How can I get enough sleep with a baby?

Guidelines from the National Sleep Foundation recommend that adults get 7-8 hours of sleep each night.^1,2 This can be difficult with an infant, as infants have variable sleep schedules partially due to young infants needing to eat every few hours.³ Attending to the baby’s needs can make sleeping difficult.

There are few evidence-based recommendations for improving sleep quality with a newborn. No interventions to improve the sleep of infants have proven to make a clear impact on either infant or parental sleep quality or duration.⁴ Instead parents can try to focus on their own sleep and techniques to improve their sleep quality.

Social Support and Community

Social support and community, a social determinant of health, is vital for physical and emotional well-being in all individuals, but especially after childbirth.⁵ It allows new parents to cope with psychological stressors during the postpartum period, especially through instrumental support, defined as practical help in terms of material aid or assistance with tasks, such as providing childcare to allow parents time to sleep.

Sleep Hygiene

Parents can help improve their sleep by ensuring that they are doing all they can to avoid sleep disturbances. The United States Department of Health and Human Services National Institutes of Health (NIH) and National Heart Lung and Blood Institute (NHLBI) 2011 guide to healthy sleep included the following recommendations for a good night’s sleep:⁶

• Maintain a consistent sleep schedule
• Refrain from exercising within 2-3 hours of going to sleep
• Avoid caffeine in the late afternoon
• Avoid nicotine
• Avoid alcoholic drinks before going to sleep
• Avoid large meals and beverages before going to sleep
• Avoid medicines that delay or disrupt sleep
• Avoid napping after 3:00 pm
• Relax before going to sleep
• Maintain a healthy sleeping environment that avoids loud noises, bright lights, discomfort, overly warm temperatures, and screens (e.g., TVs, cell phone, computer)
• Get at least 30 minutes of exposure to sunlight each day, especially in the morning

Relaxation techniques in particular can be effective in helping improve not only sleep quality but the time needed to fall asleep and are a recommended intervention in guidelines for the treatment of sleep disorders.^7,8 Research into effective techniques to combat insomnia have found that non-pharmacological approaches are most effective, namely cognitive behavioral therapy (CBT) approaches such as relaxation and counter-arousal methods. These methods can improve sleep quality, latency, and waking after sleep onset.

A 2004 randomized trial (n=63) compared CBT, pharmacotherapy, a combination therapy, and placebo.⁹ CBT was superior in improving sleep onset latency (34.2 minute improvement at 12-month follow-up) and sleep efficiency (13.7% improvement at 12-month follow-up) with the longest duration of therapeutic gains. While pharmacotherapy was effective, it was less beneficial than CBT (sleep onset latency 12.6 minutes improvement at one month follow-up, sleep efficiency 3.6% improvement at one month follow-up), and benefits ceased upon drug cessation. Combined treatment offered no advantages over CBT alone.

A 2023 randomized control trial found that CBT was associated with lower insomnia severity and sleep disturbance (two primary outcomes), and lower sleep-related impairment at the pregnancy endpoint (p-values ≤ .001), as well as at 24 months postpartum (p ranges .012–.052). Group differences across the first postpartum year were nonsignificant.

A military CBT training program developed during World War II allowed combat soldiers and pilots to fall asleep in under two minutes.¹⁰ The technique involves relaxing the body systematically from head to toe, focusing on slow, deep breathing, and clearing the mind.

Proximity

According to the American Academy of Pediatrics (AAP), surface sharing with infants is not recommended under any circumstances due to the risk of suffocation or injury to the infant.¹¹ They advise that the safest place for a baby to sleep is on a separate sleep surface designed for infants. There is insufficient evidence to make a recommendation regarding the use of devices advertised as making bed sharing safer. While some evidence exists that bed sharing can offer a few benefits, namely increasing breastfeeding frequency and duration^12,13 and enhanced bonding,¹⁴ these benefits do not outweigh the substantial increase in risk to the infant’s life.

While bed sharing is discouraged, room sharing is recommended by the AAP, especially in the first six months when the rates of sleep-related deaths are highest.¹¹ Room sharing without bed sharing can be protective for the first year of life. Having the infant’s sleeping surface close to the parents’ bed can facilitate feeding, comforting, and monitoring as well as giving parents peace of mind.

References

1. Ohayon M, Wickwire EM, Hirshkowitz M, et al. National Sleep Foundation's sleep quality recommendations: first report. Sleep Health. Feb 2017;3(1):6-19. doi:10.1016/j.sleh.2016.11.006
2. Hirshkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation's updated sleep duration recommendations: final report. Sleep Health. Dec 2015;1(4):233-243. doi:10.1016/j.sleh.2015.10.004
3. Brown A, Harries V. Infant sleep and night feeding patterns during later infancy: association with breastfeeding frequency, daytime complementary food intake, and infant weight. Breastfeed Med. Jun 2015;10(5):246-52. doi:10.1089/bfm.2014.0153
4. Douglas PS, Hill PS. Behavioral sleep interventions in the first six months of life do not improve outcomes for mothers or infants: a systematic review. J Dev Behav Pediatr. Sep 2013;34(7):497-507. doi:10.1097/DBP.0b013e31829cafa6
5. Healthy People 2030: Social Determinants of Health. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Accessed July 25, 2023. https://health.gov/healthypeople/objectives-and-data/social-determinants-health
6. Your Guide to Healthy Sleep. U.S. Department of Health and Human Services National Institutes of Health (NIH) and National Heart, Lung, and Blood Institute (NHLBI); 2005.
7. Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. Feb 1 2021;17(2):255-262. doi:10.5664/jcsm.8986
8. Taylor DJ, Peterson AL, Pruiksma KE, et al. Impact of cognitive behavioral therapy for insomnia disorder on sleep and comorbid symptoms in military personnel: a randomized clinical trial. Sleep. Jun 1 2018;41(6)doi:10.1093/sleep/zsy069
9. Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW. Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med. Sep 27 2004;164(17):1888-96. doi:10.1001/archinte.164.17.1888
10. Winter L. Relax and Win: Championship Performance in Whatever You Do. Oak Tree Pubns; 1981.
11. Moon RY, Carlin RF, Hand I. Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics. Jul 1 2022;150(1)doi:10.1542/peds.2022-057990
12. Huang Y, Hauck FR, Signore C, et al. Influence of bedsharing activity on breastfeeding duration among US mothers. JAMA Pediatr. Nov 2013;167(11):1038-44. doi:10.1001/jamapediatrics.2013.2632
13. Bovbjerg ML, Hill JA, Uphoff AE, Rosenberg KD. Women Who Bedshare More Frequently at 14 Weeks Postpartum Subsequently Report Longer Durations of Breastfeeding. J Midwifery Womens Health. Jul 2018;63(4):418-424. doi:10.1111/jmwh.12753
14. Ball H. Reasons to bed-share: why parents sleep with their infants. Journal of Reproductive and Infant Psychology. 2002;20(4):207-221. doi:10.1080/0264683021000033147