There is a lot of terminology and misconceptions thrown around in the pediatric sleep world especially on social media. Can they self- settle? Are wake windows a real thing? And what about regressions?

I welcome back Sujay Kansagra who is a pediatric neurologist and sleep medicine physician at Duke who has dedicated his life to helping kids (and their parents) sleep better. He knows sleep and the importance of it. He was on my show before on an episode called Sleep-training: What the evidence does or doesn’t say.

He joins me to discuss:

• If genetics play a role in sleep and if there is such a thing as a “good” or “bad” sleeper
• If “wake-windows” are evidence-based
• If there’s a certain age we would expect a baby to “sleep through the night”
• The truth behind sleep regressions

 

To connect with Sujay Kansagra follow him on Instagram @thatsleepdoc and purchase his book My Child Won’t Sleep: A Quick Guide for the Sleep-Deprived Parent

 

Additional Resources About Sleep:

Review of Sleep Training Data: https://pubmed.ncbi.nlm.nih.gov/17068979/

Cortisol and Sleep Training Research Study: https://pubmed.ncbi.nlm.nih.gov/27221288/

Short Sleep Gene: https://www.ucsf.edu/news/2019/08/415261/after-10-year-search-scientists-find-second-short-sleep-gene

“Sleeping Through the Night” Article: https://pubmed.ncbi.nlm.nih.gov/20974775/

Wide Range of Normal Sleep During First Year: https://pubmed.ncbi.nlm.nih.gov/12563055/

Sleep Regressions and Data Behind Fixed Months for Regression: https://www.babysleep.com/sleep-advice/what-is-a-sleep-regression/

 

00:00 – Intro

01:17 – Meet Dr. Sujay Kansagra: Pediatric Sleep Doc at Duke

04:38 – Do Genetics Impact How Children Sleep?

06:05 – Why Labels Like “Bad Sleeper” Can Be Harmful

08:06 – What’s the Deal with Wake Windows?

10:31 – Why Overtired Kids Have Trouble Falling Asleep

12:55 – Are Sleep “Crutches” Like Nursing or Rocking Bad?

15:00 – When and How to Phase Out Sleep Associations

16:33 – The Parent Sleep Guilt Spiral—And Why It’s Not Helping

18:05 – Social Media Pressure and Parenting Choices

19:30 – When Should Babies Sleep Through the Night?

23:04 – Is There a Minimum Weight for Sleep Training?

25:19 – Why Sleep Isn’t Just Sleep: Feeding, Temperament, and More

25:59 – What Science Says About Sleep Regressions

28:44 – Why Modern Parenting Creates Fear Around Normal Sleep

30:08 – Don’t Pathologize Your Parenting Journey

30:52 – Final Message: Sleep Is Hard—Even for Sleep Experts

32:14 – Where to Learn More from Dr. Kansagra

33:02 – Wrapping Up: Science, Sanity, and Sleep Confidence

 

Our podcasts are also now on YouTube. If you prefer a video podcast with closed captioning, check us out there and subscribe to PedsDocTalk.

 

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00;00;00;06 – 00;00;20;19

Sujay Kansagra

We also know that sleep. There are so many different factors that way into how we sleep, whether it be our our our caregiver approach or maybe our social environment where the beauty know sleep hygiene or approach to CPG, whether it be caffeine we adjust during the day or the substances that we ingest, electronic exposure, etc. and this, this notion of this child is a bad sleeper or a poor sleeper versus a good sleeper.

 

00;00;20;22 – 00;00;35;16

Sujay Kansagra

I like to say that every child has the intrinsic ability to sleep well, but no matter what their temperament is, what their environment is, if we set them up for success, most children have the ability to sleep well, or at least do better than what they’re currently doing.

 

00;00;35;19 – 00;00;58;14

Dr. Mona

You’re listening to the PedsDocTalk podcast, where we keep things real, science based and totally judgment free. It’s me, Doctor Mona, your trusted pediatrician, confidante and mom friend here to support you through every twist turn and 2 a.m. Google spiraling of parenting. Whether this is your first time tuning in or you’re a seasoned listener, you’re in for a treat and maybe even a full night of sleep, if we’re lucky.

 

00;00;58;16 – 00;01;17;10

Dr. Mona

Today’s episode is fact or fiction. Child sleep science with a pediatric neurologist and sleep specialist. Because let’s be honest, the pediatric sleep world is full of strong opinions, social media buzzwords, and advice that can make you feel like you’re doing it all wrong. Can babies actually self settle or wake windows backed by science or just sleep training folklore?

 

00;01;17;17 – 00;01;41;18

Dr. Mona

And what’s the real deal with regressions to help us make sense of it all? I’m joined again by Doctor Sujay Sagara, pediatric neurologist, sleep medicine physician at Duke and the brilliant mind behind At That Sleep doc on Instagram and TikTok. You might remember him from our fan favorite episode on what the research really says about sleep training. He’s back to bust myths, easier worries, and remind us that sleep doesn’t have to be so complicated or guilt inducing.

 

00;01;41;25 – 00;01;57;29

Dr. Mona

We’re chatting all about the role genetics may play in sleep, how to think about good or bad sleepers, and what to expect or not expect when it comes to babies sleeping through the night. Sleep training isn’t a requirement, but it is a credible option for families who want to explore it. And this episode is the deep breath you didn’t know you needed.

 

00;01;58;07 – 00;02;16;06

Dr. Mona

So grab your coffee, your stroller, or your noise canceling headphones and don’t forget to subscribe! Download and leave a quick review. It helps more tired parents find the show and maybe, just maybe, get a little bit more rest. Let’s get into it. And yes, feel free to listen. Lying down with your eyes half open, preferably in silence. In bed alone.

 

00;02;16;11 – 00;02;22;25

Dr. Mona

A parent can dream right?

 

00;02;22;28 – 00;02;25;04

Dr. Mona

Thank you so much for joining me again.

 

00;02;25;06 – 00;02;28;13

Sujay Kansagra

Yes, doctor. Mona, thank you for having me back. Thrilled to be here. Yeah.

 

00;02;28;13 – 00;02;51;23

Dr. Mona

Our last episode was amazing. It was a great conversation. Sort of debunking, but adding some nuance into that sleep training conversation. So if sleep training is something you’ve been considering, you don’t have to definitely take a listen to that episode. And before we get into this topic today, just kind of talking about child’s sleep, science and fact or fiction or terminology that’s out there that makes you sometimes go,

 

00;02;51;25 – 00;02;58;10

Dr. Mona

Or me as well. Tell people more about yourself and why you started that sleep, that sleep talk on Instagram and TikTok.

 

00;02;58;10 – 00;03;23;24

Sujay Kansagra

Sure, sure. Well, I’m a child neurologist by training. I did a, a fellowship in sleep medicine. So day in and day out, I’m seeing children with a variety of sleep disorders. It can be insomnia, narcolepsy, sleep apnea, restless leg parasite abuse, etc.. I absolutely love what I do. I have been fortunate to be involved with both education for other doctors as well as research when it comes to really kind of nuanced neurologic conditions and the sleep disorders that apply to them.

 

00;03;24;01 – 00;03;43;15

Sujay Kansagra

And then I joined social media. You know, I was on ex for like a decade, and then recently more on TikTok and Instagram with the goal of just kind of spreading, science based sleep education for families that hopefully is approachable and entertaining at times. I found that I think I can have more impact to the social media world than sitting in a lab writing research papers.

 

00;03;43;15 – 00;03;44;19

Sujay Kansagra

So here I am.

 

00;03;44;22 – 00;04;00;09

Dr. Mona

Yes, and I will agree to that. I said that already on the other episode. It is very entertaining. I love following you not only for the education, but the comedy as well. It’s very good. So I’m not trying to keep you to. Yeah. I’m not putting pressure on you to create more comedic TikTok TikToks, but I love it.

 

00;04;00;09 – 00;04;20;24

Dr. Mona

I literally it takes a lot for me to actually chuckle at social media posts, but I chuckle. So, you know, you’re doing a good you’re doing good work out there. Thank you. Thank you. You know, today’s today’s episode was inspired because I had put up a question box on my Instagram feed, stock talk, asking my followers, hey, I have the sleep doc coming on.

 

00;04;20;24 – 00;04;38;06

Dr. Mona

And what questions do you have about pediatric infant toddler sleep? And so a lot of this is sort of just questions people had for you. And so I was curious, your thoughts if there’s any data behind any of this. So the first question that I got was did genetics play a role in sleep. What do we know about that?

 

00;04;38;11 – 00;04;43;21

Dr. Mona

And is there such thing as being a good or bad sleeper, which we commonly hear?

 

00;04;43;23 – 00;05;03;01

Sujay Kansagra

Yeah. Great question. Yes, we know genetics play a huge role when it comes to our sleep, particularly when it comes to our sleep needs. In fact, we talk about when you’re an adult, you need about 7 to 9 hours of sleep to feel silly, refreshed. That incorporates the vast majority of adults, but we know that there are short sleepers and long sleepers that naturally need less or more sleep to feel truly refreshed.

 

00;05;03;08 – 00;05;19;22

Sujay Kansagra

And so these short sleepers are like the envy of everybody in medicine. They can get by on like five six hours and feel fully refreshed. And it’s less than 1% of the population. A lot of people like to believe they’re short sleepers, but they are not. And, they have actually found the genetic polymorphism that’s associated with short sleep time.

 

00;05;19;28 – 00;05;45;08

Sujay Kansagra

We think they just go through sleep cycles more efficiently or effectively or quicker, and do fine. And it runs in families and they do really well. So so yes, genetics plays a huge role. We also know that sleep, there are so many different factors that way into how we sleep, whether it be our our caregiver approach, whether it be our social environment where the beauty, the sleep hygiene or approach to CPG, whether it be caffeine, we adjust during the day or substances that we ingest, electronic exposure, etc..

 

00;05;45;10 – 00;06;05;11

Sujay Kansagra

And this this notion of this child is a bad sleeper or a poor sleeper versus a good sleeper. I like to say that every child has the intrinsic ability to sleep well, right? But no matter what their temperament is, what their environment is, if we set them up for success, most children have the ability to sleep well or at least do better than what they’re currently doing.

 

00;06;05;13 – 00;06;19;26

Sujay Kansagra

And so I don’t want to get into the whole narrative of this child is just a bad sleeper, because then that actually perpetuates that. Oh, they’re just by nature a bad sleeper. We can’t change anything, whereas we know that there are many things that we can modify to help children sleep better. So that’s my approach to bad versus good sleepers.

 

00;06;19;29 – 00;06;48;23

Dr. Mona

I love it, I, I agree, I, I love that you brought up the fact that there are high sleep needs. Low sleep needs. I am both me and my husband, our higher sleep needs. I am very high sleep needs and my two son has taken after myself. Which is a blessing. But I’m gonna also add that it’s kind of a curse because when he doesn’t get that sleep or I get that sleep for him, tantrums, meltdowns, like, yes, he needs that nap or like, wow, I’m so jealous that your son takes a nap.

 

00;06;48;23 – 00;07;00;27

Dr. Mona

I’m like, look, I love it. But also on the flip side, it is hard when we do not get that sleep for him because he is a wild child. It’s tough. Yes, because you can’t always do that.

 

00;07;01;00 – 00;07;14;16

Sujay Kansagra

That’s actually very funny. You mentioned that because, you know, I myself, you know, need eight and a half per night is what I figured out, which is, you know, kind of my ideal. Yeah. One of my children is is more higher sleep needs than the other. You know, he was napping even until, like, six. You know, we could we could get him down for a nap.

 

00;07;14;18 – 00;07;24;20

Sujay Kansagra

The other child is by nature just has slightly lower sleep needs. And that’s the funny thing about children. You you can have two children in your same home raise the same way. They can both be completely different sleepers. And that’s really what we have.

 

00;07;24;23 – 00;07;43;09

Dr. Mona

Yeah. And so I love that you also mentioned that it does matter, you know, that we can teach them some skills because it’s like that self-fulfilling prophecy. I’ve talked about that on my social about like if you label them as bad sleeper or label them as a picky eater, or that they’re shy, like, we don’t give them any opportunity to show us the alternative, right?

 

00;07;43;13 – 00;08;04;14

Dr. Mona

That’s right. Taught to be comfortable in new situations. Can you be taught to maybe eat new foods? Can you be taught to maybe sleep longer stretches and not need this to fall asleep? So I love that. Yes, labels in some ways can be helpful to get diagnoses for medical conditions, but for things related to temperament and you know just who a child is, it can be a little tricky.

 

00;08;04;17 – 00;08;06;19

Sujay Kansagra

Yes. Totally agree. Yeah.

 

00;08;06;22 – 00;08;24;23

Dr. Mona

And then the next. So I love that. Thank you so much about the genetics conversation. The next one is about wake windows. So I did not know that there was a thing called week windows until I joined social media. I was actually I take that back a little before that when I started really diving into sleep. But social media has made this thing like that.

 

00;08;24;23 – 00;08;41;07

Dr. Mona

This is what we have to look at. What what is the evidence behind week windows? Is it a real thing or is it something that we’ve kind of just created over the past few years? Now let’s take a quick break to hear from our sponsors who support helps us keep bringing you this show.

 

00;08;41;09 – 00;09;02;16

Sujay Kansagra

Oh yeah. In principle, it’s it’s there is science based rationale for why windows are important. I would say the clinical application of perhaps the application is probably not as specific as people like to tout on social media to say, oh yeah, at this age you need a 2.35 hour week window. It’s just because. Because it’s just so variable.

 

00;09;02;16 – 00;09;18;03

Sujay Kansagra

You know, every every child is so different that your wake windows are going to be all over the place. But the nature of week windows is such that you you are building up a sleep drive, which is true because there are two main things that modulate how sleep we feel. One is your circadian rhythm, which will put that on the back burner for now.

 

00;09;18;10 – 00;09;33;04

Sujay Kansagra

The other is a homeostatic sleep drive. And this is kind of essentially keeping track of how long we’ve been awake. And we have various chemicals that are building up in our brains or breakdown products, including adenosine, which says, okay, I’ve been awake for 3 hours or 4 hours or five hours and you get sleep. You’re based on how long you’ve been awake.

 

00;09;33;07 – 00;09;46;17

Sujay Kansagra

And so the concept of yes, you have to build up a certain amount of that sleep drive or that sleep pressure is a good one. You know, we do have to you can’t, you know, wake up an hour before bedtime from a nap and then expect the night to go perfectly because you paid off a lot of that sleep try.

 

00;09;46;24 – 00;09;54;19

Sujay Kansagra

So yes, having, you know, a good chunk of time, which will vary for the child, but have a good chunk of time before the nighttime sleep is usually important.

 

00;09;54;21 – 00;10;14;02

Dr. Mona

And you you set it perfectly the 2.35 hours. And I’m laughing at that because when you look at various sleep accounts, they’re going to have their own wake windows that are slightly different, like some will say two hours, say 2.35. And that kind of goes to show you that there’s really no, like, clear like evidence of the actual time.

 

00;10;14;02 – 00;10;30;22

Dr. Mona

But of course, you’re looking at the child. And yeah, I agree with you. Like your child’s probably going to meltdown if they’re up for six hours and they’re six months old. From a, you know, miss nap in the morning, you know, it’s really important to kind of know that, hey, we might need to start winding them down on those lines about week windows.

 

00;10;31;07 – 00;10;48;14

Dr. Mona

A question that I got was, why? Why is it that when we miss a week window or just say, a child refuses a nap, why is it that when they’re overtired, it’s harder for them to settle? Is there some sort of chemical reason behind that? Because you would think that if you’re tired, you would just fall asleep.

 

00;10;48;16 – 00;11;06;21

Sujay Kansagra

Yeah, yeah, I would tell you that the underlying homeostatic drive continues to increase the longer that, you know we are awake, which is why you don’t end up in this snowballing cascade of worsening temperament. And you and then you end up staying awake for your rest of your life, right? I mean, at some point that that reverses itself.

 

00;11;06;27 – 00;11;28;09

Sujay Kansagra

The reason that I think people have this notion of being overtired and going in the wrong direction is that, yes, sleep is important for our emotion, for regulation, etc. and so you are going to see a child that’s having a harder time maintaining that emotional regulation when they’re in that sleep deprived state. So that might appear to be a second wind, or that you’ve missed this magical window, and now your child is, you know, having a harder time.

 

00;11;28;11 – 00;11;44;18

Sujay Kansagra

And yes, they may have a harder time because that emotional regulation piece is now kind of out of whack. The other scenario is that if it happens at nighttime, our circadian rhythm is such that it tends to peak for adults right before we go to bed. But for children, it can be peaking at the highest level of activity after they fall asleep for the night.

 

00;11;44;20 – 00;11;58;24

Sujay Kansagra

And so sometimes if you’re awake too long and you’re starting to see that peak that comes along with its own burst of energy, and people might think, well, I can’t my child, settle now. Well, it’s usually because then you have to wake that peak kind of dies down on the other end of that peak where the rhythm starts making you feel sleepy again.

 

00;11;58;24 – 00;12;06;16

Sujay Kansagra

So there can be a variety of reasons, but no, that, you know, your child’s sleep drive is still building while they’re awake, so it’s okay.

 

00;12;06;19 – 00;12;19;25

Dr. Mona

Yeah. Going back to my high sleep needs kid. He we actually, from the time of this reporting yesterday, he took a flight with my husband back from Tampa nearby. And his bedtime is usually 730 or 8. But he was up until 11. And he was.

 

00;12;20;01 – 00;12;20;24

Sujay Kansagra

Yes, it.

 

00;12;20;24 – 00;12;37;08

Dr. Mona

Was. It was tough. I mean, he was so excited and happy and ready to party. And I’m like, sweetie, it’s not party time. We’re going to wind down. It’s bedtime. We’re going to give him a bath. It helps. It helps prime him for sleep. Then it was and then my husband’s like he was just talking gibberish. Like he was just repeating things over and over.

 

00;12;37;08 – 00;12;55;11

Dr. Mona

Like. Almost like he was drugged because of how tired he was. But then right then he was like, okay, mommy, I’m very tired. I’m like, yes, sweetie, you are very tired. Let’s just go to bed. You did great. No, I love this. Now, the other question I got was about sleep crutches. I’m putting that in quotes. I know it’s podcast.

 

00;12;55;11 – 00;13;08;00

Dr. Mona

People can’t, see what I’m doing. When it comes to things like nursing to sleep, using things like white noise, is there some things that are considered sleep crutches or how would you define that to a family? And if it’s something to be concerned about?

 

00;13;08;03 – 00;13;24;05

Sujay Kansagra

Yeah. So, you know, early in life it’s you know, at least you know, first few months you need to do what you need to do to get your child to fall asleep. There’s no necessarily spoiling your child, etc.. A sleep crutch I would define as anything that’s external that the child then needs every time they wake up in a way that’s that’s negative for their sleep.

 

00;13;24;05 – 00;13;46;22

Sujay Kansagra

And so that’s, that’s, that’s usually adult as the example. You know, the last podcast we talked about an adult that needs a TV on to fall asleep. And then then when they wake up the TV’s off, you know, they’re like, oh, well, I gotta turn that TV back on the fall asleep or the radio or or your meditation music, etc., etc. if you’re developing a pattern in which your child becomes reliant on something and it’s causing a longer nighttime awakening, it’s causing them to wake up and cry and not be happy.

 

00;13;46;25 – 00;14;02;19

Sujay Kansagra

That’s when it’s a that’s when it can be a problem. And we talk about the whole, you know, sleep training. We talked about that in last podcast. If, if it’s becoming in a problematic pattern and which is causing everybody to wake up multiple times and be, you know, missed out on sleep, then you can try to get rid of those sleep crutches, typically after four months of age.

 

00;14;02;19 – 00;14;13;00

Sujay Kansagra

And, and, you know, definitely up for six months of age, you can try to wean them and help them learn to self-soothe. But early on, sleep crunches and, you know, feeling asleep and rocking to sleep and all that, it’s it’s pretty much par for the course.

 

00;14;13;02 – 00;14;30;00

Dr. Mona

Yeah. And I think you had mentioned this also in the other episode that using the Nursing to sleep as an example, although it can be a sleep association that okay, they felt like they need that. The decision to eliminate that can be a personal choice like you mentioned already, like a family can finally decide, like I’m I’m done with this.

 

00;14;30;00 – 00;14;46;21

Dr. Mona

I don’t want to do it. That’s how I usually end up, guiding families in my office. They’re like, I’m ready. I don’t want this to be the reality anymore. I loved it for a few months or however long. But now I need to eliminate that sort of association. So it is, again, such a nuanced conversation there, too.

 

00;14;46;23 – 00;15;00;05

Sujay Kansagra

For sure. And I always say, you know, the nursing one is a big one and it comes with lots of emotion, lots of opinions. And I’ll say, yeah, there are times where, you know, nursing is for nutritional value, and there are times where nursing ends up being like a quick, soothing. The child has become dependent on it for soothing.

 

00;15;00;09 – 00;15;11;09

Sujay Kansagra

Yes, we have to kind of distinguish between the two, you know, nutrition of course, vital and important. If you’re using mom as a pacifier, that can become problematic for everybody. And so we have to make sure we’re drawing the distinction.

 

00;15;11;11 – 00;15;31;18

Dr. Mona

Yeah. I, I talk about that all the time with my mom. So I was like, are you okay being used as a pacifier? Because if you are, we’re not going to change anything. And most of my families that come to me are like, no, I don’t want that. I want it to be for nutrition only. I love my baby, but I would love to incorporate other, other things that we can do to help soothe that baby.

 

00;15;31;18 – 00;15;55;27

Dr. Mona

That’s not always me because I feel like I can’t ever rest. And I think it’s an important conversation because we talked about this in the last episode, that sleep is not it’s not only for the baby. It also can be obviously hugely beneficial for the family unit and especially, like you said, mom’s maternal health, which I’m very big on because if mommy’s a zombie and if mommy has zero affect because she’s so different, sleep deprived and leading to depression.

 

00;15;55;27 – 00;16;02;01

Dr. Mona

Two I don’t want that. I want to figure out, how can we get you to love to talk to your baby? Now? You know, I’d love to.

 

00;16;02;01 – 00;16;17;04

Sujay Kansagra

Yeah, I’d love to comment on that. Because, you know, at the end of the day, I’m I’m a pediatric sleep doc. And so the things that I recommend, of course, are for the child’s sleep. But parents are often this, you know, this question, this dilemma of like, am I doing this to help my myself at the risk of, you know, do my baby to harm, etc.?

 

00;16;17;07 – 00;16;33;23

Sujay Kansagra

And there are two things there, you know, when it comes to sleep thing, all these approaches, of course it’s an option. No one has to do it. It’s an option. But, you know, it is going to help your child sleep first and foremost. Now, is it going to help you as well? Well, yes, there are actually going to be some benefits for you and your child is sleeping, but that should not come.

 

00;16;33;25 – 00;17;06;15

Sujay Kansagra

That’s not come with guilt because guess what? The parents sleeping well is vital for your child’s well-being. In many ways, having a well-rested caregiver actually helps with the bond with your child. Sleep training research shows this. You know your the bond actually be better after sleep training. We know it’s important for safety for your child, right? If you’re driving a car, there are studies that show that moms have been since they’re not sleeping well, or more likely in the simulator for driving to sway from one side or the other and have higher speeding rates, than moms that are well rested than have children.

 

00;17;06;15 – 00;17;18;19

Sujay Kansagra

So, you know, a well rested family unit is incredibly vital, and it all comes back to benefit your child. So we got to take some of the guilt out of it. Yeah. Your sleep is actually helping you. Yeah, it’s helping you, of course, but it’s helping your child too.

 

00;17;18;21 – 00;17;35;19

Dr. Mona

Yeah. I mean, you both mentioned this, that, you know, we don’t carry a lot of that guilt when we make choices regarding our children only because we know the research, but also no clinical experience to know. Okay, I can give an example. I can formula feed my baby, I breastfed one. I’m not worried. They’re going to be great.

 

00;17;35;22 – 00;17;51;27

Dr. Mona

I can sleep train using this method. Sleep train doing this one. Not sleeping at all. I know they’re going to be fine because it’s not like a checkbox of parenting, right? I think a lot of our gender that’s right has fallen into that. That. Oh well, okay, I to be a connected mother and I’m speaking because a lot of mothers listen to the show.

 

00;17;52;02 – 00;18;05;24

Dr. Mona

I need to breastfeed, I need to sleep, I need to baby where I need to do this. I can’t work, I can’t do anything. I’m like, no, it’s. Yeah, that’s not how parenting is. It’s such a multi. That’s right. That’s the thing that allows us to bond to our beautiful babies.

 

00;18;05;26 – 00;18;23;17

Sujay Kansagra

The pressure that I feel like parents, parents face right now in the world of social media is immense. Like I am. I really sympathize. I can’t empathize because, you know, when I was raising kids, I didn’t that was not involved or, you know, in all of the social meet all that much or taking much from the social media world.

 

00;18;23;17 – 00;18;46;18

Sujay Kansagra

And because I had my own kind of medical pediatrician knowledge that I was kind of relying on. Yeah. And a great and a great pediatrician, you know, my pediatrician was absolutely amazing for my kids. So, it is a tough space to be raising children in. And I 100% agree with her message, which is, you know, if you’re consuming too much of this, you have to do this and you have to do that apart from safety for your child, which in my mind, that’s where I kind of cross the line.

 

00;18;46;18 – 00;19;05;29

Sujay Kansagra

That’s where I’ve. Yes, you have to if you know something is safe, like you’re going to have car seats for your child, you know you’re going to be bad for your child. This is safety, basic safety. Apart from that parenting, it’s filled with choices that you can make and feel completely fine with. You know, because your child is still safe and nourished and thriving.

 

00;19;05;29 – 00;19;14;24

Sujay Kansagra

You know, when it comes to all the different choices, when it comes to how we see how we put them to sleep, you know, what clothes we put them in, how we potty train. I mean, the list goes on and on. And so.

 

00;19;14;24 – 00;19;15;21

Dr. Mona

Oh my gosh.

 

00;19;15;25 – 00;19;30;14

Sujay Kansagra

Too much pressure. So if you’re hearing somebody saying, you have to do this, please just go ahead. No, that’s like already a yellow flag for me to be like, no one should be telling you exactly how when it comes to the parenting choices, especially when there are so many choices and all these categories.

 

00;19;30;17 – 00;19;48;21

Dr. Mona

Now were very well said. The next thing I wanted to go into was about, connecting sleep cycle. So is there a certain age where a baby or toddler should be able to connect sleep, but sleep cycles on their own, or use that term, sleeping through the night? And I know you mentioned that terminology on the last episode.

 

00;19;48;21 – 00;20;05;08

Dr. Mona

And I’ll briefly say, this is a child’s ability to wake up, whether they in the middle of the night through their sleep cycles and not need any assistance to go back down to sleep. Is there a certain age that we see that from? Research or that we should say, you know what, there’s something else that may be going on here.

 

00;20;05;08 – 00;20;18;01

Dr. Mona

Why is your child not able to do this? Now let’s take a quick break to hear from our sponsors who support helps us keep bringing you this show.

 

00;20;18;03 – 00;20;35;00

Sujay Kansagra

Yeah, I know, and I would wish, I wish I could give you a set cut to be like at this age, your child should definitely be connecting sleep cycles and sleep through the night. When we look at the data, like almost every other topic that we look at in sleep, that ends up being a wide range. And so you need to, quote unquote, sleep through the night, depending on how we define it.

 

00;20;35;00 – 00;20;53;24

Sujay Kansagra

There was a great study that looked at three different definitions of sleep into the night. One was a six hour stretch. Night one was an eight hour stretch. Night one was an eight hour session between 10 p.m. and 6 a.m.. And when you look at those three different criteria, even at one month of age, about 10% of infants at some point that first month have hit those three criteria.

 

00;20;53;24 – 00;21;21;02

Sujay Kansagra

They can they can, quote unquote, sleep. Good night. This is, you know, just naturally this is without any sleep training, etc. by three months of age, about 50% of children have met many of those criteria to, quote unquote, stick through the night. Again, you know, without this is just natural evolution of sleep without any sort of behavioral interventions or sleep training, etc. by one year of age, but age 90% of children at some point in their lives, they don’t have to currently be doing it, but at some point have been able to, quote unquote, sleep through the night.

 

00;21;21;05 – 00;21;35;11

Sujay Kansagra

So it’s a wide range. It’s a wide range. Yeah. So left to their own devices, I would say yes, at least at some point along that first year of life, the vast majority of children will have had an and likely an eight hour chunk at night where they can sleep continuously and quote unquote connect to sleep cycles.

 

00;21;35;13 – 00;22;04;05

Dr. Mona

So and I think I imagine it would be really hard to create, maybe even not so hard to create sleep, but really hard to get good information because there’s so many variables to this, right? Like is there parent intervention? What is happening, the age of the child preterm term? I mean, there’s so much again, temperament. Like it’s really hard for us to say that, oh, every kid by one year should be, you know, sleeping through in the studies that you mentioned, you know, using the I think six hours, eight hours, ten, was that including feeds or it was a variable situation in terms.

 

00;22;04;08 – 00;22;28;11

Sujay Kansagra

So they would not have woken up to have a feed because their window for wakefulness was such that it would not. Right. That’s right. Complete stretch. And if they if they wake or make noises for a short period of time and not needing active intervention from the caregiver. So yes, children can do it very young now. I guess the the million dollar question for parents is can they push to make that happen earlier, or or do it in a more robust fashion?

 

00;22;28;11 – 00;22;47;28

Sujay Kansagra

And yes, you know, that’s where we the whole episode regarding sleep training approaches or behavioral approaches to helping children sleep, we do have data that shows in the short and medium term that can help with sleep consolidation at night, and help with sleep metrics and parental reported sleep and even objective measures of sleep for children. So, and that’s usually around between 4 and 6 months of age in most situations.

 

00;22;47;28 – 00;22;49;02

Sujay Kansagra

Yeah.

 

00;22;49;04 – 00;23;04;02

Dr. Mona

And you had mentioned that on the last episode too, about that 4 to 6 month I, you know, sometimes I hear parents tell me that their pediatrician said that they also have to be a minimum weight, and I, I don’t agree with that. But is there any research about weight limitations or minimums for sleep training?

 

00;23;04;07 – 00;23;23;11

Sujay Kansagra

No. And I again, this you know, this is something I certainly would defer to you and your pediatrician. I would say that if your child is, you know, hitting their milestones and on the right curve when it comes to overall weight, once they’re past their their newborn kind of weight. So, you know, yeah, it drops annually once you’re a newborn weight and gaining, I feel like you’re pretty much you’re you’re in a pretty good zone.

 

00;23;23;11 – 00;23;39;23

Sujay Kansagra

You know, you’re kind of in a safe zone that if your child is sleeping beyond those three hours, they’re like, oh, you got to wake them up. You know, you have a little bit more liberty there. The younger they are, of course, you don’t want them going too long of a stretch. But yes, you know, by 4 to 6 months of age, we know that children physiologically should be able to make it without feeding.

 

00;23;39;23 – 00;23;55;14

Sujay Kansagra

If they’re in that situation at nighttime. That’s not to say that they can immediately go there if they’re used to consuming lots of calories at night, because if you’re used to consuming the calories, your body will naturally feel hungry at that time. And I always say in my caveat, we don’t sleep trained to hunger. And if your child is hungry, you’re going to feed them, you know.

 

00;23;55;14 – 00;24;04;26

Sujay Kansagra

And that’s that’s an important. Yeah. But yes, at the certain age, your body physiologically should be robust enough that you can’t sleep through the night without having any issues with blood sugar, etc..

 

00;24;04;29 – 00;24;21;00

Dr. Mona

Yeah. Oh, great, I love that. I know I added that question on because I just felt like I get that often. And I agree. I mean, there’s no minimum weight, but we want to see that there’s good trends, right? Like the only time I’ll ever even entertain a conversation about sleep training. Like you said, usually it’s the four month on the last episode I did discuss that.

 

00;24;21;00 – 00;24;36;15

Dr. Mona

I do sometimes talk about it earlier, like slightly around two and a half, three months. But there’s very, very clear distinctions on what I’m going to talk about it. And one of them is if the child is stretching already like 8 to 10 hours of sleep, not needing feeds, temperament is there. But it’s yeah, there’s no weight minimum.

 

00;24;36;15 – 00;24;55;16

Dr. Mona

But your child needs to be thriving. And, you know, I wish from a general pediatrician standpoint, because not many of us are well versed in sleep training, education and all the different varieties of sleep. I have just self-taught myself a lot of the stuff. But it really would be great to have that sort of holistic approach of, okay, what is going on?

 

00;24;55;16 – 00;25;19;29

Dr. Mona

How many times are we waking? What is going on with the nighttime feed? Is your child seeming like it’s a pacifier feed? Is it sort of a full feed like what is going on? Right. These are all yes reasons that there’s now all these sleep consultants. And I wish in my dream world, a sleep consultant would have educational background in child development, have educational background in formula and breastfeeding, and educational background and all of that.

 

00;25;19;29 – 00;25;37;09

Dr. Mona

But they don’t. And so I get a little bit sometimes like remember the nuance there guys. Remember that it’s sleep is not just sleep. Sleep is how is the baby feeding. What are the feedings like during the day? Are you snacking during the day? Because if we can get the calories in in the day, then we may not need to have calories at night.

 

00;25;37;09 – 00;25;59;03

Dr. Mona

And we see that depending on the baby’s age, you know, so such an important conversation. The last one I wanted to talk about was about there’s so much, you know, apps out there, things like Wonder Weeks and leaps and also about regressions. Are there really certain ages that regressions happen from science using the four month as an example?

 

00;25;59;03 – 00;26;07;23

Dr. Mona

Everyone’s like, yeah, yeah. Shifted. You know how four months sleep, you know, architectures going on. What is the you know, the things we know about sleep regressions.

 

00;26;07;25 – 00;26;25;29

Sujay Kansagra

Yeah. So sleep regressions, the whole concept behind there’s that there are going to be regressions in sleep at a certain month of, you know, of your life came about from a very a small study of about 16 infants, study was published the same time the author, you know, wrote a book and had, you know, lots of great information to share, with the world.

 

00;26;25;29 – 00;26;43;20

Sujay Kansagra

But future studies have not been able to replicate that. Even future studies from this author’s own lab with larger sample sizes are not able to replicate that same timing. And in fact, you know, Doctor Jody Mandel, who I consider the guru of infant sleep, did an informal analysis of 3500 infants looking at when new parents report that there’s a sleep problem.

 

00;26;43;23 – 00;27;01;11

Sujay Kansagra

And in roughly every month of life that first year, it comes out to about 30% of parents reporting a sleep issue. And so at three months, it was I think it was 32%. At four months, it was 25%. At five months, it was 30%, you know, so it’s relatively the same throughout. So should you be fearing a sleep regression?

 

00;27;01;13 – 00;27;19;17

Sujay Kansagra

No. Do you sleep regressions happen all the time? You know, I just experienced, like a 502 month sleep regression in my. I mean, it’s, you know, your your whole life, you know, sleep is not linear. There’s bumps in the road. It’s long as you’re you’re keeping things consistent and being persistent and using what’s worked in the past.

 

00;27;19;19 – 00;27;31;27

Sujay Kansagra

Don’t let it knock you off kilter. You know child’s going to have you know, it’s going to have teeth coming out that’s going to cause if you’re going to go on vacation, grandparents are going to come take care of the kid for a few days. Yeah. You know, there’s going to be regressions. That’s as part of the course for sleep.

 

00;27;31;29 – 00;27;38;04

Sujay Kansagra

But don’t fear that they’re going to happen at a certain time. They just happen all the time. That might not be that comforting, you know?

 

00;27;38;04 – 00;27;58;22

Dr. Mona

But yeah, but I love I love hearing the way you talk about that because I agree with the same thing. And it wasn’t again until I got on social that I was like, why are we fearing this sort of very again, common thing? And again, if we didn’t have any of this information, our parents, for example, if I told my parent, oh, yeah, my, my daughter’s going through a sleep regression shoot, my mom would be like, what?

 

00;27;58;25 – 00;28;06;27

Dr. Mona

What’s what are you talking about? Like, yeah, it’s it’s it’s almost like these terminologies have been created in modern parenting that add more stress.

 

00;28;06;29 – 00;28;07;05

Sujay Kansagra

Like,

 

00;28;07;12 – 00;28;30;12

Dr. Mona

The amount of people hearing the four monthly progression. I mean, literally, they’re in anxiety mode thinking when their babies are already sleeping, longer stretches and they’re like, oh my God, it’s coming. And I’m like, okay, even if it does come, what is the purpose of fearing it now? Because and now, not only are you are you losing sleep right now in your child’s sleeping, but now you’re going to lose sleep when the child goes to regression like we should.

 

00;28;30;13 – 00;28;44;03

Sujay Kansagra

It’s, It’s. Yeah, I you just help. I think we we’ve let’s coined a new term I love this. This is like social media induced anxiety, parental sleep progression. You know, that’s what we’re actually seeing here, you know? Yeah, but no, it’s.

 

00;28;44;05 – 00;29;07;04

Dr. Mona

It’s completely real. And I and also I will say like we talked about the different temperaments of a child, my son rarely went through many regressions in quotes like he really he did go through them, but teething really didn’t affect him as much. You know, my daughter, my goodness, I mean, she’s doing these regressions every two weeks. Anytime anything changes, she’s starting to crawl, walk teeth.

 

00;29;07;07 – 00;29;23;22

Dr. Mona

She looks a certain way. There’s some sort of change in her sleep architecture. And so we we’ve really learned to roll with it and again, not label it, not worry too much about it. It is beneficial that we’ve taught both of our children some self settling skills. So we’re able to kind of do a little bit of that.

 

00;29;23;22 – 00;29;39;23

Dr. Mona

You know, we do check ins. We use a Ferber technique for sleep regressions. We obviously go in, make sure she’s not in pain, you know, make sure our son was on pain if he went through it. And we do that. But it is there’s definitely way, I think, way too much fear. And then you’re just losing the joy of parenting.

 

00;29;39;23 – 00;29;47;16

Dr. Mona

Like, this is so fixated on what’s going to happen that you’re not even enjoying your baby when they’re actually not in a sleep regression, like just this.

 

00;29;47;16 – 00;30;08;25

Sujay Kansagra

This is this is this is a good time to pause for a parent’s sanity inducing message, which is just because. And we talked about this last time, too, just because, you know, your your sister in law’s child at, at eight weeks of age is sleeping 12 hours. You got to hear this, parents. It’s not necessarily because they’re doing something amazingly right.

 

00;30;08;27 – 00;30;32;02

Sujay Kansagra

And just because you’re having sleep challenges, it’s not because you’re doing something wrong. It’s because your children are different. They’re going to do things at a different pace in a different way. And that’s okay. Don’t feel like, yeah. Pathologize your own child in your own parenting experience because every experience is different. And you’ll see that even with children in your own home, you know, like I had two children that were different sleepers.

 

00;30;32;08 – 00;30;45;08

Sujay Kansagra

And that’s just the their nature, their temperament, their their genetics. It’s actually every child is slightly different. Right. So, we have to keep that in mind. So stay sane. Yeah. Don’t pathologize your starting experience. Yeah.

 

00;30;45;11 – 00;30;52;22

Dr. Mona

Well, I was going to ask you for a final message, but that was a great one. Is there anything else you’d like to add before we wrap up? And, for all of our listeners today.

 

00;30;52;25 – 00;31;13;10

Sujay Kansagra

I just want to let you know that sleep is hard. Even for the pediatric sleep doc, who had all the techniques and all the experience and had written books and done the research when my first child came out, dropped, kicked me in the face, you know, like when it comes to sleep. And it was it was just it just erodes at your soul.

 

00;31;13;16 – 00;31;30;12

Sujay Kansagra

I get it, you know, sleep is hard. I just want you to be comforted. The fact that if it’s a problem for you, there are things that you can do that can help them sleep better. There are science based ways to help them sleep better, but just know that sleep is hard and things, usually even on their own, oftentimes will improve.

 

00;31;30;19 – 00;31;45;27

Sujay Kansagra

So during the toughest of times, I encourage you to kind of hang in there and, and reach out to your doctors for help. You know, that’s your answer for reach out to your doctors, your support system for help. But sleep is hard, and I’m hoping to make it 5% easier with the information that I provide.

 

00;31;45;29 – 00;32;01;14

Dr. Mona

Yeah, well, you are and and so I want to thank you again for joining me on this episode, the episode we already recorded. Again, if you have not listened to that, make sure you listen to that. And thank you for joining me. I could have you on again. I know you have a lot of education and resources and older children as well.

 

00;32;01;14 – 00;32;13;00

Dr. Mona

I know one of the biggest things we talked about is maybe having an episode about melatonin, and children would love it because we get a lot of that, a lot of that information. So I know you’re going to be back on, the show many times. So it’s such a pleasure talking to you today.

 

00;32;13;06 – 00;32;14;20

Sujay Kansagra

Thank you, as always, for having me.

 

00;32;14;26 – 00;32;22;18

Dr. Mona

And where can people go to stay connected? And also, your I know you have a book that you wrote when you had your first child, so if you can give all that information.

 

00;32;22;18 – 00;32;40;24

Sujay Kansagra

Yeah, sure. So I’m that sleep doc is my handle that sleep doc on any social media platform. The book is called My Child Won’t Sleep. It’s a quick kind of high yield, step by step, science based guide to helping with all the behavioral, techniques to help with sleep, including sleep training, limit setting, for instance, or limit setting for toddlers, the late sleep phase, and insomnia for teenagers.

 

00;32;40;24 – 00;32;48;06

Sujay Kansagra

But I talk about all that stuff on my social media platform, so no pressure to get the book. Come follow me on social. We’ll talk about it.

 

00;32;48;08 – 00;32;58;26

Dr. Mona

Yeah, definitely. You must follow him on social for again, good education, very balanced information and also a good laugh here and there, which I love. And thanks again for joining me today.

 

00;32;58;28 – 00;33;02;20

Sujay Kansagra

Absolutely. Thanks for having me.

 

00;33;02;23 – 00;33;22;23

Dr. Mona

That wraps up today’s episode. And can I just say, I love hashing this stuff out with someone who lives and breathes sleep science for a living. I mean, this is literally Doctor Kansagra, his job. He knows the brain, he knows the body, and he knows how well the internet can get when it comes to pediatric sleep advice. There’s a lot of noise out there, but conversations like this are the reason I do this show.

 

00;33;22;23 – 00;33;39;23

Dr. Mona

To bring science, nuance, and sanity back to parenting. Sleep comes with a lot of personal decisions. What works for one family might not work for another. What works for one child might not work for another. But the goal isn’t to follow a trend. It’s to understand the facts so you can make the choice that feels right for your family.

 

00;33;39;25 – 00;33;59;02

Dr. Mona

Whether you choose to sleep, train or not, whether a baby naps like a dream or laughs in the face of bedtime, remember your choices don’t need to look like anyone else’s, and you’re doing amazing. If this episode brought you clarity, comfort, and just made you feel a little more human, share it. Tag at the PedsDocTalk podcast and at that sleep doc on Instagram.

 

00;33;59;02 – 00;34;20;14

Dr. Mona

So more tired parents can find this conversation too. And if you haven’t yet, subscribe. Download. Download download download and leave a review or update a review you’ve already written. It helps us grow this community and keep bringing you on as science fact episodes week after week. Until next time, may your coffee be strong, your toddler’s nap be long, and your sleep at least somewhat interrupted.

 

00;34;20;19 – 00;34;21;22

Dr. Mona

Catch you all next week.