Babies Sleep A Lot. Don’t They?

Well, yes they do – but because babies also feed a lot, usually every couple of hours, around the clock, the periods that they are actually asleep are usually quite short, around an hour or two, and then they wake and need to feed again. This is NORMAL and all babies, whether they are breast fed or formula fed, should be fed when they demonstrate feeding “cues”.  The early cues are waking, stretching, licking the lips, putting their hands in their mouths, and as they become more agitated it leads to crying, which is a late cue.  Parents need to learn to recognise and respond to the baby’s early cues before baby becomes upset, as baby needs to be calm to latch well and breastfeed.  It is normal for young babies to feed 8 to 12 times in 24 hours, which is why it is so common for new parents to feel like they hardly sleep at all.

Having unrealistic expectations about baby’s sleep can be the source of great anxiety for parents, particularly if they believe their baby is not sleeping ’well’ or ‘enough’, so it’s helpful to understand that sleep patterns vary enormously from baby to baby, and even the same baby’s patterns will vary from week to week, according to individual feeding, growth and developmental stages.( 1.)

SLEEP FACTS

Whether we are talking about babies or adults there are a few facts to keep in mind.

SLEEP IS NOT UNDER OUR CONSCIOUS CONTROL AND CANNOT BE FORCED.  If I told you to go to sleep right now, you couldn’t. Even if I threatened you at gunpoint to go to sleep, you couldn’t, could you? In fact if you are stressed it’s harder to go to sleep, and to sleep well. This is true of adults and of babies, and is strongly influenced by the hormones adrenaline and cortisol.

TWO BIOLOGICAL MECHANISMS CONTROL SLEEP.  The homeostatic sleep regulator – which is driven by sleep inducing hormones such as melatonin and cholecystokinin, and the circadian pacemaker – which is our biological clock. This is influenced by environmental cues like sunlight and activity, and the onset of darkness at the end of the day.  Wakeful hormones like adrenaline and cortisol influence the ebb and flow of these two mechanisms.

Young babies are dominated by their needs for food, comfort and sleep rather than the environmental stimuli of light and dark, day and night. Newborn babies are oblivious to day and night and do not develop circadian rhythms until about 2 months of age. However, the breastfeeding mother’s cycle of sleep/wake hormones gradually influence her baby’s circadian rhythm to develop, and environmental cues of the morning and evening help establish baby’s rhythm in sync with the mother and the family over time.

Newborn babies are adapting to their new world outside of the womb, and are comforted by familiar sensations they experienced in the womb, such as warmth and closeness to the mother’s body, especially when in skin to skin contact. Their most fundamental need is for nurture, which means receiving food as frequently as he seeks it.

They also need to feel secure, which means closeness – being held or wrapped, and they enjoy movement and soft sounds, similar to the gentle rocking and swaying they experienced in the womb as she went about her day, hearing  the soft vibrations and sounds of her voice. Life outside of the womb involves light, sound, touch, pain, clothing, poos and wees, sucking, swallowing and breathing which are all new experiences for baby.  It should not be surprising that baby takes some time to adapt to sleeping in a place away from his mother, and needs to revisit the familiar comforts often for reassurance.

CLUSTER FEEDS – It’s also normal for babies to sometimes want several feeds close together, often called cluster feeding. Typically this happens in the later part of the day and early evening, and can turn into a feeding marathon. This pattern happens for a reason, especially in breastfed babies.

In breastfed babies this is a natural behaviour influenced by the normal variation in the mother’s prolactin levels at that time of the day. Prolactin is the “make milk” hormone, which follows the mother’s circadian rhythm. Prolactin levels are highest in the night time and gradually lower during the daytime, as do her breast milk volumes. Baby’s cues to feed more frequently in the latter part of the day are a natural part of this hormonal cycle. As the mother’s body’s circadian body clock reflects the evening time, her breastmilk contains more sleep inducing melatonin which subtly influences her baby’s sleep cycles to gradually adjust to her own.

IT TAKES TIME TO LEARN THE BABY’S CUES AND SIGNALS, AND TO DIFFERENTIATE BETWEEN FEEDING CUES AND TIRED SIGNS. Recognising and responding to baby’s early “tired signs” will avoid him becoming overtired.  An overtired baby may find it very difficult to go to sleep even though rest is what he desperately needs.  A newborn baby will become tired when he has been awake for an hour or more – including the time taken for feeding.  The movements of baby’s arms and legs become jerky, he may yawn, frown, fuss, and look away from stimulating toys or faces.  His hands may be in fists, his arms become tense, and he may arch backwards when being held.  Fussing turns to crying and when very overtired he may ‘lose the plot’ and it can be difficult to calm an overtired crying baby.

To calm and settle a tired baby, remove him from a stimulating environment to a quieter zone, change baby’s nappy if needed, cuddle baby close and reassure baby in a relaxed soothing voice, and offer a feed if baby seems hungry. When baby is calm and his needs of comfort (eg. nappy change) and hunger are met, a state of drowsiness will follow. Baby can then be swaddled and either cuddled until drowsy or asleep, or placed gently in his bed to drift off to sleep. (2) You can watch my swaddling video here https://youtu.be/DDSi8INP2es

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If baby does not settle easily stay with him, with your hands resting on him for reassurance so he feels he is still being held.  Rhythmic patting gently on his bottom often helps baby to relax. Sometimes baby will settle more easily laid on his side.  This is fine if you are with him.  He can be gently moved onto his back when he is asleep, but he can be settled on his side if he prefers it.

If baby does not settle when you expect him to, it is likely he actually needs to be fed some more.  Don’t ignore feeding cues when your plan is to settle baby to sleep – the need to feed will over-rule your best efforts to settle him.  If in doubt, offer another feed.  This will save you time and energy in the long run, and will not “spoil” or over feed baby.

Young babies under 3 months old need feeds in multiple instalments.  They often need “topping up” after a bowel movement and clean up to feel full again and ready to sleep.  FOLLOWING BABY’S CUES AND MEETING HIS NEEDS FOR FOOD AND COMFORT ASAP IS ALWAYS THE RIGHT THING TO DO.

Parents will learn to read baby’s signals to understand his various awake and sleep states.  When awake, babies can be quiet alert, active alert or crying which is baby’s principal means of communicating a need. Baby’s sleep states transition between active sleep and quiet sleep. Young babies often move from state to state quickly so parents who swiftly respond to baby’s changing cues encounter fewer feeding and sleep problems. As the early weeks of baby’s life unfold patterns emerge, and the new parents learn to relax and embrace their new life-style.

WHAT ABOUT ROUTINES? Most parents crave order and predictability from day to day so knowing what patterns to expect as baby develops physically and mentally will make adaptation to their new lifestyle easier for them too. Babies respond to their needs being met rather than a rigid series of actions to enable sleep to follow.  Responding appropriately to baby’s early ‘feeding cues’ and ‘tired signs’ is the most important message to take on board. This will, in turn, keep the stress levels DOWN of both baby and parents.

Following highly structured and inflexible routines which assume a “one-size-fits-all” concept lock the parents into rigid timeframes too.  When something happens which confounds the ‘routine’ the parents are challenged to somehow get back on track, and many experience added anxiety and a sense of failure if their baby does not “fit” into the routine devised by the ‘sleep experts’. Rigid routines can actually be very stressful for both the parents and the baby.

Health professionals now recognise there are potential hazards for baby’s physical and mental development associated with rigid feeding routines and sleep training. Cue-based responsive parenting enhances baby’s wellbeing and parents’ confidence in caring for and understanding their baby’s changing needs.  “Getting into a routine” will happen naturally in response to baby’s individual developmental patterns which the parents will recognise and adapt to as they unfold.

Some Tips to help EVERYONE to sleep more: When babies become stressed the hormones cortisol and adrenaline are released in their body which they signal by fussing and crying.  Babies have ZERO ability to manage their felt stress, so they rely on their caregivers to help them recover and reset their homeostatic sleep regulator by providing the key ingredients of warmth, comfort, reassurance, security and probably milk, which stimulate the release of sleep inducing hormones and a response of calmness, drowsiness, and sleep.

Babies are unaware of the difference between night and day, but gradually develop their own “biological clocks” in response to their mothers’ circadian rhythms, or circadian pacemaker.  A breastfed baby is influenced by the subtle hormonal changes which occur in the mother’s breastmilk throughout the day and night, as well as the environmental changes of light and dark.

When parents perceive their baby has a “sleep problem” it is often actually a feeding issue. Baby’s nutritional requirements are in a constant state of response to growth.  Prolonged periods of being unsettled which are often mistaken for “wind” are usually driven by hunger, and more feeding will be the answer. If baby does not need to feed, she simply won’t.(3)

EXPECT CHANGES – Baby’s sleep patterns will change from time to time associated with growth and developmental  phases or LEAPS, sometimes called “wonder weeks”, so don’t despair if your settling strategies that worked for weeks suddenly don’t work and baby resists sleeping when she has slept easily in the past.  Flexibility is the answer to these times of change and will save parents many wasted hours trying unsuccessfully to coax a baby to sleep when it just is not what she needs.

One strategy I have found to be helpful for babies and parents in the first few months is to avoid baby having long sleeps during the daytime, unless of course the Mother needs to go to bed to sleep as well.  Most babies will naturally have a longer sleep at some time during the 24 hours of each day.

It’s quite OK to wake your young baby to feed during the daytime if he does not self-waken after four hours have passed since the start of his last feed.  This will ensure baby has a consistent food intake through the daytime and he may be more able to have the longer stretch of sleep during the night time hours.

Another useful strategy is to have baby’s daytime sleeps in an environment of normal light and noise, rather than in a darkened room. It is normal for baby to sleep for short periods of less than an hour between wake and feed cycles.

GET OUTSIDE – a walk around the garden, down the street – anywhere really, can be  helpful to both mother and baby. Walking relieves stress, and the motion of being carried in a sling or pushed in a pram can be relaxing for baby, provided he has been fed and is comfortable.  Fifteen minutes of exercise and a change of scenery from the indoors can be enormously helpful. You can watch my ABC Interview with Annie Gaffney on this topic here (4)  https://www.facebook.com/ABCSunshineCoast/videos/1402691396444296/

As baby gets older and has longer sleeps a few times in each 24 hours, bringing baby’s bed time closer to the adult bedtime – say 9pm – can lead to less night time waking in the wee hours if the baby is ready to do so.

When responding to night time feeds, it’s helpful to respond in a relaxed way, with minimal light. * This includes the bright light of a phone or tablet!  Keeping night time feeds quiet and “lazy” eg. no nappy change if not necessary,  will keep the sympathetic nervous system of both mother and baby “dialled down” which will assist an easy return to sleep for both.

Some commonly offered sleep advice such as “Feed Play Sleep” and never feeding baby to sleep, and even waking baby after a feed so he is put to bed awake and “self settles” are not evidence-based, and can actually be very unhelpful. Feeding and sleeping are biologically linked for babies, and decoupling this natural process which has developed as an integral part of human evolution makes no sense at all.

The information I have provided today is based on the latest research and evidence, and aligned with education I have undertaken to become an accredited Possums health professional.

If sleep deprivation is having a serious and lasting adverse effect on a parent’s mental state, help IS available.  A comprehensive program which looks holistically at feeding and sleep problems, and offers expert support and strategies for mothers who are struggling physically and mentally with the demands of managing a wakeful or very unsettled baby is available at The Possums Clinic in Brisbane. www.possumsonline.com

 References:

1. https://www.isisonline.org.uk/how_babies_sleep/normal_sleep_development/
2. https://youtu.be/DDSi8INP2es
3. Whittingham, K, Douglas, P. All about Sleep – Not just surviving but thriving through the first six months of your baby’s life: A Possums Guide. 2014.’
4. https://www.facebook.com/ABCSunshineCoast/videos/1402691396444296/