Newborn Day/Night Confusion: What Is It and How to Cope?

There are few things in life more precious than a sleeping newborn. However, some infants may become confused over proper sleep schedules. This can cause them to spend too much time awake at night and sleep too much during the day. This article discusses what newborn day/night confusion is and how to get infants on track for a healthy night's sleep.

What is newborn day/night confusion?

During pregnancy, most mothers keep a regular schedule (awake during the day and asleep at night). Infants in the womb are often lulled to sleep by their mother’s movements throughout the day and are more active at night when their mothers are resting. The use of vibrating chairs and swings mimic the mother’s movements and can contribute to the baby's daytime sleepiness. To help us understand more about this phase, we interviewed Pediatrician, Dr. Kayron Bradley M.D., and Family Nurse Practitioner, Joleen Sams.

When does it start?

This phase usually starts about a month after birth. During the first few months of life their sleep/wake cycle is mainly tied to feeding times, which are every few hours. This phase can be exhausting to parents, but it is not permanent.

Causes of day/night confusion

There are two main causes of this confusion. The first cause is that newborns eat and sleep around the clock, their hectic feeding schedules are a major factor. The second cause is due to melatonin production. This is the sleep hormone responsible for regulating our circadian rhythm or sleep cycle.

Sleep and feeding schedules

Babies require different amounts of sleep and nourishment at different stages. Becoming familiar with these stages can help to get into a routine. The type of food babies eat also changes how often they eat. Breastfed babies are likely to have more frequent feeds than formula–fed babies. Considering that formula takes longer to digest than breast milk, formula–fed babies are likely to go slightly longer between feeds. Dr. Kayron said "Babies don’t have the ability to keep their blood sugar regulated without eating often, which means they have to be up to eat. Eating frequently helps with positive feedback to help mom’s bodies make breast milk as well"

Infant feeding and sleep schedules according to the CDC

Melatonin

Infants receive natural melatonin from their mothers while in the womb. After birth infants do not start making their own until about 3 months old. Melatonin is also present in breast milk, even if it is frozen and thawed again. The levels of melatonin are higher when the milk is pumped at night when there is more of it in the mom’s system. Since melatonin sends chemical messages about sleep to our bodies, babies who do not make their own hormones can easily become confused regarding the time of day. Joleen Sams says. The hormones and nutrients in breast milk vary based on the time of day. When babies drink milk that was expressed overnight during daytime hours, they may experience excess sleepiness. Conversely, daytime milk includes hormones that contribute to wakefulness. If your baby drinks daytime milk during night hours, they may have trouble falling asleep.

When does day/night confusion end?

Every newborn is different, and there is no way to tell when their sleep cycle will normalize. Formal sleep training does not typically begin until around 4–6 months old. It is around this time that babies begin producing their own sleep hormones and their feeding schedules begin to space out.

"I typically see it improving in most babies around the one-month mark, but it can definitely take a longer amount of time."

Dr. Kayron Bradley M.D.

How to cope with day/night confusion

Day/night confusion can be very stressful to parents, our sleep schedules are well established, and it can be difficult to conform to baby's needs. It is important to break down this task into smaller portions to help you and your baby cope.

The best advice I received as a new mom was to sleep when my baby sleeps. That may be difficult if you have other children at home so remember to take breaks and turns if possible. Dr. Bradley advises new parents to use their support system, a grandparent or a trusted friend can come over while they catch up on some needed sleep. Remember, this phase will pass.

Treating day/night confusion

Start by creating a routine and establishing a sleeping area for your baby to be used only for sleep. Having a routine can help a baby keep track of what is coming next, and their internal clock will start ticking. Figure out a bedtime routine that works best for your family and try to do it at the same time every night.

Keep this routine simple so you can follow it consistently. Typical bedtime routines include a warm bath, feeding, and swaddling. Encourage your baby to sleep for longer stretches at night by limiting light and stimulation as much as possible.

When to contact your healthcare provider

Trouble sleeping at night does not mean there is anything wrong with your baby. However, you may want to reach out to your healthcare provider if your baby is getting less sleep than recommended for their age group, or if your baby is too tired to wake up for their feeding. Dr. Bradley also encourages parents to contact their healthcare providers especially if their babies are showing signs of pain or indigestion. Discuss any concerns with your healthcare provider. However, most day/night confusion just has to work itself out with time and consistent routines.

Tips from the experts

The experts recommend these tips for parents who are struggling with newborn day/night confusion.

• Stay on schedule. It is normal for children to have abnormal sleep during growth phases, illness and milestones. Growing and reaching milestones, especially physical ones can cause babies to be more tired. Do your best to stay on schedule, the abnormal sleep usually lasts a few days.
• Put your newborn down. Don’t hold your baby until they fall fully asleep. Put your baby down in their crib once they are sleepy to allow them to fall asleep on their own. Cuddling a baby to sleep may prolong newborn sleep issues. However, it is absolutely natural to want to rock or hold your baby until they fall asleep. Although this tip is likely to benefit some parents, trust your instincts and do what you are most comfortable with.
• Wait before responding. You don't have to respond right away when the baby starts to stir at night. Give them a few minutes to make sure they're truly awake.
• Save playtime for daytime. Be boring at night, feed your baby and change them when they need it but keep stimulation to a minimum.

Newborn day/night confusion can be a very difficult time for both babies and parents. Remember, this is just temporary, their feeding schedules will begin to space out and your baby will start sleeping longer at night. Starting a bedtime routine can help establish an easy pattern for babies to follow and can help them become more independent sleepers in the future.