Author: Cathy Daub, PT CD, CCE (BWI)

“The one thing nobody told me about having a baby was about sleep and how exhausted I would be! I haven’t had a good night’s sleep in over six months!”

Many new parents are completely unprepared to cope with a baby who does not sleep well, who wakes up much more often than normal during the night and cries.  Some infants begin to sleep through the night almost immediately and others do not do so for many months.  Newborns lack a regular pattern for waking and sleeping. Their sleep-deprived parents quickly reach a peak of frustration and experience intense emotions as they struggle to meet the 24/7 demands of their child, at the same time trying to balance that with their own needs for sleep. Dazed parents groggily note this night after night, when the baby wakes time after time for feeding or comforting.  For a while parents have to adapt their own sleep cycle to the baby’s irregular sleep, taking catnaps and rising out of deep sleep to attend the baby’s needs.  The situation intensifies if the parents are arguing about how to handle the situation.

These parents have a dangerous amount of sleep debt. Parents of newborns are said to lose 2 hours of sleep per night until the baby is around 5 months old, which decreases to 1 lost hour per night during ages 5-24 months.  Sleep and nap times shift steadily from day to day, so that parents might find themselves up at midnight one night and at 3am the next. Over the first year of a baby’s life, parents each lose an estimated 350 hours of sleep at night.  Preparation for parenthood needs to include a consideration of strategies for parents to cope with their own loss of sleep as well as wakeful babies.

After a long labor that ended up in a cesarean, and then nights with little sleep, my postpartum days were a fog.  I had all the symptoms of sleep debt – lack of focus and clarity, impatience, worry and anxiety, low energy, and crying.   My husband was in medical school and not home to help much.  My mother insisted on doing everything for me, even taking care of the baby which I wanted to do. My daughter cried a lot and my pediatrician told me it was because I was vegetarian – she couldn’t have been more wrong.

Most people in America today are suffering from some sleep debt and go about their days feeling that the tiredness is normal.  Birthing parents are likely in sleep debt even before they give birth to their baby being up through the night to change positions and urinate due to pressure of the fetus on the bladder.  Couple this with a long labor followed by needing to be awake night after night to feed and soothe their baby.  And what if their baby is one who does not sleep through the night for many months?

Even before pregnancy, we as a nation are sleep deprived and go about our days feeling that tiredness is normal.  This is mostly due to the invention of a single and profound technological advance – the light bulb (1879). Now we could work late into the night, or read for pleasure into the wee hours of the morning. The light bulb mimics daylight and has the ability to shift our internal biological clocks.

When I was travelling around the world years ago with my husband, we often slept in places that had no electricity.  We found ourselves going to sleep just after sunset and rising at sun rise.  We became more familiar with the zodiac moving across the night sky.  We were more in tune with the earth’s rhythms and felt more energy.  There was no light bulb to keep us up. The light bulb has upset the natural order.

When new parents know what to anticipate and expect, and when they have the support they need, the postpartum period can even be enjoyable. I wish I had known more.

Did you know….

• Our sleep begins well before we are born. The fetus spends most of his time asleep – about 16-20 hours a day.  Many women believe their baby is awake when kicking inside, but the baby is most likely asleep which explains why pregnant women can feel kicking at almost any hour.
• We have biological clocks and circadian rhythms: The internal pacemaker or biological clock located deep in the brain in two pinhead-size clusters of nerve cells called the suprachiasmatic nuclei or SCN, controls a profound daily continuing oscillation approximating 24 hours. These cycles are called our circadian rhythms. They can be seen in almost every function in the body, from basic cell processes to activities of the whole body.
• Circadian sleep cycles cross the placenta

The circadian sleep cycles begin before birth by passing across the placenta.  Even though the fetus isn’t exposed to light from outside the womb and can’t tell when it is night or day, the mother is communicating this information to her baby. Research on rats and mice at Harvard University showed that these signals from the mother actually stimulate the fetus to mirror its mother’s circadian cycles.  They found that the mothers’ fluctuating melatonin hormonal levels signal the biological clock in the fetal brain, preparing the babies for the rhythms of life outside the womb.

• The mother’s circadian rhythm seems to act as a gatekeeper, inhibiting birth during the day and promoting it at night. That is why women often go through “false labor” the night or two before actual labor begins. The mother’s circadian rhythm is opening the gate to a nighttime delivery, even before the baby’s biochemical push to be born is strong enough.
• The fetus starts labor: The fetus signals the mother when its body is mature and ready to be born and actually starts the labor process. All mammals tend to give birth during the time they normally would be asleep, possibly to make sure the birth happens “at home” and safe from predators.
• When does dreaming begin? Rapid Eye Movement (REM)

It was found that near term fetuses have about 60-80% of the sleep time in REM sleep, also known as “dream sleep.” Typical newborns spend about eight hours in REM sleep, about 50 percent of their daily sleep. As adults, we spend about 25% or about two hours a night in REM sleep. By old age we have only 15-20% REM sleep.

Immediately after birth, there are only two sleep stages, REM and non-REM sleep.  REM sleep is sometimes called active sleep in babies because the muscular paralysis that always accompanies such sleep is not fully developed. Non-REM sleep on the other hand is often called quiet sleep, because the baby is sleeping like a baby, perfectly still, quiet, and limp.

At birth, infants usually sleep 16-18 hours per day, distributed evenly over six to seven brief sleep periods.  They can pass directly from wakefulness to REM sleep and alternate between REM and non-Rem sleep every 60 minutes or so instead of the 90 minutes adults take to cycle from REM sleep.

Newborns can’t talk but very young children can and do talk about their dreams. Less       than two years old, a little girl was sleeping one morning and her father heard her say           “pick me, pick me.” He looked at her eyes and saw some typical rapid eye movements.        He woke her and she said ‘Oh Daddy, I was a flower.”

• Newborn sleep states: We now know that a newborn gradually develops more sleep states and these are not random. Stages that have been identified are Deep Sleep (quiet sleep), Light Sleep (active sleep), Quiet Alert state, Active Alert State, Crying State, and Drowsy State. The best time to play with a baby is in the Quiet Alert state.
• Baby’s biological clock matures gradually. A newborn’s biological clock matures gradually to keep track of the time of day. Therefore, imposing a regular pattern of sleeping and waking is bound to be met with distress for both the parents and baby. However, providing cues such as light in the morning and evening dim light along with regular feeding schedules, can help them along as their biological clocks are maturing. Because new infants have a strong homeostatic sleep drive, they build up sleep debt over a few hours and then pay it back right away with a nap. This continues throughout the 24 hour day until their biological clock is mature.
• Sleep by the age of 12 months: By the end of the first year, the overall number of sleeping and waking hours has changed very little. The infant still sleeps 14 to 15 hours a day. Except for one to two daytime naps, the sleep periods have shifted to the night and the waking periods to the day.  By about 18 months of age, most toddlers are taking only one nap.  Children slowly sleep less and less until their daily sleep measures about 10 hours which holds steady until they reach puberty.
• Dangers of sleep debt: Without warning, drowsiness can become sleep in an instant. You are only a few seconds from sleep when your eyelids begin feeling heavy. When the biological clock is not alerting the brain, the sleep debt pushes it toward sleep. The biological clock is at its lowest ebb in the middle of the night and people are more prone to distractions, lack of focus, poor memory, bad mood, and slow reaction times.  This is life threatening if for example you are driving a car.

What you can do…

• Napping – the most important solution

Taking naps is an excellent and respectable strategy for sleep management.  Naps can make you smarter, faster, and safer than you would be without them.  They should be widely recognized as a powerful tool in battling fatigue and the person who chooses to nap should be regarded as heroic. The longer the nap, the greater the benefit and the benefits seem to be long-lasting. A 45 minute nap improves alertness for 6 hours after the nap. And for 10 hours after a 1-hour nap.  The rule of thumb for new mothers is:  “Sleep when your baby sleeps.”

• Faith and Surrender: Surrender to the process of parenting, and even in your most tired moments, remember that amazing thing you have done to conceive, grow, and birth a baby.  Have faith that it will get easier as he/she sleeps through the night.
• Drink a glass of water and feel the peace that it brings.
• See birth as a miracle: Yes, your life has changed, but soon you will hardly remember the time before birth. Babies and young children make us smile. Their joy is immeasurable.
• Breathe deeply and slowly: Take long deep slow breaths in and out when you feel you have reached your limits.  Practice awareness by closing your eyes, breathing in love and breathing out your worries.