Sleep deprivation is the epitome of new parenthood. Whether it is 11pm or 4am, new parents are always lingering in the background of wailing cries and cryptic facial awes, ready to put up a fight with whatever action verb available – hushing, rocking, patting, feeding, singing and when all else fails, crying with the baby.
While sleep deprivation is bearable in the beginning, it eventually takes a toll on well-being, especially when you add to the parenting confusion – household chores, COVID -19 anxiety, self-care, and long working hours. And so, more parents are opting for sleep training consults on who can guide them through the controversial process of weaning their babies away from interrupted sleep patterns and towards a soothing full night’s sleep – for both the baby and the sapped parents.
Sleep training methods: A spectrum
The loudest misconception that tends to derail parents pertains to the ruthless “cry it out” method. As the name implies, this traditional method urges parents to leave their babies in a cot to cry themselves to sleep. Parents are not allowed to enter the room and check on their baby until the next day, no matter how extensive the crying is. Scientific literature no longer supports such a rigid way of thinking and instead advocates for gentler approaches to sleep training.
Gentler sleep training methods such as the Ferber approach constitute the core principles of modern sleep training programmes. Dr Richard Ferber’s, director of The Center for Pediatric Sleep Disorders at Children's Hospital Boston - USA, graduated extinction process involves leaving the baby to cry for a fixed amount of time before being consoled by the parents. To ingrain the skill of self-soothing, parents are encouraged to gradually increase the time between their night checks on the baby. Dr Ferber himself reported that this method does not teach children how to fall asleep, rather it prevents them from accessing their parents so that they can attempt to regulate their sleep on their own.
Such methods have been supported by empirical evidence gathered by Dr Jodi A Mindell (2006), psychologist at the children’s hospital of Philadelphia and author of the most frequently cited studies on sleep training. Upon reviewing 52 studies on versatile sleep training methods, 49 papers demonstrated a reduction in night waking and a subdued resistance to sleep at bedtime – as reported by the parents. In a more recent study conducted by Prof Harriet Hiscock, of Murdoch Children's Research Institute, et al. (2007), parents reported a 30 per cent reduction in the sleep problems of their baby even five months later.
However, all these studies do have methodological shortcomings warn experts, as these studies are based on highly controlled environments that do not reflect the true parenting environment.
At what age should I start training my child?
Eager parents may start acquiring information about healthy sleep habits and baby preparations even before the baby is due stating that the recommended age of incorporating sleep training falls between four and six months, as this is the developmental stage that allows babies to embrace structural changes and routines. Yet a growing number of sleep consultants are encouraging parents to start as early as seven weeks, because that is the developmental stage whereby the baby’s sleep cycle begins to mimic that of an adult's.
However, psychologists warn against starting sleep training too early. Dr Diksha Laungani, educational Psychologist based in Dubai Healthcare City, says: “Parents should start at six months old. When you look at the REM (Rapid Eye Movement) cycles of sleep, babies have much shorter REM cycles than adults, so they are biologically wired to wake up at specific times during the night.”
How can I go about sleep training my child?
Be prepared, there will be growing – or in this case, sleeping - pains. Judy Clark, founder of Babywinkz consultancy, is a certified sleep sense consultant based in the UK who works with families around the world through online consultations to “establish healthy sleep habits that are critical to health and wellbeing”. She says: “You have to be prepared to go through some protest because you are implementing a change for your baby. But it is done in a safe and measured way with our support, so it will be a transformational experience.”
Another prop is the pacifier, she says. “It will do the trick for that moment, but it is a short-term fix for a long-term problem.” Wholeheartedly against the use of props in her practice, Clark maintains that she teaches babies how to fully settle and independently sleep like adults.
Using a personalised one-on-one approach with her clients, she customises a two-week programme based on what the baby is consuming, what they do in the day, and what type of environment they are in.
For newborns, a one-month sleep training plan is devised, as the baby is still on night feeds. Describing the first night of her sleep training method, Clark encourages parents to stay in the room with their baby as, “They are going to facilitate a learning experience. Through my guidance, parents will teach their baby a beautiful skill of self-settling because that is how we sleep.” Once the baby is asleep, they are asked to leave the room. When the baby wakes up again in the night, she teaches parents how to respond so that their baby falls asleep again.
You have to be prepared to go through some protest because you are implementing a change for your baby.
Moreover, she warns against the stigma of babies crying during sleep training as, “...there is no magic solution to crying. Crying is a beautiful gift that lets you know something is not right. Once you pass the first night of crying, you get a well-rested baby, in a happy mood during the day, feeding better, and having a better routine.”
While sleep training methods fall on a continuum of harsh to gentle approaches, they do not all follow a highly structured and scheduled nature. Cecile De Scally, South African qualified midwife over 25 years’ experience in prenatal and postnatal support and education in the UAE, prefers using the term sleep guidance as she guides parents into positive sleep associations and good habits. She says: “Sleep guidance is not a one-size-fits-all method. It has to be very personalised, as we look at the baby’s lifestyle, family, and medical history.” Her guidance comes in the form of office consultations, online consultations, or home visit consultations.
Psychological impact of sleep training
Christine Kritzas, counselling psychologist, weighs in on the attachment styles formed through parent-child interactions and their direct impact on subsequent relationships. “A mother's level of responsivity to her child’s needs during the first year of their life is critical to a secure attachment style in adulthood. Mothers of securely attached infants are consistent in their bedtime interactions with their children and are generally more responsive and sensitive than mothers of insecurely attached infants.”
Thus, the fundamental difference is that mothers of securely attached infants tend to soothe and pick up their infants if they are crying, whereas mothers of insecurely attached infants tend to exhibit inconsistent responses to their infants at bedtime. Using empirical evidence, Kritzas warns that harsher sleep training methods can impede the attachment bond between a caregiver and the infant as, “...the less available a caregiver is to the emotional and physical needs of a child, the less secure they will feel. Such an attachment style produces a child who cries more, explores less, and tends to be more anxious.”
A mother's level of responsivity to her child’s needs during the first year of their life is critical to a secure attachment style in adulthood.
Yet, she argues, there is a lack of consensus in the research on sleep training, because gentler sleep approaches such as the Ferber method do not negatively impact the child. She says, “A study published in [the international journal] 'Pediatrics' showed that the 'graduated extinction' of Ferber method did not have a negative impact on the attachment bond between the caregiver and the child. Nor did it have any adverse effects on the stress response of infants. Additional research findings suggest that this method does not emotionally harm the baby in the long-term.” While Kritzas’ professional opinion maintains that the “cry it out method” may lead to attachment difficulties due to the infants’ feelings of insecurity and distrustfulness, she clarifies that “...no attachment research will say there is a cause and effect of sleep training in that it can ‘cause’ a certain type of attachment. Attachment is a complex relational pattern, with a multitude of interactions that shape that pattern. Sleep training is one experience, but there are many more.”
Rather than focusing on getting infants to sleep, Kritzas argues that “down regulating” infants is a far more effective method.
1. Rituals, rhythm and routine – the more consistent parents are in setting boundaries, the more safe and secure a child will feel. Routines are the antidote to stress and anxiety, so ensuring that bedtime rituals are honoured daily will aid your child in regulating themselves better.
2. The power of physical touch – using massage as a means of calming your child’s system down.
3. Dimming of lights – using a lighting colour close to red on the spectrum is found to promote melatonin production.
4. Story time – is still one of the best ways to relax a child and for teenagers, this may mean paging through a magazine together.
5. Play soft soothing music – it has been found that using 432 Hz music (soft) can be beneficial for inducing sleep.
Confirming that there is research on both sides of the sleep training coin, Dr Diksha Laungani, educational Psychologist based in Dubai Healthcare City, says: “Looking at it from a pure attachment perspective would involve a very gentle method of sleep training. Yet looking at it from a behaviourist perspective would involve harsher methods as not responding to the child teaches them how to self sooth.”
While research has reported that by the third day, babies following harsher methods tend to stop crying, Dr Laungani warns against their adverse impact on the neurodevelopment of the baby’s brain cells as, “...these same research studies also reported that cortisol levels, the stress hormone, were still high even though the baby was no longer crying. Essentially, that is what self-soothing is, babies either learned how to calm themselves down or they learned that no one is going to come so there is no point in crying, but they will still continue to stress.”
Essentially, that is what self-soothing is, babies either learned how to calm themselves down or they learned that no one is going to come so there is no point in crying, but they will still continue to stress.
While she refrains from using harsher behaviourist methods within her own practice, Dr Laungani maintains that “...not being responsive to your baby during the night, by itself, is not a singular factor that will affect your baby’s attachment style in the future.”
What parents are saying about sleep training
'By the third day she was sleeping from 7pm to 7am'
Dana Al Suwaidi, an Emirati parent from Abu Dhabi who has sleep trained both of her little daughters while maintaining a career in communications, says that she embraced sleep training because the stress of being a new mother who has to manage night feeds and simultaneously return to work took a toll on her. “The first night was difficult because I kept anxiously thinking my four-month-old baby is alone in a dark room with no one to comfort her, but by the third day she was sleeping from 7pm to 7am." Al Suwaidi noted that sleep training is not just about training babies to sleep, rather it is about empowering mothers with knowledge on regulating their feeding habits and preventing their bad habits.
Every day at 7pm I do a little victory dance, because it is time for me to compartmentalise and prepare for the next day to be the best mother I can for them. I will not be able to be a good mother if I am waking every hour in the middle of the night, and that is why sleep training pays off.
She says: “It is like a trickle effect, the naps during the day and the milk during the day has a huge effect on the night sleep. As a mother I was happy to have time for myself, but more importantly, I was happy because I saw significant development in my daughter – she was sleeping better as her sleep was no longer broken, and she was less agitated.” Al Suwaidi adds, “Even though sleep training is perceived as a taboo subject because the baby will cry, the best advice I can give as a mother is to put away your personal anxiety and take it day by day because you will be shocked how strong and brave babies are. Every day at 7pm I do a little victory dance, because it is time for me to compartmentalise and prepare for the next day to be the best mother I can for them. I will not be able to be a good mother if I am waking every hour in the middle of the night, and that is why sleep training pays off!”
'The most difficult part as a parent is hearing your baby cry during the first day'
Chiming into the same rhythm is Ahmad and Hadeel Dohjoka, a Circassian Jordanian expat family residing in Dubai. As new parents juggling new jobs within the field of social media, the most pertinent issue at hand was the lack of sleep for their baby and themselves. Hadeel recalls that the trigger of seeking sleep training was “...when Sama started learning how to roll, she would wake up about 10 times per night. When taking shifts was no longer sustainable, we reached out to a professional consultant.” As expats who could not enjoy the luxury of receiving help from their immediate and extended family, they resorted to a sleep training program that can schedule their day and night.
Ahmad shares that “...the most difficult part as a parent is hearing your baby cry during the first day, but the good thing is gentler sleep training methods allow you to remain next to your baby so you can see them, hear them, and know that they are safe.” The parents noted that by the third day their baby was able to have a full stretch of sleep, by the fourth day their baby had more energy in the morning, and was having a better feeding routine. Ahmad explained: “Yesterday we took our baby out without bringing milk with us, because according to the training schedule, you know that your baby is not supposed to drink from now till the next hours.” Upon completing the programme, the new parents proudly revealed, “...we know from 7pm to 7am Sama should receive a full stretch of sleep, and even if she did wake up, she will go back to sleep on her own without the need for milk or for anyone to carry her. With sleep training, you get your life back because you wake up with full energy to play with the baby and to continue your work. The benefits of sleep, and more specifically, consecutive sleep, changes your whole attitude towards life.”
Parenting does not come with an elaborate manual, and babies do not come with a miracle-making remote control. While empirical evidence, sleep consultants, psychologists, and grateful mum testimonies swarm parenting platforms with the efficacy of gentler sleep training methods, this is an instinctive and personal decision that the parents have to make on their own. For some babies, certain methods will work and for others they will not.
Clark explains: “Listen to your instinct and do your research. Make sure you are comfortable with sleep training because for me the baby is always ready. If it sits right in your heart, then your baby will read off that energy. Never feel a stigma for teaching your child healthy sleeping habits, establishing a routine, establishing good sleep values for your family, because there are negative effects of bad sleep on the parents as well.”