Sleep Maturity

During the first three months of development, tiny babies rarely sleep for more than four

hours without requiring feeding.  At around three to six months, the majority of babies

start to settle. They are awake for longer  periods during the day and some with lucky

parents may sleep five-hour stretches at night! The time they spend in deep sleep starts to

lengthen and the time spent in light sleep shortens. This means babies

are able to enter deep sleep more quickly. This is called sleep maturity.  (Sears, 2005).

The time your baby takes to reach sleep maturity may vary and even when she does reach

it, she may still wake up regularly.  This is because by the time she is old enough to reach

sleep maturity (usually towards the end of  the first year), uncomfortable and painful

stimuli present themselves, such as colds and teething pain.  Furthermore, separation

anxiety develops at around this age which causes sleeping problems.  Babies also start

reaching developmental milestones, such as sitting, crawling, and walking which causes

them to run through their newly acquired skills in their sleep .

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A word of caution regarding sleep-trainers

There is evidence to suggest  that sleep-trainers may be  a dangerous solution to a frequently waking baby. Encouraging a baby to sleep too deeply, too long, too soon, may interfere with the natural developmental and survival mechanisms that the baby is armed with.  Sleep researchers have found that blood flow to the brain is almost doubled during light sleep and believe this is indicative of a more active brain during these periods.  They believe important development takes place during light sleep.  Training a baby to spend more time in a deeper sleep may therefore be damaging to the baby.

Source: lullaby

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Crying it out

There is a theory that advises you not to respond to a baby’s cries during the night because it will teach him to comfort himself back to sleep and therefore, he won’t bother you as much.  I have to say, this is the worst advice I have ever come across.  A baby in the early stage of growth is very vulnerable and it is the parents’ biological duty to satisfy every need of their offspring.  Letting him  ‘cry it out’ can be very psychologically and physically damaging to the child in the early stages of development.  There does come a point in development when baby will reach the stage where he does need to learn to comfort himself on his own.  However, as far as the right and safest way to look  after your newborn is concerned, give him everything he needs, and yes that obviously means some sleepless nights in the beginning.   

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Understanding the stages of sleep

When an adult falls asleep, her higher brain functions decelerate which allows her to enter the phase known as deep sleep.  During this time her body hardly moves, breathing is slow and regular, and her muscles become relaxed and loose.  After around an hour and a half later and her brain becomes more active and she enters into a period called light sleep.  It is during this time when she may slip into REM (rapid-eye-movement) sleep where most dreams occur.  These deep/light  cycles continue throughout the night, at around two hours intervals, so that the average adult spends around 6 hours in deep sleep 

and 2 in light sleep. 

Babies need to be parented to sleep because, unlike adults, they only go into a deep sleep after an initial period of light sleep.  Let’s see how many of you can relate to this: Imagine you’re performing your bedtime ritual with your baby:  you’re rocking, walking, nursing etc until she falls asleep in your arms.  Her eyes  are completely closed, her eyelids may be fluttering and she may be twitching or showing momentary smiles (called sleep grins).  Just as you think it’s safe to place your baby in her crib and sneak away, she wakes and starts crying! Why does this happen?  It’s because she wasn’t properly asleep and only in a state of light  sleep.  Next time you attempt  your bedtime ritual, carry on past this first stage of sleep (usually takes around 20 minutes).  Wait until the twitching and smiling cease, the breathing becomes more regular and the muscles relax so that her limbs dangle weightlessly.  These are the tell-tale signs that the baby is in the deep stage of sleep and your chances of being able to put her down and sneak away successfully are dramatically improved.    

Like adults, babies’ sleep cycles continually change from light to deep throughout the night.  However, their cycles are significantly shorter than those of adults.  They will enter into a period of light sleep every hour or so.  During this time the baby is prone to awakening easily if an uncomfortable stimulus occurs, such as hunger. Some new parents will often spend time just watching their baby sleep.  If you do this, you may notice the tell tale signs that she is about to awaken.  You may be able to get your baby through this period of light sleep, without waking, if you place your hand on your baby’s tummy, whisper a comforting word  or play her favorite lullaby quietly. Sometimes letting baby know that you’re there will comfort her enough to enter back into deep sleep without waking.  Fathers may have more luck with this technique if the baby is breast fed because often the baby will pick up on the scent of breast milk and will automatically awaken for a feed.  In a chapter 2.3 we will discuss the advantages of playing comforting music in more detail.   

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Understanding why babies wake during the night ?

It is important that you understand the reasons why newborn babies wake in the night. In the first few months they have many essential needs, yet their ability to communicate is extremely low.  For example, their minuscule tummies digest milk extremely quickly and if the stimulus for hunger does not wake the baby, he  will not get the level of nourishment needed at that vulnerable age (Sears 2006). Likewise, babies are still learning to regulate temperature and it’s an important survival mechanism that they awaken if they are too cold or hot during the night.  The same applies to many stimuli that also have the potential to wake the baby.  Therefore, these mechanisms are not there just to annoy the parents, but to ensure the well-being of the baby!  As you are next dragging yourself out of bed to tend to your baby, you should take comfort in the fact that his innate, built-in defence-mechanisms are evidently working just fine!  

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Are sleeping problems common?

You’ll probably be relieved to know that they are very common and a lot of parents are in the same boat.  Between a fifth and a third of all families report they have some kind of sleeping problem during the pre-school years (Messer and Richards, 1993).  

Source: lullaby

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How much sleep is needed ?

Baby Sleepy

Parents are often concerned that their baby may not be sleeping enough, whilst others voice their concerns about their baby sleeping too much. I think it may be useful for parents to know the amount of hours that the average baby sleeps at different ages.  However, it is important to remember that there is a  huge variation that exists from one baby to the next.  Some newborn babies sleep 21 out of the 24 hours per day.  Others only need as few as 8.  The test to see if your baby is getting enough sleep is to examine if she is waking happy and alert.  If so she is getting enough sleep.  If she wakes and is irritable or tired, she may need to sleep longer.

Baby Sleeping Timing

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Sleep terrors: Risk factors and management strategies

Family history. There is a strong genetic predisposition to partial arousal parasomnias, with 80-90% of children who present with them, having a first-degree relative who had/or currently has them.

Increase in deep sleep. As sleep terrors occur during deep sleep, anything that results in a rebound (increase) of deep sleep can increase the likelihood of a sleep terror occurring. Since both sleep disruption (multiple wakings) and sleep deprivation often result in an increase in deep sleep the next night, they increase the likelihood of the occurrence of sleep terrors in vulnerable individuals (those who have a genetic predisposition). In fact, sleep deprivation is often cited as the most common cause of sleep terrors.

Therefore, ensuring that your child is getting adequate day (if age appropriate) and night sleep is important. Establishing a regular sleep schedule (set times for naps and bedtime) can be helpful in preventing sleep deprivation and ensuring adequate sleep. In some cases, it may be necessary to address sleep problems such as frequent night wakings or poor day sleep that are causing sleep deprivation.

Some medications, including those that are used to prevent sleep terrors, suppress deep sleep. However when these medications are weaned there is a rebound in deep sleep increasing the risk of a child having a sleep terror.

Being disturbed during deep sleep. Sleep terrors can be triggered by environmental events, such as noise, that cause a child to partially wake during deep sleep. White noise in a child’s room and/or in the hallway may be helpful in blocking external and household noise.

Decreased arousal threshold: Several things can cause an individual to be more easily awoken during the night (including during periods of deep sleep). Examples include: not feeling well, sleeping with a full bladder, stress, and sleeping in a different environment.

While we unfortunately cannot control whether our child gets sick or not some of these other risk factors can be addressed.
 
Limit fluid intake. Limiting your child’s fluid intake in the few hours before bed (and offering her more earlier in the day) may be helpful.

Address stress & anxiety. Working to address and decrease the stress in your child’s life may be necessary.
     

Sleep terrors: Other management strategies

Parental reassurance. While many parents worry that sleep terrors are indicative of, or may cause, psychological problems, there is no scientific evidence to support this. In fact, following a sleep terror, parents are often more upset than their children, who are unaware of their own behaviour. Parents should be educated regarding the common risk factors for sleep terrors (described above) and encouraged to speak with their child’s physician or another health care professional with training in this area if they have concerns. 

Safety precautions. While displacement from bed is less common during sleep terrors than sleepwalking, concerned parents may want to consider taking some safety precautions including: clearing the floor (in case the child gets out of bed), hanging a bell over the child’s door to be alerted if she leaves the room, installing safety gates at doorway and/or stairwells, and safety locking windows. Using bedrails and protecting your child if she ‘thrashes’ around and could hit herself on a headboard or wall are important (e.g., moving bed away from wall). If your child is sleeping away from home, you may want to inform an adult in charge of your child about the potential for these behaviours.

Do not intervene during a sleep terror. While a natural reaction may be to try and wake your child by picking him up and turning on the light, intervening in the course of a sleep terror has been shown to worsen and/or prolong the terror. Parents are encouraged to sit by their child’s side, if they wish to be present, and to let the terror run its course. Remember that once the episode is over there is a rapid return to a calmer sleep. Also, parents are encouraged to avoid talking to their child about the sleep terror the next day as this can result in fears around going to sleep.

Other treatment options. In more severe cases where sleep terrors are very frequent, cause significant family disruption, and/or involve high risk of injury to the child, other treatment options may include scheduled wakings and medication. 

Scheduled awakenings are best suited for children who experience sleep terrors that occur nightly at highly predictable times. Children are woken on a nightly basis approximately 15-30 minutes before the terror typically occurs to the point that the child is slightly roused (e.g., may mumble, or turn over). This should be continued for 2-4 weeks and restarted if the sleep terrors return. Medication options should be discussed with a physician.      

Nightmares: Risk factors and management strategies

Nightmares are usually a normal developmental phenomenon. However certain factors can be associated with increased risk.

Increase in REM sleep. If we are sleep deprived we lose REM sleep and get a rebound the next sleep period. Getting more REM sleep increases the risk of nightmares. 

So, as with sleep terrors, it is helpful to ensure that your child is sleeping well and addressing any behavioural factors that may be causing her not to be sleeping well. 

Being exposed to a frightening or scary event. Nightmares in young children may start after an exposure to something that, in the child’s view, was “scary”. This may include such things as a trip to the zoo or pet store. Also, children’s movies often have an element of evil (think Snow White, for example). 

Monitoring what your child is exposed to may be helpful.

Greater cognitive development. With greater cognitive development children become aware that the world isn’t a safe place and that bad things can happen. This is a normal part of development and often a sign that your child is developing well.

Discussing your child’s bad dream with her and providing her with appropriate coping skills can be helpful. For some children, this may include drawing a picture of their bad dream and throwing it away or reminding them that “monsters are just pretend”.

Stress. If you suspect that stress or anxiety is resulting in your child’s nightmares, or if your child is having frequent nightmares, addressing these concerns with your child’s physician or a child psychologist may be necessary. Relaxation strategies or visual imagery (such as talking about your child’s dream or imagining with them a calming image before they go to bed) can be helpful.

Nightmares: Other management strategies

Appropriate responding. Parents need to find their own level of comfort in responding to their child’s bad dreams. Often this involves verbal reassurance (“it was only a dream”). It is recommended that parents provide comfort and reassurance to their child following the nightmare but then have her return to sleep independently. If you change your behaviour and for example let your child accompany you back to the parental bed your child may interpret this as a sign that remaining in her own bed was not safe. You may also find that your child will start waking more and wanting to co-sleep with you if she knows it is an option. 

Introduce transitional object. A transitional or security object can be something to help your child soothe to sleep and comfort him during the night. The object chosen should be conducive to sleep and not disturb your child if he rolls on it at night. A ‘blankie’ is a great option.

Use of a night light. If your child is requesting the light be left on, introducing a low-level night light in his room is reasonable. Just be sure that it is not bright because it may interfere with his sleep in the early morning when there is light sleep.

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Young Children and Early Morning Waking

Common causes and what parents can do

Parents are in good company if their child is having early morning wakings – which I would define as waking before 6:00 or 6:30am. This is quite a common parental complaint and unfortunately one of the more difficult sleep problems to resolve. However there are certainly things parents can try before resigning to the fact that they will always be up before the sun.

A common cause of early morning wakings is what is sometimes referred to as a “negative” or “poor” learned sleep-onset association. This is when a child is not falling asleep independently at sleep-onset, but rather under a condition that she cannot re-establish on her own during the night. Examples include: being fed or rocked to sleep, falling asleep with a parent in the room, or with a pacifier that she cannot find and re-insert on her own. The problem with falling asleep under such conditions is that when children have arousals during the night (which we all do), they may need the same or similar condition to be re-established in order to return to sleep. This can happen throughout the night, including during the early morning hours.

Getting your child to return to sleep is probably more difficult in the last-half to the last-third of the night. This is because we (including children) get most of our light sleep in the early morning; therefore, it is more difficult to return to sleep following an awakening at this time. Parental contact at this time can serve to stimulate and arouse a child further. So be sure that you have addressed any negative sleep-onset associations that may be present and that you limit contact with your child during the night and in the early morning – unless of course she is sick. Ensuring that your child has the skill of falling asleep independently both at bedtime and following night wakings (unless she still needs nighttime feeds) is key to a child sleeping through the night.

Common Culprits 

Environmental factors such as noise or sunlight are common culprits of early wakings. Investing in room darkening shades and a white noise machine can be helpful. You also want to be sure that a heavy diaper or full bladder is not disturbing your child. If this is the case, you can try extra absorbent nighttime diapers or a larger size diaper. Parents can also try reducing the amount of fluid their child has in the last few hours before bedtime and offering her more earlier in the day.

Putting a child to bed later can actually have the opposite effect and result in an early waking. This is because when some children get overtired they actually wake more at night and earlier than usual in the morning. For some children, being put to bed a little earlier can be helpful. However you want to be careful not to make bedtime too early which can result in an early wake time. A good bedtime for most young children is between 7 and 8pm, with some preschoolers needing to be put down closer to 8 or 8:30pm if they are still napping.

When children are used to waking in the early morning they may not be aware that it is still time to sleep. A night-light attached to a timer is a simple ‘morning signal’ that can be used to teach children (toddlers and older) when it is morning time. Explain that when the light is off, everyone is sleeping and that the child must return to sleep. Teach her that when the light turns on that she can call out to be fetched. A reward chart can be used to reinforce positive behaviour.

Finally, early morning waking can sometimes be a sign that a morning nap is too early or that it should be dropped. However you would, of course, only drop the morning nap when a child was at the age where you would expect that a morning nap may be the culprit. In a child who is 3 to 6 months, this is often the case, and continuing to give her a morning nap may perpetuate the early morning wakings. This is because her body doesn't need to both sleep-in AND have a morning nap so she is waking early in anticipation of being able to nap in a few hours. This same theory applies to a morning nap that is too early. Most older infants need to be kept awake between two-and-a-half and three hours before their morning nap.

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What is Preventing Your Baby from Sleeping Through the Night?

Sleeping Baby

Here's something that may really surprise you: As much as we may want our babies to sleep through the night, our own subconscious emotions sometimes hold us back from encouraging change in our babies' sleeping habits. You yourself may be the very obstacle preventing a change in a routine that disrupts your life. So let's figure out if anything is standing in your way.

Examine Your Own Needs and Goals

Today's society leads us to believe that "normal babies" sleep through the night from about two months; my research indicates that this is more the exception than the rule. The number of families in your boat could fill a fleet of cruise ships.

"At our last day-care parent meeting, one father brought up the fact that his two-year-old daughter wasn't sleeping through the night. I discovered that out of 24 toddlers only six stayed asleep all night long." …Robin, mother of thirteen-month-old Alicia

You must figure out where your own problem lies. Is it in your baby's routine, in your management of it, or simply in the minds of others? If you can honestly say you want to change your baby's sleep habits because they are truly disruptive to you and your family, then you're ready to make changes. But if you feel coerced into changing Baby's patterns because Great Grandma Beulah or your friend from playgroup says that's the way it should be, it's time for a long, hard think.

Certainly, if your little one is waking you up every hour or two, you don't have to think long on the question, "Is this disruptive to me?" It obviously is. However, if your baby is waking up only once or twice a night, it's important that you determine exactly how much this pattern is disturbing to you, and decide on a realistic goal. Be honest in assessing the situation's effect on your life. Begin today by contemplating these questions:

• Am I content with the way things are, or am I becoming resentful, angry, or frustrated?
• Is my baby's nighttime routine negatively affecting my marriage, job, or relationships with my other children?
• Is my baby happy, healthy, and seemingly well rested?
• Am I happy, healthy, and well rested?

Once you answer these questions, you will have a better understanding of not only what is happening with regard to your baby's sleep, but also how motivated you are to make a change.

Reluctance to Let Go of Those Nighttime Moments

A good, long, honest look into your heart may truly surprise you. You may find you actually relish those quiet night wakings when no one else is around. I remember in the middle of one night, I lay nursing Coleton by the light of the moon. The house was perfectly, peacefully quiet. As I gently stroked his downy hair and soft baby skin, I marveled at this tiny being beside me-and the thought hit me, "I love this! I love these silent moments that we share in the night." It was then that I realized that even though I struggled through my baby's hourly nighttime wakings, I needed to want to make a change in our night waking habits before I would see any changes in his sleeping patterns.

You may need to take a look at your own feelings. And if you find you're truly ready to make a change, you'll need to give yourself permission to let go of this stage of your baby's life and move on to a different phase in your relationship. There will be lots of time to hug, cuddle, and love your little one, but you must truly feel ready to move those moments out of your sleeping time and into the light of day.

Worry About Your Baby's Safety

We parents worry about our babies, and we should! With every night waking, as we have been tending to our child's nightly needs, we have also been reassured that our baby is doing fine - every hour or two all night long. We get used to these checks; they provide continual reassurance of Baby's safety.

"The first time my baby slept five straight hours, I woke up in a cold sweat. I nearly fell out of bed and ran down the hall. I was so sure that something was horribly wrong. I nearly wept when I found her sleeping peacefully." …Azza, mother of seven-month-old Laila

Co-sleeping parents are not exempt from these fears. Even if you are sleeping right next to your baby, you'll find that you have become used to checking on her frequently through the night. Even when she's sleeping longer stretches, you aren't sleeping, because you're still on security duty.

These are very normal worries, rooted in your natural instincts to protect your baby. Therefore, for you to allow your baby to sleep for longer stretches, you'll need to find ways to feel confident that your baby is safe-all night long.

Once you reassure yourself that your baby is safe while you sleep, you'll have taken that first step toward helping her sleep all night.

Belief That Things Will Change on Their Own

You may hope, pray, and wish that one fine night, your baby will magically begin to sleep through the night. Maybe you're crossing your fingers that he'll just "outgrow" this stage, and you won't have to do anything different at all. It's a very rare night-waking baby who suddenly decides to sleep through the night all on his own. Granted, this may happen to you-but your baby may be two, three or four years old when it does! Decide now whether you have the patience to wait that long, or if you are ready to gently move the process along.

Too Fatigued to Work Toward Change

Change requires effort, and effort requires energy. In an exhausted state, we may find it easier just to keep things as they are than try something different. In other words, when Baby wakes for the fifth time that night, and I'm desperate for sleep, it's so much easier just to resort to the easiest way to get him back to sleep (rock, nurse, or replace the pacifier) than it is to try something different.

Only a parent who is truly sleep deprived can understand what I'm saying here. Others may calmly advise, "Well if things aren't working for you, just change what you're doing." However, every night waking puts you in that foggy state where the only thing you crave is going back to sleep - plans and ideas seem like too much effort.

If you are to help your baby sleep all night, you will have to force yourself to make some changes and follow your plan, even in the middle of the night, even if it's the tenth time your baby has called out for you.

So, after reading this section and you're sure you and your baby are ready, it's time for you to make a commitment to change. That is the first important step to helping your baby sleep through the night.

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