Healthy Sleep Habits, Happy Child
26
Compare Different Sleep Solutions (Sleep Solutions #4)
May 10, 2021

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Healthy Sleep Habits, Happy Child

5th Edition: 
A Step-by-Step Program for a Good Night's Sleep

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Healthy Sleep Habits, Happy Child

5th Edition: 
Chapter 1 (only 16 pages!) outlines everything you need to know about your child's sleep.

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Introduction

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

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

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

COMPARING DIFFERENT METHODS

All the items listed below in “WHAT A PARENT CAN DO” contribute to the prevention of sleep problems developing in the first place; the earlier you start, the more likely your success.  All of the items listed below in “WHAT A PARENT CAN DO” also contribute to the treatment of sleep problems, but they might not be sufficient.  Specific family circumstances (Blog Posts 14 and 17) and individual differences in babies (Blog Post 20) might make this difficult to accomplish and a sleep problem (difficulty falling asleep or staying asleep, bedtime resistance) 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 21) and effective treatment strategies that do involve letting your child cry are ‘Graduated Extinction’ and ‘Extinction’ (Blog 22).

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 (Blog Post 21).  Nevertheless, here are some general observations that might help you:

  • If there is moderate or severe marital distress or perhaps either one or both parents have symptoms of anxiety or depression, consider starting with ‘Fading’ or ‘Check and Console’.
  • If there is mild marital distress or perhaps only one parent has symptoms of anxiety or depression, consider starting with ‘Graduated Extinction’.
  • If there is minimal marital distress and neither parent has symptoms of anxiety or depression, consider starting with ‘Extinction’.

Here are the published facts about the different methods:

  • Graduated Extinction takes about 4 to 9 nights. In general, it is easier to implement because it is more acceptable. 
  • Graduated Extinction, compared to Fading, produced more consolidated sleep and longer sleep durations but both shortened the time to fall asleep.
  • Graduated Extinction and Extinction in infants 5 to 6 months old: First night crying duration was 43 minutes and dramatically decreased after the first night. The highest first attempt success rate was for Extinction and the most common second attempt was a switch from Graduated Extinction to Extinction.
  • Extinction takes 3 to 4 nights. In general, it is more difficult to implement because it is less acceptable.   
  • Extinction in infants 6-months-old; No crying by the 3rd night.
  • Extinction is chosen over Graduated Extinction when there is less stress in parenting and among mother’s whose discipline style was not lax (they noticed and acted on misbehavior) and not verbose (they used appropriate parental reasoning and explanations instead of coaxing or begging).
  • Extinction success rate is age dependent:
  • Starting when child is younger than 4 months:
    • Night 1            Crying for 30-45 minutes.
    • Night 2            Crying for 10-30 minutes. 
    • Night 3            Crying for 0-10 minutes.
    • Night 4            No Crying.
  • Starting when child is 4 months or older:
    • Night 1            Crying for 45-55 minutes.
    • Night 2            Crying for a little more or less than Night 1.
    • Night 3            Crying for 20-40 minutes.
    • Night 4            Crying for 0-10 minutes.
    • Night 5            No crying.

CAUTION

Neither Graduated Extinction nor Extinction will work if:

  • Parents are inconsistent, for example, “just once” take the child back to their bed for nursing.
  • The bedtime is too late.
  • Naps are not going well.

RESET

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

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

Comments

  1. Hello Dr. Weissbluth, I have read your book and have been implementing early bedtimes and various other tips from your writing with my now 6-month-old son for the last 2 months. Unfortunately, his sleep appears to be deteriorating and I’m at a loss for what to do anymore. He does have a cold right now but sleep was getting worse even prior to being sick. He may wake at 5am and poop, or be up for 2-3 hours at night, gassy or just babbling. I have tried gentle and hypoallergenic formula, thinking it’s a digestive issue, but ultimately that doesn’t seem to make a huge difference. He was given breastmilk for 5 months in combo with formula, now formula only. He is in the 90th percentile for weight and height, sitting up already, and crawling for the last two weeks.

  2. To continue above comment…his daily schedule looks something like this:
    5:30-6 often up because he poops himself
    First nap: 8:45-9am- occasionally I have to take him with me for school drop off so he sleeps in the car. This nap is often less than an hour.
    Nap 2: starts around 12, now usually his longest nap at 1-2 hours.
    If second nap is longer, I can’t fit in a third catnap anymore and try to get him down early at 630 for bedtime. If he gets a third catnap, he has a 730 bedtime.
    He is currently sick with a cold so it’s hard to say how much of that is contributing. Sometimes at night he is up from 1030/11 to 1am either crying or babbling. Then he may wake again around 3 and be up for the day by 6 after pooping at 530. During the day he can protest a lot and loudly when set down to play independently in the evening hours yet other times he is ok.

    1. Please clarify, is this description “During the day he can protest a lot and loudly when set down to play independently in the evening hours yet other times he is ok.” in general or only now because he has a cold?

      What time does your husband usually come home from work?
      What time do you usually have a family dinner?

  3. In general he can do this not just right now. My husband is home between 530-6 and dinner is usually at 6 but sometimes my toddler and I will eat sooner than my husband.

    1. The inability to play independently (no screens or parental interaction) tells you that his sleep tank is going towards empty near the end of the day.
      “his sleep appears to be deteriorating” tells you that he is suffering from cumulative sleepiness.Please read and have your husband read Blog Posts 84-86.
      “my now 6-month-old son for the last 2 months. Unfortunately, his sleep appears to be deteriorating” Probably the most common sleep issue in child #2 is that after 6 weeks of age, child #1 distracts parents from noticing and implementing an earlier bedtime for child #1.
      My advice is to implement a strict 5:30 expected falling asleep time (you have done all the bathing, feeding, soothing, lights are out and you are leaving the room at 5:30pm) on Saturday when your husband is home to help with your older child. If the current cold is present and mild, I would still try it but end the attempt if their is any crying. If the current cold is present and medium or major, wait until it passes. Do not attempt this if your husband is not supportive.
      Let me know your thoughts.

  4. Ok, is there a certain amount of time I should leave between the last nap and the 5:30 bedtime? Or just do it no matter what time he wakes from last nap? Today he woke at 3pm from last nap.

    Thank you! I am fine doing it tonight and husband is fine with it as well.

    1. I suggest that you do not let a nap begin after 3pm. If he is asleep at 3pm from a nap that started earlier, let him sleep.
      If his cold worsens, please do not continue.
      If his cold does not worsen, please do not start unless you can commit for at least 3-5 nights.
      Please keep a detailed written sleep log for night and day sleep.
      Let me know how it goes.

  5. Hi Dr Weissnluth,

    I have been practicing your method with my now 12 week old since he was about 2 weeks old. Bathtime at 530pm and feed/bedtime shortly there after around 6pm. He goes down seamlessly, falls asleep around 20 minutes after being put down awake with no issues. However, he is still struggling to sleep through the night. He will wake up at around 12/1am and I feed him a small bottle and then again at 330/430am. And then back up sometimes at 530am and 630am for the day. Once or twice he slept through to 430am for one feeding.

    At this age should I ignore the night wakings? Is he eating out of habit? Im not sure how to get him to sleep through the night. Once I feed him he goes right down no issues.

    He also fights his naps like crazy. I try to get him down for a 9am religiously and an afternoon and late afternoon one, all are faught with tears until picked up out of the basinet.

    Please help!

    1. What was his gestational age at birth?
      The night feedings appear to be age-appropriate. With the early bedtime. you are on a great sleep path!
      For now, please try to nap your son based on drowsy signs with very short intervals of wakefulness; ignore clock time. Over the next few months, you will see more of a pattern of naps and clock time (mid-morning and midday) will become more apparent.
      Does this help?

  6. Thank you! This is helpful and makes me feel much better. He was born on his due date. I will focus on drowsy signs for the time being for his naps.

  7. Hello Dr. Weissbluth! My son will be 7 months next week. We are in a difficult sleep situation and would like to try Extinction method this week.

    My son’s current schedule:
    8.00 am: wake up
    10.30: nap #1 in the stationary pram on the balcony for 1.5 hours
    12.00: wake up time
    14.30: nap #2 in the stationary pram on the balcony for 1-1.5 hours
    15.30-16.00: wake up
    18.30-19.00: nap #3
    21.30-22.00: bed time

    he has been sleeping in the snuzpod next to our bed in our room with 1-4 wake up at night+ 1 feeding. Since 4 Jan we took out his arms out of the sleep sack and his sleep just drastically deteriorated – he wakes himself up constantly – every 45 mins or so. I gave in and started co-sleeping with numerous snooze feeds as I was ill myself and could not wake up so many times at night. Now that I am recovering we are determined to do the Extinction method. We have just bought a crib for him and he will be in his separate room.

    two questions, please:
    1. Should we change his bedtime from current one? if yes, how would a schedule of naps look like then?
    2. Should we keep 1 feed at night?

    thank you very much in advance!

    1. Please read Blog Post 138 and the ‘Parents’ Reports’ on extinction on my website and the section on extinction in my book. Also, please describe his mood and behavior during the 60 minutes before his bedtime at night when he is alone with toys (no screens or parental involvement). Then, I will be able to advise you regarding changing his bedtime.

  8. I am very grateful for you replying to my post. Thank you very much! will read suggested materials.

    Before bedtime it is a mixed bag: he can be quite calm or get fussy (30% of the evenings calm: 70% fussy) in the last 60 mins. it really depends on the day but I cannot honestly clearly single out the main factor. We start wind down routine 30-40 mins before the bedtime – bottle, pjs, bedtime story, walking around with him in our arms, breastfeeding and then he usually settles at breastfeeding. Previously I didn’t have to breastfeed to sleep but now I have to over the last couple of weeks.

    we have been rather regimented with the schedule with 2.5/3 hour awake windows and naps and it was almost Ok. since recently night sleep is very bad (for us primarily) and daytime naps are fine in the pram. During the day he is still a happy curious good natured boy.

    1. At 6 months of age, 84% of children take 2 naps and 91% at 9 months of age. Your child is 7 months old and to be successful with extinction now, I think that you have to do the following:
      1. Only a mid morning and a mid-day nap. No 3rd nap. Do whatever works to maximize day sleep.
      2. 70% of the time he is fussy before bedtime because of pre-sleep arousal. The current bedtime is too late, even with 3 naps. With only 2 naps, for the next 3-5 nights, his expected falling asleep time is 5:30pm (you have already bathed, fed, soothed, put him down drowsy but awake (hopefully), and are leaving the room, lights out at 5:30pm).
      3. Commit to 3-5 nights of extinction or do not start it.
      4. Once at night, but only once, if you think that he is hungry, feed him.
      5. Read the section in my book, the ‘5:30pm rut’ to prepare for a possible complication.
      How does this sound?

  9. Thank you very much for your detailed guidance. We are very committed and ready to start end of this week. All is clear, just a couple of clarifying questions please:

    1. Is my understanding correct that for 5.30 pm bedtime his last nap should end by lets say 3.30 pm?
    2. Diaper change at feeding time only unless clearly soiled, correct?
    3. After hopefully successful implementation of the method what would be your recommended regular bedtime for a 2-nap schedule?

    Thank you very much!

    1. 1. No new nap starts after 3pm. At 3pm if he is asleep from an earlier-onset nap, let him sleep. Do not wake him. Still, the bedtime will be 5:30pm.
      2. Yes.
      3. Depends on drowsy signs between 4-5pm which depends on timing and duration of naps which will be associated with the wake-up time initially.
      Please let me know how it goes.

  10. Hello Dr. Weissbluth!

    I would like to report back on our progress. We are on the verge of incredible improvement of the quality of life and sleep of the whole family!

    We have done 5 nights of extinction and the change to our sleep has been incredible! we have put our 7-month son to bed at around 5.30 pm in his room in his new cot bed for the last five days. It did feel that the last wake window for him was too short but we still put him down at 5.30 pm. We did extinction and were disciplined not to go into his room. 1st night: 1hour 40 mins of crying, 2nd night: 1hour 31 mins, 3rd night: 1 hour 51 mins, 4th night: 1 hour, 5th night: 45 mins. Days 1-4 were on sufficient daytime sleep of 2.5-3 hours ( total for 2 naps), Day 5 was short on sleep: 2 naps of 45 mins each. During all nights our son didn’t cry and properly woke up and whimpered for food only between 4 and 5 am. this means he slept on his own for 9-10 hours of continued sleep (as opposed to 45-90 mins stretches of sleep before when i was co-sleeping with him out of exhaustion)! At 4-5 am my husband fed him and changed him and promptly left the room. Unbelievably our son fell asleep after the feed in matter of minutes on all five nights! He would then sleep until 7-7.30 am and wake up a happy calm boy. Previously after restless nights with waking up every 0.5-1.5 hours he would always wake up crying on a morning.

    I would be grateful for your guidance on a couple of points:

    1. What is the best way to to take our bedtime forward? he still had this long periods of crying on all five nights, so today for night 6 do we continue with 5.30 pm bedtime or put him to bed depending on end of second nap and his mood (i am guessing in 5.30-6.30 pm window)?
    2. Is it his stronger will at this age already or something we are missing for this still long periods of crying on a nights 3,4,5? We put him down fully awake (but not drowsy as his last wake window would be a bit short for him), his daytime sleep was fine on Days 1-4, we didn’t go into his room before 4-5 am.

    Thank you very much in advance!

    1. Congratulations! From night 1 ( 1 hour 40 minutes) to night 5 (45 minutes) there has occurred less crying; would you describe this crying as intense, moderate, mild, or mixed? Are you and your husband able to stay the course for a few more nights even though there is still some crying? If so, how would you describe his mood and behavior when alone between 4-5pm? Your description might help me advise you regarding shifting his bedtime to a slightly later time.

  11. Thank you very much for the method and your guidance! We are happy to continue with extinction for as long as needed to make sure the new way is well learned and becomes the new normal. I would describe the crying as mixed mostly moderate with some bouts of intense crying.

    His mood is dependent on the time of the last nap. If it finishes after 3 pm he is content and happy playing by himself. if the nap finishes before he is getting fussy.

    Thank you!

    1. When the nap finishes after 3pm and he is in good spirits and you can watch for subtle drowsy signs, maybe delay the bedtime to 5:45-6:00pm but please no later. It will be better to err on the earlier time if you are not sure.

      When the nap finishes before 3pm, please continue with the strict 5:30pm falling asleep time.

      Continue to keep a record of sleep and crying and let me know how it goes over the next 3-5 days.

  12. Hello Dr. Weissbluth!

    As agreed, I would like to update you on our progress. We have continued another 5 nights with extinction method and bedtime of 5.30-6.15 pm depending on daytime nap schedule (2 naps) and crying reduced to 30 mins, then 10 mins, some nights there was zero crying, some nights another 10 mins. The improvement is just great not only in his sleep quantity and quality but also his overall demeanor: happy and content when he wakes up on a morning and also calm during the day. This improvement is just great! My only regret is that we have not done it earlier.

    We will go forward with the same approach watching our son’s sleepy cues for optimal wake windows and keeping bedtime in the same range for now then. for now it does feel he needs one night time feed at around 3/4 am but he goes down after the feed very calmly and is asleep within minutes after.

    Thank you very much!

    1. You are welcome! Please consider writing a narrative report describing your child’s sleep journey and posting it here and I would publish it as a Blog Post. Your voice is more likely to resonate with mothers than mine. If you do so, the more detail the better and please include the role of the father, whether positive or negative.

  13. Since birth our son Max has been sleeping in the snuzpod next to our bed in our bedroom waking up once for a feed on most nights. He has been a decent sleeper up until 4-month sleep regression. Since then he would wake up 2-4 times a night requiring rocking to sleep. This sometimes would take a couple of minutes and sometimes would be a 20-30 minute exercise. By the time Max turned 6 months were we were already quite tired. But things just turned worse when he was 6.5 month old and started rolling actively in his sleep. He would wake himself up constantly: every 45 mins or so. I gave in and started co-sleeping with numerous snooze feeds to pacify him to sleep. I found co-sleeping very stressful as I was worried he would fall off the bed. So I could not sleep properly myself even when he was asleep in between his numerous feeds. All of this felt like a major regression with sleep situation getting worse than in early weeks of his life. At this time our approach was to be constantly increasing total awake time of Max to make him tired for the night. This resulted in a schedule whereby Max would have three daytime naps and bedtime that would start at 10.00 pm.
    We read Dr. Weissbluth’s book and understood our mistake of (a) keeping Max constantly overtired with a late bedtime and (b) not giving him a chance to learn to self soothe by constantly providing comfort feeds or rocking him to sleep at all times. We decided to implement extinction method with early bedtime at 5.30 pm, 2 daytime naps and only one feed per night. At this time we were also ready to move him to his new cot bed in his own room as he just turned 7-month old . We were very anxious about the process as usually we would not let Max cry more than 20 seconds during day or night before attending to him.

    My husband was incredibly supportive. We planned to start the training on Thursday night when he would be at home and be involved during next 5 days as he was travelling next week. He took over bedtime routine of bath, pajamas, bottle, bedtime story, transfer to bed. 1st night Max cried 1hour 40 mins. After Max fell asleep he didn’t cry and whimpered for food only between 4 and 5 am. This means he slept on his own for 9-10 hours of continued sleep (as opposed to 45-90 mins stretches of sleep before when I was co-sleeping with him out of exhaustion)! At 4-5 am my husband fed him and changed him and promptly left the room. Unbelievably our son fell asleep after the feed in matter of minutes! He would then sleep until 7-7.30 am and wake up a happy calm boy. Previously after restless nights he would always wake up crying on a morning. Subsequently crying times during extinction method were: 2nd night: 1hour 31 mins, 3rd night: 1 hour 51 mins, 4th night: 1 hour, 5th night: 45 mins. On all nights he would sleep through until early morning feed and would go back to sleep immediately after. We continued extinction method for the next couple of weeks and crying reduced to 10 minutes on a night with some nights even without any crying. Now we implement principle of many hands alternating who is in charge of bedtime routine and nighttime feeds between me and my husband. Hearing him cry was incredibly difficult for us but reminded ourselves that we were teaching Max valuable skill of good sleep. I would not be able to do this if my husband were not at home supporting me.

    The improvement is just great not only in his sleep quantity and quality but also his overall demeanour: happy and content when he wakes up on a morning and also calm during the day. Our life is starting to improve significantly with us being able to sleep at night with only one feed at night and getting our evenings back. My only regret is that we have not done it earlier as our son is already 7 months old.

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