Baby won't sleep, what can I do?

- Nicolas Belisle

We are often ask this question: "My baby won't sleep, what can I do?". This question is often followed or preceded by the question: "How much sleep does my baby need?". Let's answer both of them.

The expression "I slept like a baby"

There is an expression that says: "I slept like a baby" and there are people who say that sleeping like a newborn is far from interesting because the newborn often wakes up. Some even go so far as to correct the person who claims to have slept like this by saying "you probably mean you slept like a teenager."  Without starting a debate as to whether these expressions are good or bad, they have the merit of asking an important question for the parents of a baby which is the following: how much sleep does my baby need?

The Academy of Sleep Medicine (AASM), offers official recommendations by age category but before providing them, this American organization explains that it refrains from providing recommendations for children under 4 months old due to fluctuations and due to a lack of conclusive data. However, for other age groups, the information is interesting.

Recommendations for the amount of sleep for optimal health by age group

Here are these recommendations:

  • Babies 4 to 12 months: For optimal health, babies should get between 12 and 16 hours of sleep per 24 hour period. Note that this amount of sleep includes naps.
  • Babies 12 to 24 months (1 to 2 years old): For optimal health, babies should get 11 to 14 hours of sleep in a 24-hour period. Note that this amount of sleep includes naps.
  • Children 3 to 5 years old: For optimal health, they should get 10 to 13 hours of sleep in a 24-hour period. Note that this amount of sleep includes naps.
  • Children 6 to 12 years old: For optimal health, they should get 9 to 12 hours of sleep in a 24-hour period.
  • Adolescents 13 to 18 years old: To optimize their health, they should sleep 8 to 10 hours in a 24-hour period.

Obviously, babies and toddlers sleep in multiple sessions with naps in addition to their nighttime while older children and teens are often less likely to nap.

What are the health benefits of getting enough sleep?

Getting good sleep will help baby in the following ways:

  • Improved attention
  • Improved behavior as a whole
  • Improved learning
  • Improved memory
  • Improved management of emotions
  • Improved quality of life through physical and mental health

What are the health risks associated with a lack of sleep?

Conversely, if the baby is not sleeping enough, it increases the risk of certain problems such as:

  • Having accidents due to lack of attention
  • High blood pressure if this lack of sleep continues chronically
  • Obesity if this lack of sleep continues chronically
  • Diabetes if this lack of sleep continues chronically
  • Depression if this lack of sleep continues chronically

Baby won't sleep, what can I do?

Here are some easy tips to help baby sleep well:

  • Avoid screens as much as possible, especially before naps or at night.
  • Feed the child well with quality food filled with the right nutrients to have relatively stable blood sugar levels and optimize the proper functioning of the metabolic pathways. Some might misinterpret this point. The idea is to give the least processed food possible without following a strict eating pattern.
  • Get the child moving during the day for his motor development and to tire him at the right time of the day! Physical activity also helps cells to be more sensitive to insulin, so it dramatically lowers the risk of developing type 2 diabetes.
  • Have a room that is as dark as possible when the baby goes to bed to facilitate the natural secretion of melatonin (the sleep hormone).
  • Make sure the baby is dressed appropriately to avoid getting cold (rarer) or being too hot (more frequent).
  • If possible, breastfeeding helps sleep because the mother's circadian rhythm (internal clock) will transfer melatonin (the sleep hormone) to her baby when she sleeps. If possible, the mother should also avoid the screen as musch as possible before sleep due to the blue light which interferes with the secretion of melatonin.

Here is an example outside during the winter season when the baby does physical activity for pleasure. This physical activity helps improve motor development and the use of the senses while facilitating sleep afterwards.

Here is an indoor example where the baby is learning to climb. It should be noted that in both cases, parents should always weigh the risk / benefit ratio of physical activity while maximizing fun and learning through discovery. This activity will promote sleep and sleep will promote the integration of these learnings. 

The hammock (area for the parasympathetic nervous system for relaxation) is right next to the play module (area for the sympathetic nervous system for play and activation).

The state of allostatic load and baby's sleep

The baby should live in an environment where the allostatic load (total of the various components of chronic stress in an environment) is relatively low. Whether physical or mental, chronic stress will increase cortisol (the stress hormone) which will negatively affect the mechanisms that help sleep.

The example we can give is when we are chased by a bear. It will then be impossible to fall asleep because the goal is to flee. Nowadays there aren't really bears chasing us anymore but we can have mental bears as chronic stressors and babies too. This chronic stress will play a negative role on sleep. Here is a video explaining what the allostatic load is and the effect of chronic stress on the body of baby and parents.

 

Let baby cry until he falls asleep or not?

The technique of letting the baby cry until he falls asleep is very controversial and for good reason. Being safe (and the perception of being safe) is extremely important for the baby. If the baby feels threatened or tormented, his stress level will increase and therefore sleep will be very difficult. He may be able to fall asleep, but the quality of sleep may be poor or microtrauma may occur. This or these trauma (s) could have consequences on future behavior.

Here's a video explaining of portion of the problem.

 

The importance of physical contact for the baby

In most cases, physical contact is one of the baby's greatest pleasures since he feels completely protected. This is why some parents decide to cosleep until the baby feels independent enough to be able to sleep on his own. In Japan, children often sleep with their parents until a certain age and the phrase translated to represent the baby's sleep at this stage is "the river between the two banks."

If you opt for cosleeping, you must be organized so that the baby is safe with a playpen, a cushion or another way to avoid an accident. This is especially true if parents are exhausted.

Another way to help soothe baby by giving him a strong sense of security and giving him as much physical contact as possible is to place him in a sling skin to skin until he or she falls asleep.

 

Without necessarily cosleeping, making sure baby's physical and mental needs are met and that he feels safe will certainly lower his chronic stress and help the whole family get quality sleep!

If the sleep disorders come from digestive disorders such as colic, reflux or other?

In these cases, it is necessary to consult because the baby or the child may have food allergies or intolerances. A good start is to start by feeding your baby quality food that is minimally processed. If possible, breastfeeding decreases the risk of colic.

If you have exhausted all your avenues of solutions, a health professional can help you by going into more detail.

It should be noted that chronic stress has a negative impact on digestion and it is therefore necessary to control the allostatic load of the baby by providing him with the most zen environment possible.

How can we provide an environment that reduces the risk of a baby being chronically stressed?

As with babies, each individual is unique. However, here are some things that can be seen as stressors and that can gradually build up to generate enough chronic stress to interfere with baby's sleep. Obviously, it's not a switch that is "on / off" and every baby reacts differently. It is still interesting to be aware of these aspects and if possible, to eliminate or minimize them.

  • Have noisy toys. These loud noises are audio stresses that will grab the attention of babies and toddlers and there may be a price to be paid for the stress. Calming lullabies are obviously excluded here and they are great to help your baby sleep.
  • Eat highly processed foods and refined sugars. Processed food is much harder to digest and refined sugars will raise blood sugar levels (blood sugar levels) without providing as many nutrients as unprocessed food.
  • Exposure to screens. Blue light will interfere with the secretion of melatonin. If the mother is breastfeeding, it is also recommended to do the same for the mother so that there is more melatonin (the sleep hormone) in her milk.
  • The environment where the baby is during the day (home, daycare or other). This environment will have a great impact on allostatic load. If the baby cries constantly because the environment in question is unable to meet his or her physical or emotional needs, the baby's chronic stress will be very high. If this environment is flexible to baby's pace and fully satisfies baby's needs, he or she is much more likely to have a good sleep.
  • Parents' stress. If the baby perceives the stress of the parents, he may feel threatened. If the mother is breastfeeding cortisol (stress hormone) can be found in breast milk just like melatonin (sleep hormone).

Obviously, we live in a performance-based society and therefore, it is normal to deal with a certain level of stress. We must also be aware of this stress and manage it as much as possible because the baby is much less well equipped to manage this stress than adults.

Combined with these points, which we want to reduce or eliminate, physical activity for the whole family also has many benefits by the fact that it activates the sympathetic nervous system (activation or “fight or flight” response) to leave room for improvement. the place for the parasympathetic nervous system (relaxation) when it comes time to rest. So if the whole family is in post exercise mode, including the baby, sleep will be easier afterwards.

Optimization of the stress response by the Hypotalamo-Pituitary-Adrenal axis (HPA axis).

All of the suggestions for improving sleep quality and reducing allostatic load listed above are based on optimizing the stress response through the Hypotalamo-Pituitary-Adrenal axis (HHS axis) of all family members.

After all, the members of the family unit (where they live together) influence each other enormously through their relationships. Here's avideo that explains how the HPA axis works to understand physiological mechanisms and how they work.

 

By realizing and eliminating as much as possible the stressors presented above, homeostasis (natural balance) and cortisol (stress hormone) level of baby and family members will stabilize at a lower level and sleep will be much easier.

This will make it easier to reach the recommendations for the amount of sleep for your baby!

Sources:

https://aasm.org/resources/pdf/pediatricsleepdurationconsensus.pdf

Cohen E.A., et al, "Breasfeeding may improve noctural sleep and reduce infantile colic: potential role of breast milk melatonin." European journal of Pediatrics 2012, 171 (4): pp.729-32