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Sleep Glorious Sleep!

Sleep is one of my favorite topics. There are so many simple things that can be done to help babies sleep better and safer. Most new parents know that they won’t get a lot of sleep at first, but they don’t always know that they can teach their child to sleep and improve the situation. Most children need to learn to sleep. “Sleep training” has become such a controversial phrase that implies letting a baby cry himself to sleep. There can be a more gentle approach to teaching a child to sleep through the night but it takes patience, consistency and dedication!

One valuable resource for learning about sleep in infants is called Healthy Sleep Habits, Happy Child, by Mark Weissbluth. Dr. Weissbluth is a sleep specialist and he advocates the controversial crying method once problems develop. However you feel about that, the information on preventing sleep problems is where I feel his book has the most value. He discusses the sleep needs of babies at different stages, the need to make sleep a priority (“Respect your child’s need to sleep” is his mantra) and what signs tell you that a baby is sleepy. Most importantly he discusses the difficulty that can arise once a child becomes overtired. Many people don’t recognize that their baby is tired until she is cranky and rubbing her eyes. What is key to remember is that at this point it is much more difficult to get a baby to sleep since the child is already overtired. I’m sure we’ve all had the experience of being so tired that the adrenaline kicks in, our heart starts pumping hard and we get into bed and stare at the ceiling. This happens to babies too and can cause a vicious cycle in which a child is tired, the parents are tired but no one can get to sleep.

Another invaluable resource that I highly recommend is the Happiest Baby on the Block DVD, by Dr.Harvey Karp. He demonstrates a technique for calming a baby that involves the 5 S’s: swaddling, shushing (loudly), sucking (on a paci), stomach hold (not for sleeping of course) and a gentle shimmy type shake (never a strong shaking!) This is only one technique but it works for many babies and can be lifesaving.

The final tool that I think is crucial is White Noise and it should be loud. There are apps, there are CD’s, there are white noise machines and even fans (which help prevent SIDS). The general thought is that the baby heard fluid swishing loudly around its ears for many months and this type of sound makes it feel like it’s still in the womb and it also helps drown out sounds that could wake someone up!

So what is the magic secret? Of course there is no “one size fits all” formula. Here are some tips from the above sources and being a pediatrician for 14 years as well as a parent for 3, that I have found helpful to families.

1. Newborns should not be awake for more than two hours. Generally by about 1.5 hrs, one needs to start the process of putting the baby to bed, whatever that involves. Initially it probably involves nursing or drinking a bottle, rocking and swaddling. The point is to watch the clock and get used to making the sleep habits a priority. I admit this is much more difficult for second or third babies of course, but try to keep the schedule of the infant in mind when planning the day.

2. When a newborn cries at night, you have to attend to it. When an older infant (6-8 weeks) cries, it may not be necessary to go in right away. A mild “complaining” cry may be something that just helps the baby go back to sleep. A sight pause of a few mintues before helping baby out, may be the best help of all in teaching him to get himself back to sleep. Once the crying intensifies, then there may be a need for comfort, food, diaper change that should be met. This technique of pausing before going to the baby is quite popular in France according the book Bringing Up Bebe by Pamela Druckerman and, according to her experience, their kids sleep through the night much earlier than ours do.

3. Along similar lines at about the same point (2 months), it is helpful to start putting the baby down when sleepy but still awake. This is a skill that may take time to develop, and require some tolerance of small amounts of crying, but it is worth the effort.  All people have sleep cycles with periods of wakefulness during the night. If a baby only knows how to fall asleep with the caretaker present, then every time he wakes during the night, he will need that person there to fall back to sleep. If a baby learns to fall asleep on his own he will be able to repeat that as long as there are no other pressing issues, when he wakes normally during the night.

4. Safety is the most important thing. Babies should always sleep on their backs to prevent Sudden Infant Death Syndrome (SIDS). There should be no fluffy bedding like comforters, bumpers, or pillows around them anywhere. The AAP does not recommend anything in the baby’s sleeping space, including the products that are marketed for infants such as reflux inclines wedges. The AAP does not recommend bed sharing, but does recommend room sharing for newborns. Co-sleeping is also a risk for SIDS, increasing the risk by almost three times according to a recent meta-analysis (study that analyzes multiple smaller studies in one database) in Journal of Pediatrics from January, 2012 by Venneman et al. A fan in the room also helps prevent SIDS. It is very tempting to put baby on the tummy or do something else that helps her sleep better, but “safety first” is another good mantra to keep in mind.

5. Another book that many people know is The Baby Book by Dr. James Sears. Again, each book has its value whether you agree with all of its tenets or not. For me the most valuable piece of advice in that book was the concept of “nighttime parenting”. Just because we want a child to sleep doesn’t mean there is an on-off switch. Thinking of the middle of the night routine as parenting rather than as an interruption to my sleep helped me through the rough patches.

6. Recognizing the tired signs will help immensely in getting your child to bed (both for naps and for bedtime) before the adrenaline rush kicks in . When baby slows down kicking her arms and legs around and vocalizing, when the yawning starts and the eyes droop, it’s time for bed!

7. One thing I have found very helpful is developing a routine. Of course the general routine is important but really it’s conditioning the child to fall asleep to a particular song, with back rubbing or patting, or hair stroking, that will help immensely in the middle of the night. Pick one that the child seems to like and stick with it.

8. Babies don’t know the difference between day and night but there are some things we can do to help them figure it out as their brains develop a circadian cycle. Exposing them to light in the morning, at a reasonable wake up time (7 or 8 am) helps them to register “morning” and stimulate melatonin production. In complement to that, keep the lights low at night even with feedings and diaper changes, and try to keep the voices quiet and the mood calm. In other words, 2 am is not playtime!

Every child has their individual temperament and every family has their individual needs. I don’t think there can be a cookie cutter approach to sleep.  Sleep is important, make it a priority, read the books, take what works for you from each and then make your own plan.

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Filed under Newborn care, Sleep, Uncategorized