Understanding the keys to good sleep

Getting your baby to sleep through the night is every new parent’s ultimate goal, but often parents are striving for unrealistic expectations based on social pressures.

Dr Michal Kahn, post-doctoral research fellow at the Child and Adolescent Sleep Clinic at Flinders University says it’s not easy to define a ‘bad’ sleeper from just normal infant sleeping behaviour.

“Approximately 20 per cent of infants present with ‘Behavioural insomnia of childhood’ or ‘Chronic insomnia disorder’,” says Dr Kahn.

“These infants may have difficulty falling asleep and have highly fragmented sleep, which means they wake up recurrently during the night.

“For young infants, this is completely normal, so it is very important to consider the child’s age before determining that there is a problem.”

Dr Kahn points out that there are social pressures for infants to be perfect sleepers which can set up parents to have unrealistic expectations of their infant’s sleeping habits.

“Some parents come to our clinic with six-month-old infants that don’t sleep through the night, because they feel it isn’t normal, but it is,” she says.

“The average number of awakenings for six-month-old babies is two and a half times per night, and there are vast individual differences, so many babies wake far more than that.

“Because of today’s social demands from parents, for example, to quickly return to work or be ‘perfect-Instagram-happy’ parents, many parents feel that they aren’t functioning on a high enough level, and that their babies aren’t ‘perfect-sleeping-through-the-night’ creatures.

“Parenting is hard work, and our expectations may confuse us to think that it isn’t or shouldn’t be.”

What are the sleep recommendations?

In 2015, the National Sleep Foundation updated their sleep duration recommendations.

They found that, “for healthy individuals with normal sleep, the appropriate sleep duration for newborns (under three months) is between 14 and 17 hours, infants (four to 11 months) between 12 and 15 hours, toddlers (one to two years old) between 11 and 14 hours, and pre-schoolers (three to five years old) between ten and 13 hours”.

For adults, the healthy range was between seven to nine hours of sleep.

It is well known through research, that a good night’s sleep plays a pivotal role in a baby’s cognitive development and physical growth. 

However, what is less well-known is that disturbed sleep is just as detrimental to the parents.

Flinders University, in partnership with smart baby monitors company Nanit, conducted a study of 619 parents and their infants to understand the consequences of infants that like to party all night.

“We found that parents who perceived their infant to have a sleep problem were approximately three times more likely to report daytime dysfunction,” says Dr Kahn.

“Daytime dysfunction refers to the physical and mental experience of sleepiness, feeling worn out and depleted, and it also refers to behavioural aspects, such as the ability to complete a task successfully, or to drive safely.”

The study also found that the longer the child’s perceived sleep disruptions happened, the worse the parent’s symptoms of daytime dysfunction got – increasing at a rate of approximately 14 per cent per month.

Dr Kahn highlights that it wasn’t necessarily the child’s actual sleep disruptions, but rather how the parents perceived their child’s sleep disruptions which related to their daytime dysfunction.

“This doesn't necessarily mean that parents always thought their child was a worse sleeper than they actually were, but that their evaluation of their child's sleep was related to their daytime dysfunction,” she says.

How do you know if you have a ‘bad’ sleeper?

Dr Kahn adds that when it comes to behavioural sleep problems, it is a combination of intrinsic factors (for example, the child’s temperament) and environmental factors (for example, the parent’s behaviour at bedtime) that contribute to the development of these problems.

“There are also physiological conditions that may affect sleep, such as obstructive sleep apnea, but these were not the focus of our research,” she says.

“It has been shown that more parental involvement in the sleep context at six months old, for example rocking or soothing to sleep, predicts more sleep problems at 12 months.

“So, it does seem that parents play a key part in the development of their child’s sleep.”

What does this mean for the sleep-deprived parent?

Dr Kahn says that it is important for parents to be aware that their infant’s night awakenings can have consequences for themselves.

“Parents of infants with sleep problems are more fatigued compared to parents of infants that sleep well,” says Dr Kahn.

“They may have trouble staying focused at work, or feeling engaged in social situations, including with their own infant.

“Their mood may also be affected, as they might lack the enthusiasm they once had.

“Unfortunately, these effects exacerbate in cases that sleep problems persist.

“Understanding the implications of insufficient or fragmented sleep could help them make sense of their experience, take necessary precautions, and search for the support they need.”

Dr Kahn advises parents to keep their child’s developmental stage in mind when considering their sleep.

She says that the keys to good sleep are things like a constant bedtime routine, a dark cool room and for parents to facilitate independence in getting to sleep as they grow.

“Expecting a six-month-old to sleep through the night is not always realistic, but parents should gradually try to allow their children to cope with the challenge of sleep by themselves,” she says.

“For example, if the child needs to be rocked to sleep, try to lower your involvement and only hold or pat them to sleep.”

Dr Kahn recommends that if the infant is over six months old and the parents feel there is a behavioural sleep problem, they should seek professional support.

“We see families at the Flinders Child and Adolescent Sleep Clinic to assess such problems, and for those who require treatment the process is usually brief and effective,” she says.

“That’s the good news: there are evidence-based treatments available and we usually see improvement in only a few sessions.”