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Newborns sleep and sleep deprived parents

Important for the growth and wellbeing of babies. In the doctor’s office, I often see tired, adrenalin exhausted, sleep deprived parents hoping to get the magic formulary to make their babies sleep. New parents carry life long memories of their first 4-12 weeks of parenthood where they were threatened by sleepless fussy difficult to console babies. I tell them babies make days shorter, nights longer and homes happier and they love to have their sound sleep in the tender hands of parents. It is good for the parents to understand the baby’s evolving sleep pattern and reduce their worry about sleep quality and adequacy in their newborn.

1. What is a circadian rhythm?

The daily sleep wake cycle in an adult is called a circadian rhythm. It is a biological clock of our body trained by external cues called zeitgebers namely the light-dark cycle and social activity.

2. When does circadian rhythm develop for babies?

Fetus has the circadian rhythm generator, the hypothalamus (an area in the brain), by 35 weeks of gestation. A consolidated sleep wake cycle maturation depends predominantly on their duration of exposure to cyclical zeitgebers such as light dark cycle, care givers routine.

3. What is the sleep routine of newborns?

New-borns sleep about 14-16 hours a day which may reduce to 9-14 hours by 3 months. They wake up 2-3 hourly, rarely sleep to 4 hours and feed 8-10 times a day as their stomach capacity is small. Their days and nights are confused and have no scheduled routine. They often sleep better in the day and wake up frequently in the night interfering with the mother’s circadian rhythm leaving her exhausted. It is extremely important for the mother to understand that in the first few months the babies don’t sleep long, wakes up easily and have varying sleep duration. This can help her reduce anxiety and plan sleep with the baby.

Most of babies start sleeping long in the night (5-6 hrs) by 3 months to 1 year of age. After 6 month their night sleep is also dependent on what they eat as complimentary food

4. How can the family improve the sleep routine of the baby?

Babies should become a part of the family routine and be fed on demand. Do not force them to sleep. Babies who have an active routine like the mother tend to sleep longer in the night.

Allow the babies to experience day and night. They can be made to sleep in natural day light in their house and lights should be turned off in the night. Research has revealed babies to develop stronger circadian rhythm and sleep with exposure to natural cycles of day and night.

Keep the nights quiet, try feeding in dim light when the baby wakes up. Do not over stimulate them with bright light and noise. Avoid waking them in between to feed or change diapers.

Soothe babies with evening routine of warm bath and gentle massage with lotion. This has shown to improve their sleep.

If your baby associates sleep with feeding, carrying, rocking, singing, walking or patting it is absolutely safe to practice them as they tend to sleep longer with it these practices.

5. Why are babies often noisy in their sleep?

Baby switch between active and deep sleep. They spend nearly 75% of their sleep-in active state. Babies stretch, twitch, pass flatus, smile and make noise in their active sleep. Parents often are confused with this active state of sleep and assume the babies to be waking up. The family needs to get used to these noise and movement in sleep and avoid rushing into another feed which may actually wake up the baby.

6. What is the right time to feed for a better sleep-in baby?

Babies move through phases at the start of awake cycle.

a. Quiet alert phase: Soon after the end of sleep babies lie still ,awake staring at environment and progress to have small movements like stretching .This is best time to feed them. When done timely they are most likely to move into their next sleep or play cycle without fuss.
b. Crying phase: Here the baby becomes anxious irritable and have erratic body movement. They are fussy, crying, may resent feeding and need to be calmed by other techniques like holding, gentle rocking swaddling. Crying is usually a late sign of hunger.

7. Can swaddling babies improve sleep?

Swaddling is an age-old practice intended to keep baby warm and contained. Babies can be swaddled snuggly in the first 2 month to keep their arms and legs from flailing. Tight or hot swaddling can make them uncomfortable sweaty and fussy. Swaddling should allow movements of hip on their tummy, else it can cause abnormal hip development.

The choice of swaddle cloth should be based on the weather conditions. In a hot humid place like Chennai thin cotton cloth is preferred to prevent excessive heat.

Swaddling is better avoided beyond 2 months of age as they are more likely to attempt turning and rolling over. Swaddling can interfere with these movements.

8. Can babies sleep too long?

Occasionally babies may sleep even 18-19 hours a day but they continue to feed 8-10 times a day and follow adequate voiding and stooling. Preterm neonates, babies with jaundice or infection and babies born to mothers with diabetes are some of the high risk babies who are likely to sleep longer than usual interfering with their feeding adequacy and need the doctors consultation.

9. What are the important measures to prevent sleep accidents and suffocation?

• Keep baby in the same room with the mother.
• Keep babies face uncovered.
• Use firm mattress with tucked in covers to lie your baby. Do not have toys or unwanted thing in their sleep area.
• Have a smoke free room and let the room temperature be warm not hot.
• Cradles when used should be open above to have proper visualization of the baby at all times.

10. Quick remedies for the sleep deprived mothers of a newborn?

Take a few short naps they can be very refreshing. Breast feeding and co sleeping improves sleep in both the mother and baby. When tired ask another family member to handle the baby until you rest. Try reducing screen time and find sleep in the time you get. Remember it is a temporary phase and you will find your sleep routine with the baby soon.

Dr Shobana Rajendran

Senior Consultant - Neonatology

Rainbow Children's Hospital, Chennai