Friday, October 01, 2010

The Sleep Situation for Parents of Newborns

Dr. Michael Thorpy and Dr. Shelby Freedman Harris of the Sleep-Wake Disorders Center at Montefiore Medical Center:

For most parents, having a newborn in the house can wreak havoc on sleep schedules. Generally, there aren't any long-term health effects. I personally see it as an evolutionary thing that's built in to help us raise newborns, though there are really no studies on this. New parents can prepare by understanding, and accepting, that the first few months will most likely consist of disrupted nighttime sleep. If you follow the guidelines below, the disrupted sleep will likely last for only a few months, which is rather short-term in the scheme of things.

During the first six months of life, babies sleep soundly in two- to four-hour periods. Newborns are not born with a circadian cycle that makes them stay awake during the day and sleep at night. Rather, sleep is spaced evenly in chunks throughout the 24-hour day. Bottle-fed newborns tend to sleep for slightly longer periods, generally three to four hours, whereas breast-fed babies tend to sleep in one- to three-hour cycles.
After 6 months of age, infants begin to sleep for longer periods, and they generally sleep through the night (as defined by a six-hour stretch). From 6 months to 9 months, however, many infants, even those who were fantastic sleepers when they were younger, begin to exhibit episodes of night wakings. These night wakings are generally due to developmental and physiological milestones. Instead of sleeping, babies often find it more interesting to practice newly acquired skills like crawling or sitting up. About 30 percent to 50 percent of infants at this age awaken at least once per night for a short while, usually for about one to five minutes at a time, with 25 percent of 1-year-olds continuing to do so.

Since newborns sleep upward of 16 hours per day in small chunks, parents often find it difficult to get a full seven or eight hours of sleep at night. Parents need to work their sleep schedules around the newborn’s patterns. In essence, sleep when the baby sleeps. We realize that this is easier said than done, but making some changes — and enlisting the help of others, if possible — can help new parents adjust as best as they can to a fragmented sleep pattern.

Creativity and flexibility are important here. For example, some parents prefer to break up child care into “early night” and “late night” shifts, whereas others swap off nights. Once a baby is 6 weeks old, parents can start to have a standard bedtime routine set at a desired time, though it might migrate earlier or later depending on the baby’s schedule. Keep in mind that it is unlikely that your baby will be sleeping through the night just yet. These routines help to reinforce that it is bedtime and help the child ease into sleep.

Keep the routine uncomplicated, simple and always in the direction toward the crib — for example, bath, followed by bottle in a nursery chair, then reading in the chair and then crib. In addition, try not to have baby fall asleep at the bottle; instead, put the newborn to bed “drowsy but awake.” This helps the child learn to self-soothe. Becoming attuned to baby’s sleep signs, like rubbing the eyes, yawning or fussing, can be helpful. Pushing the bedtime later will only cause the baby to become overtired and sleep worse. Gradually moving the bedtime earlier can actually help lengthen the sleep period.

Remember to always put your baby to sleep on his or her back (the phrase “back to sleep” is a helpful reminder). Do not swaddle in many clothes or wrap the baby in a blanket; government officials also recently advised against using infant sleep positioners. Make it possible for the baby to be able to move around in the crib. On hot summer days, dehydration is a major cause of child discomfort, so be aware that babies lose water more easily than adults.

From 4 to 6 months of age, babies start to sleep through the night. They require few or no night feedings. Babies who are “self-soothers” can easily fall back asleep on their own, but some babies require the presence of a parent, food or object (such as a pacifier) to return to sleep.

If a baby continues to need your help to return to sleep, a number of methods have been developed to teach a baby to self-soothe. A common misconception is that babies will outgrow this phase. Studies have shown that 80 percent of children who had sleep problems as infants continue to have difficulties three years later.
There are many treatments available to help babies become self-soothers, including the “cry it out” Ferberizing method and “no cry” solutions. Choosing which treatment to use is a very personal decision, and one that some feel very passionate about. Many of these treatments can be helpful, but consistency is critical for success. A number of helpful books are available, including “Sleeping Through the Night,” by Jodi Mindell; “Healthy Sleep Habits, Happy Child,” by Dr. Marc Weissbluth; and “The No-cry Sleep Solution,” by Elizabeth Pantley.

As a baby begins to sleep through the night, many parents notice that they have trouble doing the same. They have adjusted to sleeping in short chunks, and returning to pre-baby sleep patterns takes time. Those parents who had trouble sleeping before the baby arrived often have more difficulties with this transition. Try to avoid checking in on your baby whenever you awaken. If you are needed, your baby will let you know.
If Mom or Dad continues to suffer from insomnia, cognitive behavioral therapy or pharmacological treatments may be necessary. We recommend that new parents first start with cognitive behavioral therapy for insomnia, as it can be quite effective without the addition of medication.

While poor sleep and fatigue are believed to be the norm for new parents, postpartum depression may be an underlying factor and can worsen sleep. Studies have shown that women with a prenatal history of depression may be more affected by the multitude of changes that happen after childbirth, including psychological, hormonal and immunological shifts. It is important that new mothers let their doctors know of any symptoms of depression, including sad mood, tearfulness, feelings of hopelessness or guilt, insomnia, changes in appetite, extreme loss of energy, loss of interest in things and thoughts about death, suicide or harm to others.
If a new parent or baby continues to have troubles with sleep, pediatric sleep specialists or behavioral sleep medicine specialists are available to help. The American Board of Sleep Medicine has a list of certified behavioral sleep medicine specialists on its Web site.

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