6 Tips for Sweet Newborn Sleep

Nothing can prepare you for the changes in your sleep when you welcome a newborn baby into your family. Experienced parents will issue dire warnings and tell you to sleep while you can during the last few weeks of pregnancy. (And you will think, yeah right, there’s a large boulder resting on my bladder, and sometimes it kicks for good measure.)

But then the baby arrives, and your world changes forever. Sleep disruption is one of the most immediate and dramatic changes associated with parenthood. It isn’t just that you’re getting less sleep; it’s that your sleep is suddenly dependent on this baby sleeping. And even though newborns sleep a lot – as much as 16-18 hours per day – it feels disorganized and unpredictable.

The thing is, babies, even brand new ones, actually do have organized sleep, it just isn’t organized like yours. But under the surface, baby is working towards being more like you in his sleep. During the first few months, you have no choice but to go with the flow and sleep when the baby sleeps (something I was never good at), but it can help to understand the inherent patterns in your baby’s sleep/wake cycles so that they become more predictable. Your goal is to work with your baby’s biology, find some time for your own sleep, and support your baby in his natural development towards more mature sleep patterns.

In the research for my book, I’ve buried myself in research papers on infant sleep, trying to glean some knowledge that can be helpful to parents in these first few months of baby’s life. Here’s what I’ve come up with so far:

1. Understand newborn sleep cycles. Newborn sleep alternates between active and quiet sleep (akin to REM and non-REM sleep in adults). During the first few months of life, infants usually begin each sleep period in active sleep. Then, after about 25 minutes, they’ll transition to a cycle of quiet sleep, also about 25 minutes long. During active sleep, babies will twitch and flail their limbs, grunt and sigh, and maybe even cry a little. Their eyes move beneath translucent closed lids and may even open from time to time. In quiet sleep, babies breathe slowly and rhythmically, and their bodies are still ^1,2.

Why care about the biology of sleep? Because it can help you in these practical ways:

• Babies wake easily from active sleep, so if your baby falls asleep in your arms, wait until you see signs of that deeper, quiet sleep before you try to move him.
• Around the 45-50 minutes mark, baby will be finishing up that first active/quiet sleep cycle of 45-50 minutes. Transitioning from one cycle to the next can be tricky for a new baby, so if he wakes during this time (particularly if it’s after just one cycle), see if he wants your help returning to sleep before assuming that he’s ready to eat or play.
• Active sleep is noisy. Parents often mistake the normal vocalizations of active sleep as the baby waking, and in their efforts to soothe the baby, they’ll actually wake him up. If you think your baby is waking up, pause and watch him for a moment. He may just be dancing in his sleep, or he might be waking briefly only to return to sleep on his own.

2. Help your baby find a rhythm. We are adapted to Earth’s 24-hour cycle of light and dark, and our physiological circadian rhythms help us to feel awake during the day and sleepy at night. Newborn babies, on the other hand, sleep just as much during the day as they do at night. It takes them some time to develop rhythms to match our day/night cycle. You can help by sending baby strong environmental and social cues about day and night.

During the day, keep the baby in a light, maybe even noisy place, even as he naps. At night, keep the lights as low as possible and the environment quiet. Even as you’re feeding frequently during the night (and you probably are), keep your interactions with your baby very quiet, uninteresting, and unstimulating. Be boring. With these cues, babies start to show physiological circadian rhythms quickly. A rhythm in body temperature can be detected around one week of age, and by two months of age, babies have robust rhythms of the hormones melatonin and cortisol. By two to three months, most babies are sleeping for most of the night (just waking briefly to feed) and have some distinct periods of wakefulness during the day (with some naps, of course)^3–6. One study reported an outlier – a baby that hadn’t developed a day/night circadian rhythm at five months. Turns out that night owl took his night feedings in a brightly lit room – he had received confusing signals about nighttime⁷.

3. Start to develop a soothing bedtime routine. It’s never too early for this. Find some calming rituals that you repeat each night before bed. These become part of the social cues that will key your baby into the nighttime rhythm and let her know that sleep time is coming. Tell your baby what is happening: It’s almost time for bed, so we’re having a bath. Then you’ll have some milk, and I’ll sing our bedtime song. And then it will be time to sleep. (Bedtime routines have been shown to help babies fall asleep faster and get more sleep during the night, but they’ve only been empirically tested in older infants⁸. I just think it’s smart to start this within the first few months.)

4. If you’re breastfeeding, breastfeed at night. During pregnancy, baby was exposed to mom’s day/night rhythm of melatonin, which increases during the dark night and decreases during the light of day. If you breastfeed, you keep sending that sleepy melatonin signal to your baby through your milk, even before he begins to produce his own melatonin. Human breast milk reflects maternal plasma melatonin concentrations, peaking between midnight and 4 AM and being virtually undetectable during the day^9–11. Melatonin during a night feeding should help baby transition peacefully back to sleep. Consider this if you supplement with formula or use pumped breast milk for a nighttime bottle. Nighttime breast milk (pumped or from the breast) might mean better sleep for baby.

5. Let your baby practice falling asleep in different ways. You’re going to want to hold him a lot, and so will all his doting family. There is nothing like watching a newborn fall asleep in your arms. He’ll also fall asleep feeding. You might enjoy having him sleep on your chest in a wrap or sling while you go about your day. Enjoy all of these snuggles with your baby. But every once in a while, see if you can put him down sleepy but awake. Some, but not all, babies can be surprisingly flexible during the first months of life about how they sleep. Letting him practice this now may give your baby the skills he needs to sleep well later. Babies that are able to fall asleep without a lot of active soothing (i.e. feeding, rocking, bouncing, walking, driving) tend to be the same babies who sleep well during the night¹². This is a great time to encourage flexibility while also providing secure and predictable routines.

6. Observe your baby. Observing your baby means learning his particular signals for when he’s feeling sleepy; then you can work together towards getting comfortable for sleep. Observing your baby may mean that when you hear him start to grunt and move around during the night, you wait a moment and watch to see what he’s doing and if he’s trying to communicate with you. Is he hungry? Uncomfortable? Wet? He’ll let you know that. But he may just be transitioning from one sleep cycle to the next. He may want to go right back to sleep, or he may not have woken at all but instead is in a noisy active sleep period. Babies that learn to transition between sleep cycles without your help will grow into better sleepers later in infancy, but you have to give them a chance to practice this valuable skill^12–14. Wait a moment or two to see if he needs your help, and if he does, soothe him quietly.

What advice do you have for helping babies and parents find their groove with sleep?

REFERENCES:

1. De Weerd, A. W. & van den Bossche, R. A. S. The development of sleep during the first months of life. Sleep Med. Rev. 7, 179–191 (2003).

2. Anders, T., F. in Encycl. Early Child. Dev. (Tremblay, R. E., Boivin, M. & Peters, Rd.) 1–8 (Centre of Excellence for Early Childhood Development and Strategic Knowledge Cluster on Early Child Development, 2010). at

3. McGraw, K., Hoffman, R., Harker, C. & Herman, J. H. The Development of Circadian Rhythms in a Human Infant. Sleep 22, 303–310 (1999).

4. Mirmiran, M., Maas, Y. G. . & Ariagno, R. L. Development of fetal and neonatal sleep and circadian rhythms. Sleep Med. Rev. 7, 321–334 (2003).

5. Custodio, R. J. et al. The emergence of the cortisol circadian rhythm in monozygotic and dizygotic twin infants: the twin-pair synchrony. Clin. Endocrinol. (Oxf.) 66, 192–197 (2007).

6. Ardura, J., Gutierrez, R., Andres, J. & Agapito, T. Emergence and Evolution of the Circadian Rhythm of Melatonin in Children. Horm. Res. 59, 66–72 (2003).

7. McMillen, I. C., Kok, J. S. M., Adamson, M., Deayton, J. & Nowak, R. Development of Circadian Sleep-Wake Rhythms in Preterm and Full-Term Infants. Pediatr. Res. 29, 381–384 (1991).

8. Mindell, J. A., Telofski, L. S., Wiegand, B. & Kurtz, E. S. A nightly bedtime routine: impact on sleep in young children and maternal mood. Sleep 32, 599–606 (2009).

9. Illnerová, H., Buresová, M. & Presl, J. Melatonin rhythm in human milk. J. Clin. Endocrinol. Metab. 77, 838–841 (1993).

10. Cubero, J. et al. The circadian rhythm of tryptophan in breast milk affects the rhythms of 6-sulfatoxymelatonin and sleep in newborn. Neuro Endocrinol. Lett. 26, 657–661 (2005).

11. Cohen Engler, A., Hadash, A., Shehadeh, N. & Pillar, G. Breastfeeding may improve nocturnal sleep and reduce infantile colic: Potential role of breast milk melatonin. Eur. J. Pediatr. 171, 729–732 (2011).

12. Burnham, M. M., Goodlin-Jones, B. L., Gaylor, E. E. & Anders, T. F. Nighttime sleep-wake patterns and self-soothing from birth to one year of age: a longitudinal intervention study. J Child Psychol Psychiatry 43, 713–25 (2002).

13. Pinilla, T. & Birch, L. L. Help me make it through the night: behavioral entrainment of breast-fed infants’ sleep patterns. Pediatrics 91, 436–44 (1993).

14. Wolfson, A., Lacks, P. & Futterman, A. Effects of parent training on infant sleeping patterns, parents’ stress, and perceived parental competence. J Consult Clin Psychol 60, 41–8 (1992).