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Night Waking: or, Will I Ever Get a Good Night's Sleep Again?
by Anne Smith, IBCLC
The answer is "no". Once you become a mother, you will never, ever sleep the way you did before you had your baby. Even when he starts sleeping through the night, which will happen eventually (I promise), you will always have your mom radar on and will be listening for a cry in the night. Even if he is a teenager out on a date, you will lie in bed waiting for his car to pull in the driveway before you can fall asleep. When he is middle aged and balding, you will still worry about whether he is taking care of himself the way he should.
The question "When will my baby start sleeping through the night?' is one that I dread the most. Like most health professionals, I like questions that have easy answers, and this one doesn't. I do have opinions about how to handle sleep problems, based on my experience with nursing six children, and over twenty years of working with new mothers. What I don't have is a quick fix, or a magic solution for you that will make your baby sleep through the night.
'Experts' can't even agree on what sleeping through the night means. Some define a five-hour stretch as sleeping all night, others define it as an eight to twelve hour stretch. Sleep problems are a hot topic. There are dozens of books and hundreds of magazine articles on how to get your baby to sleep longer. In our culture, a 'good' baby is defined as one who sleeps a lot and demands as little attention as possible. If you define sleep problems the way many experts do, then almost all babies have some sort of sleep problem.
So what is a 'normal' sleep pattern for a nursing infant? Anthropologists have found that in cultures where breastfeeding is common, babies nurse frequently during the night and sleep close to their mothers. The low fat and protein content of human milk, and the small size of a newborn's stomach indicate that human babies were meant to feed frequently during the day and the night. Mammals who live in burrows such as rabbits and foxes and leave their babies for long periods of time to forage for food have milk that is higher in fat and protein so that their babies will stay full for longer periods of time while they are separated from their mother. Formula is harder for babies to digest, so it stays in their stomachs longer and they don't need to eat as often as breastfed babies. Because it is harder to digest, it also causes more digestive problems such as gassiness and constipation.
The human infant is the least neurologically mature primate at birth and develops the most slowly. It is born with only 25% of its brain volume. Anthropologists feel that frequent feedings and close proximity to the mother, with her sounds, smells, movement, and body heat are important to the immature infant's development. Having babies sleep away from their mother for long periods of time (the norm in this country) is a relatively recent cultural development, and the biological and psychological consequences have never really been evaluated. It may be that what we define as normal is not really normal at all.
When we look at infant's sleep patterns, we find that babies are not miniature adults, and they sleep differently from adults. There are two main stages of sleep: active, or light sleep (also called REM, rapid eye movement), and quiet, or deep sleep. REM sleep begins in the womb. During REM sleep, blood flow to the brain is higher, dreaming occurs, and brain development is stimulated. The younger the human being, the greater the percentage of time is spent in REM sleep. A fetus has nearly 100% REM sleep, a full-term newborn about 50%, a two year old 25%, adolescents and adults 20%, and the elderly 15%. The periods of REM sleep are greatest during the time when humans are sleeping the most and their brain is developing rapidly.
Babies need more REM, or active sleep than adults. For the first three months, babies spend 45-50% of their sleep time in REM sleep, 10-15% in transitional sleep, and 35-45% in quiet or deep sleep. This high percentage of active sleep in infancy will gradually decrease to adult levels by the time the baby is two or three years old.
Babies have shorter sleep cycles than adults. A sleep cycle is the total time spent going through both active and quiet stages of sleep Adult's sleep cycles last about ninety minutes, and periods of active sleep occur about four times a night. Babies sleep cycles are half as long as adult's, and they have twice as many periods of active, or light sleep. When a baby is moving from a quiet into an active state of sleep, he is most easily aroused.
The way a baby falls asleep is also different from an adult. Adults usually go quickly from being awake to being deeply asleep, without going through a period of active sleep first. Babies usually go through an initial period of light sleep for about 20 minutes, then enter a period of transitional sleep, and finally fall into a deep sleep. If a baby is disturbed by a noise or touch during the initial period of REM sleep, or during the transitional stage, he will reawaken easily because he hasn't had time to enter deep sleep yet. That explains why some babies appear to be asleep, but wake up as soon as you lay them down in their crib, and also explains the baby who cat naps for fifteen minutes, then wakes up as soon as you try to move him.
A baby has no concept of day and night. Adults have been conditioned to stay awake during the day and sleep at night. The typical sleep pattern for infants is to sleep during the day and be awake more at night. For the first few months, most babies will sleep 14-18 hours each day without regard to the difference between day and night. His sleep patterns are similar to his nursing patterns :small frequent feedings and short frequent naps. Most newborns seldom sleep more than three or four hours at a time without waking up for a feeding. In rare cases a baby may sleep through the night (defined as a five hour stretch or longer) by ten days, but most babies don't do this until three months or later. Waking up once, twice, or three times during the night is not uncommon. Between one third and one quarter of all babies will continue to wake up during the night even after they are a year old. If you are one of the few mothers who has baby who sleeps through the night early, count yourself lucky, but don't think that it's because of anything you did or didn't do right. Don't brag about it too much, or two things will happen: your friends with babies who don't sleep through the night will hate you, and your next baby will probably not sleep at all just to even things out.
Babies often have their days and nights mixed up, but they soon learn that mom is in a much better mood, and life is more interesting during the day than in the middle of the night. Often older babies who had been sleeping long stretches at night will start waking more frequently when they begin teething, and also when they begin to deal with separation anxiety and need to be reassured that their mom is still there.
OK. Now you know some of the reasons why babies nurse so often during the night. But what do you do if your baby is keeping you up all night and you are suffering from sleep deprivation and ready to strangle someone? Let's discuss some coping mechanisms.
First, I suggest co-sleeping. This doesn't have to mean that your baby is in the bed with you all the time. It just means keeping him close by during the months when he needs night-time parenting. He may sleep in a cradle next to your bed, in a crib in your bedroom, on a pallet on the floor, or tucked in next to you in your bed. He may spend part of the night in bed with you, and part in his own bed.
Co-sleeping offers many advantages. Babies tend to sleep better tucked in close to you. Breastmilk contains a sleep-inducing protein, and when you nurse, prolactin enters your bloodstream and has a tranquilizing effect on you as well. When your baby is in another room, he has to become fully awake in order to fuss or cry loudly enough to get your attention. By the time you get up and go to him, you are grumpy and groggy after being awakened from a deep sleep, and it will take longer for both of you to get back to sleep. If he is in the room with you, you can nurse him as soon as he begins to make the transition from deep sleep to active sleep, and neither of you has to wake up completely. How you feel in the morning depends more on how you are awakened more than how many times you are awakened. I remember nights when I couldn't have told you how many times the baby nursed, because I never woke up enough to count.
Another advantage is that babies tend to grow better if they are nursed throughout the night. Some researchers think that the skin- to-skin contact involved in shared sleeping may stimulate the production of more growth hormone in the milk. This has been found to be the case in animal studies, and possibly in humans as well. We do know that the mother's prolactin levels are higher during the night, so more milk is produced when the baby suckles. We also know that growth hormones are secreted more during the night in babies. If babies are meant to grow during the night, it makes sense that they are also meant to eat at night.
One reason many mothers are hesitant to tuck their babies in bed with them is that they are afraid they will roll over on them. Mothers have been sleeping with their infants for millions of years without squashing their babies. When you hear a news account of this happening, it almost always involves a parent who is drinking or taking drugs.
There is some very interesting research about SIDS (Sudden Infant Death Syndrome), breastfeeding, and co-sleeping. This tragedy strikes approximately two of every thousand babies, who die in their sleep with no apparent cause. Most SIDS deaths occur between 2 and 6 months of age, with the peak occurring at around 10 weeks. Numerous studies have shown that not breastfeeding is a risk factor for SIDS. We also know that babies should sleep on their back or side, rather than on their stomach, to reduce the risk of SIDS. Co-sleeping may reduce the risk of SIDS because some babies don't wake up when they have periods of apnea (not breathing) especially during periods of deep sleep. The peak age for SIDS is around the time that babies often start spending a larger period of their time in deep sleep. Babies who sleep with their mothers spend more time in REM sleep and are aroused more often by her natural breathing and movements. Since SIDS is related to a diminished arousal response in some babies, sharing sleep and night nursing may help reduce the risk. While more research is needed, it is clear that breastfeeding your baby reduces the risk of SIDS, even if we aren't exactly sure of all the reasons why. Make sure that when you are done nursing, you lay the baby on his back or side, and not his tummy. It is also important not to lay him down and leave him on a soft surface, such as a beanbag chair or a waterbed. Sleeping face down on soft surfaces like these has been linked to a higher incidence of SIDS. By the time most babies have learned to roll over on their own, they are usually past the peak age for SIDS.
A note about co-sleeping: Dr. Sears says that although babies should not sleep on their stomachs, an exception can be made for the baby sleeping on mom or dad's chest.
During the early months, many babies enjoy nestling to sleep on their tummies. This is perfectly safe unless you are under the influence of alcohol or medications, are extremely obese, or are a very heavy sleeper.
When you are ready to lay the baby down, be sure to put him on his back.
Another reason many mothers are hesitant to sleep with their babies is that their doctors advise them not to. While I have the utmost respect for the medical profession, many mothers are not aware that doctors are trained in diagnosing and treating illnesses, not in parenting styles. Decisions about where your baby sleeps and when to wean him are not questions that involve medical expertise. These are areas where following your own instincts is more important than taking advice from someone who has no biological attachment to your baby, and doesn't know him nearly as well as you do.
Some couples are afraid that having a baby share their bed will ruin their sex life. Having a baby, period, has all kinds of effects on your energy level as well as your libido, regardless of where he sleeps or how he is fed. Parents become very creative as they find ways to make love in other rooms, or move the sleeping baby into another room temporarily. It is always a challenge to find private time as a couple once you have children, but it is possible to make it work.
In my own experience with nursing six very different children, I have found a wide range of sleep patterns. The first three all slept through the night and moved into their own rooms early, and took long naps at predictable intervals each day. They also all had security blankets and sucked their thumbs, so they were 'self-soothers'. I made the mistake of thinking that all my babies would be great sleepers. Wrong. The next three required very little sleep, nursed during the night till they were several years old, and took little 15 minute naps on the way to the grocery store and were still wide awake eight hours later. All my babies were breastfed on demand and started out sleeping in bed with me, but had very different sleep patterns. I have to believe it's biologically pre-ordained. I've never understood why we expect babies to follow a certain sleep pattern, but not adults. Everyone knows that some people require a lot of sleep and have to get their 8 hours or they can't function, while others do fine with 5 hours. Some people are light sleepers, some deep. Some people sleep better curled up close to their partner, some like to have their own space and have trouble sleeping if anyone is touching them.
I was always one of he people who needed lots of sleep, and wanted my own space to sleep in. I learned when I had night waking babies that I could survive on less sleep than I ever thought possible. I also learned to share my bed with wiggly little bodies, and a cat or dog as well. The important thing I learned is that all my babies eventually moved on into their own beds. Now and then, one of my little ones will still crawl in bed with me in the wee hours to cuddle. I remember nights when I wondered if I would ever have the bed to myself again, and now I think back on that time nostalgically. Children really do grow up fast, and I'm glad that my babies had to opportunity to move into the separate bedroom stage at their own pace.
This is probably a good time to mention a popular parenting program distributed by Growing Families International (GFI) that contains a lot of misleading and inaccurate information about infant feeding and sleeping practices. Gary and Anne Marie Ezzo have written Preparation for Parenting, a religiously based infant management program distributed through churches and the mail, and On Becoming Babywise, the same program with the religious references removed, and distributed through the mail and in general bookstores. These books have reached the parents of over half a million babies. Over 3,500 churches in North America use the Ezzo's curriculum, as well as churches in 35 other countries. Neither of the Ezzos are child development experts, pediatricians, or Lactation Consultants, but their books offer a ton of advice related to infant feeding and sleeping practices which is not only inaccurate, but can lead to serious medical problems. For example, they question the practice of putting babies to sleep on their backs as a deterrent to SIDS, and imply that babies might be better off sleeping on their stomachs. This clearly contradicts the AAP and other researcher's findings. The Ezzos advocate rigid parent directed feeding schedules for nursing babies, rather than feeding on demand. Health professionals across the country are very concerned about the number of babies who are becoming dehydrated, are growing and developing too slowly, or are "failing to thrive" while their mothers are following this program. The Ezzos also recommend letting babies 'cry it out', using the analogy that because Jesus' Father didn't answer his cries while he was on the cross, we as parents should follow His example and let our babies cries go unanswered.
Regardless of what your religious beliefs are, I feel that the Ezzos philosophy of childrearing is not only scientifically inaccurate, but actually harmful to baby's physical and psychological well-being. Unfortunately, parents are so desperate to have a "good" baby who sleeps for long periods of time that they want to believe that the Ezzo's practices work, and that following their advice will help them gain control over their baby's "sleep problems".
The Ezzos are not the only 'experts' out there writing books that tell us how to get our babies to sleep. The advice they offer falls in two general categories: the hard line approach, involving letting the baby cry himself to sleep, restrictions on night feedings after a certain age, and prohibiting the baby from falling asleep at the breast or in his mother's arms; and the more nurturing approach which involves getting to know your baby's individual sleep patterns, and gently helping him get to sleep until he matures enough to fall asleep on his own. I'm sure you can tell that I believe in the more gentle, baby-centered approach. I have never believed in letting babies cry it out. A little fussing or whimpering is one thing, but frantic, hysterical screaming is another. I have never understood why babies are expected to understand that when they cry at two in the afternoon, mom rushes over to comfort them, but when they cry at two in the morning, their cries go unanswered. I do believe that if you let a baby cry long enough, he will eventually wear himself out and go to sleep. I
wonder what lesson this is teaching the baby about trust. Trust in the people who love and care for him is the infant's first lesson in life. There is plenty of time for him to become independent after trust is established.
The majority of books on babies sleep patterns take the hard line approach. These books are everywhere and easy to find. If you are interested in finding out more about the more gentle approach, try a book called Nighttime Parenting by Dr. William Sears. He is a well-known pediatrician who is married to a lactation consultant, and has eight children of his own. He has written many books about attachment parenting, including The Fussy Baby. His approach just might be right for you and your family -- check it out.
Here are some suggestions on how to encourage your baby to sleep and stay asleep (and to help you cope if he doesn't):
- Try to nap when your baby naps. Avoid the temptation to unload the dishwasher or fold a load of laundry while he naps. Those chores can be done later, and maybe you can even get someone to do them for you. Learning to nap during the day can be an important survival technique to help you make it through the newborn period.
- Create bedtime routines and parenting-to-sleep routines. Since few babies are able to fall asleep by themselves during the early weeks because they have to go through a period of active sleep first, it helps to gently help him settle down by nursing, rocking, taking a warm bath, or lying down together.
- Find a sleeping arrangement that works for you, preferably one that keeps baby close by. You may keep him in your bed, in a cradle next to your bed, or in a sidecar attached to your bed. If he is in another room, make sure you have a baby monitor so you can respond to his hunger cues quickly.
- Have everything you need right by your bed -- extra pillows, book to read, remote control, diapers, wipes, towel or cloth diaper to absorb leaks, nursing pads, pacifier, change of clothes, extra crib sheets, etc. You want to make sure you don't have to get up and stumble around looking for stuff while you are half asleep.
- When you feel that he is fully asleep and you put him down in his bed, sometimes he will wiggle and squirm, letting you know that he isn't in a deep enough sleep to be left alone. Pat his back or bottom until he settles down, and remove your hand gradually until he settles into deep sleep.
- Play soothing music. I'm not a big classical music fan, but found that classical medleys put both my babies and me to sleep. There are special tapes on the market made just to help babies sleep.
- Create a quiet, dark, un-stimulating environment. Keep distractions and interactions to a minimum so that your baby won't be tempted to stay awake and play.
- Read his cues and respond quickly. If you catch him while he is moving from deep sleep into light sleep, you can often gentle him back to sleep by patting or nursing before he wakes up completely.
- Be aware that some babies wake for night feedings because they don't feel good. Urinary tract infections, earaches, stuffy noses, teething, and allergies can all affect babies sleep patterns.
- Don't buy into what Dr. Sears calls the "Fill'-Em-Up Fallacy". Many mothers believe that if they stuff their baby full of cereal or milk at bedtime, he will sleep through the night. Unfortunately, it's just not that simple. If that's all it took, then we'd all do it and there wouldn't be all these books about how to get your baby to sleep. Feeding solids before a baby is ready (and most breastfed babies aren't until six months or later) can cause digestive problems and allergic reactions. Study after study has shown that feeding solids at bedtime does not make babies sleep longer. They wake up because their sleep cycles are different from adults, not just because they are hungry. That's one reason they usually don't nurse for as long during the night as they do during the day -- they're nursing more to put themselves back into a deep sleep than they are because their tummy is empty. This is especially true of older babies.
Above all, be patient and try to keep your perspective. All babies eventually learn to sleep through the night, and become more independent during the day as well. Before you know it, the baby you thought would never move out of your bed will pretend he doesn't know you when he is in front of his teenage friends. Enjoy the fact that you are so important to him now, and take pride in his independence, because your loving care and attention to his needs has made it possible.
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