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.
Brain and Sleep
Eight foundational facts:
Two States
A simple way to understand what is at stake:
During wakefulness, the brain directs mood, behavior, cognition, performance, and physical activity.
During sleep — from birth through the mid- to late twenties — the brain is building new multi-nerve circuits, forming new nerve-to-nerve connections, and pruning old ones. Healthy sleep drives this process.
A more complete picture acknowledges gradations and individual differences. During wakefulness, there is a spectrum from drowsiness to optimal alertness to hypervigilant states. Some individuals are more resilient to sleep deprivation than others, and individuals may react differently to the same amount of sleep loss — one person suffering more in performance, another more in mood.
During sleep, there are gradations between light and deep non-REM sleep, and two distinct types — non-REM and REM — each with specific functions. Local sleep occurs when particular brain regions briefly go offline during waking hours, producing daydreams, micro-naps, and lapses of attention. Specific features of sleep carry specific consequences: late bedtimes are associated with obesity; skipped naps are associated with impaired memory consolidation.
The variables that determine sleep quality are duration, timing, regularity, and continuity. All four matter. Healthy sleep drives healthy brain development.
Practical Points
Acute sleep loss is inevitable. A missed nap, a late bedtime — this is real life. The mood and behavior changes that follow are real but reversible. A reset to pay back the sleep debt restores the child to baseline. If these disruptions are infrequent, no lasting harm occurs. Recovery is complete.
Chronic sleep loss is a different matter. Animal studies and research in children strongly suggest that chronic sleep deficits impair brain development. We do not yet know precisely what kinds of sleep disruption, in what amounts, over what duration, constitute a genuine threat to the developing brain. But the possibility of permanent harm is real and should be taken seriously.
My Advice
Illnesses and unavoidable circumstances will occasionally disrupt sleep. Try to avoid optional social circumstances that push your child into cumulative sleepiness. Plan for recovery when sleep loss occurs.
Respect your child’s need for sleep by watching for drowsy signs. Avoid pre-sleep arousal and cumulative sleep loss. To promote self-soothing skills, give your child less attention when the brain needs to sleep — for naps and at night. Most importantly, enjoy your child’s company when she is awake.
What to Do
Start early. The habits established in the first weeks and months are the foundation for everything that follows.
Many hands. Get the father on board. More people doing the soothing to sleep makes the baby more adaptable — to different caregivers, different contexts, different circumstances.
Many naps. Keep intervals of wakefulness brief — sometimes only 30 to 45 minutes. The period of wakefulness in young infants should always be less than 2 hours; sometimes only 40 to 60 minutes. Brief intervals of wakefulness prevent pre-sleep arousal. No pre-sleep arousal means it is easier to fall asleep and stay asleep. Sleep begets sleep.
Drowsy but awake. Do not overthink this. If colic is present, wait until 2 to 4 months.
Leave the room after putting your baby down to sleep.
Ignore non-distress sounds at night.
Increase cry tolerance gradually. When your baby makes non-distress sounds or very quiet crying and you are confident she is not wet, soiled, hungry, or in distress, delay your response by 5 to 10 seconds to see if she settles back to sleep unassisted. A very brief delay is enough.
Use low-intensity soothing in the middle of the night.
Bedtime routines, every night if possible.
At 6 weeks of age — counted from the due date, not the birth date — begin early bedtimes, sometimes even 5:30pm. Consider not allowing a new nap to begin after 3:00pm. The brain’s night sleep schedule is coming online. The longest single sleep period grows longer and begins to anchor in the evening.
At 3 to 4 months of age, synchronize nap opportunities with nap rhythms. The brain’s daytime sleep schedule is establishing itself. Protect a quiet, dark nap opportunity for a mid-morning nap and later a mid-day nap, with or without a third afternoon nap.
Do not be a slave to the sleep schedule. Enjoy your family. Social exceptions may occur once or twice a month without lasting harm.
The goal is a well-rested child and well-rested parents. Everything else follows from that.
— Marc Weissbluth, M.D.
