Newborn Sleep Jolt: Is This Normal?

Newborns can often be observed jolting or twitching in their sleep, which can be alarming for parents and caregivers. This phenomenon is known as benign neonatal sleep myoclonus, and it is characterised by repetitive twitches or jerks during sleep. While it may resemble a seizure, benign neonatal sleep myoclonus is typically harmless and resolves on its own without treatment. It is believed to be related to the immature and rapidly developing neurological system of newborns, and it may even play a role in their sensorimotor development and the strengthening of neural connections.

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Benign neonatal sleep myoclonus

It is normal for newborns to jolt in their sleep, and this phenomenon is called benign neonatal sleep myoclonus. It is a sleep-related movement disorder that occurs in very young infants. It is characterised by repetitive, rhythmic myoclonic jerks that occur during sleep. These jerks usually occur in the arms, legs, or core, and less commonly in the face. They can also involve the whole body and are usually symmetrical, affecting muscle groups on both sides of the body.

The cause of benign neonatal sleep myoclonus is unknown, but experts have hypothesised that it may be related to the incomplete development of the protective sheath around a baby's spinal cord. It may also have a genetic component, as it has been reported to run in families and occur in multiple family members. Additionally, there is an increased incidence in infants of mothers with opioid dependency.

While benign neonatal sleep myoclonus usually resolves on its own without treatment, caregivers may want to secure the area around the baby to prevent any harm from their movements.

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Newborn reflexes

It is normal for newborns to exhibit twitching or jerking movements during sleep, a phenomenon known as benign neonatal sleep myoclonus. This condition is characterised by repetitive twitches or seizure-like movements during sleep and typically affects infants within the first month of birth, with symptoms peaking between 2 and 5 weeks of age. While it can be distressing for parents and caregivers to observe these unusual movements, benign neonatal sleep myoclonus is generally considered harmless and tends to resolve on its own without treatment. The disorder is believed to be associated with the immaturity of the infant's nervous system, and episodes can be triggered by loud noises or touch.

Newborns exhibit a range of other reflexes, which are involuntary movements or actions that occur spontaneously or in response to specific stimuli. These reflexes are important indicators of the proper functioning of the brain and nervous system. Here are some common reflexes observed in newborns:

• Rooting Reflex: When the corner of the baby's mouth is stroked or touched, they turn their head and open their mouth in the direction of the stimulation, preparing to suckle. This reflex typically lasts until the baby is about 4 months old.
• Sucking Reflex: When the roof of the baby's mouth is touched, they exhibit a sucking action. This reflex usually develops around the 32nd week of pregnancy and becomes fully established by the 36th week.
• Moro Reflex: Also known as the startle reflex, this occurs when the baby is startled by a loud noise or sudden movement. The baby throws back their head, extends their arms and legs, cries, and then quickly pulls their limbs back in. This reflex typically disappears by the time the baby is 2 months old.
• Grasp Reflex: When the palm of a newborn's hand is stroked, they respond by closing their fingers into a grasp. This reflex lasts until the baby is about 5 to 6 months old.
• Walking or Dance Reflex: When held upright with their feet touching a solid surface, the baby appears to take steps or dance. This reflex is similar to the grasp reflex in the hands and typically lasts until the baby is 2 months old.

Dreaming

It is normal for newborns to jolt in their sleep, and this phenomenon is called benign neonatal sleep myoclonus. It is a sleep-related movement disorder that occurs in very young infants, and symptoms usually start within the first month after birth. The most severe symptoms typically occur between 2 and 5 weeks of age, but they eventually resolve on their own without treatment. By the time they are 6 months old, symptoms resolve for 95% of infants, and by their first birthday, 97% of infants no longer have symptoms.

Sleep myoclonus is characterised by repetitive twitches during sleep, which may be caused by sudden muscle contractions (positive myoclonus) or muscle relaxation (negative myoclonus). These twitches are usually harmless and are a result of the baby's developing nervous system and brain. Studies have shown that these twitches may be linked to sensorimotor development, where the twitching activates circuits in the baby's brain, teaching them about their limbs and what they can do. This is supported by research on animals, which suggests that twitching helps to synchronise developing structures and strengthen neural connections.

Babies can also twitch in their sleep due to reflexes, such as the moro reflex or tonic neck reflex. Swaddling may decrease the occurrence of twitching by reducing the moro reflex, as the baby is wrapped up and less able to flail about.

While benign neonatal sleep myoclonus is generally harmless, it can be confused with other disorders that require treatment, such as seizures. If you are concerned about your baby's twitching, look out for abnormal eye movements along with body movements, trouble breathing, or discolouration of the skin. If these symptoms occur, seek immediate medical attention.

Babies can also twitch in their sleep because they are dreaming. This can occur during both NREM and REM sleep cycles, with REM sleep being the cycle where we dream. Twitching during REM sleep is linked to sensorimotor development, as mentioned earlier. While babies do not have complex dreams like adults, they may experience basic dreams due to their developing brains. As they grow older and their brains become more developed, their dreams will likely become more complex and similar to those of adults.

Seizures

It is common for newborns to jolt in their sleep, and this is usually benign neonatal sleep myoclonus, which is harmless. However, it can be stressful for parents and caregivers to observe these unusual movements. Benign neonatal sleep myoclonus is a sleep-related movement disorder that occurs in very young infants, usually within the first month of birth, and the most severe symptoms typically occur between 2 and 5 weeks of age. The symptoms eventually resolve on their own, often before the infant is 3 months old, and by their first birthday, 97% of infants no longer have symptoms. It is important to note that benign neonatal sleep myoclonus may appear similar to myoclonic seizures, but there is a key difference: the jerks never occur when the infant is awake, and they stop immediately if the infant wakes up during an episode. Additionally, infants with benign neonatal sleep myoclonus display normal brain activity during an episode, which can be monitored by doctors.

Now, onto the topic of seizures, which are bursts of uncontrolled electrical activity between brain cells that cause temporary abnormalities in muscle tone or movements, behaviours, sensations, and/or states of awareness. Seizures can occur in newborns and infants, and they can happen during sleep. Infantile spasms, which are a type of seizure, typically last for one to two seconds and occur in a series or cluster every five to ten seconds, usually after the baby awakes from sleep. They can be a sign of underlying conditions such as West syndrome, which is characterised by infantile spasms, abnormal brain wave patterns (hypsarrhythmia), and developmental delays or regression. Up to 50% of children with infantile spasms have long-term developmental and neurological issues, and many develop other kinds of seizures and epilepsy. Therefore, it is crucial to seek medical attention if you suspect your child is experiencing seizures. The diagnosis of seizures requires a full medical evaluation, including a neurological exam and a sleep EEG (electroencephalogram) to record brain activity. Treatment options for seizures may include anti-seizure medications, the ketogenic diet, epilepsy surgery, and targeted therapy for underlying conditions.

Hormones

It is normal for newborns to jolt in their sleep. This phenomenon is called benign neonatal sleep myoclonus, and it is characterised by repetitive twitches during sleep. It is a sleep-related movement disorder that occurs in very young infants. The symptoms tend to start within the first month after birth, and the most severe symptoms typically occur between 2 and 5 weeks of age. The symptoms eventually resolve on their own, with 95% of infants being symptom-free by 6 months of age and 97% being symptom-free by their first birthday. Although episodes can look dramatic, researchers believe that benign neonatal sleep myoclonus is not harmful.

• Sleep-Wake Cycles: The hormones serotonin and melatonin play a vital role in regulating a newborn's sleep-wake cycles. Serotonin, also known as the "awake hormone," is produced during the day and promotes alertness. On the other hand, melatonin, the "sleep hormone," is produced at night, aiding in sleepiness and preparing the body for sleep. The balance between these two hormones is essential for a child's sleep quality.
• Maternal Melatonin Transfer: Newborns receive high levels of melatonin from the placenta while in the womb and during the first few weeks after birth. This allows them to fall asleep easily and explains why newborns can sleep anywhere. Around eight weeks after birth, the maternal melatonin levels decrease, and the baby starts producing their own melatonin. This transition may result in changes in sleep patterns, such as shorter catnaps and increased alertness.
• Serotonin Production: Serotonin is derived from light exposure, and adequate sunlight exposure during the day can promote serotonin production. This, in turn, supports the conversion of serotonin to melatonin at night, aiding in sleep preparation.
• Prolactin and Breast Growth: As maternal estrogen levels decrease after birth, the hormone prolactin, responsible for milk production, temporarily increases. This can lead to breast growth in both male and female newborns. This condition, known as "witch's milk," is considered normal and usually resolves within the first month.
• Nasal Congestion: Nasal congestion in newborns can sometimes be attributed to the hormone estrogen. Estrogen can stimulate the nasal passages, leading to stuffiness. This condition generally improves within two months and becomes less noticeable as the baby's nasal passages grow.

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