Understanding Sleep & Babies

The following is a number of excerpts taken from “Silent Night’s” by Brian Symon copyright permission granted. 

“There is a myth that says, ‘that the more tired children are the quicker they will go to sleep’.  Parents know that this is not true.

“The following points are simple and useful guides in parenting.

• Children who are sleeping well go off to sleep most easily.
• Tired children are difficult to get to sleep.
• Overtired children are very difficult to get to sleep

What I will do is try to explain why it is so.  Falling asleep is in part cue dependent and that this element of sleep achievement is learned.  Now, if going to sleep is a learned skill, then it should behave like other learned skills.  And it does.

Tiredness interferes with learning new skills.  As we become more tired it becomes harder for new skills to be learned.  As children become more tired they have more trouble performing their first learned skill.  This is the skill of achieving sleep.  The tired child has trouble achieving sleep.  The very tired baby has great trouble achieving sleep.  The reverse of this situation is also true.  The baby who is well rested is better able to perform a learned skill.  Thus the baby who is ready for bed but has not yet become overtired achieves sleep efficiently.  In addition, the more often the baby achieves sleep in a given situation the sooner those cues are learned.  Just as we learn our alphabet and our tables by repetition, so repeated exposure to certain cues of sleep achievement helps their being learned.

The better the child sleeps the better he sleeps. 

The worse the child sleeps the worse he sleeps.

I do not find many men who have experienced profound fatigue. Unfortunately a reasonable number of the mothers whom I see have experienced it.  In this situation you are so tired, so desperately tired, that once you get to bed and close your eyes, you can’t sleep.  The eyes are closed but the mind is spinning.  You know that sleep is essential, you crave it.  You get to bed at last and the brain has trouble performing the skill of sleep achievement.  Eventually sleep is achieved, but after much longer than normal.  This is just the same for young babies.  Once they are profoundly overtired they have very great trouble going to sleep.

This is why avoiding overtiredness assists in the performance of sleep skills.

Depth of sleep

Once children are asleep they become less responsive to what is happening in the house.  Now just as there was a trap with tired babies being difficult to get to sleep, so the same trap exists once sleep has been achieved.

The baby, who is getting enough sleep, sleeps deeply.  She sleeps through telephones ringing, doors banging, TV, radio, conversations, vacuuming and moving around in her room.

For babies who are not getting enough sleep it is the reverse.  As they become more overtired they are more easily awoken.  A telephone ringing, a door creaking, your footsteps –sometimes you could swear to yourself that just the sound of your breathing – wakes them.   Because they are overtired they wake easily and begin to cry at once.

It is not fair for the world to do this.  Where is justice? Where is common sense?  Logic suggests that the overtired baby should sleep deeply, but unfortunately the reverse is the case.

Once you understand this the solution becomes obvious.  If the child is restless because of fatigue then everything else has to be put into second place to increase the hours of sleep she achieves.  Once the baby has caught up on her sleep, she will achieve deeper sleep.

The child who is getting adequate sleep is easy to describe.  These children tend to be calm, they go to sleep efficiently on their own, and sleep through all normal domestic noises.  They return to sleep from their normal arousals in a block of sleep without help and almost always without you knowing they have been awake.

The tired baby is also easy to pick.  It takes a long time for them to achieve sleep.  They wake easily to normal domestic noises.  They wake for their normal waking periods within a block of sleep and, being unable to achieve sleep alone, they cry.

The moral of the story is to make sure, to the best of your ability, that the baby is getting adequate sleep to perform the learned skill of sleep achievement.

Rewarding behavior

If you are the mother of the child it is important to understand your status.  You, the mother, are wonderful.  You are the most wonderful person in the world.  Your smell, your touch, your milk, and the sound of your voice, your warmth – to a baby these things, each and every one, are attractive, pleasant and reassuring.  As a mother, and also as a father, it is a joy to feel our child’s security in our arms.  This is how life is.  These contacts provide some of life’s great pleasures and contentments.

Contact with mother or father is a reward for the child.  Now, there is a time and a place for rewards.  Midnight, 2 am, 4am and 5am are not the times for these rewards.  These are the times when as soon as possible after our child’s birth we want and need to be asleep.

From the baby’s point of view any behaviour pattern which is rewarded by parental contact is worth the effort.  So if crying or kicking does the trick, so be it.

Any contact with you is a reward for your child, even if it does not include a feed.  It is to your advantage not to reward behaviour that you do not want to see reproduced.  If you are happy that the baby is well fed, clean and dry, is in good health and is not in an uncomfortable or dangerous position in the bed, then leave him alone.  If you know that the baby is only one hour into a three hour sleep and he starts to cry a little, do not attend to him.  Your attending to him is a reward to crying and will slowly increase the frequency with which that behaviour is exhibited.  This is not being unloving but the reverse.  Do you love your baby enough to allow him to learn the skill of sleep achievement alone?

The final point is more complex.  If you reward behaviour occasionally, say one time in three, this is a stronger reward than if you reward the behaviour every time.  This if a reward is given occasionally there is an increased chance of the behaviour pattern being repeated more often and for a longer period of time once the reward is finally withdrawn.

 What does this mean?

If you have decided to assist your child in learning effective sleep skills and you have stopped attending to crying between feeds, then stick to your decision.  If you attend one time in three or four or five the child comfort, then the lesson that is learned by the child is ‘If I cry often enough and long enough the reward will come.’ The sooner the pattern of rewards in consistent, the sooner the desired sleep pattern will emerge.

Cuddles, feeding, laughing, touching, loving are wonderful.  Enjoy them to the full.  But they are for wake times.  Sleep times are for sleep and only sleep.  Love your baby enough to help him learn the skills of sleep.  Babies need much more sleep than adults.  They need it in blocks of at least three to four hours.  By twelve weeks of age many babies can sleep ten or more hours at night in a solid block.  These times are given as a guide and not as absolutes.  Use them as a target to aim for as your baby and your circumstances allow.

Baby’s Sleep Pattern

Babies have a greater need for sleep than adults.  This need is at its greatest at birth and gradually decreases as the baby grows older.  Sleep requirements are at their least in adult life.

The tired adult behaves very differently from the overtired baby.  As an adult, the more tired we become, the more we desire sleep.  This can develop to the stage that if we sit down when desperately tired, there is a danger of going to sleep in that position.  The overtired baby does not work that way.  This is a common cause of problems in the first twelve weeks of life.  The problem and the contradiction is that the overtired baby can’t and won’t go to sleep.  He cries vigorously and long.  He keeps the whole family awake when what he and the rest of the family need is sleep.

Establishing a sleep routine

Philosophies very as to how a child should fit into the family’s pattern.  At one extreme is demand feeding and sleeping, where timing is controlled entirely by the baby.  At the other extreme is feeding and sleeping by the clock, irrespective of the baby’s apparent needs.  From my experience the most successful path is a balance between the two.

I have been lectured to by eminent professionals on the virtues of demand feeding and constant physical contact between mother and child.  I have been told of idyllic African villages where babies never cry because they are demand fed and are held in their mother’s arms or on her back 24 hours a day.  The only problem with this philosophy is that very few of the families I see live in idyllic African villages.  Our culture sets other demands upon a mother.  She is responsible for at least one child, a house, shopping, cooking, partner and often work and other commitments.  Our culture does not allow the luxury of a mother sitting or lying with her newborn for 24 hrs a day for three months.  Any workable plan has to recognize the constraints placed upon the mother by our social norms.  For most of her conscious day the mother has to put her child down to allow her to continue with other tasks.

So what advice do I give that helps establish an effective sleep pattern?  I emphasize the need for success in achieving a good feeding and sleeping pattern during the first six weeks.

Contact between mother and child is fundamentally important.  It is essential to the normal psychological health of both the developing child and the parent.  For the first six weeks the baby’s important contact time is during feeds. Once the feed is finished, the nappy changes, the baby needs to sleep.  The mother is usually happy about that.  Assuming the baby is well and fully fed, she will need to sleep at this time.  Usually within five to fifteen minutes of being in bed, the well fed, healthy, tired baby should be asleep.

Other members of the family can be a problem.  Playful brothers and sisters, loving grandparents and doting fathers – all must be kept at arm’s length once it is sleep time.  If these attentive relatives wish to cuddle and stroke, kiss and play that’s fine.  But this contact needs to be limited to after feed time for a few minutes only, or at bath time.  Overhandling at feed times is a potent cause of overtiredness in the newborn baby

Once the baby is fed and changed it is time to sleep.  Good quality sleep for 18 or more hours per day is as essential as good nutrition for healthy development in these first few weeks.

The temptation will occur to hold children once they are asleep.  Sleeping babies are easy to love.  Proud partners may wish to show off their newborn to a visitor. I plead guilty to this offence before my ‘education’.  The golden rule is let sleeping babies lie!  Once sleep is established, let it continue until the next feed time.

A healthy sleep will last for times varying between two and five hours in these first six weeks.  Over a period of weeks a pattern needs to be established that will satisfy the baby’s requirements and leave the family routine reasonably intact.  It is helpful for the mother to have a plan in her own mind so that she can develop and encourage the baby towards this desired objective.

Time interval between feeds (what is normal)

 1 hour

A baby does not demand feeds one hour apart unless there is a problem.  The most common problem is hunger, ie the previous feed lacked adequate volume.  Feeding volumes must be built up.

The second most common problem is overtiredness.  The overtired baby can be woken by a minor stimulus and will then cry vigorously.  Often parents report that the child wakes regularly after one hour or thereabouts.  These children a re probably waking at the end of their first sleep cycle and having trouble returning to sleep independently.  They are requesting some assistance from their parents in the task of returning to sleep.  These babies need to increase the total number of hours sleep per day.

2 hours

With the exception of the first two feeds of the day, a healthy thriving baby will not demand feeds two-hourly.

3 and 4 hours

Most newborn babies will sleep for at least three or four hours between feeds.  The sleep should be deep, peaceful and not easily disturbed.  The healthy baby in a deep sleep will ignore most normal household sounds such as the phone, radio, conversation, vacuum. If the baby wakes too easily and if you are tip-toeing around the house talking in muffled whispers, the baby is probably overtired.

 5 hours

Within a few weeks, say by three or four weeks, the thriving baby will begin to have at least one five-hour sleep per day.  Ideally this will be overnight, but sometimes it is in the afternoon.

 6 hours

This tends to occur at about five to six weeks.  If the six-hour sleep is occurring during daylight hours it should be discouraged – not for the baby’s benefit, but the parents’.  If the baby is to receive five feeds in 24 hrs and there is a six-hour sleep in the afternoon it will probably mean two night feeds.  You do not need that.  So after four to five hours gently wake the baby (break the golden rule) and give a feed.  Try to move the six-hour sleep into night-time.

 7 hours

The baby is now six to seven weeks old and growing well.  He is strong enough to sleep this long.  Again the long block of sleep should be at night.  There is nothing to be gained by letting the baby sleep this long in the day.

 8 hours

The thriving baby should be able to achieve eight hours’ sleep at night by approximately eight weeks of age.  This is a landmark in the family’s return to normal sleeping patterns. The parents can have close to a full eight hours sleep and this creates an excellent platform for the next day.

9-12 hours

For the thriving baby a night-time sleep of this length can be achieved before three months of age.  This establishes a night-time sleep pattern for the child for the next five or six years.  Once sleeping from, say, 7pm to 7am, the child should keep that pattern until school age.  This is another landmark in that it gives mother and father time together after the children are in bed.  The return to a new but manageable family life is reasonably complete.

Note that in the first six months of life there may be a breast or bottle feed at the parents’ bedtime.  I do not count that ‘roll-over’ feed as a break in a long twelve-hour sleep.”