Sleepwalking through a fog

I have a patient who asked me how much sleep should a newborn be 
getting.  Her baby was sleeping very little, taking  2 quick cat naps 
of 30-45 minutes during the day, between the frequent feedings that 
take 1 hour to complete.  Her baby is only getting 2 stretches of 3 
hours of sleep each at night.  It didn't add up to very much sleep for 
her and probably not enough for him either.  She's beyond tired, and 
said that she can barely function, even going to the bathroom seems  
unattainable.  "I'm not having fun, it's not what I expected.  I love 
my baby, but I can't keep this up. What am I going to do?" she asked.

Get more sleep, is the simple answer and how to do it, is the harder 
part.  She wants to breastfeed her baby exclusively, and hasn't been 
able to find time to pump.  We worked on finding time to pump and 
getting her on a schedule.  Then, we talked about how to decrease the 
baby's time at the breast, so that he doesn't use her as a pacifier 
and becomes more efficient.  I recommend 20-30 minutes depending on 
the baby's pattern.  Frequent, on demand feedings work well, when 
there's a break in between to eat, drink plenty of fluids, and yes, go 
to the bathroom.  Once she has a supply of breastmilk, she can have 
someone else offer a bottle, so that she can get a nap, or some much 
needed time to herself.  She asked me if she could use formula and mix 
it with her breastmilk to provide enough for her baby, and of course 
she can, if she needs to.  Infant formulas are the only safe 
alternative to breastmilk.   The point is to do what works, so that 
she can get some rest and enjoy her baby.

(This blog was originally published in 2010)