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25th June 2018

Optimising Newborn Sleep

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Having a newborn baby is an amazing and precious time for a family but it can also be tiring! Read on to find out what's normal for newborn sleep and what you can do both in pregnancy and once baby arrives to optimise rest for you and your baby during the early weeks and months.

Everyone knows that newborn babies wake up a lot. Overall, they actually sleep a huge amount too! However, unlike adults who typically have a consolidated sleep pattern, newborn sleep is disorganised and taken in multiple smaller chunks - which can feel pretty horrendous for parents. 

These early days are not the time to worry about a little one's sleep habits. Rather it is a time for bonding with your baby, resting and recovering from their arrival into the world. A baby cannot be spoilt by cuddles, kisses or being quickly responded to, no matter what you may hear about "creating a rod for your own back". On the contrary, a baby's brain is shaped by their early experiences with primary caregivers and responsive parenting provides the best basis for a child who feels safe, secure and connected.

 

getting in-LINE

Whilst it won't help your child to sleep better, parents can make the impact of their baby's arrival less pronounced by addressing how they themselves sleep. Babies, even when sleeping at their best, are typically "larks" - rising early for day (6-something is the norm, anything starting with a 7 is a bonus!) and being ready for bed somewhere between 6 and 8pm. Whilst some adults are also natural larks, many, if not most, are "owls" who are happy being awake late into the evening and making up for it with a nice morning lie-in when life allows. Owl parents will typically find the baby-induced disruption to their sleep harder to manage than their lark counterparts. Whilst both physically ad practically an adult is unlikely to be able to shift themselves onto a 7pm-7am schedule, it is feasible to turn an 11pm bedtime into a 10pm one - I would suggest shifting it very gradually, perhaps just 15 minutes a week until the parents feel refreshed even on a 6am start.

 

top tips for once baby arrives

  1. Help your baby to establish their body-clock. Infants are not born with circadian rhythmicity, it is something they develop in their first few months of life and it is not until they do that they feel any difference between night and day. You can help this process along by exposing your baby to 12 hours of "daytime" and 12 hours of "night". Working to a rough 7-7 schedule is a great starting point. Daytime hours are all about light - preferably natural daylight which is the single biggest influence of the circadian rhythm. Get out in the fresh air with your little one as much as is weather-permissible. When indoors, aim for the environment to be well-lit and keep noise and household activity levels consistent with normal family life. Then aim for a 12 hour period of dark and quiet time with reduced levels of stimulation. Whilst a newborn will not be able to sleep for a 12 hour stretch without periods of awake time, if you can keep the lights, noise and activity levels low once you have entered "nighttime" mode it will certainly assist with your baby setting their circadian rhythm. 
  2. It's a great idea to start a short and simple bedtime routine from as early as 2-3 weeks old. Some parents prefer to bath their little ones daily whereas others choose to do it less frequently. Whilst bathroom activities are a usual step of a bedtime routine, what happens within that step does not need to be the same every night. It will potentially feel fairly pointless reading a story to a newborn but softly saying some nursery rhymes whilst holding your baby skin-to-skin for example can be a lovely way to wind-down and bond before bedtime. Over time, doing the same steps in the same order at the same time each day will start to cue your baby for what comes after and help him anticipate bedtime. Aim for a routine of around 30 minutes from heading to the bathroom to being ready to fall asleep. This can feel short but it's important for the process to keep moving towards the conclusion of bedtime - otherwise it tends to lose momentum and predictability for your little one. 
  3. A child will start to produce melatonin (the "sleepy" hormone) somewhere between their first and third month of life. Melatonin works in conjunction with the emerging body-clock to help a baby wind-down and be ready for sleep as bedtime approaches. Melatonin production is inhibited by exposure to blue-light which is emitted from televisions, tablets, smart-phones and similar devices. It is therefore preferable to avoid having these devices on around a baby in the hour or two before bedtime - even if the child isn't watching the screen, blue-light will still be emitted and potentially inhibit the child's efforts to make themselves ready for sleep. For the same reason, during the third month and onward it can be helpful to start dimming the lights and making the environment slightly darker in the hour before bedtime to stimulate the melatonin response in your baby. 
  4. Newborns often sleep best in conditions that mimic the womb so far as this is possible. Babies are unlikely to be afraid of the dark (as the womb is dark) but may have an issue with total silence. For this reason, a white noise machine can be helpful in encouraging baby to settle. Some babies like to be swaddled although many health professionals no longer recommend this practice. Swaddling is certainly not appropriate for a baby who is able to roll (or close to being able to do so). Consider what cues there are for your baby to know it's time to sleep - layering multi-sensory sleep associations such as a particular words/phrases/lullabies and/or a breathable muslin containing your comforting smell can help a little one feel secure with the process of bedtime. 
  5. Keep your baby close. Parental presence in the room where an infant is sleeping (whether day and night) reduces the risk of Sudden Infant Death Syndrome (SIDS). Taking into account the suggestion of a 12 hour "night" above, this can present something of a conundrum for parents as many, understandably, don't particularly want to sit in dark silence through the evening whilst their baby sleeps close-by! It is however worth considering whether the room can be set up in a way that enables you to watch TV whilst your baby sleeps in a quieter corner of the room, with the main lights dimmed and perhaps some white noise playing.  
  6. Infants typically have a remarkably short "wakeful window" (the period of time they can be comfortably awake between periods of sleep). For a newborn it is common for the wakeful window to be as short as 45 to 60 minutes! At the end of that period, if the baby isn't able to go to sleep then their bodies respond in order to keep them awake and taking in the stimulation around them, despite their tiredness. Once that process has triggered, sleep becomes trickier for your baby. Signs of being ready for sleep can be easy to miss with a new baby, especially in the midst of frequent visitors. Ensuring baby gets enough daytime sleep is, however, key to optimising sleep in the early days - as counter-intuitive as it sounds, babies can very easily become too tired to sleep. Cue an exhausted, crying baby and a parent walking an ultra-marathon around the lounge trying to rock, bounce or otherwise coax said screaming child into the land of nod. By watching for tired signs from baby without necessarily waiting for them if the baby has already been awake for 45 minutes to an hour, and seeing if the child will take a nap, parents have the best chance of keeping their little one in the most optimal state for restful sleep
  7. Parents are often surprised to find their child is content to fall asleep in their cot/crib/bassinet, if given the opportunity. I advocate practices which are baby-led and the nature of on-demand feeding means that sometimes baby will be ready for a feed when they wake and other times prior to sleep. Feeding or rocking a baby to sleep during the night is somewhat inevitable and it is important to note that doing so will not create an irreversible "bad" habit. It is always worth experimenting with different ways of helping your baby fall asleep. To try putting your baby down awake, when nap time comes around you can try cuddling your baby until they are very drowsy but just still awake then placing them down into their sleep space and reassuring them with lots of touch and soothing words. If baby isn't happy then pick him up and help him to sleep however you usually would. If you practice with baby going down awake little, often and gently, never leaving your little one in their sleep space for longer than they are happy with, you may find that over time your baby is able to fall asleep with you comforting and supporting him from the cot-side.
  8. Contrary to what you may have heard regarding breast or formula and their relationship with sleep, studies have found that it is actually breastfeeding mothers who ultimately get the most sleep. Breastfeeding is known to reduce the risk of SIDS - in fact, breastfeeding for at least two months halves the risk of SIDS. The longer you can continue the the more protection it will give your baby. Breast-milk also contains tryptophan which is the pre-cursor to melatonin and can both optimise sleep for a newborn as well as reducing the risk of infant colic. 
  9. It is important to do what works for your family and to do it safely. For many years, new parents have been advised not to bed-share with their baby but the Lullaby Trust has recently softened its stance on this point. Bed-sharing works incredibly well for many families - for others it is either unsafe (see here for the latest guidance) or does not lead to good-quality sleep for parent and/or child. I suspect that almost all parents have brought their baby into bed at some point or other. However, when this is done in desperation at 3am, the safe bed-sharing guidance is often flouted - for example bedding may not be removed and/or the bed re-positioned to make the safest sleep environment possible. If you want to consider bed-sharing as an option, ensure that it is done safely. 
  10. My final tip is to avoid, so far as possible, the almost overwhelming temptation to compare your baby's sleep that of other infants. Sleep is always a hot topic of conversation amongst new parents. Yet a child's natural relationship with it is influenced by a myriad of factors - many of which are outside of their parent's control. No two babies are exactly the same which makes comparing their sleep habits at best pointless - at worse, it can leave parents frustrated with their baby or doubting their own abilities. As a society, we need to move away from the notion of a "good" baby being one who sleeps well - it is much more helpful and healthy for us to recognise what normal baby sleep looks like and to concentrate our efforts on supporting parents through what is undoubtedly a very precious but often also extremely tiring time. 
Step-By-Step Sleep Training

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