To the sleepless parent, newborn sleep might seem totally disorganized.
Newborns sleep in short bouts—typically ranging from 30 minutes
to 4 hours—at seemingly random times throughout the day and night.
To make things worse for you, newborns awaken easily. This is
because they spend a large portion of their sleep time in “active
sleep," a light sleep state characterized by fluttering eyelids; rapid,
irregular breathing; occasional body movements; and vocalizations
(grunts or brief cries).
Finally, newborns vary greatly in the total amount of time they
spend sleeping. In the first few days, the average newborn sleeps
between 16-18 hours a day (Iglowstein et al 2002). By four weeks,
newborn sleep averages about 14 hours. But the range is considerable.
Some four-week-old babies sleep as little as 9 out of 24 hours. Others
sleep for 19 hours a day (Iglowstein et al 2002).
If your baby is one of these atypical sleepers, does that mean
something is wrong? Not necessarily. Some babies suffer from medical
conditions that influence the way they sleep, so if you have concerns
you should discuss them with your medical provider. But it appears that
many healthy, normal newborns deviate several hours from the average
duration of sleep.
Newborn sleep rhythms: Why newborns seem to sleep—and wake—around the clock
The timing of adult sleep is governed by circadian
rhythms--physiological changes that follow a 24-hour cycle. Many of
these changes are influenced by your exposure to light.
When you expose yourself to sunlight each morning, you help
maintain your internal clock. Even if you are sleep-deprived, morning
light exposure helps ensure that you will be more alert during the day
than you are at night. As the day wears on and darkness falls, your body
begins to produce less cortisol (a hormone that keeps you alert) and
more melatonin (the hormone of drowsiness). When you expose yourself to
bright, artificial lighting in the evening--particularly to lights that
include the blue part of the spectrum--you delay these changes and may
find it harder to fall asleep (Wahnschaffe et al 2013).
Unfortunately for sleepless parents, newborn sleep is not governed by strong circadian rhythms.
It doesn’t start that way. During pregnancy, fetuses are tuned
into their mothers’ physiological cues about day and night. Fetal heart
and respiratory rates speed up when Mom is active and slow down when she
is sleeping (Mirmiran et al 2003). Such changes may be influenced by
maternal hormones, particularly melatonin. Maternal melatonin passes
through the placenta and may direct the fetus’ internal clock
(Torres-Farfan et al 2006).
But after birth, this intimate hormonal connection is broken, and
newborns must rely on their own internal clocks. But they haven’t yet
developed their own circadian rhythms of melatonin production (Kennaway
1996). Nor have newborns developed circadian rhythms for the production
Instead, the life of the newborn revolves around a new problem:
Getting fed. Newborn sleep patterns are shaped by the length of time it
takes them to feed, digest, and become hungry again.
For most newborns, this means feeding every few hours. Sleep
episodes are brief and spaced in fairly regular intervals around the
When does it end?
Most infants take about 12 weeks to show day-night rhythms in the
production of melatonin, the “sleep hormone" (Rivkees 2003). Circadian
changes in cortisol--a hormone that helps regulate waking--may take even
longer to emerge (Rivkees 2003). And, overall, babies may take 3-5
months before they “settle" at night--meaning that they sleep for more
than 5 hours at a stretch (Jenni et al 2006; Pinilla and Birch 1993).
Nevertheless, newborn sleep isn’t completely divorced from the
natural rhythms of the 24-hour day. Studies show that circadian rhythms
begin developing in the first days after birth.
For example, German and Japanese studies have reported that
newborns sleep more at night than they do during the day (Freudigman and
Thoman 1998; Korte 2004; Matsuoka et al 1991).
And scientific evidence suggests that even newborns are receptive
to environmental cues about time. You can take advantage of this fact
to help shape newborn sleep patterns.
How to help babies adapt to the 24-hour day
• Make your baby a part of your daily routine. Some
researchers argue that social cues have the biggest impact on newborn
sleep patterns (Custodio et al 2007; Lorh et al 1999). When mothers
include their newborns in their daily activities, newborn sleep patterns
adapt more rapidly to the 24-hour day. One study took continuous
measurements of mother-infant activity patterns for four months after
birth. Newborns who were active at the same time of day as their mothers
quickly adapted to the daily schedule (Wulff and Siegmund 2002).
• Reduce stimulation at night. When your baby wakes for
night time feedings, keep activity to a minimum. Make as little noise as
possible, and avoid moving your baby around. Ideally, you want to avoid
waking her “all the way up." But if that’s not possible, at least try
to minimize the hustle and bustle.
• Expose your newborn to natural lighting patterns. Light
cues may not instantly program your baby's clock, but they help. In a
study of preterm infants kept in hospital wards, babies exposed to
natural lighting patterns--brighter during the day, darker during the
night--adapted to the 24-hour cycle more quickly than those exposed to
constant, low levels of light (Rivkees et al 2004). In another study of
full-term infants, babies who got more afternoon sunlight slept better
at night (Harrison 2004). And in case you are wondering, getting
outdoors might make an important difference. Babies who get outside
experience much higher light levels, and may develop stronger circadian
rhythms as a result (Tsai et al 2012).
• Try infant massage. One study reports that newborns who
received 14 days of massage therapy (beginning when they were about 10
days old) showed more mature sleep patterns in later weeks. At 12 weeks,
the massaged infants had higher levels of nocturnal melatonin (Ferber
2002). Was this a fluke? More research is needed (Bennett et al 2013),
but given the soothing nature of gentle, affectionate physical contact,
it seems safe to try.
• Consider keeping track of the time of day you extract and store breast milk for future use. Breast
milk contains tryptophan, an amino acid that is used by the body to
manufacture melatonin. Tryptophan levels rise and fall according to
maternal circadian rhythms, and when infants consume tryptophan before
bedtime, they fall asleep faster (Steinberg et al 1992). It’s therefore
possible that breastfeeding helps newborn sleep patterns synchronize
with the 24-hour day (Cubero et al 2005). This hypothesis was tested by
feeding infants formula fortified with varying concentrations of
tryptophan. When infants were given low levels of tryptophan during the
day and high concentrations at night (mimicking the natural fluctuations
of breast milk), infants fell asleep faster at night and got more sleep
overall (Cubero et al 2007).
Newborn sleep cycles: Why newborns are light sleepers
When adults fall asleep, we pass through a series of sleep stages,
including bouts of deep (“slow wave") sleep, and, finally, REM (rapid
eye movement) sleep. REM is famous for its association with dreaming.
But it’s also known for its distinctive pattern of brain activity, which
resembles that of the busy, waking brain. Adults are much more likely
to awaken during REM than they are during deep sleep.
At the end of a REM session, the sleep cycle is completed. Adults
either wake up, or begin another sleep cycle. A single sleep cycle
lasts about 90-100 minutes.
Newborn sleep follows a different pattern. When a newborn first
falls asleep, she enters into immediately into “active sleep." This
rather restless sleep state is similar to REM (rapid eye movement) sleep
in adults. Just as adults are more likely to awaken during REM,
newborns are more likely to awaken during active sleep (Anders 1979;
McNamara et al 2002).
Newborns may remain in this active sleep state for 25 minutes or
more, after which they slip into a deeper sleep state known as “quiet
sleep." Compared to active sleep, quiet sleep is characterized by
slower, more rhythmic breathing, little movement, and no eyelid
Babies are less likely to awaken during quiet sleep, but this
situation doesn’t last long. After about 50 minutes, the sleep cycle
ends. Newborns then either awaken or begin another bout of active sleep
(Anders 1979; McNamara et al 2002).
So newborn sleep is different in several important ways. For one
thing, newborns spend much more time in active sleep than adults spend
in REM. Whereas adults spend only 20% of their sleep time in REM,
newborns spend at least 50% of their sleep time in active sleep. In
fact, several studies suggest that, over the course of a 24 hour day,
newborns spent as much as 75% of their sleep time in active sleep (e.g.,
Poblano et al 2007; Sadeh et al 1996). As a result, newborns spend a
much greater proportion of the time “sleeping light."
For another thing, newborn sleep cycles are much shorter than are
adult sleep cycles. Instead of 90-100 minutes, the average newborn
sleep cycles lasts only 50 minutes or so. As a result, newborns are
vulnerable to awakening much more frequently.
This sounds like a raw deal for parents. But we should keep a couple things in mind.
First, it's normal for adults and babies alike to experience
frequent arousals during sleep, and most of these arousals do not result
in our waking up "all the way." A baby who seems to be waking up may,
if left alone, go back to sleep very rapidly.
Of course, this doesn't mean that active sleep is good and quiet
sleep is bad. Babies in active sleep may experience more heart rate
irregularities and more episodes of sleep apnea, conditions which may
put babies at higher risk for SIDS. There is also evidence that SIDS
cases have special problems arousing from active sleep (Kato et al
2003). Conversely, the analog of quiet sleep in older people -- non-REM
sleep -- seems to be important for good health and memory consolidation.
Perhaps it plays a similar role in newborns.
How to keep your light sleeper from waking up all the way
• Don't rush in the moment you think your baby has awakened. As noted
above, babies experience frequent arousals, but that doesn't mean they
are doomed to wake up "all the way" every few minutes. Babies often
jerk, sigh, or vocalize during partial arousals. If you avoid
stimulating them during these moments, they may go back to sleep on
• Try to feed your baby milk or formula that includes DHA. DHA is
a fatty acid found in fish oil and other dietary sources. It’s
important for brain development, and may play a role in shaping sleep
patterns as well. In one study, children who consumed low levels of DHA
had reduced amount of slow-wave (deep) sleep (Faglioli et al 1989). In
another study, pregnant women with higher blood levels of DHA gave birth
to babies who spent more time in quiet sleep (Cheruku et al 2002). DHA
is found in breast milk, so it’s seems plausible that boosting a nursing
mother's DHA intake could improve a newborn’s sleep patterns. If you
bottle-feed, find a baby formula that contains DHA.
• Tank up the baby before you go to sleep. Whether you breastfeed
or bottle-fed, try to give the baby an especially large meal before
your own bedtime. This will encourage your baby to sleep longer.
• Check out my article on
baby sleep aids,
which includes more tips for improving newborn sleep.
Staying sane: How to improve your own sleep
Newborn sleep patterns take their toll on parents. In a study
tracking the sleep patterns of mothers from pregnancy through the
postpartum period, maternal sleep worsened after childbirth and
continued to deteriorate until about 12 weeks postpartum (Kang et al
2002)—-the time when newborn sleep patterns begin to show marked
circadian rhythms (Nishihara et al 2000).
Twelve weeks isn’t forever, but it can seem like it when you are
severely sleep restricted. As you struggle to cope with newborn sleep
patterns, don’t forget to look after yourself. Here are some tips to
help you cope.
• Too wired to "sleep when the baby sleeps"? If so, keep in mind
that quiet resting is better than nothing. In fact, if you are lying
down with your eyes closed, you might be asleep without realizing it. In
numerous lab studies, subjects who were awakened from the first stage
of sleep often denied that they were asleep at all (Dement and Vaughan
1999). A nap that consists only of stage 1 sleep won't help you
improve your reaction times, but it will probably make you feel less
tired. And if you manage to slip into the second stage of sleep -- even
for just 3 minutes -- your nap may have recuperative effects (Hayashi et
• Don't waste energy on self-reproach or criticism from other
people. You might be doing everything you can to get more sleep, and
still be stuck with a baby who sleeps less than average. Research
suggests that the amount of sleep we get at night is strongly influenced
by genetics (Touchette et al 2013).
• Don't assume that breastfeeding will make you more sleepless than formula feeding. One study reported that the parents of breastfed
babies averaged 40-45 minutes more sleep time than did the parents of
formula-fed babies (Doan et al 2007).
• If you are breastfeeding, you are likely to get more sleep if
you keep baby nearby. The World Health Organization recommends that you
babies share a bedroom with their parents, and it's a recommendation
that makes breastfeeding less disruptive. A recent study found that
breastfeeding women got more sleep when they co-slept with baby (Quillin
and Glenn 2004). In fact, mothers who co-slept and breastfed got more
sleep than did mothers who bottle-fed their babies (Quillin and Glenn
• If your baby is asleep, don’t worry about changing diapers. If
your baby can’t sleep because she needs a diaper change, she’ll let you
know. And a little urine is unlikely to awaken her anyway. In a recent
experiment, researchers injected water into the diapers of sleeping
infants to see if this would wake them up (Zotter et al 2007). It
• Get sunlight and avoid artificial lighting at night. Make sure
you expose yourself and your baby to bright light during the day. And
keep lights out—-or at least dimmed—-after sunset. As noted above,
natural lighting helps influence newborn sleep patterns. But it also
helps you keep your own circadian rhythms from drifting, which is
important if you are going avoid insomnia and be a source of day-time
cues for your newborn.
• Let a friend or family member watch your baby while you take a
nap, even if this means your breastfed baby will take some of his meals
from a bottle. Lactation experts often discourage breastfeeding mothers
from bottle feeding babies for the first 3-4 weeks. The worry is that
supplemental feeds will lead to a decreased milk supply and endanger
successful breastfeeding in the long-term. But you need to balance this
against the negative effects of severe sleep restriction. Lack of sleep
puts parents at increased risk of illness and postpartum depression,
which is bad for parents and babies. If you are at the end of your rope,
you need to get help.
• Trust your instincts. If something feels wrong with you or the baby, talk to your physician.
• Remember that things will get better. Newborns have special
sleep patterns and special needs. But things will start to get better
around 12 weeks postpartum.
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