Once you become a parent, having the recommended solid eight hours of uninterrupted sleep becomes a distant memory. With babies needing feeds throughout the night, you can find yourself at your wits' end. And then there's baby's sleeping pattern to consider. How do you know what's best for them? Do your actions in the first few weeks affect how they will sleep Sleep expert Mandy Gurney, founder of Millpond Children's Sleep Clinic, said: "Since I first started advising parents 15 years ago I have seen a huge increase in demand for help from parents. "It’s not because babies are sleeping less but simply because parents are unafraid to ask for professional help and see the value it brings. "With so many women returning to work soon after the birth of their baby, they physically need their babies to sleep better so they, in turn, can sleep better." In the run up to The Baby Show in London last week, Mandy shared her top sleep tips for new parents. Do you have any tips for new mums and dads?
Share them using the form below or on our Mirror Mums Facebook page. Your newborn baby will spend on average 16 hours of every 24 asleep. The first step is to teach your baby the connection between dark and sleep and light and awake. Within 10 weeks, your baby is capable of understanding she should sleep longer at night. During the day, immerse your baby in the hustle and bustle of normal life but during night feeds avoid stimulating them. Keep your voice low and make minimal eye contact. Combined with the soporific effects of darkness and quiet, this will eventually help your baby to learn that night-time is for sleeping. Overtired babies are very difficult to settle so napping is essential and it’s very important to learn your baby’s sleep signals. These could be them going quiet and still, rubbing their eyes, yawning or crying. Respond to these sleep cues right away by putting them in their Moses basket or cot for a nap. By the end of the first month, a napping pattern typically emerges with babies needing a nap every one and a half hours after their previous waking time.
If it helps, keep a diary of your baby’s feed and sleep times so you can spot a pattern emerging. This is critical to developing healthy sleep habits. A succession of events which every night ends in your baby drifting off teaches her the simple message that it's now time to go to sleep. During the early weeks, your baby will most likely need a feed right before bed but, in time, you can bring this feed forward to before bath time so he or she becomes less dependent on sucking to sleep. While being pushed in a pram or rocked in your arms calms a baby too agitated to sleep, try not to make it a habit. If your baby is to eventually learn how to sleep through the night, they must be aware that she is in their own basket or cot. Aim to put your baby in their cot slightly awake so they get used to settling themselves. White noise, such as a detuned radio, or a white noise app can also help a baby to fall asleep. This way if the baby wakes in the night they won’t be alarmed by where they are and startle to full wakefulness.
The night time sleep cycle of a very young baby lasts for around 60 minutes but from three months of age that increases to 90 minutes. If you want to teach your baby to sleep well over night, it’s vital that they learn how to settle themselves back to sleep when they stir at the end of each cycle. If your baby’s night time cries are merely grumbles, briefly check that she is comfortable, not hungry, too hot or cold, and that her nappy is clean. If all is fine, encourage her to resettle in her cot by stroking or patting them, or try rolling her on her side and gently rocking her body to and fro until she resettles. If you need to, rock her in your arms but place her back in her cot and comfort her there as soon as she begins to calm and become sleepy.A study published online last week [] in the journal Pediatrics gives new information on the breathing environment for bedsharing and crib-sleeping infants. Dr. Sally Baddock and colleagues from the University of Otago in New Zealand conducted the study.
This study included 40 routinely bedsharing infants and 40 routinely crib-sleeping infants, all of which were healthy and between 0 and 6 months old. Few mothers in the study were smokers, and most of them breastfed. The infants and mothers were videotaped on two consecutive nights. On the second night, the babies were also fitted with several sensors for physiological measurements. Their blood oxygen was measured by pulse oximetry. Other sensors measured breathing rate, and thermometers measured body temperature during the night. The air in the space directly around the infant was also sampled periodically through a small tube attached to the infant’s face. Although these measurements bring to mind a picture of lots of tubes and wires, the authors say, “All leads were secured to allow mothers to handle infants freely during the night.” The purpose of the study was to better understand the breathing environment for bedsharing and crib-sleeping infants. Specifically, the study reported two main measures:
Oxygen saturation is a measure of the percentage of arterial blood cells that are carrying oxygen. The higher the percentage, the more oxygen is circulating in the body for cells to use. Oxygen saturation of 95-100% is normal, and baseline measured in the infants in this study was 97.6%. A desaturation event was counted if oxygen saturation dipped below 90% for at least one second, indicating a period of low oxygen availability for the baby.A rebreathing event was noted if the carbon dioxide in the air around a baby’s face increased above 3%. Carbon dioxide is normally 0.039%, so 3% is very high. This is called a rebreathing event because it indicates that the baby must be breathing air that had just been exhaled (and therefore higher in carbon dioxide and lower in oxygen), either by the baby or the mother. It usually occurs if the baby’s head becomes covered by something like a blanket. We know from previous infant studies that if the carbon dioxide level in the air gets above 3%, babies will increase their rate of breathing to try to return their body to normal carbon dioxide and oxygen balance [2].
The authors wondered if babies sleeping in beds next to their mothers or alone in cribs would be exposed differently to these minor respiration challenges. On average, babies that slept in cribs had 3.1 desaturation events per night, while bedsharing babies had 6.8. In the bedsharing babies, many these periods of low oxygen availability were associated with warmer body temperatures. During the study, only one crib-sleeping infant had a rebreathing event. This occurred when a muslin swaddle ended up around the baby’s face for part of the night. Among the 40 bedsharing infants, 22 of them had a total of 79 rebreathing events. During the rebreathing events, the babies’ respiration rates and heart rates increased, but their oxygen saturation did not change. In other words, the babies seemed to be able to respond appropriately to the challenge of high carbon dioxide to maintain their blood oxygen at normal levels. Why did the bedsharing infants have so many rebreathing events?
Some of them happened because the infants were sleeping on their tummies, in the prone position. In one case, a mother was breathing directly into her infant’s face as they slept together. However, 70% of these rebreathing events happened because the infants’ heads were covered with blankets. The same authors reported in an earlier paper [3] that head covering usually occurred when an adult shifted body position during the night and that most of the time (but not always), mothers eventually ended up uncovering their babies’ heads. OK, so bedsharing infants face more breathing challenges during the night. What does this mean? Is it a problem? Does it have any relevance to the risk of SIDS? In this study, these low-risk, healthy infants seemed to respond appropriately to breathing challenges. When they were exposed to high carbon dioxide, they increased their respiration rate in order to get more oxygen and blow off carbon dioxide. When their faces were covered, their mothers often uncovered them, sometimes in response to the baby waking and crying.
The truth is that we don’t know if these minor challenges pose a real risk to healthy infants. But what happens if the baby is sick, premature, or has been exposed to cigarette smoke? These factors may affect a baby’s ability to respond appropriately to high carbon dioxide or low oxygen. What if the mother is less responsive due to drugs or alcohol? She may not wake when the baby signals distress. The authors also point out that repeated exposure to low oxygen, as happens during the desaturation events, has been shown to blunt arousal responses in animals. They state, “We suggest that frequent desaturations in vulnerable bedsharing infants could be a contributory factor in their risk for SIDS.” The authors of this paper conclude with the following statement: “The presence of the mother and other bed-partners, and the physical environment of the adult bed clearly led to a different sleep environment for the bedsharing infant compared with the crib-sleeping infant, resulting in beneficial and potentially compromising situations.
Infant homeostatic responses and frequent maternal interactions seemed to keep these low-risk infants safe. However, we suggest that it is potentially hazardous for an infant to sleep in the same bed as their parent, if the infant and/or mother are unresponsive. We acknowledge that bedsharing is a practice valued by many; thus, it is important to identify the specific dangers related to this practice… Studies with high-risk infants are required to advance understanding of the specific mechanism(s) leading to their increased vulnerability.” We know that SIDS occurs more often in babies that bedshare. We also know that the risk is clearly higher in babies that are very young (<3 months), babies exposed to smoking, those sleeping in beds with lots of loose bedding, and those sleeping with adults that are impaired by alcohol or drugs [4]. Routine bedsharing does not seem to increase the risk of SIDS [5]. Many parents choose to bedshare because they enjoy the closeness to their babies, because it makes breastfeeding easier, and sometimes because their babies refuse to sleep any other way.
Bedsharing is also the norm in many cultures around the world. Increasing our understanding of the physiology of babies sleeping together and apart from their parents will only help us to understand and minimize the risks associated with SIDS. If you bedshare, this study illustrates some important cautions: More safe sleep guidelines can be found here and here from the AAP and here from Dr. James McKenna’s website. If you bedshare, do you worry about the risks? What do you do to keep your baby safe during the night? 1. Baddock, S.A., et al., Hypoxic and Hypercapnic Events in Young Infants During Bed-sharing. 2. Haddad, G.G., et al., CO2-induced changes in ventilation and ventilatory pattern in normal sleeping infants. J Appl Physiol, 1980. 3. Baddock, S.A., et al., Sleep arrangements and behavior of bed-sharing families in the home setting. 4. Task Force on Sudden Infant Death Syndrome – American Academy of Pediatrics, SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment.