What is Sleep Regression?

What is Sleep Regression?

By Olivia Grech, MRes
Reviewed by Sophia Coveney

Introduction
How Much Sleep do Babies Need?
When does Sleep Regression Occur?
What Biological Pathways Cause Sleep Regression?
Sleep Regression is a Developmental Steppingstone
References
Further Reading

Sleep regression refers to a period of change in sleeping patterns experienced

by babies. This change often occurs when infants who previously had no issues
with sleep, settling well, or sleeping for prolonged periods suddenly experience
wakeful nights and difficulty napping.

Sleep regression. Image Credit: Liga Cerina/Shutterstock.com

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This change in sleeping habits can be difficult for parents since the waking is
unrelated to basic needs and instead is due to the baby’s development changes
in sleep cycles. However, this period does not last forever, and disruptions in
sleep will eventually subside. Understanding the biology of sleep can uncover
the causes of disrupted nocturnal patterns in infants.

How Much Sleep do Babies Need?

Infants’ sleep needs vary depending on their age since sleep is a developmental
process associated with brain growth. Sleep requirements and the ability to fall
asleep easily in infants are also influenced by their homeostatic sleep pressure.
This pressure exists in both adults and infants and accumulates whilst awake
creating the feeling of tiredness; this pressure is decreased whilst sleeping to
allow one to stay awake for longer.

Newborn babies require approximately 16 hours of sleep split evenly between

nighttime and daytime. This gradually reduces as babies age, favoring more
total nighttime sleep until 2 years where total infant sleep of 13 hours is split
between 11 hours nocturnally and 2 hours diurnally.

Sleep in newborns, however, does not tend to occur in prolonged 8–9-hour

periods but instead accumulates during several short 1-2 hour naps at a time.
This erratic schedule of short sleep periods is due to the lack of a circadian
rhythm in infants, in addition to differences in sleep cycles in comparison to
adults.

For instance, newborn babies only experience two sleep cycles at night,
whereas adults experience 4, transitioning to the mature 4 phase cycle is
thought to underlie sleep regression and disruptive sleep behavior.

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How much sleep do you need? Image Credit: Rita Owl/Shutterstock.com

When does Sleep Regression Occur?

Sleep regression varies between infants, but it typically occurs around 4, 6, 12,
18 and 24 months of age. Despite the lack of formal research on sleep
regression and age-related stages, some older studies suggest these periods
coincide with developmental milestones. For instance, the first regression,
commonly at 4 months, is the beginning of an inevitable change in the sleeping
pattern and often occurs in conjunction with teething, growing pain and
beginning to move and roll. 8-month regressions coincide with learning to crawl
and stand, separation anxiety can also be experienced during this period which
may contribute to sleep disruption.

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Other factors may also contribute to the onset of the biological shifts
fundamental to sleep regression including significant growth spurts, disruptions
in routine such as beginning nursery or illness.

What Biological Pathways Cause Sleep

Regression?
To understand why sleep regression occurs it is important to understand the
adult sleep cycle. Sleep consists of two phases: rapid eye movement (REM) and
non-rapid eye movement (NREM) which is further divided into N1,2 and 3 in
adults. Cycles in adults begin with NREM 1, the lightest phase from which
people are easily awoken, followed by NREM 2, a deeper sleep during which
heart rate and body temperature decrease. NREM 3 is the final NREM phase and
is considered the deepest sleep stage and the most difficult stage to wake from.
NREM 3 is known as slow-wave sleep and during this phase the body repairs
tissue, muscle, and bone in addition to strengthening the immune system. REM
is the final phase of sleep, and although this is associated with dreaming it is
not considered a restful state. The EEG during this phase is similar to signals
from an awake individual, the breathing rate is irregular and oxygen use of the
brain increases due to high activity during this phase.

In babies aged up to 3 months, however, sleep cycles only consist of two

phases with sleep onset occurring in REM followed by quiet sleep, which is
similar to NREM. Sleep is split evenly between REM and MREM during these
initial months until the emergence of cortisol and melatonin cycling, which leads
to the onset of mature circadian rhythm development. REM sleeps declines from
50% to 25% and shifts later in the cycle, whilst MREM phases also change into
lighter sleep phases. It is likely that these shifts in the sleep cycle underlie
sleep regression in babies, with the lighter sleep phases contributing to the
constant waking. These cycles continue to alter and shift as babies grow and
sleep for a lower total duration, leading to short periods of sleep regression in
infants which present as difficulty sleeping for prolonged periods or altered
napping patterns.

Sleep Regression is a Developmental

Steppingstone
Although episodes of sleep regression may be difficult to manage and adjust to,

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these periods of disruptive sleep and repeated awakenings are temporary and
signify developmental milestones in an infant. Regression occurs due to
adaptations of sleep cycles to a more mature and adult-like circadian rhythm,
that supports brain growth and development. Eventually following episodes of
sleep regression, a child’s sleep biology will replicate that of an adult, resulting
in sustained sleep architecture.

References
Stanford Children’s Health. (2022) Infant Sleep. [Online] Stanford
Children’s Health. Available at: https://www.stanfordchildrens.org/en/top
ic/default?id=infant-sleep-90-P02237 (Accessed 17 July 2022)
Cleveland Clinic. (2022) Infant Sleep Regression: What Parents Need To
Know. [Online] Cleveland Clinic. Available at: https://health.clevelandclinic
.org/the-4-month-sleep-regression-what-parents-need-to-know/ (Accessed
17 July 2022)
Alicia Sparks Akers. (2021) What are the stages of sleep regression?
[Online] Medical News Today. Available at: https://www.medicaln
ewstoday.com/articles/sleep-regression-stages (Accessed 17 July 2022)
Patel, A. K., Reddy, V., & Araujo, J. F. (2022). Physiology, Sleep Stages. In
StatPearls. StatPearls Publishing.
Dunham, A. (2022). Baby Ecology: Using Science and Intuition to Create
the Best Feeding, Sleep, and Play Environment for Your Unique Baby.
Encradled Press

Further Reading
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Promoting Sounder Sleep in Older Adults

More...

Last Updated: Oct 12, 2022

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Written by

Olivia Grech
Olivia Grech is a Brain Research UK PhD student at the University of Birmingham
studying mechanisms and new treatments for headache in raised intracranial
pressure. Her project has also explored the metabolic effects of headache
mechanisms in animal models in addition to analysing metabolic profile of patients
with disorders of headache (Idiopathic Intracranial Hypertension). She has an MRes in
Biomedical Science and Translational Medicine from the University of Liverpool and a
BSc in Biomedical Sciences from the University of York.

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