Sleep training has become an industry, but parents are dreaming if they think there's a formula

by Michelle Duff / 20 January, 2017

Photo/Getty Images

Instead of asking new parents if their baby is sleeping through the night yet, consider grabbing them by the scruff of the neck and demanding: “So, are you a failure?”

It may seem as if these are two different questions, but for the sleep-deprived, they are one and the same. For the mum who has been up two-hourly to a crying baby, who has scrolled wide-eyed through her smartphone at 3am trying to find a sleep method that might work, and for whom coffee is no longer effective, the much-dreaded Sleep Question feels like condemnation.

One of the biggest stressors for new parents is sleep – how they’re sleeping, how their baby is sleeping, and whether they’re laying the foundations for good sleep in the future. “An incredible amount of energy and anxiety goes into getting babies to sleep these days,” says Susan Goldstiver, a ­psychotherapist at Auckland’s Postnatal ­Distress Centre. “And somehow, if your baby sleeps, it makes you a ‘good’ mother. There’s that desire for perfection, and control.”

The advice is relentless. Don’t let your baby cry; a little bit of crying is okay. Choose a sleep regime and stick to it. If you’re not consistent, it won’t work, and then your tiny human will have outwitted you and thus thwarted your very first attempt at discipline. How does that bode for their teenage years?

“Parents often report anecdotally that they feel judged if their baby is not ‘sleeping through the night’ by a certain point, such as six weeks of age,” says Bronwyn Sweeney, a clinical psychologist and research officer at Massey University’s Sleep/Wake Research Centre. “They feel responsible for this.”

But the newest results from the sleep centre can help to reassure parents. The most recent analysis from “E Moe, Mama”, a long-term study of more than 1200 Kiwi mums and babies, has found interrupted sleep is completely normal. It found, on average, a three-month-old baby will wake and need to be fed or resettled at least twice a night – and some babies will wake up to seven times.

“This gives us information about what regular Kiwi babies are doing at night, and hopefully, this can be used to help new parents work out realistic expectations for their infant’s sleep development,” Sweeney says. “Sleep and waking patterns develop over time, so we can expect to be woken throughout the night in the first year as infants make their nutritional, emotional and social demands.”

In a sub-study of 40 women, researchers found mothers who were given sleep ­education were more relaxed and slept easier. Sweeney spoke to the Listener ahead of the publication of results from her thesis, which examines the relationship between a mother’s mood and sleeping during pregnancy compared with a few months after giving birth. She says her advice to new parents is simple. “If you go into it with quite low expectations about the control you’re going to have over your baby’s sleep, that’s quite a good place to start. Some of it is about being aware that there’s this wide range of normal, and babies are inevitably different – and it’s about working something out together.”

Bronwyn Sweeney says parents can rest easy that their baby’s interrupted sleep is normal.

Light-bulb moment

Although for most new mothers a full night’s sleep seems like a dream, somehow the idea that a baby should be snoozing contentedly until dawn within weeks of exiting the womb has gained currency. An industry has arisen to monetise this myth, with baby coaches and sleep consultants doing big business. So where did it come from?

In traditional societies, sleep took place according to need rather than the clock. Tribes slept communally, often in exposed locations where constant vigilance was needed. But with the advent of the light bulb came the desire for more efficient, solitary sleep. “The expectation of consolidated night sleep in early infancy is quite possibly an artefact of civilisation, cultural location and electric lighting,” Sweeney says.

Sleep science is a relatively new field of research, with most discoveries made in the past 50 years, and “E Moe, Mama” is the first large-scale study of New Zealand mothers and their babies. So with little science-based information available for parents, the outdated guidance of times past still carries weight. Here’s where we can point the finger at Dr Truby King, the 1907 founder of the Plunket Society.

King’s aim was to improve infant nutrition through strict routine. Babies were to be fed four-hourly between 6am and 10pm, after which they were not to be attended to until morning. In her research, Sweeney spoke to nurses who worked at Wellington Hospital during King’s heyday. “They said you would open the nursery door in the morning, and there would be this wall of screaming babies.”

Plunket has since relaxed the rules espoused in King’s Mothercraft, and offers advice that is more flexible and baby-focused. But pressure to have babies on a “schedule” – fuelled by screeds of web pages and bookshelves dedicated to the art – remains. Although some routine is good, Sweeney says, trying to fit a baby into a rigid template will probably only end in tears.

Her baby sleep analysis involved 951 women (316 Maori and 635 non-Maori) who completed three questionnaires and a telephone survey about their sleep before, during and after pregnancy up until their babies were three months old. In the final survey, three-quarters of women said they had woken to feed their baby at least once the night before. On average, the babies were still waking twice a night and nearly a quarter of the respondents considered their babies’ sleep was a problem.

“What a lot of parents do is take it personally – they think, ‘What’s gone wrong, what’s happening?’, when a sleep plan isn’t working.” Sleep training intervention is not recommended by experts until after six months, but even if a chosen regime works, this might not continue as the baby develops. Hence, sleep consultants – who a 2016 global study showed rarely have any health qualifications – are potentially a waste of time. “We sort of expect babies to nail it and stick with the programme, but everything changes.”

However, education can help. Sweeney’s thesis included instigation of a sleep education programme for first-time mothers. Pregnant women attended an antenatal session, where they learnt about healthy adult sleep, normal infant sleep development and strategies to help. Mums’ and babies’ sleep was measured using an actigraph – a wrist-worn movement detector  – when the babies were six weeks and three months old. Mothers were also given a support phone call each week.

At three months, the 20 women in the education group were getting an average of 46 minutes more sleep at night, and reported greater confidence in managing their babies’ sleep than the 20 women in the control group, who did not receive the education. The longest stretch of sleep any woman got was 4.25 hours.

“The babies did not sleep longer, but we believe the mothers were more relaxed about their baby’s sleep development and this helped them go back to sleep more quickly after night wakings,” Sweeney says. If parents were more informed that sleep disturbances were a normal part of early parenthood, she concludes, they could better plan strategies to catch up on sleep, and lower expectations of what was possible to achieve during waking hours.

The study probably did not affect baby sleep because it was not a direct intervention. Instead, Sweeney says, parents were empowered to make their own evidence-based choices. After all, they know their baby best.

The many depictions of sleeping infants include nativity scenes of Mary and baby Jesus. Photo/Getty Images

Importance of sleep

“E Moe, Mama” was funded with $1 million from the Health Research Council in 2008, and researchers have since published papers on maternal sleep quality and duration, the links between disturbed sleep and depression and how age and ethnicity affect sleep loss.

To some extent, sleep deprivation during pregnancy and the early weeks of a baby’s life is considered inevitable. But the study’s co-lead researcher, Leigh Signal, says this risks trivialising its importance. “We know sleep is going to change in pregnancy and afterwards, when there’s an enormous number of physiological changes that happen. But there’s been this philosophy that when women talk about their sleep to health professionals, they’ll say, ‘That’s just part of it.’ Actually, sleep is fundamentally important for a woman’s health and well-being and that of her child.”

Most, if not all, new mothers are likely to suffer from chronic sleep deprivation, which begins during pregnancy. Studies have found sleep deprivation affects cognitive processing, accuracy, concentration, motor speed and co-ordination – resulting in a level of impairment that can be worse than someone who is too drunk to drive.

An extension of the study, “Moe Kura”, is re­visiting 900 of the study’s original participants now their children are three years old to investigate the relationship between mother and child sleep.

“There is a growing awareness of the need to understand these issues, but there is room for improvement and hopefully our work will add to the story.”

A separate 2005 literature review found infants have a biological need for night-time contact and feeding, and that the notion of baby wakings as “problematic” is a Western construct. Mothers reported less infant crying, more maternal and infant sleep and increased milk supply as a result of the increased frequency of night-time breastfeeding that close contact – whether in the same bed or within arm’s reach on a different surface – facilitated.

It found co-sleeping, at least in the form of room sharing – especially with an active breastfeeding mother – saves lives. Three studies have shown that when a committed caregiver, usually the mother, sleeps in the same room but not in the same bed as their baby, the chance of the child dying from sudden infant death syndrome (Sids) is reduced by half.

A review of the use of Pepi-Pods and flax pods after the 2011 Christchurch earthquake found they enhanced parents’ sense of closeness and safety, which could lead to better maternal sleep.

Sleep, precious sleep

No one can “make” a baby sleep. However, there are things that can help. These include:

  • Darkening the room to signal sleep time.
  • Creating familiar daily rhythms, including a bedtime routine.
  • Taking time to recognise tired signs before your baby becomes overstimulated and harder to get to sleep.
  • Resisting the urge to pick up your baby at the first cry or snuffle to see if they will resettle.
  • Being aware that whatever sleep routine your baby gets into, it will change with different developmental stages.
  • Resting when you can. When your baby is asleep, forget about the chores and try to sleep or at least rest.

Plunket support

Plunket has family drop-in ­centres nationwide where parents can ask for advice about sleep, ­breastfeeding, baby behaviour and other parenting issues.

The free service is staffed by Plunket nurses and volunteer, at locations listed on the Plunket ­website at plunket.org.nz.

Local and regional Plunket branches run ­mothers’ groups and provide ­support in homes, clinics, preschools and marae.

PlunketLine: 0800 933 922. ­Available 24 hours a day, seven days a week.

This article was first published in the December 24, 2016 issue of the New Zealand Listener. Follow the Listener on Twitter, Facebook and sign up to the weekly newsletter.

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