How to Get Your Baby to Sleep Through the Night
Since bringing home our daughter, Olivia, two years ago, I've become more familiar with our bedside clock than I ever dreamed I would be. I've witnessed it display hours no human being ever should—ghastly times like 2:33, 4:01, and 5:17 AM It's no coincidence that when my bleary eyes have seen those red numbers, there's been a baby howling in the next room.
The jokes about sleep deprivation start before you've even purchased your first pair of maternity jeans, but nothing can prepare you for the hell that awaits you. Best-case scenario, you'll be getting up at 6 AM on a regular basis, so you'll need to try to sleep soundly during the wee hours. But how can you do that? What's the best way to get a baby to sleep through the night?
Unless you're one of a lucky few, you can forget about getting anything close to six to eight hours of uninterrupted snoozing for at least the first three months of your baby's life. "Infants aren't wired well neurologically," says Charles Pohl, M.D. director of the Network of Apnea and Pediatric Sleep Center at Thomas Jefferson University Hospital, in Philadelphia. "They have what we call disorganized, or fragmented, sleep." That means that newborns don't sleep for long periods the way we do (or did), nor do they necessarily do most of their sleeping at night. They also require two or three nighttime feedings, since their tiny stomachs can't hold enough to keep them full for long periods. Though some babies are capable of sleeping through the night as early as 6 weeks old, for many it won't happen until age 4 to 6 months.
By then most babies should be learning to fall asleep on their own in their own crib, without being rocked, nursed, or otherwise coddled into slumber. "At the age of 4 to 6 months, most babies are also capable of sleeping for about six to eight uninterrupted hours and putting themselves back to sleep several times during the night," says James Lemons, M.D. professor of pediatrics at the Indiana University School of Medicine. By 9 months, he says, most can sleep a full 12 hours. However, Dr. Lemons and other experts say that the age at which a baby actually does sleep through the night can vary a great deal and is often related to a particular infant's weight or how satiated he is from his feedings.
Even if your baby is younger than 5 months, you can start helping her develop healthy sleep habits: "I don't think it's ever too early to get an infant used to a regular schedule, so that she starts to know when sleep time is approaching," says Deborah Givan, M.D. director of the Children's Sleep Disorders Center at Riley Children's Hospital. in Indianapolis. "Another good idea is to minimize stimulation prior to bedtime. A warm bath, a book, or a song can help a child wind down." Other simple approaches endorsed by most (but not all) sleep experts are to cut down on your baby's napping and to move her bedtime to a later hour.
If most of your nights are still being interrupted once your baby reaches 5 or 6 months—if she still isn't sleeping for six- to eight-hour stretches or can't get herself back to sleep when she awakens—consider trying one of these techniques. Each method has its proponents and detractors, but there's a good chance that one could work well for you and your baby.
Probably the most popular getting-baby-to-sleep technique is the Ferber method. named for its creator, Richard Ferber, M.D. director of the Center for Pediatric Sleep Disorders at Children's Hospital. in Boston. It's based on the notion that babies make associations with falling asleep, whether at bedtime or after waking in the middle of the night. So if you routinely rock your child until he falls asleep or allow him to conk out while breastfeeding or having a bottle, he'll come to rely on these things in order to go to sleep and will want them repeated when he wakes in the middle of the night. The trick is to teach him to learn to fall asleep by himself in his crib. Here's how it works:
1. Put your baby in his crib, say good night, and leave the room. If he starts to cry, let him—for about 5 minutes. Then go into the room, comfort him briefly without picking him up, and leave. If he cries again, wait 10 minutes before going in, then 15 minutes, until he falls asleep. The point of going in is to reassure your baby that you still exist and to reassure you that he's okay.
2. Repeat the ritual—with the same timed intervals used at his bedtime—every time he wakes in the night.
3. Each subsequent night add an additional 5 minutes to the first interval. For example, the second night, start by waiting 10 minutes before going in, then 15 on the third night.
Over the course of three to seven days—blessedly, it rarely takes longer than this, say pediatricians and experienced parents—the baby learns to associate being in his crib with falling asleep. He also learns that crying won't get his parents to pick him up. And a few nights of tears in an otherwise loving environment won't have any lasting effect on your baby.
This method isn't for the fainthearted, since you have to be able to handle hearing your infant cry, sometimes for long periods. But unlike simply letting the baby cry until he falls asleep, you go in to his room to calm him at prescribed intervals. You may have to repeat the entire process when the baby is older, since some will experience relapses.
The biggest problem with Ferberizing is when parents are inconsistent. Also, some infants just don't respond to the technique. "There are some spirited children who may repeatedly outlast the parent," says Dr. Givan. "If after two weeks the baby hasn't adjusted his sleep habits, it may be time to talk to your pediatrician about another method."
This technique is based on altering a baby's sleep habits by waking her
at prescribed times. Here's the idea:
1. For one week, keep track of the times the baby wakes each night. Then, try to beat her to the punch. If she wakes at 12 and 4 AM, for instance, go in and wake her at 11:45 and 3:45 and rock her or do whatever you normally do.
2. Day by day, extend the waking times in 15-minute increments—back to 12 and 4 AM, then to 12:15 and 4:15, and so on. She should stop waking on her own and instead wait for her parent, who has become her alarm clock.
3. As you add 15-minute increments between wakings, she learns to sleep for longer periods of time. Eventually you phase out the wakings altogether and find that your baby is sleeping through the night.
For infants who routinely awaken at predictable times during the night, the scheduled-awakenings method can be a gentler alternative to Ferberizing—there's often less crying and parents feel a sense of control, since they're in charge of when the baby wakes up.
"The biggest problem I've seen is that parents have a hard time bringing themselves to actually wake the baby," says Carl Johnson, Ph.D. a specialist in sleep disorders at Central Michigan University. in Mount Pleasant. Some sleep experts are adamantly opposed to this method and point out that there's little proof that it's effective. They argue that an infant's waking schedule is too varied for this technique to be effective. Another glitch is that this approach takes a while—as long as three or four weeks.
Reinforcing Sleep Rhythms
On the flip side of scheduled awakenings is a preventive method advocated by Marc Weissbluth, M.D. author of Healthy Sleep Habits, Happy Child. The gist of it is that you never let your baby (of 4 months or older) become overtired, because being too fatigued is the root of all sleep problems, says Dr. Weissbluth. Instead, you anticipate your infant's natural sleepiness and put him down—at nap time and at bedtime—accordingly. The approach works as follows:
1. Keep intervals of wakefulness brief when a baby's about 4 months old; every one to two hours, put him down for a nap. Infants who are older than that can handle longer wakeful periods—put them down for naps two or three times a day. Any soothing bedtime ritual can be used, says Dr. Weissbluth, but avoid letting your baby nap on the run, such as in the car or stroller.
2. Anticipate when your baby will be sleepy. This, says Dr. Weissbluth, may take a while: "It's like surfboarding—you have to catch the wave of drowsiness as it begins to surface before it crashes into an overtired state."
3. Dr. Weissbluth's motto is: Never wake a sleeping baby. Most babies (between 5 and 12 months) will take two or three naps of one to two hours a day, but he claims that longer naps will have no negative effect on nighttime sleep. "Sleep begets sleep," he says. "It's not logical, but it's biological. The better a child sleeps during the day, the easier it is for him to fall asleep at night."
4. Set an early bedtime. Babies need to go to bed between 6 and 8 PM, says Dr. Weissbluth, depending on their nap schedule. "Children who are kept up too late have trouble falling asleep or staying asleep," he says. "And they have trouble napping during the day. Early bedtimes prevent night wakings."
Dr. Weissbluth argues that with his approach, sleep problems won't develop and you'll never need to resort to Ferberizing or other techniques; all you'll need to do is predict when your baby will get tired and then let him sleep.
Never letting a baby become overtired and never waking him up can be harder than it sounds. While this approach may be less wrenching than some of the others, it's not a short-term quick fix: In order to work, you have to stick with it. And Dr. Weissbluth acknowledges that if your infant is waking in the middle of the night, this method will only bring about slow, gradual change.
The Family Bed
This method—in which children share a bed with their parents—is common in many cultures and is part of a child-rearing philosophy known in the U.S. as "attachment parenting." It's a sleeping style more than a technique for getting a baby to sleep well. This approach—not to be confused with allowing your child to come into bed with you once in a while—calls for sharing the bed most nights.
Proponents of cosleeping believe that the feeling of security the baby gets when she wakes up next to her mom and dad helps her go back to sleep right away. If the mom is breastfeeding, she barely has to open her eyes to feed her baby.
Many sleep experts offer warnings about this approach. You'll have to forget about having any privacy. "And there is the possibility that a parent will roll over on top of the baby," says Johnson. A family bed needs to be large enough to accommodate everybody comfortably and shouldn't have a soft mattress, fluffy pillows or a comforter, which could suffocate the baby. Also, you should never consume alcohol or take any medications that may make you drowsy. And there's the issue of when to stop inviting your child into bed with you, because at some point she's going to have to learn to sleep alone—which means that one of the above techniques may eventually be necessary.
With any sleep strategy, it's in everybody's best interest to start sooner rather than later—certainly by 18 months. If your baby continues to have problems falling asleep and staying asleep, talk it over with your pediatrician; she may refer you to a doctor who specializes in children's sleep disorders. "Once a kid gets older," says Dr. Givan, "solving sleep problems requires more creative solutions."
While getting your baby to sleep through the night can take some effort and willpower, if you keep up with it, everyone will rest easy.
Christina Frank writes for several national magazines and lives in New York City with her husband and daughter.Source: www.parenting.com