Baby sleep

Oh, for a good night's sleep

Is parenthood turning out into more of an eye-opening experience than you expected?

By Wendy Haaf
Oh, for a good night's sleep

Three Approaches to Nightwaking
Same-sex marriage and night-waking babies share one trait: everyone from your mother-in-law to your hairstylist holds a passionate opinion about which options are right and wrong. Even if you’ve decided where you stand, it’s worth finding out more about the different ways of dealing with sleep issues — you may find the method you originally settled on just isn’t working for your family.

Sleep Sharing
The theory
Attachment parenting advocates see bed sharing (along with breastfeeding and “baby wearing”) as a tool that forges a close, trusting bond between parent and newborn. They argue most babies feel safer and more secure sleeping near a parent, and babies whose cries are heeded day and night are more relaxed, cry less and grow up into independent, empathetic, confident kids. Some supporters of co-sleeping also believe the extra physical contact may foster weight gain and brain development in much the same way skin-to-skin “kangaroo care” helps preemies. Parents who opt to bed-share view sleeping solo as akin to potty training — a developmental stage a child reaches when she’s ready.

The real world
Bunking with baby may actually disrupt a nursing mom’s rest less than sleeping in separate quarters: You can open one eye, latch her on and doze ’til she’s done. Since a breastfeeding mother’s sleep cycles naturally fall into sync with those of her infant, the pair often wakes together spontaneously, which means the baby doesn’t have to cry loudly and so may fall back to sleep more easily. And for some parents of high-need babies, bed sharing makes the difference between functioning and falling apart.

The downside? Some parents simply can’t sleep soundly in the same room with a wiggly little body, and there are some safety issues around bringing your baby into an adult bed that must be taken into consideration. And if you decide you want to stop sharing your sleeping space before your little one outgrows the arrangement, it may take time to persuade her to sleep alone, particularly if she has an intense personality.
Sleep Training

The theory
Sleep-training advocates contend unnecessary night waking compromises the quality of a baby’s rest, and can turn into a habit that leads to later struggles over sleep. Thus, the thinking goes, when babies no longer need to feed at night — around four months — they should be taught to soothe themselves back to sleep when they wake.

Valerie Kirk, a paediatric respirologist and medical director of the paediatric sleep service at Alberta Children’s Hospital in Calgary, explains, “One of the most common problems we see in babies is what we call a ‘sleep association disorder’ where the baby has learned to fall asleep with some kind of parental involvement — being rocked, for example.” So when he reaches a stage of light sleep and senses something has changed (“Mommy was holding me, but now she’s gone”), he rouses and starts crying. By the way, adults pass through these patches of light sleep too, and if we detect a change in our surroundings — say, the pillow has slid to the floor — we may awaken at this stage.)

Parents are advised to start teaching a baby to nod off unassisted as soon as he no longer drops into a deep doze during the bedtime feed. “Babies should be put down while they’re sleepy, but not sleeping,” Kirk advises.

Around the four- to six-month mark, there are two common methods used to break the night-waking habit: the “Ferber” approach (letting the baby cry for a slightly longer interval each night before looking in on him, but not picking him up or staying in the room) or a more graduated technique (for instance, sitting next to the crib until he dozes off and moving the chair closer to the door every night).

The real world
Many parents swear by these strategies, which often work if you follow through consistently, and the baby is not waking due to a scheduling problem (a too-early bedtime, for example), illness or other underlying issues.

The cons? You’ll lose sleep in the short term, and you may have to start back at square one after every ear infection and bout of teething. Also, many parents simply aren’t made of stern enough stuff to stick to the plan — or just don’t feel right ignoring the instinct to comfort a crying baby. “Many parents can’t put up with it,” acknowledges Denis Leduc, president-elect of the Canadian Paediatric Society.

The Middle Ground
Dyed-in-the-wool attachment-parenting proponents may make you feel as if you’re neglecting your baby if she sleeps in a separate room — and strict sleep trainers view night waking and needing a parent close by at bedtime as disorders that interfere with proper rest. If you reject both notions, you’re not alone; most parents probably fall somewhere in between.

Fortunately, there’s broad range of options. You can explore co-sleeping variations such as a CSA-approved “sidecar” cot, or have your baby bed down in a crib across the hall, but still choose to soothe her when she cries. No matter where your nighttime parenting philosophy fits on this continuum, the following strategies for gently encouraging sleep should help you rest easier.

Sleep strategies
Set up a sleep routine. Whether it’s snuggling up for stories after bath time or singing lullabies before lights out, a pleasant, predictable wind-down ritual accomplishes two things: It links bedtime with warm feelings in your baby’s mind and helps her brain learn when to start switching to sleep mode, says Lee Tidmarsh, a staff psychiatrist at Montreal Children’s Hospital. And while we can’t force babies to sleep at a set time, as they get older Kirk suggests we can “provide some structure about when and how it will happen.” Regular bedtimes and naps help set the internal clock that regulates sleep.

Watch for signs of sleepiness. Overtired babies often become too “wired” to drift off, so when your baby starts signalling she’s sleepy — yawning, rubbing her eyes or looking away — get her settled. If your little one is very sensitive to stimulation or changes in her surroundings, stick close to home when she’s due for a siesta.

Bore baby after bedtime. When your baby does wake at night, try keeping lights low and noise and activity at a minimum — she may be more likely to slip back to sleep easily if her surroundings aren’t stimulating.

No matter which approach you choose, don’t worry that it will psychologically scar your baby or set him up for a lifetime of restless nights. “Night waking is usually transient, and it isn’t something you have to ‘fix,’ if you can live with it,” Tidmarsh stresses. “Parent survival is key!” Babies grow up healthy, happy and secure in families with all kinds of different sleep styles.

After all, Leduc points out, when it comes to coping with sleep issues, several factors come into play — your child’s unique temperament, the amount of crying and sleep deprivation you and your partner can tolerate, your expectations and your baby’s environment. You can only change the last two factors in that equation.

“You have to look at the situation both from the child’s perspective and the parents’,” says Tidmarsh. The formula for feeling less frazzled is figuring out what works best for you and your little night owl.

Additional reading
The Attachment Parenting Book by William and Martha Sears, Little, Brown 2001.
Solve Your Child's Sleep Problems
by Richard Ferber, Fireside Books 1986.
In Search of Sleep by Bonny Reichers, Key Porter 2002.
The No-Cry Sleep Solution by Elizabeth Pantley, Contemporary Books 2002.

Safe Sleep Strategies
What could be more natural than a newborn sleeping snuggled next to mom?

Co-sleeping is the norm in many countries, including Japan, which boasts one of the lowest infant mortality rates in the world. However, a recent Canadian Paediatric Society statement suggests bed sharing might be unsafe. “For the first year of life, the safest place for babies to sleep is in their own crib, and in the parent’s room for the first six months,” it reads.

So does cuddling up with your baby at bedtime put her in harm’s way? Critics contend the practice is risky, citing studies that have linked it with unexpected deaths from sudden infant death syndrome (SIDS) and accidental suffocation: One doctor we interviewed compared bed sharing to drinking and driving. Other experts counter that most SIDS deaths occur in cribs, and argue bedsharing fosters breastfeeding, which may reduce SIDS risk. They contend accidents can be avoided by employing safety precautions, in much the same way as buckling a baby into a car seat reduces her odds of injury.

So who’s right? Research hasn’t yet provided a definitive answer. However, it has identified some specific risk factors that make infants more vulnerable to SIDS, starting with parents who smoke, and a prone (tummy-down) sleeping position. Since the Back to Sleep campaign was kicked off in 2000, SIDS deaths in Canada have dropped by about 50 percent.

Based on the current evidence, Denis Leduc, CPS president-elect and one of the statement’s co-authors, can’t endorse bed sharing, but he can say this: “If we eliminate certain high-risk factors, the risk is probably no worse than for a solitary infant sleeping in his or her own crib.”

Apart from exposure to smoke and sleeping tummy-down, those risks include:
Drinking and drug use. Don’t sleep with your baby when you’re impaired by any drug, including a glass of wine or a cold pill.

Entrapment possibilities. Since a baby might fall out of bed, or get trapped between the mattress and headboard, the safest bed-sharing arrangement is probably a firm mattress on the floor, placed well away from walls, says Heather Mesich, a Sioux Lookout, Ont., nurse who reviewed the research on sleeping arrangements and SIDS while writing a journal article on co-sleeping safety. (Ensure the area around the bed is free of clutter like wastebaskets and laundry.) Avoid falling asleep with your baby on a sofa or recliner.

Soft bedding. An infant’s sleep environment should be free of pillows, comforters, puffy quilts, bumper pads, sheepskins, stuffed animals and other soft items.

Soft sleeping surfaces. Babies should sleep on a firm mattress — no waterbeds, soft chairs, sofas, air mattresses, etc.

Strings and other strangling dangers. Keep your baby’s sleep surroundings free of hazards such as window-blind cords, clothing ties, etc. If you have long hair, tie it back before bed.

Extra bedfellows. If you do opt to share sleep with your baby, Mesich recommends keeping siblings and pets out of the bed.

Sleep cycles
Once upon a time, there lived a baby who slept through the night....

Talk about fairy tales — you’re almost as apt to meet a pig who can build a brick house!

“When people say, ‘I slept like a baby,’ they mean they slept well, but babies don’t,” observes Valerie Kirk, medical director of the paediatric sleep service at Alberta Children’s Hospital in Calgary. Sure, brand new babies log about 16 hours of zzz’s in a 24-hour period, but they snooze in short stretches spaced around the clock, more like housecats than adult humans.

Why? Simply put, a newborn’s brain — including the internal clock that governs sleep — is still organizing itself. “We all rotate through stages of sleep, but the cycles are immature when babies are first born,” Kirk explains.

To understand what happens when your little one drifts off, it helps to know what happens after your own head hits the pillow. Your brain doesn’t shut off — it gears down, climbs up into lighter sleep, and descends again, like a cyclist travelling over a series of hills. The “peaks” are called REM (for rapid eye movement), and the slopes are dubbed non-REM or N-REM. (N-REM is broken up into stages, with the deepest sleep at the valley bottom.) During REM, which makes up roughly 25 percent of adult sleep, your brain becomes very active, and you can be easily awakened. These way stations of light sleep are more widely spaced along an adult’s nocturnal voyage than a baby’s, and it takes us about 90 minutes to journey through one complete sleep cycle, notes Lee Tidmarsh, a staff psychiatrist at Montreal Children’s Hospital.

In contrast, newborns spend half of their slumber in REM, dashing through an entire sleep circuit in about 50 minutes. Long, closely clustered periods of light slumber mean a baby is soon wakened by an empty tummy or damp diaper and, consequently, arouses about every two to four hours. Some scientists believe very young infants sleep this way not just because they need to feed frequently, but also to protect against SIDS (Sudden Infant Death Syndrome): According to one theory, a few vulnerable babies may “forget” to breathe if they fall too deeply asleep before their nervous system matures.

Whatever the reason behind the mismatched sleep patterns of infants and grown-ups, it’s clearly a recipe for losing sleep in the early days of parenthood. (Interestingly, researchers have discovered breastfeeding reprograms a mother’s cycles to mirror those of her infant — since mom is less likely to be dragged out of deep slumber, she may avoid the resulting foggy-headed feeling.) Happily, however, babies soon start consolidating their catnaps into longer stretches of shut-eye and spending less time in REM. That translates into more deep sleep and fewer fragmented nights, though toddlers continue racing through sleep cycles faster than adults until age three or four.

Staving off Sleep Starvation
It hardly seems fair — kids who wake several times at night greet the day as fresh as flowers, while mom and dad feel more like — um, the stuff gardeners spread on the beds come spring. Luckily, a few minor lifestyle adjustments can make life a little easier. Here are a few tips and tricks to help you cope:

Adjust your expectations. Simply realizing the path to uninterrupted slumber might be a little longer and rockier than you’d anticipated goes a long way to heading off frustration and resentment. Sure, you knew the first few months would be tough, but aren’t kids supposed to start sleeping through the night at around six months? Well, according to a 1999 Today’s Parent poll, most babies don’t know that: 61 percent of the 1,484 parents who responded reported their kids continued waking up at night after seven months of age.

Make a meal of sleep “snacks. You might not get eight solid hours, but you can get shorter blocks of sleep that will make you feel better,” reassures Suzanne Bell, a public health nurse with the Middlesex-London Health Unit in London, Ont.

Snatch sleep when junior naps. When your little darling drifts off to Slumberland during the day, instead of tossing in a load of laundry or tidying the kitchen, “choose sleep,” suggests Jackie Redmond, a mom in Port Hawkesbury, Ont. Which is better for your baby: slightly soiled sleepers and a cheerful, alert mother, or an immaculate outfit and a crabby parent who can’t think straight?

Hit the sack earlier. Heather Mesich, a mother of four from Sioux Lookout, Ont., offers this piece of wisdom. “Three or four times a week, go to bed when the kids do.” You’ll still be able to set aside regular times to reconnect with your partner.

Don’t dwell on fatigue. This tip comes from the Today’s Parent book In Search of Sleep, by Bonny Reichert. After a rough night, “I try not to talk about how tired I am or how little sleep I’ve had,” Reichert says. She compares complaining to reminding yourself to feel bad!

Get outdoors every day. Strap your baby into the Snugli or stroller and leg it around the block when you can. Not only will natural light and exercise lift your own mood (research suggests it can ease depression), a daily dose of sunlight helps set your baby’s body clock — the light-activated part of the brain that regulates the sleep/wake cycle. According to one study, infants who were taken outdoors in the early afternoon slept longer than those who stayed inside.

Try tag-team parenting. Divide up early-morning duties so you each get a chance to sleep in.

Let your standards slide. Stock up on easy-prep foods like jarred spaghetti sauces and frozen fish fillets. (KD plus a plate of prewashed “wok” veggies makes a reasonably well-balanced meal!) Don’t forget, you’ve got the rest of your life to concentrate on keeping a clean house, cooking gourmet meals and advancing your career.

Laugh a little. Whether it’s singing I Wanna Be Sedated while you’re pacing the floor with a wakeful six-month-old, or joking about your new-found career prospects as an extra in Night of the Living Dead IV, try to keep your sense of humour intact. It’s a parenting tool that will stand you in good stead for the next 18-plus years!

This article was originally published on Oct 25, 2005

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