Wellness

A Pediatrician on Breaking Bad Sleep Hygiene

Photo credit: Olivia Rae James

A Pediatrician on Breaking Bad Sleep Hygiene

“When you have a new baby, you really have three jobs: feed the baby, calm the crying, and get sleep,” says Dr. Harvey Karp, an assistant professor of pediatrics at the Keck School of Medicine at the University of Southern California. “If you can do those three things successfully, you feel pretty darn good.”

Karp’s work has focused almost entirely on that third job. There’s no aspect of babies’ (or parents’) sleep that’s evaded him. He’s studied the causes behind nighttime crying, the explanations behind so-called night terrors, and the reasons behind the adage that new parents can always be more exhausted. “What happens is you have this baby, and now you’re going around essentially drunk all day long because you’re so sleep-deprived,” he says. “It’s one of the biggest challenges of caring for a young child.”

They might be young, but Karp believes newborns are skilled at soothing themselves. According to Karp, newborn humans (as opposed to other species) are born “before they’re ready for the world.” Because of this, he says babies need to feel like they’re back in the womb, where there’s constant rocking and white noise, in order to be calm and sleep well. (He points out that adults are calmed by these things, too: “We tend to fall asleep in trains, planes, and cars, or rocking in a hammock.”)

Karp famously created a theory for soothing a baby called the five S’s: swaddling a baby, making “shushing” noises, swinging, placing the baby in a safe side position, and sucking. He reasoned that approximating the feeling of being in the womb will calm a baby in seconds. The five S’s are the basis of his 2003 bestselling book, The Happiest Baby on the Block. And they’re the impetus behind the SNOO—Karp’s bassinette, which goop moms have been relying on since it came out in 2016.

“Up until one hundred years ago, and throughout the history of humanity, everyone had five nannies: your grandmothers, your aunt, your older sister, your next-door neighbor’s older daughter,” he says. “You had help. Today we don’t have that help. Most people can’t afford nannies or night nurses.” What can really make a difference, Karp explains, is encouraging your baby’s ability to self-soothe in specific ways and breaking bad sleep habits early on.

A Q&A with Harvey Karp, M.D.

Q
What are some of the biggest challenges parents of newborns face? How do potentially problematic sleep habits typically develop?
A

First, newborn babies need to be fed a lot. They wake up frequently during the night. And when you feed your baby every two to three hours, you’re not necessarily sleeping all those hours in between. You have to feed your baby, change her diaper, and get your baby back to sleep. So it isn’t even just too little sleep; it’s very disrupted and discontinuous sleep that is really burdensome for parents. On average, new parents get around six and a half hours a night, broken up into little pieces. Research shows that when you get six hours or less of sleep, even just for one night, it doubles your risk of a serious car accident. One study shows that sleeping six hours or less a night is equivalent to being drunk.

So you’re tired—and recovering from labor (perhaps even a C-section)—and when your baby cries, you’re not going to leave her there; you’re going to pick her up and rock her, which is wonderful and so sweet. But as you calm your baby in your arms, what often happens next is you’ll fall asleep with your baby in bed with you.

Either intentionally or accidentally, parents may fall asleep with their baby in bed—called bed-sharing—or on a sofa or chair, or in some other unsafe location, leaving them susceptible to harm. Also, bed-sharing can cause babies to become dependent on their parents to help them fall asleep rather than teaching them to self-soothe.


Q
Tell us more about bed-sharing. Why do you recommend avoiding it?
A

Bed-sharing has been around for centuries: Many parents like to bed-share because it’s a form of closeness, cuddling, comforting, and convenience. So why do I and the American Academy of Pediatrics advise against it?

You can imagine that there could be some risks associated with a baby sleeping in bed with large blankets, pillows, and an adult who is ten to twenty times their size. One videotaped study of bed-sharing families, conducted by Sally Baddock, found that the babies’ faces were covered by a blanket for an average of one hour per night. The study also showed that for most of the night, the babies were in unsafe positions.

Of course, there are ways to make bed-sharing safer: Do not smoke, avoid having blankets and bulky pillows around, breastfeed, keep the baby on their back at all times, keep pets and other children out of the bed, and never bed-share on a sofa. But even with those precautions, the one risk you can’t banish from the bed is you. Your body is there, and you can’t be responsible for what you might accidentally do with your arm or your shoulder while you’re in a deep sleep.

This can be a conundrum for parents. Of course having your baby in bed, very close by, is conducive to a healthy breastfeeding relationship, which is something I encourage. But co-sleeping—having your baby sleep right next to your bed, in the same room as you—is just as supportive of breastfeeding without the risk of having the baby in bed with you. That’s what most doctors recommend.


Q
How do you know if you need to change your baby's sleep habits?
A

The first sign is if your baby seems unhappy. Does she cry at everything, seem overtired and irritable, or wake up crying in the middle of the night?

Other signs have to do with the parent(s): Do you feel exhausted, short-tempered? Are you spacing out at work? Do you feel depressed? (A study of 360 women found that the number one trigger of postpartum depression was not hormonal change or a prior history of depression; it was sleep deprivation.) Are you fighting with your partner?

There are also other ramifications to being sleep deprived: You could have more trouble breastfeeding and be more likely to get sick and to struggle with weight gain. You could be more likely to get into a car accident. There’s also the risk of losing your patience because you can become apathetic if you sink into a well of sleep deprivation and fatigue.


Q
How do you get babies to sleep better?
A

There are three things known to improve babies’ sleep and reduce crying: shushing, rocking, and cuddling. These three things mirror the environment of the womb.

It’s best to start with swaddling, which re-creates the snug feeling of being cocooned inside the womb. It’s important to swaddle correctly, with the arms down. Easy step-by-step instructions can be found here.

Next, incorporate white noise to mirror the shushing sound. There are two main types of white noise that each have a different effect on the nervous system: High-pitched white noise (the sound of hair-dryers) often calms crying. And low-pitched white noise (the sound of a train, plane, or car) is usually helpful for promoting a baby’s sleep.

Another useful method is the wake-and-sleep method: If your baby falls asleep while you’re holding her, put her to bed (make sure she’s swaddled), and gently wake her. This give her opportunities to learn how to soothe herself back to sleep.


Q
How important is scheduling babies' sleep? How long do you recommend naps run? And nighttime sleep?
A

It makes sense to establish flexibility in your baby’s sleep schedule rather than just having it dictated by the baby. Longer naps during the day can mean more waking during the night because your baby is hungry. In the very early months (up to four months), if your baby’s daytime nap goes longer than about two hours, it’s best to wake her up and feed her. Then you can put her right back to sleep. At night, let your baby sleep for four to five hours, if she’ll go that long. Then wake her up, feed her, and put her back to sleep.


Q
Any tips for creating an ideal sleep environment?
A

In general, new babies can fall asleep anywhere. You bring a baby to a crowded party or a basketball game and they’ll fall asleep. Babies actually have that ability to tune everything out. Once they get to be three to four months, they’re nosy and social—they’re curious about the world. So if you have too much commotion around, including talking or other distractions, babies won’t fall asleep as easily because they don’t want to miss the party. Use some low-pitched, melodic, continuous sounds (i.e., rain or other rumbly white noise) to help drown this out.

Darkening the room can also reduce the amount of visual excitement and stimulation. And keep the room at approximately seventy degrees—not too warm or too cold. You can tell if your baby’s too warm or cold by feeling their ears: If their ears are cold, they’re too cold; if their ears are red and hot, they’re too warm.


Q
For first-timers, how does the SNOO incorporate some of these elements of good sleep hygiene?
A

The SNOO is the world’s first smart sleeper. It uses three of the five S’s (swaddling, shushing, and swinging)—to boost sleep. And it mimics a parent’s intuitive response: When a baby starts to fuss, you might start bouncing a little bit more, walking a little bit faster. And if your baby starts to cry, you might bounce more vigorously, shushing loudly. When we do the right thing, babies often calm down very fast.

And that’s how the SNOO works. In the first week of life, the bed usually adds an hour to an hour and a half of sleep by giving the gentle womb sensations. And throughout the night, it responds to the baby in an intuitive way: It adjusts the level and quality of white noise and the pace of the rocking (making more jiggly motions when the baby is upset). About 80 percent of the time, the bed’s responses calm babies within a minute, as long as they’re not hungry or sick. And SNOO is ultrasafe because it prevents babies from rolling into a risky position, keeping them swaddled safely on their back all night long.


Dr. Harvey Karp is a nationally renowned pediatrician, child development specialist, and assistant professor of pediatrics at the USC Keck School of Medicine. He completed medical school training at Albert Einstein College of Medicine in NYC, a pediatric residency at Children’s Hospital of Los Angeles, and fellowships in ambulatory pediatrics and child development at UCLA. In pediatric practice for almost thirty years, Karp has taught thousands of parents his secrets for soothing colic, boosting infant sleep, reducing tantrums, promoting patience, and making parents and children happy.


The views expressed in this article intend to highlight alternative studies. They are the views of the expert and do not necessarily represent the views of goop. This article is for informational purposes only, even if and to the extent that it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice.

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