If you have not already done so, please read Blog Posts 1 through 5 that describe how sleep is important and beneficial. I will post specific information for parents and children based on my book, “Healthy Sleep Habits, Happy Child.” Please do not be put off by my book’s length. This is a reference book. Read only the topic of interest to you.
Healthy sleep, after 6 months of age, has a straightforward clinical definition: your infant appears alert when awake throughout the day — except just before a nap — and calm before and during the bedtime routine, with no pre-sleep arousal.
Unhealthy sleep looks like the opposite: your infant sometimes appears drowsy during the day at times unrelated to a nap, and shows pre-sleep arousal before or during the bedtime routine — wired, restless, difficult to settle.
This definition does not apply to infants younger than 6 months for two reasons. First, during the day, very young infants sleep frequently and irregularly, and drowsiness before naps is normal and expected throughout the day. Second, during the first few months, some otherwise healthy infants have significant fussiness and crying in the evening hours that is not related to pre-sleep arousal.
The Five Elements of Healthy Sleep
Healthy sleep is composed of five interconnected elements:
Sleep duration. More sleep is better.
Sleep continuity. Is night sleep interrupted by awakenings unrelated to hunger, thirst, or soiling — awakenings that require parental soothing — or does sleep proceed uninterrupted? Consolidated sleep is best.
Sleep timing. Does sleep begin in sync with the brain’s output for sleep, with no pre-sleep arousal? Or does it begin later, after pre-sleep arousal has already set in? No pre-sleep arousal is best.
Sleep regularity. Does sleep occur around the same time day to day and from weekday to weekend? Or does the timing drift, producing social jet lag? Regular sleep is best.
Naps. Healthy naps occur when the number of naps is age-appropriate, the timing of naps is in sync with the brain’s circadian output for daytime sleep, and the duration of each nap is ample.
Why “Interconnected” Matters
These five elements are not independent. When any one of them is disrupted, all the others follow. A bedtime that is too late produces night sleep that is too short, or fragmented, or both. A child who wakes too early — or whose night sleep was fragmented — wakes at a higher level of neurological arousal. That heightened arousal during the day makes naps irregular and short. Short naps increase cumulative sleepiness. Cumulative sleepiness raises the level of arousal at the next bedtime. The cycle tightens.
This is why small corrections in one element — moving the bedtime earlier by ten minutes, protecting the midday nap, establishing regularity in wake time — can produce improvements that seem disproportionate to the size of the change. The five elements amplify each other in both directions. Improve one and the others tend to follow. Allow one to deteriorate and the others will too.
The Bottom Line
Healthy sleep nourishes the brain just as healthy food nourishes the body. The five elements above are the components of that nourishment. None of them operates in isolation, and none can be neglected without cost to the others.
Watch your child, not the clock. Alertness during the day and calm at bedtime are the signs you are looking for.
— Marc Weissbluth, M.D.
Hi Dr. Weissbluth,
I’m at a bit of a loss after many nights of very disjointed sleep. My baby is just a few days short of 6 months old (born at 39 +5). From birth she’s had a hard time getting good sleep – allergies within breastmilk causing diarrhea and excessive spit up and reflux. We’ve had an established 6pm bedtime with a short consistent routine from around 6 weeks. Closer to 3 or 4 months she was starting to sleep longer for her chunks 4-6hrs at a time maybe waking 1-3 times for hunger or a diaper change. Usually it wouldn’t take more than 15 minutes for her to feed and go back down again. We did extinction around 13 weeks and she was able to self soothe usually within 10-15 minutes.
Currently she’s been waking up for hours in the night and nothing seems to settle her. She goes to bed and is asleep for the night around 6/6:15pm wakes around 11pm or midnight screaming and then it takes around two hours of trying to settle her (breastfeeding – she won’t take a bottle). Then she’s up usually around 3 or 4am and then up for the day (I can’t get her back down) around 5:50-6:15am. She slows down feeding, and I unlatch her and lay her down. She gets all comfy on her belly and thumb in mouth and seems like she will sleep and then about ten minutes later she’s up screaming. I’ve tried to do extinction again but she cries so hard within a couple minutes that she will spit up. We started solids per her PEDs recommendation and I’m wondering if her belly is just so upset she can’t sleep.
Her current naps are 9am (1-2 hr nap) 12:30/1 (1-2 hr nap usually shorter if am nap was long or longer if am nap was short). Then a cat nap being worn as we walk the dog around 3:30pm.
Is this something a 5:30 reset could possibly address? If so do I just skip the cat nap?
Thank you for your advice.
Does she have self-soothing skills for naps?
Try a 5:30 expected falling asleep time (she is bathed, dressed for sleep, fed, soothed, and you are walking out the door at 5:30pm) for 4-5 consecutive nights and monitor latency to sleep onset, crying, night waking, and morning wake-up times. Do extinction at night.At bedtime, can you nurse her, give her to Dad for brief soothing, and he puts her down drowsy but awake?
How does this sound?