Infant Sleep; Setting the Foundation for Good, Safe Sleep
Sleep is a hot topic for new parents. It is essential for mental and physical health to be getting good sleep. At Louisville Newborn Care we are all about supporting families in getting the sleep they need. The most requested service we offer is our overnight newborn care. Setting a foundation for good sleep and knowing what to expect with your baby can help you create a great sleeper in the long run and leave you never even needing to look into sleep training methods.
Understanding Wake Windows, Sleep Patterns, and Biologically Appropriate Infant Sleep
Wake Window
0 to 8 weeks - 45 to 60 minutes
2 to 4 months - 1.25 to 1.5 hours
4 months - 1.5 to 2 hours
5 months - 2 to 2.25 hours
6 months - 2 to 2.5 hours
7 to 8 months - 2.5 to 2.75 hours
9 to 10 months - 2.75 to 3.5 hours
11 to 18 months - 3 to 4 hours
1.5 to 2 years - 4 to 6 hours
2+ years - 6+ hours
A wake window is the amount of time your baby or toddler is awake between one nap and the next. Wake windows that are too long can result in an overtired baby or toddler who struggles to calm down enough to fall asleep or stay asleep. Understanding your baby’s cues and what their sleep patterns mean can be essential to promoting good sleep in your household.
Watching for sleepy cues is a helpful way to find the right wake window for your baby during those first four months. As babies get older, it may be harder to spot those sleepy cues as they’re more alert. You can use developmentally appropriate wake window guides to find an estimated wake window for your baby and shift the timing slightly to fit where your baby is at.
As babies get older, they need more awake time in order to be tired enough for naps and bedtime. Your goal is to find the balance between tired enough to fall asleep but not overly tired. Your baby may need some support in extending wake windows. To stretch a wake window you can try feeding, playtime, time outside, and face to face interactions.
Sleep Hygiene Tips
Some general tips include practicing sleep routines or rituals such as story time, keeping lights low around bedtime and during nighttime feeds, using black-out curtains, and using a white noise machine. It is never too early to start a routine even if they are a newborn and reading a story seems pointless, it is helping. You may not think your baby is very aware and that the light does not bother them, but it can make or break their ability to fall back asleep after a wakeup. Infant sleep cycles are only 45 minutes long and if they wake up to light peeking through the blinds they may not transition into the next cycle, even if they do not need a feeding or diaper change.
If sleep continues to be a struggle and caregivers find themselves sleeping in dangerous environments due to exhaustion it may be time to invest in a nighttime newborn care specialist or doula for some relief, or consider asking a family member to come in and help. If you are currently expecting and nighttime sleep is a concern consider registering for nighttime newborn care service as a baby shower gift. An investment in sleep provides your family with safety by avoiding exhaustion and keeping your baby in a safe place but also helps to maintain good mental health for parents. Lack of sleep is a risk factor when it comes to perinatal mental health.
Tackling Sleep Problems
Your newborn can sleep anywhere from 17-20 hours a day and likely will not be awake for more than 30-45 minutes. After a few weeks, this will increase to an hour. Try beginning a sleep routine before the wake window is over so that they are asleep by the end of the wake window. Naps are extremely important for avoiding sleep problems. Good daytime sleep promotes good nighttime sleep by avoiding an overtired baby. Your baby may start with two naps that are two hours long and a cap nap, then drop to just the two naps, and eventually just one nap. The timing of these transitions is different for each baby. Following your baby’s lead is the best technique for sleep success.
For late-night feedings, you can try a dream feed. Offer your baby the bottle or breast while they are still asleep. This can work well for a baby that consistently wakes at the same time in the night. If your baby always eats at 10 pm and has trouble going down afterward try a 9:30 pm feeding to avoid the long 10 pm wake time.
Safe Sleep
It can feel intimidating to remember so much when caring for a tiny human, but an easy way to remember the safe sleep guidelines is to follow the ABCs of sleep. This is an ultra-simplified safe sleep tip that was created to better help caregivers remember the best way to safely put an infant to sleep.
A-Alone
B-Back
C-Crib
Place your baby on their back to sleep in their own sleep space with no other people. Do not have any loose items in the sleep space. They do not need a pillow and bumpers are not safe due to the risk of suffocation. Bedsharing is not recommended, but if you choose to do so please practice safe bed-sharing techniques.
If you are worried about the baby being cold try using a wearable blanket or wool pajamas, not anything loose. Wool is great for keeping a baby warm, but monitor room temperatures and the baby’s skin to make sure they do not get overheated. If you are swaddling a baby make sure to stop once they begin rolling. Try to avoid any weighted sleep materials such as weighted sleep sacks.
Use a crib, bassinet, or portable play yard with a firm, flat mattress, and a fitted sheet. Avoid sleeping on a couch or armchair or in a seating device, like a swing or car safety seat (except while riding in the car). When a car seat is not in its base it is not at the right angle to avoid asphyxiation.
Breastfeeding is proven to reduce the risk of SIDS. If your baby is not breastfed a pacifier can help reduce the risk too. Avoiding smoking is another way to reduce SIDS, as well as avoiding any secondhand smoke.
If you are able to, room-sharing is recommended to reduce SIDS, but bed-sharing is not. The American Academy of Pediatrics has also released statements on bed-sharing safety because they recognize many families do make the choice to bed-share. Although most Americans do not plan to bed-share, 42% end up doing it. It can happen unexpectedly.
There are many resources for bed sharing and how to do it in the safest possible way. James McKenna is a great resource for families that do choose to bedshare whether they decide to prenatally or postpartum, research should be done.
If there is a risk of falling asleep with the baby in bed make sure there are no blankets or loose items around. Bed-sharing should never happen if a person is under the influence of drugs or alcohol, even cold medication like Nyquil.
Practicing safe sleep can help reduce stress in new parents. It is easy to worry about the baby, postpartum stress and anxiety are common. If the baby is in a safe space and you know you have followed safe sleep guidelines there is much less to worry about. Perinatal Mood and Anxiety Disorders (PMADS) are on the rise and I think any step you can take to reduce your risk of anxiety is a step in the right direction.
Safe sleep techniques are the best way to reduce anxiety around SIDS. It is recommended that you avoid at-home cardiorespiratory monitors. Many of these monitors are proven to be ineffective and can give false readings. This can lead to unnecessary stress for parents. Before purchasing a monitor research the product and consult with your baby’s pediatrician. Researching products is recommended for any baby-related product. Confirm that the product is approved by the AAP before allowing the baby to sleep in it and make sure that you are using the product the way it was intended.
Practicing safe sleep not only benefits your mental health but your physical health as well. Risk factors for SIDS include smoking during pregnancy or postpartum and drinking alcohol during pregnancy. Cutting back on tobacco use as well as alcohol use may be beneficial for you and the baby for many reasons, not just a reduced risk of SIDS! Secondhand smoke can be dangerous for an infant's health for many reasons and drinking during pregnancy can cause fetal alcohol syndrome.
After the first 6 months rates of SIDS lessen. 90% of SIDS cases occur in those first 6 months. By 8 months the risk is much less, but it is recommended that safe sleep practices continue till the baby is a year old. Then a pillow or blanket can be introduced when they seem necessary.
If you or your partner are extremely nervous about sleep it could be worth it to attend a newborn care class that covers sleep hygiene and rituals. These are ways to set a baby up for good sleep before getting to a point where sleep training is being considered.
