Baby Sleep


The Natural Course of Baby Sleep

  • Newborns spend most of the day napping, sometimes only being awake long enough to feed, and during the night wake every 2-3 hours at night to feed
  • Babies often add an hour per week to their "long stretch"
    • So by 6 weeks, likely sleeping ONE 6-hour stretch, then waking every 2-3 hours to feed
  • However, between 12-20 weeks, babies go through the dreaded "4-month sleep regression". During this time, their sleep cycles consolidate into 2-hour intervals and wake in between each. If a baby falls asleep independently at bedtime, he is more likely to be able to put himself back to sleep in between cycles. If not, he will likely cry for help. It is at this point that teaching baby to fall asleep on their own becomes essential.
  • Some people think babies are capable of sleeping 10-12 hours at 12 weeks, while it is almost universally accepted that all babies are capable of sleeping 10-12 hours at 6 months

DISCLAIMER: These concepts only apply to babies without any major medical problems (failure to thrive, colic, reflux, heart conditions, etc)

Structure Baby's Day

It is essential to structure (NOT schedule) a baby's day for many reasons, but especially if you expect them to sleep well. Otherwise, you run the risk of baby getting too much or too little daytime sleep, not enough wake time, not enough calories, or developing bad sleep habits (e.g. falling asleep while nursing).

The Eat-Wake-Sleep (EWS) Cycle

  • The cycle is usually 2.5-4 hours (naturally lengthening as baby gets older):
    • EAT: Baby drinks milk immediately upon waking, when well rested
    • WAKE: Baby spends an age-appropriate amount of "wake time" expending energy
    • SLEEP: Baby then goes down for a nap; each nap is limited to an age-appropriate length (usually 1.5-3 hours), with an age-appropriate amount of TOTAL daytime sleep
  • Promotes:
    • Full feeds every 2-4 hours (based on cycle length), therefore sufficient daytime calories
      • Feeds less likely to be cut short due to baby falling asleep while drinking milk
      • Baby less likely to require calories during the night
    • Independent sleep skills
      • Baby doesn't depend on nursing/bottle to fall asleep
      • Baby doesn't depend on a full belly to fall asleep
      • Baby isn't under- or over-tired at bedtime, better enabling him to put himself to sleep
  • Benefits
    • Babies and caregivers alike THRIVE on a routine:
      • Baby knows what comes next and is ideally never overtired, undertired, or hungry
      • Caregivers enjoy predictability and insight into baby's needs
    • Baby has the best chances of sleeping through the night (STTN) as early as possible because:
      • Getting enough daytime calories
      • Getting enough (but not too much) day time sleep
      • Doesn't rely on nursing or bottle feeding to fall asleep
      • Isn't over-tired or under-tired at bedtime
  • Caveats
    • Structure does not always equate to schedule, especially in the early months. The cycles will naturally turn into a loose schedule once baby is sleeping more predictable lengths of time (typically by the time they are napping twice a day).
    • Always feed baby when he is hungry! This cycle is simply a guide to help you structure baby's day, NOT a hard fast rule that requires you starve your baby; this is especially true during growth spurts and illness
    • Short cycles or "EWSWS" cycles may be necessary if baby takes short naps, which is often the case before 6-8 months

Knowing How Much Wake Time (WT) and Sleep Time (ST) Your Baby Needs

  • I'm not going to reinvent the wheel on this one. Simply Google "baby sleep needs by age" and you'll find chart after chart. I've used and trust these:
  • Know that babies can vary significantly from these guidelines. My babies have always had "high sleep needs", meaning that they could tolerate less WT and more ST than other babies their age.
    • Clues that your baby needs more WT before sleep (i.e. is undertired):
      • Waking HAPPY earlier than you expect (typically under 1 hour)
      • Taking a long time to fall asleep (typically over 20 minutes)
    • Clues that your baby needs less WT before sleep (i.e. is overtired):
      • Waking UPSET earlier than you expect (typically under 1 hour)
      • Very cranky, fussy, or upset going to sleep

Teach Baby to Fall Asleep Independently ("SLeep Training")

The whole point of "sleep training" is to teach baby how to fall asleep without any aid from a caregiver (i.e. touching, holding, rocking, singing, shushing, inserting a pacifier, etc).

Set Baby Up For Success

There are some things I strongly recommend you do before starting sleep training. In fact, you can start any of these from the day you bring baby home. They will all help lay the foundation for healthy sleep habits and make sleep training easier when you start.

  • Structure baby's day using the EWS cycle so you know baby isn't hungry, over-tired, or under-tired when you put him down. This will give baby the best chance at learning to fall asleep on his own.
  • Put baby down as awake as possible, whenever possible. Many people start with "drowsy but awake".
    • If they don't fall asleep after a few minutes or if they start crying, help them fall asleep in whatever way you prefer.
    • The less help falling asleep they get used to, the easier it will be for them to learn to fall asleep on their own.
  • Play white noise at 55 decibels. It acts as a sleep cue, drowns out household noises, and comforts baby (as it reminds them of being in the womb, which is actually quite loud). When you start sleep training, you can turn it up to soothe baby when he gets upset.
  • Make their room as dark as possible. Ideally, pitch black. Will they become reliant on this to sleep? Yes. But almost every sleep training specialist agrees that this will help baby fall asleep more easily and sleep longer.
    • If you're traveling after baby has become accustomed to darkness, simply bring black garbage bags and tape them to windows to dim the room. Or, check out my Baby Registry page under "Sleep" for other ways of obtaining "portable darkness".
  • Use a swaddle until baby starts showing signs of rolling over (typically, 3-6 months). (see my Baby Registry page, "Sleep" section, for recommendations on which one)
    • Benefits
      • Mimics the tightness of the womb, which is very comforting to babies
      • Helps baby sleep through the startle reflex, which occur sporadically while baby is sleeping
      • Becomes a great sleep cue
    • Do NOT think your baby doesn't like being swaddled just because they cry when you put it on. Almost every baby does this; despite this, they will still sleep better and maybe even learn to like the swaddle as they associate it with good sleep.
  • Separate baby's sleep space. Have baby nap in their own room, in their crib, for at least one nap a day, to get them used to sleeping in there without anyone present. Once you formally start sleep training, baby should be in his own room overnight and for every nap you put him down awake.
  • Implement a bedtime routine. This must be done for AT LEAST 2 WEEKS prior to starting sleep training so they know sleep follows the routine.
    • Nap: 5-15 minute routine of diaper change, putting on sleep sack, singing, books, etc
    • Bedtime: 30-45 minute routine of milk THEN bathing, lotion, pajamas/sleep sack, diaper, singing, books, etc

Choose a Sleep Training Method

After the bedtime routine, you place baby in the crib in his own room AWAKE. Now what?

  • "Cry-it-out" (CIO) methods:
    • Without checks:
      • Extinction method: leave baby alone in his room until he falls asleep, whether he cries or not, without any checks or time limit
    • With "checks" (enter baby's room to soothe them, whether it be with voice only, light massage or patting, quick song, shushing, etc - the less you do, the less time it will take):
      • Ferber method: leave baby alone in his room; if he starts crying, do "checks" after progressive intervals of time (e.g. 3/5/10 min on night 1, then 5/10/12 min on night 2, etc)
      • 30 minute method: leave baby in crib for 30 minutes regardless of crying, then "reset" with a 10-minute break, then re-do. Maximum of 2 attempts for nap time, 3 attempts for bedtime before "giving up" and doing whatever it takes to get baby to fall asleep. If you choose to, you can do checks during these 30 minutes.
  • "Respond-to-crying" methods:
    • Shush Pat by Tracy Hogg: when baby starts crying, turn him onto his side, pat firmly and repeatedly while shushing past his ear until he stops crying, then stop. Repeat when he starts crying again. Repeat until baby falls asleep (ideally NOT while you're shushing or patting). This can be used at any age, but works best while baby is still swaddled (due to the turning on their side part), and before 3 months of age as that's when they respond to shushing best.
    • Pick Up Put Down (PU/PD) by Tracy Hogg: when baby starts crying, pick him up. As soon as he stops, put him down. Repeat when he starts crying again. Repeat until baby falls asleep (ideally in the crib, NOT while being held). This is recommended only for babies older than 4 months.
    • SITBACK by Taking Cara Babies: when baby starts crying, employ this progression through various interventions including increasing white noise, shushing, patting, picking up, pacifier, etc. Purchase her "Navigating Months 3 and 4" to learn more! I found it incredibly useful for training my second at 11 weeks.

When To Start Sleep Training

  • DO NOT START THIS UNTIL YOU ARE READY TO COMMIT. Once you start, you must be consistent. Being inconsistent is incredibly unfair to baby.
  • That being said, the earlier, the better; this process only becomes more difficult as baby gets older.
  • How to modify your plan based on age:
    • Things to consider:
      • Many people agree that babies have the ability to "self soothe", typically using their hands, at 12 weeks. I don't think it's fair to let a baby CIO (with or without checks) without this ability or while swaddled (i.e. without access to their hands).
      • Babies become much more aware and opinionated after 16 weeks. After this, the gentler approaches may not work as well, or may take significantly longer.
    • My recommendations:
      • If done before 12 week OR if baby is still swaddled, I recommend using the "Shush Pat" respond-to-crying method
      • If done between 12-16 weeks, I recommend using the "SITBACK" or "PU/PD" respond-to-crying methods
      • If done after 16 weeks, I recommend using a CIO method with or without checks

How To Do It

  • Start with nights, as sleep drive is highest then
    • Do the usual bedtime routine
    • Put baby down AWAKE at the APPROPRIATE AMOUNT OF WAKE TIME (see "Knowing How Much Wake Time (WT) and Total Daytime Sleep (TDS) Your Baby Needs" above)
    • Then employ the chosen sleep training method
  • Repeat the process the next night. THIS IS ESSENTIAL - being inconsistent is the worst thing you can do for yourself and your baby.
  • Once night is mastered, start working on the FIRST NAP OF THE DAY (sleep drive is highest in the morning and decreases as the day goes on), then SECOND NAP, then THIRD nap.
  • I personally don't recommend ever having baby try to put themselves to sleep after 4pm except at bedtime, as naps are hardest at that time of day. I've always held or worn my babies for any nap after 4pm - it's easy and enjoyable for everyone!

Manage Middle-of-the-Night (MOTN) Wakings

  • Once baby can put himself to sleep at bedtime, wait at least 10 minutes before responding to a MOTN waking. This gives him a change to fall asleep on his own, which will reinforce the skill.
    • After 10 minutes, feed baby until you are ready to commit to NOT feeding baby overnight.
  • Once you've decided you're ready to commit to STOP feeding baby during the night, start gradually decreasing the amount (time nursing or amount of ounces) you give baby (e.g. decrease by 2 oz or minutes every night)
  • Once feed is as short as possible and you feel ready to drop the MOTN feed:
    • Choose what window of time you will NOT be feeding (usually 10-11 hours after being put down)
    • If baby wakes during that time, let baby cry as much as you are comfortable with.
      • You can employ any of the above methods (Extinction, Ferber, 30-minute, or respond-to-crying methods) during this time.
      • I personally can't do "checks" during the night. Once I'm out of bed, I just want to be actively dealing with it. I had great success doing the "PU/PD" method during MOTN feedings with my second. Within 3 nights, my 8 month old was sleeping 12 hours straight.
      • DO NOT FEED BABY. If you're at this point, you've decided your baby is well-fed enough to make it 10-11 hours without milk. If you feed baby, you WILL CONFUSE baby and only frustrate them and make the process harder.

Early Morning Wakings

  • These are technically a "MOTN" waking but are significantly harder to deal with (hardest time for baby to put himself back to sleep)
  • They occur during 4-6am (regardless of what time baby fell asleep) due to hormone levels
  • Again, I found the PU/PD method worked very well for this
  • Always do your best to leave baby in crib until the designated 10-11 hour mark
  • Try to leave baby in crib until 11 hour mark after being put down in crib
  • When you do get baby out of crib, try to wait for a moment that baby isn't crying