This post will try to address sleep throughout the ages. Of course we are going to start at the very beginning. If you have a sleepless teenager on your hands, just skip the baby stuff and scroll on down. We will move from newborn sleep, to sleep training and naps, to crib graduation, and then to healthy sleeping routines, also known as sleep hygiene. Because we can’t usually help ourselves, there are many detours in between.
Why are we doing this?
Sleep is one of the most essential components of healthy growth and development during childhood, yet it’s often one of the trickiest to navigate, and it’s one of the most common questions we get from parents. This is especially true in the early months.
Unfortunately as most parents quickly realize, there is no on/off switch. No matter how hard you look for it, it doesn’t exist.
For infants and children, sleep isn’t just about rest; it’s the foundation for brain development, emotional regulation, immune function, and even physical growth.
Newborns need to feed every few hours, so right off the bat parents face an element of sleep deprivation. But hopefully it can be short term and manageable. A well-rested baby is generally more alert, content, and adaptable. And when they are not, you know about it. No one sleeps. When parents are exhausted this impacts every aspect of… well, everything, including your relationships. For parents, consistent sleep can restore a sense of balance and improve the whole family’s wellbeing.
Human sleep needs shift significantly from birth through adolescence. Newborns require the most—typically 14 to 17 hours per 24-hour period—though this sleep is often fragmented and unpredictable. As babies grow, their sleep gradually consolidates into longer nighttime stretches with fewer daytime naps.
The challenge lies in not just how much sleep children need, but how they get it. Creating healthy sleep habits early on can prevent years of bedtime battles and nighttime disruptions. Helping your child learn to fall asleep independently and stay asleep through the night may take patience (and a good chunk of your sanity), but it’s a skill that will serve them, and you, for life.
Table of Contents
(A more extensive, navigable outline is visible on the left side if viewing on a desktop)
Newborn to 4 Months
Newborn sleep is unique!
At birth an infant's sleep-wake cycles aren’t controlled by the same internal clock (the circadian rhythm) that adults use, because that clock isn’t fully up and running yet—it starts developing in the first few months of life. Melatonin production is very low at birth and ramps up gradually. Also, their brains don’t yet link light and dark with sleep and wake. Instead, sleep is controlled more by basic biological needs, such as how full or hungry they are or how overstimulated their nervous system gets, so their sleep is choppy, irregular, and not tied to day and night in any predictable way.
Newborns cycle between REM (active) and non-REM (quiet) sleep much faster than older kids and adults—roughly every 50 minutes instead of 90, and they start out sleeping in REM. That kind of sleep is lighter and twitchier, and it’s thought to be quite important for brain development. They tend to be easily woken, especially in those lighter sleep phases, which makes their sleep seem even more erratic. As the brain matures over the first few months, the sleep cycles lengthen, deeper sleep becomes more frequent, and patterns start to settle… usually around 3-4 months when the circadian system really kicks in.
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The Fourth Trimester: What to expect the first couple of months
Aside from sleep, it’s worth pointing out some unique aspects of the first months. As humans evolved, heads got larger in order to accommodate our growing brains. The shape of the woman’s pelvis didn’t quite keep up. So while a fetus might benefit from developing inside mom for several more months, nature seemed to recognize that the fetus had better be evicted around nine months, when they could still work their way out through the narrow passage.
This phase right after birth is referred to by many as The Fourth Trimester. The term was coined by Pediatrician Harvey Karp (of Happiest Baby on the Block fame). It highlights the concept that babies aren’t completely ‘fully baked’ at nine months.
During these first three months of life, babies are now learning how to adapt and regulate to existing outside of the womb:
They need to be fed around the clock.
They do not have fixed schedules.
They need to be held and rocked. (Wearing them is great.)
And that’s about it. Even ‘Baby Einstein’ isn’t ready to learn the ABCs just yet.
So, no matter if you have the best sleeper on the planet, at the very least you have 2-3 months of frequent night time wakings on your hands during the newborn phase. Hopefully we can help you get through it.
We don’t think that during the first months there is any place for what might be described as ‘sleep training.’ But, as you snuggle your newborn, keeping the Cornerstones of Good Sleep in mind can help gently pave the way for easier sleep as soon as they show signs of readiness. These include:
Self Soothing
Wake Windows
Differentiating Day vs. Night
Cornerstone 1: Self Soothing
With a new baby, most parents are just trying to figure things out. We often slip into the routine of inadvertently training our babies that the only way to fall asleep is by rocking and feeding. Babies are figuring things out as well, and this is often the lesson they learn right from the start.
On the other hand, if we are conscious of this, allowing babies to have periods when they are not being held is good for everyone. If they are screaming, pick them up, of course, but capitalize on those calm moments. Parents should be able to poop without holding their baby! It’s okay to put them down. As long as they are in a safe space, you can take that shower even if they are crying.
In terms of sleep, having them learn to ‘drift off’ when they are already in their cribs can be incredibly beneficial.
Self soothing teaches babies that they don’t require a parent to help them fall back to sleep during middle-of-the-night stirrings. Think about how we sleep ourselves to make sense of this. Due to the cyclic nature of sleep we all have periods during the night where we are semi awake. Consider this scenario: During the night, you might fluff your pillow, get up to go to the bathroom or have a sip of water and then go back to sleep. But if you woke up and your pillow had disappeared, you wouldn’t simply turn over and go back to sleep. You would be fully awake!! Where on earth is your pillow?
It isn’t hard to see where we are going with this. If you are feeding your baby, they fall asleep and you sneak them into their bed, it is no surprise that when they enter a lighter sleep cycle they quickly become aware that something is amiss. Hey, where is that breast, bottle, pacifier, rocking body?
Some parents may be completely content to rock their babies to sleep for as long as they want (grade school?) But for those who would prefer to have their little ones become independent at night more quickly, here is the key takeaway: If they are drowsy, put them into bed. Let them be aware of how they get there.
As much as our instincts lead us to want to PUT the baby to sleep, we may be better off letting them soothe themselves down with a minimum of assistance. Perhaps gently pat them or put a firm loving hand against their forehead or chest. Go ahead and surround them with gentle shushing noises.
Of course there will be times when your baby dozes off in the middle of a feeding, that’s fine. One way to avoid that setting up as a pattern is to break the association and shift things around. Instead of feed/sleep/up-time, consider swapping to sleep/feed/up-time.
This is easier to do once they are four months and are starting to have a semblance of a schedule. But every time you are able to put your baby down while they are still somewhat awake, you are a step closer to having a baby who can help themselves sleep at night.
Cornerstone 2: Wake Windows
Wake windows are the periods of time a baby can comfortably stay awake between naps, and this concept is rooted in the science of infant sleep cycles and brain development. A newborn’s sleep is regulated by homeostatic pressure (the build-up of sleepiness) and their still-developing circadian rhythms.
With wake windows, timing is everything; if your baby is overtired or under-tired, sleep becomes a battle, so watching those windows helps prevent meltdowns and promotes smoother naps and bedtimes.
Overtired: If a baby is kept awake too long, they become overtired—releasing stress hormones like cortisol—which can actually make it harder for them to fall and stay asleep. Watching for sleepy cues, like rubbing an eye, zoning out, or yawning, within the wake window can help parents time naps and bedtime in a way that leads to fewer tears and more restful sleep.
Under-tired: On the flip side, if they’re put down too early, they may not be sleepy enough. Use the below graph as a rough guide: by matching your baby’s age to the appropriate wake window range, you can better predict their “sweet spot” for sleep.
Keep in mind, these are very rough averages. Don’t fret if your baby’s wake windows don’t match perfectly with these zones. Pay attention for several days to get familiar with the general amount of time between your baby’s waking and their first eye rub.
When you have a good sense of your baby’s pattern, try putting them down five to ten minutes before they are actually showing that they are sleepy. Babies often take a few days to adjust to new routines so don’t give up if the miracle you’re looking for doesn’t happen overnight.
Cornerstone 3: Day vs. Night
Newborns need to eat around the clock, but we still want them to start learning the difference between day and night as soon as possible. Many infants start off with their days and nights confused because in utero. They were likely lulled to sleep when mom was awake and moving about. Lots of moms will relate, that as soon as they would get comfortable in bed and ready to try to sleep, the little fetus would start to party. Lets use mom’s bladder as a trampoline!
We help get that switched by creating clear signals.
Daytime feedings can be fun. It’s light in the room and you can interact with your baby as much as you like. During the day, we would encourage you to feed every 2 ½ -3 hours and try not to let any nap go longer than 2 ½ hours.
Nighttime feedings are business. Keep the room dark and interactions to a minimum. Keep your voice calm and hushed.
We know that it feels a bit absurd to wake a sleeping baby. Listen, on occasion, if they are taking a super long nap and you are relishing that bit of free time, go ahead and let them sleep. But, in general, try not to let daytime naps that last longer than 3 hours become a habit.
Why? It is simple! As babies grow and start giving you a longer stretch in between feedings, we want that stretch to be at night!
As part of the sleep discussions it is also important to make sure you are familiar with the basics of crib safety and SIDS prevention. Please review THIS link for that essential information.
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Hot Sleep Topics for the First 4 Months
A hot topic is something about which there are many opinions, and those opinions can have a tendency to feel judgy or divisive. The internet, and parent groups, are full of hot topics. We like to make sure the arguments from both sides are laid out (pro/against), and then give our take. As with most things, there are multiple truths, and the best “answer” is probably (ours…just kidding), somewhere in the gray.
🔥 Co-sleeping
This is an arrangement where the baby sleeps in the same bed as the parent(s).
Pro: Proponents of co-sleeping emphasize a number of things, including easier feeding, more time for bonding and strengthening attachment, and better sleep for parents (sometimes, as parents don’t need to get up and down repeatedly for feeds).
Against: Almost every study that has looked at co-sleeping has agreed: it’s simply not as safe. Sleeping in the same bed is accompanied by an increased risk of SIDS and suffocation. This is especially true if parents smoke, have consumed alcohol/drugs, are extremely fatigued, or if bedding is soft/heavy.
Our Take: This is a tough one, because we don’t want to go against data and recommendations. No major country’s public health department has endorsed co-sleeping.
We also don’t want to be judgy or ignore the simple fact that new tired parents don’t particularly care what public health departments are saying. If you just know it’s going to happen, there are some important tenets to decrease the risk of co-sleeping:
Always place the baby on their back to sleep, even when bed-sharing.
Ensure a firm, flat mattress—never place a baby on soft surfaces like couches, armchairs, or waterbeds. Keep pillows, duvets, and loose bedding well away from the baby’s face and body to prevent suffocation.
Parents must be non-smokers, sober, and unimpaired. Bed-sharing is not advised if either parent smokes or has consumed alcohol, sedatives, or drugs.
Avoid overheating: Dress the baby lightly and maintain a moderate room temperature.
Do not bed-share if the baby is premature or low birthweight, as these infants are at higher risk.
While we can’t endorse co-sleeping, we get it that parents are just trying to do the best they can. If the baby absolutely won’t settle down in their own little bassinet and you do end up moving them into your bed (where you may fall asleep), following the above guidance will decrease the risk of SIDS.
Be aware that there are products available where the bassinet connects to the parent’s bed. These are called bedside sleepers and are an excellent option.
🔥 Swaddling
A swaddle is a light blanket or specially designed wrap used to snugly wrap an infant’s body (leaving the head and neck free).
Pro: A proper swaddle mimics the secure feeling of the womb, which can be soothing for newborns. It’s a nice transition to the extrauterine environment. It can also help limit the baby’s startle reflex.
Against: There’s a fear that if the baby is always swaddled, it can impact their ability to flex and move and grow their limbs, leading to hip dysplasia or other issues. Over-swaddling can cause overheating, which can increase SIDS risk. Improper swaddling could, in theory, be a suffocation risk.
Our Take: Most babies do well being swaddled during the first couple weeks. Swaddling is a tool like a weighted blanket for adults. If your baby doesn’t need it, there is no requirement to use one. Keep in mind that many babies fight the swaddle for the first couple seconds, but once they relax into it they are often much calmer.
Make sure they have plenty of time out of the swaddle where they can stretch, flex and learn how to move their extremities. Some babies from day one do well being only partially swaddled with their arms free.
Note from Nurse Judy: Swaddling is a skill that I never had. Fortunately, my husband was able to wrap our kids into nice, tight little burritos. These days there are swaddle blankets with velcro that make it much more manageable. In any event, once they start rolling, it is time to get rid of it. You can ease the transition by doing this gradually. Start by keeping the arms free before getting rid of it altogether.
🔥 Pacifiers
Most babies have a strong sucking reflex. An occasional pacifier session can take care of some of the sucking needs and be very soothing. The conflict we are addressing here is the merit of introducing an early pacifier in the newborn period, and allowing them develop a strong sleep association with it. There are valid arguments on each side.
Pro: There is some evidence that pacifiers can help prevent SIDS. Sucking on the pacifier can bring the baby’s tongue forward, opening the airway a bit. At the same time, if a baby is actively sucking, they are generally not sleeping quite as deeply, reducing the risk.
Against: Lactation consultants fear they can cause nipple confusion any/or cause early weaning. Dentists worry prolonged use can impact the shape of the palate.
Another big issue is that if a baby becomes dependent on the pacifier in order to sleep, they might wake up when it falls out. This is a nightmare cycle for parents who wake up throughout the night to pop it back in.
Our Take: Pacifiers are a tool. Some kids are really soothed by them. After nursing has been established (for breastfeeding parents), introducing a pacifier is recommended to decrease the risk of SIDS and help with sleep. Keep in mind:
Offer it, don’t force it. If a baby isn’t interested there isn’t a need to make them take it.
Try to find a balance here. Let them use it to calm down and fall asleep but don’t replace it: if it falls out naturally, babies hopefully learn to soothe themselves back to sleep. After 4 months it is fine to scatter multiples throughout the crib and see if they can manage to find one and replace it on their own (younger infants wouldn’t have the ability to find it).
Don’t affix it: pacifiers shouldn’t be on a string, on clothing, or in any way strapped in place.
When they are a year old, try to make them disappear. After 12 months, dentists move from mild distaste to full on loathing.
The longer they use them, the tougher it is to break the habit.
Check out this dusty blog post for more.
🔥 Tummy Sleeping
The idea that a baby can be placed down on their tummy for sleep instead of on their back.
Pro: They look so comfy with their little tushes up in the air. Parents often feel like their babies sleep more soundly in this position.
Against: Tummy sleeping suppresses normal arousal responses that are critical for infant survival if they encounter a breathing difficulty (like airway obstruction or rebreathing exhaled carbon dioxide). Studies consistently show that putting babies down on their tummies to sleep (in the home) is associated with an increased risk of SIDS.
Our Take: Tummy sleeping does seem to lead to deeper sleep, but as we mentioned earlier, this is not something that we want to encourage when they are too young. While a supervised nap can be okay on the tummy, babies should never be placed on their tummy for night-time or unmonitored sleep.
But what about rolling? At some point they can roll onto their tummy but haven’t mastered rolling in both directions (calls about this are common). This is the ultimate “it is what it is and you do the best you can.” Once babies can roll onto their tummies on their own, be reassured that they’re usually stronger and older (i.e. at least 4 months). At this point, they should be out of a swaddle.
It’s not reasonable for parents to need to wake up and turn them over multiple times a night. Continue to put them in their safe crib on their back, but at some point they will end up in their preferred position. Give them plenty of floor time to help them work on their skills to roll in both directions.
🔥 White or Brown Noise Machines
Noise machines make extra sounds to soothe babies to sleep. White noise contains all audible frequencies at equal intensity, creating a bright, static-like sound that effectively masks sudden environmental noises, but can sound a little harsh. Brown noise emphasizes lower frequencies, producing a deeper, more soothing rumble that some babies, and adults, find gentler and more calming for sleep.
Pro: Noise machines can be used to drown other loud noises that might startle the baby and wake them up. Some people feel they mimic the sounds from the intrauterine environment.
Against: There are some concerns that the machines could be too loud and can alter the development of proper hearing. There is also a concern that they’re used as a crutch or that people can become dependent on them.
Our Take: As long as they are used properly, we couldn’t find any long-term studies to indicate any concerns about the use of noise machines. The sound needs to be lower than 50 decibels and ideally over 6.5 feet away from the baby's ears. There are apps that monitor decibel level. Here is a blog post that discusses more about ‘how loud is too loud’.
🔥 Smart bassinets
The most well known brand is the Snoo. These baby beds rock as well as making the sound of white noise. Some have a built in swaddle.
Pro: Many babies sleep well with the extra assist. It can also be comforting for parents to know that their baby is fastened in a safe position.
Against: They are not cheap, although with some creativity you can find them available from families who are no longer using them. Babies may have an adjustment to sleeping without the movement once they age out of the bassinet.
Our Take: Just like the swaddle discussion above, a smart bassinet is a tool. Many generations of babies survived without them, so by no means are they a requirement. But most parents who get them report that they sleep better (perhaps because they had a loud sound machine next to the bed).
A note about flat heads: There is data supporting an increased risk of flat head syndrome (positional plagiocephaly) in babies who sleep on their backs, a position recommended to reduce the risk of SIDS (see above). Up to 46% of infants may develop some degree of head flattening, especially if time spent lying in one position isn’t balanced with tummy time or head repositioning. Devices like the SNOO, while promoting safe sleep, can contribute to the risk if used without preventive measures. To reduce this risk, supervised tummy time, alternating head positions, and limiting time in restrictive devices are recommended.
🔥 “8 hours by 8 weeks” or “11 pound baby can sleep 11 hours”
There are popular sleep books and methods that propose that babies should be able to sleep through the night by quantifiable biometrics i.e. age or weight.
Pro: If it works, it’s tremendous! Who doesn’t want to sleep through the night earlier?
Against: The ability to sleep at an earlier age is a trait, not a universal truth. These guidelines don’t work for everyone, and trying it too early in a baby or mom that isn’t ready can cause disruptions including depleted milk supplies for those who are breastfeeding and weight loss in kids. These ideals also place some parents under a lot of pressure.
Our Take: We don’t usually start to encourage the goal of dropping 100% of the night feedings until the baby is between 4-6 months, you’re seeing signs that the baby is ready to do so, and you are certain that they are getting adequate calories during the day. The training process will be easier if they have the ability to:
Naturally go 6–8 hours without feeding (once they’ve done it once or twice you know they can do it again).
Self-soothe
Have a consistent bedtime routine with predictable sleep patterns
Have sufficient regular daytime naps.
Our goal is not quite as lofty. At the minimum, for a typical healthy baby, if you are not getting at least a four hour stretch by 8 weeks or 11 pounds, we think that it is time for you to take some action (scroll down to the next age window for sleep training advice).
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Extra Tidbits
Nurse Judy’s Favorite Pearl
For those lucky enough to have a partner, take shifts. I suggest that each parent get at least one 3 hour break where they are OFF DUTY. Ear plugs in. Eye mask on, Have a conversation so that you can figure out what works best. Taking shifts at night should allow everyone to get at least a few solid hours of sleep.
For the breastfeeding mom, after one of the feeds, hand the baby off for burping and go find a quiet place. Having both of you up all night doesn’t serve anyone.
Dr. Ted’s Favorite Pearl
One of the emerging predictors of quality sleep is iron. Iron levels seem to be closely tied to deep sleep in research studies. Babies tank up on iron from the placenta, which is great because only a very small amount of iron is passed down in breast milk (formula is fortified with it). After 4-6 months, prenatal iron has been depleted, and it needs to be found from other sources in breastfed babies.
Evolutionarily, babies probably teethed starting at 4-6 months, right when their iron stores are low, so they could gnaw on that meaty drumstick their parents found while hunting (excellent iron source). I keep this in mind around the 4-6 month sleep regression. The AAP recommends that exclusively breastfed infants supplement iron starting at 4 months (1mg of iron per kilogram of weight, per day), and they recommend that be continued until iron-rich foods are introduced in the diet. Read more about iron and nutritional needs here.
4 Months to 2 Years
Just as you are patting yourselves on the back for getting this far, you are about to be reminded that parenting is a bit of a roller-coaster ride. Some of you may have heard people warn you about something called the four month sleep regression. Right around this age, many parents notice that babies are becoming much more aware of their surroundings. They are easily distracted. FOMO is real. They pop off the breast or bottle at the slightest hint that there might be something more interesting going on.
There is also a big shift in how sleep works. However, contrary to that dreaded label, it is not necessarily a regression at all. It is actually more accurate to think of it as a sleep progression. What’s happening is that the baby’s brain is progressing and maturing enough that the sleep patterns are transitioning to be more like those of an older child or adult.
The more mature sleep includes more distinct and structured cycles that include lighter and deeper phases. Instead of gliding in and out of sleep like a newborn, babies are hitting these new transition points between cycles, and that’s when they’re more likely to fully wake up… especially if something’s different from when they fell asleep.
Because the brain is starting to link sleep with environmental cues, habits around sleep matter a lot more now. If a baby’s used to falling asleep with rocking or feeding, they might expect that again every time they wake between cycles. If they are not falling asleep on their own, this can suddenly mean way more night waking. Keep in mind, it’s not that they’re sleeping worse—it’s that their brain is becoming more capable of complex sleep regulation.
The trick is helping them learn to connect sleep cycles independently, which often means tweaking how they fall asleep in the first place.
If you are dealing with more nighttime wakings, there are some basic things to consider:
Do they have self soothing skills?
Is it dark enough in the room? Is temperature conducive to good sleep?
Are they getting enough to eat during the day? Four months is the age that many parents get the green light to start experimenting with some solid foods.
Do they consistently fall asleep while they are feeding? Remember to break the association by shifting from a feed/sleep/up-time cycle to sleep/feed/up-time.
Napping is an essential piece of the sleep puzzle. There is a long section dedicated to nap basics a little further down.
Once they are getting any food aside from milk, it is time for them to be able to give you a longer stretch. As we mentioned earlier, if you are not getting at least a four hour stretch, we think that it is time for you to take some action.
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Points to Ponder
Why Sleep Train:
Sleep deprivation is an awful thing. We are talking about the parents here! It can impact every aspect of your life.
But it’s not just for you. Everyone has heard the term ‘You have to put your own oxygen mask on first’. In order to be the best parent that you can possibly be, you need to be rested. Your child directly benefits when you aren’t a zombie. Your relationship with your partner also suffers when you are both exhausted. Your child will be impacted by that as well.
Many people are lousy sleepers their entire lives. If you can potentially give your child the tools that it takes to be a good sleeper, and it only costs a week or two of crying, it is worth it, and you are giving them a gift for life.
The later the sleep training is done, the more difficult it is. If you wait until your little one is pulling themselves up to a standing position in their crib it is especially hard. When they first learn this skill it is usually one direction: Up. Most of them have not figured out how to drop back down.
Having a standing, crying baby adds a whole level of difficulty. Trust me. Do it before they are standing.
The very wise parent educator Julie Hartman reminds all of the parents in her classes. “This is something you do for your child, not to your child.”
On Night Feedings:
At some point, it may be beneficial for your baby to cut out night feeds.
Their little bodies have a lot of growing to do while they are sleeping. This should not include digesting food. Once they have started solids, it is time for them to learn this critically important lesson: nighttime is NOT the time for a meal.
“But they seem hungry and are so eager to feed when I go in.” Yep. Imagine if you woke up in the middle of the night and someone offered you a lovely warm chocolate chip cookie. Of course you would accept it. That doesn't mean you need it!
How to Sleep Train:
There are no firm rules about which method is best! With Nurse Judy’s first daughter they did the sleep training when she was 5 or 6 months: “I knew it had to happen. I was beyond exhausted. Reminding myself often of what we were doing and why we were doing it helped me stick to it. It also helped that my husband accepted the responsibility of being the primary sleep ‘trainer.’
Remind yourself that you and your partner are the ONLY ones who get to decide how you want to navigate this process. Each family has a different tolerance level for how much crying they are comfortable with.
Try to find a plan that you both feel okay with and then stick to it. Dr. Ted encourages his parents to “sign a solemn oath” after they’ve settled on one approach: babies thrive on consistency, and staying constant despite hardships will set you up for success.
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Different Kinds of Sleep Training
There are countless books and methods that go into great detail for their sleep training approach. We have given a taste of an array of methods that we’re familiar with down below.
Check and Console / Ferber Method
Nurse Judy’s husband started off following the classic ‘Ferber’ method. This involves going in to check on her and trying to settle her but waiting increasingly longer increments in between the visits. The first time might be 5 minutes, then waiting 10, then waiting 15… etc.
Sandy found that going in just made things worse. Poor daddy ended up just sitting on the floor outside her bedroom, while I was curled up in our bedroom also crying. (OK - Sandy just read this and said that never happened. He would go downstairs and watch reruns of the Man from U.N.C.L.E. ) On the 5th night, we put her in bed. She fussed for a few moments and then was quiet. We looked at each other in disbelief. It had been hard, but it was worth it,
Many of my patients also reported that their babies got more upset with the check ins and like us, ended up letting them just cry it out.
Extinction Method / “Cry It Out”
Putting them in and letting them simply figure it out on their own is called the extinction method. Some call it “cry it out”. It is in fact the fastest way to get results. Within a week or 2 of consistency 90% of kids are sleeping through the night.
But it is heartbreakingly difficult and there are some very stubborn outliers who take longer to learn.
Many parents resist doing the ‘cry it out’ (at least at first, until they cave). That’s fine! As we mentioned, there are hundreds of books, consultants and methods out there. Get familiar with some of the options and start with something that feels right for your instincts.
Possum
One of the gentler techniques is the possum method. This program was designed by an Australian doctor and emphasizes the importance of daytime interventions to build “sleep pressure” and use circadian rhythms to encourage good overnight habits.
For people who are really averse to letting their kids cry and aren’t in a hurry to have them sleep through the night, it might be a good fit. The downside is that it probably takes a lot longer than other methods.
Read more about the possum method here.
Nurse Judy’s Gentle-ish Method
I tend to fall somewhere in between the attachment parenting and the cry it out methods. I do NOT worry that your baby will have future psychological damage or attachment issues from a bit of crying at night. That is a lucky thing, because I also have found that even with the best routines, and watching for sleep cues, it is the rare infant who learns how to fall asleep without some fussing.
My favored method is relatively gentle. I tend to start with fairly low expectations. If a baby is getting adequate milk during the day, no one should need to eat more often than every 3 hours during the night (let’s consider nighttime as soon as you go to bed and until the sun comes up).
If they wake up sooner than 3 hours, someone can check on them. You will have much more success with sleep training if the non-breastfeeding partner is involved. Breastfeeding parents should not enter the room until it is actually time to feed (heartfelt hug to all the single parents dealing with this). The baby might need some type of comfort measure but feeding should simply not be an option until the magic 3 hour mark. Make sure you are calm before you enter the room. Take a deep breath. If you charge in there like a stressed-out hooligan, it will not be conducive to getting them back to sleep.
After a few days, stretch it to 3 ½ hours and so on. You can certainly check on them, change the diaper, even offer ½ ounce of water. If you think they might be teething go ahead and try some teething remedies. You are present for them, just not offering food (think about the above chocolate chip cookie). If you want to sit next to the crib and sing, that is up to you. The main lesson is that nighttime isn’t meal time.
Once they have shown you that they can go 4 or 5 hours at night, try not to backslide. It is okay to comfort them if they wake up, but I would do my best to avoid falling into the “feeding because it is easy” trap.
What if they’re sick or I’m worried they’ll go hungry?
If you suspect that your baby may be ill or truly hungry, in our opinion, that is not a good time for ‘crying it out’. If you’re worried, we often suggest folks come to the office for a quick visit and a weight check with their doctor so that we can make sure they are well (sometimes ear infections can cause sleep disruption). This is actually very common and shouldn’t make you feel like a “worried parent.” It’s much easier to let your child fuss a bit knowing that they are not sick and are gaining weight fine.
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Bedtime Rituals for Infants and Toddlers
Now that they’re four months old, establishing a consistent bedtime ritual becomes even more important. This is for everyone, whether you’re doing sleep coaching or not. When it’s bedtime, everybody should have some sort of night time tradition. Below is a sample routine, but obviously different things work for different people. You can create your own, drawing from the examples below:
Establish a quiet, calm energy. Some people choose to slow down their behavior, others will choose the nighttime as the time for a warm gentle bath. The warm water can be soothing and relaxing, just make sure to moisturize after every bath (water and soap are drying to the skin).
Turn the lights down low to dim. The low light tells the brain that it’s nighttime and induces natural melatonin production from the hypothalamus, the brain area that regulates sleep cycles.
Slow the mind: This is most often done by reading a book. The voices you chose and the energy with which you read can send messages. This is not the time to read something animated and excited.
Finish with a song. If you sing the same song every night, there is a Pavlovian association with the tune: it’s time to fall asleep. This was Sandy’s role and the song was In My Room.
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Naps: Age 4 Months to 2 Years
Most kids at this point will sense the difference between day and night and we still want to make sure their longest street of sleep is at night, but naps are critical to overall sleep health. If they’re not working, this will trickle down to your nighttime success.
Before we go any further, we need to stop and say that for most families, naps are messy. If there ever was a “do the best you can” situation, it’s with naps. It’s worth the effort because they are important. If you're having a hard time with them, that makes you normal.
But kids need those naps. Generally, a good napper is a good sleeper. Someone who is overtired from missing naps has an even harder time with bedtime. We know it is counter intuitive, but sleep begets sleep. Without naps, they actually don't end up sleeping as well at night. This is when many sleep consultants start talking about something referred to as sleep pressure.
“Sleep pressure” is the build-up of a biological drive to sleep… kind of like how hunger builds up the longer you go without eating. It comes from the accumulation of adenosine in the brain during wakefulness, which makes you feel sleepier the longer you’re awake. So when people talk about “building sleep pressure,” they usually mean keeping a kid awake long enough to make sure there’s a strong enough drive to fall asleep and stay asleep.
That’s why naps that are too long or too close to bedtime can totally mess with night sleep, because the pressure hasn’t built up enough. Same goes for early bedtimes that aren’t aligned with how long a kid’s been awake.
The balance between sleep pressure and overtiredness can get tricky depending on age.
As we mentioned earlier, newborns will snooze on and off throughout the day without much of a set pattern. Roughly at four months most kids are ready for a more predictable schedule, but schedule varies a lot from kid to kid because their individual sleep needs vary.
We have some rough sample schedules below, but understand that there can be lots of variations. In the reference section at the end of this post there are more samples for each age.
At 4 months, they generally need to sleep between 3-4 hours during the day. This is divided into 3 naps. The first nap is the easiest to plan. Time it for 2 hours after they first wake up. Keep an eye on the wake windows to figure out a natural schedule for your baby for the rest of the day.
At 6-9 months, the average baby now needs 2-3 hours of daytime sleep. This is often divided into two good naps with a third short ‘cat’ nap. Make sure they are up at least 2.5 hours before bedtime.
At 12-15 months, these toddlers need 1.5-3 hours of daytime sleep divided into 2 naps. Some daycares will mandate a 1 nap schedule for 12 month olds. This can be challenging to do but is still possible.
At 15 months (range from 12-20 months) they are usually able to consolidate the daytime sleep into just one nap! You’ll know they’re ready when they are consistently fighting the second nap. It is best to put them down for that one nap right after lunch. This nap can range from 1-3 hours. Make sure they are up at least 3 hours before bedtime.
It is really common for some kids to nap much better for a nanny or at daycare than they do with the more inconsistent parents. Kids can follow rules fairly well as long as they know what they are.
The best assessment for whether your child is getting enough sleep is how they seem. Are they well rested? Are they calm? Do they have dark circles under their eyes? A happy child who is sleeping well at night is probably getting enough sleep during the day. We’ve seen patients who get along very well with very limited naps (to the chagrin of their parents). They couldn’t care less about our graphs. Others seem to require more sleep. It all really depends on the child.
Just because many babies and toddlers will begin to resist their naps does not mean they are ready to drop them. We would try to resist dropping a nap as long as possible. But at some point, their schedule naturally changes.
When it is clear that your nap schedule no longer feels like it is working, don’t panic, take a few days to observe your baby’s new patterns, and adjust the schedule. Keep an eye on the lengthening wake windows and try to figure it out from that.
Of course, changing nap schedules also means that no doubt you have made many appointments that will no longer work. Sigh. Having a shifting nap schedule is always somewhat tricky!
Having a predictable schedule is ideal, but it obviously is not always possible. While first-born kids might have a schedule set in absolute stone, that all flies out the window with siblings. Many kids end up with their naps in the car or stroller on the way to school or activities…and they survive.
But, for the purposes of this post, assuming that you do have the luxury of a schedule that allows for a firm nap time, take advantage of it. Be consistent. Have a brief routine leading up to the nap, dim the lights, consider having a little quiet music playlist that you can set for a certain amount of time.
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Extra Tidbits
Swaddling
Remember, once your baby is regularly rolling from back to tummy it is no longer safe to swaddle.
Traveling
Even the best sleeper will need a tune up once in a while. Traveling babies almost always need an adjustment but these little tweaks are much easier than that first round of sleep training.
Take Shifts
As we mentioned above, while we strongly believe that the nursing parent should not go into the room unless they are ready to feed, there is no reason for both parents to be up all night. Try to establish a schedule where each of you gets a several hour stretch of being off duty!
Siblings
What if the crying is waking up an older sibling? Explain to them that the baby is learning how to go to sleep. Try a white noise machine, or temporarily move them to a quieter room if that is an option.
If the siblings are sharing a room, you can temporarily put an air mattress on the floor next to parents’ bed, just long enough for the younger sibling to figure it out. Bonus: it makes older siblings feel special (but don’t let them get used to it).
What about neighbors?
Sometimes a proactive bottle of wine, some ear plugs and a little note explaining that you are sleep training goes a long way.
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Hot Topics
🔥 Room Sharing
Having a baby sleep in the same room (but not bed!) with parents. Initially, the American Academy of Pediatrics recommended room-sharing through the first year of life. We are suspicious that none of the ‘experts’ handing down these edicts are parents. That was soon amended to six months of life due to some pushback.
Pro: The AAP guidelines refers to findings that demonstrate that there was less of a risk for SIDS in babies who shared a room with parents. We were not able to find any clear cause and effect here, but the numbers were consistent.
Against: Some parents might not sleep as well. Babies can be noisy (partners can take turns wearing ear plugs if that makes it more doable). On the other side, The little ones might also be more likely to wake up when they hear you roll over (or snore).
Our take: We agree that for at least the first four months it seems wise to keep the baby in your room. This is when the risk of SIDS is at its highest, and even though we can’t explain why the risk is lower when sharing a room. It is certainly easier where nighttime feedings are involved.
🔥 Dream Feeds
Waking a sleeping baby to offer milk before parents go to sleep for the night, oftentimes around 11pm, to encourage a longer stretch of uninterrupted sleep.
Pro: Some babies still need some calories at night. This can also help sync the babies longest sleep stretch with your own.
Against: They don’t work for everyone. Some babies might wake up fully and not go back to sleep easily. We also want to avoid the ‘feed to sleep’ association. Sleep consultants can worry that this full waking, if it happens, will alter the circadian rhythm.
Our Take: It works well for some people, not for others. If you’re struggling to get a long stretch that aligns with your own, it’s worth a try. Nurse Judy is a fan, but acknowledges that the majority of sleep consultants are probably against it for a reason.
🔥 Co-sleeping, Again
See above (we discuss co-sleeping between birth and four months), but things change a little between four months and two years.
Pro: Proponents will say that the risk of SIDS is less after four months. Parents sometimes feel like this is the best way to fall asleep, or at least involves less tears than the alternative. Some observe that “family beds” are a phenomenon all over the world.
Against: Kids are often noisy sleepers and some parents don’t sleep as well with one ear always clued in to baby’s little grunts. Having a child in the room is NOT generally conducive to intimacy. This can trickle down. Everyone in the family benefits when parents have a solid connection.
Our take: Every family is different. Wherever your child is sleeping, remember the tenets of safe sleep from above: firm surfaces, no drinking or smoking, no excess blankets or soft things, cool room.
🔥 Sleep Sacks
These are loose sacks that act as a blanket that you place your baby into at night. They provide a balance of light pressure around the body, with the ability to safely move arms and legs. Remember, once babies are rolling they should no longer be tightly swaddled.
Pro: Sleep sacks are considered very safe and take the place of blankets. They can be part of a routine and signal that it is time for sleep as soon as the sleep sack is put on.
Against: Weighted sleep sacks are considered unsafe by the AAP.
Our Take: Sleep sacks, like swaddles, are a tool. They are not a requirement, but infants who like to feel snuggled at night can find them very helpful. They also can be part of the sleep association. When they are in the sack, it is time to ‘hit the sack’.
🔥 Sleep Consultants
A sleep consultant is a person who knows how to navigate sleep training/coaching for kids. Parents can pay them for a variety of services, including text-based coaching or full in-person consultations and help.
Pro: Sleep is essential, but teaching your child to sleep can be highly overwhelming for many parents. Sleep consultants offer a more hands-on supportive approach to the process compared to what your pediatrician can offer.
Against: They’re an added cost, sometimes an expensive one. And it can feel overwhelming to navigate the opinions, sometimes strong, of others, when it comes to raising your children.
Our Take: Generations of babies learned how to sleep without one, but some parents benefit from the extra support. Sleep coaches have a wide range of approaches and costs so have a chat first to make sure it is a good fit. If you know that you are not able to listen to your baby cry, but you also want them to sleep through the night in their own bed, a sleep consultant is a great option.
🔥 Do all naps need to be in the crib?
Some naps happen in cribs, some in pack n plays, some in car seats, some strapped to your chest.
Pro: Pavlovian conditioning can work to your advantage. If sleep is always in the same crib, the brain can be trained to become sleepy when always put back into that environment.
Con: It can be stifling and restrictive to feel strapped to a nap schedule that always includes the same crib. Parents can’t get out, they’re pinned to the house.
Our take: This is nice if it works. You’re leveraging science to your advantage. But you don’t need to bend over backwards to fit this into your life. Trying to be firm about at least one nap a day in their crib/bed can help with consistency. But we realize that if you have more than one child, the baby might be doing more naps while out and about. It is what it is; do the best you can.
🔥 Lovey and Blankets
A “lovey” is a soft, comforting object, such as a small blanket or stuffed animal, that provides emotional security and helps soothe the baby, especially during sleep or times of separation.
Pro: Loveys are an opportunity to create a safe and cuddly association when your baby is sleeping away from you at night.
Against: The AAP recommends against Loveys under a year due to safety and suffocation concerns.
Our take: While many infants under a year don’t technically need a Lovey, they can be comforting to some. If you’re going to use one, follow these tenets to keep your baby safe:
Small and lightweight to reduce suffocation risk (typically no larger than 12 x 12 inches).
Firmly constructed with no loose parts (e.g., eyes, buttons, or ribbons that could detach).
Breathable materials like cotton or muslin, avoiding plush or heavy fabrics.
No long strings, loops, or tags that could wrap around the neck.
Washer-safe and durable, as it will likely be mouthed and need regular cleaning.
Age Two to Three, Including Crib Graduation
There are a variety of signs that will alert you that it is time to move the baby out of their crib:
If they are over 35 inches tall and are starting to outgrow the space
If they start asking for a ‘big kid’ bed
If they start climbing out on their own and it no longer feels safe
In Nurse Judy’s case, her first daughter Lauren took it to an extreme and proudly showed mom how she could balance on the crib rails. Oy.
It is important that the new bed be low and safe. Explore some toddler rail options that can keep kids from falling out. Some parents opt to keep the mattress on the floor for the first several weeks. A pool noodle placed under the sheets makes a nice little edge.
Once the kids are freed from the confines of the crib, there is usually a bit of an adjustment. The biggest issue is the newfound ability to wander out of their room. Even if they used to be a good sleeper, many kids may need a little help learning to stay put. If your child decides that they need to show up in your bedroom several times a night, it can get exhausting.
What often makes this especially hard is that most parents have finally gotten to the stage where they generally are able to sleep through the night. Being woken during the night by a visiting toddler has an element of PTSD. If you have a consistent wanderer on your hands, consider getting a chime on their door so you will be aware that they are roaming.
Nurse Judy shares: We did NOT have a chime on the door. Both of my kids had the unnerving habit of entering my room, coming to my side of the bed and just staring at me until I woke up. It wouldn’t take long until I was jolted out of a deep sleep (interestingly, our golden retriever would do the same thing if she needed a middle of the night pee).
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Naps (or Quiet Time): Age 2 to 3 years
There was a comedian once talking about how most adults would happily trade places with their toddler. “Hey, you don’t want to rest a bit? I will take your nap! You go and figure out what to make for dinner.”
Most kids at this age strongly benefit from a nap, but some resist them so strongly that parents give up the battle. Wait, not so fast. That break in the day might be just as important for the parents as it is for the kids. There is a middle ground. These nap-free kids can have some scheduled ‘quiet time’ in bed or on a mat at daycare.
How to navigate a quiet time:
Consider having a ‘quiet time playlist.” They can be taught that it is nap time/quiet time in bed until the music stops. There are toddler-friendly ‘podcasts’ (basically being read a story). This is the same concept. Choose something that lasts a specific amount of time. They can get out of bed when it is finished. Toddler clocks can also be set so they know when they are allowed to get out of bed.
A video monitor with a microphone that allows you to talk to your child can be a huge asset. In other words, “It’s still quiet time, get your ‘asset’ back to bed!” Be consistent and don’t wait until they are out of the room. If they do make it out, bring them right back to bed. Either say nothing or a short phrase such as, “rest time.”
As they get older and claim not to be tired, having the set habit of ‘quiet time’ can be beneficial, even if they don't fall asleep.
At some point your child might make a case that they no longer need quiet time. You can work with your child to come to an agreement. The most obvious criteria would be that If they’re having consistent meltdowns at the end of the day, it’s a strong indicator that they’re not yet ready. This can be a bargaining chip for avoiding a tantrum. “You’re showing me that you’re tired, skipping quiet time isn’t working.” Get it together, bucko.
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What to do when they come out of bed in the middle of the night
Younger Kids
If less than 3 years, be consistent with your expectations. If they wander, simply return them calmly to their room. The only thing you say is Sshhh, it’s bedtime. Shhh bedtime." Once they are back in bed, tuck them in, pat them a few times and leave.
For the first week you might find yourself doing this multiple times per night. Say nothing else. “Shhh Bedtime!” Keep physical and eye contact to a minimum.
Older Kids
Older kids (typically older than 3 years) can still tend to have challenges getting settled. Night time is not the best time to reinvent your bedtime routine. Creating an improvement plan with your child as a key member of the team should ideally take place earlier in the day when they have your attention.
These are the kids with whom you can reason. Talk about how important sleep is. Read bedtime books. The library is full of great ones. Tell stories about other children who are learning to have good sleep habits. Nurse Judy likes telling stories about the “cooperative” and the “not so cooperative” child. The troublesome child gets into all sorts of trouble and everyone is grumpy. The positive role model figures out a way to stay in bed. Everyone is proud. Yada yada yada….. Make the stories nice and silly to keep them engaged. Problem-solve with them ahead of time for ways to manage their issue without leaving their bed.
Why do kids get out of bed?
Once the lights are out, you want to minimize conversation. Evaluate the possible issues ahead of time and talk about them.
Need to Pee? Get in the habit of going to the bathroom before getting into bed.
Thirsty? Have a little sippy cup of water next to the bed.
Lonely? This is the perfect time for a special new stuffed animal or favorite blanket
Scary Shadow? Be detectives. Turn on the light and figure out exactly what is making that shape
Creaking noise? Detectives again. Shh listen. See if you can figure out what is making that sound. Maybe it is a branch scratching against the window. Or an owl, or the pipes.
Worried about a monster? Do not look in the closet or under the bed to make sure the coast is clear. That would validate the possibility that there is a monster lurking somewhere. This is a daytime discussion and activity. Tell them that smart kids have amazing brains and good imaginations. Do some exercises using that power. Draw the most frightening monster that you can conjure. Then add a pair of polka dotted underwear on that monster’s head. Now put a lollipop in their hand. There, that monster has turned from something scary to something silly.
Even if your creative kid has something else that we left off this list, most of them tend to repeat the same playlist. Try to anticipate, have an answer and be consistent.
Focus on appropriate rewards and consequences and make sure they make sense. For instance:
Reward for letting parents sleep? Parents are rested and in a good mood, follow through with fun activity.
Consequence for waking parents up? Everyone is grumpy, and may need to cancel the activity.
The One Week Sleep Reset
Once in a while, your normally good sleeper might go through a phase of tricky sleeping. Assuming they are old enough for reason and logic (usually 4-years or above), here is something you can try:
Find a moment when they are receptive (not bedtime)
Talk about the fact that bedtimes need to be better
Have them help you pick out 14 little, inexpensive, age appropriate toys or treats
Wrap them up like gifts
Each night, your child has two passes. They need to turn in one of the passes every time they need something.
An unused pass can be redeemed in the morning for one of the prizes
At the end of the week, any unclaimed prizes are given to another child who needs a treat, or put away for a later time.
It is important to know that in the immediate time frame they can amass 14 items. They are missing out on any prizes that they didn’t earn. Be clear that earning prizes for staying in bed has a firm expiration date. One week only.
This is a reset, not a new world order. If you don’t want to fuss with prizes and passes, that is fine.
Ages Three to Adulthood: Sleep Hygiene and Good Sleep Habits
Bedtime Rituals for Preschoolers and Older
Establish a ‘last call’ for food. If you are consistent this can eliminate the “but I’m hungry” stalling tactic. Shoot for foods conducive to sleep and avoid high sugar. A glass of warm milk or other warm liquid works great (unless they’re potty training in which case you’d be shooting yourself in the foot).
Limit screens to no closer than 60 minutes before bed (science suggests 90 minutes is ideal, but those scientists aren’t living in your house).
No rough housing 30 minutes before bed.
Read books, tell stories, or do a bedtime meditation. A low and slow cadence in your voice can be soothing.
Make a bedtime book.
Keep in mind the value of pillow talk as a great time for some real communication and connection
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Troubleshooting Insomnia
Some people figure out sleep from a young age, and sleep deeply and perfectly for the rest of their lives. We’ve never met them. Most people will struggle with sleep off and on, some more than others, and that’s normal. Moving through the different life stages will provide new opportunities to disrupt sleep patterns, especially the move to adolescence and puberty.
Insomnia is considered chronic if it lasts at least three days per week for three months or longer.
If you or your child are having sleep issues, start playing detective to see if you can figure out an obvious source.
Here are some things to consider:
Schedule
A regular schedule is arguably the most important consideration when addressing insomnia. An erratic schedule is one of the biggest causes of sleep issues. Does this feel familiar? You had a rough night and ended up taking a nap. Now, when it is bedtime, you can’t fall asleep. Or you have a teenager. On weekends they stay up until all hours of the night. They end up sleeping in very late. Some kids are still in bed at noon. Sunday night, they can’t fall asleep because they haven’t built up enough sleep pressure.
For those teenagers, we need to add a frustrating side note: school schedules are not biological, especially at that age. Waking up early for adolescents is NOT natural. This factor can also sabotage good sleep, but the sad fact is, most families have to figure out a way to make it work.
There is one benefit of getting up and out early. Exposure to sunlight in the morning can actually help your sleep at night because it helps reset your circadian rhythm. Light is an important cue for your body’s sleep cycle, it actually helps to encourage a circadian rhythm in the hypothalamus, one of the brain’s sleep centers. If you are living someplace where this is challenging, consider getting a lamp that mimics daylight.
A week or so of rigid bedtime and wake up, and getting a regular dose of daylight can make a huge difference. That trains your brain to release melatonin at the same time before bed every evening, and release cortisol to wake you up every morning. Without consistency, your body won’t know when to send the signals to make these processes more automatic.
Evaluate stress factors
Pay attention to obvious triggers like starting a new school or changes going on in the family.
We need you to hear that more than half of our teenage patients suffered from at least occasional anxiety. If anxiety feels prolonged… there should be no stigma to exploring therapy options! A good therapist can help give you or your kids an array of tools for dealing with it.
Managing the environment
Is the room conducive to sleep?
A cool room is better. If it is too warm, do you have options for adding some type of cooling unit?
Is it dark enough? Consider black out shades or just a simple eye mask
Is it noisy? Consider a white or brown noise machine. There are also a wide array of earplugs. It is worth trying some to see if they are comfortable.
Habits: Things to Avoid
Screen time: For several hours prior to going to sleep can be an issue. I know this is hard for folks who are trying to finish up homework, but all the specialists are emphatic about this. Try to get your child to do any computer focused homework out of the way first.
There is some science behind this. The light on the retina causes the hypothalamus (the brain's sleep center) to think that the sun is out and makes it less likely to be ready to fall asleep. At the very least, try using a program such as f.lux or nightmode that adjusts the blue light.
Obviously screens are not just for homework. They often include drama and excitement from gaming or watching a show. Social media can be a minefield. Good or bad it is likely to trigger emotions and is NOT conducive to sleep. We see you bingeing that show. If you are having trouble sleeping, cutting out some screen time should be your plan A.
Vigorous exercise: Exercise is good for you, but too much right before bed can elevate the heart rate, body temperature, stimulate the nervous system and increase stress hormones. All of this can interfere with the processes needed to fall asleep. Any exercise that is done without several hours of bedtime should be relatively mild.
Watching horrible headlines: It is important to know what is going on in the world, but watching upsetting news right before you try to fall asleep is setting you up for failure, or at least terrible dreams.
Habits: Better Choices
Engage in relaxing activities such as gentle stretching or a nighttime yoga routine. Listen to soft relaxing music. Meditate.
Diet Considerations: Foods to Avoid
Caffeine can hide in all sorts of foods and drinks. Coffee is the obvious one, but many people don’t realize that eating chocolate and drinking sodas are common culprits.
Sugar is a simple carbohydrate that is quickly absorbed into the bloodstream, causing a spike in the blood sugar levels. This spike can stimulate the body and make it harder to fall asleep.
Alcohol might make you feel like you can fall asleep more quickly, but it ultimately disrupts good sleep quality. It can interfere with the REM sleep, which is the most restorative phase of the sleep cycle.
Spicy food might trigger heart burn, reflux, leading to indigestion which makes it harder to relax. It can also cause elevated body temp. There are some folks who sweat that spicy food can be connected to vivid dreams. It is hard to find hard data on that other than anecdotal reports.
Diet Considerations: Better Choices
If you are hungry before bed, a light snack with protein and a complex carbohydrate (eg, a slice of whole grain toast with peanut butter, or greek yogurt with oats) may support better sleep, especially for people prone to early waking. Tryptophan, an amino acid found in protein-rich foods like turkey, dairy and nuts is a precursor to serotonin and melatonin which regulates sleep. Stable blood sugar from a balance evening snack might reduce nighttime waking.
Chamomile tea with a splash of warm milk has the combo of the tryptophan from the milk and chamomile in a nice soothing nightcap.
Stimulus Control
Creating a strong association that bed equals sleep is one of the strong suggestions from sleep experts. In other words, your bed should not be for eating, or being on your computer. (Guilty, guilty, guilty).
For the older kids, teens or adults that are having a tough night, don’t stay in bed tossing and turning any longer than thirty minutes or so. Instead, get out of bed and go sit in a chair or desk and do something boring. No screens! Color in a coloring book, do some needlework. This is not the time to read any book that is a page turner. One way to ensure a teen gets back in bed is to limit their reading options to their textbooks (good luck!). After fifteen minutes get back in bed and try again.
Managing the Busy Mind
Why is it that the most brilliant ideas happen in the middle of the night? Or you think of something essential that you need to deal with the next day and you are afraid you will forget what it is. Have a pencil and pad next to your bed and jot down all the jumbled thoughts. Writing them down can sometimes help release them.
Physical Health
Snoring: If somebody is consistently snoring, we would suggest checking in with an Ear Nose Throat (ENT) specialist to see if there could be tonsils or adenoids impacting sleep. Sleep apnea is also more common than you might think and is a major driver of adult (and adolescent) insomnia. Many ENTs will start with a 3-month course of nasal sprays if they find swelling, but it’s usually best to let them, or a pediatrician, check.
Anemia: As Dr. Ted mentioned in his section in the beginning, insomnia has a strong connection to anemia. Studies have shown that people with low iron, even without being anemic (having a normal hemoglobin), can be restless and have a hard time falling asleep. Iron plays a critical role in the production of dopamine, a neurotransmitter that regulates the sleep-wake cycles and movement. When iron is low, disrupted dopamine signaling may lead to fragmented sleep, frequent night wakings and trouble staying asleep. We think it’s worth checking: aside from the need to go to a lab and get a little poke, there is no downside to making sure your diet is getting adequate iron,
Vitamin D: While you’re checking your iron levels, consider checking vitamin D. Low vitamin D levels have been linked to sleep disturbances, including insomnia, shorter sleep duration, and increased daytime sleepiness. This may be due to vitamin D’s role in regulating melatonin production and inflammation, both of which influence sleep quality. While more research is needed, maintaining healthy vitamin D levels, through sunlight or supplements, might support better sleep.
Magnesium: Low magnesium levels have been associated with poor sleep quality, insomnia, and restless sleep, likely due to magnesium’s role in regulating neurotransmitters like GABA that help calm the nervous system. Some studies suggest magnesium supplementation can improve sleep efficiency and reduce nighttime waking, especially in older adults. It’s not a cure-all, but some supplements have been reported to help with sleep. Check with your doctor before trying the supplements, they can interfere with the absorption of some meds such as antibiotics or thyroid medications.
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Treatments for Insomnia
CBT-I (Cognitive Behavioral Therapy for Insomnia)
This is the gold standard, evidence-based treatment for chronic insomnia. It focuses on breaking the cycle of negative sleep thoughts and behaviors. It combines techniques like sleep restriction, stimulus control, and cognitive restructuring to improve sleep quality without medication. Studies show it’s more effective long-term than sleeping pills, with lasting improvements in both sleep duration and satisfaction.
Think of it as a way to help you avoid spiraling. “OMG my alarm goes off in 5 hours and I can’t fall asleep… NOW it’s 4 hours… OMG. We have all been there, unable to fall asleep the night before we have something important scheduled. For so many, we turn a sleepless night into a catastrophe. CBT-I gives you tools for managing your mind. The key word here is therapy. Just reading about it isn’t a magic wand. Find a therapist who offers this service. There are also many group sessions.
Acupuncture
Acupuncture is a traditional Chinese medicine technique that involves inserting thin needles into specific body points to balance energy flow (although for young kids or people who are needle-phobic, they don’t always use needles). For insomnia, it may help by regulating the nervous system, increasing melatonin production, and reducing stress hormones. Clinical trials suggest modest improvements in sleep quality, especially for people with anxiety-related sleep issues.
Hypnosis
Hypnosis for insomnia uses guided relaxation and focused attention to help shift the mind into a more restful state. It can reduce the arousal and anxiety that often interfere with falling or staying asleep. While research is mixed, some studies show benefit in improving sleep onset and depth, especially when paired with other relaxation techniques.
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Hot Topics for Big Kids
🔥 Melatonin
Melatonin is a naturally occurring hormone produced by the brain to induce sleep, which can also be taken as a supplement for insomnia.
Pro: It’s naturally occurring, so it can be an attractive option for those seeking a non-pharmaceutical option for insomnia.
Against: We’re still early in our understanding of the effects of taking supplemental melatonin. High doses over 3mg can cause drowsiness the next day. Long term use of melatonin or any chemical sleep aid can decrease efficacy over time and cause psychological dependence.
Our Take: Occasional use of melatonin is fine. Especially if it is to get over jet lag or to help you get a good night's sleep before an important test or event. Long term use of anything is not a good idea and can be habit-forming. We would rather encourage good habits that naturally increase melatonin levels, like keeping a regular bed/wake time and decreasing light/stimulation before bed (see above).
🔥 Prescription Drugs
We won’t get into a typical hot topic discussion of prescription sleep aids like Ambien, Lunesta, etc. However, we wanted to mention that they’re very addictive and habit-forming. If you need the same med for more than 2-3 nights in a row, talk to your doctor about a better option.
🔥 CBD (Adults Only)
CBD may help with sleep by reducing anxiety and improving sleep quality, with small studies showing benefits at doses between 25–160 mg/day. However, evidence is mixed, and many studies include THC, making it hard to isolate CBD’s effects. Lower doses may actually be stimulating, while higher doses appear more sedating. Over-the-counter products vary widely in quality and often contain melatonin, so it’s unclear what’s truly effective. While some adults may benefit from short-term use, CBD should be considered a second-line option, and patients should be aware of potential drug interactions via liver enzyme pathways.
If you’re going to try CBD, make sure it’s from a reputable establishment with consistent dosing. And if you’re finding you need CBD nightly, we would still prefer that you find a behavioral solution over a supplement (see above).
Reference Section
Above: The American Academy of Sleep Medicine’s recommended total sleep hours per day. The light blue represents the range of “normal” by age.
A sample nap schedule for a 4 month old
Wake up: 6am
First nap: 8am (sleep until 9ish)
Second nap: 11:30am (until 12:30ish)
Third nap: 3pm (until 4ish)
Bedtime at 7pm
There can be many variations to this, It is important that they are awake at least 2 hours before bedtime.
6-9 month sample nap schedule
At this age, the amount of daytime sleep is now between 2-3 hours total.
There is a noticeable change in the wake windows and it is easier for them to stay awake for 21/2-3 hours now.
A sample schedule might be:
Wake up: 6am
First nap: 8am (wake up 9:30-10)
Second nap: 12:30pm (wake up 1:30)
Cat nap: 4pm (wake up 4:30)
Bedtime: 7-7:30pm
9-12 month sample nap schedule
Usually they are down to 2 naps a day.
12-20 months (average 15 months)
Hive Mind
Quote from mama Tamar:
I have a lot of specific advice and wisdom, especially hitting the late evening wake windows in time, but the greatest overarching theme is that ya can't win it all, and even the best laid plans sometimes slap you right in the face. Cuz humans are unpredictable and baby humans even more so. So do your best, and then know when to shrug and laugh off what a nightmare the day has been, and that tomorrow is a whole new day. I have found that finding that balance between intentional planning and going with the flow serves me well in all aspects of parenting, heck, and life.
Tip from Mama Rachel:
When our daughter was a newborn, she wouldn’t tolerate being put down for a second. Our doula suggested that we put a warming pad in the crib to make it cozy before putting her down. It was a major game changer!
