Why Sleep Isn’t Easy: Response to Confused Parents

Did you see Ava Neyer’s brilliant summary of what she learned from reading sleep books (on the Today Show, the Huffington Post or read the original blog here). She captured what many new parents feel. Every sleep book seems to have a central theme and every author seems to insist that their process is the only way that sleep can happen. We want you to know that 1) Most of the contradicting advice is right, but for different reasons, 2) We aren’t in the business of shaming parents for making informed parenting choices, 3) Every family is different and every baby will have a different path to stable sleep. We could have devoted PAGES of response to her comedic blog, but in this article we’re responding to a few of Ava Neyer’s points to help clear up the confusion. Enjoy!

“I went on amazon and bought all the top books on baby sleep and development. I read through them all, as well as several blogs and sleep websites. I gathered lots of advice. You shouldn’t sleep train at all,”

BSS: Sleep training is a personal choice. We consider any parent lead change (usually designed to help your baby to fall asleep independently and/or consolidate into longer stretches of sleep), sleep training! For some parents this will be something like the Ferber method (or the spins off and variations there are of that strategy), and for other parents this will be incorporating small, gradual changes into their daily routine over time.

“….before a year, before 6 months, or before 4 months,”

BSS: Generally, the younger your baby, the more interactive you’ll want to be. It is never too early to give your baby practice falling asleep on his own, but babies under four months are very negatively affected by sleep loss, and structured sleep training often leads to sleep loss at first before things rebound (see our blogs on naps). This can make things worse, so we generally would recommend simply incorporating good habits into your lifestyle before four months. From four to six months is a gray zone, where some babies are ready for sleep consolidation, but others still aren’t ready due to the consequences of sleep loss, still lingering newborn medical issues, or sleep patterns that are still variable in the early morning hours (see our sleep chart). We typically recommend focusing on bedtime only as a starting point between 4-6 months if you want to do a structured intervention. Then, if your baby does well with that, you can consider doing intervention during the first part of the night (see why here). Six months is a great age to consider a structured intervention throughout the entire night. Most babies are “sleep mature” and can handle intervention well. You typically don’t have to worry about separation anxiety at that age and most babies are ready to go through the entire night without eating or with just one feeding (see our feeding chart), which makes it easier for your baby to learn what you are trying to teach him.

“…but if you wait too late, your baby will never be able to sleep without you.”

BSS: This is not true! Many families choose to extend nighttime cuddles and/or feedings or the family bed throughout the first year (or even years) and then make the transition to independent sleep during toddlerhood or preschool. Whether it’s 6 months, 9 months, or 18 months, you CAN make a change and have successful crib sleep. For family beds, as long as you have partnered with your pediatrician to create a safer sleep plan, there is no problem making the transition from family bed right into toddler bed for older 2s and 3 year olds. You still need a thoughtful plan that addresses your child’s needs and past experience, but independent sleep is never a lost cause!

“College-aged children never need to be nursed, rocked, helped to sleep, so don’t worry about any bad habits.”

BSS: This isn’t a good argument for ignoring good sleep habits. And, the truth is a lot of college kids (and adults) do have terrible sleep habits that started at a very young age. If you are happy with your situation, and you think you can maintain it as long as you need to, then we are happy too. If you are nursing, rocking, bouncing, strolling, or driving your baby to sleep and it’s driving you crazy, then it’s probably time to make a change. That change doesn’t have to be sleep training in the way that many families think about it. It can simply be a gradual adjustment over time to help your baby learn to sleep without your assistance. It’s also important to note that good sleep habits begin young, so offering your child a regular bed and wake time when he is young will likely lead to him making good decisions about sleep when he’s in college

“Nursing, rocking, singing, swaddling, etc to sleep are all bad habits and should be stopped immediately.”

BSS: Oh dear. Why must so many “experts” take such an unnecessary hardline? These are beautiful ways to fall asleep. The issue is not that nursing is bad or that rocking is bad or that singing is bad. These are all really positive interactions that you can have with your baby and let’s face it, little babies fall asleep nursing. It just happens and that’s ok. The reason these interactions get such a bad reputation is because they often become sleep associations. If you’ve read our other blogs, then you have probably learned that nighttime sleep architecture leads to a brief waking every 60-90 minutes (see our 4 month regression blog). If your baby falls asleep on you, then it feels disconcerting to wake up later in another place. The same thing happens when you move from swaddling your baby to unswaddling your baby. It feels weird. The thing is that your baby can learn to sleep in all sorts of ways if given practice. For some families this practice will be in the form of one try for falling asleep independently in the crib each day with nursing to sleep at other sleep times and gradually adjusting to more practice with independent sleep. For other families this will be structured sleep training when the time comes to drop the swaddle. Again, it’s all about you. You don’t have to make change until you want to make change. It’s not a problem until it’s a problem for you and it is possible to teach your baby new things at any age.

“White noise will help them fall asleep. White noise, heartbeart sounds, etc, don’t work.”

BSS: White noise may help some babies fall asleep, but we don’t recommend using it in that way. We would recommend using white noise to protect sleep from other random stimuli that could wake your baby up unnecessarily (see our sleep basics blog).

“Naps should only be taken in the bed, never in a swing, car seat, stroller, or when worn.”

BSS: Again, this is not true. Some people say sleep in a location other than the crib “doesn’t count.” That’s also not true. Like above, sleeping in a location like a swing, car seat or carrier is a sleep association. Your baby will outgrow these alternative sleep locations, so eventually you will have to make the transition to a bed. You just need to know what you’re getting in to. For example, some families aren’t too worried about doing a structured nap intervention and would rather go with the flow until their babies are old enough and then they’ll do some sort of crib nap bootcamp (see our crib transition nap blog). Other families would rather offer some crib naps along with some car/stroller naps in order to maintain their baby’s ability to sleep in the crib and make the full-time crib transition less dramatic than doing a boot camp. Some families certainly prefer the consistency of having all naps in the crib. All of these decisions are just fine – as long as your baby is getting enough sleep! We don’t really care as much HOW your child is napping (as long as it’s safe), we just care that he IS napping and that the way he’s napping is sustainable for you long term. The most important rule with naps is that your baby is getting adequate daytime sleep and that sleep is coming at age appropriate times.

“Letting them sleep in the car seat or swing will damage their skulls.”

BSS: In this case you need to talk to your pediatrician and do research. If you are putting your baby in the same place every day, then there is potential for your baby to get a flat head. This is also true for ‘back to sleep’ in the crib, which is why it’s important to offer your baby lots of tummy time during the day.

“If your baby has trouble falling asleep in the bed, put them in a swing, car seat, stroller, or wear them.”

BSS: Again, it sort of depends on where you are in your baby’s sleep evolution. In the first four months getting your baby regular sleep is far more important than how your baby goes to sleep (again, as long as it’s safe!). The time to avoid these alternative sleep locations would be during an intervention, where you are specifically trying to change your baby’s sleep habits and consistency is essential.

“Put the baby in a nursery, bed in your room, in your bed. Co-sleeping is the best way to get sleep, except that it can kill your baby, so never, ever do it. If your baby doesn’t die, you will need to bed-share until college.”

BSS: The AAP recommends room sharing without bed sharing for the first year (guidelines here). Bed-sharing is not recommended by the AAP, because there are strong associations between bed-sharing and SIDS and suffocation. It is extremely important for the AAP to communicate this message to parents, so that they understand the known risks associated with bed-sharing. Although the public debate assumes that the AAP is ‘against’ bed-sharing or attacking families who make this choice, the recommendations are a bit more mundane. The people in the public spotlight promoting bed-sharing are typically well-educated and take measures to make their family bed a safer sleep environment than it would be if there were no baby in the bed. In the reality of SIDS and suffocation risk, many parents are uniformed about the risks that come from sleeping with a baby on a couch or in an adult bed filled with blankets or pillows or from sleeping with a baby in a bed with an adult who has used drugs or alcohol. The AAP has an obligation to ensure that these families understand the risks associated with bed-sharing, particularly when the outcome is infant death. That said, parents make informed choices that go against recommendations all of the time. Some moms choose to use formula (or have to) instead of breastfeeding despite the AAP recommendation to breastfeed. Some parents choose to skip purees and offer their babies whole fruits and veggies despite the choking hazards. When you make informed decisions it doesn’t make the situation safer, but it does mean that you know the risks. If you strongly believe in having your baby close in the family bed, we consider that a personal choice and we want you to know that from a sleep perspective this does NOT mean that your baby will never be able to sleep without you. You can gradually teach your baby to sleep in her own sleep space whenever you feel the time is right.