In the second month you are, in the words of surviving parents, “over the hump.”
— Dr. William Sears
I laughed out loud the first time I read the quotation above. Navigating infant sleep may be one of the most challenging tasks new parents face, and rarely is a resolution found by the second month. Getting babies to fall asleep and stay asleep while also trying to get enough sleep yourself can feel like an impossible balance, and everyone has an opinion about it. Too often, exhausted parents are told that this time of broken sleep will be relatively short-lived or to “sleep when the baby sleeps.” These generic responses are not helpful, and they diminish the impact that sleep deprivation can have on parents’ moods. Without a proper analysis of just how much sleep everyone is getting, parents have no idea if what they are experiencing is sustainable or survivable. While it’s normal for new parents to complain about being tired, we should never make assumptions about what that means for them or how much sleep they are actually getting. There’s a big difference between getting up for two twenty-minute intervals to feed a baby each night for the first six months, and having your sleep interrupted every hour or two for eighteen months with an average of four hours of sleep a night.
While the impossible-parenting value of the more you sacrifice, the more you love minimizes the impact of sleep deprivation, the statistics about parental sleep don’t paint a very healthy picture. It takes parents an average of four to six years to recover from postpartum sleep deprivation, and mothers, particularly nursing mothers, have the most significant sleep debts.1 This has negative impacts on parental health, because we need to sleep! While most of us can cope with a few rough nights here and there, chronic sleep deprivation has been linked to emotional volatility, lower immunity, heart disease, blood sugar dysregulation, and hormone imbalances.2 Sleep deprivation also increases our level of daily risk, due to forgetfulness or accidents.3 One mother, who was so tired that she fell asleep holding her baby and dropped them, luckily with no injuries, invented the Joeyband to help prevent such incidents. Postpartum sleep disruption can also have devastating consequences on mental health and can intensify depressed and anxious feelings, as well as make it harder to manage stress and overwhelm.4 What’s even more scary is that severe sleep deprivation is linked to postpartum psychosis5 and mania,6 which is why many postpartum sleep experts refer to severe insomnia/sleep debt in the first months postpartum as a sleep emergency.
Part of why finding solutions to postpartum sleep is so challenging is that that each family’s experience is unique and inconsistent. Some babies just start sleeping ten hours a night from the very first few weeks, some don’t nap well but sleep through the night, some have no predictable schedule whatsoever, and some wake up every forty-five minutes around the clock and can’t be set down. Your baby will probably do something entirely different. Extra-exhausted parents often describe feelings of helplessness and desperation; those I talk to have usually tried many interventions without much success. Some are too tired to even attempt to research solutions — they’re just trying to get through each day and each night, and they describe living in a state of limbo or “just waiting” for the sleep to improve. Parents’ own issues related to falling and staying asleep can contribute to the challenge; if you had trouble sleeping before kids, you may very well continue to struggle postpartum even if you’re physically exhausted.
Each family has its own set of systems and beliefs regarding sleep patterns, such as where people sleep, what time is considered bedtime and wake-up time, or what their wind-down routines look like. These systems can be a support or a barrier for parental sleep. For example, some couples decide to protect the sleep of one parent, commonly the one who works outside the house, and agree that that parent will sleep in a quiet part of the house while the other does all the night parenting. Clearly that sets one parent up for all the advantages of adequate rest and the other up for fatigue. Some families decide to share a bed together with their children, especially if they’re nursing, so they can respond to a hungry baby in a matter of seconds and fall back asleep right away. But not every parent sleeps well with a baby in the bed; wiggly babies can make it hard to fall into a deep sleep. In families where one parent is nursing their baby exclusively, that parent often feels as though they can’t share the night-parenting work — the baby needs them specifically and they can’t go all night without feeding without becoming engorged with milk. Families are often unaware that there are other sleeping arrangement options available to them other than the one they’ve fallen into.
Taking naps as parents can also be a challenge! Parents may have visitors that they feel like they need to entertain, they may have older children that need to be taken to school or tended to, or they may need to go to paid work during the day, hugely limiting anyone who might otherwise try to get some sleep during the day.
And some parents struggle to get to sleep or stay asleep even if their baby/babies are sleeping, for all kinds of reasons. Often this starts during pregnancy, with night waking and trips to the bathroom causing parents to feel exhausted before they even give birth. Parents are advised to try to get as much sleep as possible immediately after giving birth, but many of us know how difficult that is to do. It’s common to have some insomnia in the first few days of parenting, because you’re so excited to be with your new baby, because you’re amped up from all the adrenalin from the birth, or because of pain during the recovery from the birth. For some, this insomnia continues because of anxiety, frustration with partners, difficulty soothing their nervous systems after being woken up, or intrusive thoughts about harm coming to their baby/babies. My obsession with SIDS after my second child’s birth left me struggling with serious insomnia for several months; I would spend most of the night compulsively checking on him to make sure he was breathing.
The other barrier to postpartum sleep is that you have no idea what kind of relationship to sleep your baby/babies will have. Like adults, some babies just have an easier time falling and staying asleep than others. To learn more about why this happens, I spoke with Stephanie Kishimoto, an attachment-based infant and child sleep educator who owns a company called Sleep Parenting; our interview informs much of this part of the book. She suggested that there are many reasons why a baby might struggle with sleep, and that if parents are suffering from exhaustion, it’s worthwhile to explore the underlying issues because they each require different strategies.
The first reason for disrupted sleep is simply age-appropriate waking. Before twelve months of age, most babies need to wake in the night because of varying biological and neurological factors. It’s a way of ensuring babies are safe overnight and continue to thrive — they often need to eat. Before six months they just aren’t wired for regulated sleep patterns yet because the sleep centres in their brains are just developing. Parents will likely start to see the emergence of a regular sleep pattern during the day around the six-month mark (such as three naps, of predictable length and at predictable times of day), but overnight sleep patterns may be less predictable. Under six months, there’s a significant variability in how long babies will sleep, because very young babies have a very underdeveloped ability to regulate themselves, meaning they need a caregiver to help co-regulate, to bring them from a state of dysregulation (“things are not okay”) to a state of regulation (“things are okay”). They are seldom able to independently fall asleep with any kind of consistency, which is why Kishimoto doesn’t suggest sleep coaching or following a strict sleep schedule before this age. Instead, she offers parents education about what is normal, tools to cope with exhaustion, and support strategies for implementing healthy sleep hygiene, such as tuning in to your baby/babies’ personal sleep cues.
After six months babies are usually better able to self-regulate and understand object permanence, meaning that they understand that their parents haven’t disappeared forever when they leave the room. At this point parents can start implementing sleep schedules and routines more effectively, although this will look different from one family to the next depending on many factors contributing to the family dynamic. Another reason some babies have trouble sleeping is linked to their personality, as babies that are very alert and curious about their surroundings may resist sleep because they don’t want to miss out on anything. “It’s essentially baby FOMO,” says Kishimoto, laughing. She suggests that these babies usually have at least one parent who admits to having trouble unwinding at the end of the day. These alert babies are typically the ones that reach their milestones super early and have trouble sleeping because of all of their rapid-fire neuroactivity. Meeting milestones is one of the reasons babies’ sleep habits can regress, meaning they have a sharp and temporary decline in falling or staying asleep, owing to what many refer to as developmental leaps. There isn’t much to do about developmental leaps except wait them out, and thankfully they tend to be short-lived.
It’s also possible that babies aren’t sleeping well because their parents rely on a lot of sleep associations (sometimes called sleep crutches) to get them to sleep, such as rocking them, holding them, or feeding them. Sleep associations, such as brushing your teeth, putting your pyjamas on, and reading in bed, are normal for all of us at every age and an important part of sleep hygiene. Although using sleep crutches with babies sometimes gets a bad rep, there is nothing wrong or bad about using associations to help your little ones sleep, and they can be very helpful while you’re learning how to get your baby to sleep. Almost all parents use them in the first few months of parenting. But there is a limit to how supportive sleep associations can be for babies. If, past six months, they are still waking more than four times a night and need help to get back to sleep, it can create very fragmented sleep for both parents and baby. These babies usually need support and opportunities to develop the skills necessary to fall asleep independently.
Finally, it can be important to rule out health issues that can contribute to poor infant sleep. Babies can have underlying medical issues such as reflux, tongue or lip ties, or breathing issues, such as asthma or sleep apnea, and these issues often require medical support to resolve. Also, babies who aren’t getting enough to eat during the day often do need to eat frequently at night, so it can be helpful for parents to focus on increasing daytime calories so that they can eventually wean their baby/babies from night-feeding. In the first year of life, sleep and feeding are incredibly intertwined.
Sleep is a hot topic for new parents — everyone talks about it and everyone seems to have an opinion about it. Like many aspects of parenting culture, how we manage and understand family sleep has gone through many changes over the last century. Kishimoto shared with me that family sleep was dramatically different before the invention of the light bulb in the late 1800s. Without artificial lights and the blue light from screens, such as cellphones or computers, which interfere with the release of melatonin, the hormone that allows us to feel sleepy, human sleep patterns were less disrupted. The result is that most of us today feel less sleepy in the evening and go to bed later than our historical counterparts, and some of us struggle to fall and stay asleep. That’s why one of the first tips of healthy sleep hygiene is to eliminate the use of screens in the evening. But many people find this challenging, because we rely on television or social media to help us relax at the end of the day. It’s one of parents’ most popular sleep associations! There is some evidence that before the 1900s families didn’t aim for eight hours of uninterrupted sleep in a row, and instead had three chunks of sleep throughout the day and evening. Historical records from some African and South American tribes and some parts of pre-industrial Europe suggest that in many communities sleep looked more like this: there would be a first sleep in the early evening (sometime from sunset to the middle of the night); followed by a middle of the night waking where people would pray, read, or rest by candlelight for an hour or two; followed by another period of sleep before they finally rose with the sun in the morning. Then they would have a nap in the early afternoon, which work environments were organized around — farmers coming in from the fields to lunch and a nap, or businesses shutting down for a period midday. Many parents didn’t have access to child care but did have to work throughout the day, so baby-wearing was common, which allowed babies to fall in and out of sleep as they wanted to instead of trying to establish napping schedules. In many communities it was (and still is!) common for families to sleep in one bed, often referred to as the family bed. Although the family bed may not always support good sleep for all parents, babies and children often do sleep better when they have company.
Most family systems and structures have changed significantly from the 1800s and now the cultural norm is to use artificial light, screens, cribs, and children’s beds, and to aim for eight hours of uninterrupted sleep a night. Long work hours, chronic stress, and very little time to rest have created a culture where fatigue and sleep debts are common, so it’s understandable that new parents are looking for solutions, and that interest in family sleep has led to the creation of infant and child sleep experts. Kishimoto explains that at first those claiming to be parenting experts were mostly male doctors, such as Dr. John B. Watson, who suggested in the 1920s that appropriate psychological care of babies and children involved maximizing independence and minimizing physical contact. Watson suggested that babies and children were prone to manipulating parents to get attention. He advised limiting intimacy such as kissing, hugging, and holding, and he warned against too much “mother love.” This philosophy influenced the development of sleep training, starting with the extinction sleep method in the 1950s, which was widely promoted by Dr. Marc Weissbluth. The extinction method advises parents to put their babies in cribs at a reasonable hour, firmly say goodnight, and then not return until morning. Obviously, this usually involved a lot of crying, which is why this strategy has been dubbed the cry-it-out method. Many variations of the extinction method have evolved, such as gradual extinction (also known as the “Ferber” method), where parents leave the room for short intervals (such as five to ten minutes) and then return to their baby, settle them, and then leave again; or the “camp out” or “gradual shuffle” methods where parents stay in the room next to the crib, possibly moving slowly away from it, while limiting interactions with their baby.
In the 1980s, Dr. William Sears achieved popularity with parents who were uncomfortable leaving their baby to cry by introducing attachment parenting sleep practices and coining the term nighttime parenting. Sears suggested that it was natural for babies not to sleep for long stretches and to want to sleep with their parents, and he advised parents to accept infant and child night waking and to respond quickly to their children regardless of the time of day. From this, many no-cry sleep strategies were developed.
Like most aspects of parenting, the politics of sleep at any given time are deeply informed by other popular infant and child behavioural politics. Since the rising interest in child psychology in the 1900s, there has been a sharp rise in research about infant sleep. Kishimoto explains that while some of the studies on infant sleep were conducted in sleep labs with the goal of better understanding infant and child sleep cycles or sleep apnea, much of the research was based on subjective parent questionnaires. This work led to theories about wake windows, suggesting that there is an optimal amount of time for a child to be awake before we should attempt to put them down for a nap or for the night. Some neurological development and stress researchers advocate against extinction methods because there is evidence that levels of cortisol and other stress hormones increase in the short term when babies are left to cry, and they believe this can have a long-term negative impact on them. But long-term studies have found this to be untrue, and the picture is even further complicated by research that suggests that not letting children learn to self-soothe can have negative long-term impacts on sleep and emotional regulation.7 The result of all this has been an intense political divide about what is best for children, which often overlooks the issue of parental exhaustion and creates confusing messages about what parents are supposed to do.
Some parents turn to their pediatrician or doctor for sleep solutions, but Kishimoto suggests that many parents are unsatisfied with the answers they receive because poor infant sleep usually stems from behavioural, not medical, concerns. To fill the gap, a new industry of sleep consultants has emerged, but the decision to use sleep-coaching strategies to help your children sleep is a deeply personal one, and it’s not always possible financially. If you do decide to work with a sleep consultant, finding the right one for you can be challenging. There are many different ideological and political frameworks for sleep coaching, and consultants have varying degrees of training. I find most parents want something in between the behaviourist approach (Watson, Weissbluth, and Ferber) that assumes all infant sleep behaviour can be conditioned, and the “just accept it” approach that assumes parent sleep isn’t important — and both are overly simplistic and ignore the cost of each strategy on both parent and child. This is why the developmentalist approach, based on Dr. Gordon Neufeld’s work, is gaining in popularity in the sleep-coaching world. This approach assumes that all children have the potential to develop into good sleepers, but it requires parents to get curious about their baby/babies’ sleep barrier, adjust the environment, and allow opportunities for growth. Under this model, sleep training is more like sleep experimenting and requires lots of observation, practice, flexibility, and often discomfort and mistakes.
One consistent requirement of sleep consulting is to reassure parents about the process, because the politics of infant sleep has created a lot of fear about permanently damaging children. Kishimoto says that parents often feel differently about hearing their baby cry during the day than during the night. If a baby cries for ten minutes in the car, while it’s distressing for the parents, it doesn’t usually lead to fears about permanently damaging the baby. Yet parents often feel anxious that they’ll cause harm if they allow a baby to cry in its crib for ten minutes at night. Kishimoto encourages all parents not to measure their ability to be a “good parent” by how much their baby/babies cry, especially parents with high-needs or difficult-to-soothe babies, because we have such limited control over the crying.
Exploring sleep solutions with your baby/babies is hard, and it’s often highly emotional work. Many parents feel anxious during this process, maybe because there’s some crying or because they don’t see results right away. Some parents do make great progress, but then feel isolated and housebound because they’re afraid that leaving the house will tamper with the sleep schedule they’ve worked so hard to implement. And, of course, if parents are struggling with their own insomnia, helping their baby sleep longer is only part of the solution. Parents’ biological need for sleep and their sleep debt must be considered when talking about infant sleep. It’s very challenging to feel connected and enjoy moments with your baby when you’re exhausted or resentful of their sleep resistance — you deserve a sleep solution that works for the whole family. No parent seeks out sleep consulting or tries out complex sleep programs if they’re coping well with sleep disruption; they do it because they’re desperate.
Obviously, because every baby’s relationship to sleep is unique, not all parents will feel that sleep intervention is required, even if they themselves are exhausted. It isn’t really within my scope to recommend particular parenting practices; sometimes parents ask me what to do, and I always avoid a direct answer. That’s partially because I know it’s important to first understand what the sleep issue is, as Kishimoto suggests, but mostly because I think that the right strategies are the ones that parents think are best for them, which differs from family to family. Instead I help parents understand how the culture of impossible parenting might be affecting their thoughts or ideas about infant sleep. The idea that the choices we make about our children’s sleep could affect them for the rest of their lives is directly linked to the invest up front value from the culture of impossible parenting, and it generates incredible pressure. Parents need to make decisions about sleep training with imperfect data, but really, that’s true for all parenting decisions.8
My approach to assisting clients with sleep-related concerns is to help parents get clear about their personal parenting values and support them in creating family-centred systems that respect these values. These processes are outlined in chapters eleven and twelve. Ideally I want parents to factor their own well-being into their approach. Sleep can be such a big issue that it becomes the primary, pivotal issue related to life as a parent, and it often needs to be conceived and then re-conceived. This can be very disorienting for parents who thought they had clear ideas about infant sleep before they met their baby/babies. Many parents who once said, “I’d never let my baby cry” or “I will never let the baby sleep in our bed” soon find themselves willing to try anything to get more sleep.
I encourage you to make guilt-free decisions about managing your baby/babies’ sleep in whatever way works for you. No matter what you decide, you may experience criticism, with others claiming that their position is supported by research, but when it comes to infant sleep, you can find evidence to support whatever position you want to take. What’s generally accepted is that if your sleep debt is high and you’re struggling with your mood, it will be very challenging to improve your mood without finding a way to get more sleep.
Many parents I’ve worked with who have been diagnosed with PPA say that the turning point for their anxiety was getting adequate sleep, and for parents who are recovering from a recent traumatic event, such as a traumatic birth, sleep is extra important, because it’s so critical to nervous system regulation. In fact, some trauma therapists believe that if people can get enough sleep (and support) after a traumatic event, it can make the difference between neurologically processing the event or not, meaning sleep can protect against clinical symptoms of PTSD. In these cases, often finding someone else, such as a partner, grandparent, or night nanny, to take on the majority of night parenting (even temporarily) is most effective. Naps are often suggested for sleepy parents, but many people, including myself, can lie down and try to sleep in the day, but their bodies just won’t do it. In such cases, I often suggest that parents continue to protect their time to lie down somewhere quiet and away from the children, and focus on at least getting some rest.
Having enough energy to look after your kids twenty-four hours a day is a complex problem that requires a nuanced and compassionate approach. How can you protect yourself when sleep feels out of control? I encourage tired parents to think about their energy very strategically. I’ve learned a lot about energy management from my favourite reality television show, Naked and Afraid. The premise of the show is for two people to survive for three weeks alone in the wilderness, naked (and presumably afraid), by finding food and water, making fire, and building a shelter. People on the show are literally starving and severely sleep deprived, and the impact of not being able to access adequate energy becomes startling obvious, as hopelessness, fear, anger, and trouble with emotional regulation sets in quickly. Those who make it to the end of three weeks are those who are very strategic about how they use their energy, often doing minimal daily activity; those who work as hard as they do when they’re well-fed and rested always deplete themselves to an unrecoverable state and need to leave the challenge early. Exhausted parents can learn a lot about energy conservation from Naked and Afraid, such as the importance of dividing tasks with your partner, slowing down and doing the bare minimum, lying down as much as possible, and eating to maximize energy. While only you know what foods are energizing for your body, and this will be different for everyone, I’m a big fan of easy-to-make carbohydrates, such as smoothies or toast, because carbs are our bodies’ main source of energy.
Sleep deprivation is not cute or funny or something to be taken lightly. We cannot ignore the needs of parents, or worse, dismiss their experiences with quips like “It won’t last forever.” Many parents describe feeling tortured and obsessed about when they will sleep again. Often, the first person we turn to when we want to get more sleep is our partner (if we have one). Unfortunately, as the next chapter will discuss, negotiating high-stakes parent work, like deciding who’s going to do night duty, is hard for a lot of couples.