A New Study Seems to Have the Answers…
An article was published this week in the Journal of Pediatrics, called Mother-Infant Room-Sharing and Sleep outcomes in the INSIGHT Study, whose conclusions included recommendations for independent sleep as early as 3-4 months of age. This small study of 230 participants has challenged the new American Academy of Pediatric recent statement that babies should co-sleep (room share) with their primary caregivers for the first year of life. There’s a number of issues with the study, and I don’t agree with the conclusions. Let me show you why.
What’s the best course of action for sleep? While trying to do everything right, many of us ignore our strong instincts in exchange for the newest study findings. But moms and babies have been sleeping side by side as long as humans have been humans. There are risk factors that can interfere with safe bed-sharing (See the Safe Sleep 7 for a list of criteria that make bed-sharing as safe as crib sleeping), but for families without these risk factors, sleeping snugly beside our babies feels, well, right.
This new study explores the relationship between overall sleep and babies who room share vs sleep independently. The study found that babies at 4, 6, 12, and 30 months got very similar amounts of total daily sleep. However, babies who slept independently (in their own room) got on average 45 minutes more night time sleep than those who room-shared between 4 and 9 months of age.
Ahhh.. more sleep! Today this seems to be the Holy Grail of new parenthood. You must be doing something right if your baby sleeps without needing you at night… right? Nope, that’s usually an incorrect assumption. MOST human babies will wake at night, multiple times, and we know a few reasons why they wake, but not all of them.
We don’t always know why babies wake and sleep the way they do, but we do understand a few things:
- Eating frequently is protective of milk supply, and an important factor in full term breastfeeding
- Suckling opens the airway and may improve oxygen levels
- Breastfeeding and duration is protective of SIDS
- Babies learn everything in their world by modelling the behaviours of their adults; specifically that stress regulation using calming and soothing techniques is learned behaviour via repetitive modelling
… Yet There’s More Issues than Answers
There were some disappointing aspects of this study. The biggest? They excluded bed-sharing families!! When practised safely, families feel they get the most sleep when bed-sharing as their infant doesn’t wake distressed and alone. Also, most parents will bed-share to some extent (even if only once). How could a study completely leave out the human biological norm, when studying what’s best for infants? They did of course include room-sharing, however the study asked families to self report to 30 months of age – EXCEPT for the room-sharing families. They were excluded from data at 9 months of age. Were the authors worried that the word would get out? That room-sharing got families the most sleep when continued at 9 or 12 months?
The study design let families select their sleeping arrangements. It’s disappointing that they weren’t randomized to room sharing or individualized sleep. The parents were given information, and at 3-4 months were asked to sleep their baby in the space they preferred them to be sleeping in by 12 months. In normal situations, this is fantastic because parents can tailor sleeping methods to their baby’s needs. The parents aren’t creating this – they are responding appropriately to their baby! However, this doesn’t suit the study well. If parents are choosing, how can we possibly conclude that room-sharers are sleeping less because of the room-sharing itself? I would think it was because the parents instinctively knew their baby needs closer care.
What About the Results?
Do we even know if these babies got more sleep? Or did they wake as much, and just not call out? Not all babies require as much outside regulation from their caregivers, so how do we know if they were actually sleeping in a restorative way, or were actually sleeping at all? Were they awake and just not needing help back to sleep? A recent study examining cry-based sleep support mapped the brain through sleep, and showed that sleep-trained babies weren’t actually asleep longer or better. Instead, they were awake and just no longer calling for their parents for help. It seemed to expose that sleep training was for the parents benefit. How is this different? Without mapping the neurobiology of sleep, this study can only rely on the self-reported accounts from exhausted parents.
I could go on and on.. but I don’t want to waste more time that you could be spending napping. Instead, let’s look at the one finding that most sleep-deprived parents will cling to. They got 45 minutes more sleep!! That could make an exhausted mother feel more refreshed, rested and able to take on the next day. Sure, of course more sleep is the answer to exhaustion! But if more sleep is the answer, and this 45 minutes is plausibly enough to mitigate the problems that arise from “inadequate sleep,” then let’s solve this and find ways to get 45 minutes more sleep! It’ll help with emotional regulatory concerns, mood disorders, and behaviour problems.
Creative ways to get baby 45 minutes more sleep, WITHOUT interfering with biological norms:
- Babies sleep longer when carried, so napping in a baby carrier can extend sleep times
- Bed-sharing infants sleep longer; so learn about safe sleep and remove risk factors before having babies
- Breastfeeding releases wonderful sleep-inducing chemicals, so nursing to sleep and nursing through sleep can help baby sleep longer
- Be sure to treat any nutrient deficiencies, thyroid conditions, etc. – there are so many things that your naturopath or doctor can help you with, that can improve energy levels and mood
Mom also needs 45 minutes more sleep… here’s how:
- Safe bed-sharing and learning to breastfeed lying down means less time walking to the nursery, settling them back to sleep, and settling yourself back to sleep – you just latch and go!
- Naps! Everyone says to sleep when the baby sleeps, but do you?
- Go to bed, at your baby’s bedtime. Even just one night a week. Many babies will give their longest stretch of sleep at the beginning of the night and then wake frequently until morning. Lay down for that initial stretch! If your baby sleeps 8-1, and then is up every few hours, you could get 4 hours straight. If you instead go to bed at midnight, you’ll only get the last hour, and then be up every few hours until morning. This isn’t sustainable! Choose sleep over everything!
- Enlist your partner, or a close caregiver to your baby, and share the nighttime parenting.
- Get help through the day with chores. Hire a postpartum doula a few days a week. Order in groceries. Send out laundry. Join a meal prep service. ASK FOR HELP!
Get more restful sleep so that you can manage the normal, night-time needs of your baby. Journal Articles like this INSIGHT study serve very few, and if anything, increase the feelings that we should ignore our instincts, bury those gut feelings, and separate further from our babies. If your instinct is strong to keep close to your baby, keep close to your baby! Meet their night-time needs, and get more rest in the process by staying closer together. Allow the unnoticed exchange of information between you and your baby flow freely, feed your baby on demand, and learn your baby’s language so you can meet the nuanced needs that come up. All of these amazing things happen when your baby is in relationship to you – typically in close, comfy room-sharing proximity!
Ashley Pickett, IBCLC