Understanding Sleep Deprivation
Lack of sleep is a source of stress to our body, affecting us physically and emotionally. Overtired means your body has gone from being ready to sleep to being alert and active. The reason this occurs is that the bodies homeostasis is interrupted and the baby can no longer cope, this activates a stress-response system and causes irritability or alert behavior, like getting a “second wind!” Most babies will appear cranky or irritable, and show obvious signs but over time they learn to adjust to having less sleep, even though it isn't good for them and often display over-active behaviors, appear very alert and busy and have more restless night sleep.
Once a baby is overtired, stress hormones such as cortisol and adrenaline flood their bloodstream. These are often referred to as ‘fight or flight’ hormones because they increase the state of awareness, speed up heart rate, raise blood pressure and cause tension to build up in muscles. Despite being physically fatigued, your baby’s mind is now alert and each baby will manage this differently depending on their temperament and personality. Often babies go through a stage of fussiness and then become happy again which can be misleading.
An overtired baby may catch up on sleep every few days, confusing parents!
Overtired behaviors in babies and young children can significantly affect sleep consolidation and sleep quality. When they try to sleep with too much alerting hormone on board it interferes with sleep triggers. Accumulated sleep debt can be often be mistaken for having an “active” or even “hyperactive” baby, and signs are not always as obvious such as those seen with a “fussy” baby. Poor sleeping habits are not formed overnight, accumulated sleep debt occurs over time and sleep recovery is often needed to get on track before a a new sleep schedule can begin. How much time it takes to recover sleep debt in babies is not well understood. The general rule is 3-5 days of good sleep and structured schedules.
An overtired baby might also catch up on sleep every few days, confusing parents even more. They may crash all night, sleep usually long periods without demanding feeds and appear to have had a “good” night only to fall back into old habits again in another few days. During this phase you will notice a happier baby who feeds well, settles easily and go down without much intervention from you. These moments of good sleep or catching up, provide stressed, sleep-deprived parents with much-needed relief.
Sadly they can often trick you into thinking that the situation is finally resolved. With a better understanding of sleep science, sleep associations, and recognizing your baby’s unique sleep needs, you will be better equipped to manage sleep and identify problems. Unfortunately, without identifying the cause of the sleep issues in the first place or getting to the root of the problem, the sleep will become short again. By carefully observing patterns and addressing the schedule each day, applying the six rules for sleep to your daily routine and managing your baby’s needs, you can stay on top of sleep!
Without any intervention the sleep deprivation will remain unresolved, and in a few days your baby will struggle with sleep again, which is what often pushes parents to the last resort of using CIO methodologies. I strongly discourage you from taking that approach and want to remind you that gentle sleep solutions are successful in 88-94% of the time and 100% of the time if given enough consistency and time!! Babies are trying to adapt to our world and do not understand what we want them to do. Parenting is a tough job and requires strategic planning to guide our children in the right direction. The ultimate goal is to launch these little ones into the real world with all the coping strategies, emotional tools and intelligence we can give them. Humans are complicated and require a careful balance when meeting developmental needs.
Risks Associated with Sleep Deprivation:
Sleep Deprivation Triggers Overstimulation
Overstimulation occurs when a baby’s nervous system becomes overloaded by too much sensory stimulation. Your baby becomes overwhelmed! Without enough sleep you will notice your baby becomes more sensitive to stimulation, bright lights, loud or sudden noises, even a bath or a massage is stressful, sometimes even feeding or being held is too much. The younger the baby the more immature the nervous system will be, and the more overstimulated they will become.
Sleep Deprivation Can Lead to Tummy Trouble!
Often the unsettled nature of an overtired baby is frequent waking, this is often confused with hunger. Babies can be over fed as a result and have discomfort or gas pains. They are just too immature to know when to stop feeding and have a natural instinct to suck whenever they get upset. The feed temporarily settles them by releasing oxytocin but later causes another waking due to tummy pain! Alternatively you may have a baby who responds to lack of sleep with poor feeding habits. They usually feed poorly first thing in the morning and take less volume than other babies the same age. If they sleep through the night at a very young age this can also occur. Breastfeeding may be ineffective, not draining the mother’s breast or stimulate her supply enough and thus mom’s milk supply can drop in response, which then means less milk will be available to the baby when the baby recovers from the sleep debt!
Sleep Deprivation and Parental Distress
When parents are sleep deprived and caring for their baby with ongoing sleep issues it can be exhausting and stressful. Mom’s fight or flight response also kicks in and her stress hormones are released making a bad situation for everyone and causing a snowball effect. Not surprising, babies are at an increased risk for neglect, unresponsive parenting or even hostile care if mom is chronically tired. It is just too difficult for even a seasoned parent or extremely nurturing mom to provide optimal care when she is exhausted. Know when to reach out for help!
Misdiagnosis of Sleep Issues
Overtired and distressed babies can develop chronic issues that are difficult to diagnose. Often the frequent spit-up’s or gassy symptoms are due to a feeding intolerance such as milk or soy but occasionally they are simply the result of over feeding or poor feed management causing a lactose overload. Often these babies are diagnosed with reflux or colic and given medication. Parents find nothing seems to help when the underlying cause is a sleep issue. The medical community is not well versed on the topic of sleep science and infant sleep. I am very familiar with this as a NICU RN for many years. Trust your instincts as mom, when you think it’s a sleep issue, it likely is!!
Sleep deprivation in babies and toddlers has been linked to ADHD in older children. The rate of diagnoses in pre-school has increased 66% in the last ten years and shows a strong correlation to sleep deprivation in babies and toddlers. Be aware of sleep issues as your baby grows. Watch for teeth grinding in the toddler years, restless leg syndrome, sleep apnea or snoring, and sensory processing issues. Lack of sleep causes an inability to learn and store memory. Babies with consolidated night sleep scored better on cognitive tests at 15 months old. Babies who sleep better have easier temperaments and develop more adaptable personalities. Obesity is linked to lack of sleep in babies and toddlers. As are behavioral problems, inability to recover from negative emotions and frequent outbursts. Growth impairment and developmental delays meeting milestones, clingy and insecure behavior and even depression in young children.
Signs to watch for:
- Fights going to sleep
- Easily awakened by noise
- Sleeps very little in the day
- Uncomfortable feeding or occasional refuses to feed in the day but feeds at night
- Sleep is below the recommended guidelines based on age
- Happier in the morning but fussy in the afternoon
- Struggles with sleep as the day progresses
- Cries often and sometimes inconsolable
- Short attention span
- Needs constant attention from caregiver
- Wants to be held all the time
- Fussy when held
- Cries when put down
- Protests crib, high chair, stroller and car seat
- Startles easily
- Extreme separation anxiety
- Falls asleep feeding before feed is completed
Solving the Puzzle Before Addressing Sleep Problems
Be sure you've considered the following:
- Growth spurt or regression stage in development
- Overstimulated or too much daytime activity planned
- Hungry, cold, hot, sick, or in any discomfort or pain.
- Teething or medical concerns
- Diaper rash
- Gassy/ Burping well?
- Tummy trouble
- Exercise to close to bedtime
- Vacations, move, new daycare, nanny, etc.
Overtired babies often have short naps! Short naps are defined as anything under and hour. Babies who once took a long nap and suddenly have short naps likely need more sleep and are caught in an overtired cycle. Short naps occur normally in young babies as they simply have more difficulty transitioning through the sleep cycle and wake easily. This is a common problem between 3-5months of age when naps are disorganized biologically. Once naps are corrected and your baby is closer to six months, short naps should resolve if the schedule is meeting the sleep need. After 6.5-7months short naps can be a sign of needing a schedule change and reducing to two naps, but only if sleep volume is maxed. An indicator of an overtired baby is a baby who is unhappy upon waking from a nap. Babies who habitually have short naps even once night sleep is consolidated, need encouragement to extend daytime sleep. A few options for improving this includes “wake to sleep”, assistance with transitioning, added sleep props, use of a swing or carrier temporarily in order to get the longer nap before returning to crib naps again, progressive waiting without long crying, adjusting nap schedules and reassessing feeds or increasing feed volumes.
False Starts and Frequent Wakings
Overtired babies have trouble sleeping and often have what is known as false start when they settle to sleep at night but wake up in an hour or so crying. They also have frequent wakings. This is a pattern resulting from being overtired and having too much cortisol onboard. The problem is solved with sleep coaching and better schedules.
Getting the timing of your schedule right, knowing your baby’s specific sleepy cues and managing wake windows doesn't sound very difficult, but believe me it can take time! Keeping a good schedule and a solid routine is helpful for babies to get the sleep they need and to optimize learning. It is important to keep a sleep log for your baby and review the log to evaluate patterns. When timing is well organized your little one will go down easily for a nap and nap for a longer stretch. They wake up happier, night sleep improves and baby’s remain alert and content during his awake time.
Before you can have the perfect schedule you must teach sleep skills, eliminate parent-led associations and make the crib a positive happy place to be. Once these issues are resolved, and falling asleep is mastered, the science of sleep can be included to solve the puzzle. Rewarding night waking is often a tough one to break! Be aware of how you are reinforcing the wrong behavior and change the patterns first!!
Recovering the Overtired Baby:
Sleep debt can accumulate over time and affect a baby’s temperament and demeanor. Correcting the cycle can be difficult when a baby fights sleep. During these times it is “ok” to get the nap whatever way you can. There are always exceptions to the rules and naps on the go are better then no nap at all!! If the only way you can get a nap is to go for a drive, that’s fine as long as it doesn’t become the standard. Have a day of recovery with short wake windows and minimal stimulation. Always use an early bedtime to solve the problem! Keep in mind that fragmented sleep causes a baby to be overtired too, so minimize night wakings by addressing sleep associations quickly.
Balancing a baby’s schedule can be challenging. As long as you are maximizing nutrition and sleep, loving and holding them as much as possible, while providing some stimulation for each developmental milestone, you are doing a great job!! So much to think about to get it right, the fact that you are reaching out for help and seeking information to benefit your baby speaks volumes. Remember, the most important gift you can give your baby is the gift of your time.