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Sleep training (sometimes known as sleep coaching) is a set of parental (or caregiver) intervention techniques with the end goal of increasing nightly sleep in infants and young children, addressing “sleep concerns”, and decreasing nighttime signalling. Although the diagnostic criteria for sleep issues in infants is rare and limited, sleep training is usually approached by parents or caregivers self identifying supposed sleep issues.^[1]

The idea of early independence and sleep training in babies was promoted by Dr. Luther Emmett Holt, who published The Care and Feeding of Children in 1894. This is widely believed to be the basis from which modern sleep training has evolved. Popular methods of sleep training include extinction or “cry it out”, the Ferber method, The Chair Approach, and more improvised “gentle” methods.

Sleep training tends to be popular in countries such as the USA and UK, and is mostly unheard of in societies that practice cultural cosleeping.^[2]

Development of sleep over the first year

During the first year of life, infants spend most of their time sleeping. An infant can go through several periods of change in sleep patterns. These can start at 1 week, occurring weekly or fortnightly, until 8 years of age due to innate and external factors that contribute to sleep.^[3]

Developing infants also sleep within a large spectrum of sleep — falling into high and low needs categories — fragmented through 24 hours.^[4]^[5]

These frequent night awakenings are an evolved trait, to feed frequently and playing a part in SIDS protection. However, this can be disruptive for the parent(s) or caregiver — for example, if maternity leave is non-existent or they feel the benefits of an undisturbed night can help with severe sleep deprivation. Parents who sleep trained perceive improvement in infant sleep.^[6]

Sleep conditions

Sylvia Bell of Johns Hopkins University reported that by the end of the first year, individual differences in crying reflect the history of maternal responsiveness rather than constitutional differences in infant irritability.^[7] She also noted that consistency and promptness of maternal response is associated with decline in frequency and duration of infant crying. When following through with this maternal response, Bell noted that it is most effective to apply physical contact with the infant.^[8]

The sleep position is also important to prevent Sudden Infant Death Syndrome (SIDS).^[9] It is recommended that the proper position for children to sleep in to avoid SIDS is laying on their back throughout the night. Their bedding should be firm and crib should be free from toys or blankets that could cause injury or suffocation to the child. Loose blankets and toys in the crib can increase the child’s risk of SIDS.^[10]

Criticism

Sleep training in a separate room, under 6 months is not recommended due to the SIDS reduction factors at play. A committed caregiver in the same room for all day and night sleeps reduces the risk of SIDS by 50 percent.^[11] These guidelines for baby being in the same room differs from 6 months to 12 months in different countries. An ECAS study attributed 36 percent of total SIDS deaths to sleeping alone in a room.^[12]

Another key debate in sleep training revolves around getting the right balance between parental soothing and expecting baby to be independent. Attachment parenting is a parenting philosophy characterized by practices such as baby-wearing (carrying infants in slings or holding them frequently), long-term breastfeeding, co-sleeping (sharing the parental bed with the baby), and promptly responding to a baby's cries.^[13] Popular sleep training methods, such as the Ferber Method, rely on letting the baby cry for a certain number of minutes, to allow the child a chance to fall asleep more independently and move away from an over-reliance on parental assistance to fall asleep. Advocates of attachment parenting generally reject traditional sleep training methods that involve allowing a baby to cry, asserting that such practices do not align with meeting the child's immediate needs.^[13]

A study conducted also showed that sleep trained babies displayed elevated cortisol levels (a proxy for stress, although this study did not have control babies without sleep training), but were simply not signaling to their parents.^[14] However, other studies with randomized controls have failed to detect differences in attachment or cortisol levels. This includes methods such as gradual extinction and bedtime fading.^[15] Another method found to effectively reduce short- to medium-term infant sleep problems and associated maternal depression is Behavioral Infant Sleep Intervention.^[16]

One study reported parents waking up in the night less and feeling more parental competence in the group that was taught these behavioral techniques.^[17]

The sleep coaching industry has been criticized for being unregulated, suffering from excessive fees.^[18]

References

^ Mindell, Jodi A.; Kuhn, Brett; Lewin, Daniel S.; Meltzer, Lisa J.; Sadeh, Avi; American Academy of Sleep Medicine (October 2006). "Behavioral treatment of bedtime problems and night wakings in infants and young children". Sleep. 29 (10): 1263–1276. ISSN 0161-8105. PMID 17068979.
^ Jeon, Mina; Dimitriou, Dagmara; Halstead, Elizabeth J. (2021-02-19). "A Systematic Review on Cross-Cultural Comparative Studies of Sleep in Young Populations: The Roles of Cultural Factors". International Journal of Environmental Research and Public Health. 18 (4): 2005. doi:10.3390/ijerph18042005. ISSN 1660-4601. PMC 7922907. PMID 33669583.
^ Quante, Mirja; McGee, Glen W.; Yu, Xinting; von Ash, Tayla; Luo, Mandy; Kaplan, Emily R.; Rueschman, Michael; Haneuse, Sebastien; Davison, Kirsten K.; Redline, Susan; Taveras, Elsie M. (2022-06-01). "Associations of sleep-related behaviors and the sleep environment at infant age one month with sleep patterns in infants five months later". Sleep Medicine. 94: 31–37. doi:10.1016/j.sleep.2022.03.019. ISSN 1389-9457. PMC 10315002. PMID 35489116. S2CID 248035045.
^ Galland, Barbara C.; Taylor, Barry J.; Elder, Dawn E.; Herbison, Peter (June 2012). "Normal sleep patterns in infants and children: a systematic review of observational studies". Sleep Medicine Reviews. 16 (3): 213–222. doi:10.1016/j.smrv.2011.06.001. ISSN 1532-2955. PMID 21784676.
^ Hirshkowitz, Max; Whiton, Kaitlyn; Albert, Steven M.; Alessi, Cathy; Bruni, Oliviero; DonCarlos, Lydia; Hazen, Nancy; Herman, John; Katz, Eliot S.; Kheirandish-Gozal, Leila; Neubauer, David N.; O’Donnell, Anne E.; Ohayon, Maurice; Peever, John; Rawding, Robert (2015-03-01). "National Sleep Foundation's sleep time duration recommendations: methodology and results summary". Sleep Health: Journal of the National Sleep Foundation. 1 (1): 40–43. doi:10.1016/j.sleh.2014.12.010. ISSN 2352-7218. PMID 29073412. S2CID 205190733.
^ Hall, Wendy A.; Hutton, Eileen; Brant, Rollin F.; Collet, Jean Paul; Gregg, Kathy; Saunders, Roy; Ipsiroglu, Osman; Gafni, Amiram; Triolet, Kathy; Tse, Lillian; Bhagat, Radhika; Wooldridge, Joanne (2015-11-13). "A randomized controlled trial of an intervention for infants' behavioral sleep problems". BMC Pediatrics. 15: 181. doi:10.1186/s12887-015-0492-7. ISSN 1471-2431. PMC 4643535. PMID 26567090.
^ Bell, Silvia M.; Ainsworth, Mary D. Salter (December 1972). "Infant Crying and Maternal Responsiveness". Child Development. 43 (4): 1171–90. doi:10.2307/1127506. JSTOR 1127506. PMID 4643768.
^ Mayes, Linda C.; Cohen, Donald J. (2002). The Yale Child Study Center Guide to Understand Your Child. Little, Brown and Company. ISBN 978-0-316-95432-7.^{[page needed]}
^ "Sudden Infant Death Syndrome". MedlinePlus.
^ Carrow, Jacqueline N.; Vladescu, Jason C.; Reeve, Sharon A.; Kisamore, April N. (July 2020). "Back to sleep: Teaching adults to arrange safe infant sleep environments". Journal of Applied Behavior Analysis. 53 (3): 1321–1336. doi:10.1002/jaba.681. ISSN 0021-8855. PMID 31997368. S2CID 210947902.
^ "Red Nose Australia - References for Room Sharing With Baby". Red Nose Australia. Retrieved 2023-11-26.
^ Carpenter, R. G.; Irgens, L. M.; Blair, P. S.; England, P. D.; Fleming, P.; Huber, J.; Jorch, G.; Schreuder, P. (2004-01-17). "Sudden unexplained infant death in 20 regions in Europe: case control study". Lancet. 363 (9404): 185–191. doi:10.1016/s0140-6736(03)15323-8. ISSN 1474-547X. PMID 14738790. S2CID 28243268.
^ ^a ^b Freeman, Hadley (2016-07-30). "Attachment parenting: the best way to raise a child – or maternal masochism?". The Guardian. ISSN 0261-3077. Retrieved 2023-09-15.
^ Middlemiss, Wendy; Granger, Douglas A.; Goldberg, Wendy A.; Nathans, Laura (April 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 (4): 227–232. doi:10.1016/j.earlhumdev.2011.08.010. ISSN 1872-6232. PMID 21945361.
^ Gradisar, Michael. "Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial". doi:10.1542/peds.2015-1486. {{cite journal}}: Cite journal requires |journal= (help)
^ Price, Anna M. H.; Wake, Melissa; Ukoumunne, Obioha C.; Hiscock, Harriet (1 October 2012). "Five-Year Follow-up of Harms and Benefits of Behavioral Infant Sleep Intervention: Randomized Trial". Pediatrics. 130 (4): 643–651. doi:10.1542/peds.2011-3467. PMID 22966034. S2CID 12739146.
^ Wolfson, A.; Lacks, P.; Futterman, A (1992). "Effects of parent training on infant sleeping patterns, parents' stress, and perceived parental competence". Journal of Consulting and Clinical Psychology. 60 (1): 41–8. doi:10.1037/0022-006X.60.1.41. PMID 1556284.
^ Ruggeri, Amanda. "What really happens when babies are left to cry it out?". www.bbc.com. Retrieved 2023-11-10.