Has COVID-19 made things worse for baby and parent sleep?
Flinders University researchers recently released a press statement about two infant sleep studies, though importantly, these studies are still only reported as abstracts or online conference presentations when I went looking today. It's not clear the extent to which they've been subject to peer review. That makes it difficult for me to critique these studies in depth. But since the press release is already out and being picked up online, here are my thoughts.
The first study monitors sleep in 602 children in the USA between 1-30 months of age, between mid-March and mid-May 2020, using auto-videosomnography technology.1 According to the abstract, the data shows earlier bed-times, longer daytime sleep durations, later time of waking in the morning, and more fragmentation of sleep and wakefulness at night in those children whose mothers were ‘sheltering in place’ due to COVID-19. This disruptive effect on sleep was most pronounced in March 2020. In her press release, first author Dr Kahn interprets this data as showing that working from home presents an opportunity for parents to get more sleep for themselves and their infants. However, I would interpret this data quite differently. I would argue that this data, at least the results available in the abstract, demonstrates the disruptive effects of constrained opportunities for environmental enrichment or sensory nourishment during day.
This is because, in the context of limited environmental enrichment, or limited opportunities for sensory nourishment, infants typically dial up and become difficult to manage. Parents are told by health professionals and in social media, applying the sleep training or first wave behavioural approach, that they should treat this upset behaviour as ‘tired signs’ and get the little one to sleep. Over a week or two, this increased day-time napping causes disruption to the circadian clock, resulting in worsened or more fragmented night-time sleep patterns. In fact, this is the kind of sleep pattern disruption that the Possums Baby and Toddler Sleep Program (known in the UK as Sleep, Baby and You) both protects against, and repairs.2-5
In the abstract of a second study, parents of 946 infants between 2 weeks and 18 months of age had their sleep measured by auto-videosomnography for 14 consecutive days in the home-setting.6 Every additional visit the parents had to make to the crib in the night was associated with a 31% increase in the likelihood that parents would report an infant sleep problem. The authors interpret this study as showing that it is parent rather than infant behaviour which predicts baby sleep problems (although in the absence of the data to analyse, it seems possible that the researcher's interpretation confuses association with causation). Shorter infant sleep duration, lower parental cry tolerance, and greater parental depression levels were other factors which predicted reports of baby sleep problems.
Again, we can't see the data to decide if parents were experiencing what I would define as normal or excessive night-waking in this study. Either way, dominant sleep training approaches inaccurately warn parents that the baby or toddler should be sleeping through the nights or for very large blocks of time at certain ages. Yet night waking, even up to every couple of hours, is developmentally normal between 2 weeks and 18 months of age (as long as everyone is back to sleep quickly and the infant is not experiencing long wakeful periods in the night, which signal disrupted sleep patterns). It is completely understandable, then, given the inaccurate advice parents receive, that parents worry a great deal if their little one is not achieving stipulated ideals concerning 'sleeping through the night'.7 The Possums Baby and Toddler Sleep Program gives accurate information about developmentally normal sleep in this age-group, which in itself reassures parents – and also offers strategies to put in place when sleep patterns are disrupted and night-waking is excessive.2-5
The Flinders University team also showed in a 2019 study which is again reported only in abstract form, that of 215 parents of infants aged 6-24 months, half had tried a graduated extinction (sleep training) approach, and 83% of those who had tried reported they experienced difficulty implementing it.8 The authors interpret these findings as showing that some parents are unable to tolerate their little one’s cries, and propose that there is potential to use visual and audio distraction techniques to increase parents’ capacity to ignore the baby's cries as they implement sleep training. I worry about this interpretation of their findings – because in fact, all the latest developmental neuroscience shows that responding to a baby or toddler’s expression of distress is best for developmental outcomes.9 Again, in contrast, the Possums Baby and Toddler Sleep Program shows parents that there is a way to set-up manageable nights, and doesn’t involve tolerating their baby’s cries.2-5
As parents, we feel upset and want to respond when our little ones cry, and that's biologically normal. Why wouldn't we use approaches that make life with a baby as as easy as possible? That means working with our small child's biology, not against it. Before all else, we just want to be able to enjoy having that precious little person in our life!
1. Kahn M, Barnett N, Glazer A, Gradisar M. Infant sleep during COVID-19 in the USA: longitudinal analysis of auto-videosomnography data (abstract only). Journal of Sleep Research. 2020;29(Suppl S1):72-73.
2. Whittingham K, Douglas PS. Optimising parent-infant sleep from birth to 6 months: a new paradigm. Infant Mental Health Journal. 2014;35:614-623.
3. Douglas PS. The Possums Sleep Program: supporting easy, healthy parent-infant sleep. International Journal of Birth and Parent Education. 2018;6(1):13-16.
4. Ball H, Douglas PS, Whittingham K, Kulasinghe K, Hill PS. The Possums Infant Sleep Program: parents' perspectives on a novel parent-infant sleep intervention in Australia. Sleep Health. 2018;4(6):519-526.
5 Ball H, Taylor CE, Thomas V, Douglas PS, Sleep Baby and You Working Group. Development and evaluation of ‘Sleep, Baby & You’ - an approach to supporting parental well-being and responsive infant caregiving. Plos One. 2020;15(8): e0237240.
6. Kahn M, Barnett N, Glazer A, Gradisar M. Does your baby have a sleep problem? Auto-videosomnography deerminants of parent perceived infant sleep problems. Journal of Sleep Research. 2020:32.
7. Paavonen JE, Saarenpaa-Heikkila O, Morales-Munoz I, Virta M, Hakala N, Polkki P, et al. Normal sleep development in infants: findings from two large birth cohorts. Sleep Medicine. 2020;69:145-154.
8. Whittall H, Kahn M, Pillion M, Gradisar M. Graduated extinction and its barriers for infant sleep problems: an investigation into the experiences of parents. Sleep Medicine. 2019;64:S418
9. Leclere C, Viaux S, Avril M, Achard C, Chetouani M, Missonnier S, et al. Why synchrony matters during mother-child interactions: a systematic review. Plos One. 2014;9(12):e113571.