Healthy Sleep Habits, Happy Child
133
Do Sleep Solutions Work?
May 29, 2023

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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 133Do Sleep Solutions Work?

Advice to parents on helping their children sleep better through the night is presented in ‘What a Parent Can Do’. Do these suggestions work?

YES!

Sleep Advice For Babies and Children

These suggestions to help your child sleep better have been successfully used by many parents and carefully evaluated in academic studies. Also:

  1. The first two books advising parents how to help their child sleep better were published in 1985 and 1987. Today, they still remain among the top books on Amazon’s list for books in this category, suggesting that they contain useful information that has stood the test of time.  

Together: 

  • Their 5-star ratings (4,639) are 71% of their total ratings and their 4-star ratings (785) are 12%.  
  • Their 5-star reviews (2,546) are 69% of their total reviews and their 4-star reviews (443) are 12%. 

So, among parents motivated to purchase either book and to rate or review these books to help their child sleep better, it appears that about 80% of these parents are successful in helping their child sleep better based on the books’ ratings and reviews.

2. When parents are motivated and able to hire a community sleep consultant, about 90% rate their experience as ‘complete satisfaction’ (Blog Post 27).

3. A 2021 review of 32 separately published Randomized Clinical Trials of sleep intervention, employing suggestions described in ‘What a parent Can Do’, showed that nighttime sleep duration modestly increased (averaging 14 minutes extra sleep per night) in the intervention group compared to the control group, especially when the study was for sleep-only intervention and less so for interventions that targeted sleep along with other components, such as obesity.  

4. A 2022 study of children 8-11 years were randomized with a behavioral intervention and compared to the control group, they had 30 minutes or more sleep per night.

5.

A 2023 paper examined over 2,000 families and infants, aged 3-18 months, and objectively gathered data with a camera monitor over the baby’s crib and questionnaire data about the child and the parent.  A Sleep Solution, sometimes called a Behavioral Sleep Intervention (BSI), may include allowing your child to cry (Extinction and Graduated Extinction-Blog Post 25) or not allowing the baby to cry (Fading, also known as ‘Parental Presence’-Blog Post 19).  Many published studies have shown that a BSI does not harm your child (Blog Posts 24, 67, 71, and 181).  Also, published research has shown that BSIs are effective (Blog Posts 27, 66, and 133).  Different parents choose different BSIs (Blog Posts 26 and 132).  Here are some of the results:  

Duration of BSI: 

            Parental Presence        18 days 

            Graduated Extinction  11 days 

            Extinction                     7 days 

Less time is required for Extinction. 

How long before some improvement is seen: 

            Parental Presence                                13 days 

            Graduated Extinction & Extinction      5 days 

Parental Presence takes longer to see improvement. 

Nighttime sleep duration: 

            Parental Presence                                9.5 hours 

            Graduated Extinction & Extinction    9.9 hours 

Less night sleep with Parental Presence  

Number of nighttime awakenings 

            Parental Presence                                4 

            Graduated Extinction & Extinction    3.6 

More night awakenings with Parental Presence 

Parental Presence was implemented for longer periods of time, took longer to see improvement and was rated as less difficult but also less helpful. Extinction was implemented for shorter durations, and rated as more helpful in improving sleep compared to Graduated Extinction.  Extinction entails a lower extent of parental involvement, is experienced as more challenging, yet less time-consuming and more effective.  Implementation of these approaches was not negatively associated with parent sleep, daytime sleepiness, depression symptoms, or parent-infant bonding. 

Why do attempts at sleep solutions fail in 10-20% of families?

  • The individuality of your child, your family, and your culture might make it challenging to implement these sleep solutions (Blog Post 14).
  • Parents might not act together as a team (Blog Post 18).
  • Issues within a parent (Blog Posts 3942) might be a barrier to successful implementation of a sleep solution even when a parent is motivated (Blog Post 23).

Remember this sleep advice:

  • A few minutes of extra sleep each night, over time, provides enormous benefits for your child (Blog Posts 6 and 75).
  • A few minutes of extra sleep each night for your child, over time, provides enormous benefits to the parent (Blog Posts 119 and 132).

Comments

  1. Hi, just read your book and have a baby turning 5 months next week. Have begun extinction method for 2 days now but hoping for some clarity.

    Nap 9:30am – drowsy and awake, falls asleep for 1 – 1.5 hour.
    Nap 12:30pm – drowsy and awake, cries for 1 hour and moved on with the day. Other day she slept for 1 hour with no crying.
    Nap 3:00pm – short 30 minute nap.
    Bedtime 7:00 – drowsy and awake, falls asleep immediately with pacifier in mouth and sleeps until 4:00am. Cries at this point as it is generally a feeding time so mom breastfeeds with little stimulation and puts back into crib after. She is ok for a few minutes but then cries indefinitely. Waited until 5:30am and got her as she has been awake now since 4:00am feeding crying. She then fell asleep with soothing at 5:30am until 7:00am.

    1. She relies on a pacifier a lot unfortunately but we are hoping extinction will teach her to fall asleep without it as she can’t put it back in yet when it falls out
    2. She is very good at going down at night (with soothing and pacifier to sleep) and sleeping long times like 7:00/8:00pm until 4:00am with no wakes most nights.
    3. If she continually wakes at 4:00am for feeding but cries after going back down, should we quickly soothe with a pacifier every time (as it tends to work quickly, but we don’t want to be on the hook for putting a soother in every morning between 4:00 and 6:00am)? Or do we stick to extinction from 4:00am until say 6:00am for two hours of crying if she doesn’t fall asleep?
    4. We swaddle her still with arms in but are planning to put 1 or 2 arms out soon once she is rolling over, should we do this now? Or keep her arms in for at least a week as she is used to it while we work on the extinction method?

    Generally she is a good sleeper, but hoping for clarity on what to do post 4:00am whether to go back in and quickly soothe or stick to extinction at this time too. We are following the nap protocol as well and consistently leave her for 1 hour of cry if she does not sleep and move on with the day.

    Thanks for your book and knowledge.

    1. How does she look (mood and behavior) between 5-6pm when she is unattended to and not in front of a screen? Please describe in detail. Is she breast fed or formula fed at 4am?

  2. From 5-6pm she is generally fine to hang out alone and play on a mat with a toy or sit in a bouncer chair. Don’t notice many drowsy indications until closer to 630-7pm it seems.

    She is still full breastfed so at 4am she is breastfed and then the attempt to put her back down to finish the night sleep happens.

    1. “Bedtime 7:00 – drowsy and awake, falls asleep immediately with pacifier in mouth and sleeps until 4:00am. Cries at this point as it is generally a feeding time so mom breastfeeds with little stimulation and puts back into crib after. She is ok for a few minutes but then cries indefinitely. Waited until 5:30am and got her as she has been awake now since 4:00am feeding crying. She then fell asleep with soothing at 5:30am until 7:00am.”
      Between feeding around 4am and 5:30am: Is the crying continuous or intermittent? Is it mild, moderate, severe, or mixed? Can you and your wife tolerate this crying for a few more nights?
      Please experiment with a bedtime that is 10-20 minutes earlier for 2-3 nights only; monitor latency to sleep and crying between 4-5:30am.
      I think you are doing a good job and are on the right path!

  3. Thank you. The crying from 4-5:30 was loud and consistent on previous nights, but yesterday was the second full night of extinction.

    Her pacifier fell out as soon as I left the room after putting her down at 7:00pm and she talked and then cried consistently for 30 minutes. After 30 minutes she fell asleep at 7:30 and slept until 3:50am. Mom went in for a quick feed and this time she went to sleep again after until 6:20am when I quickly went in to begin the day.

    Will continue to stick it through and work on the two naps throughout the day as well.

  4. Onto day 5 of extinction now.

    Day 4
    Woke up at 6:00am
    Nap at 8:45am with under 5 minutes of crying (she slept for 2 hours until 10:45am when we woke her)
    Nap 1:30pm with 5 minutes of crying (woke her up at 3:00pm)
    5:00pm she fell asleep in arms for 30 minutes
    7:00pm put down to bed, she cried for 10 minutes and then went to sleep
    1:00am woke up and cried until 1:45am
    3:00am woke up and cried until 3:30am, so mom went in to feed (usually 4:00am)
    6:00am woke up and went to get her to start the day

    She is definitely learning to fall asleep on her own which she would not do before, but at the same time she never used to wake up multiple times in the night. Any suggestion to try and get her to sleep until the 4:00am feed again?

    She is just turning 5 months and her wake windows are about 2.5 hours sometimes 3. She seems content with the mid morning and midday nap but wants something closer to bed time which could be causing an issue?

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