Roundtable- Sleeping

This week we’re set to talk about sleeping which is a topic I definitely have first-hand experience with, because it is something we really, really struggled with when Henry arrived. I’m not entirely sure how to structure this week so I’m going to start tonight with the things that I wish I had known about sleeping BEFORE Henry arrived. Let me know if there are questions you have or ideas for sleep sub-topics and I’ll address those as the week progresses!

In the beginning…
For the first few days and sometimes up to 2-3 weeks, many babies will seem to literally sleep all day. They’ll wake to eat and maybe open their eyes a few minutes and then it’s back to sleep. I remember the day we got home from the hospital Henry slept for 6 hours straight which turned out to be his longest stretch of sleep until about 3-4 months! Of course we didn’t enjoy it because after 3-4 hours we kept trying to wake him up every 30 minutes to get him to eat. You’ll hear differing advice on this but unless your baby had a low birth weight or s/he’s routinely sleeping through feedings—I say just let them sleep and don’t worry about trying to wake them to eat.

In these first days, your baby may seem to sleep all day and then be awake much longer chunks of the night. I believe I remember reading that babies don’t manufacture melatonin which helps us regulate day from night until later so there’s no physiological reason to sleep at night at the beginning. This is why you’re encouraged to keep everything quiet and boring at night so there’s no social reason for them to be awake at night and asleep during the day.

Learning to Sleep
Somewhere along the first few days to weeks, your baby may “forget” how to sleep. I’m sure that not all babies are like this but I’ve heard and read lots of accounts of babies that were total sleepy-heads until 2-3 weeks and then suddenly seemed to stop sleeping altogether. This is definitely something that we went through with Henry. A BIG part of the problem was that I didn’t realize that some babies need help to get into a sleep rhythm. I was under the impression that if a baby was sleepy s/he would fall asleep. Unfortunately it isn’t this simple for all babies. Some babies aren’t very good at drifting off to sleep on their own and as they start to give us cues that they’re now over-tired and cranky, we respond by going through the checklist of things that might help—change the diaper, change of scenery, playtime, etc. If the baby is really tired everything we try just makes it worse.

The trick is in realizing that your baby is starting to get tired so you can help soothe them and let them fall asleep on their own. Ideally you do this from the start and then they “learn” how to fall asleep on their own without any complicated interventions that get tried later on. The sleep cues babies give can include:
· Decreased activity
· Slower motions
· Less vocal
· Sucking is weaker or slower
· Quieter
· Calmer
· Appears disinterested in surroundings
· Eyes are less focused
· Eyelids are drooping
· Yawning

Signs such as fussing, rubbing eyes, and being irritable and cranky are actually signs that your baby is overtired. The best thing to try at the beginning is to recognize the signs of sleepiness. If you catch them you’ll want to put your baby in her crib or wherever s/he sleeps. She might fuss a minute or two and then fall asleep. Or, your baby might need to be actively soothed in which case you might try a pacifier, swaddling, rocking, shushing, etc.

The other important thing to know is that for the first few months, babies need to sleep after being awake for 1-2 hours. While getting them on a nap schedule at this point isn’t really workable, it does help to know that your baby woke up at 9 am and therefore most definitely needs to be back asleep by 11, and you might start seeing signs around 10 that s/he’s ready for sleep. Keep that 2-hour wakefulness period in mind and it will really help when you’re still trying to learn your baby’s sleep cues.

Sleep Duration
As babies get older it’s more important for them to sleep for longer periods of time and most of them will achieve this on their own. I think that if you’re tuned into a baby’s sleep needs—i.e. watching for sleep cues and helping soothe them to sleep no more than 2 hours after they last woke, you’ll find your baby sleeps longer at a time anyway. But, you should know that not all babies sleep for even a magical 3-4 hour period at first. It can literally be the case that your baby gets enough sleep overall—but gets that sleep in 20-30 minute increments. This is why it’s really important to give some thought to how you’re going to get some rest once the baby arrives.

Back-up
I’m not sure you can prepare a “plan” before your baby arrives, because you just don’t know what sleep challenges you’re going to face (maybe none!). I do think however, that you can brainstorm some possible ideas to put into place once you know what issues you’re dealing with. For example, because I was breastfeeding exclusively, I needed to be available (and awake) for all the feedings. I would feed Henry around 9 pm and then go straight to sleep while JT stayed up with Henry or Henry slept with JT on the couch. Then JT would change Henry and bring him to me for the midnight feeding. I wasn’t getting 8 hours of un-interrupted sleep, but I was getting a head-start on my sleep for the night. Also, before I went back to work, Henry would usually wake around 5 or 6 am for a feeding. At that point I would bring him into bed with me and after eating we’d both fall back asleep until 8:30 or 9. I made sure to never schedule anything before 9:30/10 and that also helped me get some extra sleep.

Other things to consider are having a post-partum doula or babysitter come over an afternoon or two a week (or family member) to watch the baby while you take a nap. A lot of women that co-sleep say that they completely avoided the sleep deprivation of a newborn, because when you’re nursing in bed you’re able to basically start nursing and then just fall back to sleep (assuming you’re nursing lying down). Other people may have lots of other ideas, but here are a few to get you thinking about how you’ll deal with the sleep deprivation.

I also want to emphasize that I say this not because you’re being “hazed” into a new parents club, but because having a newborn can be exhausting and if you don’t make efforts to get the rest you need you’re at risk for getting sick, overwhelmed, depressed or all of the above.

Q&A
Q: For everyone with babies, when did they start to have a "normal" sleep schedule? Was there anything that you did in particular that helped them fall asleep or sleep through the night? At what point did you see if the baby can soothe his/herself and stopped going into the baby's room every time the baby woke up?

A: I have to say that even though I kept meticulous records I don’t remember very clearly what Henry’s sleep schedule was really like. What I did do was go back to the sleep book that really helped us called “Health Sleep Habits, Happy Child.” Sleep is a hot topic with parents-- not only because new parents are so sleep deprived but because how we treat our children's sleep has become a marker of the type of parent we want to be perceived as. There are "attachment parents" who would never dream of letting their children cry themselves to sleep and "cry it out" parents who wouldn't want their children's sleep to be dependent on them for very long. This book, HSHHC is perceived by some people as firmly advocating a “cry it out” strategy and is therefore dismissed by people that disagree with the practice. I do want to say that the book is written by a Doctor/Sleep Researcher and it definitely has a “scientific/researchy” bent to it. He provides suggestions for how to avoid sleep problems, but also gives solutions for how to deal with them if they develop. He definitely does include “cry it out” techniques and says quite plainly that based on his research these methods are more liable to “work” and to work faster. He does provide “softer” methods as well though.

So, disclaimer over, I found this book immensely helpful and I’ve gone back to it to jog my memory about how things were working for us between 0-3 months. I’ve also looked back at my blog posts during this time for some hard data to back up my recollections.

0-2 Weeks
Things are fairly all over the map. Generally at night Henry was sleeping in 2-4 hour chunks with mostly brief awakenings for feeding. During the day naps were anywhere from 30 minutes to 3 hours. At this point you’re just reacting—trying to learn the cues your baby is giving you and feeding him when he’s hungry and helping him get to sleep when he’s tired. I have a picture of Henry’s sleep and awake periods from when he was 5-13 days old that I’ve inserted below. It’s small and fuzzy but it should give you a brief snapshot of how their sleep isn’t very organized.

2-4 Weeks
Many babies start to get fussier during this time and may have a harder time sleeping in such extended chunks as they did before. This was definitely the case with Henry. During this time you really want to make sure you’re employing your techniques for getting rest for yourself, and you want to help your baby sleep when s/he’s tired by watching for the sleep cues and soothing him back to sleep within 1-2 hours from his last wake-up time.

Also, during this time the startle reflex really hits its stride in babies. Just as your baby is about to fall asleep or sometimes wake up you’ll see them jerk their entire body and flail their arms out. This often fully wakes the baby, “startles” him, and makes him cry—meaning no one gets any sleep until you can calm him back down. Swaddling restrains their ability to flail their arms and legs and therefore helps them sleep more soundly and longer. You can swaddle with regular receiving blankets or special swaddling blankets. My personal recommendation is for the Miracle Blanket which truly does help work miracles and doesn’t take an advanced swaddling degree to operate.

5-6 Weeks
Generally the fussiness that you started noticing in your baby around week 2 peaks at week 6 (unless your baby has colic in which case you should just call me when you reach this stage). Many babies have a particularly fussy time in the evenings and will need to get out for a walk, a drive, to be held in the sling, put in the swing—keep trying things until a) you find something your baby responds to or b) you know you’re tried every idea in the book.

Around 6 weeks is when some babies start to “sleep through the night” which at this age often means going to bed somewhere from 9-11 pm and waking up at 6 am or so. This is also around the time when your baby might start having a harder time sleeping anywhere. Previously you might have been able to cart your baby around with you to restaurants, shopping, on walks, etc. and not had to think about when he would get tired because he would just fall asleep wherever he was. For some babies this continues for awhile but for others—especially very social or sensitive babies, they will start to notice their environment more around 6 weeks of age, and at this time will have a harder time shutting down and going to sleep. Just be aware this might happen—you’ll just have to start taking your baby’s sleep habits into account when trying to plan outings.

7-8 Weeks
The main thing that happens during this period is that babies may start to go to bed earlier. Rather than a bedtime between 9-11 they may be ready for bed by 7-8. They also may start to sleep longer at night—in fact I’m told that some babies actually sleep all night at this point—meaning from an earlier bedtime to 6-8 in the morning.

8-12 Weeks
Somewhere during this time your baby’s nap schedule will also start to solidify. Most likely your baby will take 3 naps at this point—one around 9 am, one around noon or one and one later in the day somewhere around 3 pm. I think it’s common for the schedule not to be set in stone, i.e. if they woke up a little earlier or later it throws their actual nap times off a little bit—but you have some kind of routine to expect during the day.

I think the keys to helping babies fall asleep and sleep through the night are:
· Swaddling
· Getting them back to sleep no longer than 2 hours after they last woke up
· Being totally boring at night (i.e. no talking, singing, playing, etc. during their night feeds)
· Paying attention to their sleep cues so you put them down when they’re tired, not overtired

From the beginning it’s a good idea to give your baby a few minutes to see if they can settle themselves, or if they’re really waking up and need you. Something I didn’t realize was that lot’s of babies make lots of crazy noises while they’re sleeping. Henry actually grumbled like an old man in his sleep all night long. There’s no reason to go in to “soothe” them when they’re making every little peep—even if they just barely start to cry or cry out. Babies make noises and I think it’s better to give them some latitude on this. Of course when they’re under 3 months old, once they do start crying you’ll definitely want to respond to them to figure out what they need.

I think the earliest you’ll really find people telling you to start introducing “sleep training” techniques is around 3-4 months. This is where either you gradually decrease your direct soothing techniques (i.e. just patting your baby on the back rather than picking her up when she cries, then singing or talking to her but not touching her, etc.) or you let them cry checking on them periodically. Of course you can help your baby try to find their hands or be soothed by a pacifier earlier than that.