From NICU to nursery: building healthy sleep habits for preemies
Bringing a baby into the world is a journey filled with love, hope and a touch of the unexpected – especially when your little one arrives earlier than planned. Premature babies, born before 37 weeks of pregnancy, often come with unique needs, particularly when it comes to sleep. And I know this first-hand, after welcoming my firstborn into the world at 33+2 weeks.
Understanding how sleep works for premature babies can help ease your worries and give you the tools to support your baby’s development in those early, crucial months. In this blog, we’ll look at why sleep is essential for preemies, how their sleep differs to full-term infants, how to create a healthy sleep environment and more. So, with all that said, let’s dive right in.
Why is sleep so important for premature babies?
Sleep isn’t just rest – it’s a critical part of a baby's growth, especially for premature infants. During sleep, the brain is hard at work building connections, processing experiences and supporting physical development. For premature babies, who missed some of this development in the womb, quality sleep becomes even more essential.
How is sleep different in premature babies?
Premature babies don’t follow the same sleep patterns as full-term newborns. In fact, premature babies spend up to 90% of their time asleep compared to full-term infants who sleep approximately 70% of the time (Barbeau & Weiss, 2017). Here’s what makes their sleep unique:
More active sleep (REM): Preemies spend a greater percentage of time in active (REM) sleep. This stage is important for brain development, even though it may look restless.
Shorter sleep cycles: Instead of the typical 50-60 minute sleep cycle of full-term babies, preemies may have shorter cycles, often waking more frequently.
Unpredictable sleep-wake patterns: It may take longer for premature babies to establish a day-night rhythm. Their internal clocks are still developing.
Common sleep challenges
Every baby is different, but premature babies may face:
Longer periods of light sleep and frequent waking
Difficulty settling, especially if they spent time in the NICU with constant stimulation
Medical concerns, like reflux or sleep apnoea, which can interrupt sleep
Supporting healthy sleep for your preemie
While sleep may not always come easily, there are things you can do to help your premature baby rest better:
1. Create a calm sleep environment
Recreate a womb-like atmosphere with dim lighting, soft white noise and gentle swaddling (if appropriate and safe). Preemies may be more sensitive to stimuli, so a quiet and consistent space can make a big difference.
2. Enjoy lots of skin-to-skin contact
One of the most comforting and powerful tools you have as a parent – especially for a premature baby – is skin-to-skin contact (also known as “kangaroo care”). This simple act of holding your baby directly against your chest helps regulate their temperature, heart rate and breathing. It also supports deeper, more restful sleep and promotes bonding, which can ease the transition from hospital to home.
Studies show that skin-to-skin contact helps premature babies settle more easily, cry less and experience better overall sleep quality. Even short, frequent sessions can make a meaningful difference in their sleep patterns and emotional wellbeing (Feldman et al, 2020, 2014; Messmer et al, 1997;
3. Follow a flexible routine
Even if your baby doesn’t settle into a schedule right away, consistent bedtime cues – like a bath, soft lullaby, milk feed and white noise – can help their body learn what to expect in the lead up to bedtime.
4. Practice safe sleep
When your preemie was in the neonatal unit, it’s likely that they slept wearing hats and with rolled up towels in their incubator. Their cots may have been raised too. This is due to medical reasons – but don’t forget, they would’ve been under constant supervision.
Before you take your baby home, the hospital staff will help prepare your little one for coming home, for example starting to sleep them on their backs. They will also talk to you about safer sleep at home to help reduce the risks of SIDS.
UK safe sleep guidelines include always placing your baby on their back to sleep and using a firm, flat mattress. It’s also important to avoid blankets, toys or pillows in the sleep area. For premature infants who may have specific needs, always check with your healthcare provider about any modified guidelines. For more info on safe sleep for premature babies, please visit the Lullaby Trust website.
5. Loosely track sleep and behaviour
If you notice a sleep pattern emerging, encourage it. You don’t need to be super strict with logging every hour or minute on a spreadsheet, but you’ll soon see if your preemie baby is sleeping at certain times of the day (this will be easier to identify the older they get and the fewer naps they take). It’s also worth keeping a record of any potential health issues (like sleep apnoea episodes) as it’ll provide useful insights for your child’s paediatrician.
6. Be kind to yourself
Parenting a preemie is hard. You’re doing the best you can – and that’s more than enough! Don’t hesitate to ask for help or lean on your family, friends, paediatrician or sleep consultant for support. You can also contact Bliss – a UK charity for babies born premature or sick. They offer emotional and practical support, financial information and resources on neonatal care leave and pay. They also offer information on caring for premature and sick babies, support for LGBT+ families and links to other helpful organisations.
Understanding corrected age for sleep expectations
When thinking about your preemie’s sleep – especially when it comes to nap schedules, wake windows or developmental milestones – it’s important to use their corrected age, not their birth age. Corrected age is calculated from your baby’s due date, not the day they were born. For example, if your baby was born eight weeks early and is now 4 months old, their corrected age would be 2 months. This matters because preemies often follow sleep patterns and hit milestones based on their corrected age. Using this adjusted timeline can give you a more accurate sense of what’s typical, help ease anxiety and prevent pushing your baby into routines when they’re not developmentally ready.
When to seek help
If your baby seems unusually irritable, has very disrupted sleep or shows signs of distress while sleeping (like frequent pauses in breathing or turning blue), reach out to your paediatrician right away. Sometimes, sleep challenges are connected to underlying health issues, so it’s important to investigate it straightway.
Final thoughts
Caring for a premature baby is a journey that comes with its own milestones and challenges. Sleep can be one of the trickier parts – but also one of the most important. With patience, love, and the right support, your baby will grow stronger every day. Trust your instincts, lean on your village and take it one nap at a time.
As a premature baby sleep consultant, I’m passionate about helping families of preemies who are struggling with their sleep. To find out how I can help you and your prem baby, book a discovery call with me today.
Sources:
Barbeau, D. Y., & Weiss, M. D. (2017). Sleep Disturbances in Newborns. Children, 4(10), 90.