"As a last resort, I broke down and gave Ferber a try. It's been two and a half weeks, and I see no real improvement. My daughter goes down faster at night, but the crying breaks my heart. I miss snuggling with her. She still wakes up every 30 to 90 minutes after her first two-hour stretch. She shrieks when it's time for a nap. I broke down and nursed her to sleep for her afternoon nap because I couldn't stand to see her so exhausted."
Sleep training means using behavioral techniques to teach your baby to sleep independently by altering her “sleep onset associations” — or the circumstances your baby needs to fall asleep at bedtime. By removing your presence at bedtime, you are providing new associations with the result that she will learn to fall asleep independently, both at bedtime and when she awakens during the night.
"My daughter woke every hour on the hour in her crib. I tried every other method available. Finally, at 7 months, we let her cry it out. It took three to four weeks to complete the sleep training and even though it was the hardest thing I've had to do thus far, it was so worth it. She now sleeps about 10 hours a night and loves her crib. We're both happier and have more energy to play."
Sears emphasizes a nurturing, child-centered approach to sleep and warns parents to be wary of one-size-fits-all sleep training. He recommends patiently helping your baby learn to sleep in his own time. He encourages co-sleeping, rocking and nursing your baby to sleep, and other forms of physical closeness to create positive sleep associations now and healthy sleep habits down the road.
• Having trouble? A consultant can help. Sleep consultants and coaches familiar with different sleep-training methods can answer questions, troubleshoot problems and help you find a method that works with your family. But before you enlist the aid of a sleep coach (whose services can range from a phone consultation to an overnight analysis at your house), look into their qualifications. There’s no national governing body for sleep coaching, but there are various programs that provide certification. For example, the Family Sleep Institute is a national training program; Gentle Sleep Coaches, led by Kim West, is another. Before you commit, find out about the coach’s training and credentials, and ask for referrals and experiences from past clients.
• No tears method. Created by sleep expert Elizabeth Pantley, this technique, also known as the no-cry method, involves subtly shifting your child’s sleep habits. For example, one trick, known as “fading,” suggests gradually easing out of baby’s go-to sleep strategy. For instance, if she always needs to be rocked, you would rock less and less until you can put her down to sleep without any rocking. Another technique, called substitution, switches out the routine—so if baby always nurses before bedtime, read a book instead.
"There are good times to sleep-train and periods when it may be less likely to work," says developmental psychologist Isabela Granic, Ph.D., coauthor of Bed Timing: The 'When-To' Guide to Helping Your Child to Sleep. "This is because infants and toddlers go through mental growth spurts that make them especially clingy, fussy, and prone to night wakings. They're learning new cognitive skills and often don't sleep as well."
Pantley offers a gentle and gradual approach to all aspects of sleep, customized to your baby's needs. She recommends rocking and feeding your baby to the point of drowsiness before putting him down – and responding immediately if he cries. Parents are urged to keep sleep logs, nap logs, and night-waking logs. Pantley also describes a six-phase process for teaching a child to sleep in a crib.
This is a very gentle, no-tears/no-cry (or very little cry) method of sleep coaching where you “fade it out” (FIO). With the Fading method, you continue to help your baby fall asleep (by rocking or feeding to sleep, for instance), but over time, you gradually do less and less of the ‘work’ to put your baby to sleep, and your baby does more and more. For instance, if you normally rock your baby completely to sleep, you may shorten the amount of time you rock each night until you are rocking for only a few minutes only as a part of the bedtime routine. This method requires quite a bit of patience on the parent’s part, in some cases, but it’s great for families who want to minimize crying as much as possible.
With the fading technique, continue with whatever method you were using to help your baby fall asleep (such as rocking or nursing), but decrease the amount of time you spend doing it until, in theory, you don’t have to do it at all. This is a great technique for minimizing crying, but unfortunately, many parents find it difficult to sustain. “There has to be an end in sight,” explains Mitelman. “For example, we’ll meet this need for five to seven days and then we’ll pull back a little bit.” But if you’re willing to stick to the plan and get your baby to the end goal of going to bed without your assistance, Mitelman says it’s worth a try. “Whichever way the child can get to sleep independently is fine because that’s the key ingredient to sleeping through the night.”
In clinic, I help parents with their children’s sleep problems. But in my own home, I found it challenging to apply the techniques I recommended to others. What seems obvious in a brightly-lit exam room is harder to follow at 2 a.m. Like many pediatricians do with their own children, I elected to try extinction sleep training, which involves letting a child cry in order to learn to soothe himself to sleep on his own. Night one was relatively easy, but night two left my wife in tears and me feeling like a heel. Things improved on night three, and our son scarcely cried on night four. By the end of the week, he was sleeping through the night again.
Most sleep coaches say the ideal time to start sleep training (or promote independent sleep, not necessarily using the cry-it-out method) is based on your baby’s development, but is usually somewhere between four and six months, when your baby hasn’t had much time to get used to nursing or rocking to sleep. At this stage, most babies are also developmentally ready to learn the skill of falling asleep on their own, explains Jennifer Garden, an occupational therapist who runs Sleepdreams in Vancouver. Around four months of age, some babies go through a sleep regression because their sleep cycles change and there are longer periods of lighter sleep per cycle. “It’s a great time to work on independent sleep skills,” says McGinn. Other babies’ slumber derails around this time because they are working on new skills, like moving around and rolling. Some parents choose to wait until things settle down before embarking on a sleep-training method, but you don’t have to, says McGinn.