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Why Sleep Matters to Babies and Parents
This is my second post in a series on sleep. My first post explained why the controversy around CIO concerns me and told the story of how sleep training helped our family. The purpose of this series is to take an honest look at the research on the risks and benefits of sleep training in babies.
In this post, I review the research on sleep deprivation in babies and their parents, because I think this topic often gets lost in the debates about how our babies should sleep. This post is not about sleep training and contains no shocking confessions, but this topic needs to be a part of the conversation.
Sleep deprivation is a part of parenthood. It doesnt matter what sleep secrets you may have discovered. It doesnt matter if your baby was sleeping through the night at 8 weeks. Regardless of our childrens sleep habits or our parenting philosophies, we parents know sleep deprivation all too well.
We now have a great sleep routine with BabyC, and she usually sleeps through for 12 hours at night. Still, we go through tough patches when she wakes during the night for one reason or another because she is teething or sick or going through a growth spurt. I do my best to parent during the night just as I do during the day: being responsive and sensitive to her needs. And that means that some days, the morning comes way too soon and starts in a bleary-eyed fog with a headache that screams for coffee two cups, ASAP!
All of this is completely normal.
Yes, sleep deprivation is a normal part of parenting. But when babies and parents suffer from chronic sleep deprivation, we need to be seriously concerned. Babies need sleep to support healthy development. Parents need sleep to maintain sanity. Sleep is a universal human need.
As parents, we have all witnessed first-hand the effects of a missed nap, a delayed bedtime, or travel-induced jet lag in our kids. I know that I consider BabyCs sleep one of my primary responsibilities, because when she is tired, I see that she has shorter attention and is less able to engage with the world in a positive way. My observations are supported by the scientific literature as well. Heres why sleep is important to babies:
Learning. Sleep has been shown to be important for maturation of infants brains and consolidation of their memories [1]. Several studies have shown that babies with more efficient nighttime sleep (greater percentage of time spent asleep during the night) had higher cognitive scores [2].
Heres one striking example of sleep affecting learning: Dr. Rebecca Gmez and colleagues at the University of Arizona played a 15-minute recording of a fake language to 15-month-old infants. Four hours later, the infants were tested for their memory of the new language. Those that napped after hearing the recording had better abstract memories of the language, which gave them more flexibility in learning, compared to those that didnt nap after hearing the language [3]. Twenty-four hours later, the nappers still remembered the grammatical structure of the language, while the napless babies had no memory of the language at all [4].
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Mood. Babies that sleep more at night have been found to have an easier temperament, being more approachable, less distractible, and more adaptable [5]. In a study of well-rested vs. fatigued infants (i.e. missed nap), the fatigued infants were more easily frustrated and more distressed by a brief separation from their mothers [6]. In multiple studies of interventions that improved infants sleep, parents noted that their babies were more secure, predictable, less irritable, and less fussy [7].
Growth. Several studies have shown that babies that get less sleep gain more fat as infants [8] and are at higher risk of being overweight at 3 years of age [9].
Of course, there is plenty of normal variation in the amount of sleep that a given child needs. Some children have high sleep needs and others dont, and parents are the best judge of whether or not their kids are getting enough sleep. I know my daughter is getting enough sleep if she falls asleep easily and wakes up happy.
Why do parents need sleep?
When infants dont sleep, their mothers dont either. And mothers of infants with sleep problems are at higher risk of postpartum depression. Approximately 10-15% of U.S. mothers report being depressed during the first year of their babys life (and how many more go undiagnosed?). The association between infant sleep problems and maternal depression has been shown in study after study [10-12]. Studies that have specifically tested sleep interventions have found that when babys sleep improved, so did moms symptoms of depression [13, 14]. [Dads: Sorry to leave you out here. I know you are probably short on sleep, too, but the research in this field has focused on moms.]
Postpartum depression is hard on moms, but it is also hard on babies. A mother suffering from depression may not be able to be emotionally available, sensitive, and responsive to her baby, day in and day out. A meta-analysis (analysis of many studies combined) showed that infants of depressed mothers had less secure attachment [15]. Mothers suffering from depression are more likely to report behavioral problems with their children, particularly issues with eating, sleeping, temper tantrums, and separation difficulties [16]. Infants with depressed mothers grow up to have higher levels of the stress hormone cortisol in preschool [17] and higher risk for depression in adolescence [18].
By the way, remember Darcia Narvaez, the author of the Psychology Today article, Dangers of Crying It Out, that warns that CIO causes neurons to die? This same author tells her readers that for her, shampooing with cool water seems to prevent depression. I dont think Dr. Narvaez understands the seriousness of depression.
Sleep deprivation puts a mother at risk for postpartum depression and can affect her parenting. Of course, missing sleep affects our lives in countless other ways. It increases the odds of getting into a car accident [19] and impacts work performance, marriages, health I could go on and on.
Sleep is important for parents and their babies. If a mother-infant dyad is suffering from sleep deprivation, the consequences are serious. I say this not to promote sleep training or any other type of sleep practice in particular. I just think we need to recognize it is not always enough to tell a sleep-deprived parent to suck it up for another month or year or two. Sleep-deprived parents need solutions.
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But wait! Maybe we just need to adjust our attitudes and expectations about infant sleep. Perhaps it is just our modern Western culture that is the problem. I often see this claim, and there is something to it. It is completely normal for a newborn to wake every couple of hours during the night, and it is vital for parents to know this and be responsive to their babys needs. But what if my 9-month-old wakes and needs my attention every two hours, night after night? Is it only in Western cultures that this is perceived as a problem?
To answer these questions, Dr. Jodi Mindell of The Childrens Hospital of Philadelphia and colleagues from around the world asked parents of over 29,000 infants and toddlers (0-3 years) from 17 countries to complete a questionnaire about their childrens sleep [20]. This survey revealed striking cross-cultural differences, particularly between predominantly Caucasian and Asian countries.
In the Caucasian families, most babies fell asleep independently and in their own beds. In the Asian families, babies usually fell asleep with a parent present, and co-sleeping was the norm. Asian babies had later bedtimes, more night wakings, and about 40 minutes less sleep per day compared to babies from the predominantly Caucasian countries. These sleep practices are the norm in Asian cultures, and Asian parents probably dont have to worry about their pediatricians or the well-meaning lady next door telling them that they have a problem.
So how did the Asian parents feel about their childrens sleep? Interestingly, 52% of parents in the predominantly Asian countries self-reported that their children had a sleep problem. In predominantly Caucasian countries, 26% of parents reported a sleep problem [21].
Im including these cross-cultural data not to say there is anything wrong with Asian sleep customs or with co-sleeping. What these data tell us is that, regardless of cultural expectations, parents around the world struggle with sleep. Sleep is a universal human need.
My husband and I fell into a common trap in how we got BabyC to sleep. Our bedtime struggles and frequent night wakings meant that neither BabyC nor I were getting enough sleep, and it affected both of our moods. I did not suffer from postpartum depression, but I do remember how sleep deprivation affected my attitude about my job as a mother. On the mornings when I awoke after only a few hours of fragmented sleep, I can remember feeling a certain kind of despair. Even though I loved being with BabyC and everyone told me that I should savor this beautiful time with her, there was a voice in my head that said, I dont know if I can do all of this all this patient feeding, changing, caregiving, and soothing all over again today. I did not like that feeling and knew that I needed to make a change to improve things for all of us.
When parents look for advice about their childrens sleep, recognizing that what they are doing isnt working, I think we need to take that call for help seriously. Instead, I see a lot of responses like this, particularly from those that insist that we should never let babies cry:
This too shall pass. One day you will miss these sweet nights with your baby.
Just sleep when the baby sleeps. Leave the dishes, and take a nap.
Ask for help. Find someone to hold the baby while you take a break.
Dont get me wrong – all of this is good advice, especially during the first few months of parenthood, but it only goes so far to help a family struggling with chronic sleep deprivation. Yes, it is good to keep perspective when things get tough. Yes, naps can save the day. And yes, we need to be better at asking for help when we need it, and we as a culture need to do more to support new parents. But in my experience, nobody no matter how close a friend or relative is willing to stay up all night with your baby, unless they are paid to do so. Even if they were, my baby wanted nobody but mama (maybe Daddy) in the middle of the night.
The struggle for sleep is a legitimate concern, and this is the context in which sleep training methods were developed. Parents dont turn to sleep training because they are lazy, insensitive, or because they think babies should be seen and not heard. They turn to sleep training because they and their babies need more sleep, and they recognize that sleep deprivation can take a serious toll on their familys health. To those that are tempted to judge, please remember this.
I loved reading all the comments on my previous post. To those currently struggling with sleep, my heart goes out to you, because I have been there and know how tough it is. To those that have found a solution whether it is co-sleeping, sleep training, or something in between I say BRAVO.
{Next up in my sleep series, Ill discuss the research on efficacy and benefits of sleep training, and the following post will be about the risks.}
How does sleep deprivation affect you? How does it affect your child? What do you do to ensure that your family gets enough sleep?
REFERENCES
1. Tarullo, A.R., P.D. Balsam, and W.P. Fifer. Sleep and Infant Learning. Infant Child Dev. 20(1): p. 35-46. 2011.
2. Scher, A. Infant sleep at 10 months of age as a window to cognitive development. Early Hum Dev. 81(3): p. 289-92. 2005.
3. Gomez, R.L., R.R. Bootzin, and L. Nadel. Naps promote abstraction in language-learning infants. Psychol Sci. 17(8): p. 670-4. 2006.
4. Hupbach, A., R.L. Gomez, R.R. Bootzin, and L. Nadel. Nap-dependent learning in infants. Dev Sci. 12(6): p. 1007-12. 2009.
5. Spruyt, K., R.J. Aitken, K. So, M. Charlton, T.M. Adamson, and R.S. Horne. Relationship between sleep/wake patterns, temperament and overall development in term infants over the first year of life. Early Hum Dev. 84(5): p. 289-96. 2008.
6. Ross, C.N. and K.H. Karraker. Effects of fatigue on infant emotional reactivity and regulation. Infant Mental Health Journal. 20(4): p. 410-428. 1999.
7. Mindell, J.A., B. Kuhn, D.S. Lewin, L.J. Meltzer, and A. Sadeh. Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep. 29(10): p. 1263-76. 2006.
8. Tikotzky, L., D.E.M. G, J. Har-Toov, S. Dollberg, Y. Bar-Haim, and A. Sadeh. Sleep and physical growth in infants during the first 6 months. J Sleep Res. 19(1 Pt 1): p. 103-10. 2010.
9. Taveras, E.M., S.L. Rifas-Shiman, E. Oken, E.P. Gunderson, and M.W. Gillman. Short sleep duration in infancy and risk of childhood overweight. Arch Pediatr Adolesc Med. 162(4): p. 305-11. 2008.
10. Wake, M., E. Morton-Allen, Z. Poulakis, H. Hiscock, S. Gallagher, and F. Oberklaid. Prevalence, stability, and outcomes of cry-fuss and sleep problems in the first 2 years of life: prospective community-based study. Pediatrics. 117(3): p. 836-42. 2006.
11. Martin, J., H. Hiscock, P. Hardy, B. Davey, and M. Wake. Adverse associations of infant and child sleep problems and parent health: an Australian population study. Pediatrics. 119(5): p. 947-55. 2007.
12. Bayer, J.K., H. Hiscock, A. Hampton, and M. Wake. Sleep problems in young infants and maternal mental and physical health. J Paediatr Child Health. 43(1-2): p. 66-73. 2007.
13. Hiscock, H., J. Bayer, L. Gold, A. Hampton, O.C. Ukoumunne, and M. Wake. Improving infant sleep and maternal mental health: a cluster randomised trial. Arch Dis Child. 92(11): p. 952-8. 2007.
14. Hiscock, H. and M. Wake. Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood. BMJ. 324(7345): p. 1062-5. 2002.
15. Martins, C. and E.A. Gaffan. Effects of early maternal depression on patterns of infant-mother attachment: a meta-analytic investigation. J Child Psychol Psychiatry. 41(6): p. 737-46. 2000.
16. Murray, L. and P. Cooper. Effects of postnatal depression on infant development. Arch Dis Child. 77(2): p. 99-101. 1997.
17. Essex, M.J., M.H. Klein, E. Cho, and N.H. Kalin. Maternal stress beginning in infancy may sensitize children to later stress exposure: effects on cortisol and behavior. Biol Psychiatry. 52(8): p. 776-84. 2002.
18. Murray, L., A. Arteche, P. Fearon, S. Halligan, I. Goodyer, and P. Cooper. Maternal postnatal depression and the development of depression in offspring up to 16 years of age. J Am Acad Child Adolesc Psychiatry. 50(5): p. 460-70. 2011.
19.
Connor, J., R. Norton, S. Ameratunga, E. Robinson, I. Civil, R. Dunn, J. Bailey, and R. Jackson. Driver sleepiness and risk of serious injury to car occupants: population based case control study. BMJ. 324(7346): p. 1125. 2002.20. Mindell, J.A., A. Sadeh, B. Wiegand, T.H. How, and D.Y. Goh. Cross-cultural differences in infant and toddler sleep. Sleep Med. 11(3): p. 274-80. 2010.
21. Sadeh, A., J. Mindell, and L. Rivera. "My child has a sleep problem": a cross-cultural comparison of parental definitions. Sleep Med. 12(5): p. 478-82. 2011.
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