Sleep and the Newborn

By Heike Millar – Midwife, BCur Ed & Ad, Good Night certified Sleep Consultant

You are pregnant and eagerly anticipating the arrival of your bundle of joy. Despite the fact that your bladder has not allowed you to sleep a solid 8 hours since you fell pregnant, your friends with children are probably telling you to enjoy your last sleep filled nights. Whoever coined the phrase “sleeps like a baby” has either, never had a baby, or was speaking of a night of frequent waking. There are, however, some things you can do to assist your baby on the journey to developing healthy sleep habits.

Understanding sleep

As adults we go through a series of “sleep states” – from deep, light and REM (rapid eye movement) sleep. Each cycle lasts about 90 minutes. REM sleep is when we dream and brain activity resembles that of the waking brain. It is during this REM sleep that we are more likely to awaken fully if we subconsciously assess a problem (there’s a dog barking, a mosquito buzzing, a baby crying, a full bladder) and we are unlikely to be able to fall asleep until we have addressed the problem (tell the dog to sshhh, kill the mosquito, feed the baby, go to the bathroom). However, if no such assessment is made we will just carry on sleeping and not know that we were half awake.

Babies have two sleep states – active (REM) and quiet. Newborn sleep cycles are about 45-50 minutes long. During active sleep you may see your baby’s eye lids flutter, her breathing is irregular, she may twitch, make small movements and even small noises. Young babies spend much more time in active sleep than adults do and this is why they awaken more easily and more frequently. Helping your baby transition from one sleep cycle to the next smoothes the journey to healthy sleep.

Safe sleep

WHO recommendations for safe sleep-

  • Place your baby on her back to sleep
  • Ideal room temperature is between 16-20° Celsius
  • Use a firm sleep surface with no pillow, feet to foot of the crib. Keep soft objects, bumpers, toys, and loose bedding out of your baby’s sleep area
  • Do not smoke or let anyone else smoke around your baby
  • Make sure nothing covers your baby’s head, dress your baby in a babygrow and use a sleep sac rather than a blanket
  • Bed sharing is not recommended but room sharing for the first 6 months is.

Establishing a safe sleep space

It should be calm and consistent. The cot is for sleeping only and your baby should sleep here at night and during daytime naps. There should be no toys in the cot or mobile above it. Introducing a safe “lovey” or “dudu blanket” as a security object is a “good” sleep association and should be included in your bedtime routine and be put into the cot with your baby to sleep. White noise is an excellent sleep aid ­ it helps baby feel secure and drowns out any other background noises that may disturb her sleep.

Starting the journey

In the first two weeks all you need to concentrate on is getting to know your baby. She needs to be loved, fed, changed, and to sleep. Newborns need plenty of sleep (16-18 hours a day). The brain consolidates knowledge during sleep and for your newborn everything is new. Imagine never having seen a dog or a teddy bear before. She needs to sleep to process all this new information. A newborn baby will wake 2-3 hourly for feeds (including nights) but is only awake for about 45-60 minutes at a time and then needs to sleep again. She will often fall asleep in your arms or at the breast. Enjoy this time.

A consistent routine

From about 6 weeks you should notice that your baby’s days and nights follow a pattern. Consistency will help cue your baby’s brain as to when it is time to sleep. Interact with her when she is alert during the day and limit interaction at night to help her recognise that night­time is for sleeping. No fuss or conversation at night. Aim to soothe as many of the senses as possible during the bedtime routine. A warm bath helps to relax your baby and make her feel sleepy. A calm, loving touch; a lavender candle in the bathroom; soft music; dim lighting. Start having a consistently early bedtime ­ sleep begets sleep. Using white noise, rocking, patting, sssshhh­ssshhhh sounds, non nutritive sucking on hands or dummy and swaddling may help to calm her down and assist her in falling asleep.

Melatonin

Breastmilk contains tryptophan, an amino acid that is used by the body to manufacture melatonin (the sleep hormone).The tryptophan levels in the breastmilk are determined by the mother’s circadian rhythm. Babies who breastfeed at night fall asleep faster at bedtime and get more overall night time sleep (subsequently so do their parents).

Melatonin is released naturally as the light fades so in the morning, open the curtains to let in light and expose your child to natural light during the day. Keep the room as dark as possible for night­time feeds as well as for daytime naps. This will help establish your child’s natural circadian rhythm.

Sleep cues

By 3 months she can be awake for between 60­90 minutes during the day and may drop the 10pm feed and stretch to 1 or 2am before waking. Thereafter she will wake 3­4 hourly to feed again. Try to recognise her sleep cues and to have her in her cot by the time these cues start. She may be more fussy than usual, have red eyes, yawn or loose eye contact. At this age, put her in her cot awake but drowsy at sleep times and allow her to self soothe.

Self soothing

From about 4 months, you can start to loosen the swaddle and when your baby wakes at night, don’t rush to her immediately. Give her a chance to self soothe. If she does need a feed go to her but don’t feed her immediately. Delaying gratification slightly may help children become independent but trust your maternal instinct on whether your child is ready for this.

Hopefully your baby’s journey to healthy sleep habits will be a short one without pot holes or speed bumps.

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