Healthy Sleep Habits, Happy Child
132
How to Choose a Sleep Solution
May 22, 2023

Found in age groups

Healthy Sleep Habits, Happy Child

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A Step-by-Step Program for a Good Night's Sleep

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Healthy Sleep Habits, Happy Child

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Introduction

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

Sleep solutions work (Blog Post 133) but it may be difficult for sleep-deprived parents to start a sleep solution (Blog Post 23).  Here is a menu of sleep solutions that may help you choose the one that best fits the specific circumstances of your family (Blog Posts 14 and 26). 

Blog 132How to Choose a Sleep Solution

A. One way to think about different sleep solutions and help you choose one is to organize them into three groups as described in Blog Posts 19 and 25 and in more detail in my book: 

  • 1 “No-cry” sleep solutions for babies Teach Self-Soothing 

Many hands: involve others, not just mother to soothe to sleep; get father on board! 

Drowsy but awake when put down to sleep 

Many naps: expect and accept many brief and irregular naps in infancy.

Move bedtime slightly earlier based on drowsy signs

Fade Procedure

Check and console
Bedtime routines 

Motionless sleep
Sleep log
Sound machine, room-darkening curtains

Positive routines plus faded bedtime with response cost 

Scheduled awakening

Control the wake-up time 

Relaxation training 

Stimulus control

  • 2 “Maybe-cry” sleep solutions 

Move bedtime much earlier
Nap drill
Parent-set bedtimes, regular bedtimes, earlier bedtimes 

Swings
Crib tent
Sleep Rules and silent return to sleep
Pass system
Day correction of bedtime problems 

  • 3 “Let-cry” sleep solutions


Extinction: with or without cap, with or without parent presence 

Graduated extinction 

B. Here is another way to think about choosing a sleep solution partially based on two parenting styles: 

  1. ‘Limit Setting’ parenting style: You are comfortable with soothing your baby to drowsy but awake state; then, putting baby down in crib and leaving the room. 
  • If you practice limit setting and neither parent has anxiety or depression symptoms, choose extinction. 
  • If you practice limit setting and either parent has anxiety or depression symptoms, choose graduated extinction. 
  • If you practice limit setting and both parents have anxiety or depression symptoms, choose check and console or fading.
  1. ‘Infant Demand’ parenting style: You always want to hold your baby, sleep with your baby, or stay with your baby until baby is in a deep sleep. 
  • If you practice infant demand, choose fading or other no-cry sleep solutions. 

More information about sleep solutions and baby sleep advice::

When to start sleep solutions (Blog Posts 49, 57, 67, 102107, and 115)?

Do sleep solutions harm your child (Blog Posts 24 and 71)?

Community sleep consultants (Blog Post 27).

Do sleep solutions really work (Blog Post 133)?

Comments

  1. Thank you for this thoughtful guidance on sleep solutions, Dr. Weissbluth. We may have chosen the wrong option. We did CIO for our 5 month old and though she started sleeping through the night, she often cries so hard that it tears at me and brings me close to a breaking point (I have some postpartum anxiety). Based on your book, we started nap training to correct what we believed was overtiredness. We are on day 5 of nap training (and day 16 of night sleep training), and there have only been a few put downs with no tears. Most days her naps are just 30-40 minutes long, and last night she started to get up frequently with crying over 10 minutes, so last night and tonight we tried early bedtime of 5:30pm. She slept after 30min of crying, but then woke up 35min later with screams and cries. It’s been 30 minutes of that and I’m at my wit’s end! I would very much appreciate your advice. Should we go back to a non-CIO method? Is it that we need to keep going for 4-5 more days to see if it works?

    Baby’s schedule yesterday (it has varied but we look for drowsy signs and never exceed wake window)
    5:00am Awake (6:30am out of crib)
    8:00am Put down for Nap 1 (8:20am Asleep)
    9:00am Awake (9am-10:30am was a long nursing session with some rest at breast)
    11:50am Put down for Nap 2 (12:01pm Asleep)
    12:40pm Awake
    2:42pm Put down for Nap 3 (2:55pm Asleep)
    3:40pm Awake
    5:26pm Put down for early bedtime
    6:10pm Asleep
    *** woke up crying throughout night; at 10:50pm changed poopy diaper and gave night feed)***
    5:00am Wake up & Feed, then put down again,
    6:30am Out of Crib

    1. “On day 16 of night sleep training…last night and tonight we tried early bedtime of 5:30pm.”
      During the past 15 nights, what was the range of the bedtimes? What was the most common bedtime?

  2. The first 14 days, bedtime ranged between 7pm – 8:30pm.

    There was only one really good nap day (day 14), so we are studying that schedule closely. Here is what schedule looked like that day & night before fyi.

    Day 13 (night) – Day 14
    6;15pm put down in crib
    7:05pm ASLEEP
    5:00am Woke up (unusually early wake up, the days prior wake-up was between 6am-7:30am, but this morning the electricity went out, and when it turned on, the beeps & sound machines woke baby)
    — Fed baby after 1 hour of crying and 5:30am Put back in crib (she slept until 7:30am)

    DAY 14
    7:30am Out of Crib
    8:46am Put down for Nap 1 (no cries!)
    9:00am ASLEEP (50min)
    9:50am Awake
    11:28am Put down for for Nap 2
    11:47am ASLEEP (50min of sleep, brief wake period of 10min with no crying, then 80min more of sleep)
    2:05pm Awake
    3:39pm Put down for Nap 3, cried for a bit after rolling on tummy (skill she learned that day), we rolled her back after awhile
    4:13pm ASLEEP (70min of sleep)
    5:25pm Awake (woke her up to not interfere with bedtime)
    7:25pm Put down (only 1 min of cries!)
    7:40pm ASLEEP —– next morning she woke up again at 5:00am and I waited until 6:30am to take her out of crib (this goes into the DAY 15 schedule I posted previously, and the start of the horrible nights & naps)

    Many, many thanks, Dr. Weissbluth! Grateful for your response.

  3. For what it’s worth, last night after the second time we put her down at 5:30pm, she woke again all night almost every hour it seemed and cried. I gave her one night feed around 10pm, but noticed she didn’t fully drain and was falling asleep, leading me to believe she isn’t hungry for overnight feeds (my pediatrician said at 15lbs, more than double her birth weight she should be able to go 12 hours). I took her out of the crib at 6:30am, though she woke at 5:00am and eventually put herself back to sleep – I was so exhausted that I fell asleep instead of seeing if she wanted another feed.

  4. So sorry, I didn’t answer your second question. Most common bedtime first 14 days = 7:30pm. (8pm bedtime was a close second)

    1. Please read the section on Extinction in my book to understand why the too late bedtime for the past 14 days prevented improvement.
      Because of her age (5 months), I would simultaneously work on day sleep and night sleep.
      Strive for a mid-morning nap, a midday nap, and if needed a third nap. But no nap starts after 3pm. The bedtime will be temporarily super early based on drowsy signs and it will vary because of variability in naps. Expect the bedtime to temporarily be in the range of 5:30-6:30pm. Be strict with this schedule and keep a careful record for 4-5 days and let me know how it goes.
      Does this help?

  5. Thank you so much, Dr. Weissbluth, for the clear advice. The extinction chapter was helpful – especially the section on nap drills. All this time I had been assuming naps have been horrible because they have only been between 30-40 minutes, but now I can see that its’ progress! Especially since before she had never napped on her own. It’s good to know napping past 3pm might also be interfering with the early bedtime. Does this mean no sleeping at all past 3pm, so if she falls asleep 2:45pm we should wake her at 3pm?

    We’ve been eager to implement your recommended plan. Today she went down for her mid-morning nap easily and is still sleeping. Will keep you posted how the next few days go.

    1. “Does this mean no sleeping at all past 3pm, so if she falls asleep 2:45pm we should wake her at 3pm?” No.
      If she begins a nap before 3pm, let her sleep as long as she wants. This afternoon nap might be brief or long so the bedtime is not rigidly fixed. Watch for drowsy signs for the bedtime because she might nap from 2:45pm to 3:45p and still get drowsy at 4:45 and need a 5:30pm fall asleep time. The reason I would not suggest a fall asleep time before 5:30pm is that it may be associated with a way too early wake-up time in the morning so that she really can’t get to a 9am biologic circadian nap time.
      Remember: The soothing bedtime routine can begin whenever you wish, the 5:30 time is when it is over and you are leaving the room hoping that she will fall asleep; You do not begin the bedtime routine at 5:30pm if she is drowsy before then.
      Does this help?

  6. Hi Dr. Weissbluth, thank you again for your advice! Following the bedtime reset and more rigorous nap training, we’re encouraged by the progress. The mid-morning nap is falling into place (9am) and tends to be 1-2 hours long. The afternoon nap is getting solidified (1pm). Almost half the time, it’s still on the shorter side of 30-40 minutes. After one week of following your recommended schedule and getting naps in place, we moved baby’s bedtime later (put down between 6:30 – 7pm), which is when she usually falls asleep regardless of what time we put her down. The biggest success is that now at bedtime she usually falls asleep within 15 minutes and there’s usually just a few minutes of complaint crying. Joy!

    The problem we’re facing now is earlier and earlier wake ups. There were several off days where I started to go in during her early AM night waking (around 5am) because I knew she had a slight fever and was fighting infection, so after significant crying (20 minutes or more) I went in to offer a feed. Ever since that began, she started waking earlier and earlier (whereas before, she usually wouldn’t wake until 6:00am) – last night, even waking up at 3:30am. Last night, we decided to let her CIO longer and I didn’t go in until an hour later at 4:30am. My worry is that these wakings (and the subsequent time it takes her to fall back asleep) is whittling down her total sleep each day (sometimes now as low at 10-11 hours total including nap & overnight sleep). Of course we’re on edge with less sleep too. Do you have suggestions for how we can end the early AM wakings?

    Many thanks in advance, Dr. Weissbluth!

    1. Perhaps the fever and/or your appropriate response triggered this. How long have the early wake-ups been going on?
      Maybe the fever itself or the early wake ups or both should be described as an unavoidable sleep disruption and she might benefit again from a bedtime reset.
      How old is she? Should extinction be used until 5:30-6:00am?

  7. Thank you, Dr. Weissbluth, for the reply. She is 5 months & 3 weeks old. The increasingly early wake ups started 6/4. But notably, last night she slept from 7pm to 5:55am! Yesterday she took a short 3rd nap from 4:10pm to 4:49pm, usually she doesn’t take a 3rd nap. We then put her down for the night 2 hours later at 6:49pm. Could that have been the helpful change? We can try the CIO until 6am if the early wake up returns.

    1. Well, you know that sleep begets sleep so becoming a little bit better rested (a third nap or slightly earlier bedtime) often helps a child sleep better at night and might even wake up a little later in the morning. Do you agree?

  8. Agreed. I think the solution is clear now 🙂 Thank you. Glad to also now feel better/not guilty that the cause was unavoidable.

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