A Parent’s Guide to Newborn & Infant Sleep

Baby Sleep—An Overview

This guide will cover the recommended number of hours your newborn or infant should be sleeping, as well as the changes in sleep patterns that you will notice over its first year.

It will also address common concerns and questions parents often have regarding their baby’s sleep and will look at how to help your baby sleep using sleep training and establishing a regular sleep routine.

Things do not always go to plan, though—which is why we’ll also go over common reasons why your baby may not be sleeping, and we’ll look at precautions you should be taking to ensure your baby’s sleep is safe.

OptimumSleep also has a parent’s guide to children’s sleep that will have you covered with valuable advice beyond your child’s first year of life.

How Long Do Newborns Sleep?

According to a National Sleep Foundation-convened expert panel and the consensus opinion of the American Academy of Sleep Medicine (AASM) and the Sleep Research Society (SRS), the recommended number of sleep hours in a day for newborns and infants are:

These are the ranges that are considered normal for a baby to sleep in a 24-hour period.

It should be noted that the AASM and SRS recommendations did not cover infants under four months of age “due to the wide range of normal variation in duration and patterns of sleep, and Insufficient evidence for associations with health outcomes.”

Baby Sleep Patterns and How They Change During Development

In their first year of life, babies’ sleep patterns change quite rapidly, with the overall sleep time requirement dropping, with sleep consolidating into longer uninterrupted periods.

Zero to Three Months

For newborns, much of the day and night is taken up by sleep, awakening mainly only for feeding. At this stage, they are ruled by their tiny stomachs, which require constant topping up.

Newborns who are breastfed will typically wake for required feeding every two hours, while those who are bottle-fed require less frequent feeds due to formula taking more time to digest, waking up on average every three hours.

A newborn’s sleep will generally be relatively evenly divided between day and night; they’ll typically sleep between 8-9 hours in total during the day and 8 hours at night.

Because the sleep/wake cycles of newborns vary and do not stabilize until around the three-month mark, there are no hard and fast rules for what these cycles should look like.

Three to Six Months

At around the three-month mark, an infant’s sleep needs start to decrease, and as the sleep cycle begins to lengthen and the need for feeding every few hours may begin to diminish, sleep begins to consolidate into longer periods.

During this stage of development, some babies may start to sleep through most of the night, and by six months of age, many can go five to six hours without the need for feeding.

Six to 12 Months

This is the period of development when infants will begin to sleep through the night uninterrupted. For some babies, this may not start to happen until closer to the 12-month mark.

By six months of age, many infants will no longer require nighttime feedings. This is the stage where many parents will rejoice at finally being able to get some much-needed uninterrupted sleep themselves!

Natural parts of development like growth spurts, which may mean more regular feeding, teething, or other factors like illness or sleep regression, can result in babies waking during the night during this phase.

If an infant is not sleeping through the night regularly by this age, sleep training is a useful option.

While infants at this age will obtain most of their sleep in a solid nighttime block, this will be supplemented by typically two or more daytime naps. Daytime naps will continue to lessen throughout the toddler years.

The Sleep Cycle of Newborn Babies

The sleep cycle of babies is much shorter than that of adults:

• The sleep cycle of newborns lasts approximately 40 minutes.
• The infant sleep cycle is slightly longer, averaging 50 minutes.
• It increases to an average of approximately 60 minutes in toddlers and young children, with the sleep cycle reaching full maturity by age 5, from which point it lasts anywhere from 90-120 minutes.

The Stages of the Baby Sleep Cycle

The sleep cycle comprises different distinct sleep stages, which are mainly characterized by changes in brain activity.

The sleep stages are categorized as Rapid Eye Movement (REM) sleep and Non-rapid Eye Movement (NREM) sleep. NREM sleep is further broken down into distinct phases: N1, N2, and N3. N1 is the lightest stage of sleep, and N3 the deepest. Each of these stages is characterized by progressively slower and larger brainwaves.

REM sleep is characterized by the rapid flickering movement of the eyes that gives it its name.

During REM sleep, brain activity increases, with brain wave activity closer to waking levels than other sleep stages. It is the stage of sleep associated with dreaming.

Interestingly in adults, during REM sleep, the body’s voluntary muscles are paralyzed (a condition known as atonia) to stop the “acting out” of dreams. This muscle inhibition is not fully developed in newborns, meaning their limbs will often dramatically twitch and move during REM sleep, sometimes enough to wake them from sleep.

This inhibition of muscle movement during REM sleep does not develop until the second six months of life.

The Importance of Regular Waking for Feeding

Regular waking for feeding is entirely normal for young babies—in fact, it is a biological necessity.

A newborn’s stomach can only hold a tiny amount of milk, so he or she needs to feed frequently to fuel the rapid growth they are undergoing.

Human breast milk is also easily and quickly digested, while formula is typically made from cow’s milk, which contains more protein and fat and other additives that make it more difficult, and thus slower, to digest. This is why breastfed babies tend to wake more often for feeding.

It’s not recommended to wake your sleeping baby for feedings unless they have not gained back any lost birth weight during the first couple of weeks, or they are not waking on their own at regular intervals for feeding—newborns will generally not go any longer than two to four hours without needing to feed.

Day/Night Confusion

It’s not uncommon for babies to get day and night mixed up, and between the ages of 1-8 weeks, it’s not unusual for this confusion, which develops in the womb, to persist.

The circadian rhythm does not become fully entrained in babies until about 3-4 months of age, which is part of why the sleep-wake cycle spans much of the day and why day/night confusion can persist.

Why Won’t My Baby Sleep, and What Can I Do About It?

While very young babies and infants’ regular sleep schedules can be stressful enough for parents, nothing can compound this stress and frustration more than difficulty getting your baby to sleep.

Problems with getting your baby to go to sleep or stay asleep are common and often unavoidable, but there are ways you can train your baby into a healthy sleep routine.

1. Sleep Resistance

It can be common, as well as downright frustrating, for your baby to be showing all the signs of being ready for sleep, but when you put them down for some much-needed shut-eye, they refuse to cooperate.

There are several reasons why this could be happening, including:

• Under-tiredness. Your baby’s need for sleep changes significantly within their first year. It may be their sleep requirement has diminished, meaning it might be time to change their sleep schedule by eliminating a nap or increasing the time between periods of sleep.
• Illness. Babies have no way of telling you they feel unwell or if something is bothering them—your only clue may be them crying. It could be a case of an upset stomach after feeding or a stuffy nose, making breathing difficult.
• Unsuitable sleep environment. Just like adults, babies can have trouble sleeping if it’s too noisy, the temperature isn’t right, or if there’s some other factor causing them discomfort.
• Over-tiredness. Newborn babies are typically only awake for short periods at a time, so if they are awake for longer than they should be and become overtired, this can trigger a stress response, causing the body to produce cortisol (the “stress hormone”), which has a stimulating effect, making it even harder to settle into sleep.
• Separation anxiety. This begins to occur once babies become aware that their parents exist even when not present and able to be seen (this is known as object permanence). This will typically happen around nine months of age but can occur earlier.
• Teething. Teething can be very painful and distressing for infants, and the pain and distress can seriously interfere with their sleep. Thankfully, there are plenty of options for soothing your child’s sore gums.

2. Sleep Regression

Baby sleep regression can be a frustrating problem for parents—just when it seems your baby has settled into a perfect sleep routine, they can begin having problems sleeping. This may be due to sleep regression.

Sleep regression is when a baby that has been sleeping well will suddenly start having trouble getting to sleep or waking up in the middle of the night.

Sleep regression will commonly happen during milestone periods—the times in a baby’s development where sleep patterns typically change or when they are going through a stage of physical or cognitive development.

4-month sleep regression may occur at the time when babies typically shift away from the newborn sleep pattern. While it can be hard to pinpoint exactly what is causing this sleep regression, the way a baby is rapidly developing means there may be some “instability,” and there may be times when there seem to be plateaus or even setbacks.

Parents will often find the 4-month sleep regression the hardest because it is often the first instance of it, and it can be frustrating to have a setback just when you think your baby has settled into a good stable sleep pattern.

Other typical times of sleep regression are:

• Six months is when babies experience significant mental and physical growth and begin developing more awareness of their surroundings, physical abilities like rolling over, and become more responsive to stimulus.
• Eight months is an expected time to have started teething, for babies to be able to roll over, sit up, and crawl, and emotional attachments and reactions like separation anxiety can begin to manifest.
• Twelve months is when babies begin to be more engaged emotionally, have more developed communication skills, physical abilities like standing and assisted walking, and increased cognitive abilities.

Signs of infant sleep regression can include:

• Difficulty falling asleep
• Waking during the night
• Reduced overall sleep time
• Sleep resistance
• Increased fussiness or agitation during awake periods

How to Help Your Newborn Sleep

The best way to retain your sanity as a parent and ensure your baby is getting the required amount of sleep with as little stress and fussing as possible is through sleep training and establishing a regular sleep routine.

Baby Sleep Training Methods

The best time to start sleep training baby is between four to six months of age. This is usually around the time when babies will first begin to experience sleep regression.

This stage of their development is a good time for them to begin learning independent sleep skills. It is at the point where they will sleep mostly uninterrupted through the night, but still early enough where the comfort provided by a parent is not yet fully associated with sleep.

Sleep training can be a matter of experimenting with different methods to find the one or combination of methods that works best for you and your infant.

1. Cry It Out

Also called the “extinction method,” cry it out can be a tough one for many parents because it involves putting your baby down for sleep and letting them cry until they fall asleep without any comforting or intervention from you.

While hard on parents, with consistency, crying should become increasingly less and cease after four to seven nights, by which stage your little one should be falling asleep comfortably on their own.

2. Ferber Method

Similar to the cry it out method, the Ferber method (also known as “graduated extinction”) involves allowing your baby to cry on their own for a set amount of time before going in to check on them.

This method can be a good compromise for parents who find the cry-it-out method too distressing, as it means you still get to console your baby when they cry, but you gradually increase the period of crying before checking in over several nights.

The Ferber method has the same result as the cry it out method—your baby learns to self-soothe and relaxes into sleep on their own, but in a more gradual manner.

3. Chair Method

The chair method is another way of gradually withdrawing the comforting presence of a parent. However, it does require discipline and can still be stressful for parents.

This method involves sitting in a chair beside your baby’s crib. Once they fall asleep, you leave the room. Every time they cry, you return to the chair until they fall asleep again.

Every few nights, you will move the chair a bit further away from the crib until, eventually, you are no longer in the room.

4. Bedtime-hour Fading Method

If your baby cries for an extended period at bedtime, it may be because they are not ready for sleep at the time that you would like them to be.

Your baby will have a “natural bedtime” when they are ready for sleep, but to shift this to an earlier time that is more suitable to you involves adjusting their circadian rhythm.

The bedtime-hour fading method involves putting them to bed at the time they naturally fall asleep themselves for a couple of nights, then gradually moving this to an earlier time, in fifteen-minute increments.

This may involve logging a sleep diary and monitoring when your baby naturally falls asleep. Put them to bed at this time to start with, before moving it by 15 minutes or so each night until they are adjusted and settled into the new earlier desired bedtime.

5. Pick Up, Put Down Method

This method can take longer than the others to be effective and can require some patience. On the other hand, it is a suitable method for parents who can’t bring themselves to leave their baby crying on their own.

This method involves putting your baby to bed as usual, and if he or she cries, waiting a few minutes to see if they calm down on their own. If they don’t, then go in, pick them up, and comfort them until they calm down, at which point you’ll put them back to bed. This process is repeated until the baby finally falls asleep.

Promoting a Healthy Sleep Schedule for Your Infant and Establishing a Regular Sleep Routine

Promoting a healthy sleep schedule is good for your baby’s development, as well as your sanity as a parent. Part of promoting a healthy sleep schedule is creating the ideal conditions for your baby to sleep, much as you would for yourself.

Some useful basic tips for helping your newborn or infant to sleep as well as possible are:

Guidelines for a Safe Sleeping for Babies

As a parent, it’s a must that you take precautions to ensure your baby’s sleep environment is safe. It’s an unfortunate statistic that there are approximately 3500 sleep-related infant deaths in the United States every year.

Common causes for infant deaths while sleeping are Sudden Infant Death Syndrome (SIDS) and accidental suffocation or strangulation.

The American Academy of Pediatrics (AAP) has made several recommendations to create a safe sleeping environment and reduce the risk of SIDS and accidental death during sleep.

Reduce the Risk of SIDS, Suffocation, and Strangulation by Taking These Precautions

1. Babies should be placed on their back to sleep.

Until one year of age, babies should always sleep lying flat on their back for every sleep.

Side or stomach sleeping is not considered safe and is not advised. The anatomy of a baby’s airway means they are protected against aspiration even when lying on their back.

It is considered safe to allow a baby to sleep in whatever sleep position they assume when able to do so themselves; when they are able to roll from front to back or back to front on their own.

2. Babies should sleep on a firm surface.

Your baby’s crib should be certified and approved as safe according to the Consumer Product Safety Commission (CPSC), with a firm sleep surface covered with a fitted sheet. There should be no other soft bedding or objects that could pose a suffocation or strangulation risk.

Importantly, there should be no gaps between the mattress and the sides and ends of the crib, as these can present a suffocation hazard.

3. Room Sharing

Ideally for the first year, but at least for the first six months, babies should sleep in the parents’ room, close to their bed (but in a separate crib or bassinet). The first six months is when the risk of SIDS is highest, and being close enough to be within view helps reduce risk and allows for easy monitoring, comforting, and feeding.

Takeaway

Bed-sharing is not recommended. Co-sleeping in the parents’ bed presents a real risk of SIDS and suffocation, and if the infant is brought into the bed for feeding or comforting, they should always be returned to the crib to sleep.

4. Keep blankets, pillows, toys, and other soft objects out of the crib.

A Baby’s sleep surface should be kept free of soft objects like pillows, soft toys, and blankets that can pose a risk of suffocation or strangulation. Even non-fitted sheets can pose a risk.

When Should You Be Concerned About Your Baby’s Sleep?

It is very natural, especially for first-time parents, to be concerned about their baby’s health—after all, they can’t tell us verbally if something is wrong.

When it comes to sleep, there are some signs that could be a cause for concern, including:

• Chronic sleepiness in newborns. If your newborn is sleeping more than 17 hours a day and it is interfering with the number and frequency of feedings, it may be worthwhile consulting your pediatrician, as this could affect their weight gain and growth.
• Extreme lethargy. If your newborn or infant is showing signs of extreme lethargy or listlessness.
• Signs of dehydration. Dark yellow urine, dry or cracked lips, or fewer wet diapers could indicate your baby is dehydrated.
• Difficulty arousing your baby, or unresponsiveness when you try to wake them.
• Extreme irritability or fussiness when you wake them.
• No interest in feeding after waking (newborns).

If you are concerned for any reason about your newborn or infant’s sleep or showing signs that you feel are cause for worry, you should always consult your pediatrician.

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