hello after many many requests we are finally taking a deep dive into infant sleep sleep training and some proven things you can do to help your baby sleep better yeah this episode has actually taken us weeks to prep for and it's going to be a pretty long but we're going to put it into chapters so you can go back and hopefully get what you need some medical evidence research about if sleep training sleep learning actually works some of the concerns about potential harm from sleep training and at the end six very practical tips to gradually reduce parental assistance throughout the night to help you and your little one get some sleep and in case this is your first time meeting us i'm sarah i am a board certified ob gyn i'm kurt i'm a board certified pediatrician and we are the doctors the yorkman welcome back before we go any further into this episode we first want to address that we are not sleep experts and we know there are a lot of strong feelings about sleep training indeed um so but we have read much of the primary medical research about sleep training when we were raising our own newborn we have read the best advice from leading experts and i've listened to many people who are big fans of sleep training and also those who think that it's downright barbaric yeah but with all of that in mind there's no doubt why so many new parents are so confused about how to help their baby get some sleep so as we try to do with every topic we are going to present you with some of the available data and then encourage you to think about you your baby your current sleep routines and then decide what will work best for you and your family like many things with parenting there's not a right or wrong answer here but there may be some friendly middle ground somewhere between those rigid models of ignoring your baby's cries in the middle of the night and the alternative of being up many times every night with responsive or attachment parenting newborn sleep is different than sleep at any other stage of life newborns have two types of sleep quiet sleep and active sleep these are comparable to deep sleep versus rem sleep in adults with quiet sleep newborns don't wake up easily remember back to when you could clip their little nails when they were sleeping or eat dinner and they'd stay asleep on your lap that's the quiet sleep then active sleep is when they're grunting and fidgeting and maybe even crying and you realize then that they're actually still asleep that's active sleep yeah now if you have a newborn we actually made a video all about sleep during the first two to three months of life that you should go check out um but you can also stay and watch this whole episode so that you're ready for when the time comes to help your baby sleep through the night yes the rest of this episode is for babies that are at the very minimum four months old um and are eating at least 24 ounces of breast milk or formula in a 24 period period and who are otherwise growing normally and without any medical concerns yep and we have to state here that the american academy of pediatricians recommends that babies continue to sleep in the same room as their parents until they are six months of age as this is associated with a decreased risk of sudden infant death syndrome there's also actually been shown an increased risk of sudden infant death in babies who have prolonged periods of sleep prior to six months of age so while you can consider sleep training or sleep learning as early as 4 months it is generally considered safest to wait until your baby is 6 months of age it's important to know that nobody actually sleeps through the night no matter what their age we sleep in chunks of time called sleep cycles for young babies that's around 45 minutes long for an adult it's roughly double that so at the end of each sleep cycle we may rouse a little bit but not fully and then we start a new cycle unaware um that we are transitioning between these two sleep cycles sometimes once in a while you'll wake up fully and you find that it's harder to fall back asleep so this is no different for babies only they have much shorter sleep cycles than ours and so they have the potential to wake up 10 to 12 times a night yeah and around four months of age babies start to change from that newborn sleep of light and deep sleep patterns to patterns that are more like adult sleep patterns and this is why this four to six month window is generally a common time for people to start thinking about more structured sleep schedules for their babies what is sleep training yeah so there are definitely some who might be triggered by the term sleep training as this barbaric process of ignoring your crying baby until they lose all hope that anyone will ever come rescue them or that anyone loves them and this is just not the case yeah so essentially sleep training is the process of your baby learning to fall asleep and stay asleep by themselves whether that's in the very beginning of the night when they're put into their crib or when they wake up in the middle of the night between those sleep cycle transitions yeah and so with that a better term might actually be sleep learning which is a bit more gentle language and actually articulates what you're trying to help your baby to do you're trying to help them learn to fall asleep to stay asleep and then fall back asleep if they wake early and at the end of this video we're going to share the steps that we actually used ourselves to help our infant do this gradually with strategically reduced parental assistance does sleep training work and why would anyone want to do it yeah so the good news here is yes sleep training methods and methods like them have been shown numerous times in scientific study to help decrease the time it takes infants to fall asleep it helps increase the amount of time they stay asleep and limits the number of times they wake during the night okay as you can imagine having a baby who gets more sleep is good for them improving their perceived moods improving parental well-being and in some studies even improving the relationship between parent and child yeah which is pretty easy to imagine that if parents are better rested and baby is better rested it makes it that much easier to just enjoy being together and learning together during normal wait time periods to some of you this may sound too good to be true so we are going to take a couple more minutes just to show you more of what the data says on this and then also dive into some of the concerns about the stress that this could create for baby or parents yeah and so the data when you're looking for good peer-reviewed research about sleep training one of the common popular pieces that you'll likely see is a systematic review from 2006 that actually looked at numerous studies about sleep training methods many of them being randomized controlled trials 19 of these studies actually used what's called the extinction method which is where at the beginning of the night parents put their baby in a crib leave the room and don't come back cry it out yeah missus cry it out now of these 19 studies 17 of them did show improvement in infant sleep now if that sounds a bit too harsh for you there are also other studies 14 that used a graduated extinction method again now this is more like the ferber method where parents would come back and check in on the infants and giving them comfort and then progressively using longer time periods between these check-ins and even still there were more studies that used what's called extinction method with parental presence where the parents stay in the room but will let the child cry and these also demonstrated improvements in infant sleep so basically what i hear you saying is that if the parents had a method for gradually decreasing parental intervention and sleep throughout the night the babies learn to sleep longer on their own yes exactly and honestly i'm hopeful all this information will help you at home if you're struggling with anxiety about abandoning your baby in the night because at the end of the day as long as you have a method where you're gradually increasing the length of time between nighttime interactions with your baby eventually they should learn to get a full night's sleep yeah the decision is really up to you as as the parent and your knowledge of your child about how fast you're able to do that and we will share some things that might help this process go a bit more smoothly and quickly for you along the way now it is important to note here that sleep training does not solve every sleep problem at once success does usually come a bit earlier to those who are able to start in that four to six month window and even still though the difference here may be that your baby is waking two nights per week instead of four nights per week as was shown in one study but i would imagine that the difference between waking up two nights and four nights actually makes a pretty big difference for those parents and those babies yeah also a big hurdle in sleep training may actually be your ability as mom or dad to hear your baby cry and not immediately run to the crib this can be an emotional process for many parents and it's honestly the reason many families give up on sleep learning and the process fails there will be a night where your baby is crying and you just have to say to them and yourself you are loved you are fed your diaper is dry and you can do this yeah and just one more kind of positive about this whole process is that there is evidence to show that mothers of babies who underwent sleep training methods have been shown to be less likely to have depression and more likely to have better physical health these moms also are less likely to use health services across numerous other studies sleep training methods are associated with less parental depression higher marital satisfaction and lower parenting stress it's also important to share that these improvements last most of the studies we've mentioned so far have followed the babies for six to 12 months after the intervention and though the improvements in sleep duration and limited night awakenings continued and you could imagine that these good sleep habits only continue to help these children as they learn and we know that it's easier to learn when we're well rested and also much of what we learn gets solidified in our brains while we are asleep so sleep training can definitely be this emotional process that you really just kind of need to be prepared for yeah i had a few friends when i was a co like when i was in residency who had babies and they you know finally kind of got to the breaking point and said i'm making my husband sleep train the baby this weekend well i'm on call i'll be at the hospital all weekend and so i'm just gonna miss it um those first three nights are kind of traditionally the worst in terms of the crying um and so they were like husband can do it well i am here because i just don't know if i can handle it yeah and like not so much that dads are heartless but like also i think something that really helped us or helped me especially was realizing that there's going to be a couple of hard nights but we're actually helping our infant learn to sleep learn to put herself to sleep learn to stay asleep during the night and that can potentially help them over the long run in terms of being rested us being more rested and just improve the health of our family overall not just for a couple nights but for months and potentially years to come right and so we really kind of started talking seriously about hey what do we want to do kind of at that four month mark you know the classic four month sleep regression um she start had been such a good sleeper which we i mean sleep was really important to us i think like i really wanted to sleep and we knew what it was like to have jobs where we didn't get to sleep much but i read multiple books many more on my ipad just to try you know to be as happy know as much as what was out there as we could and to be prepared really yeah we just wanted to be prepared yep and so kind of right at that four month mark she went from being a real good sleeper to kind of waking up multiple times in the night needing to be breastfed or rock to go back to sleep and we just said you know what what should we do and the sleep learning um made just made sense to us on the flip side if your mama heart cannot handle that and this is working for you and you the getting up in the breast and breastfeeding in the middle of the night a couple times it's like something that brings you joy because you work all day long and these are those like special moments you get with your baby and and that is working for you it is totally okay to not sleep train your kid sure there are some benefits of it but there's also some benefits of like snuggling your sweet baby and getting to spend some time with your kiddo at night so this is something that exists that you can do that maybe works for your family that maybe doesn't um this was just kind of like how we arrived at the decision when we were looking into helping our little girl learn to sleep through the night we kept hearing these comments that sleep training would have long-term negative effects on her ability to trust or form meaningful attachments and so you know how could we ever think about doing something that could cause such terrible consequences for our baby yeah so the fact here is that many of these commentaries we came across we're looking at research about long-term negative consequences of sleep training inferred from these extreme instances where infants were deprived of maternal comfort over extended periods of time and not just during sleep hours but also during daytime hours as well yeah there are some very sad reports of children that were raised in romanian orphanages in the 1980s where there was not enough staff to care for these children and so they were left to cry by themselves without ever being comforted visitors to these orphanages commented on the stark silence that was they noticed in the rooms of the infants who had just been devoid of all natural comforts and they had learned that there was going to be no one to comfort them no matter how long they cried or what time of the day they were crying yeah and these really sad results yeah um and similar things like this have been shown in monkeys too that if you deprive a baby monkey of comfort and that they not only have major long-term psychological damage but they can also have physical consequences as well with poor growth and other health issues however this is very different right there have not been any of these issues with actual structured sleep training methods graduated or non-graduated and the beauty of this structured sleep learning is that it helps your baby to sleep at night so you and they are both better rested during daytime to be able to just love on them and find joy in hanging out with each other and you have so many opportunities to respond to their cries to show them that you are there and you are there to provide and protect and care for them yeah and honestly for us we actually felt like we were able to be better parents because we were sleeping too um there was actually a swedish group that completed another randomized controlled study and they found similar outcomes that for these families who went through these sleep learning methods they found increased infant security and attachment and even improved reports of daytime behavior in the infants and improved eating as well in these babies who had had these sleep training interventions there are also many thoughtful comments about natural nighttime cycles between mom and babies with breastfeeding and hormones body temperatures and the like and we want to take some time here to say that there absolutely is potential to harm the breastfeeding relationship between mom and baby um if sleep training is done abruptly without weaning of nighttime feeds but again there are ways to do this gently and to protect your breast milk supply and for me i actually continued for a few months of getting up for nighttime pumping even when cecilia was sleeping all the way through the night yeah and so with that we're gonna take a brief jump to talk about weaning nighttime feeds next when it comes to babies and nighttime feeds a nice rule of thumb here is that your infant should be able to have one long stretch of sleep in the night that lasts the same number of hours as they are weeks old so if your baby is six weeks old in theory they could potentially sleep up to six hours at a time yeah exactly but there are some major things to consider here okay your baby needs to be demonstrating that they are growing well and that they don't have any other health conditions that might affect their ability to store nutrients how much energy they're burning on a daily basis or their ability to access those nutrient stores during the longer times between feeds so just to state what kurt said again if you are going to start spacing feeds at night your baby needs to be getting all of the calories they need during the day during the rest of the 24 hour periods so for most four to six month olds this means somewhere between 24 and 30 ounces of formula or breast milk every day yeah now once babies are this age of four to six months they should actually be able to sleep through the night from an energy and physiology standpoint and the nighttime feeds that still persist are largely for comfort or just help falling back to sleep one particular challenge here can be for moms who are breastfeeding at night um but then are away during the day and so that means the babe is eating from a bottle during the day which some breastfed babies don't love and so this can be a setup for reverse cycling where the baby chooses to eat less from the bottle during the day and then eats a lot and does a lot of breastfeeding at night so as we kind of talked about the tricky extra piece into sleep learning getting your baby to sleep through the night is nighttime feeding like babies love that boob or that bottle to go back to sleep and so if that's something that you and your kiddo are still doing at night you have to like be thoughtful about stopping that process especially if you're breastfeeding it's much easier if you're formula feeding because you decrease volumes or space or just drop cold turkey but if you are breastfeeding and all you know your prolactin actually rises most um in the middle of the night with those early morning feeds which really helps your milk production so a lot of times if you drop that middle of the night feed it can a tank your supply and b that's also the time when that if that prolactin doesn't rise as much we see women start to ovulate again and get their cycles back often when their babies start sleeping longer at night so what i did even once cece was sleeping these 12 hours at night i continued to get up at 1 am and 3 a. m and pump for her and then slowly i would drop that 3 a. m feed and then kept doing the 1am pump for a while one because i wanted to have a little bit of a um stash and it meant i got to give her a bottle every night before right time too yup um and so like but me getting up at one in the morning to pump really quickly put the milk in the fridge and go back to bed was much less involved than multiple getting up in the nights to try to get the baby back to sleep um and so but again being thoughtful and intentional about protecting your supply um and how to slowly wean those um feeds or pumps overnight is something to definitely think about now the options for weaning feeds are multiple it can be a gradual process of maybe lengthening the time between feeds or decreasing the volumes of feeds at night or there's also methods of doing cold turkey approaches where you're dropping one midnight feed and then after some time you're dropping the other overnight feed for us we chose to gradually space the middle of the night feeds by 10 to 15 minutes each night each night so kind of strategically increasing the time between those nighttime feedings yeah now feeding at night is one of the easiest ways to actually kind of fail your attempts at your baby's sleep learning and learning to sleep through the night yes now if your baby still needs the nighttime calories that's okay there's ways to do that and one of those is to kind of feed them on a set schedule where you offer them that feed and sometimes that's called a dream feed so you go in at a certain time you don't fully wake them up and you feed them sometimes that's around the time they naturally wake up and sometimes it won't be again feeding them every time they wake up and cry in the night can really solidify for them that crying in the night means they get a snack every time um and and that can just be an easy way to sabotage that sleep learning process and now as promised how do you actually do this um are six key steps to helping your baby learn to sleep yeah so now key number one is daytime nutrition for your baby to sleep longer at night they need to be getting all of their needed calories during the day time and as we've already mentioned before even thinking about extending nighttime sleep first make sure your baby is growing appropriately that they don't have any other health concerns that might make those longer times between feeds dangerous for them this is a great thing to check in with their pediatrician in at their four month or six month well child visit yeah an easy way to achieve this getting all those calories in is to make sure your baby is eating every two to three hours during the day if a six month old gets their daily fill during the day they don't physiologically need to eat during the night number two is sleep environment controlling as much as you can about where your baby sleeps is the next key step try to do as much as you can to create a space that is dark dark quiet and has stable temperature we covered much of this in our newborn sleep episode as well but some other things that were really helpful to us were things like blackout curtains and a white noise machine number three is a bedtime routine so bedtime routines are honestly not well researched but it seems to be very reasonable and common sense that you can't just kind of throw your baby in their crib and say go to sleep now and hope that they're going to have success yeah having said that our bodies do most certainly learn to respond to certain stimuli with habitual responses so in other words we can absolutely help our little baby's body learn that sleep time is coming next so for us that looked like bath time every night at 6 00 p.
m after that a bedtime feeding dad would give her a bottle um we'd read some books with dim lights on and some like lullaby music in the background and then we would put baby cease in her sleep sack um do a little bit of rocking her in the chair and sing a couple lullabies and then put her in her crib yeah now by doing this every night we're actually able to see her start to anticipate the next step and this helped her make that transition from the excitement of daytime with this in gradual wind down to sleep yeah a really really important note here about bedtimes research has kind of shown that the sweet spot for most babies bedtimes is between seven and eight pm any later than that and babies will often catch a second wind and that can make getting them to sleep a lot tougher yeah the goal is going to be for 11 to 12 hours a night in the crib and so this also makes that 7 to 8 p. m bedtime window pretty convenient for most people's morning schedules as well number four setting the baby down so when you are finally in a place and time where you are ready to commit to 10 days of sleep learning at home in the place where your little one is going to be sleeping in their own crib every night now comes the time to actually help your baby learn to fall asleep and stay asleep on their own now hopefully you've been working on developing some of those good habits already but even if you haven't that's okay and these tips and tricks can work at any time the sleep training or sleep learning method that we ended up being most comfortable with and that we're sharing with you now was a variation on the ferber method and gradually lengthening the time between these nighttime parental interventions and comforting and offering reassurance so on that first night we did our well-practiced bedtime routine um put cease in her sleep sack saying her her usual final bedtime song and then laid her in her otherwise empty crib on her back following safe sleep methods and then we left the room then came the crying part and again we knew she was loved she was fed she had a dry diaper and we knew that she and we um could do this um and we're committed to doing this um and so at that point when we left and she was crying we started our stopwatch for five minutes yep and so those five minutes passed and the crying continued and so at that five minute mark one of us went back into the room and we started this process of reassurances over 20 to 30 seconds so first i would stop we say hello cecilia you are okay you are loved you are fed you are dry and you can do this and she was still crying i gently put my hand on her for a quick gentle touch of reassurance rubbing her body or her hair if she was standing at that time i would lay her down at most once but i would never pick her up otherwise so at these times your baby is looking to you for comfort and confidence and reassurance that this is okay and you get to provide this with your voice and your presence you do not need to pick them up you want to reassure them and then leave the room any more than 20 to 30 seconds um can is unnecessary and can can potentially escalate things um and that could be counterproductive to their learning yeah and remember you can do this they are loved they are fed they are dry and this is going to get better it will get better yes so after leaving the room we start that timer again and this time we are waiting for 10 minutes and then if she's still crying you go back in and repeat the above so after 10 minutes of more crying i went back into the room again for another quick 20 to 30 seconds of reassurance and then back out this time setting the stopwatch for 15 minutes yes so again if you start your timer and at 15 minutes passes and they're still crying you go back in you repeat that 20 to 30 seconds of reassurance hey i'm here you can do this you are so loved and then you leave the room again and you continue those quick check-in reassurances every 15 minutes at that point so 5 10 15 15 15.
