Sleeping Through the Night: The Consolidation ofSelf-regulated Sleep Across the First Year of Life

WHAT’S KNOWN ON THIS SUBJECT: The majority of infants metconventional definitions for sleeping through the night by 12months of age. Changes in infants’ self-regulated sleep, as judgedby developmentally and socially valid criteria for sleepingthrough the night, are unknown.

WHAT THIS STUDY ADDS: This study is the first to investigateinfants’ sleep-regulation capabilities by comparing 3 criteria forsleeping through the night. Longitudinal data provide anempirical foundation for infants’ self-regulated sleep. A newcriterion for sleeping through the night is presented.

abstractOBJECTIVE: To investigate the consolidation of infants’ self-regulatednocturnal sleep over the first year, to determine when infants firstsleep through the night from 24:00 to 05:00 hours (criterion 1), for 8hours (criterion 2), or between 22:00 and 06:00 hours (the family-congruent criterion 3).

METHODS: This was a prospective longitudinal study with repeatedmeasures. Parents of 75 typically developing infants completed sleepdiaries for 6 days each month for 12 months. Accuracy of parent re-ports were assessed by using videosomnography.

RESULTS: The largest mean increase (504 minutes) in self-regulatedsleep length occurred from 1 to 4 months. The survival function de-creased most rapidly (indicating greatest probability of meeting crite-ria) for criterion 1 at 2 months, criterion 2 at 3 months, and criterion 3at 4 months. A 50% probability of meeting criteria 1 and 2 occurred at3months and at 5months for criterion 3. The hazard function identified2months (criteria 1 and 2) and 3months (criterion 3) as themost likelyages for sleeping through the night. At 12 months, 11 infants did notmeet criteria 1 or 2, whereas 21 failed to meet criterion 3.

CONCLUSIONS: Themost rapid consolidation in infant sleep regulationoccurs in the first 4 months. Most infants are sleeping through thenight at 2 and 3 months, regardless of the criterion used. The mostdevelopmentally and socially valid criterion for sleeping through isfrom 22:00 to 0:600 hours. At 5 months, more than half of infants aresleeping concurrently with their parents. Pediatrics 2010;126:e1081–e1087

AUTHORS: Jacqueline M. T. Henderson, PhD,a Karyn G.France, PhD,b Joseph L. Owens, PhD,a and Neville M.Blampied, MScaDepartment of Psychology and bHealth Sciences Centre,University of Canterbury, Canterbury, New Zealand

KEY WORDSinfancy, sleep patterns, development, longitudinal study

ABBREVIATIONLSRSP—longest self-regulated sleep period

www.pediatrics.org/cgi/doi/10.1542/peds.2010-0976

doi:10.1542/peds.2010-0976

Accepted for publication Jul 30, 2010

Address correspondence to Jacqueline M. T. Henderson, PhD,Department of Psychology, College of Science, University ofCanterbury, Private Bag 4800, Christchurch, New Zealand. E-mail:jacki.henderson@canterbury.ac.nz

PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).

Copyright © 2010 by the American Academy of Pediatrics

FINANCIAL DISCLOSURE: The authors have indicated they haveno financial relationships relevant to this article to disclose.

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Infants’ sleep/wake patterns consoli-date from birth and throughout thefirst year of life. The developmentaltask of sleeping through the night isattained when sleep changes from aneven, multiphasic, diurnal distributionat birth to consolidated, uninterruptedsleep during the night. The failure of aninfant to sleep through the night, par-ticularly in concert with their parents’own sleep, is a common parental con-cern. Yet, there is a paucity of reliableempirical data onwhich cliniciansmaybase appropriate developmental ex-pectations of infants’ sleep and for de-termining the optimal timing for inter-vention and prevention. This lack ofdata may, in part, be because of earlydefinitions that failed to consider in-fants’ developmental capabilities to-gether with socially meaningful defini-tions for sleeping through the night.

Defining sleeping through the nightposes challenges. Polysomonographicmeasures would permit definition interms of time spent in defined sleepstates, but such measures are notavailable or socially valid for most cli-nicians or parents. Alternative defini-tions are posed in terms of what canbe observed by parents and essentiallyinvolve detecting periods of time dur-ing which the infant is inferred to beasleep because he or she is not ob-served to be awake and signaling theirarousal in some way. Given that rapideye movement–associated arousalsare common in infant sleep,1,2 sleepingthrough the night from this secondperspective involves increasing the du-ration of sleep episodes by developingthe capacity for self-reinitiation ofsleep (self-soothing) after arousals.Pragmatically, a definition should ad-dress whether the infant’s sleep dura-tion is in phase with his or her parents,with the infant settling to sleep attimes convenient to the family and re-maining asleep when other familymembers also are sleeping.

Hitherto, a variety of definitions andmeasures have been used.3 Moore andUcko4 defined sleeping through thenight as sustained sleep between 24:00and 05:00 hours (criterion 1). This ap-proach remains influential despiteMoore and Ucko failing to provide areason for their choice of time period.An alternative approach is to deter-mine the maximum length of an in-fant’s behavioral capacity to self-regulate sleep,5–7 characterized by acombination of sustained sleep, quietwakefulness, and the reinitiation ofsleep without parental intervention,termed the longest self-regulatedsleep period (LSRSP). The authors offew studies have described changes inthe LSRSP, which makes it difficult todirectly compare infants’ developmentof the LSRSP.3

Understanding the development of in-fants’ self-regulated sleep and sleep-ing through the night requires criteriathat have developmental validity, re-flecting infants’ physiologic capabili-ties for sustained sleep, which from 2months of age typically exceeds crite-rion 1,8 as well as the behavioral capa-bility of sleep self-regulation. More-over, the criteria need social validity,capturing both the earlier onset andincreasing length of the LSRSP, andcongruence between the infant’s sleepand that of the parents. In this study,we compared the earlier criteria withnew criteria including 8 hours sleep atnight during an undetermined period(criterion 2) and a more socially validcriterion requiring an LSRSP of 8 hoursbetween 22:00 and 6:00 hours (crite-rion 3), encompassing the typical fam-ily sleep period. We therefore investi-gated infant self-regulated nocturnalsleep over the first year to (1)measuredevelopmental changes in LSRSPlength each month, (2) measure devel-opmental changes in the initial onsettime of the LSRSP, (3) use 3 criteria forsleeping through the night to establish

the ages at which infants first meet,and when they are most likely to meet,each criterion, and (4) compare in-fants’ abilities to meet these criteriaand when the majority do so.

METHODS

Participants

Seventy-five parents and their infants(43% female) participated in a studythat investigated sleep patterns overthe first year of life. Over a specified12-month recruitment period, 104 par-ticipants initially volunteered to takepart in the study. Attrition occurredmainly during the first month, and 23withdrew for the following reasons:maternal or infant illness (n� 11); be-ing too busy (n � 5); or no reasongiven, could not be contacted, or failedto return data in the first 2 months(n� 7). Inclusion criteria were infantsborn term and healthy at birth and de-veloping typically. Mothers were ap-proached by antenatal, maternity, andchild health nurses, and advertise-ments were also placed in newspa-pers. The sample was representativeof families of middle socioeconomicclass status.9 The majority of parentswere white New Zealanders; 5% of themothers and 4% of the fathers wereMaori. The majority of infants werefirst (33%) or second (57%) born. A re-searcher contacted the primary care-giver by telephone and explained thepurpose and requirements of thestudy. When consent was obtained, de-mographic data were collected overthe telephone and parents were famil-iarized with the sleep diary. A diary forthe followingmonthwas supplied afterreceipt of the previous diary. Parentsalso were invited to have a time-lapsevideo recorder for 2 consecutivenights to record their infants’ sleeppatterns. The study was approved bythe human ethics committee of the Uni-versity of Canterbury and the RoyalPlunket Society of New Zealand.

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Study Design

We used a prospective longitudinal re-search design with repeated measuresmonthly from ages 1 to 12 months.

Measures

Data were obtained from sleep diaries.Parents prospectively recorded theirinfants’ sleep behaviors monthly for 6days and nights over 12 months. Thesleep diaries were separated into“day-sleep” and “night-sleep” sections.The night-sleep section recorded thetime the infant was placed into thecrib, infant state when placed intothe crib, and the duration inminutes toinitial sleep onset. Parents recorded thetime and duration of each night-awakening sustained for more than 2minutes (ensuring that each was a com-plete arousal and not simply a noise as-sociated with rapid-eye-movement sleepor infant self-soothing) and the final“time up” in the morning.

Sleeping Through the Night

Three criteria for sleeping through thenight were investigated. To be judgedas sleeping through the night, an in-fant had to meet the criteria for 5 of 6nights of the week (or on 80% of occa-sions if there was missing data). Thefollowing criteria were used:

Criterion 1: sleeping uninterruptedfrom 24:00 to 05:00 hours(from Moore and Ucko4).

Criterion 2: the 8-hour criterion, sleep-ing uninterrupted for 8hours minimum betweensleep onset and timeawake in the morning.

Criterion 3: the family-congruent cri-terion, sleeping uninter-rupted from 22:00 to 06:00hours.

Analyses

Infant age was determined when thediary was completed; for example, ifthe infant had turned 1 month of age

(ie, between 1.0 and 1.9 months) thendatawould be treated as 1-month data,and so forth. For each daily diary, thestart time and duration of each LSRSP(ie, the total duration in minutes of thelongest sleep period uninterrupted bysignaling) for each night’s sleep wasidentified. A mean LSRSP start time(24-hour clock) and duration (in min-utes) was calculated for each individ-ual infant over 6 days at each age, andan average was calculated over all in-fants at that age. Because some par-ents did not return diaries at somemonths (sometimes because of infantillness), and some participants en-tered the study at 2 months, there wasvariability in the number of diaries re-turned at each age point. There was nosignificant difference in the age atwhich infantsmet criterion 1 if the par-ents commenced diaries at 1 month(mean [SD]: 3.7 months [2.1]) or at 2months (mean [SD]: 4.2 months [2.0];P � .29 [not significant]). Data fromboth groups, therefore, were com-bined for subsequent analysis.

Survival analysis measures the lengthof time (survival) until an event is ex-perienced, which in this study is thetime taken to meet the criteria forsleeping through the night. This is indi-cated by the (1) survival function or theprobability of notmeeting the criterionof sleeping through beyond a specificperiod of time, (2) median survivaltime, when the probability of thesample meeting the criterion is 0.5,and (3) hazard function, which iden-tifies the interval of highest proba-bility (or “risk”) for meeting eachcriterion. Differences in numbers ofinfants surviving (ie, meeting each ofthe criteria) were assessed by usingthe Gehan-Wilcoxon test. Cumulativepercentages were calculated to es-tablish the proportion of infants whomet each of the 3 criteria at each agein the first year.

Reliability Assessment

Reliability of parental recording wasassessed by comparing diaries withvideosomnography10 over 2 consecu-tive nights for 41% of the participantsand coded by 2 trained coders. Therewas no significant difference in socio-economic status9 between the infantswhose parents volunteered to have thetime-lapse video recorder in theirhomes (mean [SD]: 3.0 [1.14]) and par-ents of infants who did not (mean [SD]:2.7 [1.44]; P � .45 [not significant]).There was a high level of agreementbetween the video and parent recordsusing point-by-point agreement11 for(1) evening bedtime (97%), (2) infantstate when placed into the bed (93%),(3) frequency of night-awakening(97%), and (4) time up in the morning(97%).

RESULTS

Figure 1 presents the mean onset timeand duration of the LSRSP. The meanstart time for the LSRSP over the firstyear steadily decreased from 22:30hours at 1 month to 20:30 hours at 12months, with the greatest rate ofchange evident in the first 3 and last3 months. The greatest increase inLSRSP length occurred across the first4months, followed by aminimal rate ofchange from ages 5 to 9 months and asteady increase from ages 10 to 12months. The largest increase in meanLSRSP duration (113.7 minutes [from326.2 to 439.9minutes]) occurred fromages 1 to 2 months. The second largestincrease (42 minutes [from 326.0 to439.0 minutes]) occurred from 2 to 3months. The total increase from 1 to 4months was 178.3 minutes (close to 3hours), but there were only small, andsometimes variable, additional in-creases thereafter up to 12 months.

Table 1 lists the number of infants whohad not met the criteria at the begin-ning of each of the age intervals, thenumber of infants whomet the criteria

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during the interval, and the numberwho never met the criteria during thefirst year. The age at which most in-fants met criteria 1 (n � 24) and 2(n� 19) was 2 months; for criterion 3(n � 16), it was 3 months. By 12months, all but 11 infants had met cri-teria 1 and 2, but 21 had failed to meetcriterion 3.

Survivor Function

The survivor function illustrates theprobabilities for not meeting each cri-

terion over the 12 age intervals and isshown in Fig 2A.

Over the 12 age intervals, the probabil-ity that an infant would still be wakingdecreased, with the most rapid de-creases (Fig 2A) between 2 and 3months for criteria 1 and 2 and be-tween 3 and 4 months for criterion 3,which indicates the age intervals atwhich infants have the highest proba-bility of meeting these criteria. Theme-dian survival times, when the probabil-

ity of meeting the criteria is .5, were atthe end of the third- and fourth-monthintervals for criteria 1 and 2, respec-tively, and at the end of the 4-monthinterval for criterion 3.

It took significantly longer (Gehan-Wilcoxon test) for infants to meet cri-terion 3 compared with criteria 1 (P�.003) and 2 (P � .04); however, therewas no significant difference in thetime it took for infants to meet criteria1 or 2. Fig 2A shows that there was ahigher probability of failing to meetcriterion 3 at each age interval com-pared with the other 2 criteria.

Hazard Function

The hazard function indicates the ageintervals at which infants are mostlikely to meet the 3 criteria and areplotted in Fig 2B. For criteria 1 and 2,the slope is the steepest from 1 to 2months, and the highest hazard func-tions are 0.39 and 0.28, respectively.The slope for criterion 3 is steepestfrom 2 to 3 months (hazard function:0.27), which indicates that infants aremost likely to sleep through the nightin this interval.

Fig 3 presents the cumulative percent-age of infants who met each of the 3criteria over 12 months. The mostmarked increase occurred from ages1 to 4 months. A higher percentage ofinfants met criterion 1 at each agecompared with criteria 2 and 3. At age1month, 12% and 4%of the infantsmetcriteria 1 and 2, respectively, but allinfants had failed to meet criterion 3.The age at which �50% of the infantsmet each criterion was 3 months forcriterion 1 (58%), 4 months for crite-rion 2 (58%), and 5 months for crite-rion 3 (53%). From ages 6 to 9 months,there was a small increase in the per-centage of infants who met all the cri-teria, from 74% to 82% (criterion 1),66% to 75% (criterion 2), and 54% to63% (criterion 3). The increase contin-ued, and by 12 months, 87%, 86%, and

FIGURE 1Mean start time of nocturnal sleep onset and mean LSRSP at each age in the first year of life. Bars ateach data point represent the SEM.

TABLE 1 Life Table Data of the Number of Infants Entering Each Age Interval

Age Interval, mo No. of Infants Who Had not Met theCriterion at the Beginning of the

Age Period

No. of Infants Who Met the CriterionDuring the Interval

Criterion 1 Criterion 2 Criterion 3 Criterion 1 Criterion 2 Criterion 3

1 75 75 75 6 3 02 69 72 75 24 19 123 45 53 63 8 13 164 37 40 47 9 8 75 28 32 40 5 3 46 23 29 36 1 3 17 22 26 35 3 4 48 19 22 31 1 0 19 18 22 30 2 3 210 16 19 28 2 2 311 14 17 25 2 2 212 12 15 23 1 4 2Number who nevermet criteria

— — — 11 11 21

Shown are the number of infants who had not met the criteria (criterion 1: 24:00 –05:00 hours; criterion 2: 8 hours; andcriterion 3: 22:00–06:00 hours) at the beginning of each age interval; the number of infants who met the criterion in eachinterval; and the number of infants who never met the criteria in the first year.

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73% of infants were sleeping throughthe night as judged by criteria 1, 2, and3, respectively.

DISCUSSION

To our knowledge, this is the first studyto examine consolidation in infants’self-regulated nocturnal sleep asjudged by 3 different criteria for sleep-ing through the night and to present anew socially and developmentally validcriterion, while also documentingchanges in mean onset time and dura-tion of the LSRSP across the firstyear. Self-regulated sleep consolidatesmost rapidly in the first 4 months, andat age 3 months there was evidence ofconcordance between the initial sleeponset time (21.46 hours) and theLSRSP (8.2 hours) and typical familysleep schedules. From 4 to 9 months,the rate of change plateaus, consistentwith the results of previous stud-ies.6,7,12–14 The LSRSP begins to lengthenagain between 10 and 12 months.

The rapid increase in LSRSP over thefirst 3 months is consistent with therapid increase over the same period inthe longest sustained sleep period(LSP), a sustained period of sleep thatprecedes an arousal or awakening.2,8

The LSP is the precursor of sleepingthrough, because the LSRSP requiresboth sustained sleep and the capacityfor independent resumption of sleep viaself-regulated soothing after an awaken-ing. The LSRSPs we observed increas-ingly exceeded LSP durations when sys-tematically compared with data acrossages from Anders et al1,2,8 and from adevelopmental perspective reflect theemergence of infants’ self-regulationand self-soothing capacities.

Two months was the most likely agefor infants to be sleeping through thenight when the less stringent criteria(1 and 2) were used, which is consis-tent with previous reports.15–17 The useof criterion 1 prevented previous au-thors from establishing whether the

FIGURE 2Survivor and hazard functions of the total sample for criterion 1 (24:00–05:00 hours), criterion 2 (8hours), and criterion 3 (22:00–06:00 hours) across the first year of life. Drawn in the top graph is themedian line showing the point at which there is a 50% probability of meeting the criteria.

FIGURE 3The cumulative percentage of infants who met criterion 1 (24:00–05:00 hours), criterion 2 (8 hours),and criterion 3 (22:00–06:00 hours) each month across the first year of life.

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infants were sleeping longer than 5hours and, if so, whether they couldsustain the 8 hours of sleep needed forfamily congruence. Criterion 3 was themost difficult to achieve, and nearlyone-third (28%) of the sample failed tomeet it, versus 15% who failed to meetcriteria 1 and 2. Undoubtedly, this isbecause criterion 3 not only requiresthe infant to maintain an 8-hour LSRSPbut also to initiate sleep earlier in theevening and sustain sleep through to06:00 hours.

Survival analysis permitted the sys-tematic comparison of 3 criteria forsleeping through during the first yearof life, and our findings support thecontention that criterion 3 should beused to define sleeping through thenight for children from the age of 4months. This criterion is met by 50% ofinfants at 5 months of age, is congru-ent with family sleep patterns, andfalls within typical sleep times. The al-ternative criteria lack social validity inthat they ignore congruence with fam-ily sleep patterns and lack specificitywith regard to sleep phase. Adoptingcriterion 3 from 4 months of age alsohas implications for interventions in-tended to prevent infant sleep difficul-ties. Prevention should occur in syn-chrony with developmental tasks,18,19

which in this case is the task of self-regulating sleep throughout the night.It also should aim to achieve sociallyvalid outcomes, as embodied in crite-

rion 3. To achieve this, prevention in-terventions should target the manage-ment of infant sleep in the first 3months of life.

We also are the first study, to ourknowledge, to replicate the pioneeringstudy by Moore and Ucko,4 who re-ported the cumulative percentage ofinfants sleeping through from 24:00 to5:00 hours. Our rates were �20%lower fromages 2 to 4months and nar-rowed to �5% from ages 6 to 12months. This similarity was unex-pected given the methodologic andconceptual differences between the 2studies,3 whereas the discrepanciesare probably explained by the use ofretrospective recall by Moore andUcko.4

This study has limitations that may re-strict the generality of the results. Theparticipants were not fully representa-tive of populations with ethnic andsocioeconomic diversity. Those whodropped out of the study may have hadinfantswhowere liable to have greaterregulatory problems, so the develop-mental trajectories reported may berelatively favorable. Only additional re-search can clarify this issue.

CONCLUSIONS

The most rapid consolidation in in-fants’ nocturnal sleep occurs withinthe first 4 months of life. During thisperiod, infants are most likely to meet3 different criteria for sleeping

through the night and have a meanLSRSP that exceeds 8 hours. Criterion 3(22:00–6:00 hours) should be adoptedas the standard criterion for definingwhat sleeping through the nightmeans for infants in their first year be-cause of its developmental and socialvalidity. Our longitudinal data providea reliable empirical foundation for ad-vice about infant sleep developmentand provide a context for clinicians todiscuss sleep issues with parents.20

Prevention efforts should focus in thefirst 3 months, beginning as early as 1month for intervention to be synchro-nous with the onset of sleepingthrough the night. Additional researchis now needed to establish the factorsthat precede and predict infant sleepproblems.

ACKNOWLEDGMENTSThis study was supported by a Univer-sity of Canterbury Doctoral Scholar-ship and by Task Force Green and NewZealand Lotteries Health Researchfunding. Preparation of this articlewas supported by a University of Can-terbury College of Science Postdoc-toral Fellowship (for Dr Henderson).The research was undertaken whileJ.M.T.H, K.G.F., and J.L.O. were in theDepartment of Education, University ofCanterbury.

We thank the Plunket Nurses ofChristchurch and the families fromCanterbury who took part in this study.

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