NOTE- This post is somewhat long. If you JUST want the recommendations, feel free to skip to the end. I will always include a TL;DR (Too Long, Didn’t Read) at the beginning of every post. This way, you can get what you came for very shortly. If you want to read more, just keep on reading!
TL;DR
- Sleep training methods are all different takes on or versions of Extinction, a method borrowed from Behaviorism which notes that behaviors which are not reinforced will eventually go away. Different sleep training methods exist somewhere on a scale from ‘soft’ to ‘true’ extinction.
- Cry it Out is ‘true’ extinction
- Other forms exist which alter the structure so that it is no longer ‘true’ extinction, but is still close enough to be effective
- There exists controversy about the long-term risks of sleep training. I note here that these are not scientifically validated concerns (see below for more information).
- Sleep training has been demonstrated to be safe and effective, and no long-term negative outcomes have been evidenced.
- The version of sleep training my wife and I used was a Delayed Response version, where we would not respond for set intervals of time, and increased those intervals over time. This worked for us.
In my introduction post, I mentioned that one of the reasons that I created this blog is because of my experiences on a facebook group specific to fathers of multiples. On this facebook group, one of the most common questions I see asked is, “How can I get my child(ren) to sleep?!” This makes a lot of sense. If you read any book about caring for an infant, sleep is going to be discussed. It has been said before that the only things infants do are eat, piss, shit, and sleep. And this really isn’t that far from the truth, at least for the first few weeks or months.
If you are in search of ways to get your children to sleep and you go to google (or another preferred search engine), you will most likely come across hundreds of blogs that say different versions of effectively the same things. Some of these will cite sources, but many of these sources are just recommendations from other websites. Going back to my introduction, one of the things that is important to me is to provide evidence-based information. I don’t want to just regurgitate the same information that you could find elsewhere. I want to cut through that and actually look at the research, and then provide that information to you in a way that is helpful and easily understood.
As such, the goal of this post is to describe some of the research surrounding improving the quantity and quality of your young child(ren)’s sleep, and as a result, help you to get some sleep yourself. I will spend some time speaking to what has been demonstrated in the research literature on this topic. I will then take some time to explain my own perceptions, based in the science and study of behavior, which explain away some of the controversy in this area. After this, I will let you know what my wife and I did. I want to be clear that my experience (and my wife’s) with sleep training should only be viewed as anecdotal. That means it isn’t, by itself, research. I’m not a sleep training expert. All that I am is someone sharing what he has learned and telling you what he did.
Sleep Training
Sleep training is an often misunderstood collection of practices which do exactly what the name implies: they train babies to sleep. Contrary to what a small population of people might lead you to believe, there are actually quite a few different approaches to sleep training, each with their own rationales, evidence (or lack thereof), proponents, and opponents. Most of these practices include some type of Extinction protocol. In fact, all of them rely upon extinction as a strategy, and the differences between them are largely the degree to which they align with what might be called ‘true’ extinction. Extinction is a procedure or effect taken from Behaviorism, a paradigm in Psychology which was concerned with studying observable behavior. If you have ever taken a course in Psychology, Applied Behavior Analysis, or Theories of Learning, you have probably learned about Behaviorism.
Extinction is something which is based in the concept of Operant Conditioning, which was described by B.F. Skinner (arguably, the most influential person in the history of the study of behavior). Operant Conditioning, at it’s core, is the idea that behaviors relate to Antecedents (things in the environment which happen before a behavior) and Consequences (things in the environment which happen after a behavior). Reinforcement is a type of consequence which leads to an increase in a behavior over time and Punishment is a type of consequence which leads to a decrease in a behavior over time.
Extinction is a procedure where you make it so that a behavior does not lead to any reinforcing consequence. It’s not punishment, it’s just… no reinforcement. What happens is that a behavior which doesn’t lead to a reinforcing consequence will, over time, stop happening. As an example, let’s say that you have a switch in your home which turns on your lights in your kitchen. When you want the lights on, you flip the switch, and the lights turn on. Here you have an antecedent (darkness), a behavior (flipping the switch), and a consequence (the lights turn on). The consequence is reinforcing because the behavior worked– it’s led to the desired effect. Now, imagine that one day, you flip the switch and the lights DON’T turn on. You might flip the switch a few more times (an Extinction Burst, a concept I will return to later) but after a bit, you will stop doing that. The behavior no longer leads to reinforcement,so there is no ‘reason’ to do it.
So, why are these practices based in Extinction? Let’s remember that, from my introduction, one of the cornerstone ideas that I hold (and so is present in this blog) is that all behavior is communication. Infants may not be able to speak, but they can most definitely communicate. When an infant wants to communicate something, they have pretty much one thing that they can do: cry. Crying is a behavior. And when an adult, caregiver, or parent responds to the infant, that is a consequence. If the infant get their want or need met, that consequence is reinforcing. With this idea, extinction-based sleep training is born. Very generally, if the adult’s response doesn’t happen, then the crying behavior is put on extinction. Over time, the behavior should decrease.
Methods
Cry It Out
The most commonly understood version of sleep training is, arguably, the most intense, and that is the ‘Cry It Out’ method. This method is extinction pure and simple. With this method, once the caregiver puts the child down to sleep, the caregiver does not go back into the room or attend to the child until it is time to wake up in the morning (with obvious exceptions if the infant is in danger or becomes injured).
This method is, as I said, pure extinction. The idea is that the child will engage in their typical behavior (crying), but it won’t be reinforced. The behavior won’t lead to the desired change (getting comfort or food). Over time, the baby will cease crying because the crying doesn’t lead to the intended outcome.
Something here that should be noted relates to an Extinction Burst, which was mentioned but not described, above. An Extinction Burst is a temporary increase in the frequency or intensity of a behavior when reinforcement is withheld. Imagine that you sit down in front of your TV, grab the remote and hit the power button, but nothing happens. What do you do? Do you immediately give up? Probably not. You likely hit the button again. And again. Maybe you push the button harder. Maybe you hit the remote against your hand a couple of times. Maybe, if you are sleep deprived and you just got your child to take a nap, you internally scream obscenities (but keep them internal, because, sleeping baby). This is, essentially, an extinction burst. Your learned behavior is no longer leading to the desired outcome. You continue engaging in the behavior, and even up the ante a bit, in an attempt to get that behavior to work and get to the desired consequence. After a bit, though, if nothing works, you’ll give up and stop engaging in that behavior.
An extinction burst is relevant because this is expected when using a Cry It Out method of sleep training. The child is going to increase the intensity of their crying. This is normal and to be expected. A lot of parents really struggle with this, and understandably so.
Graduated Extinction (Basically Everything Else)
Due to the fact that pure extinction is pretty intense, there are also some other options for sleep training. These are collectively referred to as Graduated Extinction. These approaches attempt to gain the benefit of an extinction protocol but to make it more tolerable, both for the child and for the parent. There are various different protocols for doing this, and you have likely heard of them by different names. The most commonly cited (at least in my experience) is the Ferber Method.
Typically, these methods use a form of extinction but without going all the way to Cry It Out. Some of them use a delayed response protocol, where the parent will wait at least a certain amount of time before going in to attend to the child. Others use a form of systematic fading of parent presence, where the parent stays in the room with the child until they fall asleep, but moves farther and farther out of the room across a period of time so the baby becomes increasingly comfortable with this distance. Others yet allow the parent to go into the room but not to pick up the child.
The idea that is present in all of these is one that I think I can agree with: pure, unadulterated extinction is probably not a great option, or at the very least, not the best. That is not to say that it doesn’t work, because evidence indicates that it does. But evidence also indicates that it is very tough to do and a lot of parents give up because they can’t handle their child’s screaming and crying (i.e. extinction burst). So, these methods tweak that protocol slightly so it isn’t pure extinction, but a version of it that is still close enough to be effective.
As a call ahead to later in this article, this is ultimately what my wife and I chose to do for our own children. And it worked. I might be biased toward this approach, so I’ll admit that here and now. Remember, though: my goal is not to tell you what to do, but just to tell you what your options are and what the evidence behind those options looks like.
The Controversy
As with anything in life, and even more so when it comes to child rearing practices: people have some stuff to say.
There is a controversy surrounding sleep training practices, and these relate to the idea that they teach the child that their needs won’t be met. There are a lot of different ways that this is explained, ranging from changes to neurobiology as a result of increased activation of the sympathetic nervous system to damaging the development of secure attachments. Ultimately, these explanations are simply different takes on the same major complaint: kids cry to communicate their needs and parents are supposed to respond to those needs.
On the surface, this is a pretty compelling complaint. As I stated in my introduction, I believe that when we are is shaped by our genetics and our experiences. Whether a child is responded to when they have a need is definitely an experience, and it can be pretty safely assumed that this will have an effect. The question to me isn’t whether not responding can have a negative effect but rather, to what degree? And what evidence is there regarding the nature of this negative effect? Do the ends (in this case, good sleep for the child and for the parents) justify the means (some distress on the part of the child)? Here is where I think we should go to the evidence:
The Evidence
NOTE- This review is by no means exhaustive. For the purpose of this article, I searched a number of databases looking for research which was relevant to sleep training. It is very plausible that I have missed some large segemnts of this research literature. It is not my intent to be exhaustive, but rather to speak in relatively broad terms.
What Are The Compliants / Concerns:
Many of the complaints and concerns relating to sleep training can be read about in an article by Dacia F. Narvaez, Ph.D, which was published in Psychology Today (2011). The general argument presented here is that utilizing a Cry It Out method (e.g. extinction) is a form of neglect that will lead to long-term, negative effects. The effects which are spoken to are things like negative impacts to brain development, dysfunctional stress response, poor development of regulation skills, negative effects on trust, etc. Dr. Narvaez is by no means the only person presenting these claims. I just focus on this article because it broadly speaks to many of the claims.
Another article, published in 2010, provides an argument which relates to Attachment Theory (Blunden, Thompson, & Dawson). In this article, noted attachment theorists Bowlby and Aisnworth are discussed, and the question of whether ignoring infant cries may be damaging to attachment is raised. The authors’ main point can be summed up in this quote:
“What has been interpreted as the success of these techniques with a reduction in night time crying, may more accurately be understood as extinguishing infants’ communication through our own misinterpretation and potentially even alienation. Is the cessation of crying a ‘cure’ or is it that the child has ‘given up’ and is now depressed and has partially withdrawn from the attachment dyad?” p. 5
In this same article, the authors call attention to the scientific literature on trauma and note that babies who are left for extended periods show signs of stress, withdrawal, attachment disorders, and even changes to neural structures.
Middlemiss and colleagues provided some evidence for the claims relating to stress (2012). In this article, cortisol levels of the mother and the infant were taken across a 4-day sleep training program in a novel setting. The rationale for this study was that aynchronous cortisol levels between mothers and infants (meaning levels of cortisol, a known stress hormone, which are dissimilar) at 3 and 9 months of age was predictive of attachment issues when infants were 1 year old. This article found that the use of a sleep training procedure led to a reduction in crying behaviors, a reducation in the mother’s cortisol levels, but no reduction in the cortisol levels of the infant. This constitutes asynchrony between the mother and the infant. The authors did go on to note that it could be that, given additional time, the infant’s cortisol levels would become synchronous with the mother’s again, but this was not explicitly researched.
In a brief editorial published in Clinical Lactation in 2013, Kathleen Kendall-Tackett, Ph.D. presents an argument relating to elevated cortisol levels, and again speaks to the literature on the effects of trauma. The argument here is that the research literature indicates that chronically elevated cortisol levels negatively impact neurological development. As this article is in a journal which is related to breastfeeding, complications with breastfeeding are also discussed.
Should We Take This as Valid?
What has been described above might sound rather compelling. In fact, if I were to stop this article here, it might sound as if I am against sleep-training. That is not the case, however, and there are a number of reasons why. The first relates to a general understanding of how scientific knowledge is gained and evidenced.
With the exception of the article by Middlemiss and colleagues, none of the rest of these articles are actually research. They are opinions. They may be opinions of professionals who are very intelligent, compassionate, and who have worked very hard. But they are still opinions. In logic and in science, I might refer to these things as ‘claims’.
The thing is, if you are to actually engage in empirical science, claims alone are just that- claims. What these authors have done is borrow theoretical frameworks and findings from other spheres of research (e.g. the literature on trauma) and applied the frameworks from that research to this issue. What they have not done is actually investigate whether those claims are true (In this instance, by ‘true’ I mean that the claims make predictions which can (and have) been validated through peer-reviewed research).
Let’s take the Blunden, Thompson, and Dawson article as an example. In this article, the authors reference Attachment Theory and then use that theory to generate a hypothesis relating to the effects of sleep-training on infants’ and children’s development. This is not posed as a claim, though, but rather is posed as a question. “What if this is the case? Would that be ok?” This is akin to an informal fallacy called begging the question. A hypothesis has been generated for which there is, ostensibly, no real evidence, but because it was phrased as a question, it seems to be well-meaning and reasonable. This is not how good science should be done.
To further illustrate why this is problematic: imagine a polician who is speaking very confidently about an issue, and then, seemingly out of nowhere, says, “Well, what if there are Martians who are invading us and we just don’t know it. I’m not saying that’s the case, I’m just asking questions.” What this person has done is insert an idea into the conversation, and then, by framing it as a question, has shirked their responsibility to provide any evidence that their idea has merit. This is why empirical science is so necessary. If we abide the empirical process, these sorts of claims can be ignored and/or responded to with appropriate skepticism.
In this same article, reference is made to the research literature pertaining to trauma. This is another fallacy, this time referred to as a false equivalency. Equating significant trauma to sleep training is, at worst, an intentional digression meant to evoke the emotions of the reader, and at best, a misguided appropriation of research in a tangential field of study. To the credit of the authors, they did note that this may be the case, but follow that with a statement akin to, “We just don’t know.” This, again, is a fallacy. The authors presented a hypothesis generated through inferences made from literature in a different area and then stated that they just weren’t sure. This is begging the question. It may be that these authors want to do the research to examine whether this hypothesis can be supported, and I do not want to malign these authors. It just feels like poor scientific practice.
So, then, what are we to do? Well, we are to examine the research literature. Has anyone looked to see if these things actually happen? Do children who are sleep trained show signs of neglect or trauma? Is their development negatively impacted in any way? Is any of this actually true?
Well, as it turns out, this research has been done. And, as it turns out. . . no. There are not any negative effects which have been found. At all.
Evidence in Favor of Sleep-Training
When looking for evidence relating to different practices, there are different types of studies which can be reviewed. The most compelling is a meta-analysis, where a large number of studies are reviewed and quantitative analysis is completed to speak to the effects of a given practice. A less compelling but still meaningful type of study is a research review, where a large number of studies are reviewed, but no collective quantitative analyses are completed. While researching this post, I was unable to find any meta-analyses; however, a research review by Kuhn and Elliot was found (2003).
In this review, the authors identified interventions / practices for treating sleep problems in children. They organized different interventions / practices into three groups: ‘well-established’, ‘probably-efficacious’, and ‘promising’. In this review, both Extinction (Cry It Out) and Graduated Extinction were identified as well-established interventions. This means that multiple studies exist which demonstrate the efficacy, or effectiveness, of these strategies for treating sleep problems in children.
Some of the most compelling research related to these questions comes out of Australia. An article published in the Archives of Disease in Childhood in 2007 offered mothers the option of two forms of Graduated Extinction: Controlled Crying, where the caregivers respond to crying at increasing intervals, or Camping Out, where the caregiver sits with the infant until they fell asleep and then gradually removing parent presence (Hiscok et al.). This study measured changes in parent-reported sleep problems, parent ratings of infant temperament, as well as maternal well-being.
This article found that, for those mothers who participated in one of the two sleep training practices, there was a 42% reduction in reported sleep problems at 10 months and a 50% reduction at 12 months when compared to no-treatment controls (Hicock et al., 2007). They also found that maternal mental health was significantly better at both 10 and 12 months, fewer mothers reported sleep problems for themselves at both 10 and 12 months, and mothers in the intervention group actually spent less on outside resources relating to sleep problems.
This particular research aligns with much of the research in that it speaks to 2 specific benefits: (1) sleep-training practices work in that they lead to less crying and more sleep for the infant, and (2) they lead to better maternal well-being (e.g. mental health, sleep quality). Much of the evidence given in the previous section had to do with the child, though, and whether these practices were ultimately harmful.
This same research team completed a follow-up study after 5 years, when the children were 6 (Price, Wake, Okoumunne, & Hiscock, 2012). In this study, the authors sought to answer these questions. For this study, a large number of data sources were used, including parent report, child report, and most notably, measures of cortisol. This study found absolutely no differences between children who had been sleep-trained versus those who had not on measures relating to child sleep (at the time of the study), emotions, behaviors, quality of life, child-parent relationship, incidence of child mental health problems, or stress levels. They also found that there was no difference in the mother’s mental health (which means that the increases to maternal well-being noted in the previous article are not long-lasting). This is actually great news for those who choose NOT to sleep train, in that it provides evidence that the relative decreases in well-being seen between parents who don’t sleep train versus those who do is not permanent.
Take-Aways Given the Evidence
It is, in my opinion, safe to say that sleep training practices are safe and effective. As noted above, the review completed as part of this post is not exhaustive nor comprehensive; however, from what I have found, there exists no evidence for the long-lasting, negative impacts that some researchers have warned about. It may be that there are some temporary increases to stress experienced by the child, as was evidenced by the article by Middlemiss and colleagues, however, it seems most likely that this is short-lived. This article only looked at readings across a 4 day period and only had a sample size of 25 children. When cortisol levels were reviewed in the study by Price and colleagues, as well as measures of mental health, emotional, and behavioral functioning, at 6 years, no differences were found.
Perceptions from a Behavioral Background
My professional background is in education. I have a master’s and specialist’s degree in School Psychology, I practiced for 5 years as a School Psychologist, and for the last (almost) 3 years, I have worked as a consultant on a team which specializes in challenging behaviors and Autism. As a result of this, I am pretty well versed in Applied Behavior Analysis. I am not a Board Certified Behavior Analyst (BCBA), but I work with many, I engage with them as relative equals regarding this content, and I feel I have a good working knowledge of this field.
So, how does a not-BCBA think about all of this? Well, let me tell you.
So far, I have mentioned a few terms that are important here. These are:
- Antecedent
- Behavior
- Consequence
- Reinforcement
- Punishment
- Extinction
- Extinction Burst
These are all important for my perception, but they aren’t exhaustive. Something that is very important to consider is the environment. By environment, I mean all of the context around you. In the case of sleep, your environment is ‘typically’ your bedroom. There is term here, or rather two terms, which are meaningful: Discriminative Stimulus and Stimulus Delta.
A discriminative stimulus is an antecedent stimulus which signals that a given type of reinforcement is currently available. What this means, is that it is a cue in your environment that if you engage in some type of behavior, that behavior will be reinforced. A stimulus delta is just the opposite. It is an antecedent stimulus which signals that a given type of reinforcement is not available. Let’s look at an example: a vacancy sign at a hotel.
Let’s say you’re driving down the highway one night, and you’re getting rather tired. You see a sign for a hotel with a large red light below that says ‘Vacancy’. This is a discriminative stimulus. It tells you that if you stop and ask for a room, you will get a room. It signals that the given behavior (stopping and asking for a room) will lead to the desired reinforcement (getting that room). If, however, it says ‘No Vacancy’, that would be a stimulus delta. That menas that even if you were to stop and ask for a room, you wouldn’t get one. The behavior wouldn’t be reinforced.
Once you learn about these, you see them all the time. Another good example is a child who wants their parent but the parent is in the bathroom. The child goes to get their parent and their parent is in the bathroom, they see that closed door as a stimulus delta. Now, i recognize that a lot of people might read this and say, “Not my kid! They just keep banging on the door!” I would venture to guess, though, that those kids are pretty young. And that you might respond to them verbally through the door (this is just enough reinforcement to keep that behavior going). But, as they get older, they learn about that discriminative delta. 2 and 3 year olds bang on the door. 7 and 8 year olds probably don’t. 15 and 16 year olds wouldn’t be caught dead banging on the door as their mom poops.
Why is this important? Well, because our environment contains a lot of discriminative stimuli and stimuli delta. If the power is out, you don’t grab the remote to turn on the tv. If you don’t have any food in the house, you don’t get out all of your pots and pans to cook. If your spouse isn’t home (and you know this, because knowing is important), you don’t yell up the stairs for them to come look at this cool thing you just saw. Why don’t you do these things? Because they don’t lead to the intended consequence.
When you are sleep training a child, you do that in just one environment: their bed. As they learn that crying doesn’t work, they learn that ONLY in that one place. If they cry in the living room? A parent comes and calms them. If they cry in the kitchen? A parent comes and calms them. In virtually every single environment other than their bed, they get comforted. Much of the argument against sleep training is that it does damage to attachment and to neurological development. I don’t hear those arguments about not opening the door mid-poop when your kid is crying at the door. Why not? It’s basically the same situation. The child is crying because they want or need your attention, but we don’t give it because it’s not appropriate at that time. We make the child wait. Granted, for less time, but still. No one says your kid’s attachment style is going to be ruined because you made them wait while you wiped your butt.
I argue that the same is true for sleep training. Our children learn over time that when they are in bed, their parent(s) aren’t going to respond to their crying. They learn to self-soothe, to fall back asleep, and to make it through the night. That doesn’t generalize to other areas of life. Because learning is context specific. If it weren’t, sleep trained babies would stop crying in all environments, which they don’t.
My Experience
Now that we have discussed all of this, I want to take some time to talk about my own experience (also, please recognize, anytime I say something is my experience, I am including my wife, Alex, in this. She and I are equal partners). Across my daughters’ lives, there have been 3 primary stages in our ‘sleep’ journey (with a 4th ‘half’ stage that I’ll discuss as well). The first stage was trying what we thought was typical, the second was a survival decision that ended up being a lifesaver, and the third was a very specific plan that we put a lot of thought into. I’ll describe each stage here.
Stage 1- Flying By the Seats of our Pants
When we first brought our daughters home, we tried a very typical set-up. We put the girls into bassinets next to our bed. The girls ate roughly once every 3 hours (although it was often close to every 2), and so after the feed that was close to about 7 or 8, we would put the girls in their bassinets and then we would lay down and attempt to go to sleep. We did this for about 3 weeks. It was terrible.
At that time, my wife was still attempting to breastfeed. Our experience with breastfeeding is a story for a different day. Suffice it to say, the girls didn’t take well to breastfeeding, and so any time we fed, they would end up getting a bottle of formula as well. This was also done because they were born at low birth weights (they were born at 36 weeks at 5 pounds and 5 1/2 pounds), and so they were supposed to drink a special formula with extra calories to assist with gaining weight.
Due to this, my wife would follow every feed with pumping. For those of you who have never experienced this, pumping is difficult for a variety of reasons, but one of the biggest is just the time that it takes. There is set up, the actual pumping, storing what was pumped, cleaning everything, and then setting up for the next session. By itself, this doesn’t take the most time. But when you are doing it every 3 hours, that ends up being 8 times a day.
So, this is what our nights looked like. If our girls slept the full 2-3 hours between feeds (which they almost never did), we would get up when our alarm went off to feed them. My wife would attempt to breastfeed (which she quit pretty quicly, but at first this was a step). Then we would make bottles of formula and feed them the bottles. This took quite awhile because they weren’t eating vary fast for those first few weeks. After they ate that, my wife would begin to pump. We would typically hold the babies and try to get them to go back to sleep while she did this. Pumping typically took 15 to 20 minutes. After she pumped, one of us would take the bottles of pumped milk along with components of the breast pump which needed to be washed downstairs and would store and clean things. Then we would bring things back upstairs and lay down.
This whole process probably took about 45 minutes. And we were doing it every 2 to 3 hours. And this is only if the girls actually slept! Most of the time they didn’t and we ended up awake for significantly longer! For that first 3 weeks, I don’t think my wife or I ever slept longer then an hour and a half at a stretch.
At around 3 weeks, something had to change. We were both struggling physically and mentally. So, we tried something different.
Stage 2- Survival Decisions Are Sometimes Life-Saving
What we ended up trying is sleep shifts. I think we originally did it just one night out of exasperation and sheer exhaustion, but it sort of worked, so we ended up sticking with it. Essentially, my wife would go upstairs to go to bed at around 8pm. By this point in time she had made the decision that she wasn’t going to breastfeed or pump anymore (a decision which I not only supported but was relieved about when she finally made it). Due to this, I was able to feed the girls alone.
When she went to bed, I would stay downstairs on the couch. I would put the girls down just like we would when we were upstairs, but I put them down in their bassinets (and then later in a pack-n-play) in our living room. I would then attempt to get as much sleep as I could on the couch, but would wake up to feed, soothe, and otherwise care for the girls for the duration of my ‘shift’. At around 2am, my wife would come down to relieve me. She and I would switch places. I got to go upstairs and sleep in our bed and she laid down on the couch. She was then responsible for anything the girls might need.
Here’s the thing about this approach: both of us got at least 6 hours of uninterrupted sleep each night. I can tell you from experience that I would take 6 hours of uninterrupted sleep over 8-10 hours of interrupted sleep any night of the week. Once we started getting more sleep, everything seemed like it improved (at least for me). I felt better, I felt like I had more patience, and I was more able to be present with my wife and my kids during the day. When I went back to work, I was actually able to focus on work instead of just choking back coffee and energy drinks to stay awake.
Now, there was one major downside to this: I didn’t get to sleep in bed with my wife for awhile. It ended up being close to 6 months that we did this. And this part wasn’t fun. But it was worth it.
Stage 3- Research and Planning is Actually Worth It
Stage 2 and stage 3 sort of overlap with each other, because the beginning portions of stage 3 really happened while we were still doing sleep shifts. Stage 3, though, is all about sleep training. My wife and I decided that we were going to sleep train our girls. Based on what we had read, we felt like it was the right thing for us. We wanted our girls to learn how to fall asleep on their own and to sleep through the night. We didn’t put a lot of stock in the perspectives of those people who say it’s bad for kids.
Ultimately, the approach that we used was a form of Graduated Extinction, closest to a version of the Ferber method. A very short description would be this: we let our daughters ‘cry it out’ for a set interval of time. If they were still crying when that interval was done, we went in to soothe them, and then we repeated. It’s slightly more complicated that, as you’ll see here in a moment, but that was the gist of it. See the following picture for the actual plan that we used:
(This picture is literally a screenshot of a Google Docs file that I created roughly a week after they hit 4 months. You can even see my cursor after the last word.)
(Also, as a note here- when we first started, the duration of ‘cry it out’ was only 5 minutes. We started at 5 and increased by 1 minutes each night until we got to 10. I didn’t write this onto the plan, but we did start there.)
At the time, we were still doing sleep shifts. This actually worked out to our benefit, because I was the one who was with them at the beginning of the night. My wife had told me that she didn’t know how she would handle letting the girls cry. I knew that I was going to be able to handle it (partially because my job sometimes entails using Planned Ignoring, so ignoring behaviors is something with which I had experience). So this worked out nicely.
When we started this (although here, it was more ‘when I started this’ as this happened during my shift and when my wife was asleep) the girls would cry for the full period and I would then soothe them. They would typically make it through 2 or 3 cycles of crying before the finally fell asleep before the time was up. On the third night, though, they just…. stopped. Within the window of time. And then they just… kept stopping.
Each night, they would cry when I first put them down, but they would stop after 2 or 3 minutes (if even that long). And the amount of time that they cried got less and less each night. Also, they started sleeping for longer (this may or may not be due to the sleep training). When they hit 6 months, our pediatrician told us that they should be able to sleep through the night without eating, so I also stopped feeding them when they did wake up. After this, they woke up even less often (probably because waking up didn’t get them food anymore).
Stage 3.5- A Bump in the Road
The ‘half’ stage that I mentioned earlier is the transition from sleep shifts to my wife and I sleeping in bed together again. We did this when the girls were 7 or 8 months old (I can’t remember exactly). When we made this transition, we did have a little difficulty. At this change, we began to put the girls to sleep in a crib in their room (they shared a pack-n-play in the living room and then shared a crib in their bedroom until they were too big for that to be feasible).
This transition was difficult for a reason that I discussed earlier, and that reason has to do with context cues. When we began to put them to bed in their bedroom, the environment changed. With the change in environment, many of the cues that were present when this process occurred in the living room went away, or at least were changed enough, so that they may not have functioned as signals any more.
Due to this, when we first started, the girls went back to crying for the full 10 minutes for multiple cycles. This was what might be referred to as a regression, although calling it that is somewhat unfair. The girls didn’t really regress. Their ‘skills’ and learning didn’t disappear. They were just in a different environment and so needed to learn the cues again in that new environment.
This was very difficult Alex.
She had told me earlier on that if she had been the one who had to sleep train them while we were doing sleep shifts, she doesn’t know if she could have done it. This change was evidence of that. Those first couple of nights, while my daughters were crying, my wife struggled a lot emotionally. In fact, she chose to go downstairs to sleep because she knew she wouldn’t be able to handle it.
I want to take a moment to call attention to the fact that my wife is not weak. She is an immensely strong woman and a fantastic mother. Struggling with hearing your child(ren) crying during sleep training is absolutely normal. If you know that you want to sleep train but also know that you are going to struggle with it, that is something that you should consider. My wife had me to handle the crying and she could remove herself to protect herself emotionally and psychologically. She knew the babies were safe and she knew that she wanted the sleep training to hapen. But she had to find a way to avoid the experience. And that’s ok.
After a few nights, my daughters again responded very well and went back to falling asleep quickly and remaining asleep for most (if not all) of the night.
Current Reality
My daughters are now just over 20 months. They are rockstar sleepers. At least some of that is simply due to luck. I am aware of that. I am convinced, though, that a good portion of it is due to the fact that my wife and I created a plan which we were comfortable with and stuck to it. Every once in awhile we deviate from the plan, but if we notice that one or both of the girls is starting to wake up on a consistent basis, we go back to the strict plan. Within a night or two, they are sleeping like champs again.
The girls routinely sleep for 11 to 12 hours each night. It is relatively rare for one of them to wake up during the night (maybe once a week on average). When the wake up (if they cry for longer than a couple of minutes), we go in and soothe them, put them back down, and then usually they are fine (although if they are sick this completely goes out the window).
I can’t guarantee that your experience will be the same as ours. In fact, I can probably guarantee that it will differ in a lot of ways. All I can do is give you the information so that you can decide what is best for you.
Recommendations:
I want to note here that ultimately, I don’t care if you sleep train or note. It’s a personal decision and one that I don’t have a stake in. Whether everyone who reads this sleep trains or everyone who reads this sides with not, my life won’t change either way. I don’t make money off of this, and I don’t get points for making people think the way that I do.
I am also not a pediatrician nor am I a sleep expert. I have some knowledge about behavior, which I spoke to here, but this post is just informational. So, basically, I have no recommendations.
What I have is what you have read: information. Now, go, do with it what you will.
Regardless of what you choose to do, I do hope for you this: I hope you are able to get some sleep.
References
Blunden, S. L., Thompson, K. R., & Dawson, D. (2010). Behavioural sleep treatments and night time crying in infants: Challening the status quo. Sleep Medicine Reviews, 2010, 1-8.
Hiscock, H., Bayer, J., Gold, L., Hampton, A., Ukoumunne, O. C., & Wake, M. (2007). Improving infant sleep and maternal mental health: a cluster randomised trial. Archives of Disease in Childhood, 92, 952-958. doi: 10.1136/adc.2006.199812.
Kendall-Tackett, K. (2013). Why cry-it-out and sleep-training techniques are bad for babes. Clinical Lactation, 4(2), 53-54.
Middlemiss, W., Granger, D. A., Goldberg, W. A., & Nathans, L. (2012). Asynchrony of mother-infant hypothalamic-pituitary-adrenal axis activity following extinction of infant crying responses induced during the transition to sleep. Early Human Development, 88, 227-232. doi: 10.1016/j.earlhumdev.2011.08.010
Oster, E. (2019). Cribsheet: A Data-Driven Guide to Better, More Relaxed Parenting, From Birth to Preschool. Penguin Press, New York.
Price, A. M. H., Wake, M., Ukoumunne, O. C., Hiscock, H. (2012). Five-year follow-up of harms and benefits of behavioral infant sleep intervention: randomized trial. Pediatrics, 130(4), 1-9. doi: 10.1542/peds.2011-3467.
