The Sleep Consultant’s Guide to Sleep Training

An expert helps you sort through all the experts

by Brooke Nalle, MS

Before I gave birth to my son, my bedside table was stacked high with books on pregnancy, childbirth, and breastfeeding. Four months after his birth, that same bedtime table quickly became cluttered with sleep training information. These were not mere books. They were massive volumes, complete with bar graphs, bell curves, and touching anecdotes about Jennifer and Kevin in Denver and their little Cooper's sleep dilemmas.

They were really long and really heavy – just the kind of reading a new mom doesn't have the time or attention span for. But I was desperate for help, so I would nurse Alistair lying on my side, gripping one of these books and clumsily paging through. I once dropped one on his head while he was dozing blissfully and (ironically) ruined his nap.

Ten years later it's my turn to give advice, so I jumped at the chance when a client asked me to put together a crib sheet on sleep training. I tried to channel that exhausted mom slogging through way more information than is pertinent to her problem and streamline things for her.

Why sleep train
Every night I fill up a water glass, put it next to my bed, and promptly fall asleep, leaving it there for the cat to drink. For me, having a glass of water is part of my sleep association, as is having a comfortable pillow, being in a room that's the right temperature, and feeling as content and tired as possible. These associations let me know it's time to sleep and help me get there.

Your baby needs to figure out his own process to get comfortable and feel content enough to let go and fall asleep. And then he has to learn another skill most of us have (hopefully) figured out – how to fall back asleep when he wakes in the night. Babies switch sleep cycles even more than adults do during the night, so their sleep is frequently interrupted. If your child is dependent upon you to fall asleep at bedtime, he will likely need you every time he wakes up in the middle of the night. For some families, this arrangement works. But for many, helping their children learn to fall asleep means everyone rests better.

How to sleep train
It's fairly easy to come up with a plan when you strip sleep training down to two key factors – your child (her age and personality) and you (your needs and parenting style). And the two ingredients to success are consistency and confidence. If you are confident that you're doing the right thing, then you can be consistent. Here are three approaches to consider that can all be adapted to fit your approach and style.

1. Extinction (cry it out): Dr. Marc Weissbluth, author of Healthy Sleep Habits, Happy Child is the guru of this style, and he has the scientific evidence and rationale that make sense to a lot of families. You make sure that your baby is tired (but not overtired), fed, and safe and then you then put him in his crib and shut the door. (White noise and total darkness may help.) It's a concrete approach that sends a very clear message to your baby: "Mom is not going to do this for you. You have to do it yourself."

This method is the most controversial because many parents worry that their baby will feel abandoned or that their baby will be hungry during the night. But this can be a very effective method if your baby is 4 to 6 months old, was full term (and now weighs more than 14 pounds), and doesn't have any pre-existing medical issues that could interfere with his ability to self soothe and self regulate.

But if you decide to go with extinction, you have to be ready to tow the line. It's very confusing to a baby who has been left to cry for 90 minutes to have a parent then swoop in for a rescue. So decide if you're ready to weather your child's cries at bedtime and in the middle of the night. (Ideally you'll see some improvement after about three nights.) 

2. Graduated Extinction (timed checks): Dr. Richard Ferber, author of Solve Your Child’s Sleep Problems, is often associated with extinction, but he's actually the expert on graduated extinction. This method works much the same way as extinction, but you choose time intervals to check on your baby. For example, you might go in to your baby's room every five, seven, and then 10 minutes, gradually increasing the time in between. Or you may choose to go in when you hear a certain level of crying (say, a 7 or an 8 on a scale of 1 to 10) that lasts for a specific time period.

The key to success with this approach is what you do when you go in. I recommend giving your baby just a little guidance in the right direction rather than swooping up and rescuing him. You can place your hands on your baby's belly, touch his face, his head, or make gentle shushing sounds in his ear. If you do pick him up, just hold him until he is calming down, and then put him back into the crib before he is close to falling asleep. As with cry it out, you follow the method at bedtime and during wake ups in the middle of the night (that are not for feeding).

If this method interests you, another resource is The Sleepeasy Solution.

3. Fading (attended crying): Kim West outlines this approach in her book, The Sleep Lady's Good Night, Sleep Tight. You start by putting your baby in the crib tired, fed, and content, and then you stay with your baby until she falls asleep. You can use your voice and touch to guide your baby to sleep. Every three nights you move a little further from your child's crib and decrease how much you do to help her sleep. Eventually you will find yourself out of the room, intermittently "shushing" from the doorway, and then doing nothing.

When to sleep train
Four months is about the earliest you can start and have lasting success. Yes, there are babies who can train earlier, but they often have to be retrained, which is no fun. You also need to get the green light from your pediatrician (especially if you are cutting down on night feedings). If you want to sleep train but still need to feed, or if you're feeling nervous about your baby being hungry, then I would suggest adding a 'dream feed.' That's when you feed your baby in the middle of the night before he has a chance to fully wake up. This helps your baby get through the night without training him to expect a feeding whenever he wakes up.

You also should never sleep train when your child has a fever, untreated reflux, or heavy congestion. If your baby is miserable from teething, I don't recommend starting until he is more comfortable. And find a time on the calendar when you can be at home or in a familiar environment for at least three weeks to truly cement the skills you are working so hard to teach.

Finally, you don't have to sleep train just because everyone is telling you to do it. I work with families who make their own timeline and take very small steps to teach their children how to sleep. This can happen at six months, 16 months, even at 3 years. You need to feel confident to be consistent, and if you're not ready then it's going to be tough. That said, feeling jitters and guilt about sleep training is normal, so that's not a reason to put off sleep training if your family needs to be better rested. It's tough at first but is truly a gift for you and your family in the end.

If you are in the New York area and would like professional support to help your child sleep through the night, come to Seleni's sleep clinic and meet with Brooke in person. Register now!

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Brooke Nalle, MS

Brooke Nalle, MS, founder of Sleepy on Hudson is a pediatric sleep consultant who works with families and children from birth to preadolescence. Ms. Nalle believes sleep teaching (rather than sleep training) creates a healthy sleep relationship for the entire family. She collaborates with families to find sleep solutions that meet each child's cognitive, physical, and socio-emotional needs.

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