Is your baby or toddler waking really frequently at night?
Maybe they’re waking hourly or every sleep cycle (or even more often!) for some or all of the night…and you’re wondering what on earth’s going on?
Frequent night wakings are not only EXHAUSTING, they can be a real puzzle!
But now you’re here, hopefully I can help shed some light on this for you.
Before we get into the likely culprits, please know that…
Firstly: you’re not alone
Very frequent night waking is a common baby sleep challenge – in fact it’s probably the most common baby sleep ‘problem’ that I help parents with.
Secondly: there is good news!
Once you know what’s causing your little one’s wakefulness, it’s usually possible (with a few tweaks or changes) to get to a place where they’re sleeping for longer stretches – and everyone can have more restful nights! Zero sleep training required. This is what I help parents with every day!
Okay, so let’s get into it and take a look at…
Common Causes of Frequent Night Waking
1 – Temporary Illnesses
Many parents find that their little one is more wakeful when they’re unwell. And that’s simply because many illnesses cause pain or discomfort which can make it hard for little ones to sleep soundly. If your little one is breastfed, you might find they also want to feed more frequently at night for comfort/pain relief and to dose up on antibodies too.
So if your baby or toddler suddenly becomes more wakeful, definitely keep an eye out for signs of illness – sometimes it can take a day or two for symptoms to become visible to parents or caregivers.
The good news is that sleep usually improves again pretty quickly once a little one is feeling better – so if this is the cause of the wakefulness, hopefully it won’t be for too long!
2 – Health Conditions
While they only affect a relatively small percentage of babies and toddlers, it’s really important to be aware that there are a number of health and developmental conditions that can affect sleep and cause a little one to be more wakeful than they otherwise would be.
Health conditions may disrupt sleep either because they cause pain or discomfort, or because they affect functions in the body or brain.
Some of the more common health conditions that have been found to be associated with increased wakefulness include: food allergies [1], atopic dermatitis (eczema) [2], feeding issues that can prevent baby from feeding to full satiation [3], sleep disordered breathing (including sleep apnea), iron deficiency anaemia (IDA) [4], gastroesophageal reflux disease (GERD) [5] and some neurodiverse diagnoses – e.g. autism and ADHD [6-9].
Please note these are examples and not an exhaustive list of potential possibilities. Your little one’s healthcare professional is best placed to consider and investigate possible health-related causes of wakefulness. And it’s always important, if your little one is very wakeful at night, to make this your first step.
If you don’t have any specific concerns about health or development, it may still be worth having a review with your healthcare provider, even if just to rule them out for peace of mind.
3 – Separation Anxiety
I’m not a huge fan of the term ‘separation anxiety’ (even though it’s an official, scientific term) because it’s actually 100% normal for babies to need to be close to their parent or caregiver, AND 100% normal for them to become stressed if that need is not met.
It’s the biological norm for human babies to sleep in close proximity to a caregiver – either in their own little bed within arms reach, or bed sharing (sharing the same sleep surface) with their parent/caregiver. They’re wired to sleep this way for safety, warmth and to feed on demand.
It’s really only been in the last 100 – 200 years – and mostly in Western (especially English-speaking) cultures – where it has become more common for babies and children to sleep separately from their parents/caregiver, often in their own nursery / bedroom.
Some babies and toddlers are completely fine sleeping on their own at night. (Quick note: from a safe sleep perspective, it’s recommended that babies share a room with their caregiver until at least 6 months old). But others have a strong need to be close to their parent or caregiver and can become stressed if that need isn’t met. And instead of just stirring in between sleep cycles, they may fully wake up if they can’t sense their parent/caregiver’s presence close by.
If you find your little one sleeps soundly for decent stretches when close to you / when they can sense your presence, but is very wakeful when they sleep in their own bed/room, then separation anxiety might be the reason. Having them sleep close to you – either in their own bed within arm’s reach, or safely bed sharing if that’s an option available to you – can help with this.
If your little one is still very wakeful even when room sharing or safely bed sharing, you can probably rule out separation anxiety as the likely cause of the wakefulness.
4 – Other Stressful Events / Periods
A stressful event or period in your little one’s life can also affect sleep.
This is because when the body’s stress response system (the HPA-axis / sympathetic nervous system) is activated, it can make it hard to fall asleep / stay asleep. Little ones experiencing stress may also have a heightened need to be close to their parent/caregiver when they sleep.
Common possibilities include starting daycare, adjusting to a change in caregivers, the arrival of a new sibling, and other big changes / events (including family gatherings, travel etc.). If a trusted parent or caregiver is stressed, this can also affect a little one.
Some little ones will not find these things particularly stressful while others may, so it does depend on the individual (it often depends on temperament), but it’s certainly something to keep in mind if you’ve noticed an increase in night wakefulness that coincides with a stressful event or period.
If you’re pretty sure stress is the cause of the wakefulness, it’s usually be a case of riding it out and supporting your little one as best you can by responding to / meeting their needs (which may include having them sleep close to you/another trusted caregiver at night), and working with any other caregivers to do the same. And remember: this too shall pass.
5 – Low Sleep Pressure
Low sleep pressure is not commonly discussed out there in the world of baby sleep (yet!) but it’s THE most common cause of frequent night waking that I see!
Sleep pressure – officially referred to as sleep/wake homeostasis – is one of the two systems in our body that regulates sleep. It’s actually a chemical called adenosine that builds up in our brain while we’re awake, and reduces while we sleep. The higher our sleep pressure (adenosine levels), the sleepier we feel and the more we need to sleep to reduce it down again.
To sleep soundly at night, we need to build up enough sleep pressure by bedtime. If we don’t, we can have trouble falling asleep, or struggle to sleep well at night, or both. Pretty logical, right? But the science often gets lost in the sea of baby sleep misinformation.
Many people believe babies and toddlers need a lot of sleep. That they should sleep 7-7 and have long naps. While this is true for some, research shows there’s actually a REALLY wide variation in how much sleep little ones have [10]. Babies and toddlers between 6 and 24 months typically have anywhere from 9 – 16 hours of sleep per 24 hours (including naps). And babies under 6 months have anywhere from 9 – 18 hours (some up to 20 in the newborn period).
Galland, B. C., Taylor, B. J., Elder, D. E., & Herbison, P. (2012). Normal sleep patterns in infants and children: A systematic review of observational studies. Sleep Medicine Reviews, 16(3), 213–222. https://doi.org/10.1016/j.smrv.2011.06.001
Every little one is different. Some need lots of sleep, others are more efficient sleepers and have lower sleep needs.
Parents often don’t know this and so encourage long naps and set early bedtimes, thinking it’s necessary. This isn’t a problem if your little one has average to high sleep needs, but if they don’t, too much sleep / not enough awake time during the day can make it hard for sleep pressure to build, leading to:
Sometimes – though not always – they can also have trouble falling asleep or wake really early.
Many little ones who experience this just have a short term blip and then return to a restful sleep pattern without much fuss.
But some – especially those with low sleep needs – are more sensitive.
They can get stuck in a cycle, where after a string of wakeful nights, they catch up on sleep during the day, which reduces sleep pressure, leading to more wakeful nights. Some of these little ones are wakeful every night, while others ride a ‘sleep rollercoaster’ – cycling between strings of okay/good nights (when sleep pressure reaches an adequate level), and strings of wakeful nights (when it doesn’t).
Regardless of what the wakefulness looks like, if low sleep pressure is the culprit, the good news is that it is usually possible to improve the nights, without any form of sleep training.
It’s what I help parents with every day in my Baby Sleep Revolution™ program.
So if you’re struggling with frequent night waking, and you’ve ruled out the other likely causes, definitely have a look!
REFERENCES
[1] Kahn, A., Rebuffat, E., Blum, D., Casimir, G., Duchateau, J., Mozin, M. J., & Jost, R. (1987). Difficulty in initiating and maintaining sleep associated with cow’s milk allergy in infants. Sleep, 10(2), 116–121. https://doi.org/10.1093/sleep/10.2.116
[2] Ramirez, F. D., Chen, S., Langan, S. M., Prather, A. A., McCulloch, C. E., Kidd, S. A., Cabana, M. D., Chren, M. M., & Abuabara, K. (2019). Association of Atopic Dermatitis With Sleep Quality in Children. JAMA pediatrics, 173(5), e190025. https://doi.org/10.1001/jamapediatrics.2019.0025
[3] Edmunds, J., Miles, S. C., & Fulbrook, P. (2011). Tongue-tie and breastfeeding: a review of the literature. Breastfeeding review : professional publication of the Nursing Mothers’ Association of Australia, 19(1), 19–26. https://pubmed.ncbi.nlm.nih.gov/21608523/
[4] Peirano, P. D., Algarín, C. R., Chamorro, R. A., Reyes, S. C., Durán, S. A., Garrido, M. I., & Lozoff, B. (2010). Sleep alterations and iron deficiency anemia in infancy. Sleep medicine, 11(7), 637–642. https://doi.org/10.1016/j.sleep.2010.03.014
[5] Czinn, S. J., & Blanchard, S. (2013). Gastroesophageal reflux disease in neonates and infants : when and how to treat. Paediatric drugs, 15(1), 19–27. https://doi.org/10.1007/s40272-012-0004-2
[6] Richdale, A. L., & Schreck, K. A. (2009). Sleep problems in autism spectrum disorders: prevalence, nature, & possible biopsychosocial aetiologies. Sleep medicine reviews, 13(6), 403–411. https://doi.org/10.1016/j.smrv.2009.02.003
[7] Cohen, S., Conduit, R., Lockley, S. W., Rajaratnam, S. M., & Cornish, K. M. (2014). The relationship between sleep and behavior in autism spectrum disorder (ASD): a review. Journal of neurodevelopmental disorders, 6(1), 44. https://doi.org/10.1186/1866-1955-6-44
[8] Ziegler, M., Kaiser, A., Igel, C., Geissler, J., Mechler, K., Holz, N. E., Becker, K., Döpfner, M., Romanos, M., Brandeis, D., Hohmann, S., Millenet, S., & Banaschewski, T. (2021). Actigraphy-Derived Sleep Profiles of Children with and without Attention-Deficit/Hyperactivity Disorder (ADHD) over Two Weeks-Comparison, Precursor Symptoms, and the Chronotype. Brain sciences, 11(12), 1564. https://doi.org/10.3390/brainsci11121564
[9] Owens J. A. (2009). A clinical overview of sleep and attention-deficit/hyperactivity disorder in children and adolescents. Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l’Academie canadienne de psychiatrie de l’enfant et de l’adolescent, 18(2), 92–102. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687494/
[10] Galland, B. C., Taylor, B. J., Elder, D. E., & Herbison, P. (2012). Normal sleep patterns in infants and children: A systematic review of observational studies. Sleep Medicine Reviews, 16(3), 213–222. https://doi.org/10.1016/j.smrv.2011.06.001
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