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How babies sleep

By Dr Alison Bentley, Restonic Sleep Expert

From the very beginning, even before birth, babies experience sleep. It’s a remarkable phenomenon to consider that rapid eye movement (REM) sleep has been recorded in babies while they are still in the womb. As pregnant mothers can tell you, there are distinct periods of activity and calmness in utero, hinting at the sleep-wake cycles that babies will continue to experience after birth.

Maturing circadian rhythms

3 - 4 months

Then, at around three to four months of age, a significant development occurs as babies’ circadian rhythms begin to mature. This marks the beginning of a more predictable sleep pattern, with nighttime becoming associated with rest and daytime with activity.

Relief to sleep-deprived parents

6 months

By six months, many babies reach a milestone that brings relief for sleep-deprived parents: sleeping through the night. This achievement is a testament to the maturing of their sleep cycles and the establishment of sleep habits.

Settled sleep routines

6 - 9 months

As babies grow and develop, their sleep patterns evolve. Between six and eight months, most babies settle into a routine of three naps a day, each lasting around 45 minutes.

Remain flexible

It’s crucial for parents to remain flexible as their little ones grow, allowing for variations in bedtime based on the baby’s individual needs and how their routine is changing as they develop.

3 - 4 months

Importantly, at this age the gut starts to rest at night, reducing the need for frequent nighttime feeds.

6 Months

However, it's essential to remember that every baby is unique, and some may take longer to reach the maturing milestone.

18 Months

By around 18 months, babies typically transition to one nap per day, with bedtime gradually shifting later into the evening.

Baby sleep challenges

While many babies smoothly progress through sleep milestones, others may encounter challenges along the way. There are two main types of sleep problems: persistent nighttime waking for feeds and regression after previously sleeping well. These issues can arise due to various factors, including illness, travel, or changes in routine.

Addressing sleep problems

Addressing sleep problems requires patience, understanding, and sometimes, professional guidance. It’s essential for parents to observe their baby’s sleep patterns, identify any disruptions, and address underlying causes effectively. Whether it’s implementing a soothing bedtime routine, creating a conducive sleep environment, or seeking support from a healthcare provider, there are strategies available to help improve sleep quality for both babies and parents.

One common concern among parents

One common concern among parents is the reliance on sleep crutches, such as feeding, using a dummy, rocking, or feeding to sleep to help their baby fall asleep. While these behaviours are natural and comforting in the early months, they can become problematic if they develop into long-term dependencies. Babies may develop anxiety or resistance to sleep without their preferred crutch, leading to bedtime battles and sleep disturbances.

Weaning your baby

It’s important to wean babies off these sleep crutches as they grow older. It’s essential for parents to gently encourage self-soothing and independent sleep habits. As a parent, it’s essential to strike a balance between meeting your baby’s needs for comfort and fostering independence in sleep. With patience, consistency, and gentle guidance, babies can learn to fall asleep and stay asleep without relying solely on external crutches.

Crutches teach a baby a very ritualized way of falling asleep – and that’s fine until baby needs to fall asleep without that particular crutch (for example, the very specific way that mom holds the baby, which means dad can’t get baby to sleep).

My approach has changed over the years. I’m not an advocate for crying out, although I know some parents find it works for them.

Parental guilt

I want to address the guilt that many parents hold when it comes to their baby’s sleep by saying: There are things that happen in the first four months of life that interfere with being able to fall asleep, that you have no control over. For example, your baby might have acid reflux, and so lying down is a disaster, so they learn to only fall asleep being held upright, which becomes their sleep crutch. Or it might be as simple as travelling to stay with family for two weeks and you compromise on how you handle nighttime wakeups to avoid disturbing everyone else in the house, and your baby learns that whenever they wake up, you will pick them up and put them in the bed with you.

These things are not your fault. Your baby learns a way to fall asleep and sometimes there’s no accounting for what works or why. That’s kind of the same with adult insomnia. Adult insomnia can be caused initially by a whole bunch of things – a divorce, a death in the family, hospitalization, onset of a medical disorder, but when it becomes chronic and it’s been there for a couple of years or even months, it kind of looks the same. It’s all about anxiety about going to sleep.

When your baby wakes up at night and what they need (their sleep crutch) is not there, they get anxious. And if it doesn’t come, they get more and more anxious. But they never at any point go, “Oh, I know what I’ll do. I’ll just turn over and go back to sleep because a baby doesn’t yet know that’s even an option.”

Sleep training – my approach

My approach has changed over the years. I’m not an advocate for crying out, although I know some parents find it works for them. I believe that we need to give babies the tools they need to help them learn to get back to sleep on their own.

My advice to parents is not to worry about bedtime. Don’t fight at bedtime – make it a pleasant time you spend with your child. Implement a routine that works for you, whether that includes story time, saying prayers, brushing teeth, etc. Bedtime is separate to what happens in the middle of the night, so treat it that way. Do what you need to do to get your child to sleep.

Then, when they wake in the middle of the night for the first time, that’s when you need to make your stand. Don’t give them the sleep crutch. They don’t need a feed. They need to practice falling asleep on their own. In my experience, it normally takes at least three nights to even get that on their radar. But then it gets easier.

Three stages to expect

What this looks like is three phases. First, they will be furious because you won’t help them fall asleep the way they are used to. And that’s understandable. They are frustrated and they’re entitled to be.

So they will scream and you need to talk to them and keep talking to them to calm them down. It might take 40 minutes. And they will go from furious to almost sad, and then finally to sleepy. If your baby can already stand, part of this process is trying to keep them lying down.

Eventually, they will get tired and they will fall asleep. That’s a huge moment for both of you. And then the next time they wake up that night, you give them the crutch that they’re used to. You only fight once a night, at the first wake-up.

After three nights, they start to become aware that they have done this before and it was okay in the end. If you keep pushing through, that wake up should move later. So, if you were getting up at 11pm, you might now get up at 1am and do the same thing. By the fourth or fifth night, there’s normally no more screaming. They will fall asleep a lot faster because they’re less anxious because they know they’ve done it before. Gradually, that first period of sleep should become longer and longer until eventually they’re getting through most of the night.

Dr. Alison Bentley

Dr. Alison Bentley

Dr. Bentley is a medical doctor with 30 years of experience treating sleep problems in both adults and children. She has a PhD in restless leg syndrome and has worked in private practice, research including academia. She was the founding chair of the Sleep Society of South Africa and has presented at local and international medical and sleep conferences, and in her spare time, she volunteers to build nursery school classrooms. Dr. Bentley believes sleep remains under-researched and aims to improve sleep research and training for doctors. From 2023, Dr. Bentley will be partnering with Restonic SA to share her knowledge and expertise on sleep.