What are the sleep patterns of a newborn?

The average newborn sleeps much of the day and night, waking only for feedings every few hours. It is often hard for new parents to know how long and how often a newborn should sleep. Unfortunately, there is no set schedule at first and many newborns have their days and nights confused?they think they are supposed to be awake at night and sleep during the day.

Generally, newborns sleep about 8 to 9 hours in the daytime and about 8 hours at night. Most babies do not begin sleeping through the night (6 to 8 hours) without waking until at least 3 months of age, or until they weigh 12 to 13 pounds. However, this varies considerably and some babies do not sleep through the night until closer to 1 year. Newborns and young infants have a small stomach and must wake every few hours to eat. In most cases, your baby will awaken and be ready to eat about every 3 hours. How often your baby will eat depends on what he or she is being fed and his or her age. Make sure you talk with your doctor to determine if it is necessary to wake a baby for feedings.

Watch for changes in your baby's sleep pattern. If your baby has been sleeping consistently, and suddenly is waking, there may be a problem such as an ear infection. Some sleep disturbances are simply due to changes in development or because of overstimulation.

Never put a baby to bed with a bottle propped for feeding. This is a dangerous practice that can lead to ear infections and choking.

What are the sleep states of a newborn?

Babies, like adults, have various stages and depths of sleep. Depending on the stage, the baby may actively move or lie very still. Infant sleep patterns begin forming during the last months of pregnancy?active sleep first, then quiet sleep by about the eighth month. There are two types of sleep:

• REM (rapid eye movement sleep). This is a light sleep when dreams occur and the eyes move rapidly back and forth. Although babies spend about 16 hours each day sleeping, about half of this is in REM sleep. Older children and adults sleep fewer hours and spend much less time in REM sleep.

• Non-REM sleep. Non-REM has 4 stages:

  • Stage 1: drowsiness, eyes droop, may open and close, dozing

  • Stage 2: light sleep, the baby moves and may startle or jump with sounds

  • Stage 3: deep sleep, the baby is quiet and does not move

  • Stage 4: very deep sleep, the baby is quiet and does not move

  A baby enters stage 1 at the beginning of the sleep cycle, then moves into stage 2, then 3, then 4, then back to 3, then 2, then to REM. These cycles may occur several times during sleep. Babies may awaken as they pass from deep sleep to light sleep and may have difficulty going back to sleep in the first few months.

What are the different alert phases of a newborn?

Babies also have differences in how alert they are during the time they are awake. When a newborn awakens at the end of the sleep cycles, there is typically a quiet alert phase. This is a time when the baby is very still, but awake and taking in the environment. During the quiet alert time, babies may look or stare at objects, and respond to sounds and motion. This phase usually progresses to the active alert phase in which the baby is attentive to sounds and sights, and moves actively. After this phase is a crying phase. The baby's body moves erratically, and he or she may cry loudly. Babies can easily be overstimulated during the crying phase. It is usually best to find a way of calming the baby and the environment. Holding a baby close or swaddling (wrapping snugly in a blanket) may help calm a crying baby.

It is usually best to feed babies before they reach the crying phase. During the crying phase, they can be so upset that they may refuse the breast or bottle. In newborns, crying is a late sign of hunger.

Helping your baby sleep

Babies may not be able to establish their own sleeping and waking patterns, especially in going to sleep. You can help your baby sleep by recognizing signs of sleep readiness, teaching him/her to fall asleep on his or her own, and providing the right environment for comfortable and safe sleep.

What are the signs of sleep readiness?

Your baby may show signs of being ready for sleep when you see the following signs:

• Rubbing eyes

• Yawning

• Looking away

• Fussing

How can you help your baby fall asleep?

Not all babies know how to put themselves to sleep. When it is time for bed, many parents want to rock or breastfeed a baby to sleep. Establishing a routine at bedtime is a good idea. However, be sure that the baby does not fall asleep while eating or in your arms. This may become a pattern and the baby may begin to expect to be in your arms in order to fall asleep. When the baby briefly awakens during a sleep cycle, he or she may not be able to go back to sleep on his or her own.

Most experts recommend allowing a baby to become sleepy in your arms, then placing him or her in the bed while still awake. This way the baby learns how to go to sleep on his own. Playing soft music while your baby is getting sleepy is also a good way to help establish a bedtime routine.

What sleeping positions are best for a newborn?

Research has found a link between sudden infant death syndrome (SIDS) and babies who sleep on their stomach (in the prone position).

Experts now agree that putting a baby to sleep or down for a nap on his or her back is the safest position. Side-sleeping has a higher risk for SIDS than back sleeping. Other reports have found soft surfaces, loose bedding, and overheating with too many blankets also increase the risk for SIDS. When infants are put to sleep on their stomach and they also sleep on soft bedding, the risk for SIDS is even higher. Smoking by the mother is also a risk for SIDS, as are poor prenatal care and prematurity. Since the American Academy of Pediatrics (AAP) made the "back-to-sleep" recommendation in 1992, the SIDS rate has dropped more than 50%.

Back sleeping also appears to be safer for other reasons. There is no evidence that babies are more likely to vomit or spit up while sleeping on their back. In fact, choking may be more likely in the prone position.

A task force of The U.S. Consumer Product Safety Commission, the AAP, and the National Institute of Child Health and Human Development offer the following recommendations for infant bedding:

• Place your baby on his or her back on a firm, tight-fitting mattress in a crib that meets current safety standards.

• Remove pillows, quilts, comforters, sheepskins, stuffed toys, and other soft products from the crib. Also remove any soft, pillowlike crib bumpers.

• Consider using a sleeper as an alternative to blankets with no other covering.

• If using a blanket, put your baby with his or her feet at the foot of the crib. Tuck a thin blanket around the crib mattress, only as far as the baby's chest.

• Make sure your baby's head remains uncovered during sleep.

• Do not place your baby on a waterbed, sofa, soft mattress, pillow, or other soft surface to sleep.

• Offer your baby a pacifier at sleep times, but don't force the baby to take it. Some studies have shown a lower rate of SIDS among babies who use pacifiers. (Breastfeeding mothers should wait until the baby is 1 month old or is used to breastfeeding before offering a pacifier.)

The AAP recommends that parents room share but not bed share. The report advises the following:

• Parents should consider placing the infant's crib near their bed for more convenient breastfeeding and parent contact for the first 6 months.

• Infants can be brought into the parents' bed for feedings and comforting, but should be returned to their own crib for sleep.

• Infants should not bed share with others, including adults and siblings or other children. Twins and other multiples should sleep separately.

• Smoking and the use of substances, such as drugs or alcohol, that may impair parents' ability to awaken, greatly increase the risk of SIDS and suffocation with bed sharing.

To prevent overheating, the report recommends that the infant should be lightly clothed for sleep and the room temperature kept comfortable for a lightly clothed adult. Avoid overbundling, and check the baby's skin to make sure it is not hot to the touch.

Additional research has found that infants should not be put to sleep on a sofa, alone or with another person, as this practice increases the risk for SIDS.

While babies should sleep on their back, other positions can be used during the time babies are awake. Babies can be placed on their stomachs while awake and under supervision to help develop the muscles of the eyes, stomach, and neck.

Additional recommendations from the AAP to reduce the risk for SIDS and and other sleep-related deaths in infants from birth to 1 year: 

• Breastfeed your infant. The AAP recommends breastfeeding for at least 6 months.

• Make sure your baby is immunized.

• Always talk with your baby's doctor before raising the head of the crib if he or she has been diagnosed with gastroesophageal reflux.

• Avoid using infant seats, car seats, strollers, infant carriers, and infant swings for routine sleep and daily naps. These may lead to obstruction of an infant's airway or suffocation.

• Avoid using home cardiorespiratory monitors and commercial devices?wedges, positioners, and special mattresses?to help decrease the risk for SIDS and sleep-related infant deaths. These devices have not been shown to decrease the risk of SIDS. In rare cases, they have resulted in an infant's death.

• Always place cribs, bassinets, and play yards in hazard-free areas?those with no dangling cords or wires?to reduce the risk for strangulation.