History of Sleep Training
We’ve come to think of sleep training as normal in most western cultures. The practice is touted in many many parenting books as the thing to do (and only thing you can do) to get your baby to sleep at night. It gives this illusion that sleep training is based on sound research or that it’s been practiced since the dawn of time.
But that couldn’t be farther from the truth.
In the 1920’s, John B. Watson wrote a book in which he provided very stern advice to families to only kiss their children at night and only on the head. This was likely the predominant parenting approach for several previous generations. Following Watson's book, Benjamin Spock released a parenting book in the 1940s. While he did advice parents to follow their instincts, he did suggest to parents that at bedtime, they should put their baby down, close the door and walk out of the room.
This was the start of using the extinction method to get babies to fall asleep (although it was not yet named).
Later, in the 1980’s two well-known sleep ‘experts’, Dr. Marc Weissbluth and Dr. Richard Ferber began their sleep training campaigns. Weissbluth is an advocate of full extinction and Ferber created a method where you respond to babies in timed intervals (often referred to as the Ferber method, Ferberizing). Both of these methods involve leaving your baby alone in a room to cry with the intention that they’ll learn to “self soothe” (a developmental skill we know infants are incapable of doing.)
Both of these “sleep experts” really started the whole concept that is is possible to train your baby to sleep (again, something we now know isn’t a skill that can be learned but a biological function.) In the 1980s is was common practice to separate parents and babies right away. They were swept off to a nursery where they were swaddled tightly and left to ‘self-soothe’ until their parent came later to pick them up and take them home. That practice along with the concepts brought forth by Weissbluth and Ferber went hand in hand and were both widely practiced. At that time, we knew nothing about the importance of skin-to-skin and immediate maternal contact, we knew nothing about the importance of initiating breastfeeding or being there to respond to our babies. As you can see, sleep training was created in a very different time.
Ferber's ever so popular book (still widely used today), "Solve Your Child's Sleep Problems" immediately gives parents the idea that there is something wrong with the way their baby sleeps and that a change is necessary, that night wakings are a problem or harmful to the baby and must be resolved asap. Ferber’s method is intended to encourage a child to fall asleep and put themselves back to sleep independently by withdrawing parental involvement, at various intervals, or "timed checks". Ferber advises parents to put their child to bed at their normal time (or even 30-60 minutes later, as this will ‘help him fall asleep more quickly and speed up the learning process’), and put the child to bed under the circumstances the parent would like to see them sleep the rest of the night - typically in their own crib or bed "not being held or rocked". If the child cries or calls during bedtime or at a night waking, parents are given a chart with timed intervals to follow on when to briefly check in, with intervals getting increasingly longer after each check. Then there is the guarantee: "by the third or fourth day, your child will most likely be sleeping very well". This is such a broad assumption that does not take into account children's unique temperaments, and also does not define "sleeping very well". What does that mean? Sleeping 5 consolidated hours? Sleeping 12 hours without making a peep? Ferber does include options for families who are cosleeping (room-sharing or bed-sharing) by advising parents to follow the same formula of timed responses from within the room, or that the parent will have to leave their room for the sake of separation at each given interval. Parents can leave the shared bed to sit in a chair in the room or install a gate on their bedroom door and leave the room during wakeups.
It is important to note that Ferber has since said that mothers should follow their instincts and that, “I went to great pains in the second edition to clarify that that treatment (gradual extinction) is not appropriate for every sleep issue, of which there are many.” He goes on to say that if a child is 9 months, and experiencing fear and separation anxiety, putting them in a dark room by themselves “would not be the best idea.”
Unfortunately though, his initial methodology is still widely used and doesn’t take into consideration his later statements.
The following is an excerpt from Dr. Gabor Mate (attachment expert) and his thoughts on the Ferber method:
"Named after Dr. Richard Ferber... Ferberization is the process of "training" an infant to sleep by ignoring her crying. As a family physician, I used to advocate the Ferber technique and, as a parent, practiced it myself. Since then, I have come to believe that the method is harmful to infant development and to a child's long-term emotional health. Ferberization seems simple: "After about one week, your infant will learn that crying earns nothing more than a brief check from you, and isn't worth the effort. She'll learn to fall asleep on her own, without your help," reads Dr. Ferber's advice. The question is, what else does a baby learn when treated this way and what is the impact of such learning? People cannot consciously recall what they "learned" in the first year of life, because the brain structures that store narrative memory are not yet developed. But neuropsychological research has established that human beings have a far more powerful memory system imprinted in their nervous systems called intrinsic memory. Intrinsic memory encodes the emotional aspects of early experience, mostly in the prefrontal lobe of the brain. These emotional memories may last a lifetime. Without any recall of the events that originally encoded them, they serve as a template for how we perceive the world and how we react to later occurrences. Is the world a friendly and nurturing place, or an indifferent or even hostile one? Can we trust other human beings to recognize, understand and honor our needs, or do we have to shut down emotionally to protect ourselves from feeling vulnerable? These are fundamental questions that we resolve largely with our implicit memory system rather than with our conscious minds.... The implicit message an infant receives from having her cries ignored is that the world -- as represented by her caregivers -- is indifferent to her feelings. That is not at all what loving parents intend. Unfortunately, it's not parental intentions that a baby integrates into her world view, but how parents respond to her....When the infant falls asleep after a period of wailing and frustrated cries for help, it is not that she has learned the "skill" of falling asleep. What has happened is that her brain, to escape the overwhelming pain of abandonment, shuts down. It's an automatic neurological mechanism. In effect, the baby gives up. The short-term goal of the exhausted parents has been achieved, but at the price of harming the child's long-term emotional vulnerability. Encoded in her cortex is an implicit sense of a non-caring universe.... In our stressed society, time is at a premium. Beholden to our worldly schedules, we try to adapt our children to our needs, rather than serving theirs. More "primitive" aboriginal peoples in Africa and North and South America kept their infants with them at all times. They had not yet learned to suppress their parenting instincts. The baby who cries for the parent is not engaging in "tyranny," she is expressing her deepest need -- emotional and physical contact with the parent. The deceptive convenience of Ferberization is one more way in which our society fails the needs of the developing child."
In Dr. Marc Weissbluth’s book "Healthy Sleep Habits, Happy Child", he advices a similar approach with timed checks, as well as full extinction sleep training. Weissbluth recommends sleep training babies at 6-8 weeks of age, with the disclaimer that it will work well for "common fussiness/crying babies, especially if they appear to have an easy temperament". Other options are waiting until 8-16 weeks of age, and that after 16 weeks, "success may be slow and difficult". He is essentially telling parents that if they don’t sleep train by 16 weeks it will only get harder and harder. His four methods include full extinction (let cry, ignore), controlled crying (partial ignoring, graduated extinction), check and console, and scheduled awakenings. He claims that full extinction is often "simpler to execute, and therefore parents can be more consistent", as opposed to the other methods that require more planning and modification.
It is important to remember that sleep training works for a lot of babies, but it is also important to know WHY it works.
“But sleep training works!” Sure! If by works you mean they no longer single for you. But it doesn’t teach a baby to sleep. Unsupported crying results in heightened stress levels and as a defense mechanism, their body shuts down and goes to sleep. A study by Middlemiss, et. al (2012) has shown that even after they quit signaling for you, stress levels still remain high, and by the third day the baby and mother were no longer attuned to each other. Eventually they do learn to no longer signal for a caregiver because it’s useless (which, as we know, crying is a baby’s main form of communication, so them learning that it isn’t an effective tool to get a caregiver’s attention when they need one is pretty sad.)
“The best sleep outcomes long-term come about if our babies’ or children’s sleep-times are consistently pleasurable and easy. That is, if the sympathetic nervous system is consistently dialed down for sleep, creating positive associations, the biological sleep regularity will kick in easily at bed-times and this becomes a habit.” Possums Clinic, 2015. Meaning, falling asleep out of extreme stress is not the ideal situation.
Other studies have shown that sleep training doesn’t actually reduce night wakings, it’s just that we don’t know about them (Hall et. all 2015).
