How Little Sleep in Residency Inspired Me to Become a Baby Sleep Expert

As a resident, our schedule involved something called “q 4.”  This meant that every 4^th night, you spent in the hospital, rather than in your comfy bed. So, you would come in at 6am or so the morning of, and stay until about noon of the next day. Thirty hours straight, every 4^th night. Boo.

After my husband and I got married at the end of our intern year, he looked at me and said, “You’re plotting when we are going to have a baby, aren’t you?” And I was. I had to figure out how a baby was going to work with q4 and an eighty-hour work week.  (Not to mention living on one resident’s salary with a baby, because remember people, our super country doesn’t pay for maternity leave).

It took a lot more then plotting, though. Careful planning and scheduling added up in the ideal time to have that baby being the end of residency.  Fortunately, we were required to complete a reading elective to graduate. Seeing newborns day-in and day-out, and the toll they took on their zombified parents, it was a no-brainer: infant sleep.

So, while in third trimester, right before my due date, I had four weeks to read everything I could about infant sleep. Not just that, but I also had the benefit of a child development specialist as my mentor along the way. Now, I pride myself in being somewhat of an expert, and thank God Almighty, because q4 is nothing compared to q1.

Before I start, I just want to make it clear that I have been there. The feelings of panic upon hearing that pitch, you know, the one where they are crying like someone is ripping off their arms, sustained, for hours…Nausea, followed by vomiting. Sweaty babies, swollen eyelids. Tears, ear plugs, cookies, wine. Going through boxes and boxes of tissues listening to my baby cry on the other side of her door.

I have been ex-communicated from my house while trying to sleep train (yes, I am the softy and always wanted to pick up my crying cherub, ready to sabotage the sleep training). Upon return, I was then forced to remain in the basement, lest I resist my common sense and walk in on the third or fourth hour of crying (the baby and me) and teach her that if she cries long enough, Momma will pick her up, instead of the intended lesson: You CAN soothe yourself to sleep without external assistance. Our second cried three hours every night for three weeks – it was awful (note, our toddler slept straight through this with a few exceptional nights). But it was either that, or me having a nervous breakdown from sleep deprivation.

Below is the guide, roughly divided by age and as simplified as I could make it for a blog entry.

First days after birth

I should start by saying, babies should always sleep on their back, without anything soft in their bassinette/crib. No blankets, pillows, lovies, bumpers, etc. The rate of Sudden Infant Death Syndrome (SIDS) has decreased 80% by people putting babies on their back and even more without soft items. People: I have seen suffocated babies. It has changed all those it touched forever. Just. Don’t. Do. It. Keep your treasures safe.

In the first couple of days, I hear, “This isn’t so bad! My baby sleeps all the time!” Unfortunately, after 24 hours to a few days, baby wakes up and screams a lot at night. The honeymoon is over.  Welcome to parenthood.

Babies are born with days and nights backwards – also, they only have 1-2 “long” sleep stretches every 24 hours (“long” = 3-4 hours); if they have these stretches in the daytime, they will not have them at night; they will be up for a long stretch usually between 1am and 5am.

For the above reason, families should wake up their babies every 2 hours (not 2 hour and 15 min!) from 7am until about 12am. Babies do not care about noise or light. You have to be pretty brutal : make baby naked, place on cold, hard surface. You may even have to stick your hands in freezer and put icy cold hands on baby to wake them up.

Your baby only has to stay up for 10-15 minutes and then is allowed to go back to sleep. The idea is to break up the 3-4 hour daytime cycle so they are forced to do it at night (newborn’s night = 12am to 5am). Feed the baby each time you wake them up.

First 4 to 6 weeks

In the first 4-6 weeks, it is ok to let the baby sleep in your arms. You cannot train a baby this young. You will not spoil them.  Remember, they have been in a hug for 9-10 months. We need to give them time to transition to being out of that hug (hug is a euphemism for womb…)

6 to 24 weeks

As babies approach their 6 week post due date birthday, their crying gets worse. This is known as the six week crying peak. They can cry for several hours in evening before passing out around 12 or 1am for their “long” period. Once they reach the 6 week mark (must be after the due date – if baby was a premie, will take longer to reach!)  the crying usually dissipates within a week and they only fuss if they are hungry, tired, stinky, or have a love emergency.

If a baby has colic, crying peaks at 8 weeks after due date and does not resolve until about 12 weeks. (Colic = crying for more then 3 hours per day more then 3 days per week; has nothing to do with gas; But, babies are gassy when they cry a lot and swallow air).

2 months

Bedtime gets pulled earlier as baby gets older. Until about 8 weeks, bedtime tends to be late – 11pm or later.  After 8 weeks, I ask parents to move the bedtime earlier by 1 hour every week so that by 12 weeks bedtime is between 5:30 and 7:30pm.  If you have a festively plump baby (13 pounds is minimum cut off for this as at that size the liver is big enough to provide glucose to brain all night long) they can sleep all the way through the night.

If you do not do the above, by 4 months you will have a kid that doesn’t sleep and doesn’t eat, or is overfed out of confusion (people will frequently feed their over-tired crying baby thinking they are hungry), as they will have been hyper-stimulated!!!

Additionally, around 12 weeks after the due date, babies loose the ability to sleep well with TV/lights on or in the living room. By this time, start putting babies in quiet, dark spaces for all sleep.  I actually recommend doing this from the start.

Once a 5:30 -7:30 pm bedtime (approximately) is established, the goal is:

Sleep 7-7am (babies who fall asleep at 5:30 will still sleep until 6 or 7am). No joke. For reals.

Naps

Protect 1^st nap which could be as little as 30 minutes from nighttime sleep; this is thought to be an extension of nighttime sleep

Other naps irregular but no more then 1.5 hours between naps at this age. If a child is “cat napping” meaning, most naps are < 45 min, that child is sleep deprived and needs an earlier bedtime.  They are allowed ONE short nap per day, others should be at least 45 min long, the shortest duration of a complete infant sleep cycle and one cycle of brain rest.

Wake up babies at 5 pm to protect the bedtime – if your baby falls asleep at 4:55, they get a 5 min nap

You can push the last nap back if you want to turn it into bedtime. For example, baby needs a nap around 4:30. You can either let them nap for thirty minutes or push it to put them down for the night at 5:30.

4 months

Easiest time for sleep training

If you did not move your angel’s bedtime to earlier, you are likely a zombie.  You may try to push the baby’s bedtime to later thinking this will tire the kid out only to make them hyper-stimulated and unable to sleep longer then an hour unless they are held; most kids will also have cat-naps from sleep deprivation.

Bedtime should fall into the 5:30 – 7:30pm window. At this point, most babies can sleep 12 hours through; I allow one awakening until 6 months, then I advise you to nip it.

Don’t forget quiet, dark spaces for sleep.

Naps

First nap usually within 1 hour of awakening

Second nap within 1.5-2 hours of awakening from 1^st

Third nap within 1.5-2 hours of awakening from second

Up after 5 pm to protect bedtime.

If no third nap is taken, move bedtime earlier.

IF YOUR BABY IS NOT SLEEPING THROUGH THE NIGHT by four months of age but you have followed the bedtime advise, you can now let them cry it out – one of the hardest things you will do as a parent.  It is really their first tantrum, so to speak, you will witness.  No way to sugar-coat it. It sucks.  You will not cause any abandonment issues/psychological damage – at least not any more then you would have caused by your bad mood from being over tired yourself. Just kidding! Lighten up! Ok, only kidding a little…

By 5 months, babies have a predictable sleep schedule parents should be encouraged to stick to; this can effect their development. Chronic sleep deprivation can lead to developmental delays, obesity, asthma, and behavioral issues that look like ADHD (but aren’t – they are just sleep deprived).  Babies consolidate new information when they sleep and growth hormone is only released while asleep.

6 months

If babies are not sleeping through the night (and they have no medical problems) then think about if this is a mommy/daddy enabling issue.  There is no new information here with the exception that time between naps can be extended to about 2 hours.  Some babies will tolerate slightly longer spacing, but don’t push it.

9 months and up

They usually drop the third nap around 9 months.  This is not mandatory and if you like three naps, keep three naps.

They usually go from 2 naps to 1 long nap around 12-18 months and it takes 3-6 months for that drop to occur. That is a topic for another blog.

That’s it. As concise as I can make infant sleep.  I have guided many families through this very successfully. You just have to ask yourself if you are ready for the commitment it takes to make it happen.

Are you ready to sleep through the night?

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