Episode 15: Napping Spectacular!

Ep 15 audio only
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Craig Canapari MD: Welcome to the Sleep Edit, a podcast devoted to helping tired kids and parents sleep better. We focus on actionable evidence-based sleep advice, so everyone in your home can sleep through the night. Now, a quick disclaimer, this podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice.
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Or that their children may have, they should seek the assistance of their healthcare professionals for any such conditions. Nothing stated here [00:01:00] reflects the views of our employers or the employees of our guests. Enjoy the show.
Okay, so welcome back to the sleep edit. I am Dr. Craig Canapari
Arielle Greenleaf: And I’m Arielle Greenleaf.
Craig Canapari MD: And we are here to talk about what I feel is one of the thornier issues in pediatric sleep and that is napping.
How to do it, when to do it, when to drop naps. As a parent, I’d say this is a topic close to my heart because we struggled with naps in our kids and in different ways with the two of them.
Arielle Greenleaf: Mm-hmm.
Craig Canapari MD: and some of that is just ’cause napping is much more variable than nighttime sleep.
Arielle Greenleaf: My
Craig Canapari MD: they sleep at night, right?
Arielle Greenleaf: right?
Craig Canapari MD: Like kids with terrible sleep. They’re still sleeping at night most of the time, but napping is a whole other animal.
Arielle Greenleaf: it sure is.
Craig Canapari MD: yeah. I can tell you with Charlie, my older son, we had kind of crappy naps till he walked.
Really?
Arielle Greenleaf: man.
Craig Canapari MD: just like [00:02:00] little 20 minute cat naps here and there. with my younger son, it was easier except that he had to be around our older kid schedule. so that’s another layer
Arielle Greenleaf: That is so, so common. I feel like my child was a textbook case, high sleep needs child, and as soon as I was able to. do any sort of sleep training with her. The first day I wrote to my sleep consultant and I was like, it’s been like an hour and a half.
Should I wake her up? Do what? What do I do? And she was like, oh my goodness. And Ashley really was like, you know, four hours, a daytime sleep, 12 plus hours of overnight sleep as an infant. It was kind of crazy.
Craig Canapari MD: What did you do differently that got you such a good result?
Arielle Greenleaf: I didn’t know what I was doing before I hired a sleep consultant, so I was just kind of like napping her when she got fussy or just kind of winging it. I don’t even know. I mean, maybe [00:03:00] I was, look it, it’s such a fog, honestly. Her birthday is this weekend, she’s turning 11, and I can tell you she was not napping in a crib because.
I was too afraid, I thought. And anytime she squeaked, I was like, uhoh. she’s never gonna be able to sleep in a crib. And the first time I put her in the crib for a nap at the appropriate time, I think she cried for five minutes and then fell asleep for, I woke her up after two hours.
It was like wizardry.
Craig Canapari MD: Just putting your kid in the crib. Well, that, that’s it. People just put your kid in the crib. That’s, uh, I guess the episode’s over.
Arielle Greenleaf: Yep. There we go. All
done.
Craig Canapari MD: but you know, this does highlight, an important point. That is you can’t, when, if you’re working as a provider, you don’t make assumptions about what people know because it’s not like kids come with a manual.
And even if you read parenting books, it’s not always clear what to do in the moment.
Arielle Greenleaf: No. And I think [00:04:00] that’s the number one thing that I deal with is people just don’t know what they don’t know. and I don’t blame them, there’s supposed information at our fingertips, right? We have our phones and we look on Instagram and we look on Google and we look at, well, what is this influencer saying about naps and how, you know, what time should I be napping my child, and what are their weak windows?
And there’s just so much stuff that they, you know, so many myths that are pumped out about sleep through social media in particular. And they come to me and they’re like, well, isn’t XY, z? True? And I laugh and I’m like, I’m really sorry that you were fed that garbage because it is garbage.
there’s no sleep education for parents. They don’t go home understanding anything when it comes to sleep.
Craig Canapari MD: So let’s talk a little bit about what’s in the medical literature around napping. And, um, it is, uh, it, it’s, it’s limited and we’ll get into the reasons [00:05:00] why. I think when we’re talking about napping, we have to start by talking about how much sleep kids need overall. So in 2016, the American Academy of Sleep Medicine published a consensus document, which is usually what is recognized as gold standard guideline for sleep duration. So I’m just gonna go through the kids numbers. so according to that document, infants four months to 12 months of age sleep, 12 to 16 hours per 24 hours. Children one to two years of age should sleep 11 to 14 hours. per 24 hours, children ages three to five should sleep 10 to 13 hours.
Six to 12, they say nine to 12 hours, and teenagers 13 to 18 years of age. Eight to 10 hours. And I’m just looking at this and I’m like, what do they say about kids less than four months of age?
Arielle Greenleaf: they didn’t make any recommendations about children under four months of age.
Craig Canapari MD: oh, thanks for keeping me honest here. Because I’m like, why [00:06:00] didn’t I put that here?
Arielle Greenleaf: Yeah.
No, they, they, they didn’t do any newborn, um,
Craig Canapari MD: and, and,
and I think part of the reason is that it’s a wide range, but to put a number that, I’d say newborns are, it could be anywhere based on some other data I’ve seen from like 14 to 20 hours.
Arielle Greenleaf: I get nervous about, you know, so many people say newborns sleep so much, they need so much sleep, they’re gonna sleep 20 hours. And then I have these clients who come to me after the newborn stage where they’re like, my child’s sleeping 10 hours in a 24 hour period, and I’m losing my mind.
when ultimately there really is nothing wrong. they either have lower sleep needs or their sleep hasn’t quite yet matured and things are happening and they improve as they get older.
Craig Canapari MD: Yeah, it’s important to note that where you are on your sleep requirements tends to be kind of fixed. So if you have a baby that needs a lot of sleep, they’re probably gonna be on the higher end of those ranges at age three, ages six, ages 18, what have you, and vice versa. That seems to [00:07:00] be relatively fixed in people.
according to the authors, napping was considered biologically appropriate under age seven, and quote, ” naps may be important. Missing one nap by preschoolers produces more negative emotional responses.
And nap provision improved toddler’s performance on a generalization task in grammatical language 24 hours later compared with non-AP groups.” So it’s important to note that even in this document where they don’t deal with naps, they talk about naps being important for learning and mood.
Arielle Greenleaf: some adults are that way.
Craig Canapari MD: Yeah. and there was a study that came out of UMass that was looking at the predictor of when kids sort of give up naps, shorten naps. And it actually had more to do with hippocampal maturity.
So the hippocampus is a region in their brain that’s associated with memory. So for kids where this matures more quickly, they seem to give up naps more quickly. Which kind of makes sense.
Then there’s an article by Staton et all from 2020, which is a review article on napping. Here’s what they said. infants less than 12 months of [00:08:00] age on average, napped 3.1 hours kids, one to two years of age, 2.3 hours, two to three years, 1.9 hours, and three to four years, 1.7 hours. And I feel like those are good ballpark numbers.
there is a huge amount of variability here. Right? But, I don’t think they’re crazy numbers, right?
Arielle Greenleaf: No, I wouldn’t say that they’re astronomical, but I would say I get very nervous about anything written in stone when it comes to sleep totals, because parents really glom onto those things and then they think there’s something wrong with their child if they’re below that number. rarely do they think something’s wrong if their child is above that number, but if they’re, below, a certain number or they’re lower on a scale, they tend to get, there’s a lot of anxiety there.
Craig Canapari MD: Sure. I just think it’s good to kinda like level set for where we’ll be. in this article they say, across these articles they referenced [00:09:00] 94% of kids stopped laughing by age five. I actually think that’s a little bit high. we know for example, in children whose family identify as African American have prevalence at age 5.
Arielle Greenleaf: Hmm.
Craig Canapari MD: Most kids in kindergarten, it actually may be a metric of kindergarten readiness. If you have a five-year-old who’s needing a long nap in the afternoon and you have the luxury of not sending them to kindergarten that year, they might have an easier time the next year.
Arielle Greenleaf: Yeah.
Craig Canapari MD: Then, here’s a graphic from, Iglowstein et all.
And this is just a percentage of kids who nap during the first seven years after birth. And in these bars, they just have the black bars represent two or more naps, the light bars are just kids who are napping, one nap. and then after age four, a dark bar means napping every day. And a light bar means napping occasionally.
So what we see on this graphic, for those of you who are listening, is that [00:10:00] age one month, everybody’s taking more than one nap. Interestingly, at age three months, that look like there were about. I don’t know, just eyeballing that’s maybe 5% of kids who are just taking one nap,
Arielle Greenleaf: Is it one nap or two naps?
Craig Canapari MD: Dark bars represent two or more naps and light bars represent one nap per day. So I’d say these kids are outliers. for me,
Arielle Greenleaf: Oh yeah.
Craig Canapari MD: This is just what parents were describing. So we don’t know the circumstances here. what we do see is a clear progression in this graphic, from more than one nap to one nap. it looked like most of the kids by one and a half years of age were napping once a day by age
four, only about 10% of kids were napping every day. And by age seven, nobody was ever napping.
Arielle Greenleaf: about 40?
Craig Canapari MD: and I know little babies take multiple naps and then they give up those naps and they’re gonna go from say, three naps to two [00:11:00] nap, to one nap. The hard part is predicting when that’s gonna happen and we’ll get into that. would you agree that it’s fair to say that that’s a typical progression?
Arielle Greenleaf: Yes. I was just looking at this next.
Craig Canapari MD: Oh, so the Galland review article, so again, this is another, I believe this is,
Arielle Greenleaf: this one definitely looks more realistic than that other one.
Craig Canapari MD: Yeah, no, hold on. I’m just pulling this up. So this was a study of about 900 families
Arielle Greenleaf: Oh, that’s
Craig Canapari MD: just gimme one second because I,
Arielle Greenleaf: This ILO thing is blowing my mind though.
Craig Canapari MD: I think that there’s
Arielle Greenleaf: a six month old or a nine month old on one nap
Craig Canapari MD: normal sleep pattern in infants. So this is, uh, uh, the Galland study. This is From 2012. This is, um, a systematic review. So that meant they, they aggregated a bunch of different studies. They had 34 different studies that they included in this. And this is, this is actually a fairly interesting study. So here’s what these authors found.
for nap duration, fewer studies reported For zero to five months of age, they found that [00:12:00] the average amount of napping in that age group was 3.1 hours
Arielle Greenleaf: Yeah, it is a little, but that makes sense. Daytime naps, zero to five months, 3.1, six to 11 months, 2.21 to two years, 1.2. All infants. Those all seem very correct as far as like number of daytime naps by age.
Craig Canapari MD: Okay. So in this review article, they were looking at nap duration, the mean nap duration for children, 0.5 months of age with 3.1 hours per day. The lower limit was 1.2 hours. The upper limit was five hours for six to 11 months. It was 2.2 hours with 0.9 is the lower limit.
3.5 is the upper limit. One to two years of age was 1.2 hours a day with a lower limit of 0.4, upper limit of 2.1. they actually [00:13:00] did scatter plots of the reported sleep duration and the number of daytime naps by month actually has a very nice, I guess the technical term we would have would be a line of fit.
So you can look at this data over time and it looks like what they found is around two months of age, 3.5 per day was typical and over time, that drops this graphic ends at 24 months of age. When. one nap is typical. So it looks like this is a fairly linear progression, meaning that it’s somewhat predictable.
I think the challenge we have here is it’s not like your child goes from having 3.5 naps a day to three naps to 2.5 in a very clean incremental pattern. They go from like four naps to three naps, to two naps, to one nap. And those transitions are really tricky. So again, we know that it’s predictable giving up naps, [00:14:00] but this data doesn’t tell us much for an individual parent sitting the exam room or consulting with a Arielle. When can we predict the nap’s gonna go away? So like this is kind of like the frustration here for parents and honestly for providers as well, is we know that the sleep is gonna go down over time. If somebody comes in and is like, my kids’ naps are crappy. Like, what do we do about it? I am gonna be more of the sort of, the interlocutor here because this is more the art of napping versus the science of it, which is a domain in which, Arielle who unfortunately didn’t have access to when my kids were horrible nappers.
Arielle Greenleaf: Neither did I.
Craig Canapari MD: I thought we would, kind of go through this and start with some just general questions about napping and then maybe get into some cases as well, I think if a parent is struggling, they should seek help from, you know, check in with your pediatrician, make sure that there’s no medical problem going on.
working [00:15:00] with somebody who’s experienced in troubleshooting child and infant sleep problems can be very helpful if you’re struggling. understanding a little bit how expert may solve these problems can be very helpful I think.
Arielle Greenleaf: absolutely.
Craig Canapari MD: So let’s start by, what’s the relationship between napping and nighttime sleep?
Arielle Greenleaf: I mean, I think you’ve already talked about it. We have to look at 24 hour sleep, like you’ve said, in young children and infants. Naps serve a purpose. They are,
Craig Canapari MD: can I just stop you there?
Arielle Greenleaf: Okay.
Craig Canapari MD: I know that we’re to,
Arielle Greenleaf: What did I say?
Craig Canapari MD: Oh yeah, we’ve talked about sleep before
Arielle Greenleaf: Oh, okay.
Craig Canapari MD: I know we,
Arielle Greenleaf: No, yeah, that’s fine.
Craig Canapari MD: we’ve talked about this in earlier episodes, but just quickly
Arielle Greenleaf: Yeah,
Craig Canapari MD: I think it’s so important,
Arielle Greenleaf: It’s essential.
Craig Canapari MD: in the cannon of the sleep edit.
Arielle Greenleaf: no, It’s true.
Craig Canapari MD: Lemme ask the question
Arielle Greenleaf: Yep.
Craig Canapari MD: So let’s start, what is the relationship between napping and nighttime sleep?
Arielle Greenleaf: So I think you just went over, a little bit of the sleep science and the point of napping and the fact that napping serves a purpose for younger children. And, there is that body of evidence right now that shows that once the, hippocampus or whatever, is that what it’s called?
Craig Canapari MD: Hippocampus,
Arielle Greenleaf: Hippocampus is matured and memory sort of, matures, that napping. So the sooner that happens, napping starts to go away. So there are, there’s real reason for naps. As children grow, I don’t want anybody to get caught up on the fact that their child is a bad napper and think that because they’re a bad napper, their child isn’t gonna be smart or won’t have good memory or things like that.
when I go to solve a nap [00:16:00] problem and I’m looking at naps versus nighttime sleep, I have to look at 24 hours sleep. And what is 24 hours sleep? We go back to look at those American Academy of Sleep Science recommendations.
Right? So you said for infants four months to 11 months, that’s 12 to 16 hours in a 24 hour period. Now a child that needs 12 hours of sleep is gonna have, much less daytime sleep than a child that needs 16 hours of sleep in a 24 hour period.
But I have to look at each child individually and start to determine, okay, What are their 24 hour sleep needs? A lot of times when they come to me, we don’t have a great handle on that because things are so all over the place. But sometimes if they do have data, we can see. Okay, your six month old is napping for six hours during the day and then only sleeping five hours overnight, six hours overnight.
we would hope that a child that [00:17:00] age is sleeping somewhere between 10 to 12 hours overnight. Overnight sleep is the most restorative sleep a child can get or a human can get, really. So we wanna maximize that sleep.
So what I would do is say, okay, how are we gonna shift some of these hours into the overnight hours? but then it becomes a delicate dance because, you know, do we have a child that’s super sensitive to wake times? Because as much as I hate wake windows, every child does have a specific amount of time that.
First of all, they have a specific amount of sleep that they need, but in turn, they also have an amount of awake time that they need, to, in order to achieve whatever that 12 to 16 hours is. So I have to look at nighttime and daytime and balance that appropriately. so that’s where I start basically.
But I will talk about, I think I put in here, some children are just very sensitive to timing [00:18:00] and when they’re being put down. And so I actually have a quote from a mom. I got permission to use this This was when we first worked together. So this was probably back in, I don’t know, he was five or six months old.
So she says to me, she’s actually a doctor. and she says to me, ’cause she’s looking at the data that we have and I have all my clients log all their sleep naps nights. How long is it taking for them to fall asleep? How many wakings are they having? how long is everything?
You know, how long is the nap? All of that jazz. The other pattern I’ll add that we’ve noticed is if we push him a bit too far, he tends to take an hour and five to an hour and 10 minute nap, then he will wake up. He did that this morning for his first nap, but was able to settle back pretty quickly.
Not sure if I’m over analyzing. Sometimes when we push him way too far, then he does have like a 27 minute nap and cannot get himself back down to sleep. And that’s when I think he’s overtired ’cause we’ve pushed him too far. So I think the biggest nuance for figuring out daytime sleep is how do you balance awake time with sleep time and then, making sure that you’re [00:19:00] prioritizing overnight sleep, but also, making sure that the child is well rested throughout the day as well.
Craig Canapari MD: So let’s talk concretely here.
Arielle Greenleaf: Yeah.
Craig Canapari MD: Do you have a set amount or proportion in your mind for like, say a infant, what’s the minimum amount of sleep you think they should be getting at night
Arielle Greenleaf: at night, minimum 10 hours. And I will tell you anecdotally that it’s extremely rare for me not to achieve that. it is extremely rare for me not to get to at least 10 hours of overnight sleep for a baby.
Craig Canapari MD: So in the example where you’ve got, a six month old is taking five hours a nap during the day, I assume, is that in two naps, three naps.
Arielle Greenleaf: it really depends. Sometimes it’s, well, at six months he’s taking 5, 5, 1 hour naps and
He’s going to bed at 11 and he is waking up at five in the morning and then taking five one hour naps
Craig Canapari MD: I think one of the really important points here is that babies [00:20:00] don’t deprive themselves, right? they’re gonna get their whatever hours of sleep they need. there are probably some neurological benefits to having longer sleep periods at night for kids. There are definitely neurological benefits to parents.
Um, and that part of the reason we do this is like, again, even kids that whose parents are struggling, they still usually sleep the normal amount every 24 hours. One of our goals is to get them to consolidate sleep
Arielle Greenleaf: Yes.
Craig Canapari MD: I think we’re helping the kids, but we’re also helping the parents. ’cause if we help the parents, it also helps the kids.
Arielle Greenleaf: Absolutely. It’s a family affair.
Craig Canapari MD: Yeah. and I’ll say that right now we’re mostly talking about situations where people have the luxury of moving things around, which is not always that case. I think we’ll talk later about things like childcare or kids who aren’t the first kid, where there are other kids in the house and it gets even harder.
But I think it’s still more [00:21:00] important for people. Right now we’re talking about if under optimal conditions, what do you do?
Arielle Greenleaf: Yeah, and I would say under optimal conditions, when I go, what is my goal for, let’s say an infant, four to 12 months-ish. My goals are at least two naps each nap, one hour each minimum, and then a minimum of 10 hours of overnight sleep.
Craig Canapari MD: sorry, what age is that?
Arielle Greenleaf: so that’s a very wide range there. So that’s for an infant.
some even young infants don’t like to take a third nap. But let’s say, you know, that’s at the very minimum, I would say at that 12 hour mark, you know, 12 to 16 hours, two one hour naps and a 10 hour night. it’s usually not, it’s very rare for me to see an infant that only needs twelve hours, especially a young infant, although it’s not unheard of.
it’s, there’s so many nuances to all of it, and I think that’s why it’s frustrating to see so [00:22:00] much nap advice out there because. so many parents are like, I’ve done that. I’ve tried that. I’ve tried that schedule. I’ve, you know, there’s no way my child can sleep more than 30 minutes, or, you know, whatever it may be.
And it’s because it is so nuanced and it would just be nearly impossible to help every single parent with their nap struggles,
Craig Canapari MD: Like in speaking in generalizations.
Arielle Greenleaf: Yes.
Craig Canapari MD: No, I agree. I’m curious when you’re saying high need versus low need sleep babies, do you have numbers in your head?
Arielle Greenleaf: I would say a high need sleep baby is somewhere from like 14 and a half to 16 hours in a 24 hour period, and then lower is closer to like 12 to below 14.
Craig Canapari MD: Yeah. And, I, in my world, my clinic is full of little kids who don’t need a lot of sleep and big kids who need a lot of sleep. Like if you’re thinking about the healthy kids that come in, right? Like the kids that don’t have neurodevelopmental [00:23:00] disorders, whatever. often I’ll see like toddlers or preschools.
The parents are like, well, they nap. They’re up till like 10 o’clock at night. I’m like, well, stop napping. You know, they don’t need the nap anymore even though they’re two.
They can’t always do it if it’s a second kid or in the, they’re in childcare. And those kids might fall apart a little bit if parents aren’t actually giving them enough nap time. But it tends not to be that hard to actually get them to go down for a long nap. ’cause they need a lot of sleep. So sometimes I feel like those are the parents who are the envy of, their peers if it’s a first kid.
Arielle Greenleaf: Yeah.
Craig Canapari MD: Because they’re like, oh yeah, people be like, oh, my neighbor’s kid is like taking three, two hour naps a day and sleeping 12 hours a night. And I’m like, well, my 18 hours of sleep a day.
Arielle Greenleaf: And that’s highly unusual. I also find that I feel like everybody is always doing so much better than everybody else. You know? And also, I don’t trust what other people are saying based on the stuff that my clients say.
Craig Canapari MD: You always fixate on. It’s like, look, the cliche is the grass is always greener. like in our world, the cliche is someone’s kid is always sleeping better than your kid. Right? Like, their child might be struggling with something else. so let’s talk about nap routines versus bedtime routines.
Arielle Greenleaf: I don’t see them as all that much different. really it just needs to be a [00:24:00] regular flow of steps that you go through to prepare your child for bed, whether that be naps or bedtime. Obviously I find that bedtime is usually longer in that there’s often, a bath involved or, more cuddling with mom or dad beforehand.
Whereas a nap is, not necessary to go through that big longer process. but I think just having some sort of consistency with, okay, we’re gonna go change you, change your diaper, change into a sleep sack, read a book, cuddle for a little bit, and then it’s time for bed sort of situation.
It doesn’t have to be overly complicated, just a predictable routine that a child gets used to and gets to understand that what’s coming at the end is sleep.
Craig Canapari MD: Sure. Yeah. And I think it’s like, it can be shorter, right? You know, you could do a story in a song,
Arielle Greenleaf: Yes, Absolutely.
Craig Canapari MD: especially if you’re doing this three times a day.
Arielle Greenleaf: [00:25:00] I will say though, that when I think about like toddlers in particular, sometimes they need wind down time transitions can be difficult. Some children really struggle with, okay, we’re eating lunch and now we’re going for a nap. It’s like they need some time to, settle and get into bed.
So sometimes in those situations, if we have the luxury of controlling that, we may extend that a little bit just so that there’s some wind down time.
Craig Canapari MD: Absolutely. Yeah. I think children benefit from routines and if things are predictable. Just like bedtime, you wouldn’t have your kid going from bouncing on the trampoline expecting to be sleeping in 16 minutes
Arielle Greenleaf: exactly
Craig Canapari MD: that’s true during the day as well.
Arielle Greenleaf: Yes,
Craig Canapari MD: okay, now this is such a great question. how to get longer naps.
Arielle Greenleaf: Okay. So I mean, if you’re, we talk about daytime sleep and nighttime sleep. [00:26:00] I think it’s important to understand that the same basic, The same things are true for daytime sleep, as they are for nighttime sleep. If a child is struggling, you need to look at it all. Are they falling asleep independently?
Are they on the right schedule? I think those are the two most essential pieces to figuring out how to get longer naps.
Craig Canapari MD: so just to be clear, part one, knowing how much sleep they actually need.
Arielle Greenleaf: yeah, but they might not know that right away,
Craig Canapari MD: no. but I still think it’s fair. Like, what are the things that you need? First of all, you need to know how much sleep, your kid needs in 24 hours. And that’s like probably a minimum of three days of sleep diaries,
Arielle Greenleaf: I would say three to five days is probably good.
Craig Canapari MD: and the second,
Arielle Greenleaf: The second thing is that your child needs to know how to fall asleep independently. I get a lot of people who. their babies are, or their children are taking 30 minute naps. A lot of times that’s infants, like, they just cannot consolidate their daytime sleep. And I ask them to [00:27:00] walk me through, okay, well how are you putting your baby to sleep?
And it’s like, I’m nursing him, he’s falling asleep, and then, I’m putting him in the crib and then he pops up 30 minutes later and he won’t go back to sleep. But if I pick him up and he starts nursing again, he falls asleep again.
You know, things like that. So, helping a child understand or learn the skill of falling asleep independently is really the linchpin to nighttime and daytime. So if your child is dependent on anything to fall asleep, then it’s, it’s gonna limit your ability to extend naps. some children know how to sleep independently.
They’re on a great schedule and they just don’t like to nap. they just aren’t big nappers. I think you have to set the bar low, and if you exceed that, then congratulations.
But I do think it is achievable to get more than a sleep cycle. And a sleep cycle is [00:28:00] typically anywhere from 30 to 45 minutes. So I think anything beyond 45 minutes is great. for some kids, for that one nap, it’s enough. so that, that’s really the baseline that I’m at.
Craig Canapari MD: There were two studies of interventions for improving sleep in kids. We usually, when we talk about formal sleep training, we’ve talked about Cry it Out on an earlier podcast. these real studies we’re looking at infants from like three to four weeks of age. And there were parent interventions, to extend sleep, and one is called the SAAF trial.
Another was, called the INSIGHT trial, and this was all sort of common sense stuff, but I think it’s worth enumerating the things that these two protocols had in common. So the first was avoiding feeding kids to sleep after a month of age, which I think is very good advice.
Arielle Greenleaf: It’s great advice,
Craig Canapari MD: No, no,
Arielle Greenleaf: different listeners.
Craig Canapari MD: but yeah, at least as a stated goal,
Arielle Greenleaf: Absolutely. It’s a good goal.
Craig Canapari MD: the second was putting infant down for sleep, drowsy, [00:29:00] but awake. To me, that’s four to six weeks is maybe when it’s worth the earliest you’d consider doing it, and it’s more like, try it and see what happens.
Arielle Greenleaf: Yeah, I mean, I think you can try that right away. it doesn’t hurt, but as soon as your newborn needs you, you need to pick them up right away. There’s no like, put ’em down. If they’re crying, leave them. It’s like, try putting ’em down, see what happens. They might be fine. I’ve had clients that have babies like that, and they’re astonished, so
Craig Canapari MD: And another was, only feeding at night if the infant actually seemed hungry. not just fussy and sort of trying to soothe them a little bit first, actually pausing before you go in the room for a moment.
Arielle Greenleaf: for sure.
Craig Canapari MD: Taking a beat and then trying calming techniques. Shushing, white noise, gentle touch before picking them up, changing their diaper.
Like your baby doesn’t necessarily need to have their diaper changed. And this is the way you’re taught when you’re in the hospital. But you know, once you’re like six or eight weeks of age, I don’t think they necessarily need a diaper change and feeding in the middle of the night every time they wake up.
Arielle Greenleaf: No.
Craig Canapari MD: So I think this [00:30:00] is good stuff. predictable bedtime routines, earlier bedtimes and, and I think this is so important for napping, actually. And I think Arielle, you taught me this, recognizing sleep cues, yawning eye rubbing, or a fixed stare.
They said, put your baby down when they seem tired.
Arielle Greenleaf: Mm.
Craig Canapari MD: and I think that you need a routine ’cause you need to know what to look for. But the flip side is, I feel like one of the ways that we struggle with my kids is we were trying too much to be on a schedule and sometimes missing our windows for when our opportunity to put our kids down.
Arielle Greenleaf: You’re talking about the art of napping, and that’s part of it right there. what is your child showing you.
Craig Canapari MD: So I think it’s useful to have like an idea of when your kid’s gonna nap, but my colleague Monica Ordway had this great thing, and this is more like for older kids, like middle preschoolers, elementary school kids, the parents were having these long, battles at bedtime and she’s like, whenever your kid starts to freak out, their [00:31:00] bedtime is probably 20 minutes before that.
Arielle Greenleaf: Yeah,
Craig Canapari MD: I think there is something to be said for that when your baby is, I don’t like the term overtired ’cause I actually don’t know what that means medically. But like, if your child is,
Arielle Greenleaf: Dysregulated,
Craig Canapari MD: where they can self-soothe and then they get too dysregulated and then they can’t soothe themselves anymore.
Arielle Greenleaf: mm-hmm. Yeah, it’s kind of like what that parent said where we push him a little too far and we only get 27 minute naps, you know? But I would say one thing that I caution parents about, when we talk about sleepy cues after the newborn stage, it gets tricky because infants can seem, or they can act tired if they’re bored.
So if there’s no stimulation going on, if they’re just sitting there and there’s not like nothing going on, they can start to rub their eyes or seem tired and. You know, it’s only, they’ve only been a week for an hour. You put them down, they sleep for 20 minutes ’cause they haven’t built enough sleep pressure.[00:32:00]
So again, it’s, it’s such, this is why it’s so hard. Like, I think this is why people struggle so much because it’s like, just put ’em down when they seem tired. No, just put ’em down at this time. And with anybody that comes to me, it is such a balance. It is such a nuanced balance for each child based on, so today, for instance, I’m working with a, four and a half month old and he was actually, he’s the one I texted you about this weekend, where I was just so confused, which is rare, but I just was, something just felt off and it turned out well.
He was about to roll, so it was a big gross motor development situation that was disrupting him. But he hadn’t slept independently, ever. And, has been held for all naps and co-sleeping. last night was night four. It was an incredible night. he woke once to feed, he did wake a little bit early this morning, but I mean, he slept independently last night, which is just incredible.
So he did so well that I decided, let’s try him for nap time today. We did try nap time the day [00:33:00] before, and it was a complete fail. He cried and was unhappy for an hour. But today he, I said, let’s do it. So we put him down, based on like when he woke up and what my witchy magic was feeling in my head.
And he slept an hour and 45 minutes for his first nap. But like for his second nap, they said, okay, so what time should we put him down for the next nap? And I was kind of had an idea in my head, but about 30 minutes before that time, I wrote to them and I said, how’s he doing? Is he tired?
Is he okay? And they said, well, I just fed him. And he was starting to fall asleep while I was feeding him. And then he was kind of rubbing his eyes and I was like, forget it. Put him down in 10 minutes. And they put him down in 10 minutes and there we go. So he fell asleep in a few minutes. so point being is like, it’s such a balance between all of those things.
And it can be very, I think it’s very challenging for a tired parent to decipher [00:34:00] all of the, like, to really put all those things together to determine. The right timing and all of that. And that’s where I come in and then help you get to that place where you feel confident and you understand
Craig Canapari MD: it’s also gonna change.
Arielle Greenleaf: Oh yeah.
It’ll change soon.
Craig Canapari MD: I feel like the tempo of like in the first month, things are changing every couple of days, right? And then four to six weeks in maybe. They’re changing weekly and that rate of change slows down through childhood. But it’s just, you know, if you’re really struggling parents, just wait a little bit and it actually might get easier.
Arielle Greenleaf: Absolutely.
Craig Canapari MD: so let’s talk about sleep training can you sleep train for naps or not nights or vice versa?
Arielle Greenleaf: So yeah, that’s a tricky one.
Craig Canapari MD: Yeah, I’d say, first of all, it’s you shoot for the whole thing.
Arielle Greenleaf: Yeah. I think the thing that we need to come back to is the idea of consistency and your baby knows when it’s late and it’s dark and their bodies get used to a [00:35:00] circadian rhythm, but they don’t understand why sometimes you’re holding them and sometimes you’re not.
Sometimes you’re feeding them to sleep and sometimes you’re just putting them down in the crib. I would say for some younger infants, even this baby I’m working with, right? four and a half months, I said, let’s just start with nighttime and let’s see how he does.
And then, like I said, the first day he did not do well with naps, so we continued to support them, but he did so well last night that I felt like I really don’t wanna confuse the situation and set us back at night. So let’s try at least that first.
But like, the goal is let’s get them sleeping independently for all sleep so that they get it and they’re not confused. Like sometimes you pick me up, sometimes you don’t. and they’re able to, be consistent for you because you’re being consistent for them.
Craig Canapari MD: Well, if you think about this in behavioral terms, it’s like intermittent positive reinforcement, right? you cry and fuss and every time you do it, you get [00:36:00] a reward. It’s actually not as powerful as sometimes getting a reward. So I think, again, it’s not that it’s always all about crying or screaming, but parental consistency is so powerful in helping children form new patterns, even really little kids.
Arielle Greenleaf: yeah. I had someone who really wanted to support naps and sleep train overnight Our relationship didn’t work out because it was just so clear that the, I mean, this was an older baby, it was like a 10 month old, and it just, it was very confusing to the child and therefore it made things a lot less consistent.
And, you know, it’s a parent’s choice. Whatever they feel comfortable with, it’s fine. But, you know, if you want consistency, I always say if you want consistency from your child, you need to give them consistency too.
Craig Canapari MD: well I also feel like every time you put your kid down, you have an opportunity to put in place the pattern you want.
Arielle Greenleaf: Absolutely.
Craig Canapari MD: So it’s [00:37:00] much more powerful to do your intervention saying a kid that’s napping three times a day, you could get in four reps a day instead of one.
Arielle Greenleaf: Yeah.
Craig Canapari MD: When should my baby, and I guess we could say, kid, take a nap. ’cause I think this is, it is important, like recognizing this is a balance between recognizing sleep cues, right? Your kid really looks tired, you probably should put them down. But also having some idea of like, well, around when would you expect them to go to sleep?
Arielle Greenleaf: A period during which your child should sleep.
Craig Canapari MD: I do think there’s something to be said for knowing approximately when your kid will be due for an nap.
Arielle Greenleaf: Yeah. So I’m gonna put this in such general terms. I would say babies under six months, starting a nap anywhere between eight and nine in the morning. Eight is like very, very early. I wouldn’t stay there long unless your baby’s like really young and maybe on four naps. ’cause you can get into a problem where your naps are starting so early that you’re [00:38:00] finishing your third nap by, you know, two 30 in the afternoon and then your baby’s not gonna stay awake for another five hours before it’s bedtime.
So if your baby may be on four naps at that point, I would say a baby on three naps, you really wanna be closer to 9:00 AM nine ish. So that could be eight 30 and then that could be, depending on, they can get older, like 10. As they get older, they need more time to be awake.
So anywhere from 10 probably would be that morning nap for like an infant over six months. And then the afternoon is usually somewhere, for a younger infant around 12, 12 30. And then those can actually start. To push out later as they get older. So it can be anywhere from one to two and then as they’re about to transition to one nap, it can often be like two to three at the very latest, but that’s like at the very latest and capping it at an hour or [00:39:00] so.
I would say there needs to be like a mid-morning nap between nine and 10 and a mid-afternoon nap between one and two. If you have a third nap somewhere happening between, I don’t know, three to 4:30, but finishing naps by a certain time is kind of important, otherwise you kind of get into this zone of pushing into bedtime.
so like ending naps for younger infants by five and then sometimes as they’re getting older, ending them by four in order to get them down by eight-ish is important because otherwise you’re pushing bedtime way out. Depending on how old they are.
Craig Canapari MD: I really like this part about nap training and which we’re gonna cover in more detail later on. here, let me, it starts with rarely,
Arielle Greenleaf: Okay.
Craig Canapari MD: or just state that,
Arielle Greenleaf: So rarely do I see an eight or nine month old on three naps. I rarely see the two to one transition before 12 months or later than 16 months.
Craig Canapari MD: Yeah. And because, you know, in the medical literature, these are huge ranges, like six to 15 months going down to, two naps. But again, that’s true, [00:40:00] but most kids are gonna fall in the middle.
Arielle Greenleaf: Okay.
Craig Canapari MD: how do I get my newborn on a good nap schedule or lengthen their naps?
Arielle Greenleaf: I mean, if someone hires me for the newborn stage, I give them no false information, and therefore I tell them that. extending a newborn nap, your baby’s either gonna do it or they’re not. it’s totally normal to have a 20 minute nap or a two hour nap, but extending a newborn’s nap is kind of like trying to sleep, train a newborn, and you can’t sleep, train a newborn.
Their sleep is erratic. Now you can, as we were talking about, you can practice, a couple of things. You can practice trying to put them down, awake, at an early age and see how they do if they’re just kind of fussing, give them a little space and see if they’re not like screaming at the top of their lungs and they’re just kind of like kicking around or whatever.
You can sort of observe and see what they’re doing. If they get a little more fussy, you can try crib [00:41:00] side soothing. So, you know, going over and rubbing their belly or even picking them up. Soothing and putting back down. For some babies, that’s gonna work. And for others it’s just not gonna work. I don’t try to give any sort of, false notion that you can extend a newborn’s nap or train them to be on a specific schedule because it goes against biology really.
Craig Canapari MD: I wanna take a quick sidebar on contact napping here too. ’cause this is. Not something that’s, you know, so there’s, there’s kangaroo care that’s skin to skin. That’s like when your baby is born, they put the baby on your chest to try to, you know, help with bonding and also help with, milk supply. And then there’s contact napping, which as I understand it, is a less well-defined term, but it’s like holding your baby to sleep.
Right.
Arielle Greenleaf: Yeah.
Craig Canapari MD: And I think that contact napping is one of those things where I, because I’ve seen on Reddit and stuff, parents saying, oh, my kid can only contact nap. And I’m like, well, [00:42:00] it’s ’cause it’s the only way you’ve offered to have them nap, right? Like, and there’s a safety concern for small infants here too.
And the risk is if you yourself are tired. Falling asleep while holding your baby is one of the riskiest things from a suffocation or entrapment standpoint. So if it’s like eight or nine in the morning and you’ve had a cup of coffee, that’s one thing. But if you are like really sleep deprived and you’re regularly holding your baby for an entire nap, I really worry about these babies getting injured.
Arielle Greenleaf: I mean,
Craig Canapari MD: you know,
Arielle Greenleaf: I think that we need to be real about that, especially in that newborn stage. but yes, I think it’s really important to educate around it as well. if you’re too tired, I mean it would almost be better for you to put the baby in the bassinet and just have your hand in the bassinet.
You know what I’m saying? Like just to soothe that way versus holding upright and positional asphyxiation is just so real.
Craig Canapari MD: Well, you know, there’s also this period of purple crying,
Arielle Greenleaf: [00:43:00] Yep,
Craig Canapari MD: And it’s this idea that there’s this whole like dogma in pediatrics that crying increases over time in the first four to six weeks and then falls off.
And this isn’t really well understood. It’s attributed to the maturation of neurological and GI systems. and it does seem like this particular flavor of crying, this fussing of like a four week old,
Arielle Greenleaf: Hmm.
Craig Canapari MD: what parents do does not influence how much kids cry.
Arielle Greenleaf: Correct.
Craig Canapari MD: So I think that there’s this desperation sometimes if your baby is crying and some babies cry quite a a lot . I, I, you know, I’m just looking at, this graphic I have here, which I’ll throw in. And it was like, kids are on four weeks of age, crying age, 150 minutes a day.
Arielle Greenleaf: Oh, yes.
Craig Canapari MD: it’s important for parents to recognize you could be holding your baby or not holding your baby. Sometimes they’re just going to cry.
Arielle Greenleaf: Yeah.
Craig Canapari MD: And it’s not that we shouldn’t be at. And I’m not talking about sleep training here. [00:44:00] I am just talking about the reality of having a neurologically immature little baby.
and you are so desperate to stop them crying if you are holding them to try to soothe them. And you’re so exhausted, you’re gonna fall asleep holding them. Or you are like losing it. It is okay to put your dae down and go walk, go in the other
Arielle Greenleaf: Yes.
Craig Canapari MD: put them in a safe place, put them flat in their back in case they do fall asleep.
You are not doing harm to your other child. They’re gonna cry that much regardless of what you do.
Arielle Greenleaf: Yeah.
Craig Canapari MD: And I have seen so much stuff online directed at me and other people who talk about things like sleep training, about how it is child abuse to let your kid cry. I think it’s actually this whole narrative about you can’t let your kid cry is actually dangerous.
And you know, it’s okay for babies to cry sometimes.
Arielle Greenleaf: Well, it’s part of development,
Craig Canapari MD: they do.
Arielle Greenleaf: it’s not, something that can be controlled.
Craig Canapari MD: Okay, so do you think we just
[00:45:00] Thanks so much for listening to the Sleep edit. You can find transcripts at the web address Sleeped show. You can also find video of the episodes at that address as well as in my YouTube channel. You can find me at Dr. Craig canna perry.com and on all social media at D-R-C-A-N-A-P-A-R-I. You can find Ariel at Instagram at Ariel Greenleaf.
That’s A-R-I-E-L-L-E-G-R-E-E-N-L. If you like the flavor of the advice here. Please check out my book. It’s Never Too Late to Sleep. Train the Low Stress Way to high Quality Sleep for babies, kids, and parents. It’s available wherever fine books are sold. If you found this useful, please subscribe at Spotify or Apple Podcast and share it with your friends.
It really helps as we’re trying to get the show off the ground. [00:46:00] Thanks.
package this up as one and publish it and then do the
Arielle Greenleaf: I think the case studies will be helpful for people.
Craig Canapari MD: I think so too.
Arielle Greenleaf: stay tuned for part two.
Craig Canapari MD: and then we’ll have something to work on Okay.
Arielle Greenleaf: Yeah.
Craig Canapari MD: So this is part one of our napping spectacular. in part two we have cases, which Arielle has brought, which look great.
We are gonna talk about transitioning from three to two naps, two to one nap, and one the dreaded one to zero nap. and we’re also gonna talk about some of the milestones, like how do you know when these transitions occur? how do you know when your kid’s ready to give up the nap? And also finally, strategies for napping around childcare and around older kids’ schedules, which are really complicated.
So we’re gonna put a pin in it here, and we will be back hopefully in a shorter interval than usual for part two.
Arielle Greenleaf: Part two of the Napping Extravaganza.
Craig Canapari MD: Spectacular. So, where can we find us?
Arielle Greenleaf: You can find us at the Sleep Edit podcast@gmail.com.
Craig Canapari MD: [00:47:00] Yeah, send us an email. thanks for listening.
Arielle Greenleaf: Take care.