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Macmillan Childrens Publishing Group

The Good Sleeper

The Essential Guide to Sleep for Your Baby--and You

Janet Krone Kennedy, PhD

Holt Paperbacks

MORE ABOUT THIS BOOK

1

It's All About Adrenaline



Everyone knows that babies need a lot of sleep, but most of us still underestimate how much. In the first week or two of life, an infant will sleep up to 18 hours a day. As the weeks roll by, infants gradually spend more time awake, but the average 3-month-old still needs 14-16 hours of sleep per 24-hour period.

It's usually pretty easy to get your baby to sleep during the first couple of weeks. It might even be hard to get a photo of your baby with her eyes open during that time. But after a week or two, your baby will start to wake up more, and she will need your help to make sure that she gets enough sleep.

New parents often assume that babies will naturally fall asleep when they are tired. But the truth is, babies have to learn how to fall asleep. As a parent, you will become your baby's sleep facilitator. By responding to your baby's need to sleep, you will keep your baby well rested and guide her through the process of learning to be a good sleeper.

Adrenaline and Overfatigue

The guiding principle of raising a good sleeper is to keep your baby from becoming overtired. The vast majority of sleep problems (and quite a few behavioral problems) have some root in overfatigue.

There is plenty of research on the chemical process that occurs in response to overfatigue, but it boils down to this: When the body becomes overtired, the sympathetic nervous system responds with a release of adrenaline. This is the body's fight-or-flight response, which is a very primitive one. Essentially, if we do not sleep when we are tired, the body presumes that there is a reason for it, some form of problem or threat that requires our attention. The body "helps" out with a burst of energy that keeps us awake. You might notice that when you have been up every 2 hours feeding your infant, it is sometimes difficult to fall asleep at your first opportunity. That's because your own body is hopped up on adrenaline. The same thing happens to babies but in a much more disruptive way.

Babies become overtired quickly, and the adrenaline response is intense. Adrenaline makes it harder for the baby to be soothed or self-soothe, fall asleep, stay asleep, and sleep until a respectable morning hour. Overtired babies fight sleep, wake frequently, and start the day too early. Your job as a parent is to keep your baby from entering this adrenaline-fueled state. Being attentive to your baby's need for sleep and preventing overfatigue can solve sleep problems before they start. A well-rested baby is able to learn how to self-soothe, fall asleep independently, return to sleep during normal night waking, and sleep.

Think about sleep as a 24-hour process. The length and quality of naps and night sleep are connected. Good naps lead to good nights and vice versa. And of course, bad naps and bad nights affect each other, too. You just can't separate day and night sleep. So if your baby is struggling, the task is to figure out when and how to break into the 24-hour loop to get out of the cycle of overfatigue.

Remember: Until your child is well into elementary school, whenever you hit bumps with sleep-bedtime battles, night waking, early waking, night terrors, bedtime separation anxiety, nap resistance-step back and figure out when and how your child is becoming overtired. Focusing your attention on the source of overfatigue is the first step to getting back on track.

Of course, it's impossible to avoid overfatigue altogether. It happens to everyone, despite the best intentions. A baby who occasionally becomes overtired won't struggle too much as long as she is well rested overall. But fatigue accumulates over days and weeks. A baby who routinely becomes overtired can get stuck in a cycle of poor sleep that wears everyone down.

Keeping Your Baby Well Rested

Keeping a baby well rested involves two things: watching the clock and watching the baby for drowsiness signs. Paying attention to these will allow you to respond to your baby's need for sleep before she becomes overtired.

Watching the Clock

Babies cannot and should not stay awake for very long. This is critical information, and it contradicts what you will hear from most of your well-meaning family and friends. People tend to believe that babies who sleep too much during the day will not sleep well at night. You must tune folk wisdom out and put your baby to bed frequently. You might not be able to convince the people around you, but if you quietly follow these rules, your critics will see the results.

The truth is, the more your baby sleeps during the day, the better he or she will sleep at night.

Your baby should not be awake for more than 90 minutes at a time during the first 3 months of life. In fact, your baby might need to sleep again after as little as 1 hour of wakeful time. This might seem crazy, especially if feeding your baby takes a long time (as it can early on). But keeping your baby up longer will result in overfatigue and make it harder for him to get the rest he needs.

The period of wakefulness stretches out after about 3 months, coinciding with longer naps and better nighttime sleep. But even then, watching the clock is critical (more on this later).

Your baby might not look tired, especially if she is overtired. Work by the clock anyway. There's no such thing as an 8-week-old baby who needs to stay up for 4 hours. Over time, you will establish a rhythm: your baby will associate a feeling of drowsiness with being soothed to sleep. The more you follow the rule, the easier it becomes to spot when your baby is sleepy and the easier it becomes to help your baby fall asleep.

Following Drowsiness Cues

When your baby is reaching the end of the wakefulness period, he will probably show some signs of drowsiness. If you don't notice any of these signs, start soothing your baby to sleep after about 1 hour and 15 minutes awake.

Babies give subtle cues of drowsiness that are easily missed. If you learn to recognize them, your baby will get better at letting you know when she is ready to sleep. Over time, you will learn the progression of her cues, and she will learn which of her actions will result in being put down for a nap.

Following drowsiness cues prevents overfatigue because you catch the baby at the optimal time for sleep, before the body releases adrenaline. Adrenaline makes babies seem more awake, making it more difficult to see that they need to sleep. Without the adrenaline to mask the drowsiness, the cues become easier to spot.

One of the first things I ask the parents I work with is what their baby does to tell them she's tired. The most common answer is "She gets fussy." Therein lies the problem: a fussy baby is already overtired and will fight sleep.

Instead of waiting for your baby to become uncomfortably tired, look for the subtler cues. If you have trouble identifying them, start tracking how long your baby has been awake when she gets fussy and overtired. Then start watching your baby closely about 15 minutes earlier.

Drowsiness cues are changes in the baby's alertness, activity, and even facial expression. Look for:

- A pause in activity. Your baby might be happily engaging with a person or toy-looking, kicking, cooing-and then suddenly she's quiet for a moment. Your baby might re-engage after the pause, but don't be fooled.

- A single vocalization. Some babies let out a single squawk or exclamation. This is different from fussiness. It's more like a call to action: imagine your baby saying, "It's time!"

- The thousand-yard stare. This often happens during the "pause" described above. Your baby will space out and stare off into the distance. You can almost see her vision blurring. She is clearly less focused.

- The long, slow-motion blink. This tends to follow the "thousand-yard stare." Your baby's eyes close slowly and stay shut for longer than the typical blink.

- Droopy eyes and/or face. The muscles around the eyes and mouth tend to relax when a baby becomes drowsy.

- The first yawn. Don't wait for lots of yawning; the first yawn is a good indication that it's time to go to sleep. (Note, however, that babies often yawn soon after waking up. A good rule of thumb is to attend to yawns that come after your baby has been awake for 1 hour.)

- "Comfort feeding." You can tell when your baby is feeding and when he is just sucking for comfort. Comfort sucking is generally weaker and involves less swallowing. If your baby is comfort feeding and the timing is right, he's probably drowsy. Similarly, less intense pacifier sucking can also be an indication of drowsiness.

When you see these signs, start soothing your baby to sleep. Initially, this might involve significant effort, like bouncing, walking, shushing, patting, or even wearing the baby in a carrier. As time goes on, your baby will get used to going to sleep when drowsy, and the routine will become less involved.

If you miss the drowsiness window of opportunity, your baby will become overtired. There are times when it can't be helped and times when it happens so quickly that you're caught by surprise. Don't beat yourself up about it. Just be more vigilant for the next nap, and things will even out.

Here are some signs that your baby is already overtired:

- Eye rubbing. This sign is often mistaken for a drowsiness cue, but it is typically a sign of overfatigue.

- Fussiness, crankiness, irritability, whining.

- Thrashing around.

- Intense effort to nurse but failure to concentrate or settle.

- Volatility. Your baby might be happy one minute, frustrated the next, and then happy again.

- "Wired" appearance. Eyes wide open, searching for stimulation/activity, the opposite of sleepy.

- Bursts of energy.

- Putting head down. This sign is usually followed by jerking the head back up.

- Clumsiness/sloppiness/loss of coordination. This triad is more evident in older babies, but it bears mentioning.

If your baby is overtired, all is not lost. You can still soothe your baby to sleep. It's just more difficult, and over time the adrenaline will start to become more disruptive.

Keeping the interval of wakefulness short and responding to drowsiness cues will keep your baby well rested, allowing her sleep to improve naturally as she cruises through the rapid physical and neurological development of infancy. How you get your baby to sleep (and even where you get her to sleep) depends on her age. During the early weeks, you will be doing most of the work. As time goes on, your baby can learn to do more of her own soothing until she ultimately begins to fall asleep independently. The next chapters will take you through that process step-by-step.

Common Myths and Misconceptions

BABIES WHO SLEEP TOO MUCH DURING THE DAY WILL NOT SLEEP AT NIGHT. WRONG! Adult sleep is very different from baby sleep. Adult bodies are programmed to get a certain amount of sleep per 24 hours (7-9 hours). If an adult gets too much sleep during the day, he will get less sleep at night. The priority for adults is to consolidate sleep because nighttime sleep is critical for daytime functioning and health. But naps will help your baby sleep longer at night. The more babies sleep, the better they sleep.

BABIES JUST FALL ASLEEP WHEN THEY'RE TIRED. WISHFUL THINKING! In the first couple of weeks, babies sleep easily, and this can lull parents into thinking that the baby will continue to sleep this way. Babies will fall asleep spontaneously sometimes, but they will need your help most of the time. Because they transition from drowsy to overtired so quickly, they often miss the opportunity to fall asleep. When parents respond to drowsiness cues and watch the clock, they intervene when the baby is most easily soothed to sleep, essentially transitioning the baby into sleep instead of allowing the body to take over with the adrenaline response.

Babies need about twice as much sleep as adults do while their bodies and minds are growing and developing at lightning speed.

Key Points from Chapter 1

- Babies need tons of sleep, but it is hard for them to get the sleep they need when they are overtired.

- Keep in mind that, for at least the first 2-3 months, your baby should not be awake for more than 90 minutes at a time. After that point, he will become overtired.

- The adrenaline release that occurs when your baby is overtired will cause him to fight sleep, sleep fitfully, and wake up before he is fully rested.

- Your baby will show signs of drowsiness before he becomes overtired. Use these as your cue that it is time to start soothing your baby to sleep.



Copyright © 2015 by Janet Krone Kennedy