Sleep and newborn babies

How do newborns sleep?

The first weeks and months after bringing a new baby into the family can be a trying time. The newborn's sleep patterns often play a major part in the difficulties faced by new parents. Parents often find that their sleep schedules are thrown into confusion and are concerned about their newborn and their own sleep.

Newborn sleep patterns come in many forms and can vary widely between babies. A healthy newborn can sleep as little as nine hours a day, or as many as 20; the average is 16-18 hours. There is neither one 'right' pattern, nor is it a competition between babies or families. You will know that your newborn is sleeping enough if they are healthy and active during waking hours.

One large reason why sleep is such an issue in newborns is that newborn sleep patterns are very different to those of their parents. As a parent, it is important to understand that newborns do not sleep in the same way that adults do.

The infant has just arrived into this new, strange world. It is undergoing several processes at once:

• Developing its brain and body at a very fast rate;
• Learning new information about this new environment, and;
• Physically adjusting to the new environment and its rhythms.

Thus, sleep in the newborn is a different activity than it is later in life.

How much will a newborn sleep?

Healthy newborns spend from nine to 20 hours a day in sleep throughout their first three months of life, with an average of 16-18 hours. These numbers drop off gradually as your baby grows. A one-year-old baby will sleep for 12-15 hours on average. ^{[1] [2]}

At first, your newborn can sleep anywhere and anytime, day and night. After 10-12 weeks, more mature sleep patterns begin to emerge. During the first three months or so, a baby's biological clock starts attuning itself to day-night cycles. They will wake one to three times a night on average. ^[1]

What happens during newborn's sleep?

Adults spend about a quarter of their sleep time in REM, or 'active' sleep, which is when we dream. Infants in the first three months of their life have a different pattern. They fall almost immediately into active sleep (REM) - eyes closed but moving, limbs moving and twitching. Breathing is often irregular (periodic) and can stop for up to 20 seconds.

Your newborn spends about half of its sleep time in active sleep. Active sleep is necessary for brain development. During sleep, the newborn brain is busy growing, developing and assimilating the information it has gathered while awake. Experiments show that newborns can even learn new things from their environment during sleep.

Why do newborns wake up so often?

An adult 'sleep cycle' - the transitions between deep and light sleep - normally lasts about 90 minutes. We go through several such cycles every night. Your newborn's sleep cycle, however, lasts for only 45-55 minutes.

A newborn baby's stomach is very small - about the size of a marble at birth. Because of this, even a fully-fed baby cannot hold food to sustain them for more than a few hours. Thus, infants need to wake up every one to three hours in order to feed again.

It is not expected that a young infant will 'sleep through the night'. A baby in its first few months who is a 'good sleeper' is not one who sleeps for six to eight hours at a stretch. Rather, it is a baby who can wake up, feed and return to sleep with minimal fuss.

The good news is that after a few months, your newborn will gradually move into a more mature sleep pattern. Sleep patterns change - often just when you have finally become used to the existing pattern.

'Problem sleepers'

Every baby is unique. Different babies will have different sleeping patterns and different rates of development. About one in five babies are considered 'problem sleepers', but there is no set definition.

You may find that your infant is more than three or four months old but:

• Is still not adjusting to sleeping mostly at night;
• Needs a parent with them to fall asleep;
• Cries when you try to leave the room;
• Is having trouble going to sleep at bedtime, or;
• Wakes up and has trouble falling asleep again.

The question of whether your baby is a 'problem sleeper' depends largely on your baby and your family. Some families are more accommodating of a baby's sleep preferences than others. Generally speaking, a baby is a 'problem sleeper' when their sleep routine (when otherwise healthy) is a persistent disruption to the family's conduct.

The field of infancy sleep is hotly debated even between experts, let alone parents. Faced with this debate, it is good to bear in mind that there is no universal 'solution' to infancy sleep problems. Different children may respond differently to methods, even within the same family.

It is also good to bear in mind that having a sleeping problem before six months of age does not indicate that your child will continue to experience sleep problems at a later age.

Bedtime routine

In order to encourage your baby to move into a more mature sleep pattern, you can try establishing a bedtime routine. This will signal to your baby that sleep time is approaching and prepare them for sleep. Bedtime routines can be started early, or at a later period. Remember that babies can learn, adapt and change as you change your behavior.

Steps you can take include:

• During the daytime, encouraging play and activity and, when baby falls asleep, speaking at a normal voice and going about your daily activities as usual;
• When bedtime approaches, moving baby into the bedroom, away from noise and bright light (such as TV);
• Dimming the lights;
• Speaking in a soft voice;
• Changing nappy, clothes - making sure that baby is not overdressed or underdressed;
• Establishing a 'pre-bedtime' routine, such as bathing, reading a story, rocking and cuddling, or singing a lullaby;
• Putting your baby to bed when they are sleepy, but not yet asleep, and;
• Having the baby sleep in the same room as you.

Sleep training

'Sleep training' is the name given to several techniques directed at babies who wake up often and cannot go back to sleep by themselves.

The rationale behind this approach is that a parent who rushes to a crying baby's bed is actually reinforcing the baby's unwanted behavior (crying). The parent is not allowing the baby to learn how to 'self-soothe' or 'self-settle' back to sleep without help. Thus, sleep training consists of the parent refraining from comforting a baby who has woken up and is crying.

Techniques

There are a number of sleep training techniques, including:

• 'Cry it out' - the most direct or extreme method, which involves leaving the child to cry until it learns to fall asleep on its own;
• 'Progressive waiting' - leaving the room and waiting for progressively longer periods of time before returning to calm your crying baby, and;
• Staying in the room with your crying baby, offering comfort through your presence, but no more.

Criticism and alternatives

Critics of this approach maintain that:

• It has not proven effective for infants younger than six months old;
• It has not been shown to improve mothers' and babies' overall mood and wellbeing;
• It encourages increased crying, which drains the infant's scant energy resources and may damage its normal development;
• It encourages cessation of breastfeeding, and;
• It links bedtime to feelings of frustration.

Alternate methods include a variety of approaches aimed at settling a baby to sleep with parental help, comforting and guidance.

Co-sleeping

Globally, co-sleeping (baby and parent sleep together) is the most common sleeping arrangement in the world. In Western society it is less common, though it has become more popular in recent years.

Advantages of co-sleeping include:

• Reduced anxiety levels for baby and parent;
• Quicker access to baby, so that soothing or feeding can be done while the baby is still stirring and has not completely woken up, and;
• Less need for 'fuss' (entering the child's room, lighting a light, making noise, etc.) when baby wakes.

The main disadvantages of co-sleeping are safety concerns (see 'Safety' below) and, for some parents, discomfort and sleep disturbance when sharing a sleeping space with a baby.

Safety

A safe sleeping environment

During the first six months of life, infants are at particular risk of dying while sleeping. Sudden unexpected infant death (SUID) is a harrowing experience and a constant worry for any parent. SUID can have a number of causes, including:

• Accidental suffocation and strangulation by bedding or another object or person;
• Infection;
• A previously unrecognized birth defect, or;
• Sudden infant death syndrome (SIDS) - when the cause of death is unknown.

Overall, about 80% of sudden unexpected infant deaths are eventually categorized as SIDS. ^{[3 ]} Researchers believe that SIDS occurs when the brain stem (which is in charge of regulating our breathing, heart rate and sleep) fails to respond well to a temporary lack of oxygen.

Adopting a safe sleep position will help reduce the chances of SIDS and of suffocation and strangulation. The safest sleep position is:

• On the back (for short naps as well as longer sleep periods);
• In a smoke-free environment;
• In the same room with another person;
• Alone in the bed/crib;
• On a firm surface;
• With baby's feet at or near the foot of the bed, and;
• With no other objects in the bed.

Extreme parental emotions

Raising a new baby can be an overwhelming task, both physically and emotionally. It is common for a parent to find themselves exhausted and frustrated when dealing with a baby who will not sleep or stop crying. In some cases, these feelings can cause parents to act irrationally and harm their babies by shaking or hitting them.

In such situations, it is the parent who is, temporarily, the greatest source of danger to the infant. It is therefore important for the parent to recognize when they are nearing such an extreme state of mind and react accordingly. You can try putting the baby down safely and leaving the room for a short while in order to calm down and compose yourself. If possible, seek help from family, friends or a helpline. In situations where you believe your baby is at risk of harm it is important that you seek professional medical help.

References

1. Galland B.C. Taylor B.J. Elder D.E. et al. (2012) Normal sleep patterns in infants and children: a systematic review of observational studies. Sleep Medicine Reviews 16:213–222.
2. Tarullo A.R. Balsam P.D. and Fifer W.P. (2011) Sleep and infant learning. Infant and child development 20:35–46.
3. Kinney H.C. and Thach B.T. (2009) The Sudden Infant Death Syndrome. New England Journal of Medicine 361:795–805.
4. Choices N.H.S. (2014 December 8). Getting your baby to sleep - Pregnancy and baby guide - NHS Choices. Accessed 19 August 2014 from link here
5. Douglas P.S. & Hill P.S. (2013). Behavioral sleep interventions in the first six months of life do not improve outcomes for mothers or infants: a systematic review. Journal of developmental and behavioral pediatrics: JDBP 34: 497507.
6. Fransson P. Skiöld B. Engström M. et al. (2009). Spontaneous Brain Activity in the Newborn Brain During Natural SleepAn fMRI Study in Infants Born at Full Term. Pediatric Research 66: 301305.
7. Gallagher S. Hiscock H. Morton-Allen E. et al. (2006 March). Prevalence stability and outcomes of cry-fuss and sleep problems in the first 2 years of life: prospective community-based study. Pediatrics 117: 836+.
8. Galland B.C. Taylor B.J. Elder D.E. et al. (2012). Normal sleep patterns in infants and children: A systematic review of observational studies. Sleep Medicine Reviews 16: 213222.
9. Getting Your Baby to Sleep. HealthyChildren.org. Accessed 20 August 2014 from link here
10. Infant Sleep | Johns Hopkins Medicine Health Library. Accessed 20 August 2014 from link here
11. Lagercrantz H. & Changeux J.-P. (2009). The Emergence of Human Consciousness: From Fetal to Neonatal Life. Pediatric Research 65: 255260.
12. McGuire E. (2013). Maternal and infant sleep postpartum. Breastfeeding Review 21: 38+.
13. Microsoft Word - CHW MANUAL Dec 2011.doc - CHW_Manual.pdf. Accessed 19 August 2014 from link here
14. Ng D.K. & Chan C.-H. (2013). A Review of Normal Values of Infant Sleep Polysomnography. Pediatrics & Neonatology 54: 8287.
15. Sadeh A. Tikotzky L. & Scher A. (2010). Parenting and infant sleep. Sleep Medicine Reviews 14: 8996.
16. Schwichtenberg A.J.M. & Poehlmann J. (2009). A Transactional Model of SleepWake Regulation in Infants Born Preterm or Low Birthweight. Journal of Pediatric Psychology 34: 837849.
17. Sleep and your baby | Better Health Channel. Accessed 19 August 2014 from link here
18. Tarullo A.R. Balsam P.D. & Fifer W.P. (2011). Sleep and Infant Learning. Infant and child development 20: 3546.
19. Tikotzky L. & Shaashua L. (2012). Infant sleep and early parental sleep-related cognitions predict sleep in pre-school children. Sleep Medicine 13: 185192.
20. Zentall S.R. Braungart-Rieker J.M. Ekas N.V. et al. (2012). Longitudinal Assessment of SleepWake Regulation and Attachment Security with Parents. Infant and Child Development 21: 443457.

10 Most frequently asked questions (FAQs)

About this article