The ultimate guide to breastfeeding and sleep
This blog on breastfeeding and sleep is based on the talk I did for Breastival 2023 entitled Baby Sleep.
Is breastfeeding to blame for your lack of sleep?
Almost all my sleep clients are breastfeeding (or have breastfed in the past). Likewise, I usually give my breastfeeding clients a bit of advice about sleep! The thing is, breastfeeding and sleep are closely intertwined, and it can often be difficult to separate the two, or to deal with each one separately.
I think that breastfeeding mums usually find sleep really challenging. It can be hard to work out if sleep is hard because of breastfeeding, or whether it would just be hard even if you were bottlefeeding! It’s also fairly common to hear comments like:
“Oh, if you just gave them a bottle, they’d sleep through the night!”
“You’re creating bad habits by feeding them to sleep!”
“I don’t know why you bother breastfeeding. You don’t need to be a martyr. Just switch to bottles and you can get more rest!”
Sound familiar? I think all of us, at some point, have had comments like that directed at us. Maybe you just bite your tongue and smile a thin lipped smile. Perhaps you do start to wonder whether it is really worth it. You think that maybe you should stop breastfeeding.
What if I could tell you that you don’t have to stop breastfeeding to get more sleep? What if, and here’s a really novel idea, what if breastfeeding actually led to BETTER sleep? Want to find out? Well, that is exactly what I’m discussing in the blog.
But first, let’s start with what we assume to be true about baby sleep.
Society's expectation of baby sleep
Society has a very definite expectation of baby sleep. It probably looks something like this:
Babies should sleep for long periods of time
We expect them to sleep for 2-3 hours during the day, and long chunks at night time, possibly 5-6 hours at a time.
Babies should be able to sleep alone
We expect them to go to sleep happily in a cot and stay there.
Babies should be able to fall asleep independently
We think it’s normal and desirable for babies to go into the cot awake, and fall asleep without any help.
Babies should be able to sleep through the night ASAP
We allow them a few weeks when they’re newborns but realistically we expect them to be sleeping through the night consistently by at least 6 months, if not earlier.
Night feeds should stop ASAP
You may have heard all manner of comments from health care professionals and friends: Oh, by the time they are 12 lbs or 3 months, or (insert random age or weight), they shouldn’t need night feeds.
Society’s expectations of baby sleep are not based in reality
These ideas about baby sleep are, to put it bluntly, nonsense. There is no scientific basis for them at all. Genuinely, most of these ideas about baby sleep have been conjured out of thin air over the last century or so, by men with next to no knowledge of babies, but just some grand theories on how to improve the human race. These ideas have filtered down through the generations and often still feature prominently in baby books. Of course, when your baby DOESN’T behave like this, you start to think you are doing something wrong or there is something wrong with your baby.
The biological reality of baby sleep
The biological reality of our babies is very different. We know, from the research, that human infant sleep actually looks very different to what society tells us.
Babies have short sleep cycles and light sleep
On average, newborns have a sleep cycle that lasts around 30/40 minutes and a one year old has a sleep cycle that lasts around 60 minutes. They also spend more time in light sleep than adults do. (Hookway, 2019)
Babies sleep better when in contact with an adult
We all know that a baby will sleep for several hours when in contact with you and sleep through all manner of noises and disturbance. Put them down in a cot and they stir within 10 minutes!
Most babies need help falling sleep
Yes, babies almost always need to be fed, cuddled, rocked to sleep. This is really, really, normal.
Night waking is normal well into toddlerhood
One study found that 60% of toddlers still woke at least once a night (Hysing et al, 2014). The thing is, even adults wake up at night time! We often stir at the end of a sleep cycle, and resettle without being fully aware of having woken up (Mendelson, 2017). One way to think about it is this: at what age is your child able to meet all their needs during the day time? Unless they are able to meet their needs during the day, there is a good chance that they will still need you, either occasionally or regularly, during the night.
Night feeds are normal into toddlerhood
This is particularly true for breastfeeding toddlers, and there is a complex interaction between night feeds, milk supply and how long your breastfeed for. As a rule of thumb, most toddlers need night feeds until around 18 months.
What type of mammal are we?
We also need to think about the type of mammal we are, and the type of milk we make. All mammals feed their babies milk. However, this milk varies in composition. So, for example, a kitten can’t survive on cow’s milk, because it has too much lactose (the carbohydrate in milk).
Cow’s milk needs to be altered in the balance of macronutrients in order to make it a suitable composition for human babies. Essentially, formula is cows milk that has been watered down but has added fats and carbohydrates, as the protein composition is higher than human milk. Cow’s milk, after all, is designed to grow a baby calf into a huge 1000 kg bull or cow. We don’t need quite so much protein, but we do need lots of ready available energy to grow our babies’ brains! Depending on the type of milk and maturity at birth, mammals can be classified into cache mammals, nest mammals, follow mammals or carry mammals (Mohrbacker and Kendall-Tackett, 2010).
Our human babies aren’t nest mammals
Society tries to treat human babies like nest mammals. These are the mammals (like cats and dogs) that give birth to immature babies. They keep these babies in a nest, and feed them roughly every 3 hours. We expect our human babies to lie happily in a cot and to be fed every 3 hours.
Human babies are carry mammals
However, we aren’t nest mammals. We are carry mammals! Carry mammals keep their babies close (think chimpanzees, monkeys, marsupials like kangaroos), and they have milk that is very high in carbohydrates and low in fat and protein. Our babies are designed for very frequent feeding (hourly is really normal when they are newborns), and to be kept close.
You can’t fight biology
We can’t fight our babies’ biology. Our babies expect to be kept close and fed frequently. Therefore, if you want to breastfeed successfully, and long term, then to a certain extent you need to accept this reality. This doesn’t mean that breastfeeding automatically results in less sleep. In fact, breastfeeding can promote sleep!
How can breastfeeding promote sleep?
Sleep inducing properties of breastmilk
There is tryptophan and melatonin in breastmilk which help your baby sleep (Anderson et al, 2016). In fact, breastmilk you make in the evening is higher in melatonin, that “sleepy hormone” that helps us sleep. Babies don’t make their own melatonin until they are at least 8 weeks old. This means that your baby gets a helping hand with sleep from you.
Sucking and swallowing is soothing
The nerves in the face and throat that are involved in sucking and swallowing are linked to the dorsal branch of the vagus nerve. If you’ve never heard of it before, your vagus nerve runs throughout your body. The dorsal branch of your vagus nerve is your “calm down nerve”. When it becomes activated, it lowers your heart rate and breathing. So, when your baby is sucking and swallowing, they are being soothed. This helps babies transition into a “rest and digest” state. (Douglas, 2021; Porges, 2023)
Contact with an adult is regulating
Babies have no capacity for self-regulation, or self-soothing. They rely on contact with an adult to soothe. When you are breastfeeding, the contact with you helps to regulate their nervous system.
Biologically normal to feed to sleep
When you put all of this together, it becomes inevitable that babies will fall asleep at the breast! I’m not talking about those babies who take a few small sucks and then fall asleep, those babies that are struggling to transfer milk at the breast. I’m talking about the babies that start off with big sucks and swallows, they’re transferring milk great. Then they gradually transition into those little fluttery sucks, before finally coming off the breast floppy, relaxed and asleep.
Breastfeeding can boost your sleep too
One study found that breastfeeding mothers reported better quality sleep (Doan et al, 2007). Breastfeeding releases oxytocin into your system. Oxytocin helps you relax and feel sleepy. Often, breastfeeding mums find that breastfeeding helps them sleep too! In fact, a lot of mums will report that once they stop breastfeeding, they struggle more with getting back to sleep at night, because they’ve lost that oxytocin “hit” that helped them sleep.
You can't avoid night feeds
Unfortunately, night feeds are going to be an important reality when you are breastfeeding. There are very few mums that can get away with no night feeds with a baby under the age of a year. In fact, trying to stop all night feeds will almost certainly result in the cessation of breastfeeding, as your supply will drop.
Prolactin levels are higher at night time
Prolactin in the hormone that drives milk production. Frequent stimulation (breastfeeding) at night time will help to keep those prolactin levels high. High prolactin levels = a better milk supply (Wambach and Riordan, 2016).
Breastsleeping is a concept coined by Dr James McKenna (McKenna, 2020). He is an anthropologist who has studied breastfeeding, co-sleeping practices and safe sleep for decades. He noted, after observing breastfeeding mums and babies, that they behave in a very specific way at night time. When babies sleep next to their mothers, there is a syncronization at night time – neither mum nor baby fully wake, but they stir in response to each other. If baby cues for a feed, then mum latches baby on without fully waking and then they both snooze through the feed. When baby is finished, they reposition themselves on the bed. You may have experienced this yourself if you co-sleep with your baby. You wake up in the morning and you know your baby fed overnight, but you have no idea when or how often.
Bedsharing/co-sleeping results in longer duration of breastfeeding
There is good evidence that bedsharing results in mums breastfeeding longer than 6 months (Ball et al, 2016). Essentially, bedsharing makes breastfeeding, especially night feeds, so much more sustainable. This means that if your goal is to breastfeed past a few months, bedsharing may be an important aspect of meeting this goal.
The path of least resistance to better sleep
What I normally recommend as a starting point for mums is that they go down the path of least resistance. You might be pleasantly surprised with how easy night time becomes, and that you actually feel quite rested in the morning! What this looks like is:
This has been debated for many decades. However, it would appear that in the absence of risk factors, co-sleeping/bedsharing can be as safe for breastfeeding mums, as having your baby sleep in a cot next to the bed (Ball et al 2019, McKenna, 2020). It is important that you follow the guidance for safe co-sleeping. I discuss this in more detail here or you can read about the Lullaby Trust guidance.
Feeding to sleep
If your baby is sleeping in bed with you, then feeding to sleep and feeding back to sleep often results in the easiest sleeping arrangement for everyone. It’s very little effort to feed to sleep overnight, and if you’ve mastered the side lying position for feeding, then it is really easy to doze while your baby feeds. Your baby is also lying in a very safe position on the bed next to you. Compare this to mums who sit up to feed – there is the danger that a baby will roll off their lap. This has happened to me for sure! I remember those middle of the night feeds where I could barely keep my eyes open. Once I mastered side lying feeding it was a game changer.
Feeding on demand
Honestly, the easiest thing to do at night time is just feed them back to sleep every time they wake up. If you try to use other ways of getting them back to sleep eg shushing, patting, rocking, then often that’s much more effort and it brings everyone out of that night sleepy state.
What if the path of least resistance isn't an option?
Of course, not all mothers find that they can co-sleep or find that their sleep is restful with a baby in bed with them. In fact, the main reason I became a sleep consultant is that I kept working with breastfeeding clients who needed a bit more than “Just wait it out”. There is still a lot you can do to improve sleep without stopping breastfeeding!
Most of the clients who contact me don’t expect their baby to sleep through the night, they are just trying to achieve a block of sleep of maybe 4-5 hours. This is usually achievable through a few tweaks to sleep, and won’t have a massive impact on breastfeeding. I also think that if your baby is waking every 45-60 minutes at night, that really isn’t sustainable long term. We can almost always improve on this pattern. So, if you can’t go down the path of least resistance, than what other options do you have?
What if you can’t bedshare safely?
Remember, that our babies are helpless and depend on us to meet their needs. We cannot reduce this dependency at night time. We can’t fight their biological need for us. Therefore, the trick isn’t to make our babies independent, but to help them feel safe and secure, even if they aren’t sleeping right next to us. Ideas that might help include:
- A “side car” crib or cot;
- Keeping them in your room as long as possible, beyond six months;
- Sleeping on their cot sheets or tucking a top you’ve been wearing over the mattress;
- Putting photos of you near the cot (if they aren’t in the same room as you).
How do you manage the transfer to the cot if you’re breastfeeding?
Transfer once they are asleep
I’d experiment with transferring them as soon as they fall asleep. This may take a bit of practice initially and you may find that you have to pat/shush them if they were in a light sleep when you transfer them. The reason I recommend that you work on transferring them in light sleep, especially at night time, is that you want as little disruption to your sleep as possible. I often see parents holding their baby upright for 20-30 minutes after a feed, thinking that they need to do this to get them into a deep sleep, or because they have reflux, or because they need to bring wind up. Experiment with transferring them as soon as the feed is finished (yes, even if there is reflux or you’re worried about wind) – you may be pleasantly surprised at how much easier night sleep becomes!
Help them fall asleep in the cot
The other option is to work on them not feeding to sleep and getting them to fall asleep in their cot. Honestly? This is a difficult option. First of all, feeding to sleep is a really normal way for babies to fall asleep. This, plus the contact with an adult helps them fall asleep so much more easily. You really are fighting biology when you try to do this. I usually don’t recommend trying this with a baby under six months, and it may still be fairly tricky with a baby between six and twelve months. Not impossible, but a lot will depend on your baby’s temperament. If you want to be gentle and responsive, there really is often no way to make this change without some tears and upset. The other risk is that you’ll end up having to do something that is more effort than breastfeeding, for example, rocking or pacing the floors with them. Of course, at least someone else can do that, it doesn’t have to be mum, so there are some advantages to this option!
Improving sleep without stopping breastfeeding
We can use sleep biology principles to improve sleep without stopping feeding to sleep.
Circadian rhythm and sleep hygiene
Our circadian rhythm is our body clock that helps us consolidate most of our sleep at night time. We can use sleep hygiene to strengthen our baby’s circadian rhythm. Some of the most important things you can do include:
- Start your day at the same time, every day. Even if you’ve had a tough night.
- Regular times for naps, bedtime and meals (over six months). Milk feeds should still be on demand at least to a year.
- Lots of exposure to daylight during the day.
- Dark room at night – you shouldn’t be able to see any shadows. If you do use a night light it should be dim and red toned.
- Comfortable temperature – between 16 and 20 degrees.
Homeostatic sleep pressure
Sleep pressure is like a safety release valve. Essentially, when any of us get too tired, our body makes us sleep to release that sleep pressure. As adults, our sleep pressure should be highest at bedtime. This, in conjunction with a strong circadian rhythm, promotes good sleep for us. Babies take naps throughout the day because their sleep pressure rises more quickly. Essentially, naps help to reduce this sleep pressure. Naps AREN’T controlled by their circadian rhythm. However, babies should also have high sleep pressure at bedtime, in conjunction with their circadian rhythm. This means that there are two ways we can increase the sleep pressure and this often results in less night waking.
Shorter night in bed?
Usually, the first thing I suggest to parents is to shorten their baby’s night in bed. Very few babies can manage a 12 hour night in bed. If there is a lot of waking, then shortening the night often increases that sleep pressure and makes night sleep more “efficient”. You can see my chart below that gives averages – you’ll see that for most babies 10 hours in bed is still within that normal range!
Don’t make naps irresistible
Your baby can only achieve a maximum amount of sleep in 24 hours. If you expect your baby to sleep for 12 hours in bed at night, plus take long naps during the day, you may find that they fight sleep, wake frequently or it’s a struggle to get them to take long naps. Some babies only need around 12 hours of sleep in total. Work out how much sleep your child actually gets and then adjust your night sleep and day sleep accordingly.
I’m a big fan of cat naps! Often, this is all the sleep that your baby needs during the day to help reset that sleep pressure. Some babies will sleep a lot longer if the conditions are right – for example during a contact nap. But they may not actually need all that sleep. Sometimes making day sleep a little less irresistible will actually result in increased sleep pressure at night, which in turn, reduces night waking. So, if you are seeing a lot of night waking, and you’ve been doing a lot of contact naps, read my blog on transitioning away from them.
Other ways you can improve sleep overnight include:
Get help with feeding problems
I often find that fixing feeding problems, for example a shallow latch or slow weight gain, really improves a baby’s sleep!
Make sure your baby is feeding well during the day
Most breastfed babies need to feed at least 8 times in 24 hours. Realistically, it’ll probably be a bit more like 10-12 times. If your baby is going long periods of time during the day without feeding, then they probably will make up for it at night time.
This is another good reason to reduce the day sleep. Less sleep and more feeds during the day means that they won’t wake as much overnight! Of course, you can’t push ALL the feeds to daytime, at least not with a baby. Perhaps with a toddler you can. Some night feeds are still important for babies. But as a rule of thumb, make sure that at least half of your baby’s feeds are happening during the day.
Anything making your baby uncomfortable?
Babies get enough sleep provided that there is nothing disrupting their sleep. Common reasons for babies waking more frequently than they should include allergies, reflux, eczema, tongue tie, mouth breathing or sleep apnoea. These are all issues I explore during a consultation.
Meet your baby’s need for connection
Don’t forget! It’s really important that your baby feels connected to you overnight for sleep to happen.
What about your sleep?
Is your sleep the issue? Sometimes I work with families and their babies are only waking a couple of times at night, and going back to sleep really easily. However, sometimes even these wake ups are really disruptive because the mum is struggling to get back to sleep! So what can you do to improve your sleep?
Scroll back up and look at the sleep hygiene measures I mentioned above. All of them apply to you too! In addition, I’d recommend that you aim to get 30 minutes of exercise a day (a walk in the park with your baby is enough), and avoid caffeine especially from lunch onwards.
Not using your phone overnight
This is a big one! Often we reach for our phones and start scrolling while the baby feeds. We used to make a big deal about the blue light emitted by phones, but we now think that’s less of a problem. It’s really the fact that your brain becomes too alert when you’re scrolling and reading. We want to keep everything low key at night time. If you feel you need some sort of distraction while you are feeding, consider an audiobook or soothing music instead.
Making the most of your baby’s longer stretch of sleep
Most babies will sleep the longest at the start of the night. I know it’s not a popular suggestion but if you are really exhausted, then it makes sense to go to bed at the same time as your baby. That way you make the most of that longer stretch of sleep.
Mindfulness and acceptance
Sometimes, we become frustrated by being woken at night, or, we lie awake worrying about the next wake up. It can feel torturous to JUST get to sleep, only to be woken by our baby! In these situations, using some mindfulness techniques, or positive affirmations can help to reframe and change how we feel about being woken at night. You’ll also probably find that you fall asleep a bit quicker.
Flexibility - what CAN you change?
Remember there are a few things we CAN’T change about our babies. We can’t change their need for connection and closeness. We can’t change the fact that they will almost certainly wake for feeding for at least the first 12 months of their life. However, we can change our expectations, as well as some of our routines.
Ultimately, if you want to breastfeed long term, there does need to be a shift in thinking to accommodate normal patterns of sleep. This doesn’t mean that you need to get less sleep though! With some flexibility, you can improve your sleep too.
Need some help with breastfeeding or sleep?
I offer gentle but practical solutions to breastfeeding and sleep problems. The most common breastfeeding issues I see include:
- Painful feeding
- Slow weight gain/low milk supply
- Fussiness at the breast
Common issues I’d look at during a sleep consultation include:
- Reducing night waking
- Early waking
- Night weaning
- Reducing contact naps
- Helping babies fall asleep without breastfeeding (useful when you go back to work!)
You can book a free 15 minute consultation to discuss your issues, or find out more about my other consultations here:
Anderson et al, (2016) Breast Feeding and Melatonin: Implications for Improving Perinatal Health Journal of Breastfeeding Biology , vol. 1 , nº 1. p. 8-20.
Ball et al, (2019) Towards and Integrated Anthropology of Infant Sleep, American Anthropologist, https://doi.org/10.1111/aman.13284
Ball et al (2016) Bed-sharing by breastfeeding mothers: who bed-shares and what is the relationship with breastfeeding duration? Acta Paediatrica, https://onlinelibrary.wiley.com/doi/10.1111/apa.13354
Doan et al (2007) Breastfeeding increases sleep duration of new parents, The journal of perinatal and neonatal nursing, 21 (3) 200-206
Douglas, P (2021) The Discontented Little Baby Book, University of Queensland Press, St Lucia
Hookway, L (2019) Holistic Sleep Coaching, Praeclarus Press, Amarillo
Hysing, et al (2014) Trajectories and predictors of nocturnal awakenings and sleep duration in infants, Journal of Developmental & Behavioral Pediatrics, 35(5), 309-316.
Mendelson, W (2017) The Science of Sleep, Ivy Press, London
McKenna, J (2020) Safe Infant Sleep, Platyplus Press, Washington DC
Porges, S (2022) Polyvagal Theory: Neural Exercises for Safety and Connection, online course accessed 2022
Wambach, and Riordan (2016) Breastfeeding and Human Lactation 5th ed, Jones and Bartlett Learning, Burlington