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Interpreting Night Waking

Decoding your baby’s night waking pattern can be very helpful if you are trying to make improvements in sleep. Understanding if your baby is hungry, overtired, not tired enough, waking out of habit, or simply uncomfortable is very important so that you can troubleshoot appropriately. This blog describes five common types of night waking: False Starts, Difficulty Falling Asleep, Frequent Night Waking (Every 60-90 mins), Frequent Night Waking (every 2-3 hours), Frequent Night Waking (every 10-20 minutes). Note that your baby may have more than one type of waking in a single night.

THIS BLOG IS FOR BABIES OVER 5 MONTHS.


1. “False Starts” at Bedtime:


The Sleep Pattern: Your baby falls asleep well at bedtime but you usually get a short stretch of 20-60 minutes, then a wake-up requiring you to re-feed, re-rock, or re-soothe your baby back to sleep. Your baby may do this once or even 2-3 times before settling into a longer, more predictable stretch of sleep.

The Science: False starts often occur due to a misalignment between the circadian rhythm and the homeostatic drive for sleep (more on how the sleep drives work here). This misalignment can be caused by short daytime napping, or bedtime being too early. A day of short or non-existent napping can translate into more fragmented nighttime sleep. For example, babies who have too much awake time or insufficient daytime sleep are more likely to experience a wake up after a short bout of rapid eye movement (REM) sleep at the beginning of the night. Similarly, when bedtime occurs too early a baby will often have very fragmented sleep at the beginning of the night. This often happens after the spring Daylight Saving Time transition, or after a day with short naps. This is because the circadian rhythm is strongly promoting wakefulness right before your child's biological bedtime. If you try to put your child down too early, then she may keep popping up because her internal clock is preventing sleep from stabilizing.


Finally, sleep associations can cause frequent waking early in the night. If your baby doesn’t know how to fall asleep on her own, she may wake and cry for help again in the first part of the night a few times before she gets into her first long stretch of deep sleep.

The Solution: For overtiredness from daytime naps that are too short, plan to prioritize napping and catch your baby up on daytime sleep even if this means providing some extra soothing, rocking, or holding for several days. Use these better naps to help move bedtime later to better align with your baby's sleep pressure and circadian rhythm drive for sleep. If you aren't sure how much sleep your baby needs, then see our Age by Stage Schedules blog to make sure your expectations are reasonable.


For sleep association pop-ups, using a sleep training method that feels like a good fit for you and your baby will help solve this problem (our sleep class covers four different options for sleep training).

The Overview: If your baby has false starts at bedtime, inappropriate daytime napping or a too-early bedtime is the likely cause. However, if your baby is not falling asleep independently, then that could also be part of the waking.

2. Difficulty Falling Asleep At Bedtime:


The Sleep Pattern: Your baby seems well-rested overall. Putting your baby down for sleep at bedtime requires more than 20 minutes of rocking, holding, non-nutritive nursing, or other soothing. OR, your baby knows how to go to sleep at night but lies awake in his crib for more than 20 minutes at bedtime.

The Science: The time that it takes a baby to fall asleep is called sleep latency. It takes a healthy sleeper approximately 5-20 minutes to fall asleep at bedtime in an ideal sleep environment. As noted above, the circadian rhythm is strongly promoting wakefulness right before your child's biological bedtime. If you try to put your child down too early, then she may still be in the "wake maintenance zone" or "forbidden zone" for sleep. Babies and children who are generally rested and know how to fall asleep on their own, but who lie awake for more than 20 minutes each night are probably being put to bed too early or have a problem with their sleep environment. Babies and children who are generally well-rested and have a sleep association they enjoy (like bouncing or rocking) but still take more than 20 minutes probably also need a later bedtime.

The Solution: Review your expectations and your baby’s schedule to be sure you are asking your child to fall asleep at the right time. Temporarily make your child’s bedtime later, at the time she has been naturally falling asleep lately, to get her back in the habit of falling asleep quickly and easily at a time she can achieve. If that later bedtime doesn't work for your social schedule, then you can slowly shift bedtime earlier, by about 10 minutes a night. Take a close look at the sleep environment – particularly at temperature and light to be sure the room is not too hot or too bright for sleep.

The Overview: If your child is generally well-rested and has difficulty falling asleep even under ideal soothing conditions, a too-early bedtime is the most likely cause.

3. Frequent Waking (Every 60-90 minutes):


The Sleep Pattern: Your baby may do one fairly long stretch of sleep (usually 2.5 – 5 hours) at some point during the first half of the night, but then wakes every 1-1.5 hours during the second half of the night. Not all of these wakings seem to be associated with hunger/full feedings though some parents may be nursing briefly or offering a small bottle at each wake-up. Note that some babies will not eat at all overnight, but will wake at this frequency and require other comforts to get back to sleep.

The Science: Babies wake briefly between each sleep cycle. This is a normal and natural occurrence and happens approximately every 60-90 minutes during the night. Deeper sleep dominates the beginning of the night, which is why babies will often sleep for longer stretches in the first part of the night. Babies who have a parent-led sleep association (a need for something external from their parents like sucking, rocking, soothing) will often wake fully at each of these sleep cycles and call for help going back to sleep. Note: A baby can fall asleep independently at bedtime and still expect certain conditions to be present to go back to sleep at night. Note also that babies with very strong sleep associations will often wake every hour starting at the beginning of the night.

The Solution: Implementing a sleep training method that feels like a good fit for your family is the best option in these situations. You’ll work towards changing a parent-led sleep association into a baby-led sleep association by following a consistent set of responses in the night. These responses could be very interactive and involve you staying in the room with your child, or less interactive with periods of being out of the room. If you need help figuring out how to change your baby's sleep associations, then you may find our sleep training class helpful.

The Overview: If your baby is waking every 60-90 minutes, parent-led sleep associations are the likely cause.

4. Frequent Waking (Every 2-3 Hours):


The Sleep Pattern: Your baby is usually able to sleep a long stretch of 3-5 hours during the first third of the night, but then wakes approximately every 2-3 hours.


The Science: Babies who are sleeping 2-3 hours at a time are usually capable of putting themselves to sleep independently, so usually wakings of this frequency are truly due to hunger. If you do not think that your baby needs to eat at night (based on your baby's age or your pediatrician's advice), then it is possible that your baby is not getting sufficient daytime calorie intake to make it longer stretches overnight.

The Solution: If your baby is eating more than needed overnight, you’ll want to taper down the extra feedings and rebalance the calories into the day. See our blog on how to reduce night feedings here. Our sleep class also provides guidance on how to create a plan to taper night feeding.

The Overview: If your baby is waking every 2-3 hours overnight and easily goes back to sleep with a feeding, hunger is the likely cause. A gradual calorie rebalance should occur to shift extra nighttime feedings back into the day.

5. Frequent Waking (Every 10-15 Minutes or at atypical times):


The Sleep Pattern: Your baby can’t seem to get comfortable for more than 10-15 minutes at a time at bedtime and it’s very difficult to get into the first long stretch of sleep. Or, your baby wakes at a time when he or she is NEVER awake (e.g., 9:30 pm). Or, your baby has a good first stretch of sleep but then is fitful (often after a feeding) and can’t seem to settle for more than 15-20 minutes at a time.

The Science: Randomly timed unexpected and frequent waking is often due to pain/discomfort/illness or, more rarely a sleep disorder.

The Solution: Your child may be uncomfortable. Take steps to adjust your child’s environment or clothing for more comfort and be sure your baby is not too hot or too cold. Feed your child if he is hungry. Go up a size if your baby's diaper seems uncomfortably wet. Discuss treatment options with your pediatrician for pain or illness and try to return your child to a state of comfort so that he may fall asleep again. Talk with your pediatrician about other potential causes of pain or discomfort, such as acid reflux.

The Overview: Off-cycle and ultra-frequent waking should be discussed with your chlld’s pediatrician and interpreted as discomfort. Look for signs of overheating, illness, pain or teething, reflux or allergies, or itching.



If your baby wakes for hours during the night, then check out this blog to better understand why that type of night waking might be happening.

References


Jenni, O.G. and LeBourgeois, M.K., 2006. Understanding sleep–wake behavior and sleep disorders in children: the value of a model. Current opinion in psychiatry, 19(3), p.282.


Martin, J., Hiscock, H., Hardy, P., Davey, B. and Wake, M., 2007. Adverse associations of infant and child sleep problems and parent health: an Australian population study. Pediatrics, 119(5), pp.947-955.


LeBourgeois, M.K., Carskadon, M.A., Akacem, L.D., Simpkin, C.T., Wright Jr, K.P., Achermann, P. and Jenni, O.G., 2013. Circadian phase and its relationship to nighttime sleep in toddlers. Journal of Biological Rhythms, 28(5), pp.322-331.


Akacem, L.D., Simpkin, C.T., Carskadon, M.A., Wright Jr, K.P., Jenni, O.G., Achermann, P. and LeBourgeois, M.K., 2015. The timing of the circadian clock and sleep differ between napping and non-napping toddlers. PLoS One, 10(4), p.e0125181.


Sadeh, A. and Anders, T.F., 1993. Infant sleep problems: Origins, assessment, interventions. Infant mental health Journal, 14(1), pp.17-34.


Machado, R., Woodley, F.W., Skaggs, B., Di Lorenzo, C., Splaingard, M. and Mousa, H., 2013. Gastroesophageal reflux causing sleep interruptions in infants. Journal of pediatric gastroenterology and nutrition, 56(4), pp.431-435.

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