By Lena DeGloma, MS, LMT, CD, CLC, CCCE
Baby sleep has become a huge industry. Supposed experts stand to profit if they can sell you the idea that your baby's biologically normal sleep patterns are really sleep "problems" and that their method is the only right (or healthy or effective) way to get your baby to sleep. Most baby sleep books are written by dubious experts and are not evidence-based. Even those written by doctors are frequently more opinion-based and a product of deeply rooted cultural beliefs than they are on biology.
Given the overwhelming challenge new parents face sorting through an over-abundance of (often unreliable) information, one of my goals as a childbirth educator is to help parents access sound resources. In that vein, here are three evidence-based things to know about infant sleep:
1. Infants do not have the same sleep stages as adults. While researchers categorize adult sleep into stage 1, stage 2, slow wave sleep, and REM sleep, newborns only have two sleep stages: quiet sleep and active sleep. These sleep stages, which comprise what is known as "neonatal sleep," develop in the third trimester of pregnancy and last through the first 2-3 months of life. During the first 2-3 months it is very useful for parents to be able to differentiate between active and quiet sleep. Quiet sleep generally involves little or no body movement and the baby's hands are likely to be relaxed with fingers loose and open. In contrast, active sleep typically involves wriggling, mouth movements, rapid eye movement under the closed eyelids, and the baby's hands are more likely to be clenched into little fists. Babies enter sleep via active sleep, stay in that stage for about 20 minutes, move on to about 20 minutes of quiet sleep, followed by another 20 minutes of active sleep to complete a one hour sleep cycle. Active sleep is a baby's first feeding cue and, amazingly, babies don't actually have to wake up to feed - they frequently feed during active sleep! After 2-3 months of age, active sleep develops into REM sleep and quiet sleep develops into non-REM sleep (this phase is known as "infantile sleep"). After about 4-6 months, non-REM sleep further differentiates into the same sleep stages as adults with stages 1, 2, and slow wave sleep. During the first few months, try to look for signs as to which sleep stage your baby is in and you will be better able to predict when they may want to feed next or how much longer they are likely to stay asleep.
2. Sleep "regressions" are a myth. While babies and toddlers slowly start to consolidate their sleep into longer stretches of time over the first few years of life, this does not happen in a linear fashion. So, it is entirely normal for an infant to go from sleeping longer stretches for a period of time to going through periods of waking more frequently and back again - many times over the first few years of life. But the key to remember is that as challenging as this may be, it is just a part of normal development, not a "regression" that you need to figure out how to "fix". It is important to understand that "sleeping through the night" is not a biological norm for babies. Newborns in particular evolved to wake and nurse every few hours and these frequent wakings are actually protective against SIDS and help maintain a good milk supply and weight gain. And while not all toddlers will continue to wake frequently during the night, it is important to remember that night wakings are biologically normal through 2-3 years of life and do not necessarily constitute a sleep problem. Understanding what is normal can prevent you from going down the rabbit hole on a desperate search for the solution to "fix" something that isn't actually a problem. This allows you to take a step back and simply experiment with arrangements that make everyone in the family as happy as possible as each particular stage of development comes and goes. There is not one single correct way to do this, just whatever works best for your family at any given time.
3. For a breastfed baby, sleep and feeding are functionally interrelated; this is known as "breastsleeping". If you are planning to breastfeed then any evidence-based information you would want to consider regarding infant sleep should be based on the parent-baby breastfeeding dyad, not a solitary sleeping baby. Most baby sleep books that do cite any evidence at all, refer to research on solitary sleeping babies which is not the biological norm for the breastfed infant. Biological anthropologist, Dr. James McKenna, who coined the term "breastsleeping," is the world's leading researcher on the biological norms of sleep in the breastfed baby. McKenna's Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame has conducted decades worth of research demonstrating exactly what happens physiologically when a breastfeeding parent and baby sleep together. His research has formed the basis for a set of guidelines on how to safely bedshare. One of his most fascinating findings is that the sleep stages of the parent and baby entrain (meaning they synchronize) when they are next to each other at night, and this is believed to be one reason that co-sleeping is protective against SIDS. McKenna has also found that, on average, bedsharing parents get more sleep (in part due to the entrainment of sleep stages) than parents who sleep separately from their babies. To learn more about McKenna's research, including guidelines for safe bedsharing practices, please visit https://cosleeping.nd.edu.
Finally, remember that every baby is as much a unique individual as any adult, so there is no one-size fits all approach when it comes to sleep. Listen to your baby and your gut over well-meaning advice or "experts" as you figure out exactly what unique sleep arrangements will work for your family. Your arrangement will certainly evolve over many months, so stay flexible and attuned. Every challenging phase will pass and no decision you make regarding sleep set-up is irreversible, so don't be afraid to do whatever works for your family in the moment.
If you want to learn more, I teach about the basics of infant sleep in my holistic newborn care and breastfeeding workshop at Bend + Bloom. My approach to infant sleep is based on what is biologically appropriate, evidence-based, and safe; from there I encourage families to explore what unique arrangement will work best for them. My next class takes place on Sunday, July 22nd and you can save $80 if you also register for the paired childbirth education intensive the weekend before, on July 14-15.
Lena DeGloma has a master of science in clinical herbal medicine and is also a licensed massage therapist, certified birth doula, certified lactation counselor, and certified childbirth educator. She currently sits on the board of directors of the Childbirth Education Association of Metropolitan New York and teaches in their Teacher Certification Program. She is the mother of an exuberant one year old girl and the founder of Red Moon Wellness in Park Slope, where she has been in clinical practice for a over decade. www.redmoonwellness.com