Holistic Babies London

23. Jan, 2021

Understanding & Coping with the 4 Months Sleep Regression

How to cope with the 4 months sleep milestone? 

Please note: 

Due to their brain's immaturity, rapid growth, calorific needs, and emotional needs, "sleep training" is not recommended before the age of 6 months. Babies do not need sleep training; parents do! By understanding the baby's brain development, the parents can set reasonable expectations around infant sleep. 

"Understanding a baby's sleep cycle is important for parents interested in sleep training. Because babies are not born with a strong circadian rhythm, sleep training is not possible for most newborns. Parents who want to sleep train have to work with their baby's unique development timeline, and might not be able to sleep train until six months of age." The Sleep Foundation UK

Infant Sleep Cycles: How Are They Different From Adults? | Sleep Foundation

Why sleep regression? The neuroscience behind it: 

Did you know that sleep patterns start in the womb? Babies in utero go through short episodes of sleep until they are born. Initially, babies will spend around 50% of their time asleep, but those will be short and frequent sleeps (REM sleep or "active sleep" where the baby may move around, open her eyes, smile). 

From birth until anytime between 2 and 6 months, babies' sleep cycle consists of 2 main phases: REM sleep (active sleep) and NREM (quiet sleep). As the baby hits the 4 to 6-month mark (sometimes sooner), the circadian cycle starts maturing into the sleep cycles we experience as adults (4 phases). 

• Stage 1 (NREM 1): alpha waves and low-amplitude mixed-frequency activity
• Stage 2 (NREM 2): sleep spindles and K-complexes
• Stage 3 (NREM 3): delta waves
• Stage 4 (REM): alpha and beta waves (similar to waking state).

This transition is a significant change for babies and can lead to many night waking and parasomnia (crying in sleep but not waking). 

First, we have to remember that it is not because your baby's sleep matures that she will sleep like an adult! Like all milestones with babies, it takes time to nail it! 

From the Sleep Foundation UK:

"Although babies begin experiencing four stages of sleep around three months, it is not until closer to 5-years-old that children's "sleep architecture," or their time spent in each sleep stage, begins to mirror that of adults. As babies, they experience a short REM stage almost immediately after falling asleep instead of the last in the cycles. In contrast, adults do not experience REM until they have been asleep for around 90 minutes."

As the baby's brain goes through the various phases of sleep, the baby experiences those cycles and wakes (please note, some babies are oblivious to this!) very frequently. 

This phase is often occurring in conjunction with acquiring new motor skills such as rolling/ grasping, and the baby will often try and practice at night. 

Different needs:

During this phase, the baby will also experience significant growth leading to more feeding. It is not unusual for a baby who was a good sleeper and only needed a night feed to start waking a couple of times a night. The calorie requirement needs to be met, so it is ok to feed more. 

Behaviour:

The behaviour of the baby might also change. She might be more irritable, cranky, wants lots of cuddles & one to one. 

Tips to get through this phase: 

• A gentle but consistent routine now becomes essential. Whatever you implement now will have its benefits/repercussions later. 
• Daytime naps should not be skipped & bringing bath time/bedtime earlier might be necessary at this age. 
• The baby is so tired that her cortisol (stress hormones) levels creep up by the late afternoon, which inhibits melatonin production (sleep hormone). 
• Using blackout blinds might be necessary to ensure the maximum production of melatonin. Any light, even dimmed, can inhibit its production. Avoid all sorts of blue light, including "baby projectors," as they inhibit melatonin production.
• Expose baby to 12h of daylight per day, including naps in a room that is not blacked out and 12h of darkness to condition the baby's circadian rhythm. 
• At this age, babies are most susceptible to noise and waking quickly. It is worth continuing using pink noise to block out unwanted noises. 
• If the baby starts rolling, it is time to get out of the swaddle and into a sleeping bag to prevent suffocation. 
• When the baby is waking up (unless it needs a feed), patting off the nappy and using a "shhh" sound can help get back to sleep without being picked up. 
• A good technique is to roll the baby on her side and pat her bottom then, once calm, place her back on his back. Babies should never sleep on their side/stomach due to risks of SIDS. 

How to reduce the risk of SIDS for your baby - The Lullaby Trust

• You may have to push day feeds a little, but it is never guaranteed to stop night feeds. 
• Plenty of tummy times, too, so she can practice rolling as much as possible in the day and hopefully not so much at night! 
• Sleep associations: if a baby has been used to falling asleep using any sleeping aids (breast, bottle, dummy, etc.), the baby expects those to be available when she wakes up and needs them to be able to go back to sleep. Breastfeeding to sleep and during the night is lovely, and I would never discourage it. However, some mothers struggle when the waking occurs frequently, and the only way the baby can go back to sleep is by suckling at the breast. 

I am all pro-attachment parenting, but I also understand sleep deprivation! . 

However, one must understand that it is hard for a baby to be used to a specific way to fall asleep then have that way taken away. 

If a mother wants to avoid sleep association, the best way is to avoid using the sleeping aid to put the baby to sleep.

In the baby who feeds to sleep, feed before the bath, top-up after the bath but try to avoid the baby to fall asleep while feeding. Replace the feed with a cuddle, so the touch remains.

As the baby gets used to this (there might be tears, but if the baby is reassured by touch or a gentle "shhh," she will not experience stress (unlike the baby left to cry out).

Then slowly move the baby to the crib, leaving a reassuring hand on the tummy until the baby is fast asleep. These create a new imprint on the baby's brain; with repetition, she will consolidate this new way of falling asleep. 

• Introducing solids: you may be told to introduce solid food, hoping it will "fill her up," and she will sleep through. It is a myth that science has now backed up. Moving onto solid doesn't reduce night waking. If anything, vegetable or fruit purees have so little calories that they take volume in the baby's tummy while offering fewer calories than milk! A great read to understand the introduction of solid in babies: "Why solids matter" by Professor Amy Brown. Persistence is key! It is exhausting but implementing good habits early on has long-term benefits not only on the baby but also on the parents and siblings. 
• Formula does not make babies sleep better or longer. Breastfeeding remains the best source of nutrition, immunity, comfort and much more for your baby.
• Babies and children grow and learn in their sleep; there is a considerable brain activity going on! 
• It is exhausting, but remember it will pass!

Stephanie is a Gentle Sleep Coach who has worked with new parents for the past 12 years in promoting good sleep habits in babies and children while protecting breastfeeding. Her approach is always respectful of the baby/ child, promoting a secure attachment between child and parents. She is currently studying for her Masters in Psychology and Neuroscience with a specific interest in baby's neurodevelopment and the impact on parenting on the developing brain.

For more information or to book a consultation, please contact admin@holisticbabies.co.uk