What is the difference between ‘sleep training’ and ‘gentle, holistic sleep support’?

7 Feb

**I provide gentle and attachment-focused sleep support. But what does that mean?**

Recently, I was asked this question: what is the difference between sleep training and what you offer? The sleep industry is full of confusing and misleading information about baby sleep. I think it would be helpful to look at both sides of the argument (because let’s be honest, it is one) and explain why I don’t offer the more traditional sleep training methods and what I offer as an alternative.

Why is sleep important?

It feels like an obvious question. Of course, sleep is important. So why, as parents, are we expected to put up with a baby who just isn’t sleeping? Is this what we signed up for? Yes and no. Some babies struggle with sleep, and some will settle and sleep for long stretches right from day one. We are all different. It is impossible to know what the sleep deprivation is going to be like when your baby arrives and until you are in it, you won’t truly understand how it will affect you. Poor sleep can lead to low energy, low mood, poor decision making around food, memory issues, and longer-term health issues. On this basis alone, we should not feel guilty about wanting to improve our baby’s sleep.

Can we train a baby to sleep?

Short answer: No. You cannot train a baby to sleep. The phrase is completely misleading. Sleep is a biological function, and our ability to sleep for longer stretches and settle to sleep is something that comes with time. The more traditional sleep training methods, such as Cry It Out and the Extinction Method, offer solutions based on leaving your child to cry until they figure out how to get themselves to sleep. Modern solutions, based around attachment parenting, healthy sleep habits and habit layering, are focused on the developmental ability of the child and their biological need to be close to their parent.

The Biology of Baby Sleep

Newborns sleep in what can seem an erratic pattern. They sleep a lot and they are awake for short periods of time. This is for two main reasons. The first reason being that their circadian rhythm (aka the body clock) doesn’t fully develop for 12 weeks. This can mean that their day and night are a bit mixed up, and they may be awake for long periods at night. Baby’s sleep cycles are also different from that of an adult. An adult sleep cycle is approximately 90 minutes and is split between NREM (non-rapid eye movement) and REM (rapid eye movement) sleep. NREM is much deeper, quieter sleep, and the sleep cycles we have at the beginning of the night contain a greater proportion of NREM sleep. REM sleep is also known as active sleep, and this is when we dream. Our sleep cycles contain higher amounts of REM sleep in the early hours of the morning. A baby’s sleep cycle is around 30–50 minutes long. As a newborn, their sleep cycles are split 50:50 between REM and NREM sleep. This changes around four months old, and they start to take on more NREM sleep. Their sleep cycles mature to be the same as an adult around 3–4 years old.

The second reason for the erratic sleep is the combination of hormones that drive your baby to sleep. The key one to know about is adenosine, also known as sleep pressure. Sleep pressure builds throughout the day, and it is what drives us to fall asleep. This buildup is too much for babies, which is why they take naps, to relieve some of the sleep pressure buildup, and therefore allowing them to stay awake for another short period of time before requiring another nap. Their ability to stay awake lengthens as they get older, which is why they then need fewer naps. On average, young children stop napping between 2.5 to 4 years. This is a huge window of time, which is why looking at sleep holistically, along with developmental milestones, nutrition, environment and their overall routine is really important when working on sleep.

We also have differing sleep needs. Some babies and children will sleep 12 hours a night. Some only need 10 and some will sleep for 14. We are all different. Understanding the individual sleep needs of your child is a key element in improving their sleep.

Traditional Sleep Training Methods

I want to briefly look at the two main sleep training methods and then discuss some of the language used and the effectiveness of these methods.
The Cry It Out Method was developed by Dr. Richard Ferber, a paediatrician and author of the book Solve Your Child’s Sleep Problems. Dr. Ferber introduced this method as a way to help parents teach their infants to “self-soothe” and sleep through the night. In brief, your baby is placed in their crib while “drowsy but awake”, and if the baby cries, you initially wait for a short period (e.g. 3–5 minutes) before going in to offer comfort. Over several nights, parents gradually increase the amount of time they wait before responding to the baby’s cries. This can range from 5 to 10 minutes or longer, depending on the specific approach being followed. This approach, Ferber claims, will allow your baby to teach themselves to fall asleep independently.

The Extinction Method is a technique where parents allow their baby to cry without any comfort or intervention during bedtime until the baby learns to “self-soothe” and fall asleep independently. The method advises placing your baby in their crib while they are still “awake but drowsy”. If the baby starts crying after being put down, parents refrain from providing any comfort or intervention, such as picking the baby up, patting, or feeding. Over several nights, the baby is expected to learn to “self-soothe” and fall asleep without crying or with minimal fuss. In 1987, Marc Weissbluth published Healthy Sleep Habits, Healthy Child which advocates for complete extinction. Essentially, you shut the door and return in the morning.

I think it is important that we look at what these methods tell us they are for: teaching your baby to “self-soothe”. The idea of self-soothing (in infant sleep terms) was coined by sleep researcher Thomas Anders in the 1970s. It is often used synonymously with the idea that babies can self-regulate their emotions. For Anders, however, a self-soothing baby was simply one who put themselves back to sleep without parental intervention. Babies are unable to self-regulate as they are not developmentally able to do so. Their brains aren’t mature enough. Self-regulation, i.e. returning from a level of stress to a comfortable base level, is something children learn to do from caregivers. We show them how to do that and they learn how to do it themselves as they get older.

The idea that leaving a baby to cry for a set amount of time or, indeed, all night will force them to self-regulate their emotions and sleep independently is not backed by scientific research. In fact, scientific research relating to sleep training cannot be relied upon at all for several reasons. Firstly, very few studies on sleep training have met the gold standard of scientific research. The gold standard being trials where participants are randomly allocated to receive the intervention, that have a control group that did not receive the intervention and that have enough participants in the trial to determine cause and effect. In many sleep training studies, parents have chosen which method and how to implement it based on how they think their baby will respond. This skews results as it is temperament-based rather than random. There are also high dropout rates as parents often find sleep training difficult to see through. Many studies also rely on parental reports on how well their baby is sleeping. This means it is not in a controlled environment so the reports that a baby is now “sleeping through the night” due to sleep training cannot be confirmed. It is likely that the baby is still waking in the night (as is normal and natural) but not calling out for a parent, so the parent doesn’t know they are awake. Parents have also reported having to retrain several times whenever there has been illness or some kind of regression in sleep.

Additionally, studies into traditional sleep training methods have inconclusive results around the long-term effects of leaving a baby to cry. Parental attachment and cortisol (stress hormone) levels are the main indicators that are studied to try and determine if there is any long-term impact on the child. However, due to the reasons I stated above about studies of this kind, it is hard to know, definitively, what the impact is. This is also due to the many other factors that can impact attachment and stress levels such as: family environment, school, other caregiver relationships, nutrition etc. None of these factors can be controlled in a trial. Cortisol levels also naturally change throughout the day so it is difficult to link those levels to any kind of cause. Taking all of this into consideration, I think it is reasonable to conclude that: we just don’t know the impact of traditional sleep training methods.

So, my question is, why risk using them? I know why lots of parents use these methods. I don’t judge them for it. The sleep training industry is full of professionals telling you this is the only way your baby will learn to sleep independently. The literature is everywhere on social media. As soon as you make a pregnancy announcement on Instagram your Explore Page will be full of it. In the US, where parental leave is virtually non-existent, parents can feel they are left with little choice around sleep training. They need to go back to work and they need to be able to function and sleep is required for this. When this approach is compared to other cultures, particularly African and Asian cultures, the difference is stark. Children often bed share or room share with parents for many years. The thought of placing their children in another room doesn’t even cross their minds. So what is the issue here? Western society and culture forcing parents to take these measures to ensure they get some sleep and can get back to work? Possibly.

What are the alternatives?

Modern approaches to working on infant sleep tend to focus on building and creating healthy foundations in sleep. They focus on routine, sleep needs and consistently setting boundaries you are comfortable with. When I work with clients 1:1 I always start with the basics. Working on the foundations can have a huge impact on overall sleep and wellbeing. The foundations I focus on are: sleep environment, sleep associations and building a bespoke and developmentally appropriate routine for that child.

Working on building an appropriate routine can take a few days. It requires looking at the overall sleep in a 24 hour period and taking into consideration the child’s mood, sleep cues, sleep latency (how long they take to fall asleep) and then making tweaks until it is correct. If a routine is correct it should allow a baby or toddler to be awake for a length of time that is suitable for their needs before they require a nap to relieve the build up of sleep pressure. Any naps taken should also be enough to relieve the pressure but not deplete it as this will impact their ability to sleep for longer stretches at night. It is about getting that balance right.

In terms of independent sleep, there are an array of options available in the gentle area of the sleep industry. It can greatly depend on the age and temperament of the baby or child which method to choose and how long it will take. An excellent example is the idea of habit layering. This works by removing sleep associations and replacing them with others. I have used this with clients who have been rocking their baby to sleep (which is fine if you want to) but want to move away from it now their baby is bigger or if it’s taking too long. To do this we have introduced additional associations such as shushing and patting and then slowly reduced the rocking when the baby is used to the new associations. You can then reduce those new associations if you want to move to independent sleep.

The idea that babies must be able to fall asleep independently to be able to sleep well is another myth. Babies can be supported to sleep at bedtime and still settle in the night by themselves. This can be achieved by offering support when they wake and slowly reducing that support over time at a pace that suits the temperament of your child. It is not a race to be able to achieve independent sleep. You don’t get an award for it. If you want to support your baby to sleep — that’s okay!

Additionally, I have worked with clients who have come to me and said their baby is waking 7–8 times a night and they are at a loss for what to do. We have worked on the foundations, made sure their routine is spot on and those night wakings have then reduced down to 2 a night. They have then said they are completely happy with that. It is manageable, the wakings are brief and they have a method to help them get back to sleep with their support. There’s no miracle solution to babies waking in the night. It is normal and natural. Adults wake in the night too. We might go to the toilet, have a drink or roll over and go back to sleep. To expect a baby to sleep solidly for 12 hours and not disturb you is likely asking too much.

Another gentle approach that I have seen great success with is the introduction of attachment-focused activities. It is really common for toddlers and young children to resist bedtime and subsequently wake in the night and need help to get back to sleep. One of the barriers to them getting themselves back to sleep can often be their connection to you. If you have been at work all day or they have been in childcare it may just be that their emotional cup needs filling back up. They have missed you. Introducing an activity before bed which focuses on just being together and reminding them how much you love and missed them can have a huge impact on how they feel when they go to bed.

Pros and Cons

As you can hopefully see, the differences in approach are incredible. I have tried to be balanced in my description and analysis of the traditional approaches. The pros to those approaches are that they tend to be marketed as the quicker option. The cons are that they often need to be redone several times and they don’t actually stop your baby from waking in the night they just teach them not to cry out for support as it isn’t coming. We also don’t know the long-term effects on children when using these methods.

One of the biggest pros about working with gentler approaches is the requirement to understand the individual sleep needs of the baby or child. You can then see when something needs to change. For example, sleep latency at bedtime is suddenly 45 minutes when it used to be 20 minutes, it is likely that a routine alteration is needed — not that they need to be “sleep trained” again. As part of my approach, I focus a lot on sleep education for the parents I am working with. I help them understand what is developmentally normal for their child and manage their expectations and provide them with resources to help manage sleep after our time working together. The main con for gentle approaches is that they tend to take longer. The idea is to go at the pace of the child to minimise upset. However, this con then becomes a pro, in my mind, because you are forming consistent habits which will benefit your child in the long run as children thrive on consistency and routine. It allows them to feel safe and in control.

Conclusion
I was taught about all of the approaches in my sleep consultant training and very quickly decided, both professionally and as a parent, that my work would focus on the gentle side of sleep work. I could never ask a client to leave their baby to cry if a) I couldn’t do it myself and b) I didn’t know what long term impact that would have.

I think it is important that parents make informed choices when it comes to their children. The pressure to sleep train in the traditional sense is rampant. I have come across forums online focused solely on supporting parents through Cry It Out and citing studies to support it which simply aren’t scientifically sound. They even offer solutions such as putting headphones on and turning the monitor off when the baby is crying if you are finding it upsetting. If you need to do that to get through it then that tells me it isn’t the right approach for your parenting style or for your baby.

I would be really interested in hearing your thoughts and experiences on the sleep industry and how it has affected you and what changes you would like to see. Feel free to comment here, send me an email leah@thesleepsnug.com or DM on Instagram.