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Baby Sleep Problems

Newborn And Infant Sleep Needs Explained

Babies sleep problems are most often related to the eat-activity-sleep cycle and how these cycles are distributed within a 24 hour period.

Tracy Hog (British nurse and bestselling author) calls those cycles E.A.S.Y. An acronym that stands for: Eat, Activity, Sleep, and Time for you!. These cycles vary in length and how long each stage lasts, depending on your baby’s age.

In this article I refer mainly to new borns, 0 to 11 weeks of age.

Newborns don’t have their circadian rhythm (the internal body clock that helps to differentiate day and night for example) regulated yet and as a result their system functions in a 24 hour cycle. This is also because of:

  • Their nutritional needs and their stomach size.
  • Their short sleep cycles and their arousal state.

Newborn Nutritional Needs

Know-how

Newborns need 8 to 12 feeds in 24 hours and their intake at each feed grows quickly from birth to the three months of age, after which it stays stable (around 750 to 900 ml in 24 hours) until 10-12 months of age.

The ability to drink more milk with each feed grows as the baby stomach size grows; as well as the ability to latch-on improves and the mother has more milk, usually after the first two weeks of stimulation.

If the baby is formula fed is important to respect this gradual build up rather than feed 90ml ‘form the start’. Smaller and more frequent feeds will allow your baby to avoid being overly hungry. This will in turn help with possible reflux probems and stretching the stomach.

Possible Problems

1.As a general rule of thumb, if the baby ‘misses feeds’ during the day, say because she is sleeping a little more, this can make her wake more often at night to catch-up on nutrition she needs. The reason she is waking up at night is most probably not because she slept too much during the day, but because she missed feed(s) during the day.

2.Entering a cycle where the baby is too tired to feed but too hungry to sleep. This may be due to a variety of reasons including maternal supply.

Possible solutions

1.Making sure your baby has all the feeds he needs during the day is a good general rule.

Often cluster feeding your baby is a good way of helping him catch-up with what he needs. And often babies naturally cluster feed, or you can encourage too, in the afternoon/ evening so they can ‘store’ more milk ready for the night ahead. This is usually a good sign of establishing circadian rhythms and moving towards longer streatches at night. What makes it also particularly interesting is that in the afternoon/evening, the maternal milk, which is naturaly rich in enzymes and hormones, has more sleeping hormones such as serotonin and melatonin, as the mother herself approaches bed time.

Also, keep in mind that if your baby has had a longer stretch than usual, say at night, she may be more hungry than usual in the morning for instance. So it may be that cluster feeding in the morning is also needed.

2.Pay attention to your baby’s behavioural states and his ‘I’m hungry’ and ‘I’m tired’ cues before he cries.

Baby Sleep Cycles

Know-how

Babies have short sleep cycles of around 30 to 45 minutes each. During this time they go through different phases of sleep form drowsy, to light sleep, deep sleep and REM or dreaming phase.

Sleep supports growth and developemt. Each sleep phase has it’s characteristics; from improving motor skills, stabilising mood, strengthening memory and immune system as well as enhancing brain connections (neurosinapsis).

The fact that babies have short sleep cycles is a survival mechanism and it is good for a variety of reasons:

  • Babies are less likely to experience deep sleep which will interfere with their arousal state. Arousal state and the ability to wake when they feel hungry, or cold or hot or having breathing difficulties or feel in danger for any reason, is key to survival.

This may sound bizarre to you, but often babies lose unnecessary weight because they don’t wake up to feed and the parents leave them asleep, only to then discover they are becoming more lethargic and less energetic. This can lead to dehydration and quick deterioration. The ability of that child to wake up and ask for food is a key sign for wellbeing. It is important to wake a newborn, in the first two/ three weeks of life, to feed every 3 hours, if she doesn’t do so on her own. You can consider this just until you know she has regained her birth weight and gives signs of waking up asking for food every 2 to 3 or 4 hours from 2 to 10 weeks of age.

 

  • Babies can transition more often in and out of all the sleep phases. This is important because it means that they can experience its benefits repetitively, instead of only once or twice. Having shorter and more frequent naps means they can experience the REM phase more often, for instance. The REM phase is believed to be the stage of sleep connectd to brain development.

Please visit Dr. Sears’ article on 8 infant sleep facts every parent should know to read more science base information on this topic.

Baby Sleep Needs

Age

No. of Naps

Tot. hrs. Naps Sleep

Endurable  Hrs. Between Sleeps

Tot. hrs. Night Sleep

Tot. hrs Sleep in 24 hr.

Newborn

6 to 8 in 24 hrs.

 

The Awake time can be anything between 15 minutes to 50 minutes but not  at every cycle.

At this early stages your baby may be connecting sleep cycles right after the feed. Without awake time.

 

15 to 18 hrs.

4 – 8 week Weeks

3-4

5-7

1-2.5

8-10

15-16

11 – 20 Weeks

3-4

4-5

2-3.5

10-11

13-15


Possible problem

If your baby is missing out on sleep time, she will be more cranky than usual. Elisabeth Pantley (author of many bestselling parenting guides) talks about homeostatic sleep pressure. This is when you notice your baby (or child) being less able to focus, having more crying spells or being more clingy.

The homeostatic sleep pressure continues to build the longer it passes from the previous nap, as well as growing in intensity, creating a volcano effect.

Possible solution

Making sure your baby dones’t go past her endurable hours. Allowing for winding down time as well, if needed. Please refer to the table above for a general guide. Being in tune with the subtle ‘I am tired’ cues will help you recognise the right moment to create a E.A.S.Y rhythm that works for you and your baby.  

Creating a safe and comfortable sleeping/ napping ‘routine’ and enviorment to encourage your baby to sleep.

Keep in mind the ‘transition form womb to cot’ is a gradual one and a new born has an instinctual need of being held and craving human contact in order to thrive.  

Dispelling the myths

1.‘Reducing naps’ during the day to sleep more at night.

I often hear parents wondering whether keeping the baby a little more awake during the day is the solution to her sleeping more at night.

Think about when you work all the time, have a social life and family commitments, and you still have energy for all of it. Then you go on holiday and all of a sudden you want to sleep all the time. You don’t understand why because you are on holiday, you are supposed to be more rested and have more energy, right?

I am sure most of us have experienced this at some point or the other.

Know-how

Human beings’ nervous system is complex, but for the purpose of this article I will focus on the two main divisions:

  • The parasympathetic nervous system. The rest and digest system, giving you relaxing hormones.
  • The sympathetic nervous system. The flight or fight system, giving you adrenalin. In the past it was mainly to run away, or fight potential danger. Nowadays it is more to cope with all the stresses of modern life.

A baby is equipped with the same nervous system divisions.

Possible Solution

A well rested baby is in a calm, parasympathetic, rest & digest, oxytocin based nervous system and will sleep well at night. While a baby that is not well rested and is missing naps will be a little overexcited and overstimulated. This means that the flight or fight response is rushing some adrenalin and cortisol to give the hormones needed to cope with it all. It’s easy to understand that this actually creates a vicious circle where the baby is overexcited and/ or overstimulated, and can’t go to sleep but is too tired to enjoy awake time. This results in a cranky, and often crying, baby.

2.Back sleeping is the only safe way for baby to sleep

Since the 1990’s the back-to-sleep campaign has taken over any parental instinct.

I believe there is a lot of fear around this topic and usually if there is fear there is also confusion. This topic is strictly connected with the topic of SIDS ( Sudden Infant Death Syndrome) so it is understandable that parents are cautious, but in my opinion it it not fear that parents are terrified!

Sarah Ockwell-Smith wrote a concise booklet that includes an incredibly well written chapter on the science of SIDS

Know-how

‘The label SIDS’ is given to explain a death after a post mortem has failed to find another cause of death. It therefore doesn’t recognise symptoms.

Research on this topic are not clear, but it seems it could be connected with genetic defects in the baby’s brain stem. One thing is more clear though, it is connected with the baby ability to become alert. (please refer to the above section of Baby Sleep cycles).

Things that appear to increase the risks of SIDS are:

  • Smoking
  • Formula feeding (this could be connected to the fact that formula dones’t have hormones such as serotonin that regulates the homeostatic system: heart rate, temperature, breathing etc.
  • Solitary sleeping
  • Overheating
  • Not allowing the baby to such for comfort.
  • Prone sleeping according to public health organisations.

Prone Sleeping (Tummy Sleeping)

This topic is highly controversial. But there are doctors such as Dr. Nils Bergman (Swedish neuroscientist), that believe “prone (tummy) sleeping is the biological normative standard in healthy infants, as it supports autonomic regulation.” Bergam talks about potential of stress factors affecting babies that are placed to sleep on their back.

Possible Solution

As a Postnatal Doula I always encourage parents to be well informed and ultimately to follow their instincts.

Observation of your baby is the key to help him/ her thrive.

Considering the risks factors above and observing your baby ability to rouse as well as all the other infant cues – being content versus stressed – will help you decide the best way to for your baby to sleep.