■ Amy Brown, professor of child public health, Swansea University & Lyndsey Hookway, PhD in public health, Swansea University
A FULL night’s sleep will be near the top of many parents’ wish lists. Sleep deprivation is no fun and many parents find themselves turning to baby care books that promise to train their child to sleep through the night.
These books promote a range of ideas. At the more extreme end, extinction — often known as ‘cry it out‘ — involves putting the baby to bed and ignoring their cries (sometimes checking periodically to make sure they are not unwell or in danger). A modified version of this, often known as ‘controlled crying’, suggests parents should ignore cries for a set amount of time, before responding briefly to reassure their baby, gradually increasing the amount of time between checks. The idea is that babies will eventually realise no one is going to come — and sleep instead.
But there are two main issues with both variations of this sleep training. Babies can become distressed during longer periods of crying, with raised levels of stress hormones. In addition, not responding to a baby’s cries goes against everything we know about building positive attachment relationships. Babies who learn that someone will respond to their needs, in a loving and appropriate way, typically go on to have better social, emotional and educational outcomes.
The research explained
Research into these methods has shown mixed results, mainly because many parents find leaving their baby to cry too distressing. This is unsurprising. Parents are hardwired to want to respond to their baby’s cries. Other research suggests that such techniques may only work temporarily or only work for some babies.
In one study that examined whether mothers implemented sleep training advice in books, the advice only worked for around 20 per cent of babies. Most struggled to follow the guidance or it had no impact, leaving them feeling frustrated and even like a failure.
One reason why sleep training might not work is because waking at night is developmentally normal for most babies throughout their first year. Even adults sometimes have difficulties sleeping through the night and insomnia is a common complaint. But, unlike babies, adults are able to meet their own needs. If we do wake, we can get ourselves a drink, pull the covers back or rationalise our thoughts.
In addition, some parents may be getting confusing advice, as research headlines don’t always give the full picture. One trial randomised mothers who felt their baby had a sleep problem to either behavioural sleep training techniques or ‘usual care’. Those in the sleep training group reported better mental health and fewer sleep problems at one year. But those mothers were also taught about normal infant sleep and given an opportunity to chat to a nurse about their worries and ideas for self-care.
At the end of the trial, mothers rated ‘having someone to talk to’ as the most useful thing. Is this evidence that rather than trying to teach babies to sleep, there should be more support for new families instead?
So what does work?
If you are reading this as a sleep-deprived parent, do not despair. There are gentler ways to help your baby sleep better that do not involve listening to your baby cry. And the good news is that responsive sleep support can be just as effective and less stressful for everyone.
First, understanding the sleep needs and circadian rhythms of the baby can go a long way towards optimising sleep. There are two sleep regulating mechanisms in the human body. The first is the Circadian rhythm, or body clock. This is regulated by exposure to light, noise, activity and social cues at the right time of day. Getting outside in the daytime and having a predictable darkening of the room one to two hours before bedtime can really help. Some parents find a predictable routine that signals bedtime helps (having a bath, getting changed and maybe a soothing story or song).
The second regulating mechanism is something known as ‘homeostatic sleep pressure‘. The drive to sleep (when your eyes start drooping) builds during wakeful hours. The younger we are, the less time we can manage awake. So, understanding how to support babies to take regular naps to prevent them from becoming overtired makes a big difference.
This is easier to achieve when you learn to recognise your baby’s sleep, feeding and other cues. Understanding these cues helps parents to spot when their baby is ready for sleep, before they become overly tired and frustrated. It also helps deepen the bond between parent and child. Being able to accurately interpret a baby’s need for more action, quiet time, food, cuddles or sleep will mean that parents are more in tune with them. No book can tell a parent what their baby needs right now. This can only be learned through observation and trial and error.
Finally, decreasing parental stress can make a huge difference to sleep. The more we worry about sleep, the worse it gets. Little things like accepting what’s normal, taking time for self-care and accepting offers of help, not only make it easier to feel more rested and able to cope, but can also rub off on the baby. Babies are masters at responding to emotional states, so parents will probably find that their baby is easier to settle and sleeps better when they take care of their own emotional well-being.
And if you are one such sleep-deprived parent, please remember: your baby will not be like this forever — they will sleep one day.