Key questions asked by parents of twin infants generally involve when their babies will start sleeping through the night (i.e. for how long will the parents have to survive on less sleep than they are used to), and how will they (parents) cope with the night-time care of TWO babies? On these topics there is a growing amount of published evidence:
A longitudinal study (Damato et al 2008) examined parental sleep and fatigue at 2, 12 and 20 weeks following birth of twins. Actigraphy and sleep diaries were used to measure sleep duration. Fathers obtained less night sleep (5.4 hours and less 24 hour sleep (5.8 hours) than mothers (6.2 and 6.9 hours), however mothers experienced more sleep disruptions (mean 2.3 vs 1.0). Morning and evening fatigue levels did not differ between parents, and sleep efficiency (sleep duration represented as a percentage of total time in bed) increased linearly over time for both parents.
In comparison to the above, mothers of single infants have up to 4 disruptions of sleep per night and are awake for 28% of the time after onset of sleep in 1st 2-3 weeks postpartum – the night-time experiences of mothers were therefore similar, regardless of whether they were caring for one infant or more. Fathers of single infants, however, obtained more sleep than mothers – whereas twins’ fathers were not so lucky! When it comes to night-time caregiving fathers are minimally affected by one infant, but have greater involvement when there are two. This has implications that need further consideration.
Chang (1990) interviewed parents of twins and found that inadequate sleep was the most commonly mentioned problem associated with caring for twin babies. Fathers of twins were considered to be at high risk of sleep loss due to their earlier resumption of employment; mothers were more able to catch up on their lost night-time sleep via daytime naps. The effects of prolonged sleep restriction include increased sleepiness, depression and decreased cognitive performance, together with a higher risk of illness and decreased ability to cope with demands. These contribute to an increased risk of postnatal depression with the mothers of twins known to be at increased risk, especially when coupled with difficulty falling asleep. Parents of twins should therefore be vigilant for signs of postnatal depression in both mothers and fathers, and seek support should PND be suspected. One way to help avoid PND is for parents to make a special effort to maintain their own normal circadian rhythms.
See our page on parental tiredness for more information.
Schedules and Routines
When coping with new babies (singletons or multiples) development of routines is generally a good thing as they help parents cope, provide structure and an order to do things in, encourage the division of tasks etc. Routines are not prescriptive and all families develop different routines. Routines have flexibility and can be varied as necessary. Schedules, on the other hand can create stress for parents rather than reduce it as they are often rather rigid, and babies don’t stick to the clock. Schedules can become a source of additional stress and conflict when things don’t go according to plan, especially when they constrain family life around the supposed needs of the babies. Parents of multiples are often tempted to implement sleep training in order to avoid night-time disruption. Remember that sleep training is a controversial practice that is often undertaken for the purpose of the parents rather than the infant(s) [link to ISIS section on sleep training]. It works under certain conditions, but it breaks the synchrony between parents and baby and causes babies stress. Researchers recommend that sleep training is not appropriate for babies under 6 months old.