How can I get my baby to sleep? Dr Pamela Douglas & Jennifer Leake ABC Radio National 1_04_21

This is an extract transcript of a conversation between the Medical Director of Possums & Co, Dr Pamela Douglas, and journalist Jennifer Leake of ABC Radio National.

Jennifer:

Sleep. Getting enough of it makes a huge difference to your life! The less sleep you get, the more anxious you get about not getting enough sleep. There's nothing worse than dragging yourself through the day when you haven't had enough shut eye. Getting your baby to sleep well is good for them and good for you, but how to get little ones to sleep is a problem that pretty much all parents face. There's no shortage of advice though, but it can often be contradictory, sometimes overwhelming, especially in your wrung out under slept state.

Parents are given a lot of familiar advice around infant sleep. Don't let your baby get over tired or overstimulated. Don't feed them to sleep, get good daytime naps and so on. But I'm going to visit a clinic in Brisbane, which says you can forget all of that and just trust that your baby will get the sleep it needs. Here's Dr. Pamela Douglas, a GP and Medical Director of the Possums Clinic.

Pam:

Parents are being told that that if you don't get good sleep habits now your child may not reach their full cognitive potential and in fact may be more at risk of behavioural problems. Now these are things that parents are actually being told very regularly on the ground. I've got to tell you, it makes parents really, really worried. I mean, If I say that to get your child's best developmental outcomes, you've got to do this and this, you'll walk over hot coals to do it.

Let's look at newborns. You can have a newborn who really is just sleeping nine hours in a 24 hour period, maybe just half an hour total during the day. It does pose challenges for parents, but these are normal babies. And then you'll have a newborn who's sleeping literally twice as much in a 24 hour period, still normal and the same developmental outcomes. One baby is born needing a certain amount of sleep to begin with another one another. It's like the colour of our skin, the shape of our bodies, our sleep needs are biologically determined and highly variable.

We start by setting the circadian clock with a fairly crisp wake up time every morning. This is really important. We're not saying get your rigid bedtimes at night. We're saying let's get a really reliable get up time in the morning and then move into a day that's full of rich sensory nourishment, not focused on sleep at all. Sleep happens as if the bubs just fitting into your day, basically outside the home.

Then in the evenings, again as is happening during the day, sleep is being driven by sleep pressure. The homeostatic sleep pressure is a biological need for sleep that builds the longer you go without sleep. If a baby's sleep pressure, isn't high enough, getting to sleep will be a struggle. The idea that sleep is driven by sleep associations and that we have to teach our baby sleep associations to go to sleep really doesn't make sense. Biologically, sleep is controlled by sleep pressure. And so, we're often asking our little people to go to sleep before the sleep pressure is high enough.

We don't talk about tired cues because often when parents are being given these lists of tired signs, they're being taught to interpret their baby's communications in ways that may actually be very unhelpful. For instance, a little one might be dialling up inside the house during the day, getting a bit cranky. Sure, the sleep pressure might be starting to rise, but actually as soon as you step outside and change the sensory environment, that little one's dialled down and happy to be engaged with the world for quite a lot longer yet before the sleep pressure really is high and sleep is easy.

So similarly, in the evenings, we're actually letting sleep pressure be the guide. If we're using a crisp get up time each morning in the family so that the circadian clock really is set in a healthy way, then sleeps happen during the day flexibly and in the evenings we're just waiting till that sleep pressure is really nice and high and then you know that the little one's going to drop off to sleep really quickly. Let's say with the breastfeed or with the bottle.

Jennifer:

After parents have had an initial consultation at Possums, they're able to attend free support clinics that are run every fortnight. Mothers and babies gathered to share stories and ask the Possums staff questions. I caught up with a group of mums after a session.

Mother #1:

You read a lot online about cues and that was the thing that stood out to just annoy me because there's this list of cues as long as your arm and it all means he's tired or he's hungry, and then you're supposed to put him down drowsy, but awake and you're supposed to feed every four hours. So you're supposed to meet these cues. But only in this way and if you're not doing that, then you're doing it wrong?

Jennifer:

You took up that idea of perhaps letting her sleep less during the day and lots of sensory exposure. And how did that work for you?

Mother #1:

Yeah, it was fine. I was sort of creating the sleep environment so she would look a little bit tired and I'd close the curtain, swaddle her up, put in the dummy, check her into bed with the white noise. She had this glorious two hours, which was great for me because I cook in my house and do my laundry and whatever. So it wasn't that hard to just open the curtains and she sleeps less and she's a little bit grumpy in the day getting less sleep, but she sleeps at night better.

Mother #2:

I think we're kind of back to front in that we were naturally doing the Possums way when he was younger and it was working, so very early on, he actually slept bigger chunks at night and pretty much didn't sleep during the day. I was lucky. I had a lot of friends with babies, so I just went, 'ah, I've got a non-sleeper, like my other friend, so I didn't worry about it'. We were fine. Then I think over time, all those voices get to you. I was like, 'oh, he's not normal' or, you hit a patch where things aren't quite as good and you go, 'oh, it's because he's not sleeping during the day or he's not doing this'. So I think we got a bit mixed up the other way in that we were doing it and then stopped.

Jennifer:

Your, your baby is 10 months old (Mum #1). You've obviously had some good patches and bad patches in terms of sleep, looking back on the last 10 months, how's it been for you emotionally and your partner? How have you weathered all of that?

Mother #1:

I think we're lucky in that we have very similar approaches. He supports me and we tried the whole 'ah, we've seen the sleepy cue he needs a nap'. A three-hour battle later, he slept for 40 minutes and we just went: that was not worth our entire Saturday. I've stopped obsessing as well. I don't know how often he wakes at night because I don't care. I mean, obviously I'd love to sleep through it. That'd be great, but you just stop counting and stop looking at it and just be relaxed and you can actually enjoy your baby rather than trying to make him fit the mould.

This conversation first went to air in 2018 and can be listened to in full here.