The Obligatory Sleep Post

Stay awake, don’t rest your head
Don’t lie down upon your bed
While the moon drifts in the skies
Stay awake, don’t close your eyes
Though the world is fast asleep
Though your pillow’s soft and deep
You’re not sleepy as you seem
Stay awake, don’t nod and dream

Mary Poppins

What is it with babies and sleep? Get a group of new mums together and soon the conversation turns to sleeping – is he sleeping through the night? How often does she nap? How do you get him to sleep? And underpinning all that, am I doing the right thing, should I be doing something different, am I the only one who is seeing spots because I’m so bloody tired?

A quick search on Amazon for ‘baby sleep’ brings up no less than 17,342 books on the subject, with about as many solutions. And what varied solutions they are, from no-cry to cry-it-out, from quick fix to long term. And each of them full of recipes for success – sleep logs, nap schedules and cut-out-and-keep wall planners with a free fridge magnet. And then there’s the CDs of soothing lullabies guaranteed to get your little tinker dreaming, the white noise apps, the vibrating bouncers…. And the sleep trainers/night nannies who will read all the books and sing all the songs for you and get that little tinker sleeping through the night within three days!

And what do they say? Make sure you teach your baby to self-settle, make sure your baby breaks the magic 45-minute sleep cycle, make sure your baby is lying on its back on a hard surface in a temperate room. Never let the baby fall asleep on the breast/bottle, never rock the baby to sleep, never let the baby sleep with you.

So, with so many solutions, I think we have to agree that infant sleep is a big, fat, moneyspinning problem. And not a trivial one – sleep affects our ability to concentrate, our memory, our relationships. And our mood – one study even suggests that the high rates of postnatal depression in new mums may in fact be chronic sleep deprivation.

But who is sleep a problem for? Looking cross-culturally, there is huge variation in the percentage of parents who report sleeping as a problem – from 10% in Vietnam to 76% in China. And that doesn’t mean those babies aren’t waking up – in Korea 83% of babies were reported to wake at night, but only 16% of parents saw this as problematic. When we put our babies to bed also differs, from the typical 7:30pm bedtime of the UK to 10:30pm in Hong Kong. So, while you’re being (literally) kept awake wondering whether your baby’s sleep is normal, it appears that really there is no ‘normal’.

Often, sleep only feels like a problem when you start to compare your baby, and your sleep, to those around you. Parents may be perfectly happy rocking their baby to sleep until someone tells them they shouldn’t be. Everyone has their failsafe solution to getting a baby to sleep, and they’re not afraid to tell you where you’re going wrong. When we read between the lines of all the advice, often we are left with a choice – do we try and fit into our baby’s rhythms, or do we try and fit them into ours?

The trouble is, an infant’s natural rhythms tend not to fit ours, especially if ours are designed to fit around work/other kids/partners or just life-as-we-know-it. We’ve spent years falling into bed when it’s dark and waking when it’s light (or usually, after hitting the snooze button a few times). But sleep-wake cycles in a newborn, rather than being set to day and night, are spread through the day, not naturally consolidating until 9-10months. While our sleep cycles run at around 90 minutes, newborns move into light sleep every 20-45 minutes, and of course can easily move into wakefulness at any discomfort. And while newborns sleep a phenomenal amount – needing 12- 18 hours a DAY – this will be spread throughout the whole 24 hour day rather than in long chunks. In fact, when you dig into the literature a bit, “sleeping through the night” is defined as a five hour stretch of sleep, not the 12 hours you might have been gunning for. And, when you think about it, that’s a pretty reasonable way to sleep when you have a tiny little tummy that needs filling, and you might have pooed your pants, and you want to make sure someone is nearby in case of any pesky tigers lurking. Not only reasonable, but frequent waking is also potentially protective against SIDS.

In fact, until fairly recently, it was pretty standard to sleep in two chunks of time with a break in the middle. And, of course, as adults we may still wake many times in the night, just we don’t need a cuddle to get us back to sleep again (although it’s nice when one’s available).

So what actually constitutes a sleep problem for babies? Of course, the research differs. Ian St James-Roberts  suggests that, after 6 months, a baby waking at night and signalling for help constitutes a problem. But other research shows that over half of babies are still waking regularly at 12 months (Scher, 1991), and only 16% are ‘sleeping through’ at 6 months (Golding et al, 2001).  Few studies have made the distinction between babies who find it difficult to go to sleep, and those who wake up a lot, but one of the few studies which examined this found they do tend to be related – in other words, some babies may just sleep better than others. And although it may not feel like it when you’re dragging yourself out of bed for the third time in four hours, only 5-6% of babies have consistent, stable problems with sleep, although it is very common to have intermittent night waking.

And what might cause these problems? Just as an aside, why would we want to know what causes sleep problems – so we can do something about it. So it might not be reassuring to know that the amount of factors which can contribute to sleep problems are as long as the amount of solutions being peddled. They include: adversity during pregnancy (alcohol or drug consumption, stress); stress at home (such as marital conflict), medical conditions (like asthma, allergies) and maternal factors (such as anxiety and depression). The list also includes ‘individual differences’ (that’s going to help you at 3am isn’t it?!).

In all infants, sleep could be affected by the parents’ anxieties about leaving the child (this is the one book I would recommend on sleepless nights, which looks at the underlying causes for sleeplessness rather than just the solutions).  And in older infants, fighting sleep might also be due to the infants’ fear of being left – and our own expectations of compliance in babies who are becoming independent (Iglowstein et al, 2003 argue that older babies may not sleep simply because they are being put to bed too early). Of course, it makes sense that, once babies discover there is a whole world out there, they might begin to fight off sleep. Imagine watching the best film you’ve ever seen, then 10 minutes before the end being told it’s bedtime, and you get an idea of what we sometimes ask our babies to do.

A couple of factors which come up time and time again are what babies eat, and where they sleep. It’s not a myth that formula fed babies do tend to settle for longer at an earlier age (in one study, the median length of sleep was 8 hours in formula fed babies compared to 3-5 hours in breastfed babies). This is due to the nutritional content of formula milk, which has a high fat/protein content so is digested more slowly. And, leaving aside the scary Daily Mail headlines about sleeping with your child, the little valid research done on co-sleeping suggests that protesting against sleeping alone is just a useful evolutionary survival mechanism. While those who co-sleep may have more frequent waking, they also tend to sleep better and in tune with the baby. In this context, sleep problems can be seen as a battle between the baby’s biology (and the mum’s), and what is seen as socially acceptable.

So if aaaaaall those things influence sleep, what do we then do about it? How do we get a newborn from waking every 45 minutes, to the baby equivalent of rolling over and pulling the duvet back up?

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I feel like I should have in big bold flashing letters here – BIT ABOUT SLEEP TRAINING COMING UP. Because leaving your baby to cry is possibly one of the most divisive practices out there in parenting. Stop reading here until the next ** if you don’t want to read yet another opinion on controlled crying. I’ll keep it short, and factual.

(While of course there is a difference in leaving your baby to cry for gradually prolonged periods of time (controlled crying) and leaving your baby to cry until they fall asleep (cry-it-out), I’m going to lump them together as they all involve a lack of response to a baby’s cry and are often conflated in the literature.)

The first thing to say is that any parenting practice that involves the word ‘training’ should be given careful consideration. Moulding behaviour to comply with norms that you choose must inherently take some control away from your child, and reduce your ability to consider what your particular individual baby might need. BUT. For some people, a sleepless night is simply not an option. And, while there are a million and one guilt inducing articles out there about long term damage on babies, the fact is there is no hard evidence on either side, and more research is needed. BUT. Although hard evidence might not yet exist, many child psychologists express reservations about controlled crying, and the possibility for lasting damage (such as Oliver James, Penelope Leach and Sue Gerhardt if you want to read further). The strongest statement comes from the Australian Association for Infant Mental Health

“Crying is a signal of distress or discomfort from an infant or young child. Although controlled crying can stop children from crying, it may teach children not to seek or expect support when distressed”.

When you look at the evidence which does exist, there are certain key elements which jump out. Firstly, while leaving a baby to cry might be an effective solution in the short term, one Australian trial found it made no difference to sleep problems by 3 and 4 years of age.  And, although reduced sleep is linked to maternal depression, controlled crying doesn’t make any long term difference to either mood OR sleep, indicating that babies will eventually learn to settle. The clearest evidence that controlled crying may have longer term repercussions comes from studies examining cortisol (stress hormone) levels, which demonstrate that, even when babies have stopped crying, they still show high levels of distress.

With this in mind, choosing whether or not to ‘sleep train’ involves making an informed decision about the risks and benefits in your individual situation. It’s worth saying here that the critics of controlled crying have left some parents with a fear of their baby ever crying at all. But there is a difference between leaving a baby to cry alone, and cuddling a baby who is crying because he can’t get what he wants (e.g. milk/another story/Incy Wincy Spider for the millionth time) AND that there is a difference between leaving a 2 month old who can’t understand why she is being left and encouraging a 2 year old who is aware you are in the next room.

**

Funny isn’t it that here we are thinking about how to get a baby to sleep, but we don’t usually ask how to get a baby to roll, or crawl, or walk, or talk. If we know that sleep cycles develop over time, and that development of all kinds doesn’t tend to be linear, why are we obsessed with getting this one thing in the bag? Of course, we can force our children to learn to sleep earlier, but what’s the consequence of that? We can encourage our children to walk earlier too, but there is growing evidence that this can lead to an increased risk of hip dysplasia.

The difference is, we don’t tend to see walking as our responsibility. You don’t tend to hear mums discussing their babies’ crawling habits, or going into minute detail about what they are doing to encourage first words. But with sleep, we can spend hours trying to get a baby to sleep past that magic 45 minute cycle, or using blackout blinds, lullabies and white noise to get that baby on a schedule. But, like walking, you can’t force sleep. And when you begin to see sleep as something you can encourage, but not force, sometimes you can start to enjoy those long, lazy bedtimes. Not every time. Not when you’re dying for an evening on your own, or have an ever expanding to do list, or can smell dinner burning. But sometimes. (Incidentally, one little tip for those bedtimes that are going on forever and you notice your irritation and frustration growing… think of one funny/sweet/awesome thing your baby did that day. Or smell their hair, rub their soft cheek. Anything to remind yourself that this is your child, who you are helping to sleep, because you love them. Whatever you do, don’t think about the things you were planning on doing, or the TV programme you’re missing, or the voice telling you this is actually a demon sent to drive you to insanity).

There are certain ‘solutions’ which are worth bearing in mind. It’s true that sleep begets sleep, and an overtired child takes longer to wind down. But often babies go through phases where sleep is more difficult, then phases where they catch up again. And while having a bedtime routine (your bog standard bath, books, bed) has been shown to reduce night waking, other families are happier just keeping their extra little guest with them throughout the evening and all going to bed together. If you can create an environment conducive to sleep, and trust that – like walking – your baby will learn how to sleep without you at some point, then really you’re doing all you can. Rather than changing our babies’ habits, maybe it’s more helpful to change our expectations of them. And while I know it’s thoroughly depressing to look towards the coming months of broken sleep, all those times you comfort your baby in the middle of the night add up to a long term investment in trust, and a relationship which is connected throughout the 24 hour day. One guarantee is that babies change – and eventually all babies will learn to sleep on their own. How much or how little you tinker with that is up to you.

There will be a time when your child has taken themselves off to bed, and you say to your partner ‘man, remember when we used to have to rock AND feed AND sing him to sleep?’ There will be a time you’ll miss the late night feeds, and the sweaty snuggles. And I’ll be honest, I didn’t mind missing sleep when it meant I could dance till the small hours. Rocking is a bit like dancing, isn’t it?