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Early in a baby’s life, a lot of parents find themselves in a spiral of sleeplessness: the less baby sleeps, the less they do too, and the less rationality the parents have to solve it. But there are ways to overcome that, discovers Brigid Moss.
First, is your baby’s sleep really a problem? “A lot of information makes it seem as if the baby has a problem or the parents are doing something wrong,” says Sarah Ockwell-Smith, author of The Gentle Sleep Book. “Often parents’ expectations come from family, who may have an old-fashioned view of how much babies should sleep.” Anthropologist Professor Helen Ball, who leads Durham Infancy & Sleep Centre’s outreach project the Baby Sleep Information Source (Basis) says popular beliefs about when babies should be ‘sleeping through’ are based on studies of formula-fed babies from the 1950s-60s. Breast-fed babies need to feed more often, so tend to wake more often. Parents often think their baby ‘should’ be sleeping for a certain number of hours, based on what’s ‘average’.
“But most babies don’t sit on the average of anything. Your baby will fall somewhere in a wide range of sleep needs – say from ten to 20 hours out of 24,” says Professor Ball. Apps that track when a baby should be sleeping and feeding, also based on averages, can make parents really anxious, she says. What helps is for parents to know their baby’s patterns are normal: “that at four months most babies are waking regularly, and most are having lot of night feeds. That for the whole of the first year, it’s really normal to feed at night. And that most 12-month-olds still wake up regularly,” says Ockwell-Smith. “It also helps to realise that this is a temporary stage, even while it feels as if it will never end.”
All human beings sleep in cycles, but very young babies have very short cycles, “around 16 in a night”, says Ockwell-Smith. That means there are 16 times that a baby reaches the end of a cycle and slightly comes to. At this point, three things can happen. First, they might wake up a little bit, wriggle, coo or gurgle a bit and start a new cycle. Second, they may wake fully for a bit before going back to sleep quietly by themselves. Or thirdly, if something isn’t right, they will wake up fully and start crying to tell you they need your help. “We tell parents to remove any issue that can come up between sleep cycles,” says Ockwell-Smith. That could be pain, but also anxiety, stress or fear. The baby could be hot or cold; remember they can’t regulate their temperature by covering up or kicking off the covers, like adults can.
It’s better to have a cool room and warm body – wear more in a colder room,” says Ockwell-Smith. If there is central heating or air con, it can make the air very dry, and this can give your baby a dry mouth. “In that case, use a diffuser to put water vapour into the room,” says Ockwell-Smith. The room could be too bright, or they might feel scared of the dark. “Younger babies sleep best in the dark but babies over the age of nine months can become scared and so do best with a night light. But it must be red light; other colours of light, even white, blue or green can stop the production of melatonin, the sleepy hormone. Think about sleep 300 years ago. The only light would be firelight or candlelight, both on the red spectrum of light,” says Ockwell-Smith.
You also need to know about sleep pressure. In adults, this builds up over the course of the day and finally you drift off. But in babies, says Professor Ball, it builds up over shorter periods, around every three hours. This one piece of information, that babies have ‘awake windows’, is life-changing for parents, says Heidi Skudder, founder of Positively Parenthood. A rough guideline is that a three-month-old will have an awake window of 90 minutes. And each month, add around 15 minutes to the window.
Of course, babies will vary. “They change over time,” says Professor Ball. You may find that at four months, for example, as the circadian system comes online, your baby’s habits will alter. “It’s not like a ladder they’re climbing to more sleep. It’s more like a rollercoaster, getting better and worse.” And every time your baby has a developmental transition, such as starting to grasp, crawl, walk, it will disrupt their sleep. But over time, it will gradually improve.
On the flipside, how can you get more sleep? “People often assume that babies should be in bed by 7pm. But baby’s first sleep of the night is often their longest sleep,” says Professor Ball. Try pushing the baby’s bedtime a little later by keeping them downstairs with you, perhaps napping, and bringing yours earlier, she says. By going to bed at the same time as the baby, you’ll both get a good chunk of solid rest.
Alternatively, if your baby is an early waker, they may benefit from going to bed earlier. “This can surprise a lot of parents,” says Skudder. “When babies go to bed more tired, they can produce more of the stress hormone cortisol in the early hours of the morning – and so be more likely to wake up earlier.”
Just like adults, a baby can’t drift off when frightened, frustrated or wound up. “Sleep pressure can only do its job if the baby is in a calm state,” says Professor Ball. But babies aren’t born being able to soothe themselves. “It’s one of the things that develops over time. The main thing that calms babies is physical contact.” Another calming strategy, but one that may feel counterintuitive, is sensory stimulation.
If you take a tired but still awake baby out for a walk, you’ll likely find they fall asleep almost immediately because being in an environment where things are moving and changing dials their stress down. Sensory stimulation also helps build up sleep pressure. “It’s not certain but I suspect it’s to do with the fact that a growing brain expects to receive the kind of intense sensory stimulation you get outdoors,” says Professor Ball.
You can begin to shape your baby’s patterns from as early as a couple of months old, says Skudder, with some low-pressure practice for one or two naps a day. “If you want to start putting baby down in her cot or moses basket, take her into her room, read her a story, put her into her sleeping bag or swaddle, sing her a song, switch the white noise on (if you’re using it). Put her down while she’s awake but sleepy. Stay in the room. Some days she’ll settle easily, some she won’t. If she cries, pick her up and try again. Try for 15 minutes and if she doesn’t sleep, don’t stress. Just put her in a sling and off you go.” Eventually, this can turn into a bedtime routine. “Do the same things in the same order, so the baby can know what’s coming next,” advises Ockwell-Smith. Babies love regularity.
That might be a warm, relaxing bath (but only if the baby likes baths). Do the rest of the routine in the bedroom. “If you read a story, make it the same book every night, so it’s the same words and the same rhythm.”
Once baby is asleep, “do not change anything!” says Ockwell-Smith. That means no singing and talking as they go to nap. If you use sound, play it on a loop and do not worry when people say a baby is getting into a bad habit, for example, being rocked to sleep or having a dummy. “No five-year-olds need rocking and there are no 10-year-olds with dummies. Do what works for you.”
As an anthropologist, Professor Ball’s approach starts with the question: what do they need for their survival? The answer is: you. They can’t regulate their own temperature. They need close contact, for you to feed them and keep them safe. They need you to calm them. They don’t even have any circadian rhythms – babies don’t register day or night – which is why they’re awake in the small hours. ”Parents think they’ve got to make a baby sleep better, or they have to teach her to sleep. But the baby develops all by herself,” says Professor Ball.
Their inner clock begins to form at around three to four months. You can support this by helping your baby to wake at a similar time each morning, then taking them outside because daylight sets the circadian cycle via the eyes. Interestingly, babies who are breast-fed may develop a circadian cycle earlier than bottle fed babies. There’s preliminary evidence that hormones in breast milk vary across the day; more wake-up cortisol in the morning, and sleepy melatonin at night (if you pump, use milk you’ve pumped at night for bedtime).
Another question that Skudder asks is: does the baby have a comfortable gut? It can look as if a baby is waking because they’re hungry when it’s actually due to their tummy. There are obvious signs of allergy, such as rash, hives, vomiting, mucus or blood in the poo – and for those symptoms, you do need to go to a doctor. But reflux, broken sleep, short day naps and early waking are less obvious signs.
She says a second issue that comes up frequently with clients is that more babies now have tongue ties. This makes them gulp in air, which gives them stomach-ache. It also causes them to breathe through their mouth, rather than their nose, which can stop them getting into a deep state.
Once you know baby is healthy and well, then sleep coaching (Skudder’s term for sleep training) may be the next step. This is more gentle than traditional cry-it-out method. “What we are aiming for is baby to be able to settle independently,” says Skudder. This can take from a few days to a few weeks; depending on the approach that’s right for you as a family. With the quicker approach, the parent will put the baby down, pick them up if they cry,
soothe them then put them back down, giving them a chance to settle themselves. If parents want to stop feeding baby to sleep (and baby is the right age to do so), for the first week they might rock them, the second week they might shush and pat them, the third week they will stay next to them. Slowly removing your presence means that your baby will hardly notice the transition.
Brigid Moss is a health writer, editor and co-author, with Professor David Nutt, of "Psychedelics" (Yellow Kite). Follow her on Instagram: @brigidmoss | Further reading: sarahockwell-smith.com www.BasisOnline.org.uk positivelyparenthood.com
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