Confessions of a Twin Mom: Straight Talk About Sleepless Nights and Advice From a Pediatrician on Overcoming Them
By Ashley Antle
If you are the parent of a baby, you’ve probably been given the advice to sleep when the baby is sleeping. While well-meaning, it’s not always that easy.
As a mother of twins, now 14, I often rolled my eyes when someone would tell me this. It was hard enough getting one baby to sleep, much less two asleep at the same time long enough to catch any meaningful minutes of shut-eye for myself.
I’ll never forget one night in particular. On the way home from an outing the babies fell asleep in the car. My husband and I carried them into the house in their infant car seats and placed them by our bed. We were so tired and didn’t want to risk waking them in a transfer from their carriers to their cribs. Never wake a sleeping baby, right? Another well-meaning but not so practical or sound piece of advice.
So we left them strapped in their seats thinking they would wake on their own soon and we could move them then. In the meantime, we decided to get a little sleep, too. Hours later I woke up to find both babies still in their car seats and, uncharacteristically, still asleep.
I’ve since learned how dangerous it is to leave babies asleep and unattended in their car seats for long periods of time when not in a moving vehicle. Babies can and have died while sleeping in a sitting device like a car seat, bouncer or swing when used improperly as a sleeping location. A 2019 study that reviewed more than 11,700 sleep-related deaths over 10 years found that 3% of infant sleep deaths occurred in baby-sitting devices, most of them a car seat used improperly outside of the car.
So far in 2023, Cook Children’s Medical Center has recorded five baby sleep deaths, with one of them occurring while a baby was sleeping in a baby chair, according to Sharon Evans, Cook Children’s trauma injury prevention coordinator and car seat safety expert.
The danger lies in the positioning of the baby’s head and neck while asleep in a sitting device. The incline of the seat can cause a sleeping baby’s chin to fall and rest on its chest, closing their airway. Most newborns do not have the muscle strength to raise their heads on their own and, when in this position for too long, they can suffocate.
A seat’s degree of incline poses a risk, too. Baby sitting devices with an incline greater than 10 degrees is unsafe for baby sleep, according to the American Academy of Pediatrics. The incline makes it easier for a baby to turn over onto their belly in the seat. For those not strong enough to turn back, this can result in suffocation or injury.
A lot of babies are lulled to sleep while in their car seats in a moving vehicle, and that’s okay, Evans says. Who among us hasn’t driven extra miles during an outing so that your baby could finish their nap? When a car seat is properly installed in a car, it sits at the correct recline angle, which helps ensure the baby’s airway remains open. When placed on a flat surface like the floor or a table, the angle could pose a danger. Also in the car, you’re right there with your baby hearing their giggles and cries and are more likely to know if something is wrong. That’s not always the case when outside of the car where you can easily walk away, get distracted or, like me, go to sleep.
We were fortunate that nothing tragic resulted from that night of car seat sleeping, and were careful not to make the same mistake with our third baby. But, sometimes, exhaustion and desperation speak louder than reason and safety.
So what is a sleep-deprived parent to do?
Sireesha Mutyala, M.D., a pediatrician at Cook Children’s Pediatrics Plano Legacy, is a mom, too. As a working parent, she knows the exhaustion from sleepless nights followed by busy days as well as anyone. She also knows the dangers that certain factors bring to a baby’s sleep. Factors like cribs with blankets or stuffed animals, or unattended bouncy seats, and bed sharing, to name a few.
“With the alarming number of infant deaths from unsafe sleep that our medical center has already seen this year, I am so thankful that Cook Children’s is getting the word out to families about safe sleep,” Dr. Mutyala said. “It’s an issue near and dear to my heart.”
I asked Dr. Mutyala to demystify baby sleep. What’s normal and what isn’t? How can parents create a safe sleeping environment that encourages our little bundle — or bundles — of joy to sleep peacefully for as long as is appropriate for their age and development so that mom and dad can get some much-needed rest, too.
What is normal baby sleep in the first year? How long do babies usually sleep and how many times do they typically wake at night?
Usually, during the first three months, babies sleep about 14 to 17 hours per day, but in short spurts, like 30 minutes to two hours at a time all day and night. Newborns need to feed about eight to 12 times a day, so they have to eat almost every two to three hours even during the night. So there's very little continuous sleep happening in that stage.
Once they get to 4 to 7 months old, they're sleeping about 12 to 16 hours per day. Hopefully, five or six of those hours are at night, and they have three or four naps throughout the day. Those could be one to two-hour naps during the day and then a little bit longer stretch at night. At just a little under a year of age, they're still sleeping the same amount, 12 to 16 hours, but we're hoping about eight to 12 of those hours are at night, and they take about two to three naps during the day. Again, those are usually one to two-hour naps.
Typically nighttime sleep gets better as they get older. When a baby sleeps five to six hours in a row at night, we consider that sleeping through the night. Most babies will be able to do this between 3 and 6 months old.
Is it true that formula-fed babies sleep longer than breastfed babies?
That’s somewhat of a myth. Studies show that babies who are breastfed actually get more sleep throughout the night. They do wake up a little more frequently but their total sum of sleep is actually more, at least for the first few months or so. By the time babies are about 6 to 8 months old, the differences are gone and formula-fed babies and breastfed babies are sleeping much the same.
It’s important to know babies wake up for different reasons throughout the night, not just because they are hungry. They go through their sleep cycles multiple times throughout the night, so when they hit that light sleep cycle, that's when they wake up. For most that will be about four to six times a night. A lot of times they'll just go right back to sleep after a few minutes, which is why it's good not to rush in to them and automatically assume that they need to be fed every time. If you know they are safe, give them some time to fall back to sleep, especially if they're over 3 to 4 months of age. They will never learn to fall asleep on their own if we don't give them a chance to do it!
How should parents set the stage to encourage their baby to sleep?
Most importantly, make sure that it's a safe sleep environment. For every stage of infancy, babies need to sleep flat on a firm surface in a bassinet or crib and on their back. Close by is good, but definitely not in a bed with anyone else.
Most babies will sleep in a bassinet near the parents’ bed in the same room as them until they're about 3 months old. Then, they usually have to move from a bassinet to a crib. I wouldn’t wait too much past three months to move into a crib because it becomes really hard for a baby to change sleep environments after that age. A lot of families will keep the crib in the parents' room for maybe the first six to 12 months. The American Academy of Pediatrics recommends babies sleep in the parents’ room but on a separate surface for at least the first six months and up to one year, ideally.
Whatever you do, consistency is key. End the night where you started it. If your baby is in a crib, start the night in the crib. Keep the lights dim and the noise low from the beginning of the bedtime routine all the way through the night. That helps signal to them that it's nighttime.
Also, one of the things I really try to talk to families about is making sure that the baby's getting enough of their eating and drinking done during the day. Try to meet all those calorie needs during the day so that the baby understands that daytime is for eating and nighttime is for sleeping.
A lot of families do give babies a bath in the evening, give one last feeding, clean their gums or teeth and maybe read a bedtime story. Reading to them is important even at this early age as it helps with language development. Then, place the baby in the crib while they are sleepy, but still a little awake and have them fall asleep there.
Speaking of routine, how important is routine for a baby? Does it impact their sleep?
I find that routines really help babies understand what's happening around them and what to expect. You might not be able to do an actual schedule with exact times, but you can have an order and pattern to things. I liked having a pattern of eat, play, and then sleep for the baby. Even from the newborn period you can start establishing that pattern. Keeping a similar time for waking up in the morning and falling asleep at night actually helps them sleep better in general, too. It may be counterintuitive, but we don't want to make them overly tired by taking away naps in order to try to get them to sleep more during the night. Overtired babies can have a more difficult time falling asleep or staying asleep.
Look for their sleepy cues, too, like rubbing their eyes. Every baby may be different in what they do that signals they are tired, but look for those behavior patterns. When they start displaying those sleepy cues, that’s a good time to start getting them to sleep. If you wait too long, they’ll get past the point of tiredness and sleep will be harder.
There are a number of books written about different sleep training techniques. What do you recommend to parents about finding one that works for them?
Every baby is different, and so is every family. Sleep training can be very personal based on the parents’ comfort levels, their cultural practices and beliefs and a whole bunch of other factors. Families just need to be realistic in using a technique that they're going to actually be able to stick with and continue for a consistent amount of time.
Most of the common themes in these techniques is making sure the baby gets sleepy and then putting the baby down in their crib while they are drowsy but awake so they can learn to fall asleep on their own. This way, if they do wake up in the middle of the night, they look around and know that they are in the same place they fell asleep. They will be more comfortable going back to sleep again instead of being shocked that they're not in their parent’s arms or wherever they fell asleep initially.
I’d say the biggest difference in each of the techniques is what you’re supposed to do when the baby starts to cry during sleep time. Just remember it's not always hunger when they do wake up in the middle of the night, so don't rush in to them just because they're waking up. Give them a few minutes, and you might find they’ll put themselves back to sleep on their own.
The biggest thing that we find is parents say it doesn't work, but they're not sticking with it and being consistent. Give whatever method you are using a good solid two weeks of implementing it and continue with it as long as the baby is healthy.
I do not recommend any sleep training method before three months, as newborns need to eat every two to three hours for their growth and development.
What is sleep regression and how can parents get their baby back on track?
Sleep regression is when a baby who was previously sleeping well all of a sudden has trouble either falling asleep or staying asleep, and it can last a few weeks. A lot of times it can be triggered by things like growth spurts, teething, changes in routines like traveling or the baby starting a new daycare, or an illness. Reaching a new developmental milestone, like learning to roll or sit, can also cause a regression. We see it a lot around four months and then again at six months and nine months.
To get over the hump, you want to stay consistent with that bedtime routine, avoid letting them get overly tired and always give them a few minutes to try to go back to sleep themselves before you jump in there. Sometimes you do have to go back to your original sleep training method for a couple of weeks if you used one. It does tend to be much easier the second, third and fourth time around with that sleep training.
What is the most important thing you want parents to know about baby sleep?
Have your baby sleep in a safe sleep environment, flat on their back and alone in a bassinet or crib with a firm mattress every single time. This is healthy for the baby and really helps the family sleep soundly, too, knowing that the baby is safe.
When we are consistent with our baby's bedtime routines and have them fall asleep on their own, they tend to sleep so much longer and better. That continues on through early childhood and through those transitions with school bedtime routines. It really fosters good, long-term sleep habits. They grow better when they sleep well. They eat better when they sleep, and it translates to all sorts of healthy habits during the day, too.
Building healthy sleep habits is a marathon, not a sprint. We really need to remember that, even when we're exhausted, we've got to do what is going to be best in the long run and not just what is easiest to get us through the night. Healthy sleep habits are built over time and we just need to be very consistent with them.
Simple Solutions for Sleep Safety
My husband and I employed a simple yet effective strategy to keep us from nodding off during late-night feedings and putting our newborn twins in danger. We turned on the TV and had a little help from our friends, “The Golden Girls.” It was the only show worth watching that late at night. As silly as that sounds, it worked like a charm. To this day, hearing “The Golden Girls” theme song brings back what I now consider sweet memories of my newborn twins and those long, exhausting nights we spent together. Thank you for being a friend, Dorothy, Rose, Blanche and Sophia!
Putting in place a few simple strategies of your own can help you overcome exhaustion and keep your baby safe.
- Feed your baby in a chair that isn’t super comfortable. If you are feeding in bed, remove your pillows and blankets so you don’t get too comfortable. You’ll be less likely to relax to the point of falling asleep before the feeding is complete.
- Set an alarm for the typical duration of a feeding. If you do fall asleep, it won’t be for long.
- Have your partner check on you periodically during feedings to make sure you are awake, alert and have placed the baby back in their safe sleep space after a feeding.
- Turn on the TV and catch up on your favorite show.
- Drink a glass of water and have a snack, especially if you are breastfeeding.
- Read a book or listen to an audiobook.
- Turn on a lamp or night light.
- Play a game, scroll social media or review sweet baby pictures on your phone.
- Get up and walk around.