Can We Stop Sacrificing Breastfeeding for Sleep?

Returning to infancy, although researchers have generally focused on this element of wakings, there are other ways in which breastfeeding impacts sleep, ways that actually facilitate sleep. One way is simply in terms of how much sleep infants get early on. One study found that breastfed babies at 3 months of age slept a total of 40-45 minutes longer (measured via actigraphy) than formula-fed babies and parents of breastfed babies reported fewer sleep troubles[18]. This coincides with other research finding breastfeeding mothers, especially those who bedshare, report better sleep than their counterparts[19][20]. 

Another effect that is rarely mentioned to mothers is the transmission of certain hormones, notably melatonin and tryptophan, through breastmilk, which not only helps babies fall asleep, but actually provides critical information about the circadian rhythm. 

As babies are born with no real circadian rhythm, it is something that first emerges in the first few months of life, but then continues to develop over years[21]. However, research has found that breast milk is one of the ways in which babies develop this rhythm, as the mother’s body passes on hormones at the levels she has to help the baby learn the difference between night and day[22]. Of course, this is coupled with exposure to light which helps define this difference as well (and why formula fed babies do develop this rhythm), but the effects of these hormone levels in milk have a distinct benefit for mothers that is rarely discussed. 

Notably, as baby develops his or her rhythm in conjunction with Mum (if no form of disconnect occurs), babies are more likely to share a circadian rhythm with their mother[23]. This means babies are more likely to not wake early if Mum is not a morning person, stay up too late if Mum is exhausted, and so on. Now, of course, the relationship isn’t perfect and we all know those families where Mum may be breastfeeding on demand and not sleep training and still has a child with an opposite schedule to her own, but the likelihood is much less. Given many mothers find the hardest part of sleep with little ones is to do with schedules that are opposed to their own, it would seem we should be prioritising breastfeeding as a way to help cope with this. 

Summary 

We need, as a society, to stop trying to sacrifice breastfeeding for sleep. This isn’t just to the sleep trainers and people peddling magic sleep solutions (yeah right), but to the researchers who continue to make limiting or structuring breastfeeding a piece of their sleep interventions. Not only is this really not warranted in most situations, but may also lead to the perceived necessity of sleep training as the biological mechanisms in place to help our infants develop their sleep become compromised. 

So for all you parents out there, nurse. Nurse to sleep. Nurse on demand. Nurse often. Nurse as long as you wish. Do not let anyone tell you otherwise. 

References:
[1] St James-Roberts I, Sleep J, Morris S, Owen C, Gillham P.  Use of a behavioural programme in the first 3 months to prevent infant crying and sleeping problems.  J Paediatr Child Health 2001; 37: 289-297. 

[2] Perkin MR, Bahnson HT, Logan K, Marrs T, Radulovic S, Craven J, Flohr C, Lack G.  Association of early introduction of solids with infant sleep: a secondary analysis of a randomized clinical trial.  JAMA Pediatr 2018; 172: e180739. 

[3] McKenna JJ, Gettler LT.  There is no such thing as infant sleep, there is no such thing as breastfeeding, there is only breastsleeping.  Acta Paediatrica 2016; 105: 17-21. 

[4] McKenna JJ, McDade T.  Why babies should never sleep alone: a review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding.  Paediatric Respiratory Reviews 2005; 6: 134-152. 

[5] Moon RY, Patel KM, Shaefer SJ.  Sudden infant death syndrome in child care settings.  Pediatrics 2000; 106: 295-300. 

[6] De Jonge GA, Lanting CI, Brand R, Ruys JH, Semmekrot BA, Van Wouwe JP. Sudden infant death syndrome in child care settings in the Netherlands. Arch Dis Child 2004; 89: 427-30. 

[7] Hauck FR, Thompson JMD, Tanabe KO, Moon RY, Vennemann MM.  Breastfeeding and reduced risk of sudden infant death syndrome: a meta-analysis.  Pediatrics 2011; 128: 103-110. 

[8] Ball HL, Ward-Platt MP, Heslop E, Leech SJ, Brown KA.  Randomised trial of infant sleep location on the post-natal ward.  Arch Dis Child 2006; 91: 1005-1010. 

[9] Ball HL.  Breastfeeding, bed-sharing, and infant sleep.  Birth 2003; 30: 181-188. 

[10] Ball HL, Howel D, Bryant A, Best E, Russell C, Ward-Platt M.  Bed-sharing by breastfeeding mothers: who bed-shares and what is the relationship with breastfeeding duration?  Acta Paediatrica 2016; 105: 628-634 

[11] Galbally M, Lewis AJ, McEgan K, Scalzo K, Amirul Islam FM.  Breastfeeding and infant sleep patterns: an Australian population study.  J Paediatr Ch Health 2013; 49: E147-E152. 

[12] Ball HL.  Breastfeeding, bed-sharing, and infant sleep.  Birth 2003; 30: 181-188. 

[13] McKenna JJ, Mosko SS, Richard CA.  Bedsharing promotes breastfeeding.  Pediatrics 1997; 100: 214-219. 

[14] Gettler LT, McKenna JJ.  Evolutionary perspectives on mother-infant sleep proximity and breastfeeding in a laboratory setting.  Am J Phys Anthropol 2011; 144: 454-462. 

[15] Weinraub M, Bender RH, Friedman SL, Susman EJ, Knoke B, et al. Patterns of developmental change in infants’ nighttime sleep awakenings from 6 through 36 months of age.  Developmental Psychology 2012; 48: 1511-28. 

[16] Brown A, Harries V.  Infant sleep and night feeding patterns during later infancy: association with breastfeeding frequency, daytime complementary food intake, and infant weight.  Breastfeeding Medicine 2015; 10: https://doi.org/10.1089/bfm.2014.0153. 

[17] Pennestri M, Laganiere C, Pokhvisneva I, Bouvette-Turcot A, Steiner M, Meany M, Gaudreau H.  Sleep patterns as a function of breastfeeding: from infancy to childhood.  Sleep 2018; 41 supp 1: A98. 

[18] Doan T, Gardiner A, Gay CL, Lee KA.  Breast-feeding increases sleep duration of new parents.  J Perinat Neonat Nurs 2007; 21: 200-206. 

[19] Rudzik AE, Ball HL.  Exploring maternal perceptions of infant sleep and feeding method among mothers in the United Kingdom: a qualitative focus group study.  Maternal and Child Health Journal 2016; 20: 33-40. 

[20] Cong Z, Hale T, Kendall-Tackett K.  The effect of feeding method on sleep duration, maternal well being, and postpartum depression.  Clinical Lactation 2011; 2: 22-26. 

[21] Brooks E, Canal MM.  Development of circadian rhythms: role of postnatal light environment.  Neuroscience & Biobehavioral Reviews 2013; 37: 551-560. 

[22] Cubero J, Valero V, Sanchez J, Rivero M, Parvez H, Rodriguez AB, Barriga C.  The circadian rhythm of tryptophan in breast milk affects the rhythms of 6-sulfatoxymelatonin and sleep in newborns.  Neuroendocrinology Letters 2005; 26: 657-661. 

[23] Thomas KA, Burr RL, Spieker S, Lee J, Chen J.  Mother-infant circadian rhythm: development of individual patterns and dyadic synchrony.  Early Human Development 2014; 90: 885-890. 


Originally published here.

Tracy Cassels, PhD is the Director of Evolutionary Parenting, a science-based, attachment-oriented resource for families on a variety of parenting issues. In addition to her online resources, she offers one-on-one support to families around the world and is regularly asked to speak on a variety of issues from sleep to tantrums at conferences and in the media. She lives in Prince Edward County, Ontario, Canada with her husband and two children.

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