The Truth About Sleep Training
Greetings from parenthood! For many of us, becoming a parent is like being dropped into a strange land where protohumans rule and people communicate by cryptic screams and vibrant secretions. To top it all off, sleep is as valuable and scarce in this new society as money. Children were often raised in big, extended families throughout human history, including siblings, grandparents, aunts, and uncles. It didn't make much of a difference to have another baby in the mix. However, a lot of parents today are making decisions on their own. As a result, caring for a baby can be very demanding. There aren't enough hours in the day to watch The Great British Bake Off, and there aren't enough chests for sleeping or arms for rocking. Many parents eventually need the infant to sleep for a few hours in peace and solitude.
As a result, many of us turn to the ubiquitous, if contentious, practice of sleep training to get the infant to go asleep on her own. Parents who use it swear by it. They claim that it was the only way they and their infants could sleep at all. Some parents believe it is bad to let a newborn cry. What does science have to say? Here, we attempt to distinguish between fact and fiction and provide some reassuring advice for worried parents. Let's begin with the fundamentals.
Myth: The "cry-it-out" technique is the same as sleep training.
Today, a wide range of more moderate sleep training techniques are being researched by researchers.
The mommy blogs and parenting books often mix up sleep training with "cry it out," says Jodi Mindell, a psychologist at Children's Hospital of Philadelphia who has helped thousands of babies and parents get more sleep over the past 20 years. Most of the time, it's not that.
"I think unfortunately sleep training has gotten a really bad rap because it's been equated with this moniker called 'cry it out,' " Mindell says.
Indeed, the cry-it-out approach does sound cruel to many parents. "You put your baby into their crib or their room, you close the door and you don't come back till the next day," Mindell says. "But that's not the reality of what we recommend or what parents typically do."
And it's not what scientists have been studying over the past 20 years. Cry-it-out is an old way of thinking, says Mindell, author of one of the most frequently cited studies on sleep training (and the popular book Sleeping Through The Night).
In today's scientific literature, the term "sleep training" is an umbrella term that refers to a spectrum of approaches to help babies learn to fall asleep by themselves. It includes much gentler methods than cry-it-out or the so-called Ferber method. For example, some sleep training starts by having the parent sleep next to the baby's crib (a method called camping out) or simply involves educating parents about baby sleep.
"All these methods are lumped together in the scientific literature as 'sleep training,' " Mindell says.
In several studies, parents are taught a very gentle approach to sleep training. They are told to place the baby in the crib and then soothe him — by patting or rubbing his back — until he stops crying. The parent then leaves the room. If the baby begins crying, the parent is supposed to check in after waiting some amount of time. In one study, these types of gentle interventions reduced the percentage of parents reporting sleep problems five months later by about 30%.
Myth: When you're trying to sleep-train your infant, there is a certain length of time that you should let them cry.
There isn't a set method that works for all parents, which is a fact (or baby).
There isn't a magic number of minutes that works best for checking on a baby after you've put her down, Mindell says. It depends on what parents feel comfortable with.
"Doesn't matter if you come back and check on the baby every 30 seconds or whether you come back every five minutes," she says. "If it's your first child you're going in every 20 seconds." But by the third, she jokes, 10 minutes of crying may not seem like a lot.
No scientific data is showing that checking every three minutes or every 10 minutes is going to work faster or better than checking more often. There are about a dozen or so high-quality studies on sleep training. Each study tests a slightly different approach. And none compares different methods. In many studies, multiple methods are combined. For example, parents are taught both how to sleep train and how to set up a good bedtime routine. So it's impossible to say one approach works better than the other, especially for every baby, Mindell says.
Instead of looking for a strict formula — such as checking every five minutes — parents should focus on finding what Mindell calls "the magic moment" — that is, the moment when the child can fall asleep independently without the parent in the room. For some children, more soothing or more check-ins may help bring forth the magic, and for other babies, less soothing, or fewer check-ins may work better. Even having a good bedtime routine can make a difference. "I think education is key," Mindell says. "One study I just reviewed found that when new parents learn about how babies sleep, their newborns are more likely to be better sleepers at 3 and 6 months."
"So you just have to figure out what works best for you, your family, and the baby's temperament," she says.
Myth: If you don't hear a lot of baby weeping, sleep training isn't working.
Fact: Milder methods also work. And occasionally nothing works.
The scientific literature suggests all the gentler approaches — such as camping out and parental education — can help most babies and parents get more sleep, at least for a few months. In 2006, Mindell reviewed 52 studies on various sleep training methods. And in 49 of the studies, sleep training decreased resistance to sleep at bedtime and night wakings, as reported by the parents.
There's a popular belief that "cry it out" is the fastest way to teach babies to sleep independently. But there's no true evidence, Mindell says.
"Parents are looking for like what's the most effective method," Mindell says. "But what that depends on the parents and the baby. It's a personalized formula. There's no question about it."
And if nothing seems to work, don't push too hard. For about 20% of babies, sleep training just doesn't work, Mindell says.
"Your child may not be ready for sleep training, for whatever reason," she says. "Maybe they're too young, or they're going through separation anxiety, or there may be an underlying medical issue, such as reflux."
The bottom line is don't expect a miracle, especially when it comes to long-term results. Even if the training has worked for your baby, the effect will likely wear off, you might be back to square one, and some parents choose to redo the training.