Transcription
Matt Dwyer: Hey, I’m Matt Dwyer, and welcome to Sleep, where Professor Harriet Hiscock and Associate Professor Emma Sciberras from the Murdoch Children’s Research Institute help you identify sleeping problems in your children from infancy through to secondary school and give you easy-to-understand steps to improve their sleep cycles and overall health. Harriet, you’ve helped so many families rest easier at night because it’s like a flow-on effect: if your kids aren’t getting the sleep, chances are, the parents aren’t either. What exactly do you do, and how important is sleep? Not only in general, but, you know, in each developing stage? Infancy, toddler?
Professor Harriet Hiscock: I’m a paediatrician. I’ve been at the Royal Children’s Hospital in Melbourne since 1993, and I direct The Unsettled Babies Clinic there.
We see lots of babies every week with sleep problems and crying problems, and I guess sleep is one of the fundamental parts of life for all of us. If we don’t sleep, we know that as adults, we get pretty cranky, and then it can affect our mood and start to affect our memory. But it also has a similar effect on babies. If they don’t get enough sleep, they can get pretty cranky, cry a lot, and have difficulty settling in, which in turn makes it hard for parents to look after them. Then, they can start to have their sleep disrupted, which affects their mental health and wellbeing. It also makes it harder to be a parent when you’re exhausted and have no energy left to do the things you might want to do and have fun with your baby.
Matt Dwyer: Emma, you’ve got a slightly different approach, but just as important, what role do you play when managing and maintaining healthy sleep cycles?
Associate Professor Emma Sciberras: Most of the work that I’ve done in sleep is for older children and adolescents. So, I help families implement strategies to improve sleep in children and, I guess, try to deal with some of the difficulties that can happen with sleep problems. We noticed that if kids are tired, they can have difficulties with learning and managing their behaviour at home. So, really, I provide strategies around those sorts of things.
Matt Dwyer: We want to start out as early as possible when putting our babies into healthy sleep cycles. Well, how much sleep do they need?
Professor Harriet Hiscock: Every baby’s different, but typically, a newborn might sleep between 16 and 18 hours per 24 hours. So really, when they come home, usually from the hospital, they might just be feeding and sleeping and feeding and sleeping. It’s not until they’re about three weeks of age that they start to wake up a little more between their feeds and sleeps. They begin to look around, check out their environment, and have periods of time when they’re just a bit more awake and interactive. Coincidentally, that’s the time they also start crying, which peaks at around six to eight weeks of age. No matter where you’re born, if you’re born in Melbourne, Thailand, London, or Africa, all babies follow a similar pattern.
Matt Dwyer: Why exactly do they need that amount of sleep?
Professor Harriet Hiscock: People need that amount of sleep for a number of reasons. They certainly need it for growth. If you don’t get enough sleep, it affects some of the hormones that are produced in your body overnight, including growth hormone, which, you know, helps you get longer and bigger. It’s also important for the immune system.
Whilst there haven’t been studies done on babies depriving them of sleep, there have been in adults. They’ve done studies where they’ve stuck the common cold virus up the nose of adults and sleep-deprived them or not sleep-deprived them. The adults who have sleep deprivation tend to get the cold, and the cold lasts longer compared to the adults who don’t get sleep deprivation. We can’t entirely ethically do that with babies.
Matt Dwyer: What happens during the sleep cycle? I mean, they sleep for 18 hours; what happens? 18 hours, that’s a long time.
Professor Harriet Hiscock: Yeah. Well, the same sort of sleep cycle occurs across the lifespan. So we all start off awake, and then we go into what we call REM or rapid eye movement, sleep before we move into non-REM, or non-rapid eye movement, sleep, which is our deep sleep. Babies tend to have more light sleep than older kids and adults. So often, parents will come and say to me, “Oh, my baby’s so restless. They don’t get a deep sleep. They’re always moving around in their cot and moving their head and legs.” And that’s often quite normal because they’re just having more REM or light sleep than we do as adults. Typically babies will pass through these sleep cycles every 30 or 40 minutes in the first few months of life. Then, the sleep cycles start to get longer, about 60 minutes for school-aged kids, and then by the time they get to us as adults or adolescents, those sleep cycles are 90 minutes long.
Matt Dwyer: If we’re struggling to get them into a healthy sleep cycle, are there permanent effects if we don’t get them?
Professor Harriet Hiscock: Yeah, not permanent. So you’ll see the temporary effects, but it’s not like, “Oh my God, my baby hasn’t slept for the last few weeks properly there’s going to be lifelong issues!” No, I can reassure you that’s not the case, but the longer it goes on, the harder it is to try and shift patterns. I think a big myth out there is that we all believe that babies know how to go to sleep. Sleep is a learned skill and we have to teach babies how to put themselves to sleep,
Matt Dwyer: As new parents, how do we tell if our child is experiencing sleep difficulties?
Professor Harriet Hiscock: I might throw it to Emma with this. What did you notice, Emma, with your little one?
Associate Professor Emma Sciberras: So some personal experience, my little one’s two now, and after working in sleep for many, many years with children and adolescents, it was my first experience managing sleep in an infant. I guess in terms of the initial experience of having a child, the sleep deprivation that you experience is quite significant. I think when you’re in that sleep-deprived state, all you want to do is sleep and so it can be really hard to determine what’s normal and what’s not. And, in my experience, having that initial period of acceptance around some night waking, there was quite a lot of it. Also, I guess once my child started to get a little bit older, speaking to other mothers in my mother’s group and other people who had had children to understand how often their child was waking in the night.
Professor Harriet Hiscock: Emma raises a really good point: what’s the blur between regular and a problem? At a very simple level, if it’s a problem for you as a parent, it’s a problem, so ask for advice from a trusted health professional. But night waking is normal. Babies need to be fed overnight, and it’s certainly up to six months of age that they will often wake up. After six months of age, they can get enough nutrition during the day to not have to wake up overnight and feed, but many parents choose to keep feeding after that time point, and that’s a personal decision.
Matt Dwyer: What are the biggest causes of sleep trouble?
Professor Harriet Hiscock: Yeah, the most significant issues that we see in the first few months are, I think, just like Emma’s saying, you have to go with the flow. I think for the first three months, this baby’s just come into the world. They’re learning to bond to their primary caregiver, the mom, the dad, or both, or someone else, that they’re adjusting to this big bright world. So, in the first few months, go with the flow, and that might mean to get your baby to sleep, you have to put them in a carrier or have them in the pram for some of the daytime naps. After three months, we can help babies learn to put themselves to sleep; the first step is recognising when your baby’s tired. So the signs they might show you are that they might be frowning, clenching their arms and fists, and jerking their arms and legs. Then they start to cry, but crying is often a late sign. If you’re trying to put them to bed, it might be too late.
So, step one is to recognise when your baby is tired. Step two is, then, say, “Okay, it’s bedtime”, and have a consistent sort of routine. That might be giving them a cuddle, wrapping them, and then taking them into a dark, quiet room and putting them down into their cot or bassinet, drowsy but still awake because you want them to be able to put themselves to sleep.
The tricky part is that a lot of parents get into this, particularly if they have had a baby that’s cried a lot if they pat their baby off to sleep, or if they feed them to sleep. So every time that baby comes out of the deep sleep up into light sleep and wakes up from their sleep cycle, they want to be patted again or rocked again or have the breast or bottle-fed again before they go back to sleep.
So I guess, as a parent, it’s recognising those tired signs and then getting your baby calm, but letting them do that last little bit of going off to sleep without you patting them or rocking them or feeding them to sleep.
Matt Dwyer: I guess on the opposite side of that, are there signs that we can feel confident that our babies are getting enough sleep?
Professor Harriet Hiscock: Yeah, look, certainly, if your baby is waking up pretty happy and having periods during the day where they’re awake and interactive and happy before going to sleep, that’s a pretty good sign. So rather than an absolute amount of sleep they’ve got to have, it’s more about their temperament and whether they are happy and interacting and developing typically. I guess the other thing, as you were saying is, what causes sleep problems? Right from the get-go, We see some babies who are hyper-alert and really what we call ‘vigilant’ about their surroundings. Those babies, you know, no one can get them to sleep and settle them in the first few months of life. So I think parents need to take the guilt off their shoulders, we have enough parenting guilt, so that they just go, “Okay, my baby’s like this. I will go with the flow until at least three months of age when I’ll try some of these more, you know, hands-on settling strategies.”
Associate Professor Emma Sciberras: And I think I found that helpful. So I remember being in the hospital after I’d given birth at about four o’clock in the morning. We went back to the room and I remember my little one was awake for that whole time, for at least three hours, and was lying there with her big eyes open.
I was thinking, ‘Is this child going to go to sleep?’ We found it really hard initially because she was really alert. I think the other thing that we found with her is that she didn’t have as many obvious tired signs. One of the things that we found helpful with that was having a set time to put her down again because she was kind of just on the go and interested in everything.
So, we found it helpful to put her down every hour and fifteen minutes and then slowly extend that time as she got older.
Professor Harriet Hiscock: Yeah, that’s great. And I think that structure—you don’t have to be to the minute and rigid about it—that overall sort of structure actually helps babies learn to anticipate what’s coming in their day, and that, for them, is reassuring.
That helps them start to go to sleep and learn to do that by themselves. If you’re doing something different every time it’s nap time, that’s very confusing to the baby.
Associate Professor Emma Sciberras: And Harriet, I guess one of the things that I heard a lot of early on before the three-month mark was that I was doing a lot of baby carrying, and I was getting the message a lot that, you know, you’re setting up bad habits.
Professor Harriet Hiscock: Yeah.
Associate Professor Emma Sciberras: For your baby. Can you set up bad habits? Before three months?
Professor Harriet Hiscock: No, that’s a fantastic point, Emma, I don’t think you can. And I think, you know, some of these babies are just born very alert, and they won’t close their eyes on the world cause they’re so interested. And some of the babies with colic, which is just another way of saying that they’re crying for more than three hours a day for more than three days in a week, you can’t do anything to settle them. Sometimes, carrying them is the only way to help them calm down. So indeed, before three months, I would say, do what you need to do to survive.
Associate Professor Emma Sciberras: Survival mode.
Professor Harriet Hiscock: Absolutely. And, you know, a bit of a serious point; if you ever feel like you are getting angry towards your baby, put them in the cot and walk away; they’re safe there. Never, ever, ever shake a baby because that’s what we know can lead to brain damage. And that is a permanent consequence.
Associate Professor Emma Sciberras: And I guess, just on the baby carrying the thing too, I think another piece of advice that you hear a lot is, you know, resting when your child’s sleeping.
And I think that’s hard when you do much of that baby-carrying. So I guess I’m just highlighting the importance of getting additional support and getting people to come over and do a bit of that carrying, too.
Yeah.
Professor Harriet Hiscock: So
Associate Professor Emma Sciberras: you can get some rest.
Professor Harriet Hiscock: Absolutely.
And indeed, in our clinic, we talk about this with moms: who else can help you?
Is it friends, family, et cetera? I think we’ve got to, as mums, take the pressure off making sure our house is perfect and everything is done. Being a parent is a 24-7 job, and people say that flippantly, but it is. I often say to moms, “When your baby is sleeping or resting, try and rest. You won’t sleep but do try and rest. Don’t run around the house doing the housework because you need rest and sleep to function and look after your baby best.”
Matt Dwyer: As babies age, at what age do we start to transition into newer sleep cycles and methods to keep them asleep? Do things start changing at a certain age?
Professor Harriet Hiscock: Yeah, they certainly do. After six months, I think it will get a lot easier often. You’ve started solids and not just having milk feeds, which also sets up a bit of a rhythm for the day.
So, I think that’s a great time to start with a lot of sleep strategies if that’s what you want to do. I think we should also just be aware that 15% of babies are what we call ‘catnappers’. They sleep for one sleep cycle two or three times a day. They have 30 or 40 minutes, and that’s it, and you can set your clock by it. I see a lot of very distressed parents going, “But he’ll only have one sleep cycle”, but it doesn’t matter. Usually, these babies tend to sleep well at night, and it’s just a phase that they go through; anecdotally, sometimes what I find is once they start crawling, they physically exhaust themselves, and then they start to string together two sleep cycles and have a longer nap.
Matt Dwyer: Are they still getting the same amount of sleep?
Professor Harriet Hiscock: They often don’t get as much sleep because they just are catnapping, and they can sometimes wake up from that cat nap grumpy. I tell moms and dads, “Try to resettle them in their cot for 15 minutes but don’t try after that. If it’s not working, if you can tell they’re not going to settle, pick them up, put them in a sling, put them in the pram, go for a walk and try again. next nap”. Hopefully, they’re having four or five naps a day, and these will drop off as the baby ages. So, indeed, by the time they’re 12 months of age, they usually have two naps a day: one in the morning and one in the afternoon. Sometime around 18 months or two years, they might start dropping to one daily nap. You can often tell this cause you put your baby in the cot, and they won’t sleep. They’re just playing and mucking around, or they’re not tired. That’s often a sign that they’re dropping to one nap per day, but that transition time can be a messy couple of months when they’re going between two naps on some days and one nap on others. Could you tell me when your little one was transitioning?
Associate Professor Emma Sciberras: Yeah. So she transitioned about 18 months. We were doing the morning and afternoon nap, and I must say I was pretty keen for it to become one nap. I was finding that a little bit restrictive. But yes, just like you described, it was more the afternoon nap that she stopped having. So what that meant is that she had the morning one, and it was a long, awake time. So we needed to push her back slowly for that middle-of-the-day nap.
Professor Harriet Hiscock: And how did you do that?
Associate Professor Emma Sciberras: Well, I think I combined approaches initially. So, I guess I started by pushing it back. It was around 9:30, and then we got her to stay up until about 10 o’clock. Then I think I moved it to around 10:15, but then once she could get to that point, it was just easy for me to change it to 12 and have a couple of days that were a bit tough. I had to keep her engaged and entertained until 12 to keep her awake.
Professor Harriet Hiscock: Yep.
Associate Professor Emma Sciberras: Initially, I guess, when we did that, her naps were kind of around the hour mark, but over a couple of weeks, she just began to naturally extend them to a good two-hour nap.
Professor Harriet Hiscock: Great. One of the fundamental challenges around this is when your baby is in daycare and how you manage naps in that setting. From a baby’s point of view, the more consistent you can be across home and daycare, the better. So I encourage parents to write down and have a conversation with the educators from the day programs or if they’re in long day stay or whatever it might be, just have a conversation about, “This is how I settle my baby at home,” and see if they can do the same thing. Hence, your baby gets some consistent messages, which will help.
Associate Professor Emma Sciberras: Yeah. I must say that we were onto that with a plan at childcare, and I think the staff were supportive because I think from their understanding of what I was doing at home and what was working, it made their life a lot easier.
Professor Harriet Hiscock: yeah.
Associate Professor Emma Sciberras: at childcare. I think the thing that happens sometimes is that they might not take a nap because it’s so exciting and there’s so much stimulation. In our experience, just trying to manage that by going for an early bedtime once we got home from childcare was the only way we could survive at home because it was quite a hectic kind of 5:00 to 7:00 PM period.
Professor Harriet Hiscock: The ‘arsenic hours’ as we sometimes call them. I had the opposite experience. My firstborn would sleep well at daycare, but I think he wanted to see me when he came home. With my husband, he was fantastic. He took a day off a week, and he would sleep well for him. But when it was my day to have him, he would not sleep.
I don’t know if that’s a compliment, but again, you must go with that flow a bit. Try to encourage them, have your routines, and have them trying to go down for naps, but also realise that they’re negotiating between different caregivers and different settings, so be a bit patient.
Matt Dwyer: So you want to try to get the routine happening more organically?
Professor Harriet Hiscock: Yes. Yeah. But they will thrive on routine. It doesn’t have to be to the minute, but having a thing where they know, “Okay, we have time for a feed, time for a play, then it’s time for sleep,” and having that sort of sequence throughout the day can help.
Associate Professor Emma Sciberras: And what about early waking? What is early waking, and what is considered early?
Professor Harriet Hiscock: Again, there’s no absolute definition, but anything before 6:00 AM is pretty rude. That’s how I view it. And there’s not a lot you can do for tiny babies, mainly if they’ve been in their cot for 12 hours; they might have had enough sleep. One of the things, and we’ll talk about this in toddlers and older children, is when they wake up, not rewarding them for that waking. And by that, I mean not giving them time in front of a screen or television because that can reinforce that behaviour, certainly for the little ones.
If they haven’t fed overnight, you can offer them a feed, and maybe that feed is in the bedroom, still dark and still quiet. And if they’ve woken at 5:00 or 5:30 AM, you might be able to feed them, and they can go back to sleep again for another hour or an hour and a half if you’re lucky.
Matt Dwyer: And Harriet, what about dummies? Are they safe?
Professor Harriet Hiscock: So dummies or pacifiers, called in Northern America, can be absolute lifesavers for parents, mainly if their babies cry a lot. This is a way of soothing them. So again, I tend to say, “look, go with the flow in the first few months, whatever works is fine.” The issue after that is that the baby can learn to only fall asleep with a dummy. Then the dummy drops out, and parents find they’re waking up every three hours and have to go and put the dummy back in. I have seen glow-in-the-dark dummies and all sorts of products to try and help with that, but it doesn’t help.
There are a couple of options that we can discuss later in the management segment about managing dummies, but I really think they can be lifesaving in the first few months of life. There have been concerns in the past that they interfere with breastfeeding establishment. So the advice really is to try and hold off from giving your baby a dummy for the first couple of weeks of life, at least to let them establish breastfeeding, and then offer it after that.
And there’s good evidence that it doesn’t interfere with breastfeeding rates if you do that after a couple of weeks.
Associate Professor Emma Sciberras: Harriet, can you tell us a little bit about postnatal depression and the links between postnatal depression and sleep?
Professor Harriet Hiscock: Yeah. Look, there are solid links, Emma. Indeed, about 10 to 15% of Australian mums will experience postnatal depression, and that’s defined as persistent feelings of feeling down, feeling sad, crying, feeling hopeless, and being so sorry you can’t sleep properly or eat or function properly.
And what I’ve noticed a lot with postnatal depression is it tends to fluctuate. So some of today’s mums will have perfect and bad days. And they’ll say, “Look, I can’t possibly be depressed ’cause I have some bad days”. But if these are symptoms that are going on for weeks or months, you need to get help and speak to your nurse, GP, or someone like that.
Or, there’s an excellent national group, an antenatal depression association, PANDA, which has excellent support for mums and dads because dads can get postnatal depression, too. But what we know from some of the work we’ve done is that if you have a baby with a sleep problem, that doubles to triples your risk of having postnatal depression, and that’s in both moms and dads.
There’s a solid connection between the two, and it’s probably not surprising; if your sleep is chronically disrupted and you’ve got a baby crying and won’t settle, it’s tough on your mood. And I think it’s also tough for you to bond with your baby. Another myth we have in our society is that you should fall in love with your baby the day they’re born. And that doesn’t usually happen, particularly if you’ve got a baby who won’t sleep and all they do is cry, or they’re vomiting all the time and often not enjoying your baby is a bit of a red flag for postnatal depression. So I think as a mum or a dad, if you’re not enjoying your baby in this context, that’s when you should be going and talking to someone about it and getting some help.
Matt Dwyer: Thanks so much. There’s a lot of good information there for new parents or parents having their second or third child.