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Sleep!

A couple of nights ago I hunkered down with my trusty laptop and a bunch of people that I could neither see nor hear (they actually numbered around a thousand!) and chatted about sleep, or, to be precise, the lack of it. This was my 5th Mother&Baby Facebook Live and, as always, it was friendly and fun as well as, I hope, informative and reassuring.

It says something about our cultural expectations that it was the 2nd M&B Facebook Live on sleep and that this is the 3rd blog on the subject (see blogs #4 and #5 for more). We value our shut-eye and guard it closely. We check our clocks on waking to see how long we’ve slumbered and fret before our first coffee hit of the day about how we’ll cope when our precious night has been broken.

When it comes to our babies, the phrase “when will he start sleeping through?” enters our vocabulary at about the same time as our stitches heal and the visiting frenzy tails off. Books line the shelves promising to show us how we can train our babies to sleep more, to get into a routine, to self-soothe before they have even had their births registered! So we expend vast amounts of emotional energy searching for the secret to getting our babies to sleep from dusk til dawn without disturbing our beauty sleep.

Now, of course, humans have evolved over millions of years and, despite our little individual quirks and unique personalities, we’re actually all a pretty standard model – we all eat breathe, poo and sneeze in much the same way, have a head at the top end and toes at the other and hit developmental milestones along a surprisingly similar curve. How we, as humans experience and develop sleep patterns is also staggeringly similar, and understanding the fundamentals can shed some light on how we can support our babies and children to gain good sleep hygiene and social behaviour around bedtimes.

Your baby comes to you hardwired for survival and with the evolutionary “expectation” that mum will be a pretty instinct-driven cave woman. The hormones which give us our circadian rhythm and different sleep states are deregulated under about 4 months of age and the similarly deregulated autonomic nervous system (see blog #5) ensures that your little one spends many hours each day, and certainly most of the night, snuggled safely in your arms or suckling. Despite your 21st century sensibilities and the insistence of books and relatives that you should stop picking her up, your baby’s cries dig deep into your primitive soul and twist it until you respond, again and again and again.

Your newborn’s sleep is made up of lots of power naps – she suckles whilst dozing on and off, then falls deeply asleep in your arms for half an hour or so before waking up, refreshed and ready to spend more time being rocked, patted and suckled. She can sleep anywhere, as long as it is in arms!

Those parents who learn to trust evolution, relax, and spend their time honing their soothing strategies rather than attempting the impossible (and potentially risky) task of “teaching” their tiny baby to learn to be alone, find that life is far less stressful and far more conducive to a happy home life. They know that, in time, their baby will follow a human developmental curve and sort their sleep out.

From the very end of the third month the hormones and body systems which govern human sleep start to coordinate and settle and the erratic power-naps of the newborn are gradually replaced by sleep cycles. It is this emergence of cycles which puzzles parents – they expect that their teeny tiny should be starting to “sleep through” (after all, that’s what the books and your mother tell you) but nights now seem even worse: your baby wakes every hour and cannot resettle without a lot of help from her parents.

So let’s get this straight – none of us sleeps through! There, I’ve said it …

We all wake at quite frequent intervals through the night and then doze back off again. Some of us remember these wakenings (I certainly do), and some don’t. But we all have them. Each cycle is made up of different types of sleep, including deep sleep and dream sleep (R.E.M. sleep) and we need to go through the deep sleep part of the cycle in order to feel refreshed. Even those of us who feel we are plagued by insomnia actually do achieve enough sleep to survive – it is as basic as breathing.

What marks babies out as different from adults is that they need support to get back to sleep after each wakening. They can’t self-soothe. Developing the ability to self-soothe takes time and experience and, until around the six-month mark, babies are not even developmentally able to learn how to self-soothe. This is good news! You can simply stop worrying about what you should be doing to sleep-train your baby and just do whatever you know works best for him. He can’t learn good habits for sure, but this also means that he can’t learn bad habits.

Between three and six months, as the sleep cycles gradually emerge, babies also start to show distinct sleepy cues. Typically these are nose-rubbing, eye-rubbing, ear-pulling and tired noises. Parents always spot them but often don’t realise what they are.

From around six months, babies start to develop the ability to get into routines and self-soothe. But they still need help and support from their parent.

So, what CAN you do?

Well, for the first three to four months, simply soothe your baby whenever he needs it in whatever way works best. More often than not this involves rocking, patting, white noise and, of course, suckling. Certainly arms will always work in a way that a crib cannot. What you do so beautifully during these intense months is give your baby the experience of what it feels like to be distressed … and then soothed. This will set the groundwork for him to develop his own self-soothing strategies in due course. You see, the only way a baby can confidently soothe themselves is if they know how it feels to be soothed. So soothe away without the guilt and anxiety that usually pervades and poisons the parenting space.

Months four to six are about patience and watching as the changes take place. Many parents find that safe co-sleeping returns (if it ever went away!) as the only way for everyone to get any rest whilst the littlest member of the household, beset by changing systems, wakes almost every hour. Try to learn your baby’s unique sleepy cues and, as soon as you see them, start soothing your baby to sleep and continue to soothe, in whatever way works at that moment, until she has had a full cycle (this will lengthen gradually over the months from as little as half an hour, up to a couple). Some babies start to prefer a quieter, more still space to nap and sleep so try to be sensitive to these emerging needs and fulfil them as best you can.

From around six months, you should start to see distinct nap and bed times emerge. Generally the first sleepy cues of the day show about one and a half to two hours after the start of the day and then again after the same interval from the end of the first nap. Babies can often go two to three hours in the afternoon before showing sleepy cues and they often have a very late nap at around 6-7pm which parents mistake for bedtime. Bedtime itself is often around 9pm and this will move earlier as the year goes on.

At this point you get to choose: carry on providing the soothing strategies for your baby or set about giving him the opportunity to discover his own. Whatever you decide is not written in stone (you get to change your mind as often as you wish – it’s a parent’s prerogative!), and it doesn’t define you as a parent or person.

If you want to remove a soothing strategy (maybe you no longer want to offer the boob at every overnight wakening) then, until your baby can self-soothe, you need to replace it with another. That might be picking your baby up and patting him, or offering a dummy, or hauling him into your bed to snuggle down to safely co-sleep (for useful links, see below).

If you choose to give your baby the opportunity to develop self-soothing strategies, then you will need to gradually remove your support over a period of weeks or months and give your baby just enough space and time alone to find what he can do to get himself to sleep, but not so much space and time that she is overwhelmed (never a good way to learn).

In time, your highly-evolved human will learn that, in your house, people repeat the sleep needs of other people and sort themselves out at night rather than waking the whole household! This takes time and patience but she will get there. After all, she is only human …

NOTES:

  1. Chapter 10 in my book “Your Baby Skin To Skin” covers both these approaches in detail if you want to explore a little more deeply.
  2. Safe co-sleeping advice:
    CLICK THIS LINK to read the parent information leaflet on caring for babies at night from UNICEF babyfriendly.org and then …CLICK THIS LINK to read information to healthcare professionals from about the evidence behind the leaflet.
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Ask Rachel – Sleep

There is, we are told, nothing new under the sun and, in my work, it seems to be true. Women worry when their baby sleeps too much and they worry when they sleep too little; they fret when their little one suckles all day and then fret all over again when they barely give the boob a second glance. Women worry and always have done. Women call this “being neurotic” or “ridiculous” or “silly”. I call it being conscientious.

Every now and then, as an aid to all those conscientious mums and dads out there, I will fill my blog page with some answers to the most common questions that come my way on a daily basis, always accompanied by “you’ll think I’m being silly but …”

Today’s questions are about sleep.

Q. When will my baby “go through the night?”

A. This must be the number one question. The fact that everyone asks this should tell you that every young baby is keeping her parents up half the night!

Babies lack the hormones that help us sleep in the way we do and these do not start to kick in until the third to fourth month and then continue to be erratic for some years. Now, let’s be clear, no-one sleeps through the night. All adults sleep in cycles of around about 1.5-2.5 hours and each sleep cycle is split into bits of light sleep, R.E.M. (dream) sleep and deep sleep. We wake at the end of a sleep cycle and then return back to sleep for the next cycle. Some of wake fully in between cycles and remember these wakenings and some of us don’t wake so fully and then don’t remember in the morning. These lucky people think that they have slept right through. As one of the former, married to one of the latter, I know that my bloke wakes repeatedly through the night, bothers about and grumbles for a while, punches his pillow into submission and then drifts back to sleep. He believes that he sleeps soundly, unbroken for eight hours.

When you wonder when your baby will sleep through the night, what you really want to know is: “when will she do whatever she needs to do through the night without telling me about it?” It seems that very few babies are able to self-soothe and, until about 5-6 months old, a baby is unable to learn a routine or habit (when you think you have taught your young baby a routine, you’re just having a few lucky throws of the dice, or have a naturally settled baby).

After 5-6 months, you can, if you wish, start to use a sleep-training strategy and, whichever one you choose, you have a good chance of your baby developing self-soothing strategies. However, every time your baby cuts a tooth or has a cold or visits granny etc, expect the routine to slide and you will have to re-train. If you choose to go with the flow then it really doesn’t matter because all babies, whether sleep-trained or not, become more reliable at leaving her parents alone at night at the same age – about five years old.

Q. Why is there so much conflicting information about co-sleeping?

A. Quite simply because there is so much conflicting evidence. It is very hard indeed to find evidence that only looks at safe co-sleeping (see below) and, because numbers of SIDS and co-sleeping deaths are so low, analysing data can be tricky. Furthermore, because so few women exclusively suckle their babies, the info has to be geared to the general population who happen mostly to mixed or exclusively formula feed. On top of this, frustrating as it is, most health care professionals do not choose to specialise in infant feeding and so their attention is elsewhere and they may not keep so informed as those whose anoraks are clearly labelled “infant feeding geek”!! If you like to read studies, here is a link to the evidence on the topic of where babies sleep from the “Born in Bradford” study.

So what do you need to know? Firstly, babies aged 0-4 months do more suckling between 5pm and 5am than between 5am and 5pm. Not more feeding, just more suckling. There are good evolutionary reasons for this – of course, anything that affects all babies must have an evolutionary basis for protecting survival. The drive to suckle keeps a baby skin to skin where the heart rate, breathing, reflexes, temperature, gut and infection control are all brought to normal (remember that small babies are unable to regulate these things). Furthermore, suckling protects the rather odd sleep that, in turn, protects against SIDS. Being driven to stay close to mum in the darkness hours is an evolutionary survival strategy to protect a baby from cold, hunger and predators during the hours of pitch-dark at the equator where the sun dives below the horizon at 6pm and rises with the larks at 6am.

Mums, on the other hand, have evolved to nod off to sleep when they suckle at night and the sleep of a suckling mum is hormonally altered to maximise her deep sleep whilst ensuring she is hyper-protective of her baby. Fighting evolution is a fool’s errand. Millions of years of evolved protective strategies are not easily overcome. This is why mums who nurse their babies find that they end up co-sleeping by accident.

If you are exclusively feeding your baby on your own mum’s milk (suckling or expressing) then, because you are evolutionarily driven to nod off when you hit night-time suckles, always lie down to suckle (or for night-time cuddles) and, because you may well nod off in spite of your best efforts, ALWAYS prepare for safe co-sleeping even if you plan to put your baby back into his crib – better to be safe than sorry. Safe co-sleeping: make sure you are sharing a firm mattress (not a waterbed or very soft, squidgy mattress) bring baby in skin to skin with you; have baby under your own light covers (a summer duvet or comfy sheets and light blankets) and pin the covers under your elbow to prevent your baby’s head getting wrapped; don’t try to limit your baby’s movements by pushing the bed against a wall or putting a pillow behind his back or tucking in the covers around him; no-one in the bed should have been smoking or be drunk or drugged; never leave baby in bed if you are not there (your partner will not be hormonally altered so will not naturally protect baby). Finally, NEVER risk falling asleep with your baby on the sofa. This is dangerous.

If you are formula or mixed feeding, or do not want to co-sleep, then still prepare for safe co-sleeping if bringing baby into bed for soothing, but set an alarm on your phone to vibrate after 30-40 minutes so that, if you nod off despite your efforts, you will quickly wake-up and be able to put your baby back in his crib. Now, of course, he has a cave brain and so he will simply wake after a little while as his evolutionary survival strategies kick in and send him howling back into your arms. Such is life with a little baby!

Finally, remember that the risks people are talking about when co-sleeping is discussed are not to do with SIDS : SIDS is sudden and unexplained. It is a worry about accidents in the bed such as over-lying. Women who exclusively feed their own mum’s milk are, as we have seen, so hormonally altered that they behave in a very different way at night compared to other adults. The evidence that these hormonally-changed mums will cause harm to their babies when co-sleeping in the way described is not available. Can you ever reduce your baby’s risk to zero? No. But remember that giving your baby your own milk reduces the risk of SIDS by up to 50% and that safely co-sleeping for the purposes of suckling appears to lead to better weight gain in babies, better sleep for both parents, more months of baby getting mum’s milk and so a reduction in all the risks associated with giving formula.

As adults, we have to look at the available evidence (as conflicting as it can sometimes be), consider our own lives and stresses, assess our own actual risk and our perception of risk and then make an informed choice, accepting that no choice is risk-free.