Is your Baby Sleeping Through the Night Yet? Warning: this is not your mother's sleep page.
I'm going to start charging anybody who asks the parents of one of my patients "is your baby sleeping through the night yet? It's a ridiculous question...the answer is almost always "no" but when we give that answer, we feel like bad parents, and we start to believe that something is wrong with our child.
Equally as annoying is the "let them cry it out, is the nursery ready, put that baby down you're spoiling him" attitude that wears on the souls of the parents. As if normal babies were never meant to be held all the time, and were meant to sleep all by themselves.
They were never mean to sleep alone. They were born to be held. Kids are not supposed to be sleeping through the night.
Let's understand normal sleep. Probably the two most important stages of sleep are stage 4 sleep and REM (rapid eye movement) sleep.
In stage 4, you are completely unresponsive, with a disconnection between sensory information coming in and your ability to receive it. You can't hear people taking to you, you don't know your bladder is full, you don't smell smoke, and you can't tell if tigers are around. This is the prevalent sleep stage of the first part of the night, and the more tired you are, the longer you spend in stage 4 sleep. You have a really hard time being awakened or awakening from stage 4 sleep. Kids with disorders of stage 4 sleep will have sleepwalking, sometimes bedwetting, or night terrors.
In REM sleep, you have a complete loss of muscle tone. That's a good thing, since you dream in REM sleep, and if you acted out your dreams you could really hurt somebody or yourself. REM sleep happens towards the last part of the night. You can wake up easily from REM sleep. Kids with disorders of REM sleep have nightmares.
The stages of sleep, and there are more than just stage 4 and REM, are things we go through each night, but we go through them in cycles. Every 90 minutes of so we actually wake up, check out our surroundings and go back to sleep if everything feels safe. Awakening about 5-8 times a night is normal.
So, as sleep has developed, one of the major issues surrounding it is safety. We could comfortably enter stage 4 sleep because other people were around us to keep us safe, and at least one person was probably in lighter stages of sleeping so that they could warn us if tigers were around. That sense of connection is really important to us now even though we aren't really worried about predators. We were designed to be social sleepers.
Normal babies
We spend so much time dreaming of what our children will be and very little time realizing what they are.
Let's say, for the sake of argument, that human evolution is like a football field. Human beings as a genus start at the far end of the field, and we as a species show up at about the opposite 10 yard line. At about the one inch line ( and that's generous) we as an industrial society show up. Why am I rambling about this? Because we have to understand that the way we do things is a new idea...but the babies we bring into this world don't know about the way we do things. They are programmed to do things that human babies have been doing for thousands of years.
And human babies are really vulnerable. If you've ever seen what baby elephants or horses can do at birth, you know that they can walk shortly after birth, and are running soon afterwards. Why can't humans do that? Well, if we waited until the brain was mature enough for our kids to walk, the baby's head would be too big to come out safely. We don't need to run to stay safe. Our gestation period is designed to make sure that our kids arrive in the world with their future intact-- our kids arrive in the world when it's safest for the brain to come out.
Our children arrive in the world as the most neurologically immature primate of them all, and remain the most dependent on a caregiver for the longest period of time. Our kids can't keep themselves warm, get food, walk, speak, or reason. They can't manipulate us and they can't consciously choose to make you look like a bad parent.
What do we know about their sleep patterns? Well, they need to be near a caregiver-- mostly mom. It makes sense if you think about it. This immature baby, with little in the way of self-preservation skills, needs to hang out with the source of food and warmth, with the person who is most likely to wake up to meet the needs that they express in the middle of the night. There are beautiful videos of moms and babies who are almost totally in sync in terms of sleep cycles, showing them waking at about the same time several times during the night, with mom responding to the baby and the baby, who rarely cries, getting their multiple needs met. There is also good evidence that shows that children sleeping near mom have less time in stage III and IV sleep. More later.
Normal babies sleep during the day and are up at night, at least for the first several (6-8) weeks. That is normal and expected and nothing we can do to change that. That means that parents need to sleep when the baby is sleeping to avoid all the great things that go along with sleep deprivation. Older infants get up at night, but less often, and it is normal for one year olds to not be sleeping through the night. Of course, if I did my job earlier, you now understand that nobody sleeps through the night. Interesting tidbit: about 80% of parents of one year olds identify their children as having "sleep problems." Eighty percent? Maybe we have an expectation for our children that is not based on human physiology and is therefore not realistic. Maybe they don't really have a sleep problem.
How 'bout this idea that we have to teach our kids to "soothe" themselves? I would argue that a several month old child is still not able to feed themselves, find food, or do any other thing that it would take to live independently. Why on Earth would they need to soothe themselves? They are speaking up because they need something. If they need something, even if it just to feel safe, why shouldn't we help them? Do we really need to teach a 2 month old independence? Why should they do it by themselves? Because we want to sleep...I understand that... but sometimes our needs aren't what our kids are considering.
Sleeping Arrangements
The choice of where our children sleep affects (and there is research to show all of this): breastfeeding duration, feeding frequency, infant sleep position, arousal patterns, temperature, carbon dioxide levels, crying, heart rate, parental emotional expectations.
Babies who have more skin to skin contact with their parents show better oxygen delivery, less frequent crying, higher temperatures, better weight gain, better digestion and less physiologic markers of infant stress. (It's why kids who are held more have less colic.) So, based on that, it makes sense that more contact with mom and dad makes for a more physiologically sound child.
Sleeping Alone
This is what we are supposed to do. Kids should learn to sleep by themselves to become more independent, less dependant on mom and dad, able to handle situations better when confrontation happens in the future. In general, kids who sleep by themselves are better humans. Right? Does that even make sense?
Interestingly, and really tragically, we (and now I mean me as a doc) said over and over again that sleeping alone was where kids needed to be. And we as parents did that. We put our kids on their stomach. They were sleeping alone, getting really deep levels of sleep that they were never built to handle, got high levels of carbon dioxide around them, and some died. The great majority of deaths of infants occurred while they were sleeping alone. We never asked "is it safe for children to sleep alone?" We got our answer-- it's safe if they are on their back, on a hard mattress, without any environmental smoke exposure, and if there are no other soft fluffy things in the crib. We learned that answer the hard way: 92% of the infant deaths in a the 1999 Consumer Product and Safety Commission data base occurred while infants slept alone outside of adult supervision.
Studies recently published show that kids who were never in their parents bed tend to be harder to control, more fearful than children who were permitted to bedshare, more dependent on their parents, and dealt less well with stress.
Co- sleeping
Fortunately, most of us as parents have our kids nearby as we sleep. Of course, not many of us ever tell anybody that we do this.
Co-sleeping needs to be defined. It means being close to your baby as they sleep. And there are safe ways to do this, and ways that we shouldn't do it.
Safely co-sleeping: (these are going to look a lot like the recommendations for SIDS prevention)
How come my friend's baby sleeps through the night?
I don't know. I don't even know what that means. When I ask about what that means, I get a great variety of answers. Some people think 6 hours of sleep at night is "through the night" other people want to sleep like they did before they had kids.
I would guess that the kids aren't sleeping through the night, but that the implications of admitting that your kid isn't sleeping are too nasty to admit. We equate "good sleepers" with good kids, and "bad sleepers" with bad kids. Really, we make moral implications from normal baby behaviors. And of course, parents of good sleepers are good parents. And since 80% of us have kids with "sleep problems," 80% of us are bad parents. Yipes.
Plus, feeding choice plays a role here. Formula fed kids sleep differently than breastfed kids. Formula fed kids sleep for longer stretches of time and therefore have less contact with their parents at night. Formula fed children are much more likely to be sleeping alone.
The sleep training techniques that have been sold in the US have never been shown to be associated with anything good for infants but it has been associated with bad stuff, like more anxious children and behavior disturbances. There is no emotional, social or intellectual benefit to the kids, nor has it ever been shown to help us develop into healthy adult sleepers.
So...we have to decide what we want from our kids sleeping through the night. I would guess that all the good things that we want for our kids' futures mean that we don't have them sleep through the night.
more info on co-sleeping
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updated July 26, 2007