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.
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. Also, 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’.
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:
Graduated extinction means that after a bedtime routine including soothing, at sleep onset and in the middle of the night, you let your baby fuss or cry for a predetermined brief period, say five minutes. It may be a little less or more. Then you pick up your baby, talk to him, feed him if hungry, and do whatever is necessary to calm him down. You might either calm him to a drowsy state or to a deep sleep state and then you put him down and possibly leave the room. On a given night, you might keep the interval constant, say five minutes, or progressively increase the delay interval by, say five minutes, with each episode. Or, on a given night, keep the interval constant, but on each subsequent night, progressively increase the delay interval. During one of these delays, your child learns to fall asleep unassisted because he is learning self-soothing skills.
Extinction (you are extinguishing the habit expectation that crying out always brings parental attention) means that after a bedtime routine that includes soothing, at sleep onset and in the middle of the night, except for feeding, changing, and any suspicion of medical distress, you let your baby fuss or cry without time limit until the morning.
Your child learns to fall asleep unassisted because he is learning self-soothing skills.
Neither Graduated Extinction nor Extinction will work if:
(To be continued.)
Hi Dr Weissbluth
We are 13 days into extinction with our daughter- 8 months old. After 45 minutes of crying on the first night, she gradually improved until there was only a few minutes of crying on night 5. However, since then, it’s been more of a roller coaster. She’s had some nights where she’s cried for an hour and others of 15 minutes or 45 minutes. Last night there was no crying but tonight she cried for 58 minutes! This inconsistency is making me doubt myself.
Her naps total about 2.5 hours a day, and we try put her down when she shows drowsy signs. We put her to bed between 5:30 and 6:30, depending on when she wakes from her final nap.
There has been an improvement in terms of her night waking- she was waking twice a night for a feed but since we started extinction she has dropped to one feed and has no trouble falling back to sleep after her feed.
Given that she’s been so inconsistent with her crying, should we give extinction a break? Or is it too early to give it up as we’re only on day 13?
I appreciate any advice!
Please describe the drowsy signs that immediately precede your soothing bedtime routine.
Yawning and rubbing her eyes and face. Her wake window before bedtime is usually around 3-3.5 hours after the last nap.
Please read about Drowsy Signs in Blog Posts 9 and 83 and give me your thoughts.
I’ve read Blog posts 9 and 83- thanks for directing me to them. She is definitely showing fatigue signs on the nights with crying. I am going to try and start the bedtime routine earlier while she is happy and soothe her to sleep when she shows the drowsy signs instead of starting the routine when these first appear.
Thanks again
Please let me know how the next 3-4 nights go so we can fine tune this if needed.
Sweet Dreams,
DrW
Hi Dr Weissbluth
We’ve had a huge improvement over the past 5 nights. We’ve gone through the bedtime routine much earlier than we were and have started soothing our daughter to sleep as soon as she yawns. Her routine now starts around 4:30 pm and she’s in bed between 5 – 5:30pm. Out of the past 5 nights, we’ve had one where she protested then cried for 28 minutes, but on the other 4 nights, she went to sleep with no tears. She even woke up after an hour on several nights but put herself back to sleep with no tears. It’s hard to believe that all she seems to have wanted was an earlier bedtime- we are in shock!
Thanks again for responding and for your amazing blog.
Hi Crystal,
I am happy that you had the courage to try a super-early bedtime. Not all parents are able or willing to give it a try. As weeks go by, she will be napping better and then will appear less drowsy in the late afternoon and early evening. At that time, slowly and in small increments, allow the bedtime to become later. Follow her lead and don’t be tempted to rush her. Also, please resist family and friends who might suggest that it is all right for her to stay up later. By the way, today I started to post ‘Fake News’ reels about children’s sleep on Instagram (#marcweissbluth). If you find it worthwhile, please spread the word.
Sweet Dreams,
DrW
Thank you for that extra advice- I will look for the signs that she’s ready to go a bit later over the next few weeks.
Friends and family have been quite surprised to hear how early we’ve been putting her to bed and some have suggested to me that she may wake early as a result- she hasn’t! I just tell them about your book and blog. I’ll have to mention your instagram too. My husband has also had a few days where he’s not seen her because he’s had to work late. However, we know it’s just a short term thing and we’re so happy to have seen her sleep so soundly this week.
Thanks again
Hi Dr Weissbluth
We are having similar issues with our 6 month old as Crystal did (still crying after 10 days of ST) and are planning to move her bedtime earlier – from 7pm to 6pm – in hopes that will help.
My question is around the napping. Is it ok for her to take 3 naps still? Right now she is napping around 9:30, 12:00 and 16:00. The naps are usually 40 mins to 1 hr. We are basing this off her sleep cues (starts to fuss or doesn’t want to play anymore, eye rubbing, face rubbing). She is still waking up at the 30 min mark during naps and in the evening – sometimes she soothes herself back to sleep quickly and sometimes there is crying.
Any advice would be appreciated.
Thank you!
A common reason why ST does not work well is a bedtime that is too late. Depending on naps and drowsy signs, think of bedtime as between 5:30-6:00pm, for now. Based on her age, I would not let her start a third nap after 3pm. Thus, she may need extra soothing and distraction in the late afternoon. The extra sleep in the beginning of the night will allow her to wake up better rested which will allow the naps to get longer. Weeks later, the longer naps will permit a later bedtime. But please don’t rush this. Your guide for the bedtime will be her drowsy signs and because of nap variability, the bedtime will vary. Does this help?
Hi Dr Weissbluth,
Thanks so much for the amazing content you provide, helpful as we try to sleep train our 7 month old. I have a clarification point here for the extinction method. You say “except for feeding, changing, and any suspicion of medical distress” to let the baby cry. How should we know if we need to leave the baby alone or feed them? I read somewhere that your view is that babies perhaps need night feedings up until age 9 months, but I can’t find any more information on this. If my son wakes up 3 times at night (between 6pm bedtime & 8am wakeup) and falls back asleep right away if I feed him, what category does this fall in?
How does he look between 5-6pm?
Please describe a typical night feed: type, duration, time when it occurs, etc.
Hi Dr. Weissbluth.
My Baby is 7 1/2 months old. He is thank Gd a very easy going baby generally. He naps pretty well overall. His last short nap of the day some time between 3-5 pm does not always happen. He sometimes will just cry and not sleep. Each of his first 2 naps of the day range from being an hour-2 hours long generally.
He nurses some time between 530-6 for the last time before bed time. I have been trying to wean him off of night feedings slowly because he was still waking up well before midnight to nurse. For maybe 2 weeks, I have not been going to nurse him before midnight. He still wakes up and cries before then, sometimes for a long time. Shouldn’t it have taken fast if I did extinction and didn’t even go into him? Shouldn’t he be accustomed to not waking up before midnight?
I want to get him down slowly to 2 feeds then 1 feed then no feeds. Any advice is appreciated.
Thank you!
What is his most common sleep schedule: time of naps, duration of naps, beginning of bedtime routine, time of falling asleep, times of nighttime feedings, and wake up times?
Does he self-soothe for naps and night sleep?
Do you ever use a supplemental bottle (expressed breast milk or formula)?
He goes in for a nap in the morning between 8:30-9. He generally sleeps until 10/10:30. Depending on when he wakes up from that morning nap, he goes in around 2 hours later (between 12-12:30). Sometimes, he’ll go in closer to 1 if he takes a longer morning nap. Then his afternoon nap is a lot of times only about an hour (again, sometimes it can be 2 hours, but I think usually his morning nap is longer it seems). So I guess his last short nap of the day might be around 3:30, but he doesn’t always fall asleep right away. Sometimes it can be at 4 or later.
Then if he’s very cranky, I start nursing him before he goes to sleep around 5:30/5:45. I do not nurse him to sleep. He falls asleep for bed time and naps completely unassisted. He doesn’t take a pacifier – he sucks his thumb. He seems to often be tired and fall asleep in the early 6s for the night.
The time he’ll wake up and cry for a bit at night varies. And sometimes, it’s only a few minutes and then he’ll sleep a few more hours. Sometimes, it’s for a while (the other night was an hour until midnight and then I went in to nurse since it was midnight). There is nothing so specific about his nursing times at night besides that I won’t nurse until midnight at least. The first one might be around midnight, and then 3 hours later, and then he has been waking up in the 5s or at 6 and is still tired, so I nurse him and he goes back to sleep until 7 or until I wake him at 7 something.
One night he slept until 2 am and nursed only then for the first time. He seems to not be so consistent with his night wakings/feedings.
I don’t do bottles of any sort.
What is exactly your concern?
I’m wondering why he is still waking up crying before midnight so often if I haven’t gone into him in 1-2 weeks I think – so I’m not encouraging or rewarding his waking up. I don’t want him to cry every night. Does extinction work for eliminating feeding sessions at night? Am I doing the right type of method in theory? I want to get him down to 1 feed eventually and then no feeds…
How certain are you that your breast milk supply is adequate? Are you thirsty much during the day? Have there been any new stressful events in your life? Are you getting enough sleep? Maybe your breast milk supply is not quite adequate near the end of the day and his bedtime feeding is not quite sufficient so he wakes up before midnight. If you try test feeds before midnight, by his sucking pattern (suck-swallow-suck-swallow-suck-swallow) you might determine that he is hungry then, or not (suck-suck-suck-swallow, suck-suck-suck-swallow). What are your thoughts?
He stops nursing on his own, even when I try to offer more. He’ll just push his head away and seems happy and satisfied.
He also eats some solids during the day – of course not enough that it would be filling him, but I have not reduced nursing times during the day and he also has solids.
If he is hungry, please feed him. If you are not sure that he is hungry, perhaps his care-giver or a lactation consultant might help you decide.
Ok, thank you for your input.
Dr. W,
Started extinction w/a cap on my 8 week old son last night. I know the book said the first night (for children under 6 months) they usually will cry between 45-55 minutes, so we used a 1 hour cap. My son cried the entire hour and did not seem to be winding down. My question is – what do we do after “the cap” comes around? Soothe him to sleep? Give it up and try again the following night?
For reference, he had been up for 90 minutes since his last nap and we put him down at 7:15 after he took 5 ounces of breast milk. His naps that day were slightly shorter than normal since we were traveling for Christmas, but other circumstances seemed optimal and I was surprised he outlasted us. We will try again tonight with a longer cap. But I am curious to know what we should plan to do if he outlasts the cap again?
Thanks for your help!
What is the usual timing and duration of naps and when did you begin soothing to sleep and when did you leave the room at bedtime?
His morning nap is around 9-10am depending on when he wakes up for the day, and lasts 2 hours. After that his routine is that he spends 80-90 minutes of wake time before napping again for 45-60 minutes repeatedly the rest of the day, with the last nap usually starting between 4-5pm.
The first night I started soothing him about 10 minutes prior to laying him down and did not stay in the room after laying him down – I walked out immediately and left the house while my husband stayed with him outside the room.
(For reference, night 2 he cried for 1 hour 40 minutes before I went in to soothe him & put him back down, and then he cried for 10 more minutes before falling asleep. After that he was still restless and waking on and off for the next hour before really getting to a deep sleep for the night.)
Please clarify: For the bedtime, what time at night did you begin the soothing to sleep process and what time did you leave the room?
Sorry, night 1 I started soothing at 7:05pm and left the room at 7:15pm. Night 2 we tried earlier due to an earlier last nap of the day – I started soothing at 6:20pm and I left the room at 6:30pm.
OK. His last nap starts between 4-5pm. How does he look and behave between 3-4pm? How long does this nap last? When this nap ends, hoe does he look and behave before 6ish?
Between 3-4 he acts “normal” for his average wake time – alert, happy, content, interactive. That last nap is only 30-40 minutes max.
Around the 6pm hour I would say he is usually more fussy and overall discontent than other wake times.
Was he born on his due date or early or late?
“Around the 6pm hour I would say he is usually more fussy and overall discontent than other wake times”. These are fatigue signs, not drowsy signs. He is overtired and in a state of higher neurological arousal which makes it harder for him to fall asleep and stay asleep. Because you innocently were putting him to bed at night too late, there was a lot of crying.
Please review drowsy signs in my book or on my Blog and then you will understand that his sleep tank is going towards empty around 4-5 pm. Therefore, no nap then. Keep him up. Begin a soothing bedtime routine around 5ish, put him down for the night and leave the room at 5:30pm. There will be less crying because he is at a lower level of neurological arousal. This super early bedtime is temporary until long regular naps develop between 4-6 months of age.
How do you feel about this?
He was born 2 weeks past his due date. So he would be 11 weeks now if he had been born on time.
We can definitely try this the next several nights. How long of a cap would you suggest given the information? Or in this case would we remove the cap? Thank you for the help.
You are welcome. How about a 3-5 night trial of 5:30 bedtime with extinction (with or without a 1 hour cap on crying) at bedtime and in the middle of the night (of course feed him when he is truly hungry and attend to him if you think he is ill)?
Keep a detailed record of nap times, nap duration, bedtimes, crying episodes, crying duration, and crying intensity (mild, moderate, severe,) for these 3-5 nights. Please be compulsively consistent during this 3-5 night trial.
Are you ok with this?
Is your husband on board?
Does he sleep in your room or in a separate room?
Let me know how it goes.
We have moved ahead with your suggestion and did the 5:30 bedtime last night and tonight. (This makes night 4 of using extinction at bedtime.) Both nights that we used the earlier bedtime of 5:30pm, he seems super drowsy after our bedtime routine and lays down awake but drowsy with no crying or protest. However, both nights this was followed by only 30 minutes of sleep and then 3 hours of on/off crying. He will lay down and appear to be going to sleep for 2 minutes or so, then wake back up and cry for 2-3 minutes, then lay back down for 2 minutes, and so on, for hours. Both today and yesterday he woke up for the day between 7-7:30am and napped for 5 hours. He does not have reflux, colic or illness. I’m not sure what else to try. Considering his young age, I had hoped for more progress by now and can’t help but feel discouraged.
Is there any chance we started him too early on this and need to postpone this another month?
Please be patient and stay the course for 2 more nights and then give me a report.
Please be optimistic because he is demonstrating self-soothing at sleep onset. During those 3 hours of on/off crying, would you describe it as mostly mild, moderate, or intense crying?
Am I correct that during this time he is being left alone?
Is the napping for 5 hours his old pattern or is it new?
Is the wakeup time (7-7:30am) his old pattern or is it new.
The crying during the on/off hours starts out mild, and eventually moves to moderate. I don’t think he ever persists long enough to get past that level since he lays down and rests every couple of minutes.
The 7-7:30 wake up time is new as of the last week or so. He used to sleep much later (9:30-10am). The 5 hour total nap time each day is normal as far as I know – I only started timing it every day for about the last 2 weeks. Yes he is being left alone in a crib in our bedroom and we leave the room completely. He is in our room at nights since I am not ready for him to move in with his 4 year old brother just yet. We will stay the course and hope for improvement in the next couple of nights. I’m sure if he were sleeping consistently during that 5:30 – 10pm window that would make a world of difference for him. Thanks again for your guidance.
Perhaps white noise machine might help if your child is hearing household noises early in the evening. The continuous sound dampens the signal intensity of intermittent sounds.
Well we seem to have had a breakthrough!
Last night he went down at 5:30pm and followed his usual routine of waking at 6:00pm and starting intermittent fussing/dozing. However, this time the on & off fussing only lasted 40 minutes, and then he went back to sleep on his own until 11pm with no more wakings. Not only that, but after the 11pm feeding he went back down in his bed with no crying. The rest of the night was a little rough because he got really congested and was struggling to breathe, but up until that point felt like a big victory for us! Definitely enough progress to alleviate my discouragement and keep us going. Thank you for helping us get through this week.
You are welcome. Did extinction coupled with a super early bedtime begin on the night of 12/27 or 12/28? Either way, congratulations, you and your son have accomplished a lot in a very short time!
Regarding his congestion, if he has fever, weak suck, decreased sociability, difficulty breathing, or really appears ill, please check in with your child’s caregiver to give you advice on how to proceed. If he is only congested but does not otherwise appear ill, please stay the course.
Extinction began on 12/25, paired with super early bedtime on 12/27. We will definitely keep an eye on his congestion as time goes on. Thank you!
Hello Dr. Weissbluth. We graduated from extinction after 4 nights a month ago. Tonight my little guy woke up and initially was showing signs of self soothing. Well after 40 min of intense crying I went in and did a sniff check and placed his pacifier in his mouth. He did not need to be changed and we have not fed him for over a month now. He will be 5 months in 2 days. He slept 4.5 hours of daytime sleep today. My question is , do we start over on extinction after a solid one month of no intervening with baby. Thank you so much.
The most common problem with extinction is having a bedtime that is too late based on the age of the child and his naps. Reviewing my Blog Post on Drowsy signs might be helpful when you experiment with an earlier bedtime.
Thank you will do tonight
Hello, I have a 10 month old who goes down for bed independently (due to sleep training at 5 months), but she still wakes 2-3 times per night to feed. After reading your book, I know this is due to me over responding to her at night (responding by picking her up when she’s not hungry, etc.). However, I’m ready to be done with being sleep deprived!
At this point, since she doesn’t need any overnight feeds, would you go cold turkey (with extinction) for no feeds, or one feed after 4-5 am? Or would you slowly wean off feed by feed over the course of a few weeks? Right now, bedtime is 8, she feeds around 12:30-1:30, 2:30-3:30, and sometimes 5:30-6ish.
Extinction is safe. Extinction works quickly in 3-4 nights, if, and only if, the bedtime is not too late. 8:00 is probably too late. Read about Drowsy signs in my book on the Blog Posts to determine how early the bedtime should be.
Hello,
My daughter will be 8 weeks old tomorrow. I read and followed your recommendations with our first child, but we didn’t discover your book until he was about three months old.
I have read and reread parts of your book, but feel I need more concrete guidance on what to do. Should my eight week old have a nap schedule? She falls asleep between 8-9 on most nights, wakes around 3:30 to eat, and then usually wakes again between 5-6. Then, her naps are inconsistent and short all day unless she is being carried or in the car seat. While she stays in her bassinet at night, she won’t during the day.
There have been times where she can soothe herself to sleep, but not consistently. I am unsure of next steps since she is not three months yet and is still under 11 pounds, can she cry it out?
Thank you,
Chelsea
Hi Dr. Weissbluth,
I read your book and it helped us tremendously with my then-4-month-ld. Wish I’d read it before we had our late-preterm baby! We would all be happier and better rested today. I’d love your feedback on my sleep issue described below.
My son is currently 9 mos 2 weeks old, adjusted age is 8 mos 2 weeks. He has unexplained night waking, and I feed him once at 4am when he seems very hungry, but then he’s not very hungry when he wakes up at 7am.
Here’s his typical day:
6:45-7:15am wake for the day, breastfeed
8:30 solids
9:15-10:45 nap, less than 5 mins light crying to go down for nap, sleeps very well
11am breastfeed
1/1:30 solids
2-3:30 nap
3:30 breastfeed
I’ve read your book and based on his happy demeanor between 3:30-7, he’s happy to play independently while I make dinner, we eat together, and then he plays independently while I clean up dinner. Based on his attitude at this time I don’t think he’s overtired or needs an earlier bedtime. When he was younger we did a super early bedtime because he was definitely SOS from his early months but his bedtime slowly progressed to 7-7:30 that it is now.
6 solids
6:45 start bed routine: breastfeed, bath, pjs, snuggles, short breastfeed sesh (doesn’t eat much, more for comfort/wind-down), put him in his bed around 7:30. He’s usually awake and very sleepy when we put him down, but sometimes he’s asleep.
About 3/7 nights a week he wakes once between 4-4:30am actually hungry, I feed him, I put him right down after (whole process is no more than 15 min – he’s an efficient eater, drains both sides, probably eats around 6-7 oz) and he immediately falls back to sleep until about 7am, when he wakes up not very hungry for breastmilk.
About 4/7 nights a week, this happens, and this is what I’m trying to figure out how to help him sleep through:
1:30/2am awake crying hard. We’ve tried each thing below for 4 days each and didn’t come to any conclusions:
– Breastfeed him. He’s not hungry, but if I stimulate him until he eats then he falls back asleep, but then wakes up at 5:30ish actually hungry and crying again. Then he isn’t hungry for breastmilk at 7am.
– My partner tries to soothe the baby. It makes the baby more agitated, harder crying, etc.
– Ignore him. He alternates between crying hard and fussing for the next 2+ hours until 4am when I know he’s hungry so I feed him. He then falls back asleep and sleeps until 7am.
7am feeding, not usually very hungry.
I’m looking to help him sleep through his 2am cry sesh primarily, and secondarily I think I need to remove the 4am breastfeeding session so that he gets his breastmilk during the day (and so we all sleep better!)
I’m thinking I need to move his bedtime a bit earlier, like 7-7:15, and we are also thinking of doing extinction for the whole night, no feedings, for 7 nights and seeing how it goes. We know it will be a low-sleep week so pretty hesitant to do that.
I’d love your insight on the above issues!
Thanks so much,
Meagan
Hi Dr. Weissbluth,
Read your book and my nephew went through extinction with great success.
My husband and I are 7-day in Extinction with our 3 months first child (a boy).
We started bedtime routine (bath, breastfeeding, book and pacifier) between 4:30-5:30pm and put him to bed between 5:30-6:15pm. He naps in total per day around 120-240min.
First night he cried 120mins, second 40min, third-sixth 30min and today 45min…
I am concerned with two points
(1) that we are putting him to bed with the pacifier…
(2) we are bot doing extinction for naps given he is 3 month old…
Any thoughts?
Perhaps stick with a strict 5:30pm expected falling asleep time for 3-4 days and report back.
Naps begin to develop around 4 months and are well in place by 6 months. So for now, for naps, focus on short intervals of wakefulness before each nap and drowsy but awake.
How does this sound?
Will do and report back! Thank you Dr Weissbluth!
Hi Dr. Weissbluth, as an update we tried the 5:30pm asleep time the last 4 days… we maintained the bedtime routine of bath, breastfeeding, book and pacifier. Please see the report below.
What do you recommend?
Report
– 09/10: during the day had 4 naps (2 of 45min, 1 of 55min and 1 of 50min). My husband put him to bed at 5:05. Started crying at 5:19pm. Cried until fell asleep at 5:54. Woke up at 3:00am. Breastfed. Slept at 3:25am. Woke up at 6:21am.
– 09/11 (had 3 month old vaccines): during the day had 3 naps (1 of 35min, 1 of 1h40 and 1 of 1h45). My husband put him to bed at 5:30pm (when we were supposed to do at 5:10pm he pooped and had hiccups, delaying the process). Started crying at 5:42pm. Cried for 15min or so and slept at 5:59. Woke up at 10:35 pm, breastfeeding and slept at 11:09pm put to bed at 11:30pm. Woke up ate 2:20am, breastfeeding, changed diaper, put to bed at 3:10am and slept at 3:35am. Woke up at 5:35am, breastfeeding, changed diaper, put to bed at 6:15am and slept at 6:20am. Woke for the day at 7:40am
– 09/12: during the day he had 4 naps (1 of 50min, 1 of 45min, 1 of 1h35 and 1 of 30min). He cried more before the napping. I put him to bed at 5:15pm. Started crying at 5:16pm until fell asleep at 5:30pm. Woke up at 5:42pm complaining and slept again at 5:48pm. Woke up at 6:03pm complaining and went on/off until fell asleep at 6:15pm. Woke up at 6:54 complaining and went on/off until fell sleep at 7:15pm. Woke up at 7:50pm, cried until 8:00pm. I breastfed him cause thaught he was hungry. He slept at my breast at 8:10pm. Woke up again at 2:05am, diaper change, breastfeeding, put to bed and slept at 2:40am. Woke up at 6:50am to start the day.
– 09/13: during the day he had 3 naps (1 of 50min, 1 of 40min and of 40min). One of his naps was compromised given pediatrician appointment. He did not cry before napping. My husband put him to bed at 5:10pm and slept immediately. Woke up at 5:50pm (seemed to be due to losing pacifier). Cried for about 55min. Sucked his finger and fell asleep at 6:48pm. Woke up at 7:04pm. Complained a bit and sucked his finger until falling asleep at 7:14pm. Woke up at 9:29pm, breastfeeding, slept at my breast 9:45pm and put to bed 10:00pm. Woke up at 3:30am, diaper change, breastfeeding, slept at my breast at 4:00am and put to bed at 4:20am. Woke up at 7:50am for the day.
Look forward to hearing from you.
Thank you!
I know that there is variability, but in general, is most of the crying mild, moderate, or severe? Has there been any change in the intensity of crying?
I note that he is attended to at night for feeding + soothing;
Night one: 3:10-3:35
Night two: 2;20-3: 10 or 3:35
Night three:2:05-2:40
Night four:3:30-4:00 or 4:20.
Because a baby can consume 80% of a feeding in about 5 minutes, I suggest that you spend much less time with your baby for the night feeding. Perhaps only 12-15 minutes. Feed, change if needed, put down with a single kiss (no real soothing). Try this for 4-5 nights and report back.
How does this sound?
Please describe the drowsy signs that you observe before naps.
Hi Dr. Weissbluth, thank you for replying.
The crying is most moderate. Yesterday (09/13) was a bit severe.
As for the night feeding, I was waiting 20min after breastfeeding to see if there was a burp or regurgitation… will try to spend less time for 4-5days and report back.
Drowsy signs before naps are less movement, yawning and fixed gaze. Sometimes he is rubbing his eyes… may be it is a bit late then.
Any thoughts?
Because “Sometimes he is rubbing his eyes… may be it is a bit late then.”, Yes; try to shorten the period of wakefulness before a nap by 10-15 minutes and keep a record of naps. Maybe he will go down easier or nap onger or both.
Thank you! Will do and report back in 4-5days. Have a great Sunday Dr. Weissbluth!
Hi Dr Weissbluth
Hope you are well
Please see below the detailed report of the last 5 days
In a nutshell, he managed to sleep faster with less crying. But yesterday he did cry more again and woke up more… in addition, he cries less for naps and in the least two days the first nap fell asleep on his own. But naps are still short
Detailed report
– 09/14: had 3 naps (1 of 50min, 1 of 55min and 1 of 40min). After bed time routine, my husband put to bed at 5:22pm. Cried 25min or so and slept at 5:52pm. Woke up at 4:20am, diaper change, breastfeeding and burp. Put to bed at 4:44am and fell asleep at 4:57am. Woke up at 7:20am for the day.
– 09/15: had 3 naps (1 of 40min, 1 of 50min and 1 of 1h20). Before finishing bed time routine (after breastfeeding and before book), started crying… regurgitated… I put him to bed at 5:18pm and soothed him (book + pacifier), left the room at 5:29pm. He started crying at 5:31pm… did so for 15min or so. Sucked finger and fell asleep at 5:52pm. Woke up at 1:30am, breastfeeding, put to bed at 1:44am, fell asleep at 6:35am for the day.
– 09/16: had 4 naps (2 of 45min and 2 of 30min). After bedtime routine, my husband put him to bed at 5:14pm. He started crying at 5:18pm and did so for 5min or so. Sucked his finger and fell asleep at 5:25pm. Woke up at 2:45am, diaper change, breastfeeding, purp and put to bed at 3:08am. Fell asleep at 3:10am and woke for the day at 6:20am.
– 09/17: Had 4 naps (1 of 35min, 1 of 40min and 2 of 45min). After bedtime routine, my husband put him to bed at 5:01pm. He complained at 5:04pm until 5:07pm and fell asleep at 5:10pm. Woke up at 3:15am, diaper change, breastfeeding, burp and put to bed at 3:44am. Fell asleep at 3:54am. Woke up at 6:20am for the day.
– 09/18: had 4 naps (2 of 40min, 1 of 30min and 1 of 45min). After bedtime routine, my husband put him to bed at 5:14pm. He started complaining at 5:15pm…. Started a bit of crying at 5:18pm… when on and off while trying to suck his hand / finger. Started crying harder at 5:42pm. Fell asleep at 5:50pm. Woke up at 8:20pm crying… I waited and went at 8:35pm as crying was strong, breastfeeding, slept at my breast at 8:45pm, waited for purp or regurgitating and put him to bed asleep at 8:55pm. Woke up at 2:05am, diaper change, breastfeeding, burp and put to bed at 2:35am. Fell asleep at 2:48am. Woke up at 5:00am. Went to him at 5:40 to breastfeed and purp. Put him to bed at 5:50 and he instantly fell asleep. Woke up 7:10am for the day.
Any thoughts?
Look forward to hearing from you
Thank you
Consider crying at night immediately after being put down:
9/14: 25 minutes
9/15: 15 minutes
9/16: 5 minutes
9/17: complained for 3 minutes
9/18: much more
The trend from 9/14 to 9/17 is much more important than last night. It indicates increasing self-soothing skills.
Because he is napping well and sleeping great overnight and you were able to spend less time settling him, please be optimistic.
Are you able to stay the course for several more days?
Please praise and encourage your husband to continue his efforts.
Has there been any suggestion of improved awake behaviors?
How old is he now?
Thank you Dr. Weissbluth!
Yes, we can continue the course for several more days.
As per his age, he is 14 weeks (will be 15 by Sunday).
As per awake behavior, it has improved. He wakes up for the day smiling and with no crying. In addition, today 60-90minutes before going to bed he was laughing and playing – great performance, behavior and mood.
Today we have been surprised that we put him to bed at 4:55pm because he did not nap after waking at 1:40pm. He slept at 4:57pm but woke at 5:22pm after loosing pacifier… started crying at 5:33pm and did it for 50min then stopped… and has not slept yet (it is 7:04pm)… will keep you posted tomorrow!
Look forward to hearing from you.
Most importantly, focus on “He wakes up for the day smiling and with no crying. In addition, today 60-90minutes before going to bed he was laughing and playing – great performance, behavior and mood.”
Why there are setbacks or off days might mot be known, but you have accomplished so much in such a short time, please expect continued improvement as his sleep/wake rhythms continue to mature and become more stable. During these next several days or weeks, try to be super consistent knowing that in the future, you can be more flexible regarding naps and bedtimes.
How does this sound?
Thank you Dr. Weissbluth,
As an update last night after sleeping at 7:50pm he woke at 4:00am for breastfeeding and diaper change, fell asleep at 4:30am and woke for the day at 7:25am.
As per next steps, will be consistent until he manages to really learn self soothing.
Can I just clarify 4 points
(1) Do you have any point of view if being put to bed with the pacifier is not good to develop self soothing skills? I am thinking of not giving it to him when put to bed given he loses it and then is too young to take it back…
(2) As for bedtimes should we still keep the 5:30pm? Or should we do it accordingly to the time of the last nap? Sometimes he sleeps until 3:30pm others 3:00pm and rarely 4:00pm…
(3) if his mid day nap is shorter, lets say ends at 2pm… should we aim for a last nap after 3pm?
(4) should we use extinction for naps now? So we are consistent with every time we put him to bed we do not come back until is time to wake up… I am in doubt given that I am not sure yet which are the best times for him to nap… and he is not yet 4months old
Look forward to hearing from you.
Thank you
1. If the pacifier helps, use it.
2. For now keep a very early clock time for bed time but watch him closely between 4-5 pm. Because of natural nap variability, later, the bedtime will vary and you will base bedtime on drowsy signs (not clock time). Review my Blog Posts on drowsy versus fatigue signs.
3.I strongly urge that no new nap starts after 3pm because it will mess up early bedtime. If the mid day nap ends at 2pm, maybe try for another nap at 2:45pm, or use extra distraction and a 5pm bedtime.
4.Naps emerge around 4 months of age and are regular and long around 6 months of age. Review “Nap Drill” for time when naps are off schedule. For now, your goal is to keep the interval of wakefulness before a nap brief so he doesn’t get overtired. Watch mood, behavior, and the clock and expect that he will need another nap 60-90 minutes after a nap ends.
Does this help?
Yes!!! Thank you!!! Will keep you posted Dr. Weissbluth
Hi Dr. Weissbluth, how are you? As an update, we have managed to in the last 3 days have no crying, only some complaining once we put Theo to bed. He is falling asleep in 10-15min. Usually asleep by 5:25pm. But last two nights woke at 9:15pm to breastfeed and then at 2:30am, waling for the day between 6:15-7:15am. Naps are still irregular. He continue to have good mood, behavior and performance between 4-5pm. Plan to continue consistent with early bed times until we have more regular naps. Please let us know if you have any other thought. Thank you again!
Congratulations! Your son is sleeping well with no crying. Naps regularize and lengthen between 4-6 months of age.
If your breast milk is decreased at the end of the day, your child might awaken, out of character, for a night feeding.
Drink more fluid, pamper yourself, pay attention to your thirst, consider offering a test bottle of expressed breast milk or formula after nursing at bedtime to determine if your breast milk subpply at bedtime is sufficient.
How does this sound?
Great! Will try the test bottle. Thank you Dr Weissbluth! Will keep you posted.
Hi Dr. Weissbluth, hope you are well. We tried the test bottle yesterday and he did not take it. Slept from 5:20pm until 2am… we again fell asleep without crying. Woke for the day at 6am. Will continue to work on naps during the day based on brief intervals of wakefulness and observe his signs / clock time as he approaches 4months by next week (october 9th). If you have any recommendation please let me know. Thank you again.
Stay the course. Expect a more regular and longer nap to develop in the mid-morning before a regular and longer mid-day nap. Nap schedules naturally mature between 4-6 months and the key to success is an early bedtime.
How do you feel about your child’s sleep journey in general?
Hi Dr. Weissbluth, thank you. Will keep working on early bedtime.
As for the journey I am satisfied. His night sleep is great and he is developing self soothing skills.
My frustration is to see some regression.
Example 1 today he cried 10-15min before falling asleep…
Example 2 last two days he wont sleep his naps on the bed, only in my arms. I suspect it is because my husband who usually puts him to bed for naps is out of town until Friday. Would that be something to consider? Or a coincidence?
1. Was the crying mild, moderate, or severe?
2. Read the section in my book on the “Nap Drill” and use this method when your husband is away. Naps are only in his crib; do not allow naps elsewhere or you will undo all your hard work.
Thank you for such a quick reply. Very helpful
1. Crying was moderate today and lasted 10min or so. Yesterday it had less than 5 minutes of severe crying.
2. Ok. I tried the nap drill for mid morning nap yesterday and he cried for 1h. Then did not attempt it at the midday nap… he ended up sleeping 12h55 for the 24h period and I got worried and thought I should make anything today to make him sleep more than 14h. Should I attempt the nap drill in the mid morning and midday nap?
Because he has healthy night sleep, I think it best to try to imitate your husband’s soothing style for naps and also to use the nap drill for all naps. When day sleep is short, a 5:30 pm expected bedtime might me a reasonable attempt.
How does this sound?
Great. One last doubt: if he wakes for the day at 6am. Should I try to make him stay awake the most to attempt to get to 9am for the mid morning nap drill?
The competing goals are:
1. Sleep your child in synchrony with circadian sleep rhythms. For example, keep him up until about 9am for a mid-morning nap.
2. Don’t let your child become overtired because of presleep arousal.
At 4 months of age, nap circadian rhythms are developing but not well established; by 6 months of age, nap rhythms are more regular (predictable).
I think he is closer to 4 months of age than 6 months of age. If correct, than you want to be a bit more flexible and while 9am might be a goal, perhaps stretching him a little, with extra soothing, you might only get to 8am or 8:15am for a mid morning nap when he wakes up at 6am. Watch the clock a little but more importantly watch your son and expect some trial and error. When older, using the natural nap rhythm as a sleep aid will help him nap better.
How does this sound to you?
Will do! Thank you.
As an update, for the mid morning nao today he cried 60min and severe for a good part of it…. Will keep on trying.
Additionally next week we will be at my in laws in the countryside and will share a room. Any recommendations?
How long will you be there?
Here are some items to consider:
There might be a conflict between maintaining nap schedules and early bedtimes and grandparent’s wishes. If so, the conflicting goals are your child’s sleep and family harmony. If so, have a discussion with your husband and create a realistic plan that you can implement.
Maybe having your husband having a frank talk with his parents might help.
Maybe bring along stuff to make the room extra dark or a white noise machine to enhance naps.
Maybe dedicate your room for the baby’s sleep and you both sleep nearby but elsewhere (camp out) for 5 nights.
Maybe prepare for a ‘reset’ as described in my book upon return.
Does this help?
5 nights
Yes! Very helpful! Thank you Dr. Weissbluth. Will keep you posted.
Hi Dr Weissbluth, hope you are well. We survived the trip and kept the 11-13h sleep at night. Continue to focus on naps. Will keep you posted.
Hi Dr. Weissbluth,
We have a 17 week (age adjusted 15 tomorrow) old who recently hit the 4 month regression and we are ready to sleep train using extinction.
One thing to note is that she hasn’t taken any night feedings since probably 9-10 weeks. She is combo fed and in the 10th percentile for weight, but on her curve.
Naps are short, but we extend with contact to get to 4.5-5 hours of sleep per day. We practice drowsy but awake in the bassinet. Most nights, bedtime is 8-8:30pm because any earlier and she false starts repeatedly and it leads to 3+ hour bedtimes. Before the regression, she’d sleep uninterrupted 9-10 hour stretches. I’m guessing the later bedtime works for her since she doesn’t wake to feed?
Should we be feeding her at all during extinction, or no since she has shown she can go a long stretch without a feed?
Please read the sections in my book or Blog that mention ‘sleep regressions’, bedtimes, and extinction to help clarify your misunderstandings.
I have read them. To clarify, are you suggesting that an earlier bedtime will help solve the night wakings most of us associate with a “regression”?
And if she is going to bed earlier, she isn’t getting the current total of daytime ounces, so is it fair to assume she should be given a “dream feed” in the night? I didn’t see anything in your posts or book about feeding, specifically for a baby who slept long stretches from an early age.
Understood.
Please look at Blog Posts 91, 224A,B, and C regarding early bedtimes
Please read Blog Posts 143 and the hyperlinked Posts and Blog Posts 146 and 147 regarding ‘sleep regressions’ and ‘dream feeds’
Blog Post 219 gives an overview of extinction that might help.
Hi Dr Weissbluth,
I am currently trying to encourage healthy sleep in my 13 week old baby. He was born late at 41+4. I have several sleep problems I would like to correct but am not sure where to start as it feels like a vicious cycle. Additionally, he went through a few days of having uncomfortable gas which led to excessive screaming which has led to him having a horse voice. His voice makes me less prone to allow him to cry longer as his crying typically gets more intense, thus making his voice more hoarse. Here are the sleep problems:
1. I try my best to watch for his drowsy signs then put him down drowsy but awake. However, he wakes up consistently 30 minutes into a nap, sometimes immediately crying. A few times I believe it has been for gas, as he was inconsolable, but frequently when I would pick him up he goes back to sleep. Am I understanding drowsy but awake incorrectly? I rock him until his eyes have just closed then put him down. Is he associating me with sleeping and wakes up due to not being with me?
2. I feel that if I allow him to try and self soothe for naps, he’s up way past his desired wake window and then becomes overtired and then won’t nap well which will affect his night. So I find myself holding him for some naps so he can sleep so he doesn’t accumulate debt for the evening. This however is impractical and I’m not sure if he’s getting restorative rest when I hold him. He will often wake up from these “naps” ready to eat and then yawns right away.
3. Last night for the first time, I tried a much earlier bedtime of 5:30 (started the process at 5:15). This went OK except he woke up at 6:12, cried for 20 minutes, I then went up to settle him, but he really did not go back to sleep, and eventually became hungry for his normal last feeding at 7:30. Then it seemed he gained a second wind after feeding, and he eventually fell asleep while my husband rocked him at 8:45. He then woke at 2:30 in the morning to feed; I put him back down drowsy but awake and shortly after he woke up crying. We let him cry for 15 minutes, but then my husband rocked him back to sleep, and he went back to sleep very quickly. we did not want to commit to hours of crying right away because of a poor night sleep the previous night due to gas and my husband needing to work.
Should we just focus on improving the nighttime bedtime? I am frequently having a mentality of fingers crossed he stays asleep – it feels like a gamble. Do you have any recommendations to eliminate the 30 minute wake up?
Please carefully read Blog Posts 83 and 115X.
Because of his age, focus on night sleep.
Is he breast fed, and if so will he take a bottle of expressed breast milk or formula?
Do you want to fix his sleep issue quickly (3-4 days) which might involve some crying at night or do you want a no-cry sleep solution that might take much longer?
Thank you for getting back to me!
He is currently breastfed, but has successfully taken a bottle of breast milk in the past due to me being away from him at a feeding point – I haven’t tried a bottle in the middle of the night. When he does feed in the middle of the night, he does suck, swallow consistently.
I would prefer to fix his sleep issues quickly, but my hesitation is his hoarse voice and if it will cause more damage.
Thank you!
Regarding his hoarse voice, perhaps discuss this with your child’s pediatrician. Let me know your decision.
Hi Dr Weissbluth,
I’ve decided with his hoarse voice to first implement a method with minimal crying. For naps during the day, I would put him down drowsy but awake, and when he woke up 30 min in allow him to cry for 15 min then settle him by giving him his pacifier and patting his bottom.
I also have some interesting observations from last night. We had difficulty at bedtime and so he went to sleep later than desired around 7:45 after breastfeeding at 6:30. Due to him eating earlier, he did start stirring around 9:45, so I fed him and he went back to sleep fine. He woke again at 2:30, but this time I was suspicious that he wasn’t hungry since I fed him so late. The previous night I last fed him
at 7:30 and he woke at 2:30 hungry. My husband rocked him and settled him and put him back to sleep around 3. He stirred a few minutes later, and I was going to see if he was hungry by having my husband offering a bottle, but my husband was very tired at this point. I conceded to breastfeeding him and he went back down at 3:30. He then stirred again but self soothed and truly fell back asleep at 3:40.
Please read the Chapter in my book on Sleep Solutions and tell me which specific solution you wish to use, then I will be able to guide you.
Hi Dr. Weissbluth!
We have implemented different approaches to sleep and saw improvement, but are now seeing a regression again. Earlier this week, our baby was taking great naps, anywhere from 2 – 1 1/2 hour long. However, he woke up twice to feed. Last night he did not go back to sleep as he normally would after his dream feed. I let him cry and after about 25 minutes, he settled himself down and went to sleep on his own. Should I let him cry it out for daytime naps? He has started waking up 30 minutes in again and doesn’t seem to like being rocked, but he struggles to fall asleep without help.
How old is he?
Dream feeds are bogus and your awakening him might be the direct cause of the current problem.
Please read the section in my book on the nap drill which may not be appropriate now because of his age or maybe it might make sense only for the first nap of the day because he is most well-rested from night sleep.
Let me know your thoughts.
Hi Dr Weissbluth,
I am following up per my previous posts. He is 14 weeks, but was born at late at 41+4. By dream feed, I mean he wakes up hungry and goes right back to sleep. I do not wake him up to eat.
I realize my last post was confusing. Earlier this week he was taking 2 to 1 1/2 hour long naps with no interruptions, but now he is waking up 30/40 min in even after self soothing. Is it due to overtiredness?
When do you begin his bedtime routine?
What time is he actually falling asleep?
Please describe in detail his mood and behavior during the 60 minutes before you begin his bedtime routine when he is alone with toys (no screens or parental involvement)
We begin his bedtime around 6. Some times he is already overtired due to taking a poor nap in the late afternoon, so his mood might be described as slap happy or extra wiggly. He typically falls asleep anywhere between 6:30 and as late as 7 some nights if he is especially cranky.
You have already read Blog Posts 83 and 115X, so you know that his falling asleep time is too late.
Please carefully read Blog Posts 171, 172, and 204 to fully understand why I am suggesting:
1. For 3-5 nights only, temporarily have a 5:30 bedtime (he is bathed, fed, soothed, and you are leaving the room when he is drowsy but awake at 5:30pm). Do this only when you see a 5 day period ahead when you can do this and do not do this if you cannot commit to a 5 day trial.
2. Feed him only when he is hungry at night.
3. Father is to go at other times and use low intensity soothing (Blog Post 145) if needed overnight.
4. Later, when naps are better established and longer, the bedtime will be moved a little later.
Let me know your thoughts.
Hi Dr. Weissbluth,
We are working to get our 4-month-old little girl sleeping regularly. Naps are inconsistent, and 45 minutes at best when they do happen. Sometimes she will refuse naps altogether. For naps we are trying to watch for drowsy signs but maybe missing the sweet spot. She becomes agitated and cries when we start to soothe her in a dark nursery with sound machine on.
At night she is going to bed at 7:00-7:30pm, on a good night will wake up 3-4 hours after. We feed and from there the night is inconsistent and a struggle to get her back to sleep. We take shifts trying to soothe her, she will fall asleep only in our arms. Other nights she is up 90 minutes after we put her down and from there it is the same struggle getting her to sleep any significant stretch of time.
At this point we are so sleep deprived; we are ready to get her sleeping. We know she cannot self soothe because we have rocked her to sleep since she was a newborn. The four times we have tried to set her in the crib drowsy but awake, she has very aggressive crying. So, without any self-soothing ability, is it ok to go the Extinction route for sleep training? Or should we do gradual extinction and try to get her to develop some self-soothing skills first? My last question is- would it be better for the father to take on the sleep training and night feeds during this time? Is that more successful than each of us taking turns with bedtime and middle of the night feeds?
Thank you very much!
Please describe in detail her mood and behavior when alone with toys (no screens or parental involvement) between 6:00pm and her bedtime.
She is fussy if we are not around. She needs us to walk her around the house, constant movement or watching her 2-year-old sister play and dance. But we are involved every night, holding her, singing to her or interacting with her.
Please carefully read Blog Posts 9, 83, 115X and 226C to fully understand why her bedtime is too late which causes pre-sleep arousal (“She is fussy if we are not around…She is fussy and clingy … Usually when we are getting her dressed, she started to become agitated, fussy).
Please carefully read Blog Posts 159, 171, 172, and 204) to fully understand why pre-sleep arousal makes it harder for her to fall asleep and stay asleep at night.
Thus, she awakens in the morning short of sleep which makes it hard for her to nap well during the day.
All of this can be corrected in 3-4 days with father’s involvement.
Let me know if you can commit to a 3-4 day trial and you wish to proceed.
In additional to previous post- She is fussy and clingy (no tears) until we start bathtime, which is the first step in our bedtime routine. She is content in the bath until we remove her and start the next portion (pajamas, lotion, feeding, sleep sack and rocking) of the bedtime routine. Usually when we are getting her dressed, she started to become agitated, fussy and we have to hurry through the process to get her into her pajamas and a bottle going to keep her as calm as we can.
We will read those blog posts and get into the routine of an early bedtime. We are committed to getting her sleep problems resolved as quickly as possible. Our entire family will be happier for it! We have time to dedicated to the process, her father is currently on leave for the next month- hoping to implement better sleep during this time
OK
For the next 3-4 days:
Because night sleep rhythms develop around 6 weeks of age:
Temporarily, her bedtime is rigidly set at 5:30pm (she is bathed, fed, and soothed and you are leaving the room at 5:30PM). Anytime after 9:30pm, if you think she is hungry, feed her. She might be fed around the middle of the night and again in the early morning (at least 4 hours later) or only once overnight. Father does feeding duty if she is bottle fed and the entire feeding time is about 10-15 minutes with no soothing except for a hug or kiss. Extinction, as described in my book is performed overnight. Do not go to her before 5-5:30am to start the day. This is when extinction ends.
Because nap rhythms develop between 4-6 months;
During the day, do whatever you can to maximize sleep and minimize crying (contact naps, car rides, swings, etc) but their is no nap schedule. No new nap is to start after 3pm. If she is asleep at 3pm from an earlier nap, do not wake her.
Keep a written record.
Your expectation is that night sleep will rapidly improve and as a direct result of this, subsequently, she will nap better. Better naps over the next weeks will eventually permit a later bedtime based on drowsy signs.
Do not do this if you and your husband cannot commit to a 3-4 day trial.
How does this sound?
That sounds great, completely obtainable.
As far as the 5:30pm bedtime, is this a time that will gradually shift later as daytime sleep becomes easier and more consistent? Or is there a set period of time in which we keep a 5:30pm bedtime?
“Your expectation is that night sleep will rapidly improve and as a direct result of this, subsequently, she will nap better. Better naps over the next weeks will eventually permit a later bedtime based on drowsy signs.”
Thank you Dr. Weissbluth! We implemented early bedtime last night with much success of a longer stretch of sleep to start the night. Tonight we are starting the 3-4 day plan as you outlined above! Looking forward to more restful sleep for the entire family!
Hi Dr. Weissbluth,
We have been doing extinction for 9 nights with our 8 month old twins and it has been going pretty well. They were going to sleep pretty easily, but waking up a lot. We feed them at 9pm and 3am. It is mostly going well, except sometimes one will wake up around 2 and cry for a long time, maybe 45 minutes, which is so hard! I’m wondering what could be causing this. Do you think it might be too late a bedtime? Last night they slept at around 7, after waking up at 2 and no third nap. What do you recommend? I am worried that it won’t work and we will just be letting them cry it out
indefinitely for weeks or months. Thank you!
What was the gestational age at birth?
Are they identical or fraternal twins?
What is a common nap schedule and duration of naps?
What is a common bedtime and expected falling asleep times?
Are they breast fed, formula fed, or combination?
They were 37 weeks and 4 days! They are fraternal (boy/girl). Common nap schedule is 2 hours after waking up, then another 2 hours, then a nap at 3 if they wake up before 1 or the nap is short. The nap time is variable; yesterday, it was 2 hours and an hour and a half. It’s starting to be usually like an hour and then 80 minutes, and then maybe 40 minutes if they do a third nap. They are all formula-fed
And their usual bedtime is between 6:30-7; they basically fall asleep immediately.
What are the common times that the naps begin?
Please describe their mood and behavior when alone with toys (no parental involvement or screens) after 5:30pm
Common times are between 8 and 9 and then between 11 and 12 or 12:30 at the latest.
Their behavior is cheerful, but maybe getting crankier…our son will sometimes yell a little bit and want his pacifier…our daughter seems to lose steam a little bit
You are describing mild pre-sleep arousal (please
read Blog Posts 159, 171, 172, 204) caused by a bedtime that is too late. Extinction works well in 3-4 nights if, and only if, the bedtime is not too late.For 3-4 nights only, have a rigid 5:30 expected falling asleep time (they are bathed, fed, and soothed and you are leaving the room at 5:30pm). Continue with extinction.
Keep a written record of day sleep and night sleep.
The expectation is that they will first have improved night sleep and then later, an improved and later mid-morning nap followed later by a later mid-day nap, and then the bedtime will be later based on drowsy signs.
Do not do this unless you can commit to a 3-4 night trial.
How does this sound?
Thanks so much, and I really appreciate your quick reply. This sounds good. We will try this starting tomorrow. At around what times would you expect the naps to settle? Have we caused harm in letting the extinction go too many days?
“Have we caused harm in letting the extinction go too many days?” NO!
The improvement in naps should take place over several days to a couple of weeks.
Let me know how it goes.
Thank you so much, Dr. Weissbluth! We will keep you posted!
Hi Dr. Weissbluth, so far it is going ok after 2 nights. Only our son cried after bedtime for only about 15 minutes and they slept until 6:45am
We decided to feed them at 3 hours after they last ate and then 6 hours later; our son woke up crying at about 5 hours after last eating, cried for about 20 min, went back to sleep, and woke up about the time we were feeding them. His sister woke up around 15 min before we were going to feed them. Should we just assume they are hungry and feed them immediately if they are crying around
5 hours after eating? Thank you!!
Because they are formula fed, you can record the volume of feedings. Noting also the time of feedings and the duration of the feeding, you can keep a record for just a few days and determine an approximate night time feeding schedule.
They should be able to easily go 4 or more hours between feedings.
A goal would be to make a plan whereby if you feed one, you wake the other for a feeding so both are fed at the same time but this might be obtainable only for identical twins. If you try to achieve this goal, keep a feeding/sleeping log for just 2-3 nights and then look at the data to see if this is or is not messing up the sleep of the twin that you awaken. If so, abandon this goal.
How does this sound?
Thanks for the advice! We have done the logs, and it is hard to know the feeding schedule bc our son will always take a full feeding (120mL or 180mL) at night regardless of the time between feedings. Before we started sleep training, it would be every three hours like clockwork. The good thing is we can feed his sister at the same time and it doesn’t interrupt her sleep. With this pattern, what do you think makes sense? Thank you again
Stay the course with sleeping and consider feeding once at night 4 or more hours after the previous feeding (middle of the night) and if needed, once again early in the morning at least 4 hours after the previous feeding. Is this doable?
Thank you! This seems doable! So, to confirm, if they eat at 5, would feeding at 9 and 2 make sense? Or more like 10 and 3?
If one baby wakes up before 9pm, extinction is in place.
If one baby wakes up at or after 9pm, feed both and consider feeding again 4 or more hours after that feeding.
So there might not be an exact clock-time feeding schedule but a feeding pattern.
They were born just a few weeks before there due date so keep in mind that most babies after 9 months of age do not need any feedings overnight…so look forward to no more feedings at night.
Ok, thanks so much! We will try this!
Hi! I just wanted to update you after night 5 of early bedtime. Last night, there was no crying! Tonight, we had about 7-10 minutes because they got overtired from a close to 2.5 hour wake window between their 2nd and third naps (12:30-2:50) and then a very short third nap. They also went to bed even before 5:30, at 5:15. Is it normal for crying to recur if the naps aren’t going great/how can we continue to improve them, and also should we be concerned their wake windows are so short at their age?
The night feeding has gone much better and overall they are getting much more sleep, so we thank you so much for your help and support!
Please carefully read Blog Post 119 and tell me your response.
Please be patient.
Thank you! It seems that since there is a lot of variation in how much time it takes for them to become drowsy, it’s normal that ours are showing drowsy signs after comparatively shorter periods of time.
Watching your own children for drowsy signs offers clues to how much wakefulness they can comfortably tolerate.
Individual variation means that watching the clock for published wake windows to guide parents is much less reliable.
Yes, I think after watching them very closely and knowing more about the drowsy signs, I have realized that the amount of wakefulness they can tolerate is much less than we previously thought.
I think the popularity of published ‘wake windows’ has confused many parents. I know that you are on the right sleep path and will succeed soon. Please consider writing a narrative account of your sleep journey and I would use it as a Blog Post. Mothers would be more attuned to your voice than mine.
Thank you so much! The affirmation and support mean a lot. Oh wow, I would be honored to write one that could help others!
Thank you. Do you think your subtle point regarding how much wakefulness is comfortably tolerated can be emphasized?
Also, please include the role of your husband
Of course, I can definitely include both
Hi again, I am working on the blog post and will share it here soon. I am sorry to keep coming back with more questions, but we are still struggling with night waking and I wanted to ask you about it. They are sleeping around 6:15 after having around 3.5-4 hours daytime sleep w no more than 2-2.5 hour awake time based on drowsy signs. At night, one or both of them often will wake up before 4 hours since they last ate, sometimes even before 3 hours. Then they will cry for long stretches, 45 minutes to one hour, usually/sometimes until it’s time to feed them and we do so. We are baffled and unsure why this could be happening. Thank you so much for your help.
Please clarify: They are currently falling asleep around 6:15PM?
If so, separate them and leave them alone with toys (no parental involvement or screens) between 5:00-6:00pm and observe closely: describe their mood and behavior.
Read carefully Blog Posts 83 and 115X.
My apologies, yes, they go to bed at about 6:15 and fall asleep quickly. I will try the observation; I am also wondering what you think about their nap habits. They tend to wake up from their second nap between 1:15-2 and then become drowsy and nap again about 3:30. I know this is after 3 for starting a 3rd nap, but as they are tired and definitely can’t make it to 5:30 even without becoming overtired, I am not sure what to do. What do you think? Thank you!
When does the first and second nap start?
How long do these naps last?
The first nap starts about 2 hours after they wake up. It usually lasts 80-90 min. The second one usually starts about 2.5 hours after they wake up, all based on drowsy signals. It usually also lasts 80-90 min
Their naps seem great! Congratulations.
Currently, what time do you leave the room at night after bathing, feeding, and soothing?
Currently what time are they actually falling asleep at night
Thanks! We leave at about 6:15 and they seem to fall asleep pretty much immediately or within 5-10 min
Please experiment with a ‘leave the room’ at 6:00pm and monitor latency to sleep onset for only 3-4 nights. If they fall asleep in 5-10 minutes, then you will know, after the fact, that 6:15 was too late.
Is this OK?
We will try our best and let you know!
Dear Dr. Weissbluth,
Thank you for sharing your knowledge through your book and blog! We only wish we had found you and your work sooner.
Our son turned 5 months old today. Based on what we understand and our review of the (imperfect) logs we kept in the first months, we believe he fits the definition of “extreme fussiness” in terms of sleep duration, but was a very happy and pleasant baby outside of sleep. His sleep improved between months two and three—easier to get him to sleep and he would stay asleep longer—and then fell apart over the course of months three and four.
By the time we had our 4-month well visit with our pediatrician, bedtime could be a 3–4 hour ritual of him falling asleep only to wake again after 5–40 minutes, at which point a new round of soothing would commence. After the 3–4 hours, he would normally sleep pretty well and wake to nurse twice overnight. About half the time, there would be one additional wake with a meltdown, which could take anywhere from 30–120 minutes to get him back to sleep. His naps also went from about 40–120 minutes to 15–30 minutes. We discussed what we thought was this “4-month sleep regression” with his pediatrician at his visit, at which time the doctor strongly recommended we try full-extinction/CIO. We did so at 19 weeks and had extreme results unlike anything we’ve seen anyone else report: three days in a row where he cried and screamed wildly/intensely for 3–4 hours until it was time for him to nurse, at which point he was frantic, hoarse, and soaked in sweat. She also recommended your book. After the first night of this, we reached out to the pediatric practice and the nurse we spoke to said that seemed long, but there was really no limit to how long to allow the baby to cry, so keep going. After the third night, we were really concerned, as our son was clearly exhausted, withdrawn, and stopped expanding on recent developments (stopped trying to roll after successfully learning to roll over). This time we reached the pediatrician, who had a different answer than the nurse. He told us that 3–4 hours was too long and that our baby must not be mature enough, and we should try again later.
His sleep only got worse after that. The long bedtime continued and now he was much more demanding in what constituted soothing. Crib soothing was no avail—he would only respond to being held and when very calm through co-sleeping. He would only tolerate the crib when put down already asleep. Since our failed attempt with CIO, we got your book and have been reading. Based on it, we have instituted the following: 5:30 p.m. bedtime, wake-up between 6–7 a.m., vigorous play after wake-up, quiet play before nap routine, a 9 a.m. nap where we put our son down and leave the room (for the duration of his nap or for an hour if he doesn’t sleep). After that we shoot for a nap at noon, but we prioritize him getting good sleep over the timing, so we limit his wake windows to 2 hours or earlier if we see signs of drowsiness (we used to think of “drowsy signs” as the ones you refer to as signs of “fatigue,” so we are adjusting).
My question is: how do we prioritize sleep without further reinforcing habits that don’t teach him to self-soothe or confusing him with inconsistency? I know we can get him to sleep by taking him in the stroller during the day and by co-sleeping at night, and I can extend his sleep by soothing him every time he starts or stirs, but I also know these don’t give him the best quality sleep or teach him the skills he needs to self-soothe. Is it a problem for him to have one experience with the 9 a.m. nap (down drowsy-but-awake, left alone in the room at the end of the lullaby, allowed to cry) and another for all other sleep (often put down asleep, soothed beyond lullaby, and soothed if he wakes and cries)? From what we’ve read, it seems like consistency is key, but so is his getting sleep. It also seems like extinction won’t work if he isn’t well rested, so the sleep has to come first. We’d love your advice so we can fix some of our prior mistakes and set him up for the sleep he (and we) needs. In addition to the questions above, any guidance on how we will know our boy is sufficiently caught up on sleep to try extinction for the midday nap or night sleep?
Thank you,
Rae
How old is he now?
Clarify when and where do you currently nap him? Are you actually following the ‘Nap Drill’ as described in my book?
Describe in detail the timing and your behavior at bedtime and your son’s mood and behavior when alone with toys (no screens or parental involvement) during the hour before you begin the bedtime routine.
The most common mistake when attempting extinction is not having a super early bedtime in place and good naps. In retrospect, was this the case for you?
Thank you for getting back to me so quickly! He is exactly 5 months old today.
We only got your book, began reading it, and started to put the practices into place in the last few days. Three days ago we began instituting the nap drill for mid-morning nap (9am unless he seems to require earlier). We are doing the nap drill in our shared bedroom, putting him down in his crib and letting him attempt to self-soothe for one hour. For the remainder of the day we try to maximize sleep, minimize crying, and keep wake windows brief (2 hours max), targeting an early bedtime (5:30pm.) So we are not doing the nap drill for the midday or subsequent nap – we are doing “check and console” to try to maximize sleep.
Prior to reading your book, his naps were sometimes in the stroller and sometimes in his crib or on our bed, timed based on the Huckleberry app’s SweetSpot recommendation (unless we thought he clearly needed it earlier) with a goal of 3-4 naps per day, but often with more since naps were usually for 20-40 minutes at a time and we were shooting for a 8pm bedtime.
Now that we are targeting the earlier bedtime, we are looking for calm play and maybe a little spaciness as cues that he is ready for bed. Since it ahas only been a few days, additionally, he hasn’t spent much time alone with toys during that window. Play with toys has included parental involvement. We don’t give him screen time.
Our current behavior at bedtime is about a 20 minute routine – nurse, diaper change, wash hands and face, put on pajamas, quietly cuddle for about 10 minutes listening to the same few songs every night. Since we are focused on maximizing sleep, we then stay with him until he is asleep (though he usually wakes up crying within 15-20 minutes, and then frequently after that until 10 or 11pm, when he finally crashes for three or four hours.)
You are correct, we did not have a super early bedtime and good naps in place before attempting extinction.
Congratulations! Everything that you are doing is excellent and age-appropriate. For exactly how many days have you had this program in place? Have you seen any improvement in sleep, mood, or behavior since you started?
Previously, you wrote, “My question is: how do we prioritize sleep without further reinforcing habits that don’t teach him to self-soothe or confusing him with inconsistency?”
How may I help you?
Thank you for the encouragement! The inconsistency issue as we see it is that for the mid-morning nap we utilize the nap drill to try to develop self-soothing skills, whereas for all other sleep we prioritize sleep with check and console (often going to great lengths to console so he will sleep), which seems to reinforce the bad habit that we will sooth him rather than him soothing himself. If you don’t see that as a problem, we will go ahead as descrilbed in our prior messages. If that does seem like a problem from your perspective, could you please let us know how we should modify our actions. Also, is there a rule of thumb for how we will know he is napping well enough and has caught up on sleep debt enough to expand the nap drill from the first nap to all naps and to attempt full extinction again?
Many thanks!
Nap rhythms are well established by about 6 months of age, the morning nap develops first so:
1. Maybe wait until 6 months of age to do the Nap Drill for both the midmorning and mid-day naps.
2. Try the nap drill now for both the major naps for 2-3 days only and then reconsider whether check and console makes more sense for the second major nap.
3. Experiment with shorter intervals of wakefulness before each nap to reduce pre-sleep arousal.
Now that an early bedtime is in place, and night sleep rhythms begin to develop at about 6 weeks of age, I suggest now is the time to retry extinction. But don’t do it if you cannot commit to a 3-5 day trial (because of your experience in the past). Better night sleep will definitely make naps easier.
How fragmented or consolidated is his night sleep now?
Thank you again. Regarding your questions and with some clarifying questions of our own:
Based on our past experience where he cried the full 3-4 hours between bedtime and nursing, when we try extinction at night, should we be concerned about that happening again? What if that repeats for the entire time from bedtime at 5:30pm to wake-up at 6am? If either of those things happen, should stop our attempt at extinction? Should we stop for the night or for several weeks before trying again? Is there any cap on how much crying (duration and/or intensity) is too much?
Should we try the nap drill for both naps and extinction at night simultaneously or should we try one first? If we shouldn’t try them simultaneously, which should we try first?
For context on the past three days with the mid-morning nap drill: The first morning we put him down asleep and he stayed asleep for 75 minutes without a need to console. The second two mornings we put him down drowsy but awake and he cried for the full hour.
Sleep is currently very fragmented. Last night looked like this:
4:46pm – nursed
5:27-6:04pm – asleep (crib)
6:06-6:14pm – asleep (crib)
6:30-6:37pm – asleep (crib)
7:32pm – nursed
8:06-8:15pm – asleep (crib)
8:28-9:30pm – asleep (crib)
10:45pm – nursed
11:35pm – 1:37am – asleep (being held)
1:42am – nursed
1:50-4:07am – asleep (cosleeping with occasional hand on chest or shushing when briefly woke)
4:09am – nursed (one side)
4:14-5:39am – asleep (cosleeping)
5:41am – nursed (other side)
5:48-6:59am – asleep (cosleeping). Woken up per 6-7am wake-up time.
As a side note, this is more nursing than I would do if we weren’t prioritizing to maximize sleep. In addition to the sleep issue, our son also refuses a bottle most of the time as of the last month.
We really appreciate your help!
Because the night sleep rhythm is much better developed than his day sleep rhythm for now and because his night sleep is so fragmented and because the fragmented night sleep means that he wakes up short on sleep which messes up naps, I would encourage you to try extinction for 3-5 nights now. The super early bedtime should produce better results than last time.
However, I know that this will be stressful to you and during this 3-4 night trial, consider abandoning the nap drill and check and console for the second nap. Instead, do whatever you can to maximize day sleep and minimize crying (contact naps, swing naps, car-ride naps, etc.) and not worry about habit formation. Yes, it might undue some progress that you have made with with self-soothing for the first nap, but if night sleep improves a lot over the next few days, than we will go back to self-soothing attempts for naps.
How does this sound?
Also, by sleeping more during the day,there will be less pre-sleep arousal at 5:30pm. He is bathed, fed, and soothed and you are leaving the room at 5:30pm. He is fed once at night at or more than 4 hours after his last feeding and if needed at or more than 4 hours in the early morning. Do not awaken him in the morning for nap scheduling purposes and do not cap naps. But no new nap starts after 3:00pm. If he is asleep at 3pm, do not wake him.
How does this sound?
Thank you.
We’ll try extinction at night. Can you please confirm you would feel okay about him crying for the full 4 hours between feedings? And if he does so, after feeding him would you let him return to crying for potentially another 4 hours?
Yes, let me know how it goes.
And if we understand your recommendations correctly, we will continue the nap drill mid-morning and abandon it for mid-day nap.
Depending on how the first night goes and how you feel about it, you might want to do the nap drill only for the morning nap. Or forget the nap drill entirely and nap scheduling for 3-5 days and do whatever you can to maximize day sleep and minimize crying. Keep the intervals of wakefulness between naps brief. The emphasis for the next 3-5 days is on a super early bedtime and extinction at night.
I wrote:”However, I know that this will be stressful to you and during this 3-4 night trial, consider abandoning the nap drill and check and console for the second nap. Instead, do whatever you can to maximize day sleep and minimize crying (contact naps, swing naps, car-ride naps, etc.) and not worry about habit formation.”
Is this OK?
Thank you so much for your generous support, Dr. Weissbluth. We truly appreciate it.
We will give the 3-5 day trial a shot as you advised (making a decision on the nap drill based on how the first night goes). We will hope for the best, but be prepared to let him cry the whole span from bedtime to wake up (with nursing breaks every 4 hours), if need be. We feel much more confident moving forward with the potential for a long duration of crying hearing from you that it is okay, based on your expert knowledge.
We will report back. Fingers crossed!
Please keep a written record of crying (intensity and duration).
Hi again,
We are planning to start nighttime extinction Sunday night. Meanwhile we have been prioritizing sleep. Today, however, we had to take him in the car. He cried in the car seat for about 40 minutes, then threw up, so we pulled over to soothe him. We’re concerned that he gets himself so worked up when he’s crying. If vomiting occurs during the extinction attempt, should we stop it? Or does this degree of crying intensity mean we shouldn’t attempt it Sunday?
Thank you.
Was vomiting with hard crying a common problem when you tried extinction before?
Always promptly attend to vomiting.
He’s never vomited before from crying
“If vomiting occurs during the extinction attempt, should we stop it? Or does this degree of crying intensity mean we shouldn’t attempt it Sunday?”
Commit to 3 nights of extinction or don’t attempt it.
If he vomits from crying, Dad immediately attends, cleans, gives a kiss or hug and puts him down, no soothing.
Typically, there is some improvement on the 2nd night.
Thank you for the continued advisement
An update for you – since our child’s crying during extinction attempts had been so frantic and intense, we decided instead to use the “check and console” method at night, increasing the time period between checks each night. After 2-3 hours of check and console, we moved him to our bed to co-sleep. During the day we maximized sleep with lots of soothing, stroller naps, etc. and tried to minimize crying. After about 6 nights, he fell asleep by himself for the first time, about an hour and half into the routine. It was only for three minutes, but that encouraged us to add the nap drill for the morning nap. On the second day of the nap drill, he fell asleep after 59 minutes of crying. On the third day, after 33 minutes, and on the fourth day after only 5 minutes. Meanwhile at night we increased the check intervals to an hour, and last night he fell asleep on his own after the first check, then slept for over three hours without waking. We’re going to continue with one-hour check-in intervals at night until the time to fall asleep drops, continue with the morning nap drill, and start the nap drill for the mid-day nap. We are so relieved that our baby can finally put himself to sleep. Thank you again for the support!
Congratulations.
Please read the sections “Graduated Extinction’ and ‘Check and Console’ in my book to clarify what you are doing at night.
How old is he now?
My sincere goal is to raise the visibility of accurate information regarding children’s sleep. To encourage other parents, please consider writing, and posting here, a narrative report of your sleep adventure (please include the role of the father) that I would use as a Blog Post or perhaps, only if you feel comfortable, an Amazon book review.
Thank you! He is now 5 months and two weeks.
You and your book have been so helpful for us, we would be happy to write a narrative report if you think it would be helpful for others. Perhaps when we’ve made a little more progress so we can share a fuller picture of our sleep journey? We can definitely include my husband’s role. He was already involved in the process but based on your book, he took over bedtime (including check-ins).
We would be happy to write an Amazon review as well, however we didn’t acquire our book through Amazon, so I’ll have to check if that’s a requirement for posting there.
A bit of an update and a question:
Nap 1 and 2 are going great! He now consistently falls asleep in less than 15 minutes after being put in the crib (and often in only a minute or two). Nighttime sleep has also improved greatly from where we started, but it takes our son much longer to fall asleep at bedtime than at nap – typically 1.5-2hours from when we put him in his crib (we no longer check and console after the hour mark). We’re not sure why there would be such a marked difference from the naps in terms of time to fall asleep. Other than having a more robust bedtime routine than nap time (a bath, change into PJs, and more songs and cuddling vs. no bath, just removing his pants, and one or two songs with cuddling), we treat the two the same. Do you think we should abbreviate the evening bedtime routine? We currently do a 5:30pm bedtime (or earlier if we see sleepy signals and/or the wake window from his last nap would be over 2hrs), do you think out bedtime is too early and we should add a forth nap to address the wake windows? Or something else entirely?
Thank you!
Please clarify, are you starting a bedtime routine at 5:30pm or are youi leaving the room after soothing at 5:300pm?
Now tat he is napping better, base the onset of soothing to bedtime subtle drowsy signs. His bedtime might therefore be a little later, but don’t push it.
Please also shorten the duration of soothing to sleep, that is, a shorter bedtime routine.
Wake windows are bogus; ignore them.
Is this OK?
Thanks so much for getting back to us! We leave the room after soothing at 5:30pm. We normally are seeing drowsy signs corresponding with our start of the bedtime routine, so it sounds like we should stick with the time as long as that remains the case. We will shorten the bedtime routine and report back!
Thank you again!
We’re on night two of trying to get my 4m old to sleep without a pacifier. Tonight we put him down at 5:30 pm. I put him down. Let him cry for 10 minutes before I rocked him and patted his butt for less than 3 minutes until he was asleep. I transferred him and provided a few chest taps to help him transition. I have anxiety and straight extinction is a lot on me.
If he wakes up at say 6:45. Is this plan ok? Cry 10 minutes then chest taps then pick up if necessary?
So the first 2 nights of 530 bedtime were great!!!. Tonight i put him down at 530 but now at 730 he’s awake and crying. Does that mean I put him down too early?
Did you observe drowsy signs or fatigue signs between 4:30-5:30pm?
Around 5 he was absolutely loosing it when i walked out of room but was fine during diaper change and bedtime routine.
What is the latest that you would put a 4m old down for a nap?
I think that a new nap should not start after 3pm in order to get a 5:30pm expected falling asleep time.
If he is asleep at 3pm from an earlier nap, do not wake him.
For clarity, please write a summary of what has been happening recently.
I will have to get back to you. We were on a roll but Im starting back at work. Family watched him. Gave him back a pacifier and didnt make him nap. Its like we’re trying to undo all of that. It seemed like up until then we were making really good progress
Hi Dr. Good morning
Our daughter is 2 years and 7 months old and she has been sleep trained under your methods since she is 7 months old.
She’s been a wonderful sleeper ever since and we’re the envy of plenty of our friends with kids as we’re the only ones with good naps and long night sleep through the night.
All that changed back in May, as our daughter got potty trained. Since the first week, she got used to the potty, but she also started having shorter nights, or waking up in the night as she wanted to go to the bathroom.
For us this was fine as we knew this was part of the potty training, however, in June, once she had settled nicely, she took her night sleep as a pattern to wake up between 5.00 and 5.30 am, and only sleeping between 10 and 10.5 hours during the night.
We have always encouraged the early bedtime, so she religiously goes to bed between 19.00 and 19.15, so we tried to adapt as well and also went ourselves early to bed to be ready when she wakes up, as she never wants to go back to sleep.
She changed to a normal bed in July, which did not disrupt her sleep at all, but since 3 weeks ago it has been a bit of a nightmare. She’s waking up at 4 and not going back to sleep at all.
Funny thing, her naps are OK. She sleeps in daycare and at home between 1 and 1.5 hours.
We switched her bedtime to 18.30-18.45 and it did work, but only for a couple of days, and then we tried exctintion for 7 consecutive days, without any change at all. Actually, exctintion is the method we always used since she was a baby and it worked every time in a matter of one or even two days maximum.
After these 7 days, and since she speaks now, she started expressing her sadness, frustration and anger for being left in the room, especially as we have always had a safety gate, which she no longer wants to have closed.
The last two weeks have been really bad. And she is fighting nap time, fighting bedtime, waking up at 4 and not going back to bed, and her hours of sleep have decreased dramatically from 12 to 10.
We’re scared of trying exctintion as she has now these feelings she’s expressing, and we tried another example of your book with the sleeping rules of when to stay in bed, when to get out, and we bought a digital clock to show her the 4,5,6 am and have for the last two weeks repeatedly showed her when she shall stay in her room and when to go out, but she’s taking it more as a game.
Would be great to have your advice, because this decrease in sleep is clearly showing at bedtime as overtiredness, she is more fussy, and the days when we tried the early bedtime, she ended up waking even earlier.
Thank you!
Please re-read the section ‘Sleep Rules and Silent Return to Sleep’ and tell me what you have used for positive and negative reinforcers. Did you make a poster and does she understand consequences? If yes to both, for 3 nights only, try again extinction but with a ‘reset’ which is a 5:30pm expected falling asleep time (she is bathed, dressed for bed, fed, soothed, and you are leaving the room at 5:30pm). The last ‘Sleep Rule’ regarding her leaving the room might be temporarily 5 or 5:30am.
PLease describe in detail how she is currently napping.
Back in May, during the hour before her 7- 7:15pm, when alone with toys (no parental involvement and no screens) did you notice any subtle or minimal pre-sleep arousal (fatigue signs)? If so, cumulative sleepiness (Blog Posts 84-86) over months might be the cause of her developing impaired sleep.
How does this sound?
Thank you for the speedy response!
To your questions:
No, we didn’t make a poster, we were planning on doing it this weekend.
And yes, she understands consequences as she does react to them for other things (like eating or playing)
Regarding napping. She has been consistently taking her nap between 11.30 and 11.45 and sleeping minimum one hour, maximum 2. But the last 2 weeks, depending on the time she wakes up, she’s taking longer to fall asleep or just fighting the nap all together. This has resulted in a couple of days sleeping up to 3 hours and another couple of days skipping it completely, then she is absolutely exhausted by 17.00.
Back in May, she was not fatigued. The issues really started more from mid June, but at least she was sleeping straight through the night still. Now as of three weeks ago, she’s waking up almost every day, and when she’s not, she’s up at 4.00 and crying for at least an hour. That’s when we decided to stop and bring her to our bed, and she did fall asleep inmediatly up until 6.30 (we all did)
But it’s not a rule, it’s quite an irregular rhythm.
And regarding the reinforcement, we did use praising excessively when the clock hit 6 am, but after she had been crying since 5.00, so that’s when she started to tell us that she felt sad and frustrated. I feel it was more the negative reinforcement of closing her gate that didn’t help. Although we still use it because she comes out of bed still when she goes to nap or to bed at night.
She asks for the gate to be kept open and we tell her the consequences of coming back out, which is to close the gate, so we give her a chance every night to keep it open if she jumps to bed and closes her eyes, but I think she wants to double check that the gate is open so she comes out each night.
We are trying to be consistent so when she does this once, we close the gate and tell her she has not done what we agreed, so the gate closes. Funny enough, she then takes this as final, stops crying and then crawls in bed and falls asleep.
Should we still try the extinction as you recommend for 3 days? Or does this has another impact on your recommendation?
Thank you!
Please re-read the section ‘Sleep Rules and Silent Return to Sleep’ to better understand my suggestions:
Please let her contribute to making a colorful ‘Sleep Rules’ poster.
Discover a more powerful + and – reinforcer as described in my book.
Extinction over night and ‘Silent Return to Sleep’ means there is no emotional, social, or verbal interaction overnight.
“Should we still try the extinction as you recommend for 3 days?” Yes, if, and only if, you can fully commit to 3 consecutive nights with a consistent 5:30 expected falling asleep time.
Do the ‘Nap Drill’ as described in my book for the 3 day trial.
Your thoughts?
Thank you Dr. Yes, that sounds like a good plan.
We’ll do the poster with her tomorrow and continue reinforcing the sleep rules and the silent return to sleep.
We need to accommodate daycare pick up times and work first, but we can commit in a few days to the 3 consecutive day 5.30 pm bedtime.
Up until then (just 2-3 more days) shall we keep the 7.00 pm bedtime unchanged? Or try to put her a bit earlier each day?
“Or try to put her a bit earlier each day?” Yes
Describe the + and – reinforcers that you use for Sleep Rules.
Thank you Dr.
We re-read the section for the sleep rules and we have now made her poster with images and colors. We actually did the same for potty training, so she has sort of an extension of that one, but now with the bedtime rules.
We will use stickers as this worked before, but also the cookies as they are big motivators nowadays for her, and we will offer the choice of not locking her safety gate any longer once she has reached a few consecutive days of staying in her room.
The last two days we put her to bed earlier and she only had 1 night waking the day before yesterday, but went back to bed up until 5.45, and yesterday she slept through the night from 7.00 to 5.45. Which is already progress.
We’ll keep you posted for the next few days with the updates.
Thank you!
I feel like something is off with our 4.5 month olds sleep schedule. Looking for input.
Wakes around 6-730
Aim for 9-930 nap which has been about 2 hours.
Nap again 1. Usually about an hour.
The dilemma becomes do we put him down for a short nap at 3:30 and put him down around 630
Or
Skip 330 nap and aim for a 530 bedtime?
Have you read the age-appropriate chapter in my book? I need more information to help you.
Yes I have. I feel like I remember it saying 3 naps is normal. And to start scheduling naps instead of going purely off signs
Putting him down at 530 results in a super overly tired baby because he bas often been up since 2-230.
A third nap gives a later bedtime but I know you favor early bedtimes
Regular nap rhythms develop between about 4-6 months of age and by 6 months of age, infants have a major midmorning naps and a mid-day nap +/- an irregular and sometimes brief 3rd nap.
Because of his age, nap him when drowsy signs appear and the bedtime (based on drowsy signs) will vary because of the variability of naps.
There is nothing wrong with a third nap and a bedtime around 6:30.
Hi Dr. Weissbluth,
I have an 8-month-old, and we began using the Weissbluth extinction method around 5.5 months. With our pediatrician’s support, we cut out night feeds cold turkey (instead of gradual weaning) and accomplished that over about 2–3 weeks. For the next two months, she consistently woke between 5–6am, and I would feed her because she seems very hungry in the morning and we would start our day . Our desired wake time is 6–7am, but we were satisfied with at least 5am.
During this sleep training time, we disassociated eating and sleeping by putting her down for naps and bedtime awake, and had her sleeping long naps in her crib (and elsewhere if we are on the go, but mostly in her crib). She goes down for bedtime and naps with minimal crying. A couple times last month I nursed her around 5am and put her back to sleep (awake) and she slept until I woke her up at 7am. Since she went right back to sleep and needed to be woken up, I have thought that she needs the sleep and would benefit from this so I repeated this a couple more times when I craved more sleep.
Recently, she has been waking even earlier (around 4:30am). I’ve been nursing her and putting her back down, which feels like I’ve unintentionally reintroduced night feeds and created inconsistency. Now I’m unsure whether to let her cry at 4:30am or feed her, and I usually end up feeding her.
I’m comfortable with cry-it-out as a short-term tool but don’t want to do it inconsistently and prolong the process. I’d love your thoughts on how to handle these early morning wakings and move toward a consistent 7–8pm bedtime with a 6–7am wake time.
Some additional information: she nurses and takes bottles of breastmilk, eats solids 1-2 times a day, her naps are long (~1 or 2 hours) and we are currently in the transition from 3-2 naps.
Thank you so much,
Alex
Currently, what time does the bedtime routine begin and when does she fall asleep at night.
It appears that you want to control her sleep schedule: “and move toward a consistent 7–8pm bedtime with a 6–7am wake time.” Is this correct? If so, what are your thoughts regarding her circadian sleep rhythm?
Hi Dr. Weissbluth – wow thank you for the quick response! I’m sorry that wasn’t clear and I’d like to clarify. We have a consistent bedtime between 7 or 8, usually closer to 7. We typically start the routine with nursing around 6:30, then bath, then books and bed and she’s typically asleep by 7:15. She only cries for a couple of minutes. I am seeking advice on how to support her with sleeping through to 6am or later. I’m not sure about her circadian rhythm exactly, but she does have blackout curtains.
Please describe her mood and behavior when alone with toys (no screens or parental involvement) during the 60 minutes before the start of your bedtime routine or last nursing at night.
She is typically very happy and playful. We often play with her on the playmat, but sometimes leave her for independent play when she is fine with that without crying or reaching for us. She recently started crawling and trying to pull up on everything she can get her hands on. We have never put her in front of a screen and keep the TV off when she is in the room and try to limit our time on our phones when around her. Our bedtime routine is now nurse, bath, books, saying goodnight to the animals on the walls of her room, and down in the crib awake. We have noticed that the books really calm her before naps and bedtime now that she engages with them more. She is very distractible while nursing so I try to do it upstairs away from the dogs or dad because she’ll turn away to play or make faces at them and I want to ensure she gets a good feed. I have thought about pumping and giving her a bottle before bed to ensure she get enough to last until morning, but when we do that she still has the early wakings.
Does she have anything like a ‘witching hour’ or a fussy period in the late afternoon or early evening?
Am I correct that your main concern is recent early morning wake-up times?
If so, the most common cause is a bedtime that is a little too late. Please read Blog Posts 84-86 regarding Cumulative Sleepiness
To more fully understand the role of circadian rhythms, please read Blog Posts 8, 62, and 112.
Reading Blog Posts 160 and 173 will clarify my suggestion: Please put your infant to sleep 20 minutes earlier than usual for 4 consecutive nights and monitor the latency to sleep onset and the wake up times and report back.
How does this sound?
That sounds great, thank you for the suggestion. I will reference those blog posts and report back on how these next for nights go!
If she does wake up before 6, do you recommend I feed her and put her back down to sleep until 7am, feed her and start our day, or delay going into the room even if she is crying a lot?
Starting the day substantially before 6am is problematic because it becomes harder for the baby to get to a circadian nap around 9am.
If quickly responding with a feed +/- diaper change around 4-5 am usually allows her to return to sleep, go for it.
If quickly responding with a feed +/- diaper change around 4-5 am rarely allows her to return to sleep, try leaving her alone to see if she will return to sleep unassisted.
The key to avoid wake-ups in the morning that are too early is an early bedtime.
The times above are guidelines, not rules. Many babies her age start the day around 5:30-6:30am.
Does this help?
This is incredibly helpful! Thank you Dr. Weissbluth!
Hi Dr. Weissbluth,
We started extinction with My 6 m.o. daughter, She usually takes 2 naps (1st nap around 9-10:30 and 2nd nap is usually around 2-2:30 for an hour and a half) I’ve been doing early bedtimes (around 6pm) the first few nights after extinction she was amazing! She slept better than ever and woke up only twice to eat and went happily back to sleep, but then a few nights later she started waking up crying again throughout the night. The first time she did this I went in and burped her because she seemed gassy which she was, now I’m worried that I’ve created a night-waking habit. She’s been waking up throughout the night (not just too eat) and early morning as well. She won’t calm herself on her own in middle of the night, but she does put herself to sleep in the beginning of the night. Should we try extinction again?
Is it possible that this is happening because of her day naps? she is at a babysitter in the morning and I have a feeling that her second nap is too late but there isn’t much I can change about her schedule unfortunately.
I was okay to do extinction and I saw those amazing results that you talk about in your book, but I think my excitement was short lived. I’m hesitant to let her cry without limit again, but I am also not convinced that any of the other methods will work for her, she is strong willed!
I would love your advice!
What is her current falling asleep time?
“her second nap is too late [YES!] but there isn’t much I can change about her schedule unfortunately [PLEASE EXPLAIN].
6PM
She is in a day care and if she falls asleep too early than I’m afraid when I pick her up she’ll be in middle of the second nap.
Please clarify when and where she takes her first nap and when the day care offers a 2nd nap opportunity.
Sure, the first nap is at the day care between 9-9:15
She can take a second nap at daycare at around 1Pm but I pick her up at 2/2:15 and then I worry that she will wake up. So i’ve been giving her a second nap at 2:15 at home but she is already overtired at that point.
I think a nap attempt beginning in synch with her biologic nap rhythm is best. Starting a nap after 2pm seems late to me.
How about encouraging a nap at day car around 1pm and then try a super early bedtime, if needed for 3-4 days and see how night sleep goes?
I will try this, thanks!
How early bedtime would you suggest?
Another question- if her caretaker at daycare helps her sleep longer by putting in a pacifier in middle of her nap when she cries, will this contradict my efforts with extinction? (I’m not putting in pacifiers at night I want her to return to sleep on her own)
Read Blog Posts 83,115X, 226C,232X, 232BX, and 232D to have a clear understanding of drowsy signs.
Put her alone (no screens nor parental nor sibling interaction) with toys for 15-30 minutes between 4-5pm and look for drowsy signs.
Depending on her 2nd nap, the bedtime might vary a bit but it might be as early as 5:30pm (she is bathed, dressed for sleep, soothed, and you are leaving the room at 5:30pm).
Because the day care is different (noise, lights, caretakers) let them use the pacifier to maximize her naps. She will know that these associations are different from the home.
How does this sound?
This sounds wonderful. I will try this. thank you!
I so appreciate your advice! The most wonderful thing about this sleeping method is that it honestly doesn’t feel like training- it feels like I am deeply listening to my child’s needs and her natural rhythm.
Thank you for your advice and for sleep!!!
Please keep a written record and let me know how it goes.
Hi Dr. Weissbluth,
My friend recommended your book, and I have it on hold at the library — in the meantime, I’m hoping you might be able to point me in the right direction.
I’m trying to help my 8-month-old sleep better. I’ve been reading about the importance of an early bedtime, but I haven’t found much guidance on wake time. Right now she’s on a 9pm–9am schedule, though sleep is a real struggle: she can’t fall asleep independently, wakes every 1–3 hours, and has a hard time settling.
My main question: should I gradually shift her schedule, or just move her bedtime to, say, 5:30pm tonight? And is there a target wake time I should be working toward?
Any guidance you can offer would be so appreciated. Thank you!
At marcweossbluth.com, go to the Blog and read Posts 74, 212, 228C, and 235AY. How does this sound?
Hello,
My 12 week old (born 1 week early) can not fall asleep on his own without bottle/nursing followed by rocking and being held until asleep once in his crib he’ll sleep about 2 hours at night followed by frequent wake ups. Around 3 times to eat and several other comfort nursing. Sometimes he’ll only last 40 min in the crib at night. During they day, he also only falls asleep from nursing/rocking. We have tried placing him down “drowsy but awake” but he has a very intense temperment (per the pediatrician) and escalates from calm to screaming immediately. When he contact naps he’ll sleep for an hour or more. I put him down for 5 naps a day and he has about 60-75min wake windows consistently. He rarely has typically drowsy cues and will go from awake and calm to crying when overtired if we miss the window to out him down.
We would like to try the extinction method to get him to learn to fall asleep on his own and stay asleep when he wakes up during the night. Given that he still needs several night feedings, how do we handle that with the extinction method?
Also, given his intense nature, I’m concerned the technique of letting him cry won’t be effective and he will simple cry all night. How should we approach this method to set him up for success?
Before trying extinction, tell me the approximate clock time(s) that you begin to soothe him to sleep for the night.
Currently he starts bedtime routine with Dad at 7, finishes bottle by 7:45 and is sometimes asleep by 8 although sometimes need so much rocking it can take another hour.
(During the day, he wakes up at 6:30am. Naps are pretty consistently 75 60 min after awake period. At the 60 min mark I start swaddle/white noise/short nursing/rocking 60 minutes of wake time
For 2-3 nights, bserve him placed alone with toys (no parental or sibling interaction, no screens) for 15-20 minutes between 6-7pm and describe his mood and behavior
He was alert, calm and waving his arms, looking at toys for about 10 min, making cooing sounds. He then began mild fussing. Once picked up he was relaxed and looking around but started to fuss off and on for brief periods throughout the hour.
“Once picked up he was relaxed and looking around but started to fuss off and on for brief periods throughout the hour.” This is pre-sleep arousal and the cause of his sleep difficulties. Read carefully Blog Posts 9, 83, 115X, 226C, 232AX, 232D, and 232BX ti understand drowsy signs and Blog Posts 159, 171, 172, 204, 233X, 235C, D, and E to understand pre-sleep arousal. Tell me what I will recommend.
Seems like he is getting overtired and needs an earlier bedtime when his drowsy signs appear after the last nap of the day
YES! For three nights only, try an expected 5:30pm falling asleep time (he is bathed, dressed for sleep, fed, soothed and you are leaving the room at 5:30PM). Ne new nap starts after 3pm. If he is asleep at 3pm, do not wake him. Keep a written record and report back.
How does this sound?
Thank. I am planning to give this a try next week. One question- he has been having very short periods of wakefulness between naps, typically only about 60 min. For example, of he gets up at 3:15, by about 4:15 he is going to need to be settling for a nap again (and will start crying hysterically of not). How should I handle that given that we are aiming for a 5:30 bedtime?
The suggestion of no new nap starting after 3pm and a 5:30 falling asleep time is a guideline, not a rigid rule. Do your best to avoid pre-sleep arousal and the the early bedtime.
We just started extinction method with 12 week old. We do an hour cap for nap time and no cap for bedtime. He has always been a great eater and eats the biggest feed in the evening around 6 so we have moved up bedtime and start the wind down routine right after he eats. Last night he only cried for 20min then fell asleep.
I’m wondering, what do we do for nighttime wake ups since we share a room with him? I usually intervene to avoid crying and give him his pacifier, place my hand on his chest and he soothes back to sleep. But is that breaking the consistency? Should I be letting him cry?
He was sleeping 8-10hrs a night without waking up at all, but now he has started these mini wake ups where he talks and is building up to a cry unless I give him the pacifier.
Why do you cap the nap?
My thought was he would get too tired? He’s only cried longer than an hour for a nap a couple times but he doesn’t sleep long during the day at all. Ever since he was three weeks he will sleep 15-20min during the day. Every couple days he will nap for 30-maybe 40min. He’s continued this time even with extortion in place.
He’s always been a great nighttime sleeper though.
i misunderstood your comment. Am I correct that you cap for the nap is for crying, not the duration of the nap?
Describe a typical 24-hours of sleep; when he naps and when you start the bedtime routine and when he falls asleep at night and what happens over night.
Yes. We only let him cry for one hour at naps.
Bedtime routine starts at 5:30pm (feeding, bath, pjs, reading, put down awake) he’s in bed by 6pm at the latest cries for about 20min then is asleep.
Wakes up about 3-4 times at night, very lightly cries or only whines for 5-15min. and falls back asleep.
At the 5am wake up I feed him, and he usually falls back asleep nursing. I try to wake him up so he’s alert when I put him back in his bed, and falls asleep without crying for 30min-1hr.
The rest of the day is big fights against napping. He only makes it about an hour before the first sleep cue shows.
Then I put in pj’s on sing him a quick song to get him relaxed in my arms but still fully awake then lay him down. He’s usually very happy and relaxed, I give him his pacifier then leave the room.
Takes about 5-10min before he starts crying. And he cries hard for 30min-1hr.
If he falls asleep he will sleep for anywhere between 10min-45min.
If he doesn’t fall asleep within an hour I go get him, keep him up for an hour and then try again.
He fails with no sleep for 1-2 naps a day.
He’s never been good at napping even as a newborn.
He is a fantastic eater and quite a chunky little guy, so I know he is eating enough through the day.
He has slept through the night many times, it is only recently he has started these middle of the night wakings.
He was born 1week past his due date.
We have black out curtains and a white noise machine.
He does share a room with us, but has his own bed.
For 2-3 nights only, put him alone in a separate room for 15-20 minutes with toys (no parental interaction or screens) between 4:30-5:30pm and record his mood and behvior and report back.
Describe the duration and timing of the usual last nap of the day.
He was a little fussy when left alone but content with the toys. Cried to be picked up at around the 15min mark.
His last nap is between 3-4pm and is between 30-50minutes long. Takes him about 20min to fall asleep.
Read Blog Posts about pre-sleep arousal (159, 171,172, 204, 233X, 235C,D, &E) and tell me your thoughts.