Tuesday, April 28, 2015

Sleep and Babies


I get a lot of questions about sleep. Moms often ask, "How can I get my baby to sleep longer." First an foremost, there are no majic answers. I have no majic bullet solution. However, after doing some research, this is the best set of advice I can pass on to moms. I'd highly recommend Elizabeth Pantley's book, The No Cry Sleep Solution, available here.  Much of the advice I will pass on below comes from her book. Some comes from my own expereince with my 2 girls, as they grew up.
  1. Make sure baby is nursing/eating as often as possible during the day. Feed on demand is the bottom line. Be generous in offering time at the breast, if breastfeeding. The fuller baby is during the day, the better they will stretch out sleep at night. When your baby clusterfeeds in the afternoon and nurses every 45 minutes to an hour, they are ramping up to a longer set of sleep at night. Let them nurse when they are hungry.
  2. Establish a good night time routine and stick with it.  This becomes important as baby is about at that 3-5 months old. Now is a good time to start routines that will last well into childhood. We got to a point where we wrote it down and followed it religeously. You can tweak this as needed, but here's a sampling:
    1) start early... many times parents put baby down way too late. We always started bedtime routine at about 6pm and had baby down by 6:30 or 7pm. If you keep baby up later than their body needs, they get overtired and often fight it. EARLIER IS DEFINITELY BETTER.
    **turn down lights, turn off tv, quiet the household
    2) Bath
    3) Wash/brush gums/teeth
    4) books
    5) Last nursing
    6) rock/cuddle with music - wait until baby is in deep sleep, eye movement is done, when you lift an arm, it falls back limp and does not stir baby awake
    7) lay down to sleep

    This is a sample. Add in or take away things as needed. But notice, the rocking or cuddling after can get baby relaxed without boob in the mouth. As our kids got older, we'd add in an opoprutnity for bathroom, drink/snack before teeth brushing.
  3. Put baby to bed at the same time each night, without fail, no exceptions. We should ALL do this to improve our sleeping. Same time to bed solidify's the body's internal clock for sleep and wake times.
  4. Have Dad (or other care provider) put baby down at night after the last nursing. This became helpful for us. Be patient. It may mean you taking a walk while this is happening. It will allow baby to relax without needing to be attached to your breast.
  5. Employ music or other auditory cues when winding down to sleep. We used the same CD each night and I think it helped as a auditory cue for sleep. Think pavlov's dogs.
  6. Calm the household and shut down other media 1/2 hour to an hour before bed.  I'm preaching to myself too. I think we would all sleep better if we shut off electronic devices about 1/2 hour to an hour before bed. I do not follow this. I also do not sleep well. A friend was telling me she started removing electronics from her bedroom, tv, phone, computer, and it has helped her sleep. This might be a good thing to try. I think our kids feed off of our energy. If we are 'wired' they are 'wired'. If we are stressed, they are stressed. Maybe a media break beofe bed would help the household sleep better.
  7. READ, READ, READ.  We know how good it is to read to children in their early childhood. It is so important and positive in brain development and reading-skill development. It also helps with sleep. Reading from real books (not tablets) helps wind down the brain. It gives the brain a focal point. Make sure books are part of your bedtime routine. It's good for sleep and intellectual/brain development.
  8. Make sure baby is napping enough during the day. Establish napping routines as you have done with nightime routines. Full disclosure, we were failures at this. But in an 'ideal' world, you'd establish regular and predictable napping opporunities. These can be approximate nap times, but based on what baby is doing at the time. At 4/5 months, baby usually has 2-3 morning/afternoon naps. By about 1 year to 18 months, that switches to one afternoon nap. Have a napping routine, similar to the nightime routine. For a couple of days, record sleep patterns. Try to encourrage sleep when they are regularly sleepy with that nap routine/ritual. My kids always napped with me, 9 times out of 10, which is generally not encourraged, but do what works for you. I know moms who were religious about naps and routines, and they had good nappers. Same concept, set up a good and structured, predictable routine, the body responds. Being rested during the day helps. If they are overtired at night, it is harder to relax into sleep, which is counterintuitive, but a well supported piece of evidence in sleep studies. Sleep, play, nap is often a repeated pattern several times throughout the day.
  9. Understand a normal baby's sleep patterns. This is from Elizabeth Pantly's book, The No Cry Sleep Solution. It goes to show how often baby naturally wakes at night:

    Typical sleep cycling of a baby:
    Drowsy, falling asleep
    Light Sleep
    Deep sleep (for about an hour)
    Brief awakening

    Deep sleep, for about 1-2 hours
    Light sleep
    Brief awakening

    REM (Rapid Eye Movement): dreaming sleep
    Brief awakening

    Light sleep
    Brief awakening

    REM sleep: dreaming sleep
    Brief awakening

    Toward morning, another period of deep sleep
    Brief awakening

    REM: dreaming sleep
    Brief awakening

    Light sleep
    Awake for the day
    The takehome message with this is, it is NORMAL for baby to wake during the night. We all do. Taking away some sleep associations is helpful (i.e. always nursing back to sleep, esepcially if cosleeping is not practiced). Putting baby to sleep when you can sleepy, but not fully asleep can help. If baby heavily resists this, you need to either try another option... wait till baby is in a deep sleep to transfer them. Or, you can try putting them down and rubbing their back a bit to get them to ease back to sleep. Honestly, it's a little bit of trial and error to see what works best. There is no one majic-bullet answer.
  10. It's the total amount of sleep that matters. Understand what your baby needs based on their development.  Finally, this is from Elizabeth Pantley's book-- a list of 'average sleep hours' for different ages. Take this with a grain of salt. Babies will differ from each other. But I've heard many an expert say babies need about the same total hours of sleep a day, they just break it up into chunks based on their body's needs. Use this as a guide:

    1 month, 3 naps, 6-7 hrs of total nap time, 8 1/2-10 hrs of night sleep, 15-16 hours of total sleep per day

    3 months, 3 naps, 5-6 hrs of total nap time, 10-11 hrs of night sleep, 15 hrs of total sleep per day.

    6 months, 2 naps, 3-4 hrs of total nap time, 10-11 hrs of night sleep, 14-15 hrs of total sleep per day.

    9 months, 2 naps, 2 1/2-4 hrs of total nap time, 11-12 hrs of nightime sleep, 14 hrs of total sleep per day

    12 months, 1-2 naps, 2-3 hrs of total nap time, 11 1/2 -12 hrs of nightime sleep, 13-14 hrs of total sleep.

    2 yrs, 1 nap, 1-2 hrs of naptime, 11-12 hrs of night sleep, 13 hrs of total sleep per day

    3 yrs, 1 nap, 1-1 1/2 hrs of naptime, 11 hrs of night sleep, 12 hrs of total sleep per day

    4 yrs, 0 naps, 0 naptime hrs, 11 1/2 hrs of night sleep, 11 1/2 hrs of total sleep per day

    5 yrs, 0 naps, 0 naptime hrs, 11 hrs of night sleep, 11 hrs of total sleep per day.