To Sleep, perchance to dream

It is the dream of every parent of young babies and toddlers to get some sleep. Endless longing to be able to sleep influences how people feel about breastfeeding since they attribute much of their lack of sleep to breastfeeding.

“Sleep issues” are among the top reasons for for supplementing with formula or even stopping breastfeeding completely even when everything else is going well with breastfeeding:

• Many parents give their babies a bottle of formula to get them to sleep at night.
• Getting the baby to “sleep through the night” is seen as a reason for “night weaning” of the baby or for stopping breastfeeding altogether.
• Some parents “top up” with formula after a breastfeed to get the baby to fall asleep.
• Some fathers or other family members bottle feed their otherwise breastfed babies at night so that the breastfeeding mother may get some sleep.
• Some psychologists/psychiatrists, in order to prevent postpartum depression have thought it wise for the baby to be fed formula by bottle in the night, by someone other than the mother, so that the mother will be able to sleep though the night.
• Some parents worry that the baby is not getting enough milk in case the baby does not fall asleep once they have breastfed.
• How long a baby sleeps is sometimes taken as a measure of whether the baby got enough breastmilk or not and if the baby wakes up after a 20 or 40 minute nap, it is taken as a sign of “low milk supply”.

 

Breastfeeding and sleep are inextricably connected.  So much so that James McKenna describes the interconnectedness of the two as “breastsleeping” – i.e. sleeping by breastfeeding and breastfeeding while sleeping.

People are really losing their sleep over the erroneous notions around baby sleep that have been created in the past 100 years; erroneous notions based on the formula fed baby as the “model” for baby behaviour. They, and health professionals, have forgotten how babies sleep and what is normal. They have accepted that there is only one correct way to sleep for both babies and adults – 8 hours of uninterrupted sleep. And everyone who does not sleep that way has a “sleep problem”. People have come to believe that they can “turn babies off”, like the light, for the night. Consequently, the baby sleeping through the night has become many parents’ life goal supported by hosts of “baby sleep trainers” who promote various versions of controlled crying or crying it out “solutions”.

In fact, sleeping 8 hours in a row was not considered normal even for adults until recent history.   References from as long ago as Homer’s time (not Homer Simpson, Homer the Greek poet) to the 17th century describe a first sleep which began about two hours after dusk, followed by waking period of one or two hours and then a second sleep.

Contrary to people’s endless search for the Eldorado of parenting – sleeping through the night as soon as possible – James McKenna explains that waking up at night while “breastsleeping” is good for the baby because providing protection for the baby because:

• the baby gets to be checked
• the baby absorbs all sorts of stimuli from the mother such as her breathing out carbon dioxide which helps the baby to breathe more continuously
• the baby absorbs also her smell, her touch, her warmth, the movement of her chest
• the baby spends the night in safer lighter sleep
• the baby gets to practice getting awake quickly which is important in SIDS prevention
• the baby grows specific brain architecture
• and the baby’s lighter sleep terminates apneas (abnormal cessation of breathing, said to be more than 20 seconds) which occur during too deep sleep.

In other words, it is far more important for a baby’s health and survival to learn to sleep lightly and to awaken quickly, than to learn to sleep deeply without waking up. “Sensory deprivation” and “arousal deficiency” is what happens to babies who are missing the stimulation the mother’s body provides.

In a laboratory study, mothers experienced 30% more arousals when they slept with their infants (Mosko et al 1997a). And mother-infant pairs tended to sleep in synchrony, with more than 70% of their arousals overlapping (Mosko et al 1997b). Moreover, mothers who bed-shared checked on their babies more frequently during the night. In Baddock’s study, bed sharing mothers checked on their babies a median of 11 times. For mothers sleeping in separate beds, the median was 4 times (Baddock et al 2006).

Knowing all this and accepting how babies sleep goes a long way to sleeping better at night because much of the sleeplessness parents experience is caused by their endless struggle to “create good sleeping habits”. And what really keeps parents awake at night is worrying that there is something intrinsically wrong with their baby or toddler who keeps waking up at night.

The myth of “sleeping through the night” is preventing us from asking the most essential question: “What sort of sleeping arrangement makes babies feel best?” It is not in the baby’s best interest to sleep deeply and through the night.

Throughout pregnancy the baby’s existence and well-being are conditional on his being regulated by his mother’s body – the baby is in constant physical contact with the mother, receives sensory input from his mother, is rocked to sleep by his mother and is awake when his mother is motionless. It is an exercise in futility to act on this notion that babies lose the need for all this sensory input and physical contact as soon as they are born and that their desire to be constantly close to their mothers is a result of being spoiled and is a bad habit. It is remarkable how much independence is being required of newborns or 4 month old babies. “Sleeping through the night” and “babies self-soothing and being independent” were two concepts that appeared as a direct result of the wide spread use of formula which enabled both daytime and nighttime separation of mothers and babies. But biology does not change as quickly as culture.

Additionally, parents have been made feel guilty for letting their baby fall asleep at the breast once they have breastfed well because they were led to believe that babies should be taught to fall asleep on their own and to “self-soothe”. Breastfeeding, however, has, as one of its functions to put both the mother and baby to sleep.

It is normal for mothers to feel drowsy towards the end of the feeding and it is normal for babies to fall asleep at the breast. Many parents get frustrated when they spend their time trying to “break” this sleep association. In many languages of the world the word breastfeeding translates as “calming down” or “quiet down” – all references to what breastfeeding does for the baby in order to enable his transition from being awake to being sleepy to falling asleep.

The need to suck in order to fall asleep is obvious to parents – that is why so many use pacifiers as a substitute for the breast. This has actually reached absurd proportions when people turn the physiological function of breastsleeping around and say “The baby is using me as a pacifier.” In fact, the breastsleeping baby is only doing what his innate physiology is telling him to do – falling asleep by breastfeeding.

In order for breastfeeding and sleeping to work together the first step is to ensure the baby is breastfeeding well and getting enough milk from the breast. How?

• Ensure the baby has the best latch possible.  This is most important in the first days and weeks, and after that, the baby “gets it” and does it on his own, as long as he doesn’t receive bottles and pacifiers. Or is feeding on a nipple shield.
• Learn how you can tell whether the baby is getting milk from the breast or not by watching these videos: Really good drinking with English text, Twelve day old nibbling, English Text, “Borderline” drinking for video clips showing babies drinking well at the breast, or not or somewhere in between.
• Learn how to use breast compressions to increase the amount of breastmilk the baby gets.
• Switch sides when the baby is no longer drinking even with compressions.
• If you are unsure whether your baby is getting enough and/or you have sore nipples, and/or a baby who does not gain weight, and/or is fussy, and/or crying, and/or “colicky”, and/or your baby is not exclusively breastfed, and/or does not latch on well or has other issues, make an appointment at our clinic or see someone who knows how to provide practical hands on help with breastfeeding.

What if your baby is thriving and breastfeeding well and exclusively and yet you are unsure about what do to about your baby’s sleep , here are some tips:

Your baby needs help to fall asleep. Expecting the baby to “self-soothe” and magically fall asleep on his own leads to a lot of crying while parents are hoping the baby will somehow understand that he should fall asleep. Thus it is important that you find a way to help your baby fall asleep. What can you do?

• Let your baby fall asleep at the breast once he has breastfed well.  The baby will usually gently release the breast as he falls asleep.
• Take your baby to bed, breastfeed lying down and let him fall asleep.
• Wait until your baby is really asleep (this may take much longer than you expect) and do not put the baby down before he is asleep.
• Walk your baby to sleep by putting him in a carrier or a wrap while breastfeeding him at the same time. Or take your baby for a walk outside.
• Put your baby to sleep before he is too tired and overstimulated.
• Vertical motion (up and down) helps babies to quiet down and fall asleep. One way to do this is to use a big exercise ball to gently rock the baby up and down.
• Know that falling asleep gets easier and easier for babies as they grow older.
• Make sure your baby gets enough sleep. Some parents try to have their babies sleep as little as possible during the day hoping the baby will sleep better at night. However, for babies it is important to get good sleep both during the day and at night.  In any case, trying to keep the baby up longer during the day so he will sleep longer at night hardly ever works, if ever.
• Just as breastfeeding and sleeping are interconnected, so is sleep and brain development. Lighter sleep and frequent night-time waking are connected to memory formation and developing brain.
• Use skin to skin contact to help your baby calm down and fall asleep.

Formula marketing tries to convince us that formula is the answer to “sleep problems”. Formula companies make all sorts of “good night” and “good sleep” formulas and this leads to some people giving babies formula just to put their baby to sleep or to get the baby to fall asleep during night.

Instead of giving babies a bottle of formula at night, make sure the baby is breastfeeding well and increase your milk supply if necessary. Often mothers observe that they have more milk in the morning and early afternoon and less in the late afternoon and evening and that their babies are more difficult to put to sleep in the evening. The answer may be increasing milk supply. If your baby is breastfeeding well, then developing strategies to help the baby relax and fall asleep is what is necessary. However unbelievable it may sound, babies will eventually sleep through the night and there is no reason for “night weaning” in order to achieve that. Nighttime breastfeeding provides security to the baby as well as transition from one sleep cycle to the next. Statistically speaking, the overall length of breastfeeding is heavily dependent on the baby and toddler breastfeeding at night. There are other things you can do to help you feel better about the night during which your baby wakes up frequently to breastfeed:

• Accepting the situation goes a long way.
• Taking your baby to bed with you.
• Making sure you have enough comfortable sleeping space. Feeling cramped into a too small bed or worrying that the baby might fall down can cause you to sleep less well than you would. Putting a mattress on the floor and sleeping there with the baby may help a lot.
• Knowing that you are helping your baby’s physiology to receive the stimuli he needs for the right sleep cycling and brain development can help you accept the situation as well.
• Stopping counting the times your baby woke up at night. If you avoid the counting, “nighttime harmony” will develop in which you wake up a few seconds before your baby, put him to the breast and continue sleeping without almost noticing the interruption. Nighttime harmony is disrupted if the baby is getting bottles from other members of the family who might be hoping to help you by “letting you sleep while they give the baby a bottle”. In the long run, giving bottles to the baby at night may lower your milk production too because some babies get a lot of their breastmilk intake at night and milk production is to some extent connected with breastfeeding at night – sleeping with your baby at night increases the number of times the baby breastfeeds and because most babies breastfeed well at night and get plenty of milk, it increases mothers’ milk supply.
• Starting breastfeeding your baby as soon as your baby stirs instead of waiting for full blown crying which may make the baby inconsolable.
• Knowing that the average sleep cycle of a baby at night is about 90 minutes.
• Trying to go to sleep as soon as the baby goes to sleep at night instead of using the first sleep of the baby to stay up.

Rest assured that eventually all babies will sleep through the night and begin to fall asleep on their own as well and it can be done without letting them cry it out. They simply “grow up” and what changes is how long it takes for them to fall asleep and their sleep patterns naturally change. They begin to transition from sleep cycle to the next without needing the help of breastfeeding.

Need help with breastfeeding?  Make an appointment at our clinic.

Copyright: Andrea Polokova, Dr Jack Newman, MD, FRCPC, 2018