WHAT YOU NEED TO KNOW ABOUT SLEEP TRAINING

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BY LAUREN HEFFERNAN

I am going to apologise in advance if this is more like a novel than a blog post.  I do understand that a blog is supposed to be short and an easy read.  This will be neither of those things and TRIGGER WARNING, if you feel guilty that you sleep trained, PLEASE DO NOT READ.

So… this blog post is coming from a place of absolute frustration after six families that I have spoken to/started working with recently who have worked with a sleep consulting group that has a guarantee that babies will sleep through the night, as early as four months, within a short period of time.  I am so upset.  SO ANGRY.  So ashamed to call myself a sleep consultant and am really thinking that it is time to abandon the title all together.

One of the families, that I am currently working with did one whole month of the toddler screaming, and so clearly the guarantee did not work and within our first consultation, I realised that he has SLEEP APNEA. When he is waking, he is likely so scared BECAUSE HIS AIRWAY IS BLOCKED!!!!! This is why he was not sleeping! The diagnosis has recently been confirmed by a specialist.

Another mum’s supply has completely tanked after her five month old started sleeping through the night (after A LOT of screaming and crying) because he has an undiagnosed tongue tie and is unable to maintain supply and get the 6-8 full feeds during the day as he tires out at the breast.  All night feeds were removed during the sleep training.

More recently, and this one REALLY GETS ME, I spoke to a mum whose toddler has been vomiting in the crib every night for a month at bedtime.  EVERY SINGLE NIGHT.  And she was told, by this company/consultant that this is behavioural. Clean it up and back in the crib, he is just trying to get out.  WHAT???!!!! This is INSANE. So a 2 year old, is throwing up so they do not have to go to sleep? He doesn’t want to go to daycare either and he is not throwing up at drop-off? He does not want to go in the stroller because he wants to walk and he is not throwing up???? It is really important to remember that “facing separation is one of the most wounding experiences of all.” Dr. Gordon Neufeld.  For those of you who are responsive parents and decide that one night, you are simply going to no longer respond to your child for 12 hours, HALF OF THEIR DAY, what type of response do you think that is going to trigger? Imagine being in a healthy relationship with your husband, and then one day he disappears and decides not to call you back/come home when you are clearly in distress. Does it really matter that he showed up again 12 hours later?

I know this blog is going to be really upsetting to people, especially for those of you who have decided to sleep train.  Know that I sleep trained my oldest, I thought it was my only option, I really did.  I feel upset by how I felt like it was just something I needed to do, like feeding my child solids.  I am upset by the fact that I actually thought I was ‘training’ my baby to sleep.  It is my hope that parents can at least know that they do not have to.  We can make changes to overnight parenting and patterns and STAY WITH OUR CHILDREN as they go through these changes.  If you are in a pattern of waking up every two hours, all night long and feeling like you have to nurse back to sleep then this is a pattern that you have created.  You have likely fallen into this pattern because if you don’t nurse, your baby cries and you do not want to upset them.  If this is the case, closing the door and not coming back, not supporting the pattern change and coupling that with separation is not going to be any easier on either one of you.

As Dr. Gordon Neufeld says (about sleep training):

This is a dreadful idea, of allowing kids to cry themselves to sleep.  This was completely uninformed, this idea, this advice by what children truly need and how development works.  When children cry, whether it is distress or tears of futility or upset, they need to cry in the comfort of those who are responsible for them.  The fact is that it can produce sleep, just as it does in the neonatal nursery, in the hospital but that is because of defendedness.  The most difficult thing for the child to face is separation and when we say, ‘ok, I am not going to talk to you anymore, I am closing the door, that is it, we push the child’s face into separation, it alarms them and it can call forth defendedness that can actually put them to sleep out of defense.  But this is not a place where children need to go to sleep from.  They need to go to sleep from a place where they relax, where all is well, just like we do.

My intention with this blog is to help you to understand what sleep training is and how it works.  If you know how it works, and you still choose to do it then you will not feel guilty about it.  We feel guilty when we do something we did not understand and later learn that it goes against who we are as parents or goes against our values so again, if you have sleep trained and you are fine with it then no need to read on.

Before I start, I would like to define what I consider sleep training.  

To me, sleep training is doing anything that goes against your instincts.  If you feel like picking your baby up and you don’t, that is sleep training.  If you feel like looking at/and speaking to your baby and you don’t, well that is sleep training.  If you aren’t following your instincts, and you aren’t ok, then your baby knows and mirrors back everything you are feeling and therefore they are not ok either.  “Mummy doesn’t feel safe, so I don’t feel safe.”  If you are interested in more on this topic, you can have a read of my Instagram posts here and here (otherwise this is going to be a novel and not a blog post). 

So the following are coming directly from my email series, ‘The 8 Things You Need to Know About Sleep Training.’  I usually send it out when families sign-up to my newsletter but because of how frustrated I am about all the sleep myths that are being perpetuated, I will post here.  I am going to share some popular sleep training myths because as you know, I am constantly learning and can’t seem to keep my mouth shut, lol.

1. First of all, let’s talk about the HISTORY OF SLEEP TRAINING

Where did sleep training come from? Is it rooted in science? When did it start?

The very first childcare book came out in the 1920’s and was written by John B. Watson. In his book, he provided very stern advice to families to only kiss their children at night and only on the head. If they do a really good job, then they can have a pat on the back. If you think back to the era that your parents were raised, this may have been the parenting approach that their parents took. Following this book, in the 1940’s came a book by Benjamin Spock.

His approach to raising children was much less harsh than that of Watson, and advised parents to follow their gut and trust their intuition. He did, however, suggest to parents that at bedtime, they were to put their baby down, close the door and walk out of the room.

This was the start of using the extinction method to get babies to fall asleep (although it was not yet named). In the 1980’s we have two well-known sleep ‘experts’, Dr. Marc Weissbluth and Dr. Richard Ferber. Weissbluth is an advocate off full extinction and Ferber created a method where you respond to babies in timed intervals (often referred to as the Ferber method, Ferberizing and timed checks).  The one thing that both of these methods have in common is the idea of leaving your baby in a room (alone) to cry, in hopes that they will eventually learn the all-important skill of self-soothing. It is important to note that Ferber has since said that mothers should follow their gut and that, “I went to great pains in the second edition to clarify that that treatment (gradual extinction) is not appropriate for every sleep issue, of which there are many.”

He goes on to say that if a child is 9 months, and experiencing fear and separation anxiety, putting them in a dark room by themselves “would not be the best idea.” Both of these two sleep experts really started the whole idea of sleep training - that you can train your baby to go to sleep. This likely worked well in the 1980’s because we lived in a time when babies were born and immediately separated from their mothers. They were swept off to a nursery where they were swaddled tightly and left to ‘self-soothe’ until their mother came later to pick them up and take them home. We knew nothing about the importance of skin-to-skin and immediate maternal contact, we knew nothing about the importance of initiating breastfeeding or being there to respond to our babies. It was a different time, sleep training was created in a very different time. 

It is important to really reflect on what we are asking a baby to do when we are ‘training’ them to sleep, especially when we are asking them to fall asleep on their own without any parental support... are we ‘training’ them to sleep or are we ‘training’ them to stop signalling (crying)?

2. CAN A BABY REALLY BE TRAINED TO SLEEP?

Falling asleep is not within our conscious control. 

Sleep training often suggests that a baby who isn’t trained cannot or does not want to sleep. You cannot teach a baby to sleep. It is a biological function, just like eating and eliminating. It is really important to understand this.  Falling asleep is not within our conscious control - this is true for both babies and adults. The more you try to force yourself to fall asleep, the harder it is to actually fall asleep.  
 
It is not the parent that is telling the baby to go to sleep, or training them to sleep.  Their sleep-wake homeostat and the circadian clock are the two biological sleep regulators that make sure that our bodies fall asleep when they need to, not a schedule that has been presented in a book, not hours of rocking and certainly not being left to cry.  Sleep inducing hormones build up sleep pressure until we reach a point where we absolutely need to fall asleep.  This sleep pressure will build and build throughout the day and will reach its peak at night which is when we usually see the longest sleep block - especially in the first part of the night.

Light and darkness will also help our bodies to know when it is time to sleep and when it is time to wake up as they help to set our internal biological clock, the circadian clock.  For this reason, we encourage parents of young babies not to nap their babies in a dark room.  We want to help them set this internal clock and in order to do this, we want them to be exposed to light during the day and remain in the dark at night.  This one of many reasons that we love a motion nap!

It is important to remember that your baby has been sleeping just fine in utero, without any lessons or training. If in close contact with the mother after birth, most babies will sleep just fine, and sleep just enough to take the edge off the daytime sleep pressure and continue to build enough pressure for the night. For some babies, 20 minutes might be enough to take the pressure off and for others, they may need 2 hours.  

So now that we know that we can’t force or train a baby to sleep, what can we do as parents to support our babies to sleep?  Really key to having your baby know and learn when to fall asleep is making sure that your baby is in a relaxed and calm state, that they are not in a state of stress, and that they are not in fight or flight (which can happen when left to cry in a dark room alone).  If they are not in this state of stress, they will be able to fall asleep and remain asleep.  This is really important because we really need to look at our day, to figure out whether we have created an environment that is conducive to sleep.  

You may want to ask yourself the following questions if your baby is struggling to sleep:

Have we given them enough sensory stimulation? Are we providing them with a variety of sensations? 
They will not be getting enough stimulation (and therefore struggle to fall asleep) before nap times if you are sitting in a dark room and rocking for hours. Getting out of the house almost always leads to relaxation and can help most babies relax enough to nap as your baby is getting that sensory input needed to be able to build up sleep pressure and eventually fall asleep. 

Have we met their nutritional needs? 
Failing to do this by putting them on a feeding schedule will lead to stress in babies and will lead to both nap time and bedtime battles (interfering with their natural ability to fall asleep).  

Have we previously turned nap time and bedtime into a battle - forcing them to sleep when they are not ready? 
Doing this can lead to sleep reversal - where their body learns to fight against sleep.

“The best sleep outcomes long-term come about if our babies’ or children’s sleep-times are consistently pleasurable and easy.  That is, if the sympathetic nervous system is consistently dialed down for sleep, creating positive associations, the biological sleep regularity will kick in easily at bed-times and this becomes a habit.” Possums Clinic, 2015.

Sleep is not something that you can train your baby to do - their body knows when it needs to sleep.   As parents, we can teach them to have a healthy attitude about sleep and we can also teach them that their sleep space is a pleasant place to be and that sleep is a relaxing and enjoyable state. 

3. We HAVE to teach our babies to self-soothe.

In order to keep this blog a bit shorter, I will just let you know that a babies and toddlers cannot self-soothe.  If you would like to read more about this, please see this post.

4. A baby needs to learn to be independent.

In order for our babies to grow up and become independent, they need to have a strong attachment to a parent. In order to build this attachment, we need to respond sensitively and consistently to help them to trust that their needs will be met - both day and night. According to Neufeld and Maté (attachment experts), attachment happens in stages. You must first meet their attachment needs in the first stage in order for them to move to the next. In the first year, this stage is referred to as proximity and is met when a baby remains close to the caregiver, when they feel safe, when their day is predictable and when they are able to play. They need all four of these things to then move them to the next stage, which then moves them closer to independence. This is important to understand - they need this closeness and security in order to become independent. Forcing a baby to be alone (isolating a baby), can result in defensive attachment, it can actually create defendedness against attachment.   We want babies and children to slowly create space at a pace that they are comfortable with and this happens when they know that their caregiver is always there, that they can always come back.  This CANNOT be forced, that is not how independence works.

“Twentieth-century Western culture has stressed independence. Many experts assert that if an infant doesn’t learn to be independent quickly, it will never learn. Yet, attachment studies have shown that infants who receive strong responses from caregivers request holding less often and appear to enjoy holding more. Attached children also become more responsive to parental requests, a kind of ‘dependence’ that is preferable.” Dr. Linda Palmer, The Baby Bond

5. It is the ‘right thing to do’. After all, it is being advised by books and pediatricians. 

How can the ‘right thing’ feel so wrong? 

I have yet to find a single parent who goes through sleep training and comes out saying it feels really good. It goes against every part of a mother’s instinct, against her gut. No one knows your baby better than you do. We trust our instincts when we sense danger, when we want to help someone, when we know how to do something. Why should we not trust our instincts when it comes time to our baby? Every moment of the crying tells you to go in, and yet somehow we feel like not going in is the right thing because someone (who does not know your baby), told you not to. 

Why does sleep training feel wrong?

It is critical to understand that a baby’s development relies heavily on nature, on a parent trusting their instincts. When a baby is born, their brain is only 20-25% of its adult brain. It is really important to understand what is there (an amygdala which is fully developed so they can understand and sense fear, can go into fight or flight and also freeze) but even more important to understand what is not. It is a primitive brain, and the primitive brain needs the support of a mature brain to help it do things like up-regulate and down-regulate.

A baby is not born with the systems needed to tell the baby that it needs to replenish and restore its energy when it is burning so much - which is a CRITICAL function for survival. This is why we have something that nature created, called the interbrain. The interbrain connects this primitive brain to a mature brain through all the senses - touch, gaze, smell. So in order for the baby to be able to complete this very important function, a mother must follow her instincts and trust herself to know when the baby needs to be down-regulated and unregulated. This is something that she will know, not something that she will read in a book. The reason that sleep training feels so wrong is that it goes against nature, therefore compromising the interbrain.

We need to follow our instincts. We created the Baby-Led Sleep Approach™ using the motherly instincts that guide both of us.  We understand what it means to hear a baby cry and we want you to use those instincts that you have to respond in a way that feels right for you.  This instinct that drives your response is there for a reason.

6. There is nothing wrong with a little unsupported crying at bedtime and overnight.

If you are one of the lucky ones who used extinction and had five minutes of crying for two nights, then this next section may not apply to you.  We feel that it is important to know (as we pointed out above) that for a lot of babies, the crying can last for hours each night and for some can last for months before it actually stops.  For most, sleep training does not happen once - every time a baby meets a new milestone, they need to be retrained to sleep.  So for these reasons, we would like to point out that it is more than ‘a little crying.’

Are long periods of unsupported crying even stressful?

Let’s first understand what stress is.  Our body has a resting temperature around 37 degrees, and this temperature fluctuates throughout the day based on what we are doing and how we are feeling.  If this temperature rises too much, the hypothalamus will trigger cooling mechanisms to bring this temperature back down (we perspire, sit down, etc.).  It is important to remember that these cooling mechanisms burn energy. A stressor is defined as anything that disrupts homeostasis, that requires an organism to burn energy to get back to the base point.  As you can imagine, the World is full of stressors.  Not only is temperature a stressor but light, crowds, new experiences and pain could also be stressors for some. Think about all of the stressors present for the baby on their day of birth - possible raised cortisol levels from the mother going into labour (we know that elevated cortisol in a mother throughout her pregnancy will impact the developing fetus), the pushing, any interventions, the bright lights, the change in external temperature, complete strangers poking and prodding baby, and all the new smells.  What calms that baby from this stressful experience, what down-regulates the baby and helps their body to relax and stop burning excessive amounts of energy? Being placed on a parents chest, skin-to-skin.  It is the mature brain (mom), that relaxes the baby and tells their body to stop burning energy.

As I mention in my blog post on self-soothing, babies cannot calm from a state of heightened stress and need parental intervention and support to down-regulate.  They rely heavily on the interbrain in order to stop burning energy and to cope with stress.  We know that leaving a baby alone can trigger a flooded state, so leaving a baby for long periods of time will absolutely lead to a significant amount of energy being burned (stress).  We really need the parent to regulate a baby’s energy and tension so that eventually, they are able to learn from the parent and do it themselves.

What does this increased stress do to a baby?

We know that a baby’s stress reactivity is set in the first year of life. If we do not respond to our babies when they are signaling for us, their HPA pathway can become highly sensitized.   If we look at this from an evolutionary perspective we can better understand the purpose of this heightened stress reactivity.  Babies who are raised in an unsafe environment need to have a heightened awareness of stress and easily move into fight or flight as they grow up.  Having this heightened stress reactivity will keep them alive.

What we do in that first year determines whether the baby/child is easily set off by stressors.  Constant exposure to stress can create a heightened stress reactivity, which, can then cascade and impact the child's reaction with their caregivers, their interaction with other children, their language, and social interaction (Shanker, 2017). "We want to do whatever we possibly can in the first year of life or first three years of life to provide children with the type of caregiving experience and environment that will keep them feeling safe and secure so that their alarm system doesn't become so highly sensitised…. If you have grown up in an environment where your stress system has been turned on all the time because of maltreatment, because of trauma, because of neglect, your system is going to be turned up really high so that anything around in the environment is going to turn it on.  When it is turned on over and over again, the hippocampus, it accommodates for that because we like to have things nice and homeostatic/nice and even.  The hippocampus is trying to turn off the system but eventually, it can't and we actually see cell death in the hippocampus.  The stress response system is being biologically wired in the earliest years is setting the pathways for the responses later in life."(Shanker, 2017) 

As I discuss in my email series, sleep training is not just a one-time experience that lasts three nights. Yes, I am aware that sleep training in itself is not the only stressor that a baby will go through in that first year but, it all adds up.  “Every amount of stress adds incrementally to change the neural development from that of expected neural development to something different…It can, however, become ‘bad’, and the stage at which that happens is likely different for each child based on a host of factors including temperament and overall responsiveness, amongst others.” Cassels, 2016

Repeated exposure to stress in that first year will have a long-term impact.  Because our World is full of hidden stressors - fast paced lifestyles, lack of a village, toxins in foods, constant wifi exposure, global warming and extreme heat, and technology, we need to do whatever we can to control what we can control and limit the stresses that we can limit.

What about parents? How does sleep training (specifically the unsupported crying) impact a parent long-term?

Sleep training is not only stressful for a child but it is stressful for a parent.  Sleep training asks a parent to disconnect from the interbrain which can impact the mother-baby relationship.  Not responding to your baby when they are in need can also lead to a tremendous amount of guilt felt by both parents.

There is a really great episode of the tv series, 'Mad About You' where you can see exactly how parents feel when they do not respond to their instincts.  This clip is worth watching and can be found here.

It is also important to understand that sleep training can be a trigger for a mother who is experiencing Postpartum Depression and Postpartum Anxiety.  Not being able to follow your instincts combined with excessive crying can definitely lead to increased PPD and PPA.

I realise that one of the biggest stressors on parents is the myths about baby sleep that continue to circulate. When we created the Baby-Led Sleep Approach™, we knew that it was very important to help to understand what normal infant sleep looks like in the first few years.  We want parents to know that night waking after a year of age is normal, that sleeping through the night at 5 months is five hours (and MOST 5-month old babies are not doing this), that waking up for an hour at night and wanting to play is normal, that feeding at night beyond a year of age is normal and that it is normal to feel overwhelmed and tired in the first year.  We want to reduce the stress off parents around baby sleep and get back to a time when you can follow your instincts and trust your gut, without worrying about sleep totals and age-appropriate wake windows.

I realise this blog post is now WAY TOO LONG so if you do want to read more of the myths, sign-up for the email series through my website.

My hope is again to let you know that you don’t have to sleep train to get sleep. You can be there to support your baby through changes in patterns, the same way you will be there to support them when they go to daycare, and when they head to jk.  The same way that you will be there to support them when they lose a pet or when their best friend no longer wants to be best friends anymore.  Yes, they will cry but they will cry WITH YOU.  In that moment, you will respond in a way that feels right to you.  This is how we support our children through changes in patterns that are no longer working for us or for them.

If you decide to work with a sleep consultant, and they tell you that you will be ‘training your baby to sleep’, or ‘teaching them to self-soothe’, or that you need to ‘teach them to be independent’, please run.  And if anyone tells you that vomiting is your child’s way of manipulating, please, please, PLEASE don’t listen.

The last thing I would like to get out is my concern over a blanket statement, that a lot of people make, that sleep training is ok, that it is completely fine, that it does no harm.  To me, sleep training should be treated like a drug where we are required to list potential side effects, and we give people a time limit on how to tell whether the drug is working/effective.  No two families or babies are the same.  To say that sleep training is ok does not take into account how long it lasts and the level of distress.  Is it ok for one hour, 3 nights? If it lasts for two months and a baby is vomiting, is that ok? In order to sleep train, we are being asked to go against our instincts so how on earth are we then expected to use them to know when to stop.   Along with this, knowing that 58% of 6 month old babies are not securely attached to their primary caregiver, how can we then say that it is fine? is it fine for a baby is securely attached? How about a baby who is not? What does it do to attachment? All I am asking is that we start questioning the practice.

ABOUT THE AUTHOR

Lauren Heffernan is the Founder of Isla-Grace. She’s a certified Holistic Maternity & Child Sleep Consultant and Certified Sleep Educator. She provides information and support to women at different stages of motherhood, and walks each one through the personal journey to become a more confident mother.  For more information you can visit her website or follow her on Instagram @islagracesleep

REFERENCES:

Bebo Mia, 2017. Infant Sleep Educator Course. Toronto, ON. Retrieved from: www.bebomia.coM

Cassels, T. 2016. ‘It’s just a Little Cortisol’: Why Rises in Cortisol Matter in Infant Development. Retrieved from: http://evolutionaryparenting.com/its-just-a-little-cortisol-why-rises-in-cortisol-matter-to-infant-development/

Hoffman, J. 2016. Sleep Training, night Waking & Parents. Retrieved from: https://self-reg.ca/2016/07/17/sleep-training-night-waking-parents/

Loutzenhisera, L. Hoffman, J. & Behauche, J. 2013. Parental Perceptions of the Effectiveness of Graduated Extinction in Reducing Infant Night-Wakings. Journal of Reproductive and Infant Psychology. 

Palmer, L. 2009. The Baby Bond. Naperville, Illinois: sourcebooks, Inc.

Shanker, S. 2017. Transcripts for Foundations 1. The MEHRIT Centre. Peterborough, ON. 

Whittingham, K., & Douglas, P. 2014. Optimizing Parent-Infant Sleep from Birth to 6 Months: A New Paradigm. Possums Clinic. Queensland, Australia. Retrieved from:www.possumsonline.com