Multiple Sleep: The Parent's Challenge of Getting a Full Night's Sleep

Solutions with twins and more in mind

By Dr. Arthur Lavin, MD

Note: Working Moms of Twins is pleased to feature a guest article from Dr. Arthur Lavin, MD, co-author of "Who's the Boss? Moving Families from Conflict to Collaboration," and "Baby and Toddler Sleep Solutions for Dummies." Educated at Harvard (BA) and Ohio State (MD), Dr. Lavin has been in pediatric practice for more than 20 years. He is also the father of identical twin girls. You can learn more about Dr. Lavin and his books at www.wtboss.com.


More than any other problem, getting a real night's sleep challenges parents of very young children, and as with other challenges of parenting, having multiples makes such challenges all the more profound.

Why is finding a way to sleep all night the number one problem parents of infants face?

The reason is obvious: sleep is central to living and functioning. A fight over other issues is a real problem for that day, but not sleeping can ruin months.

The biggest obstacle to getting a full night's sleep is the notion that a young child cannot do it. And there are two very good reasons why many parents wonder if their young infant can get to sleep and stay asleep well enough to let the parents get a full night's sleep.

The first is that newborns cannot sleep the whole night. They sleep all the time, but they cannot fall asleep all on their own, reliably. The second reason is that newborns are so small, and need to grow so rapidly, that they physically cannot go a whole night without eating. They must wake up and eat several times a night.

But babies do not stay newborn. They grow and mature. And yet, parents retain that sense that sleeping through the night is unreasonable or dangerous for many months and years after it is no longer true.

Two questions that are the most important questions for parents seeking a full night's sleep:

1) At what age does an infant no longer need to eat at night?

2) At what age can parents rely on a child's ability to get themselves to sleep?

It turns out the answer is the same to both of these questions, and is surprisingly young:

4 months.

By 4 months of age, parents can be very confident that their infant can get to sleep without their help and needs no food overnight. How does an infant develop these abilities so rapidly? Through the dramatically rapid rate of growth right after birth and the rapid development of the brain.

Within one week of birth, newborns develop the fastest rate of growth seen in life. Newborns achieve annual rates of growth reaching 50 pounds a year, a number often 6-7 times their birth weight!

Of course, no one actually gains 50 pounds in their first year of life, but that is because the speed of growing slows as you get older. Put those facts together, and you get the universal experience of newborns reaching a size by 4 months of age that eliminates the need for night time feeding.

With regard to the brain's management of sleep, the revolution is just as amazing. Newborns begin life without few of the adult brain's features of sleep. Newborns alternate between two rudimentary sleep states: active and quiet sleep.

Active sleep develops into mature REM sleep, where most dreams occur. Quiet sleep develops into a cycle of highly developed stages of sleep.

Remarkably, the full architecture of adult sleep with its cycling from Stage 1 to Stage 4 and back to Stage 2, interspersed with increasingly longer REM sleep overnight, is in full bloom by 4 months of age. This is why newborns often struggle to go to sleep all on their own, but 4 month olds can do so with few exceptions.

These changes put parents in a challenging position. They start their life as parents with a baby whose life depends on rapid response to waking. They need to eat, they cannot get through a whole night, and parents must feed them when they call.

But in just a few weeks, by 4 months of age, the child no longer needs to be fed at night. The change is so rapid that when parents hear their 4-, 6- 9- or even 39-month-old child call for them at night, parents often feel the same urgency they did when their newborn called. After all, the call sounds the same.

But starting at 4 months of age, children sleep as their parents direct. From birth to 4 months of age, parents must follow the lead of their infants' need to be fed and to get back to sleep. From 4 months of age onward, however, children follow their parents' lead.

If parents want to see their child several times a night, children will wake several times a night and call for them. If parents want everyone to sleep all night without interruption, children will do just that and not wake in the night to call their parents.

Now, many parents ask, how do you lead your older infants to a night of sleep without interruption?

The only way is to ask them not to call for you. If you do not ask, infants, like adults, have to think you like getting up to see them. And the only way to ask them not to call you is to not go in when they do call for you at night. Details on how to do just this are available in the parenting book: Who's the Boss? Moving Families from Conflict to Collaboration (Collaboration Press, 2008).

For Twins/Multiples

The principles remain the same no matter how many infants parents have who are the same age. Namely, newborns cannot sleep through the night, but nearly all healthy babies are able to do just that by 4 months after their due date.

The specific problems posed by multiples and their solutions can be listed as follows:

1) Prematurity: The more infants gestated in one pregnancy, the earlier they tend to be born in that pregnancy. If the infants born early are healthy, then the solution is simply waiting until they reach 4 months of age after their due date.

2) Illness: If the illness is severe enough, then due to prematurity or not, it can profoundly interfere with good sleeping and normal sleep development. All the comments in this essay relate to healthy infants. The complications created by serious illness require specific medical guidance to achieve normal sleep.

3) Waking each other up: This is the essential challenge created by healthy multiples. And the solution is parallel to that of singletons. For singletons, the key challenge is for parents to give their infant the opportunity to get themselves to sleep. That means letting them be, letting them find their own path.

The same is just as critically important for multiples. Let them find their own way to their own solution, even if that means they wake each other up. The alternative is to go running from one to the other as each wakes up--a full-time, all-night job we would not wish on anyone; and that blocks each multiple from finding their path to sleep without interrupting you.

So let them wake each other up, tolerate the messiness of it all, for only in that way can you let them have the chance to find out how to get themselves to sleep all night.

Summary

Parents identify getting a full night's sleep as their greatest challenge. It turns out the parents most reliable ally in seeking sleep is their child. By four months of age, essentially all infants can sleep through the night, without needing feeding or help getting back to sleep. The best way to reach this goal, if one wants it, is to let the child find their way to get themselves back to sleep without being fed or held.

© Dr. Arthur Lavin, MD, November 22, 2010.