Loved a study published today in Pediatrics. Researchers sought to determine if mothers who breastfed slept less than those who formula fed their babies. I hear lots of talk (at birthday parties to office visits) about how formula or rice cereal creates better infant sleepers. So far, science doesn’t back up these claims. But as every new mom (and dad) knows, sleep is the major commodity during your infant’s first 6-12 months. We really want our babies to sleep through the night. Desperately. Six weeks in, crying is at a peak for infants and mothers are utterly exhausted after a pregnancy, a labor/delivery, and a month or so of very fragmented and dwindling sleep. Not only are we at peace when our babies sleep, we often rest, too. Maternal rest is essential for familial functioning, enjoyment of a baby’s infancy, and simple recovery. Sleep is not just about feeling rested or perceiving that you get more (or less) sleep than the other baby’s mothers on the block. It is about wellness, too. The study asserts that, “a growing body of evidence shows that mothers may not, in fact, do fine with less sleep.” Maternal sleep may affect rates of postpartum depression and an infant’s emotional and cognitive outcome. Getting rest is something we actually CRAVE in the first few months of our baby’s lives. Sleep, at some point, has to be a priority.
Researchers in West Virginia wanted to figure out if mothers of formula fed babies got a better night of sleep compared to those who breast fed or partially breast fed. The motivation behind the study was to dispel any perceived disadvantage of breastfeeding. Before you get up in arms about how bad your night sleep was while breast feeding compared to baby Jane next door who was chugging formula, look at what they did. Sometimes understanding how a study was performed helps you interpret how much weight you put into the results.
- Two groups of women participated, 80 completed the study in entirety. The first group consisted of first and second/third time moms from 9-16 weeks postpartum. A second group consisted of first time moms from postpartum weeks 2-13.
- Moms logged their total night time sleep, the number of times they got up to feed their babies, and duration of time they were up each night on a PDA (think old school palm pilot). This is good from a reliability stand point–moms actively filled out information just after their night of sleep so researchers didn’t have to trust memory or recall.
- Moms wore actigraphs (yup, I had to look this up, too) that monitored their movement. Actigraphs are wrist monitors that help in quantitatively capturing how much sleep moms get by looking at gross body movement.
- Moms self-scored “sleepiness” using three standardized scales translating daytime functioning. Basically, moms reported their sensations of sleepiness throughout the day.
- Moms were divided into breast feeding, partial breast feeding, and formula feeding groups to run results.
- Moms were excluded if they had a history of depression, anxiety disorder, multiples, premature delivery, or had an infant in the NICU.
Drumroll….what the researchers found was that moms didn’t differ (statistically) in the amount of sleep, daytime functioning, or in the sleepiness scales. All moms were getting about the same amount of sleep, feeling the same amount of fatigue, and were awake about the same amount of time at night. The study found no difference in objective sleep (the actigraphs), subjective sleep (moms logging their sleep) or sleepiness between breastfeeding and formula feeding moms. Further, one interesting difference found using actigraph data (objective) was at 10 weeks postpartum, breastfeeding moms has greater sleep efficiency than formula feeders. Huh. I wouldn’t have guessed.
At least in the first 3 months, switching to formula feedings will not guarantee an improvement in maternal sleep. Some mothers may be led to believe this. Consider talking with your pediatrician if you’re weaning because of sleep deprivation. Particularly if you’re going back to work and worried about the juggle between breastfeeding & work. Of course, there are outliers to this data. Not all women fit into this mold. Further, this data can’t be extrapolated to women who suffer from postpartum depression or anxiety (the study excluded similar moms).
What is your experience? I don’t really remember much this time. I’m not kidding; I can hardly remember those months. With both my boys, I was up multiple times every night in the beginning (of course), and come 6-12 weeks, very bleary-eyed.
We’ve co-slept with our daughter since she was born (now 13 months old) and she is still breastfed. The co-sleeping was by far the best thing we have done for her sleep and ours. The brain research in co-sleeping is amazing. No needing to get out of bed and trudge down the hall several times a night. Just latch the baby and fall back asleep. I KNOW I got more sleep than my formula feeding friends and many breastfeeding friends too. I think it’s a shame co-sleeping is so vilified when the benefits are so high.
Unfortunately I was not able read the study in its entirety, but did they take into account that fathers can feed if either partially or fully formula fed? I was unable to breastfeed due to medical issues and the one thing I really enjoyed was that my husband could take at least one feeding a night.
Well, I would have been excluded from the study, since I have twins, who were born prematurely. But, it is my belief that individual babies have individual sleep patterns, regardless of what they eat.
My boys were basically formula fed, I was pumping for a while, but that didn’t work out. Here’s the breakdown:
I believe I got more sleep than I would have if exclusively BFing, because my husband helped out. We took shifts which allowed the other person to sleep a 5hr block. During the first 4wk, I was up anyway, pumping, but when I quit that, I did get more sleep. I still heard the babies every time they cried, and woke up, but if it was my husband’s shift, I could go back to sleep.
I’m not saying I got enough sleep—the children didn’t STTN until 6mos old and it took until they were 7mos old for that sleep dep fog to truly lift. But I believe that if I’d continued pumping and/or BFed, I would have been up more often and for longer periods of time in the night.
As I said, I’d be excluded by this particular study and maybe preemie twins can’t be compared. If there was only one baby, sleeping next to the bed, maybe I would have been able to drowsily nurse wo/really waking, assuming the baby fussed briefly, ate quickly and went back to sleep after eating.
Anyway, I think that having a partner help with night feedings, whether by feeding pumped milk or formula, may help mothers get more sleep, if the partner reliably wakes when the baby cries, and if the mother can fall back asleep if she is woken by the crying.
I would love to see this paper in its entirety, as I have some further questions about the design and study population. I haven’t been able to find it on-line yet, but I am curious about it. One word I see missing from the study design here is DAD. I wonder if, for the study, the moms were allowed to pass a feeding on to their partner. Because I do know that most of my friends who formula feed pass at least one feeding off to someone else, while most of my friends who breastfeed handle all of the feedings. I think the ability to have someone else handle a feeding would make a difference in the amount of sleep that mom gets.
In any case, I think that how much sleep you are going to get is probably based on your individual baby and their personality, rather than how much they eat or don’t eat. I nursed both babies and Will didn’t sleep through the night until 11 weeks, while Emma slept through at 6. Even before that, Will was up every 2 hours and Emma was up every 4. Her need to eat during the night was always less.
Will was a HUNGRY baby and between 8 – 11 weeks, he was up every two hours to eat. I tried other ways of soothing him and he wanted to eat. He would go right back to sleep after a feed, but my sleep was incredibly fragmented. I felt as if I lived on a different planet during that time. I was barely functioning during the day and I would do ANYTHING to eek out even a few more precious minutes of sleep. I am probably most famous amongst my friends for driving to University Village to buy a $30 miracle swaddle blanket. . . which, by the way, did NOT work.
What cracked me up about this post was the study’s assertion that “a growing body of evidence shows that mothers may not, in fact, do fine with less sleep.” Really? It took SCIENCE and a STUDY to tell us this? Ask anyone who saw me in the first 12 weeks of Will’s life! I was a hot mess. Sleep deprivation is a form of torture for a reason. But I think that when you have a newborn, you are probably going to be sleep deprived, regardless of what you feed your baby.
Wendy Sue Swanson, MD says
Katie, the link to the study is in the first sentence of the post. You can access the abstract by clicking on the link. or here: https://pediatrics.aappublications.org/cgi/content/abstract/peds.2010-1269v1
Unfortunately, you’ll need a subscription to Pediatrics to read the full study. Next time you’re in clinic, I’ll share it with you!
neat study. i’ve seen the claim run both ways–that formula feeding lets you sleep better and that nursing moms sleep better. i have to disagree about cosleeping though! sure, at first you sleep better because you’re not getting out of bed. but when your 2 1/2 year old is still nursing though the night, i’m pretty sure the moms who never coslept, with kids that only wake them up once a night, are feeling better rested. i speak from experience, as a cosleeping mom who hasn’t slept through the night in more than 5 years!
I agree it is all about the co-sleeping. We bought a crib and never planned to co-sleep, but right from the start, baby slept 12 hours a night. She never once slept in her crib, and now she is 4 years old and still a good sleeper. If you think back to caveman days, of course a baby put in the next cave over will automatically scream so the parents who lost her can find her and save her from the wolves. If she is right next to you, she can just make a few little grunts to get you to whip out your boob, and then both of you can sleep right through the feeding. I never felt tired or depressed during the day. And I’ve heard the argument about suffocation, but if the baby is not in the middle and in her own place scooted off to the side with pillows wedged into the gap next to the bed–and if the parents aren’t drunk, I think it is safe. We never had any close calls with squishing. And we have had many years of bonding with all her best stories told to me as she drifted off to sleep. Some friends of ours were so exhausted from their baby’s crying, that they moved her room to the opposite side of the house and hired a nanny to deal with her at night. Illogical and unnatural, I think.
+1 on co-sleeping! Neither of mine STTN until 12-14 months.
Baby #1 was a bigtime comfort nurser, wouldn’t take a binky. We were attached 24/7 for the first 13 weeks until I returned to work. Neither of us did well with the transition to work, and what helped was reading about milk supply and sleep issues on https://kellymom.com. I can’t say enough good about Kelly’s articles and advice on breastfeeding. I learned that my baby was reverse-cycling and I decided to let her and co-sleep. It was a wonderful arrangement until 6 months. (We took careful precautions from Dr Sears Sleep book and other sources to make co-sleeping safe. Including a side-car bassinet/crib where baby slept when I was truly exhausted and might be less responsive to her.)
Sleep arrangements that yielded most sleep:
1) Co-sleeping and nursing in side-lying position. Worked best after 2-3 months IME. (My babies had GERD and needed to be proped up after feedings in the early weeks.)
2) Room-sharing, with baby in side-car crib. I found that when baby was 12 inches away, I could sit up, reach, nurse, burp, resettle baby and myself in a semi-wake state that allowed me to quickly return to sleep.
3-a) Baby in separate room. When baby was in a separate room (> 6 months for us), I found it more difficult to stagger over there, stagger onto the rocker. I was more prone to fall asleep on the rocker, which felt more hazardous. (Woke up with baby upside-down on my lap once.)
3-b) Tied with nursing in different room is bottle feeding, but where infant is older and can have cold milk. When I weaned baby #2 (12 months), I’d pre-pour his bottles and let him drink them cold. (Yes, I’m a mean mama that way. He was a year old! If he wanted a warm meal, he could wait till morning.)
4) Baby bottle fed warm milk. Regardless of where baby sleeps, you must get up, go to the kitchen/cooler, get bottle, warm it, test it, feed baby. IME it was really hard to get back to sleep after that. We did formula for 2 weeks and at least you can mix large quantities, keep a cooler and bottle warmer in baby’s room.
5) Baby breastfed expressed breastmilk. OK, seriously, if you pumped exclusively for any amount of time, I stand and salute you. Tried this for 1 month w/ baby #2 and it’s the most difficult scenario all around because you have to wake up and pump even if you aren’t the one feeding the baby. If you don’t pump overnight in the first 12 weeks, your body is less likely to produce enough milk cells to sustain long term lactation. (New study from 2-3 years ago, I can look for the citation.)
Thanks for the notice on this super interesting article, Mama Doc! This is something that is anecdotally advised to the tired mama… interesting to see some evidence. I realize that all studies have other unmeasureable variables that may cloud the results… but I really think this study design is pretty cool!
I also believe that every infant and every family is unique. But all I have to compare with is my little N of one, my own experience: a 20 month old who was breastfed for 13 months and still comes to bed with us almost 2 years later… and while he thinks he sleeps pretty well…. my husband and I have not slept more than 2-4 hours in a row since he was born. Every once in a while, when we hit the wall of fatigue, we wonder- what have we done! I think when he was little, I actually felt more comfortable and at ease knowing he was safe with a full tummy right next to me… Now I think that in all his toddler glory- he knows exactly what he wants- and we are too tired to help him to sleep in his own bed. Will be interesting to see if the authors looked at other sleep practices!
We all feel so passionately about our sleep, and I think we are always looking to help one another out! Thanks for this post!
I transfered from breastfeeding to bottle feeding at 7 months and I honestly think I got more sleep breastfeeding. Not in the first few months, but after he was sleeping most of the night I could as Viki mentioned stumble into his nursery half asleep, nurse him half asleep and then get back into bed and easily fall back to sleep. Now if he wakes up in the middle of the night, I have to get myself to the kitchen… usually turn on a light to see what I’m doing… and then feed him the bottle. It always takes me longer to fall back asleep when this happens than it did when I was breastfeeding.
I second this opinion. It is way easier to fall back asleep after breastfeeding. Washing those damn bottles gets old.
Don’t stop breastfeeding to get more sleep. Simply not true.
I was happy to see this study yesterday! It was my experience that I got plenty of sleep when breastfeeding and co-sleeping with my children when they were very young. It was pretty easy to let her suck while I drifted back to sleep. I couldn’t tell from the page the age of the babies they studied. I had a similar experience to Kelly once my kids reached about 6-8 months though. I rarely got more than 2-3 hours at once until I finally night-weaned them and moved them into their own beds at around 18 months. But that may be more related to co-sleeping than breastfeeding!
Baby sleep through night says
An important aspect of getting your baby to sleep through the night to have a consistent bedtime routine. A solid evening routine will help your child understand that it is time to sleep when the routine is finished.
I was able to find the abstract, but it doesn’t show the complete study design, so I’d love a copy when we’re in next, if you have the time. Which you probably don’t :). It’s really not a big deal, I was just curious about the ability of the mom to have someone else do a feeding during the study, because that would make a huge difference in how much sleep a mom was or wasn’t getting.
Wendy Sue Swanson, MD says
Greeeeeat comments, all! Thank you. Addressing some of your points:
1) The study doesn’t discuss partners sharing the load (at all), and your point is well taken here. Mothers who have partner support with night time feedings (primarily those formula feeding) may be able to skip an entire feed and have a longer period of sleep time. I agree with you all that it is something to consider in regards to daytime functioning, fatigue, etc. I had a TON of help from my husband during night time feedings with my first son (I was pumping exclusively after a severe breast infection landed me in the hospital) so he would do 1 or more of the night feedings. With my second son, I breast fed him at night and my husband didn’t do any of the feedings. The experiences were very different for me, but I don’t think I can tell you which one had me functioning better of which experience left me less sleepy 🙂 I would have needed an actigraph and a PDA to tell you…my memory on this likely doesn’t serve me well. I feel it would be too editorialized…
2) The study addresses some of your points about the difference in breast feeding versus preparing formula at night. For example, 1 study done previously found that although breast feeding mothers spent more awake time during the night, they didn’t have any difference in total sleep time. Another study reported that BFing mothers slept about 40 more minutes per night. Some of this is explained just like you all state, moms will often co-sleep or fall asleep during breast feeding versus the less likely event during feeding formula (after preparing it, etc).
3) They theorize that if BF moms are awakened more at night, BFing likely has a compensatory effect. Ie, although they are awake more, they also fall back to sleep more easily.
4) Previous study (Quillin and Glenn, J Obstet Gynecol Neonatal Nurs. 2004)) reported that BFing mothers who coslept slept more than those BFing mothers who didn’t or those who used formula. This may be explained by just the time moms sleep during feeds or a possible physiologic effect: that prolactin levels (released during feeding and make you sleepy) or change your quality (sleep architecture) of sleep. Prolactin may simply make it easier to fall back asleep in a BFing mom.
5) Lastly, limitations of this study are really notable. It is know that women who are depressed or suffer from postpartum depression are less likely to continue breastfeeding. So this information on sleep may not be generalizable to many mothers.
Kathy Early says
I too was a breastfeeding, co-sleeping, full-time working mama and sure, I had lack of sleep at times, but I never reached the point of “I can’t do this anymore”. It was well worth it to me/us. I valued BFing for at least 12 months (both kids made it to 16 months) and I found co-sleeping the best approach for family sanity and quality sleep.
It is too bad that they didn’t account for partner support. Even for families who don’t have dad offering a bottle, emotional support and encouragement, and respect/admiration for mom’s efforts certainly can be motivating!
Cultural and education background and socioeconomic status can also play a role in the decision to BF vs. formula feed, so those would be other factors I would be interested in seeing evaluated.
Thanks for sharing another interesting study!
Both my kids slept 10-11 hours a night from the third month onward and I am not sure what did it, other than a bedtime routine or luck or both. My son slept from 9 weeks onward, formula fed, and my daughter slept from 12 weeks onward, breastfed and then formula fed at 3 months. I think the peaceful quiet bedtime environment and routine was a big part of it, but who knows. We just consider ourselves very lucky about that aspect of parenting!
Ditto Colleen and ditto the co sleeping comments. It saved us for sure! And as for Dad, I was an anxiety ridden mess when he was smaller, so woke up every single time he did anyway. It wouldn’t have mattered if we had passed off feedings. Even after co sleeping, I could pull him from his crib into the bed for the one night feeding he still held on to and he went back to sleep MUCH more reliably.
I’m wondering: do FF babies STTN earlier in life? I’ve always suspected that once you get past early infancy this is the case. Oh, how I’d envy the 8oz bottles of formula my daughter’s daycare companion would chug before taking a miraculous 3 hour nap. I was hard pressed to get large quantity of milk into my babies during the day. I don’;t think they consumed enough calories to allow them to fast for 8, 10 or 12 hours overnight.
I also wonder if babies have different metabolic rates. My babies finally slept well when they could eat a solid 1000+ calories per day. (They are tall/lanky and in constant motion.)
Isabelle: if my kids slept like yours, I’d have 2 more!
We figured out that our boys didn’t NEED to eat in the night anymore by about 6mos old, but they still expected a bottle for comfort. We figured they were getting enough food during the day because their intake dropped off overnight—they were still waking at 3am, but taking mere sips of formula before falling back to sleep. So, we stopped offering the bottle and within a few days, they didn’t even wake at 3am anymore, or if they did, they didn’t cry.
But, if a parent continues to offer the comfort sucking in the form of a bottle or a breast, some children may not take it upon themselves to STTN, and instead get into the routine of waking and being unable to fall back asleep wo/the associated bottle or nursing.
So, that seems to be a situation really tailored to individuals—some babies will drop O/N feedings sooner than others, some will still need to eat, and others will prefer to comfort-eat even though they don’t need the calories. I guess the parents would have to figure out if the child still really needed food if he/she seems to be asking for it in the wee hours. And if the eating was comfort eating, then the parents have to decide if they want to curtail it, or let it taper off on it’s own.
One thing is comparing sleep within first 3 months, other from 3 months on/later.
Bottle-fed babies often sleep through the nite when 2-3m. old and from 3. on too, while BF babies wake up quite a few times still even at 10 months and that is hard (speaking from my exper.)