Healthy Sleep Habits, Happy Child
69
My Opinion, #2
March 7, 2022

Found in age groups

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Introduction

A Healthy Child Needs a Healthy Brain, A Healthy Brain Needs Healthy Sleep

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.

Blog 69My Opinion, #2

My Opinion:

The most common cause of sleep problems in young children is a bedtime that is too late.

This is my opinion, based on my general clinical pediatric practice over 40 years, my many sleep consultations, my own research, and reviewing published scientific papers. Additionally, data shows that there is a long-standing trend towards later bedtimes that causes a decrease in total sleep duration. As more and more infants and children become short on sleep, they have more difficulties falling asleep and staying asleep. Here is the data:

What is an Early Bedtime?

Bedtimes have become later and later. This trend began a long time ago. Here are data showing bedtime (PM) by age:

Age    1974  1979 1986  2011-2015  
6 months 7:18 7:41  8:16 8:54
1 year 7:08 7:35 7:46 8:39
2 years 7:08 8:07 8:54

The trend towards later bedtimes means that the total sleep duration has decreased. Here are data showing total sleep duration (hours) by age:

Age    1979-1980 2004 2011-2015
1 year 13.8 13.4 12.8
2 years 12.8 11.9

Data specific for Spain shows the same trend towards decreased total sleep duration (hours) over time:

Age    1987 2011
2.5 years 10.7 10.3
6-9 years 9.9 9.5
10-14 years 9.3 8.9

As described in Blog Post 6, small differences in sleep duration can produce major consequences over time.

My published research, in 1982, shows that moving the bedtime to an earlier hour dramatically reduces the number of night wakings and the time interval between being put down to sleep and actually falling asleep (sleep latency). To accomplish the earlier bedtime, the parents woke her every morning at 7AM and did not permit afternoon naps. This tactic of ‘controlling the wake-up time’ has mostly been discussed in the adult literature in the context of ‘chronotherapy’, that is, resetting the circadian clock. Although this tactic is effective, it is not well known in pediatrics.  For example, my paper has been cited only once, in 1993.

In 1999, a study of children 2 to 5 years of age showed that the later bedtimes were associated with shorter night sleep duration. Less sleep at night was associated with behavior problems even when short night sleep is associated with longer and more frequent naps such that 24-hour sleep duration is normal.

In a 2020 study, objective measurements, using sleep actigraphs at 6, 15, and 24 weeks showed that “Infants who fell asleep earlier also slept longer at night. Keeping infants up later in hopes of them sleeping in longer may be counterproductive.”

A separate study in 2020, using objective measurements, found that at 3, 6, and 13 months, “that infants with later sleep times had less nighttime sleep.” They did not wake up later.

So, no matter your child’s age,  when you consider early bedtimes (Blog Posts 7 and 22) and use drowsy signs (Blog Post 9), don’t be shocked if your child goes to bed much earlier than your friends’ children. Their late bedtimes might be very common but being common is not the same as being healthy. Today, commonly occurring bedtimes might be too late, and unhealthy, for most children.

WHAT IS YOUR OPINION? HAVE YOU EVER TRIED AN EARLIER BEDTIME?

Comments

  1. Hi Dr. Weissbluth,
    Your book was a huge help when my 5 and 7 year old kids were babies. Now I have a nine week old, and he’s the hardest one yet. He’s the first that I’m able to nurse. He will not take a bottle or paci even though we have tried from the beginning. From two weeks on, he wouldn’t sleep for more than a minute, so we got Dr. Harvey Karp’s Snoo and that helped a lot. I am careful to put him to sleep within 1-2 hours of wakefulness. In the morning he goes down while awake for 1-2 naps in the moving Snoo, but after that he needs to be nursed to sleep. For weeks he would nurse all evening and all night long, and if I would stop he would fuss or scream. His weight is very good according to the pediatrician. He’s in the 55th percentile. When he turned 7 weeks he only nursed in the evenings for hours but then started sleeping five hours straight, usually from around 2am-7am. Then he got his 8 week vaccines and started nursing all night again. I am at a loss of what to do. The pediatrician said it’s okay if he cries a little, but I’m not sure what that means. Do I just wait this out until 12 weeks? My husband cannot help me with the baby because he’s taking care of the bigger ones. The bigger ones feel like I’m not with them at all and I feel horrible. Do you have any guidance for me? Please!
    Ariella

    1. What are the most common times that he falls asleep during the day and at night? How many times do you attend to him at night and is it just for feeding?

  2. His schedule is still very irregular… he usually falls asleep around 8/9am, then around 12/1pm, then around 3pm. After that he often takes 1-2 more naps. When he’s been very fussy he’s skipped those evening naps. The morning naps are sometimes longer, sometimes 2-3 hours. But sometimes in the morning he eats and sleeps every two hours, like 6, 8, and 10am. As the day goes on the naps get shorter, sometimes 1- 2 hours and sometimes 30 minutes.
    At night he was falling asleep between 1:00 and 3:00 a.m. after nursing for hours straight, then waking up at 6:00 or 7: 00am. But now he’ll just keep nursing sometimes again the entire night until 5:00 or 6:00 a.m. Last night he nursed from 11pm/12am until 3:30 a.m. and then woke up at 6:20 a.m.
    He usually nurses to sleep before his naps. After trying unsuccessfully twice to do that this last nap, I let him cry for 15 minutes and he fell asleep. Is that something I should try in the evening/ night? He is much fussier in the evening and night and I’m afraid it won’t work or that the crying will be much more intense.
    In the night my attendance to him is just for nursing and changing diapers and burping.. But that does go on for hours and hours. I don’t think he can be hungry for so long but I don’t know how to deal with the crying if I stop nursing him. And I don’t know how much to nurse him so that he’s not hungry.
    Thank you so so much!
    Ariella

    1. “For weeks he would nurse all evening and all night long, and if I would stop he would fuss or scream.” Children with colic often are like this and your narrative description.. Blog Posts 43 and 44 might clarify whether colic is or is not creating the stressful situation that you are dealing with. I suspect that this is so because you are an experienced mother and have tried carefully to help your baby sleep well. If you think that your baby might have colic, please read the section in my book on colic and how to prevent post-colic sleep problems. If you think that your baby does not have colic, then other sleep solutions might be appropriate now. Please let me know your thoughts.

  3. Dr. Weissbluth,
    I have a 12 week old who usually goes to bed at 8 pm. Based on her drowsy cues, I think she could go to sleep earlier (maybe 7) but it is still light out where we live and my husband believes this would throw her off. We could blackout her room but of course there would still be some natural light in the house and bathroom where she bathes as part of her nighttime routine. What are your thoughts? Can night sleep start when it’s still light?

    1. Please read, and have your husband read, Blog Posts 23 (How to motivate a parent) and 62 (I learned to stay on the schedule in order to avoid fighting with circadian rhythms.
      I concluded that I won’t win that fight, but my baby would lose!) to convince your husband that you have the correct viewpoint. Let me know how it goes.

  4. Thank you, Dr. Weissbluth. I just reread your section on colic (I’ve actually been reading it over and over these last few weeks) and the two blog posts you mentioned. Yes, I do believe my baby has colic. I got a confused, though, because he got a lot better at 7 weeks and started sleeping 5 hours in the night, only to regress a week later after his vaccines. Can that still be colic? Everything else seems to point to it.
    Based on your book, it seems I have to wait it out until 3-4 months, is that so? Is there anything I can do? I’m exhausted.
    The baby falls asleep on me while he’s nursing and I fall asleep too, sometimes, with him lying on top of me. It feels unsafe.
    Thank you again!
    Ariella

    1. Colic ends in 50% of children at about 2 months of age, 30% at 3 months, and 10-20% at 4 months. ” because he got a lot better at 7 weeks and started sleeping 5 hours in the night, only to regress a week later” suggests that colic was winding down around 7 weeks but because the brain wants an earlier bedtime around 6 weeks of age, he accumulated a sleep debt from a too late bedtime and over a week his sleep again worsened. Consider now a 5-day trial of any sleep solution you wish to prevent post-colic sleep problems, but definitely include a much earlier bedtime. Perhaps the two older children distracted you from implementing an appropriate early bedtime when he was younger. Let me know how it goes.

  5. Hi Dr Weissbluth,

    The baby has slept the last four nights! Thank G-d. I did as you suggested and put him to bed earlier with lights out, between 9:00 and 11:00 p.m. I didn’t even have to let him cry, just nursed him first. The first two nights I also gave him Tylenol as per the pediatrician, as he thought the baby might be still reacting from his shots from the week before when the sleeping problems all started again. I hadn’t been putting him to bed earlier because he showed no signs of drowsiness at night and was just fussy and demanding nursing. But so far now he has been sleeping 5-7 hours and then waking up once around 4 or 5am and going back to sleep. Thank you so, so much for all your help! I feel like I am finally coming out of this nightmare.

    One more question… I used to wake my other babies up by 7:00 a.m. to keep them on schedule. Right now this baby is waking up at 8:00 or 9:00 a.m. Am I supposed to start waking him up at 7:00? I feel like we are both catching up on so much lost sleep.
    Thank you again!!

    1. Your baby’s brain will want an even earlier bedtime soon, so continue to gradually move the bedtime earlier. This will automatically cause the wake-up time in the morning to move toward 7ish. If this gradual approach fails, then maybe go ahead and wake him to get naps around mid-morning and mid-day and a bedtime that is early. Let me know what you do.
      Sweet Dreams,
      Marc

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