Baby Sleep is Complicated
I'm a big baseball fan (now stay with me, there is a point). One of the things I really love about baseball is that with every new batter, new pitcher, and new situation, the game changes. Baby sleep is a lot like that. Babies' sleep location, their own physical and developmental characteristics, and their parents' behaviors, all interact to influence infants' sleep. And, the game keeps changing as babies grow, as parents change, and when babies sleep in different places. I wish I could give you the answer to get babies to sleep quickly and for long stretches but I continue to believe that there is no single intervention that will help all babies, or even the same baby over time, in all circumstances. Now, I don't mean to imply that there is nothing parents can do. Instead, parents should think of themselves more like the baseball batter adjusting to the pitches that are thrown to them. Some adjustments in parents' actions and in babies' environments will help babies fall asleep, others might help babies stay asleep.
Believe it or not, there is a technical term for the time it takes to fall asleep, it's called "sleep-onset latency." Most newborns fall asleep while feeding (but they wake and feed frequently!) so falling asleep becomes more of a problem for older infants, especially those who hate being drowsy. Caffeine exposure and over stimulation can be important factors that might hinder babies' ability to fall asleep. Babies who are sick or uncomfortable (as with teething) will also have problems falling asleep. Dealing with these issues (with help as needed from the doctor) can be a big help to tired parents. But, there are other babies who don't want to fall asleep even when they are not sick or overstimulated. The research we found indicates that consistent bedtime routines (lasting from 20 to 40 minutes) can help babies to wind down. Some routines include a bath, a massage, some rocking, and a story or a song. The key is for parents to be consistent with a series of pleasant and soothing activities night after night. One large study found that a routine helped babies fall asleep faster and stay asleep longer with or without putting the babies down slightly awake.
Let's get back to the "put your baby down while awake" recommendation. This suggestion is used primarily as a way to prevent babies from calling out for their caregivers if they wake at night. The idea is that babies who always fall asleep in their parents' arms won't be able to fall asleep any other way. We found several "observational" studies that found that babies who were put down awake were more likely to stay asleep. In observational studies, researchers look at things the way they are and they don't try to change anything as they do in "intervention" studies. Because the same babies who accept being put down awake may sleep longer naturally than those who fight sleep, the relationship between the slightly awake baby and longer sleep may be related more to the baby's characteristics rather than the action of putting the baby down awake. So, we need intervention studies to see if the action results in longer sleep for all babies. This is where it gets tricky. There are plenty of intervention studies that include putting babies down while they are awake but none that includes only this one action (for infants). Most of the interventions include 1) education for parents about infant sleep, 2) standardized bedtime routines, 3) putting baby down at the end of the routine awake or not, and 4) changing parents' response if the baby protests going to sleep. Some of the interventions included instructions for parents to wait to respond (letting the baby cry). In other studies, parents were told to respond by touching the baby (like putting a hand on the baby's back) but not picking the baby up. Some interventions also included white noise, music, and other changes to the sleep environment.
Ok, that's a lot to take in. What does this all mean to you, a tired parent? We'd like to end this series with a few key messages.
- Newborns need to wake for many reasons. Get some help for this tough time.
- A single intervention is not likely to increase sleep for all babies or permanently for any baby.
- When trying to help your baby go to sleep faster and sleep longer, you need to consider his health, age, size and developmental characteristics, your own actions and beliefs, and characteristics of his sleep environment. How a baby sleeps is not an indicator of parenting skill.
- There are a lot of options for parents of older babies to get more sleep. Understanding more about how babies sleep, why they wake, and how "the game changes" over time can help you make informed decisions about what steps will work best for you.
Next time: Back to your questions!