Twins: Safe sleep, settling and routines

Welcoming twins into your life is at once exciting, wonderful and overwhelming.

No-one can prepare you for the reality that descends upon you once you get your twins home and begin to parent them. When you parent twins or more babies at once you certainly have many more demands on you than when you parent just one new baby at a time.

One of the major challenges is coordinating your twins feeding, socialising and sleeping routines.

If your twins routines aren’t synchronised you may get locked into a never-ending cycle of feeding and attending to a busy and sociable baby while your other twin is sleeping. When you have this kind of disruptive routine you’ll be exhausted and possibly quite irritable.

Therefore it’s important for you and your family to put in place a predictable and synchronised day and night routine for your twins.

It’s often difficult to initially establish a predictable and synchronised routine for some twins for several reasons such as:

• Your twins and other multiples are often born prematurely.
• They can spend varying periods of time in the neonatal intensive care nursery (NICU) or a special care nursery (SCN) where they are nursed in a predominantly brightly lit, noisy and stimulating environment.
• In the NICU and SCN the babies are usually handled and cared at very frequent intervals by multiple people.
• Your twin babies have to share space in your uterus so they often have lower birthweights even when born near their due date.
• Twins usually need frequent feeds around the clock because they have lower birthweights.
• Once home the twins may still receive quite a bit of extra care and handling from a few different carers during the early “settling in” period.
• You can be tired, tense and worried if you’ve had two or more unwell babies in NICU and SCN and you will take time to recover as well

Safe Sleep for Twins

Many parents initially “co-bed” or sleep their twins in the same cot once they bring their twins home from hospital.

You may have been told this has some advantages such as your babies may sleep better because they prefer being together; if you can’t fit two cots in your room this saves space and makes it easier to care for your babies.  Research has been done to find out if these recommendations hold true. The best support seems to be twins do seem to synchronise their breathing and sleep cycles when you co-bed them.

On the other hand research also finds that when twins sleep side-by-side there’s the risk that one twin can move some part of his body and cover the other twins face, mouth or nose and disrupt his breathing for a moment or two.

For the first 6 to 12 months, the safest way to sleep your twins is:

• If possible keep both twins in your bedroom, in their own cot for the first 6-12 months.
• Place each twin in their own cot or bassinette on their back to sleep.
• Place their cots side-by side so your twins can see each other.
• If you can’t fit two cots in your bedroom then use a room that can accommodate two cots so the twins can remain together.

If you’re in a temporary situation where you only have one cot, this is the safest way to co-bed your twins:

• Don’t use any bedding.
• Use a separate safe sleeping bag with fitted neck, fitted armholes (or sleeves) and without a hood; or use a firm wrap, but not too tight wrap, with arms flexed at baby’s chest. Once twins can roll, stop using wrapping.
• Place twins on their back at the opposite ends of the cot, with both heads towards the middle. Don’t place twins side-by-side.
• Babies should never co-sleep with older children.
• Once babies can move around they must be placed in separate cots to sleep.¹

Establishing a routine for your twins

Once you have brought your twins home and finally settled in you can begin to establish a day-night routine where they enjoy feeding, socialising and sleeping together. 

It’s important to begin this process as early as you can because it’s nicest and more comfortable for you and your twins to have a fairly synchronised routine at the beginning rather than adjust and modify later on.

Modifying established sleep associations when the twins are older can be more difficult and upsetting for everyone. Apart from that, your twins will probably be much more settled and happy for you when they are cared for together.

Now, you won’t be able to totally synchronise your twin’s routine because both have their own personalities, likes and dislikes. As you get to know them better, you will begin to understand and recognise how to adjust their care. Here’s an example of how you can work through a way to synchronise their routine.

Often you have one twin who sleeps differently to the other. Twin 1 sleeps a little more than Twin 2 and is the first to get tired and sleepy and sometimes goes to sleep quickly on his own. So how can you get Twin 1 to sleep if he’s not showing that he’s drowsy or sleepy when Twin 1 is ready for bed?

Firstly, as you get to know your twins you’ll probably begin to recognise and anticipate when Twin 1’s nap time/bed time is approaching. This is your opportunity to jump in and have a try to prepare Twin 2 for his nap. Try to reduce the amount of stimulation Twin 2 is exposed to prior to the twins approaching nap/bed; this will give him time to wind down and relax.

The best way you can reduce stimulation is to move him away from the normal, exciting household environment with all the noise, siblings and busy “going-ons”.

Next and very importantly is reduce his or her exposure to stimulating blue lights associated with televisions, smart phones and tablets, game consoles and fluorescent lights. Reducing blue-wave light will reduce stimulation and help sleep. In fact this is essential for both your twins. Use low lighting that is in the yellow to red range, especially at night.

Finally, both twins need a repetitious, soothing and calming bedtime routine, such as cuddling, gentle rhythmic touch and lullabies; include a relaxing bath for the evening bedtime.

Bedtime routines only need be short for young babies and can increase in length as your twins get older.

Toddlers and pre-schoolers usually have bedtime routines no longer than 30-40 minutes. No matter what age-group your twins are, their bedtime routine remains repetitious, soothing and calming with the reduction of exposure to stimulating blue lights.

Once you have both twins in a calm and drowsy state for sleep, settle them on their backs in their own cot, for each sleep. If it’s a day sleep you don’t have to make the room totally dark, just make sure the light is low and conducive to sleep, just the same as you would when you take a daytime nap.

Once you have them in bed for a daytime nap or for their night time sleep you can begin to try and synchronise their sleep cycles as much as possible.

Once you have your twins to sleep, you may find you have a second common and normal sleep “hiccup”. It could be that Twin 1 is also better at self-soothing back to sleep between sleep cycles than Twin 2. It’s a very normal development process for some babies to have more trouble than others developing the ability to self-soothe between sleep cycles, but with a bit of gentle help at the right moment you can resettle him back to sleep. However, if you begin to have difficulties resettling, this is the situation where sleep difficulties often arise.

If Twin 2 wakes between sleep cycles and if Twin 1 continues to sleep on, you can try to synchronise their sleep by settling the more wakeful Twin 2 back to sleep. This is always a circumstance for you to make a judgement call; depending on whether it a daytime nap or night time sleep, you decide how much sleep they’ve had and whether they could do with some more sleep. After you make that decision you can use gentle resettling strategies to soothe Twin 2 back to sleep. You may have to try this several times to help modify his sleep patterns and synchronise your twins as closely as possible.

Your twins feed times also need to be coordinated with sleep times as well. To do this you try and work feed times similarly to sleeps.

If Twin 1 wakes and wants a feed and Twin 2 is finally sleeping and you really don’t want to wake him, try getting Twin 1 to wait just for a few minutes. Use the time to socialise and get to know each other if he’s willing and not too ravenous.

You’ll probably have to manage this process of coordination and synchronisation of feeding and sleeping quite slowly, but eventually their feeding, sleeping and social patterns will slowly merge with your help.

When twins are unsettled

So what happens when your wakeful Twin 2 doesn’t resettle between sleep cycles and begins to cry and fuss? After all twins are just the same as singleton babies and have the same sleep and settling difficulties. 

If you are having settling problems with one twin or even both twins this can be very distressing. When the twins share the same bedroom, parents usually try to juggle keeping the wakeful Twin 2 from disturbing the sleeping Twin 1.

The most common approach parents use, is to quickly attend to wakeful Twin 2 so he doesn’t wake Twin 1. The unlucky spin-off from this approach can lead to a sleep association; that is Twin 2 starts to rely on you to go back to sleep rather than developing his own ability to self-soothe back to sleep between sleep cycles.

The good news for this situation is if Twin 1 is pretty good at self-soothing back to sleep, Twin 2 may not disturb him at all. You may be getting distressed and anxious for no reason. It could be worth a try to see if Twin 1 does get disturbed while you give Twin 2 an opportunity to try and resettle. This is another opportunity to get to know your twins.

If Twin 1 does get disturbed, and you have the room you can separate the twins into different rooms while you resolve Twin 2’s sleep difficulties.

So what if both Twin 1 and 2 synchronise their sleeping problem! This is a difficult problem for you and possibly the best solution is whatever works best for you, as well as all the help and support you can muster. However, here are some ideas:

• Sleep your twins in the same room.
• Keep them in their own separate cots side-be-side.
• Stand between the cots and provide both twins soothing, rhythmic, gentle touch and voice e.g. pat, stroke, ‘shhh” at the same time.
• If both twins are crying and very upset and you can’t hold both, Twin 2 can be held first and Twin 1 placed in a rocker. Provide eye contact, soothing rhythmic movement and gentle voice to both twins, but especially Twin 1 who will need extra reassurance. Twin 1 will need to swap places with Twin 2 for a reassuring cuddle. Slow and rhythmic rocking is very soothing when a baby is crying and distressed.
• If you have a partner or other supportive family member or friend they can help hold and soothe as well.
• If you think the twins are keeping each other awake then they may be better off settled separately in different rooms.

Ways of Settling

Here is one way to try to resettle:

You need to settle your drowsy and sleepy twins in a darkened room, in the same safe sleep place, on their backs in their own cot, for each sleep as often as possible. However, if either twin is crying he needs to be picked up, cuddled and given plenty of reassurance. When he cries he’s telling you he can’t cope and needs your help and support.

Once he’s calm put him back in his cot and gently use a rhythmic pat, stroke, gentle “shhhh” or soft singing until he’s drowsy and almost asleep. Then try leaving the room. If either baby calls for you and depending on age stands up, cries or some other behaviour start the settling over again. Repeat the soothing steps calmly and gently until your baby falls asleep. You are allowed to make contact with your baby; in fact it’s essential because your babies need to see your face and eyes to gain the reassurance from you that the help you’re giving is safe and perfectly okay.

Exhausted parents

Parents of twins are usually very tired and often feel a bit overwhelmed by the amount of caregiving they have to squeeze into their day. It’s very easy to place too much pressure on yourself to do far more than is humanly achievable such as trying to keep up with all the housework and cooking you used to be able to do! Taking care of two babies is more than enough, so taking breaks and rests whenever you can is essential for your ability to be the best mother and father you can be to your twins.

If family and friends offer to help this is the time to take up the offer. You will have plenty for people to do such as give you 15 or 30 minutes’ break to put your feet up or nap, have a shower, do some laundry, a bit of grocery shopping – just about anything.

Most people want to help because people really do understand that having twins are wonderful, exciting but absolutely exhausting.

Finally, if you can try to establish and maintain a predictable and coordinated routine with your twins right from the start, this may really help you and your twins enjoy a much happier time with each other.

Your days won’t always go smoothly, but that’s pretty normal for all parents, just a bit more chaotic for you and your twins.

The good thing about predictable routines is you can more easily pull it all back together after the chaos has subsided.

The most important thing to remember is that you are building a special, loving relationship with your twins and that’s really all that matters. The way you build your special relationship is by enjoying most of the time you spend with each other.

A good website access support information for twins and multiples is the Australian Multiple Birth Association (amba.org.au).

1 Adapted From “Tresillian Sleep Book”