Baby Sleep 101: The basics of baby sleep
It is only after we become parents that we realize what a rocky road baby sleep is and how there is just so much learn and unlearn as we meet our baby’s biological needs while getting some rest ourselves! Let’s talk about some of the basic concepts of baby sleep.
Why is sleep important for your child?
Whether you have a baby or a toddler, sleep plays an important developmental role. Sleep is as important as food and, yet, somehow it does not receive the same mindful attention from parents. Often, parents are advised to let the child stay up until they drop off to sleep or to skip nap times to have an early bedtime or to reduce nightwakings. This advice usually backfires but is also developmentally potentially harmful. Good sleep is important for physical growth (the growth hormone is secreted during sleep), lower chances of obesity, heart protection, stronger immunity (proteins called cytokines, the building blocks of immunity, are produced during sleep), better attention spans, greater ability to learn and higher brain growth amongst other things. Night sleep and day sleep have different functions so naps play a vital role as well.
What is “Sleep Parenting”?
A commonly asked question is, “Don’t children just sleep when they are tired?”. The answer is no. The first step to sleep parenting is acknowledging that parents have to support the child to sleep. We help our babies to eat, bathe, play, walk, learn, talk and, yet, somehow we assume that parenting ends when the baby is asleep. This is where many things go wrong as our babies actually continue to need parenting when they sleep. Sleep parenting involves :
Observing cues: Babies and toddlers show sleep cues in stages. It is important to observe for early sleep cues (see chart). When intercepted early, it is easier to make the baby/ toddler sleep than when the cues are not understood and the baby/toddler reaches the crying, overtired phase. An overtired child resists sleep and does not sleep well.
Feeding or rocking to sleep: It is biologically normal for babies and young toddlers to sleep while nursing/bottle feeding and rocking/walking. These are not “bad sleep habits” or “bad sleep associations”. It is biologically normal for babies to need assistance in this regard and that too with active soothing methods such as these (patting does not work until much later). Children under 3.5 – 4 years cannot be expected to fall asleep on their own. Follow a child-led approach to trying different soothing methods.
Holding while asleep: Young babies often wake when put down. They have a biological survival instinct that makes them seek the comfort and security, which comes from physical contact. If your baby is waking up when put down (either immediately or a few minutes later), we need to take the hint and keep holding them This is one vital example of how parenting does not end when the baby is asleep. Babies often need to be held for up to 10-11 months and during regression phases even after. This is biologically normal and not a bad habit. They outgrow the need when they are ready. Further reading on this:
Helping to go back to sleep: If your concern is that your 5 month old or 1 year old doesn’t nap more than 30 minutes at a stretch, the solution is to “bridge the nap”. When your child takes brief naps it doesn’t mean that her/ his nap is complete. It means that the child needs help in going back to sleep through active means of soothing.
Bedsharing: Bedsharing is safe and normal and often leads to better sleep for the child and parents. There is much evidence on the benefits of bedsharing as well. For example, see Professor James McKenna’s research: https://neuroanthropology.net/2008/12/21/cosleeping-and-biological-imperatives-why-human-babies-do-not-and-should-not-sleep-alone/
Following baby’s schedule: A baby’s sleep schedule – based on the baby’s cues and natural biological rhythms – is sacrosanct. It works much better if adults adapt to the baby’s schedule rather than the other way round.
Creating the right sleep environment: A pitch dark and quiet room for both daytime naps and night sleep (after the age of 3 months in particular) are vital to good sleep. These are biological needs as babies are very easily stimulated and jerked out of sleep. These do not form “bad habits”.
What is Overtiredness?
A child is overtired when she/he is awake beyond the age appropriate awake window. The child’s body recognizes that sleep isn’t coming and secretes the stress hormones cortisol and adrenaline to cope with it. The child experiences a “second wind”, wherein the child snaps back to wakefulness and becomes hyperactive. Does your baby/ toddler get over active when it is time for bed? Does she/he resist bedtime even though they look tired? Does your child often cry before sleeping? All these are classic examples of overtiredness. An overtired child does not sleep well, which can lead to multiple night wakings, including active nightwakings.
Sleep Cues and Awake Windows
Every baby is unique but babies of the same age range have similar sleep needs because it is biologically determined, like any developmental milestone. Looking out for sleep cues is important to determine when the child is ready to sleep. Babies and toddlers have early and late sleep cues, and the earlier a caregiver responds to sleep cues and soothes a child to sleep the better because late sleep cues lead to sleep resistance and disturbed sleep – also signs of overtiredness. Please refer to the chart above to understand what cues to look out for. “Awake window” means the time in between two naps or between naps and night sleep when a child can stay awake and interact without getting overtired. The first awake window of the day (between morning wakeup and the first nap) is usually the shortest, and they become longer as the day progresses, with the window between the last nap and bedtime being the longest). For example, a 10-month-old taking 2 naps does very well on a 2-3-4 schedule, with the first awake window being 2 hours long, then 3 hours long between the 2 naps and then 4 hours before bedtime. Parents should learn about age appropriate awake windows and observe their babies as this is a critical element of baby sleep management.
“When will my child sleep through the night?” is a question on the mind of every new parent. The technical answer is: never. What your child will eventually learn is to connect sleep cycles without your help. Everyone sleeps in cycles- with adult cycles being around 2 hours long. A sleep cycle moves through stages like light sleep, deep sleep, deepest sleep, REM sleep and then back through the stages in reverse. At the end of every sleep cycle, all human beings wake up, including adults. Older children and adults are able to soothe themselves back to sleep by turning over, pulling up a blanket, fluffing a pillow etc. Babies and young toddlers cannot be expected to go back to sleep on their own as they are biologically not able to do so without help. It is the job of the parent to soothe the baby back to sleep for another sleep cycle. Babies may also wake during the light stage of sleep and need further soothing to sleep. Cycles may be tougher to “connect” or “bridge” during regressions, growth spurts, teething etc or if the baby is overtired, does not have an age appropriate routine or has stimulating light and noise around her when sleeping. It is biologically normal for them to wake during naps or night sleep until they reach the “sleeping through the night” milestone at around 3.5 – 4 years. Until then, caregivers have to put in the work to soothe them back to sleep. They develop the ability to connect sleep cycles increasingly until they reach the final milestone (so, a 2-year-old may be connecting 60% of her sleep cycles). So, if your baby is waking up frequently at night, it is most likely normal! We just need to support our babies by meeting their needs so that they do not wake up any more than they optimally need to, and fall back asleep easily and quickly when they do.
Bedtime Routines & Sleep Environment
Creating a sleep-friendly environment includes a bedtime routine and pre-nap routine (a series of steps you take every day in the same pattern to signal that sleep time is coming, including an activity like reading books, for baby to unwind, disconnect from the outside world, connect with the parent and prepare for sleep), then actively soothing the baby to sleep in a quiet, pitch dark room. After the age of 4 months, babies become very easily distracted and stimulated. They find it difficult to fall asleep and stay asleep if there is any visibility in the room. By then, their circadian rhythms have formed and there is no risk of day/night confusion. Their environment should be pitch dark for both naps and night sleep (no light leaking from behind curtains and no night lights). This will help them fall asleep at the early stage of tiredness and will prevent them from jerking awake at the end of a single sleep cycle or when they are in light sleep, when their sleep needs are actually not complete. This is biologically appropriate for them and not a bad habit (see graphic).
A “sleep regression” is when a child that was previously sleeping well suddenly resists nap times and does not sleep well at night, in spite of following awake windows and maintaining a sleep environment. The phase is confusingly termed “regression”, because sleep “regresses” while the baby actually experiences a “progression”, achieving important milestones like crawling, walking, speech development etc. The most significant sleep regressions occur at 4 months, 8 – 10 months, 12 months, 16 months, 18 months, 21 months and 24 months. It is best to go with the flow and not be rigid about the sleep schedule at this time (though continue to observe or shorten awake windows). Hold the baby for naps, bridge the naps, make the sleep room pitch dark and quiet and avoid implementing major changes. Be patient, sleep regressions are temporary and will pass within 1 – 3 weeks.
As babies grow up, both awake windows and naps become longer. As sleep consolidates, the frequency of naps decreases. A new born has no sleep pattern, but after four months, babies start following a loose sleep pattern. A 4-month-old usually takes 5 naps, a 5-month-old takes 4 naps and a 6-month-old has a pretty solid 3-nap routine. Between 8 and 10 months, babies move to 2 naps and the golden 2-3-4 pattern. Babies usually gibe us clear cues that they are ready to drop naps and it’s important to follow their lead. At the same time, it is important to facilitate the transition when baby is ready as an extra nap hanging around due to lack of proper bridging on our part or an inappropriate sleep environment can disturb night sleep. When babies need longer naps and longer awake windows, it is important to help them achieve those. Cues include resisting bedtime, resisting naps (especially the last one), taking short naps, waking up early and having active night wakings. The nap transition will take a few weeks and caregivers should continue sleep parenting. Facilitate and don’t rush the process.
Babies sleep best in sync with circadian rhythms – the setting and rising of the sun. Usually, one hears about a “7 pm to 7 am” stretch of night sleep for babies. Early bedtimes are important. Not only do babies sleep better with an early bedtime, it also helps to prevent overtiredness as babies usually have a naturally early morning wake up time. A later bedtime does not usually lead to a later morning wake up time. It just leads to overtiredness. The growth hormone is also secreted in the hours before midnight so it is good to maximize the sleep at that time. An early bedtime is also extremely helpful to us as parents as it gives us the opportunity to have some time to ourselves for work or leisure or to spend with our partner, or even to go to bed early ourselves. A video baby monitor is a great investment for this purpose (and even to bridge naps after a certain age). However, a rigid early bedtime usually does not work. It needs to be based on the nap routine of that particular day and the prevailing awake windows. A range of 30-60 minutes is quite common (like between 7:30 and 8:30 pm). Also, bedtimes are linked to nap transitions and are cyclical in nature. Just before a nap drop, a baby’s bedtime will be late and, after the nap drop, bedtime will shift super early. Once the transition is complete, bedtime will return to normal. A range of 6:30 pm to 10 pm over the months between nap transitions is quite common.
Why No “Sleep Training”?
The term “sleep training” refers to a very specific practice that is common in some parts of the world. It is not a practice we recommend. It usually involves withholding support to the baby, in the hope that the baby will develop “independent sleeping habits”. This usually involves leaving a baby to cry for short or long periods. It ignores biological norms around baby sleep and hopes to force a premature independence. Sleep training is unscientific as it believes that babies should self soothe or self-settle, whereas the part of the brain (the neocortex) which helps human self-regulate is not fully developed in babies. Much research has shown the potentially harmful effects of sleep training but it is also something that most parents find counter to their own natural instincts. It causes stress to both parents and babies. The results are short term and superficial – similar to those of fad diets. Sleep training is a multi-million dollar industry and the internet is full of articles based on its tenets. Any sleep advice that uses terms like “self-soothing”, “break sleep associations”, “teach baby good sleeping habits” are red flags. Further reading on sleep training:
Cry It Out Method | 6 Baby Experts Who Advise Against It – Bellybelly.com.au
Self Settling – What Really Happens When You Teach a Baby to Self Soothe to Sleep – Sarah Ockwell-Smith
Is Self Soothing the Biggest Con of New Parenthood – Tracy Gillett, Raised Good
Dangers of “Crying It Out” – Psychology Today
Ten Reasons to Not Sleep Train Your Baby – Sarah Ockwell-Smith
Bedsharing promotes better sleep for both parents and child, reduces chances of SIDS, promotes the development of several infant bodily functions like regulating breathing, absorption of calories, oxygenation, absorption of stress hormones and more. It boosts the breastfeeding relationship. Sometimes, parents are concerned about hurting the baby while bedsharing but in fact bed sharing is completely safe from the new born stage. It is also the cultural norm in India and much of South East Asia. If bedsharing is not possible, a baby cot – possibly open from one side – may be attached to the bed as a middle ground solution. This way the baby can still come over to the parents’ bed during the night for feeds and comfort. It is best to be child-led when trying to shift to a separate bed as until the age of 3.5 – 4 years (and beyond), children usually prefer to bedshare. With infants, please follow Safe Sleep 7 bedsharing rules (see image).
Is Nursing to Sleep a Bad Habit? Will Weaning Help My Baby Sleep Better?
Certainly not a bad habit! Nursing to sleep is the biological norm. Nothing is easier or more effective than nursing to sleep as the suckling motion promotes sleep and breastmilk contains sleepy hormones. It is often heard that nursing to sleep is a bad sleep association but the truth is, babies do not form habits. They do not manipulate or “remember” that they should do something to get a particular result. Their neocortex (thinking brain) is not developed enough. Instead, they follow biological programming and nursing to sleep is how nature intended babies to sleep. For babies that are distracted during day time, night feeds can help make up for less day time intake. Over all, nursing creates a sense of security and comfort for babies. It is nature’s perfectly designed sleep solution for babies.
Alternate soothing methods are rocking and walking to sleep. Most babies respond well to multiple methods of soothing, especially with different caregivers. Follow the baby’s cues to settle on a soothing method.
Since babies wake at the end of sleep cycles and for various other reasons, nursing is actually the solution to the problem and not the cause of the problem. Many babies continue to wake even if they are not nursing and then a more labour-intensive soothing method is required, like rocking or walking. Sleeping longer stretches is a milestone that babies achieve in their own time.