As we all know, newborn sleep is challenging for parents new and old! Dr Sears in his The Baby Book (2013) writes about “The tiring facts of infant sleep”. It’s not tiring for baby but the adults caring for them! And we all know that we are not at our best when we’re sleep deprived and tired to boot! How can we as postpartum doulas help parents overcome these “tiring facts”? Newborns can sleep up to 16-18 hours in 24 hours (Turgeon and Wright, 2014 ) made up of frequent naps and stretches of nighttime sleep. Newborns do not sleep like adults and their sleep is somewhat erratic due to their immature body clocks and nervous systems.
New parents and not so new parents may get knowledge about newborn sleep from a variety of sources, there’s a huge selection of baby sleep books on the market, they may get advice from family and friends, from the internet via social media and maybe have their own ideas about how their babies should be sleeping. Sometimes, these ideas are how they want their babies to sleep, to fit in with their lives rather than how their babies are able to sleep. They may want their babies sleeping through the night by the time their babies are 12 weeks old. Developmentally most babies will be able to sleep about a 6 hour stretch by 6 months of age and 30% of children still wake at least once a night by 18 months of age.
In order to normalise newborn sleep, we must first know how newborns sleep. We must also have resources to hand if we are to dispel any myths about baby sleep that our clients may tell us, for example, “If we keep holding the baby to sleep and not put baby down when baby’s asleep, baby will never sleep unless they are in our arms.” I sometimes like to counter this by explaining that babies need to feel connected and attached to their parents or caregivers before they are confident to go to sleep independently.
When we go to sleep, we are entering our own independent sleep world, that’s different to the world that we all share when we are awake. No one shares our sleep world but us, and so it’s important to feel connected with our care givers and loved ones, so that when we emerge from our sleep world we have the confidence that they will still be there. Hence the importance of attachment for babies in order for them to gain confidence and independence that we will still be there when they wake up.
Of course, I am talking to parents of full term, healthy newborns who have not been diagnosed with any disorders or conditions that may affect their babies ability to sleep. This blog is about healthy, full term newborns, with no underlying conditions that may cause sleep to be disrupted more than normal for a newborn.
Here’s a refresher about newborn sleep.
- Babies do not need to be taught how to sleep
- Sleep is a normal physiological function
- All babies are individual and sleep differently – their sleep is more determined by individual temperaments than parents’ nighttime abilities (Sears, 2013)
- Some babies may need more support than others to fall asleep and stay asleep.
- Sleep is controlled by the circadian rhythm and sleep pressure.
- The circadian rhythm (body clock) controls a lot of different bodily functions that are related to time. Hormones like cortisol (alerting hormones) and melatonin (sleepy hormones) are released according to the time of day.
- At birth a newborn’s circadian rhythm is very immature and they do not differentiate day time and night time.
- The newborn’s circadian will mature with time and exposure to natural daylight and normal activity levels.
- Sleep pressure builds up the longer we stay awake. The drive to fall asleep becomes overwhelming if this pressure builds up enough.
- Sleep pressure builds at different rates for different babies, and so some babies may be able to stay awake longer than others.
- If sleep pressure builds up too much, babies can get fussy and may need more support to fall asleep.
- Having a nap will take the edge off the fussiness and evidence suggests that taking naps can help night time sleep too. (Taken from Sleep Guide for 0-18 months Lyndsey Hookway, 2020)
- 50% of newborn sleep is REM, light sleep and therefore they are easily awoken and may need help to remain asleep.
- Newborns sleep differently to adults, their sleep cycles are shorter and they go through a period of light sleep first before entering deep sleep ( Sears, 2013)
- Newborns don’t sleep as soundly as adults as a consequence.
- Babies are designed to sleep this way. ( Sears, 2013)
- Baby’s brain is exceptionally good at working out what type of sleep and how much sleep it needs.( Hookway, 2020)
- Newborns sleep cycles gradually get longer as they get older , and start to have less active sleep when they’re developmentally ready.(Hookway, 2020)
- We can’t do anything to lengthen a newborn’s sleep cycle (Hookway, 2020), this may have a protective benefit for babies, reducing the risk of SIDS. (Sears, 2013).
This is a sleep developmental timeline from birth, taken from Lyndsey Hookway’s book-‘Let’s talk about your new family’s sleep’ (Hookway, 2020)
One month – Immature cortisol and melatonin rhythm starts. Core body temperature rhythm emerges.
Two months – Differences in sleep state emerge. More sleep achieved in the night than the day.
Three months -Response to light and activity levels anew circadian -linked. Secretion of melatonin reaches stable levels.
Six months – Circadian rhythm is generally mature.
The development of sleep is not a rapid process as we can see.
What can we do as postpartum doulas to help normalise newborn sleep?
As a postpartum doula, I often share with parents how to read their babies cues. Hunger cues, sleepy cues, cues that they are ready to engage with their parents. This is a useful tool for parents to have as they learn to get to know their babies. Getting their babies to sleep when their babies need to sleep will prevent an overtired and difficult to soothe baby later in the day or night. I often remind parents that their newborns ability to stay awake lasts about 45-60 minutes in the first month of life. This period of time is referred to as a wake window or wakeful window. Although I don’t advise parents to clock watch and put their babies on a schedule, I ask them to just be aware of how long their babies have been awake and to watch for tired cues once the time the baby has been awake approaches the wake window mark. If the baby had a good nap or sleep prior to waking, baby may be able to stay awake for longer, but if the nap was short, less than 45 minutes, then the next wake window may have to be shorter. The important thing here is for parents to recognise baby’s cues for tiredness, sometimes subtle ones, like the ‘fencer’s pose’ or baby gazing blankly into space when a second ago, baby was actively engaged looking at their parents. This is a signal that baby is beginning to tire and it is time for another nap/sleep.
Having realistic expectations on how newborns sleep will also help parents to cope and prepare for disrupted sleep in the first few months of parenthood. Having an understanding that they are not doing anything wrong, and that babies will develop their ability to sleep with time and it’s not something that they can control.
We can help them optimise their babies ability to sleep according to their development by instilling good sleep hygiene. Learning to recognise when baby is tired and helping baby to get to sleep, swaddling baby and using white noise safely for naps and nighttime sleep. Letting baby have naps during the day in a naturally lit room and night time sleep in a darkened room with lights off will help baby’s circadian rhythm fall into place.
Educating parents about the 4th trimester and helping babies transition into their new world can also help optimise babies ability to sleep. Recreating conditions that were in the uterus are sometimes needed to soothe a baby to sleep and keep baby asleep. All babies are individual and have different temperaments. Some will need a lot of comforting and others will happily sleep on their own once in deep sleep. Parents will have to discover what their babies are capable of and support their babies sleep as necessary. Holding a baby to sleep will help with parent and baby attachment, promote bonding and eventually promote baby’s ability to sleep independently. There’s a quote I like to use but I’m not sure who said it first, “ We must first be attached and secure in that attachment in order to be independent “
In the first month or two of life, when babies do not know their night from day and have little stomachs so are constantly feeding every 2-3 hours, parents won’t be getting the long stretches of sleep that they were used to having before their baby arrived. I often suggest that parents form a tag team for the evening hours in order for one parent to get at least a 4-5 hour stretch of sleep in. They take it in turns to care for the baby, while the other parent gets some rest and sleep. Once the baby is eating well and gaining weight steadily, the nursing parent may be able to get a 4 hour stretch of sleep in with the non nursing parent looking after the baby. They could also hire a postpartum doula to support them overnight for a few nights a week to help them get some well deserved rest and sleep. If this is not available to them, then perhaps friends or family can offer to sit with baby while they get some rest during the day.
Finally encouraging parents to let go the things that they cannot control like whether their baby sleeps or not and how long their baby sleeps (Hookway, L, 2020). Letting go of unrealistic expectations of newborn sleep is not easy to do especially when these same unrealistic expectations get thrown at them all the time and appears to be a measure of whether they are a good parent or not. Nothing could be further from the truth of course. Words of encouragement and reassurance from a doula will do wonders for a parent’s confidence. Celebrate every win and build confidence in your clients at every opportunity. Let them know that they are doing their best and they are enough for their babies.
References and further reading.
Hookway, Lyndsey (2020) Sleep Guide for 0-18 months
Hookway, Lyndsey (2020) Let’s Talk About Your New Family’s Sleep, Printer & Martin Ltd 2020 London
Hookway, Lyndsey (2019) Holistic Sleep Coaching Preclarus Press Texas
Sears, William & Martha (2013) The Baby Book , Little , Brown and Company, New York.
Turgeon, H and Wright, Julie(2014) The Happy Sleeper Tarcher/Penguin USA
McKenna, James (2020) Safe Infant Sleep Platypus Media Washington
Weissinger, Diane; West, Diana ;Smith, Linda J and Pitman, Teresa (2014)
Sweet Sleep Ballantine Books New York