't nap in her crib (she's used to the couch) which I think is problematic in and of itself, but that means she goes through the entire day with a maximim of one hour naptime and still gets up at 5:30-6. I don't think she's getting enough sleep and someone recommended melatonin.

Do you have any suggestions!

Dear Trish,

Most babies your daughter's age sleep 10-12 hours per night. It could be that she only needs ten hours, which could explain her early waking, but I would guess that she needs 12. Why? First, you say she isn't getting enough sleep, and moms can usually tell. Second, it sounds like your daughter was getting a little over twelve hours of sleep nightly, with some additional nap time, and was doing well. So I suspect she needs more sleep.

So why does she resist going to sleep at 8pm, even when she hasn't had a nap and is very tired? And what's more, why is she waking up at 5:30 or 6am after only 10 hours of sleep, before she is fully rested?

Almost certainly, she is over-tired. When little ones miss naps or experience stress of any kind, they have to work hard to function. Their bodies go on alert and pump them full of stress hormones like cortisol. Cortisol makes them cranky and hyper-alert, so they have a harder time falling asleep. They are also more tense at night, so when they experience the normal slight awakenings that happen for all of us as we cycle through the phases of night-time sleep, they pop awake, instead of putting themselves back to sleep. For the same reason, they also awaken earlier in the morning.

So what can you do?

1. Try putting her to bed earlier, at 7pm. It defies logic but if she actually needs the sleep, this will help her catch up, and could solve the problem within a couple of days.

2. Figure out what's stressing her. Is it that you started a new job? Is it separation anxiety? Does she need more cuddle time with you? You might want to make sure you're showering her with attention during the time you are awake with her.

3. Kids in daycare often have elevated cortisol levels in the afternoon. I gather from your letter that she is with her Grandfather, but if she is in daycare, you might want to think through other alternatives that would leave her in her own home in the afternoons.

4. To get past the cortisol build-up in her system and let her catch up on her sleep, you could try melatonin for a night or two. I would not use it for a baby for longer than that, simply because we don't have any research showing what the long-term effect is on babies.

5. Don't let her watch TV. TV suppresses melatonin production and makes it harder for kids to fall asleep and stay asleep at night.

6. Invest in blackout curtains so her body will be fooled into sleeping longer. A bright room will lure anyone to wakefulness.

7. Teach her to put herself back to sleep. Since she's been a good sleeper since she was three months old, she already knows how to fall asleep. But sometimes babies her age benefit from tools that help them. For instance, you could tape record yourself singing to her. Show her the tape and play it for her during the day. Get her a tape player that she can turn on and off by herself and set it up accessible to her crib or bed so she can turn it on herself when she awakens.

8. I am not a fan of CIO, but it may be that your daughter can easily learn to keep herself asleep longer in the morning. Get a CD alarm clock and put her favorite music in it. Start by setting the alarm for 6 a.m. Tell your daughter that she needs to sleep all night. In the morning, the clock will play her music and you will come and get her. If she wakes up before 6am, go in and hug her and tell her that it is still night and she has to wait until the music comes on, and then you will get her. When the alarm goes off at 6am and the music plays, get her up. Once she is routinely sleeping till 6am, start adjusting the time by 5 minute increments until she is sleeping until 7 am. I realize that it will seem crazy to let the music wake her on a day when it seems she will actually sleep past 6am, so if you can get one that has a remote, and turn it off if your daughter is still asleep, that is of course the best scenario. Little ones love the reassurance that when the alarm goes off, mom appears, and many seem to regulate themselves to wake with the alarm.

9. If you can't find an alarm clock with a remote that you can adjust from outside the room, you could try a visual cue, like a bunny rabbit alarm clock whose eyes open at the time you set. It won't wake her, of course, if she's still asleep, but she can check to see if it's time. These are available at: http://www.bunnyclock.com/ . Another, less expensive option, is to get a plug-in timer and a night light, and set it to go on at your target time.

10. Make sure she naps, so she isn't over-tired at night. By the way, I would not worry about Grandpa napping on the couch with her. Kids can learn that the rules are different with different people. But it may be that you will have to schedule your weekends for awhile so that she naps in the car while you run errands.

11. Simply take her into your bed when she awakens at 5:30 or 6am. If you don't want her to get used to your bed, you could go back to sleep with her on the couch. If she is actually tired, she will probably go to sleep with you for another hour. If this works, I regard it as the easiest solution for everyone involved. Early waking is the hardest sleep problem to solve, because kids are somewhat rested and usually just work themselves into a frenzy and can't fall asleep. So if napping on the couch with her gets you an extra hour of sleep, that might be the best you can do for now.

12. Don't feed her until what you would consider wake up time (7am?)

13. For some kids this age, teething is an issue. If you suspect this, from her behavior during the day, you could try some tylenol to see if it helps.

14. Try reading Elizabeth Pantley's No Cry Sleep Solution for Toddlers and Preschoolers, which is full of helpful ideas.

Wishing you and your daughter a good night's sleep -- Sweet dreams!
Dr. Laura