Premature Baby Sleep - Patterns & Behaviour

Preterm Babies and Sleep – What to Expect

If your baby arrived a little sooner than expected you will obviously be worried about his health. You will ask your doctor about the extra care that you need to take to help him make it through this phase. You will also notice that your preterm baby sleeps longer and it may worry you instantly. But don’t you panic. Read to know about the sleeping habits of a preterm baby.

Why Some Premature Babies Have Trouble Sleeping?

Sleep pattern of premature babies is different from the babies who are born full term. This means, although preterm babies sleep longer, they are less likely to follow a predictable sleep pattern. Their sleep cycles are shorter and they dwell longer in the lighter stages of sleep where they can be easily awakened. Also, they may still be unsettled by their hospital time in the neonatal unit. The hospital environment with bright lights, sound and routine medical procedures or care can be stressful for the babies and it may disrupt their sleeping pattern.

A Premature Baby’s Sleeping Guide

Here’s how what you need to remember about the sleeping routine of a premature baby to make them sleep peacefully:

1. He needs more sleep

According to the AAP, a preemie sleeps as much as 22 hours a day as he needs more rest for his body to develop properly. Although he might wake up often in between for feeds, he will spend most of his time in different states of sleep.

2. He needs more feeding in the night

Unlike full-term babies, preemies wake up more often in the night for feeds, as it provides the required nourishment for their growing body. In the first few months, it is advisable to feed a preemie every 3 hours or so to keep him well hydrated. Smaller feeds and gaps between the sessions also bring down spit ups.

A mother nursing her baby

3. Make him sleep on his back and not on the stomach

Just like it is with full-term babies, preemies should be put to sleep on their back for a comfortable sleeping position. The mattress should be firm and not too soft and it is advisable to remove any pillows, blankets, toys, and comforters if given by you. This is essential to reduce the chances of Sudden Infant Death Syndrome (SIDS).

4. Let him sleep in your room but in a separate cot

Your room is the ideal place for your baby to sleep where you can check up on him often. It will be easier for you to feed him this way and know immediately if he shows any signs of distress. Having him next to you also lowers the chances of SIDS.

5. Encourage him to sleep more overnight

As your preemie will get older, try to shift his sleeping routine closer to the night. Play with him during the day but do not keep him awake so he can sleep longer in the night. When he is up in the night for a feed, feed him in a quiet environment and keep the lights dim and make him sleep once he is done.

6 Sleep States of Preemies

Initially, preterm babies show these sleep states which you need to look out for:

1. Deep Sleep

In the state of deep sleep, preemies eyes are completely closed and they show anywhere from little to no movement. Their breathing is also even and regular. If you have a preemie baby, do not try to wake him from this deep restful sleep to feed him.

2. Active Sleep

This is a light sleep phase where newborns and preemies spend most of their sleep time in. If you have a preemie baby, you will notice that he will move but his breathing may not be regular. This state is called the REM sleep for ‘Rapid Eye Movement’ stage of sleep where your baby is dreaming.

A newborn baby sleeping

3. Drowsy Awake

Babies who are drowsy but awake look tired with heavy eyelids. You will often find them in this state just after waking up from active sleep or before they are ready to fall asleep. They can still suck while in this sleep and sometimes even feed quite well so they can be breast or bottle fed at this point.

4. Quiet Alert

This is a much more relaxed phase where preemies look wide awake and observant. If they bring their hands to their mouth and suck on the fingers, they could be hungry and it’s a good time to feed them. Preemies may not spend much time at this stage, but as they get older you’ll get to enjoy it more.

5. Active Alert

When babies are in this state they can be restless and fussy. They can also get annoyed easily by all the all the activity around. Feeding a preemie in this stage can be hard but if you are able to console and calm him down, he may go back to the quiet alert phase of sleep.

6. Crying

Babies cry for numerous reasons. They may be hungry, need a diaper change, or feeling uncomfortable and overwhelmed when out in the public. Some babies can calm themselves down but if your baby doesn’t calm on his own, try to comfort him by swaddling or rocking or by changing his diaper.

Sleep Pattern for a Preterm Baby

It takes a little more time to build a sleep pattern for a premature baby as compared to full-term babies. By 4 months of age, a full term baby may sleep for 6 to 8 hours in the night while a preemie would take 6 to 8 months to do the same. Here are some things to keep in mind before setting a premature baby sleep routine:

1. Build a Routine

To build a sleep routine for your preterm baby, first, watch your baby’s sleep pattern. Play with him, keep him busy during the day. He will feel sleepy as the night dawns. While putting him to bed, make sure the environment is peaceful and lights are soft. And feed him an hourly before it is sleep time.

2. Teach Self-Soothing

Comforting himself to sleep is an important skill your baby needs to learn. Once you have his sleep routine figured out, allow him to soothe himself to sleep. Babies cannot self-soothe in the first three months of their birth. The best time to start teaching self-soothing to a baby is between 4 and 7 months.

3. Set the Environment for Sleep

Playing white noise such as the radio static softly or a ticking clock can help set the rhythm for sleep. Soft light helps, a night-light is also reassuring. Offer your baby a pacifier or let him suck on his fist if that calms him. However, watch that this doesn’t become a habit.

When Do Premature Babies Sleep Through the Night

Since all babies are different and take their own time to develop a regular sleep pattern, it’s not possible to tell exactly when preemies can sleep through the night. Generally, a preemie may not sleep for long stretches up until 6 to 8 months. Moreover, some babies are naturally more wakeful than others. Talk to your paediatrician if you have questions about your baby’s sleep routine.

Comparing Sleep and Wake Behaviour of Premature Babies and Full-term Babies

Although all babies seem alike to the untrained eye, there are differences between the behaviour of preemies and full-term babies. Some differences that you should notice are:

  • A healthy full-term baby can sleep for 18 hours a day while a preemie will sleep less or more than that.
  • If preemie babies sleep longer, they spend more time in the light sleeping stages where they wake up often and fuss, which is not the case with full-term babies.
  • A full-term baby may sleep the whole night by the age of 4 months while a preemie might do the same after 6 months or more.
  • Sleep and wake behavioural patterns can be easily recognized in full-term babies. Although preemies show these states too, they often deviate and do not spend the same amount of time in each state as full-term babies. They can be unpredictable and change states quickly or skip them altogether.
  • The behaviour of preemies can also vary from day to day. They may eat and sleep well one day and be irritable the next day having difficulty eating and sleeping.


Why Do Some Premature Babies Sleep so Much?

The answer to why do premature babies sleep more is that they have much catching up to do on their growth and development so you shouldn’t be surprised if you find a preemie baby sleeping for 22 hours a day in the first few weeks after his birth.

As premature babies grow and mature their behaviour becomes more predictable and even. They only need a little more time than the full-term babies. Don’t you worry about your little one, if you have any doubts consult a doctor.

Also Read: How to Take Care of Premature Baby at Home

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