Blog Post 26-Compare Different Sleep Solutions (Sleep Solutions #4)

Healthy Sleep Habits, Happy Child
by Marc Weissbluth, M.D.

A Healthy Child Needs a Healthy Brain,
A Healthy Brain Needs Healthy Sleep.

If you have not already done so, please read Blog Posts 1 through 5 that describe how sleep is important and beneficial. I will post specific information for parents and children based on my book, “Healthy Sleep Habits, Happy Child.” Please do not be put off by my book’s length. This is a reference book. Read only the topic of interest to you

COMPARING DIFFERENT METHODS

            All the items listed below in “WHAT A PARENT CAN DO” contribute to the prevention of sleep problems developing in the first place; the earlier you start, the more likely your success.  All of the items listed below in “WHAT A PARENT CAN DO” also contribute to the treatment of sleep problems, but they might not be sufficient.  Specific family circumstances (Blog Posts 14 and 17) and individual differences in babies (Blog Post 20) might make this difficult to accomplish and a sleep problem (difficulty falling asleep or staying asleep) might develop in your child. 

Two safe and effective treatment strategies that do not involve letting your child cry are ‘Fading’ and ‘Check and Console’ (Blog post 19). 

Two safe (Blog Post 24) and effective treatment strategies that do involve letting your child cry are ‘Graduated Extinction’ and ‘Extinction’ (Blog Post 25).

            Because of differences in specific family circumstances and individual differences among babies, it is difficult to give specific advice regarding which method best suits a particular family.  Nevertheless, here are some general observations that might help you:

                        · If there is moderate or severe marital distress or perhaps either one or both parents have symptoms of anxiety or depression, consider starting with ‘Fading’ or ‘Check and Console’.

                        · If there is mild marital distress or perhaps only one parent has symptoms of anxiety or depression, consider starting with ‘Graduated Extinction’.

                        · If there is minimal marital distress and neither parent has symptoms of anxiety or depression, consider starting with ‘Extinction’.

Here are the published facts about the different methods:

· Graduated Extinction takes about 4 to 9 nights. In general, it is easier to implement than Extinction because it is more acceptable than Extinction. 

· Graduated Extinction, compared to Fading, produced more consolidated sleep and longer sleep durations but both Graduated Extinction and Fading shortened the time to fall asleep.

· Graduated Extinction and Extinction in infants 5 to 6 months old:  First night crying duration was 43 minutes and dramatically decreased after the first night.  The highest first attempt success rate was for Extinction and the most common second attempt was a switch from Graduated Extinction to Extinction.

· Extinction takes 3 to 4 nights. In general, it is more difficult to implement than Graduated Extinction because it is less acceptable (especially outside the US and Canada).   

· Extinction in infants 6-months-old: No crying by the 3rd night.

· Extinction is chosen over Graduated Extinction when there is less stress in parenting and among mother’s whose discipline style was not lax (they noticed and acted on misbehavior) and not verbose (they used appropriate parental reasoning and explanations instead of coaxing or begging).

· Extinction success rate is age dependent:

                                    Starting when child is 4 months or younger:

                                    Night 1            Crying for 30-45 minutes.

                                    Night 2            Crying for 10-30 minutes.      

                                    Night 3            Crying for 0-10 minutes.

                                    Night 4            No Crying.

                                    Starting when child is 5 months or older:

                                    Night 1            Crying for 45-55 minutes.

                                    Night 2            Crying for a little more or less than Night 1.

                                    Night 3            Crying for 20-40 minutes.

                                    Night 4            Crying for 0-10 minutes.

                                    Night 5            No crying.

CAUTION

            Neither Graduated Extinction nor Extinction will work if:

                        · Parents are inconsistent, for example, “just once” take the child back to their bed for nursing.

                        · The bedtime is too late.

                        · Naps are not going well.

RESET

            Real life events will occasionally disrupt your child’s sleep and cause a sleep debt to occur.  A reset is an extremely early bedtime (for example, 5:30 PM) that is strictly enforced (Extinction) for only one night to pay back a sleep debt.  A reset might be needed just a few times a year or more often, depending on the specific circumstances of the family (Blog Posts 14 and 20). 

            My observation is that families who choose Graduated Extinction or Extinction are more able or willing to do resets when needed so that their child continues to maintain healthy sleep habits.  The reason(s) for this might be because of the parental factors (Blog Posts 17 and 18) that originally allowed them to choose these methods and/or the rapid success they experienced when they originally tried these methods gave them confidence that allowing crying again, for one night only, would not harm their child.  In contrast, families who choose Fading appear to be less likely to employ resets and thus, they are buffeted by periods of healthy sleep habits interrupted by periods of struggling with unhealthy sleep.

DO I HARM MY CHILD IF I LET HIM CRY AT NIGHT TO LEARN SELF-SOOTHING?           

• Studies show that children are not harmed (Blog Post 24) when extinction or graduated extinction is used. Blog Post 25.

IT IS NOT NECESSARY TO MAKE YOUR CHILD CRY TO HAVE A GOOD NIGHT’S SLEEP

WHAT A PARENT CAN DO

• It may be difficult to begin or choose a sleep solution. Blog Post 23.

• No television or digital electronic devices in child’s bedroom (Blog Post 21), if possible. Blog Post 22.

• Some babies sleep better than other babies. Develop coping strategies to reduce stress if your baby has extreme fussiness or crying.  Plan to encourage self-soothing skills at 2 to 4 months of age. Blog Post 20.

•  ‘No Cry’ sleep solutions (‘Fading’ and ‘Check and Console’) may solve sleep problems. Blog Post 19

•  Communicate with each other and coordinate nighttime parenting practices.  Consider delaying your response to nondistress sounds your baby makes at night by 5-10 seconds, especially after 3 months of age.  Blog Post 18.

•  Encourage partner to help care for baby daytime and nighttime.  Be emotionally available at bedtime.  Seek help if your child is not sleeping well and there are symptoms of anxiety or depression for yourself or partner.  Blog Post 17.

•  Encourage self-soothing; the earlier the better.  Consider leaving the room after putting your child down to sleep. Provide opportunity for naps based on drowsy signs.  Encourage partner to help care for the baby daytime and nighttime. Blog Posts 16.

•  Plan for healthy sleep by focusing on sleep quality, not just sleep quantity. Provide opportunities for naps. Blog Post 15

•  Make a sleep plan that you are comfortable with; be flexible and tolerant.  Blog Post 14.

·  Become more aware of the difference between how you feel when well-rested versus mildly sleepy. Blog Post 13.

·  Try to maintain a regular sleep schedule.  Blog Post 12.

·  Try to not respond immediately to every quiet sound your baby makes at night.  Blog Post 11.  

·  Practice soothing to sleep and bedtime routines, every night, if possible. Blog Post 10.

·  Watch for drowsy signs. Blog Post 9.

·  Respect your child’s natural sleep rhythms.  Blog Post 8.

·  Encourage an early or earlier bedtime (even a slightly earlier bedtime may produce better sleep.  Blog Post 6) especially at 6 weeks.  Blog Post 7.

∙ Recognize that a healthy brain requires healthy sleep. Blog Posts 1, 2, 3, 4, and 5.

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