When Will My Preemie Sleep Through the Night?

Many parents want to know when, at long last, will their preemie sleep through the night?

It’s a good question.

First Things First

Perspective is an easy thing to lose. So is patience, especially when you are massively sleep-deprived and stressed out. I know. I’ve been there.

My second child was born at 35 weeks. He spent the first 13 days of his life in the NICU. We were lucky. Every day I walked past the ventilators and isolettes of babies who would be living in the NICU for weeks, possibly months. I couldn’t imagine what kind of stress these parents were feeling.

And yet, life was stressful. We already had an energetic pre-schooler at home. Now we were caring for a tiny little guy who ate well, but he was so… small!

I saw a picture of myself taken when the baby was 4 months old. I gasped out loud. I had lost a ton of weight without realizing it. I’m quite sure I did not lift a finger of exercise. And the majority of my diet probably consisted of eating stuff that my 2 1/2 year old dropped on the floor.

I don’t remember a whole lot from that first year, but I do remember asking when will our preemie sleep through the night.

And I remember stopping myself. “What am I saying?”

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Would that it were so simple!

We were lucky we had a healthy, growing boy. We had avoided a much worse fate. Was I asking too much by wondering when would our preemie sleep through the night?

With the passage of time and the acquisition of some perspective, I can answer ‘yes’, I was asking too much. He’s in high school now. The time went by so quickly. In the big picture, the sleep-deprived part of my life was very short!

When WILL My Preemie Sleep Through the Night?

There’s an answer to this question. But when parents ask me, I always begin by telling them my story. I want to help them gain some perspective on their situation. Most of them had endured extreme stress, as I had. I want them to know that there is a light at the end of the tunnel. I want them to know that with the passage of time, they too will see that the sleep-deprived part of their lives was relatively short.

The due date is a big event. I counsel parents to celebrate this day. Take stock of what they’ve gone through, and pretend to start the clock again.

Full term babies start to sleep through the night between 4-6 months of age. By “through the night” I mean 5-6 hours. I give a range of 4-6 months because girls tend to reach the milestone closer to 4 months, boys closer to 6 months.

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Night-night!

For babies born early, you can predict when they will sleep through the night using “corrected gestational age“. When they reach 4-6 months, corrected, you can expect that they should be ready to stretch those hours of blissful sleep together.

Now, I’m hesitant to dangle promises. I hate to write checks that your preemie cannot cash. But I should say that often a preemie will sleep through the night prior 4-6 months corrected. This is because of a phenomenon I call “catch up development”. What I mean is that by being here on earth, a baby learns some things that she might not otherwise know if she were “inside”. Sometimes the experience of being here helps accelerate certain developmental milestones. Sleep is one.

For example, there is the the development of circadian rhythm, the daily cycle of her body’s systems. It goes without saying that there is no day and night inside the uterus! Once she is out here in the world, the relative brightness of day and the relative darkness of night helps train her brain to adopt a day-night sleep cycle. Sometimes, despite premature birth, a baby can be “nudged” into sleep habits that are more mature than her corrected gestational age.

Summary:

  • Feed the baby! If your pediatrician suggests that the baby needs to eat every 3-4 hours, you may need to wake her up, even if she’s sleeping! If she’s gaining good weight (an ounce per day), waking her may not be necessary.
  • Back to sleep saves lives! She should always sleep on her back, on a firm surface.
  • SHHHHH! Premies can be more sensitive to sensations than full-term babies. Try to keep her environment as calm and quiet as possible. This will help her sleep better.
  • Consistency, consistency, consistency.  Try to keep the baby’s day as regular and as predictable as possible. Falling into a routine will help her eat and sleep!

If you need any help getting your preemie to sleep, I can help!

Sleep Deprivation With a Baby

Sleep deprivation after the baby comes home is no joke. You may think the all-nighters you pulled in college were a piece of cake. Maybe you thought the “tiny bladder syndrome” you had when you were pregnant would prepare you for loss of sleep after the baby came home. I’m here to tell you that nothing can prepare you for this kind of sleep deprivation. Real postpartum sleep deprivation can harm your health and your relationships, not just with your significant other, but also with your baby.

The Toll Sleep Deprivation Takes

Just because you’ve brought a baby home doesn’t mean you need less sleep! To the contrary, you need all the sleep you can get. Yet one study showed that mothers get an average of 1.5 fewer hours of sleep per day in the first week after giving birth. And the quality of that sleep wasn’t very good, meaning it was fragmented into smaller parts. This happens with newborns, who sleep short intervals.

Most of the research we have was done on generally young, healthy volunteers who knew that they could drop out of the study if the stress became too much for them. So research probably does not tell us the full story of what happens to parents when they come home from the hospital. Real mothers and fathers do not have that luxury. In addition to being sleep-deprived, they know that they cannot drop out of the study at any time.

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Weight of the World?

The good news is that we do not see any increase in child abuse that occurs because of sleep deprivation. Although we have read warnings about it on the internet. However, it does appear that new moms with sleep problems may be more susceptible to postpartum depression.

Postpartum Brain

It’s clear that lack of sleep makes it harder to think. Working memory, flexibility, even reaction time are diminished when you haven’t slept. The risks can be substantial if you get in a car and try to drive, with or without the baby! Between 15-33% of fatal car accidents are caused by driver drowsiness.

Need a SLEEP COACH?

And many studies have shown that your satisfaction with your partner can be damaged in the first year of a baby’s life, possibly related to other stresses in addition to lack of sleep. But lack of sleep certainly does not help. It’s clear that sleep-deprived people are grumpier, less patient and more argumentative.

So What’s a Sleep-Deprived Parent to Do?

 

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Don’t be that guy

There are many things you can do. Here’s a list of some of the better ideas I’ve come across.

  • Sleep When You Can: This means sleep when the baby is sleeping. Sure there are other things to do: bathe and wash clothes, etc. But some of these things you can do while baby is awake. Baby sleep time is the best time for you to sleep as well. This goes for night-time bedtime as well!
  • Exercise: This is one of the three legs on which all of health stands. It’s best to get some vigorous exercise in the morning or the afternoon. Night time would not be ideal, as it may wire you up too much and make it difficult for you to sleep.
  • Eat Well: Meat and vegetables, nuts and seeds, some fruit, rare grains, no sugar. Diet matters. You’ll feel better and you’ll sleep better.
  • Avoid caffeine, alcohol and nicotine: Especially after lunch time. These substances are not the friend of sleep.
  • Avoid screen time at night: The blue light from screens inhibits melatonin, the “sleepy hormone”. We tell teenagers this all the time. It goes double for sleep-deprived parents!
  • Get help: Yes, you can do this alone. But if you can get someone to help you do things around the house, including taking care of the baby, by all means do it. And take a nap when you are being helped, for the love of Pete!
  • Remember perfection is unattainable: Stop trying to do it all and cut yourself some slack. Learn to prioritize. Sometimes you have to wear the same pair of panties two days in a row and eat leftovers.  The world will keep turning.

 

 

Getting Baby to Sleep: A Case Study

The following is the story of a couple that sought my advice to help get their baby to sleep. I’ve changed all information that might identify them in order to preserve their privacy.

Baby Name: Darcy, age 4 months, is the healthy baby girl, product of an uncomplicated pregnancy, labor, and delivery. Darcy has been exclusively breast fed since birth

Mother: Melanie, 26 years old married, first child, living in Framingham MA.  Married three years to Jim.

Melanie is a graphic designer who runs her own business.  Jim is an attorney at his first job post-law school. Melanie would like to return to working but is not taking new clients until Darcy will be at least a year old. Then her mother (Darcy’s grandmother) will assist with child care during the day.

The problem

Melanie and Jim cannot sleep.  The sleep deprivation is creating an enormous amount of stress for Melanie, for Jim and for their marriage. They fear it’s negatively affecting their daughter and her relationship with them. They are worrying now that they are not enjoying parenthood as much as they were. Melanie describes feeling “like she’s at the end of her rope”.

Need a SLEEP COACH?

They are begging for some help getting the baby to sleep long enough for the parents to get some sleep themselves and regain their sanity.

Melanie and Jim filled out an Intake Form and made some guesses as to what they chose as their SMART goals. They scheduled a consult with me. I spoke with

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Sleep. Something Melanie and Jim were not getting

both parents together.

After explaining again the stresses, physical, emotional that they were feeling, I asked Melanie to walk me through a typical day for Darcy.

We talked about her feeding schedule, how often and for how long. The baby had just been to the pediatrician to be weighed, so we knew that Melanie’s milk supply was adequate. The baby was peeing and pooping normally.

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Darcy nursed a LOT

She was feeding on demand, but Darcy “fed like clockwork” every two hours, including at night. Lately she’d been waking up every 90 minutes at night, adding further stress.

I asked Melanie specific questions about how she fed Darcy before bed and naps. Melanie told me that Darcy would fall asleep at the breast. Always. Melanie would then put Darcy’s pacifier in her mouth, swaddle her, and put her down in her crib.

Darcy would sleep well as long as she had the pacifier in her mouth. Sometimes it would fall out and she would stay asleep. But lately she would root and “look” for her pacifier, rouse herself and cry, about 90 minutes after falling asleep.

I wondered aloud if part of the problem might be that Darcy’s falling asleep at the breast was causing her to associate sleep with breastfeeding. In other words, maybe nursing was becoming a sleep association.

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A cat nap before heading back inside

Getting Baby to Sleep

Darcy was four months old now, and she was a normal thriving full-term baby, so I felt it was possible that she was now able to develop her own internal self-soothing mechanisms. I speculated that Darcy might be developing a more mature sleep-wake cycle. I explained that this would mean that Darcy was now cycling between deep and shallow sleep. When she would arrive at the shallow stage, she would arouse briefly, look around for the breast or the pacifier, not find it, and become distressed and cry. It could be the case, I explained, that if Melanie and Darcy could make some space between breastfeeding and falling asleep. For the baby to sleep, she would have to develop her own abilities to self-settle.

Melanie, Jim, and I began to develop a sleep plan. They both felt that if bad sleep associations were interfering with Darcy’s ability to stay asleep, then they would be willing to tolerate a bit of crying on Darcy’s part if it meant she’d be able to fall asleep on her own.

We developed a schedule based on the schedule Melanie was already following. The only difference was that Melanie would try to keep Darcy awake through the end of the feed, first for a minute, then gradually up to ten minutes before putting her down. We would do this over 5 days.

We discussed ways to keep Darcy more stimulated so that she wouldn’t sleep while feeding. We talked about keeping her baby clothes open so that the baby could feel some cooler air on her skin. Or Melanie could play with Darcy’s feet or blow gently on her face.

Then Melanie would swaddle Darcy and place her, awake, in her crib, stroke her a few times, and leave the room.

Based on this plan, Melanie and Jim wrote up a SMART goal for Darcy. She would sleep four hours straight at night, and she would accomplish this goal in seven days.baby to sleep

We also decided that we would try to go without the pacifier, as this might also become a sleep association for Darcy.

We followed up by email and phone several time over the next few days. The first two days were rough, according to Melanie.  Darcy would cry and fight her way out of the swaddling blanket. Melanie confessed she’d put the pacifier in and Darcy would fall back asleep.

The good news was that Darcy was indeed settling herself to sleep.  It turned out that she would cry for about 3-4 minutes after being put down, but she’d fall asleep.

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Blessed relief

Then at day four the magic happened.

At 7 PM Melanie nursed Darcy, put her down in the crib awake, and left the room.  Darcy fussed for a few minutes and settled.  On the baby monitor, Melanie could see Darcy sleeping quietly.

And she stayed asleep until 11 PM.

She started to stir. Melanie took her out, changed her and breast fed her again for 10 minutes.  She struggled to keep Darcy awake because the baby was so sleepy. She isn’t sure Darcy was awake when she put her down. But the baby slept again until 3 AM.

Two four-hour stretches in one night!

Over the next few weeks, Melanie worked on making sure that she put the baby to sleep surrounded by all the things that would be there when she had her periodic brief awakenings every 1 ½ – 2 hours. Darcy was developing good sleep associations.

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Almost normal

By five months she was sleeping from 11 PM to 5 AM, a six-hour stretch.  Se was feeding more often during the day to compensate, but Melanie did not care: she was ecstatic because everybody, baby and parents, were sleeping better at night. Melanie said she was starting to feel “almost normal again”.

Now that they were both better rested, Melanie and Jim told me that they really felt good again about being parents. The admitted that they had feared they’d turn out to be terrible parents and they’d hate the whole experience. Now they were both feeling confident and competent to handle anything that parenthood might throw their way.

Melanie and Jim were able to restore their sanity and begin to enjoy being parents because I helped them drill down into what Darcy’s real sleep problem was: she had begun to associate being at the breast with falling asleep. Together we worked out a plan to dis-associate nursing and sleeping, and it worked!

This all occurred a few years ago. Melanie and Jim had a second baby, another girl. This second baby had no sleep problems at all. Melanie stayed wary of negative sleep associations and made sure #2 daughter didn’t develop any.

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Happy ending

They referred Melanie’s sister to me when Darcy’s aunt was having trouble getting her baby to sleep. And Jim told a few associates at his firm about me and I ended up being the unofficial “sleep consultant to [Jim’s Firm]”