Graduated or total extinction? Yes, another sleep training question.
July 20, 2014 7:55 AM   Subscribe

We're thinking of starting some sort of sleep training for our four month old. I know, she's young, but the "magical thinking" we have in getting her to sleep (hours of nursing, rocking, squats, singing, nursing) as well as the hourly (or even half-hourly) wake ups are not good for us, and they're not good for her. She really needs to sleep, and I can tell she really wants to. The question is, how?

We have Ferber's book, and I am keen on his idea of gradual sleep training -- i.e., checking in at set intervals. But then there's the Bringing Up Bebe doctor Michel Cohen who says just let them cry it out. I.e., put the baby in the crib at 7:30 pm, close the door, come back the next morning.

Friends, etc. differ on these approaches. The Ferber method sounds kinder, but we've heard from some people that it just extends the process (all the check-ins just get the baby upset you aren't picking her up.) But the Cohen method just sounds mean -- but is it cruel to be kind? I've seen other sleep training questions on mefi, but I'm most interested in evaluating these different approaches.

Other key facts -- she's huge for her age (95th percentile height, weight and head), so I'm not too worried about her really needing the night nutrition. (Exclusively breastfed). And she was over 41 weeks and 9lbs when she was born, and I think she's been a bit ahead of her development according to her birthdate because of it. I'm very happy to keep one or two night wakeups for food, but not ten. She naps ok during the day with a lot of work putting her down. And, also, until the last week or so she's been sleeping exclusively in the Rock n Play (an inclined sleeper) and she really does not like the flat surface of her crib. Now she sleeps in our room, but we're thinking of moving her soon.

I know this is a minefield, and that all kids are different, but I can take it. Tell me about which method of sleep training worked for you, and if you think that there's an alternative, let me know.
posted by EtTuHealy to Human Relations (25 answers total) 7 users marked this as a favorite
Every baby's different; for some, the sight of parents might be so stimulating that it'd set back the self-soothing process, I guess, but you can't know if your baby is in that group until you try. Mine sleep-trained in about three days (via Ferber's method) at 6 months of age.

Given that (a) Ferber's method is gentler than Cohen's, (b) Ferber is a proper Harvard sleep researcher while Cohen is just some random pediatrician, and (c) Ferber's method has been around longer and has a greater weight of parental anecdata behind it, I'd be inclined to start with Ferber and see how it goes. You'll be able to tell if the graduated check-ins are working the baby up unduly, and can dial down the engagement, space them out, or abandon them accordingly. Starting with the harsher approach means that you never get the chance to see if a gentler method would have worked for your child.
posted by Bardolph at 8:09 AM on July 20, 2014 [4 favorites]

if you think that there's an alternative, let me know

Just to clarify -- are you open to alternatives to sleep training, such as: not doing it, or are you open to alternatives to Ferber/Cohen that still involve "CIO"...?

(I did no sleep training of any kind; just nursed to sleep. It went fine. If you are determined to try to impose some sort of order, I would first try Pantley's The No-Cry Sleep Solution. Have a look at the stuff on the Mother-Baby Behavioral Sleep Laboratory site. Co-sleeping helped MY sleep quality, and not just because I didn't have to get out of bed.)
posted by kmennie at 8:14 AM on July 20, 2014 [5 favorites]

I also have a four-month-old whose sleep has been awful for most of the last month (up 9 times in 8 hours last night, woo!), so I really, really feel for you and I am definitely not coming at this from an angle of 'parents just have to suffer'. Sleep deprivation is horrendous.

But yes, I would still say it is cruel to leave a 4-month-old in its room all night and ignore its crying. It will probably work in the sense that it will get the baby to stop crying, but the idea that it's teaching a baby so young the useful skill of self-soothing (rather than, say, teaching them there's no point crying at night because nobody will come for you) is... one school of thought, not an objectively proven fact.

My favourite academic resource on infant sleep is ISIS - their information on sleep training, with an overview of the current research, is here.

Also, the four-month sleep regression seems to hit an awful lot of babies at this point, and it usually does get better. (I appreciate this isn't helping you sleep right now, but it definitely helped me in the bleary sleep-deprived early hours to know that my baby is doing a developmentally normal baby thing that will end.)

One suggestion: if she slept better on the inclined Rock n Play, could you try inclining her crib slightly by putting a couple of books under one end? I know a couple of people with refluxy babies who that worked quite well for.

What has worked for us (to a point!) is not doing any sleep training but having the baby in a 3-sided cot strapped to our bed. I was reluctant to go down this route, but the sleep deprivation was hellish and I was getting really worried that I'd fall asleep and drop her when I was feeding her at night, so we bought one and it's been great. She starts stirring, I put an arm round her and/or feed her without ever fully waking up myself. We are both getting more sleep, she's less cranky and I'm less exhausted. (And the bonus is that for the first time I can actually nap when the baby naps - before this she wouldn't sleep anywhere except on someone's chest.) We just spent two nights away from home with the baby back in a separate cot and it was miserable sleep-wise, so I'm confident we made the right decision for our family. Might not work for you, but it worked brilliantly for us.
posted by Catseye at 8:51 AM on July 20, 2014 [7 favorites]

Okay, well, you're asking about alternatives so I can tell you how we did this with all of our babies. We didn't "sleep train" to a method - we kind of did our own thing that ended up working out quite well for our family and with our children (and also made night weaning much easier than other people's experiences): I wrote it up pretty thoroughly in a previous AskMeFi answer. It involves some co-sleeping. I nursed exclusively and had big babies who didn't actually need to eat more than once or twice a night when little.

Another thing you might want to look into, since you're saying you can tell she wants to sleep but can't - is tension increasing & decreasing; and here is something I wrote about that in a previous AskMeFi answer as well.

I'll include the AskMoxie links I posted in that answer right here: on Babies & CIO (she also mentions "sleep regressions" - particularly her theory on the 4-month old sleep regression) and on tension increasers and tension decreasers.

I will say in my experience that my babies did change their sleeping habits a lot around 4 months, and it was kind of touch-and-go for the rest of the first year (they'd get predictable and then change it all up again). It didn't mean we couldn't establish a routine or figure out things that worked; but I don't think any of the methods that are like "you do this thing for a week and then the baby is sleep-trained!" would really work like that for most babies unless they were already disposed to respond to it by nature of their personalities. And the one method you're describing - leave the baby to cry and that's it - I would never do, especially with a baby that little.
posted by flex at 8:53 AM on July 20, 2014 [3 favorites]

We used the Ferber method. It worked for our son, but it was tough. One thing you might consider is how much stimulation your baby is getting with all singing, squats, nursing, etc. right before bed. I would suggest doing one of those things, not all of them. I had a sensitive baby and found that doing too many activities just wound him up. That's why he needed to cry at the end of the day... But you need to choose a method that you and your partner are comfortable with, and give it several days before you conclude that it is not working.
posted by tuesdayschild at 8:58 AM on July 20, 2014

Flex has it with the tension increasers/decreasers. My son was the latter. He just needed to get the tension out before he fell asleep.
posted by tuesdayschild at 9:06 AM on July 20, 2014

Yeah, getting babies to sleep can just suck. We're at about 8 months with ours and were just talking about it this morning.

One issue I have with the cry it out method is the practicality of it. I have neighbors who need sleep and a baby who is loud. And all the 'I let my baby cry it out and it was horrible for us and for them for at least a few days/weeks but now she sleeps' crowd don't really include how they handled neighbors, or if they had other children around who were also trying to sleep.

For us, what as worked because we bottle fed, is feeding her in her crib until she conks out. I recognize all of the concerns about babies choking from being fed on their back/side, but we figured it was our version of cosleeping feeding, and for ours it just worked. About 7:30 we dimmed the lights, turned on the white noise sound on spotify, swaddled her while she was using a pacifier to try to minimize the crying, the swapped the pacifier for the bottle, and sat next to her and stroked her head while she fed, and then when she was 2/3rds done, picked her up to burp her. Then put her back down, finished up her feeding and immediately popped in her pacifier.

We still did a dream feed at about 11, and sometimes she got up at 2:30, and we repeated the feeding her in her crib, and sometimes she slept til five, six or seven.

The other thing that just helped was reading about all the other parents: baby center has a nice long thread on the topic with ideas.

At eight months, she's variable. Sometimes she sleeps through the night but when we hit a developmental stage, like crawling, things get wonky again. Last night was no exception, with three hour intervals, so this morning I am groggily in a cafe, and my husband is sleeping on the couch while our daughter bounces up and down in her jumper in front of him gleefully. As I was going out the door I said, "I'm really tired and don't want to do this work I have to do." He said, "I'm really tired too." I replied, "I don't want to point fingers at the problem, but....." And then we both meaningfully glanced at each other and pointed fingers directly at our daughter and yelled in fake french accents: "J'accuse!". In what appeared to be a response of appreciating the attention, she bounced up and down even more gleefully, and we all laughed.

All to say that we weave back and forth between frustration and despair and it's-okayness, but it really helps to try to break up the moments with whatever humor and optimism you can find in your hearts. My optimism is that I hope she remains a morning baby, and when school starts I'll never have to drag her out of bed.

Hang in there - I don't know where in the world you are, but you're not alone!
posted by anitanita at 9:12 AM on July 20, 2014 [2 favorites]

Have you tried co-sleeping? Sometimes a baby will sleep if you simply lie down with her in a dark room. When she fusses rather than rocking her or turning on any lights just nuzzle her or pat her just enough so she knows you are there but without moving very much yourself. She may have to cry for ten or fifteen minutes or even an hour but it might be a little easier on you than leaving her alone to cry herself out.

When she does wake you in the night have you tried disturbing her as little as possible? No lights, no picking up unless needed to nurse her, no rocking, just well, boring dark with a parent present so she knows she is safe.
posted by Jane the Brown at 9:14 AM on July 20, 2014

Have you tried wearing your baby?
posted by pick_the_flowers at 9:39 AM on July 20, 2014

I am in almost exactly the same boat as you -- so much so that I had to make sure my wife didn't write this question using a sock puppet!

We bought the Sleep Easy Solution book, which is presented as a sort of "third-way" between "no cry" and Ferber. We tried to follow it, but found that babykins didn't really appreciate the scheduled waking/feedings and that after one night, it basically turned into the Ferber method anyway. So we adapted it and are having some success with our own version of the method.

Progress is ongoing, so unfortunately we can't give you any definitive advice on that front. Still, I felt compelled to write in just because I wanted to present a different point of view from what appears to be the conventional wisdom here and on pretty much every other baby bulletin board.

In my opinion, letting your baby cry is not cruel. Babies only have one method of communicating anything: crying. Sometimes that crying means "I'm hungry" or "I'm in pain" but often times it just means "?????" To assume that every time your baby cries, she is in a special kind of agony that can only be resolved by mother's attention is, again in my opinion, somewhat solipsist. The mother/baby bond is so close that I think it is easy for Moms to believe that it is literally the only thing that matters -- all decisions about baby care (what to feed, when to feed, how to sleep, where to sleep) are resolved exclusively on the basis of how the relationship is affected. People who choose other solutions -- like, feeding formula, say, or letting the baby learn that she can put herself back to sleep -- are accused of being selfish and cruel. Maybe sometimes it is cruel -- no one would suggest letting a one-month-old cry it out -- but other times doing these things can be in everyone's best interests.

Whatever you choose, do your best to stick with it, be clear, and realize that it is temporary. Three nights of two hours of crying is better than 3 months of waking up 9 times a night crying, no? Make your choice, realize that EVERYONE will be happier with more sleep, and go for it!

Memail me if you want more details about sleep easy and what exactly went wrong with it.
posted by artichoke_enthusiast at 9:45 AM on July 20, 2014 [4 favorites]

Pick up/Put down is one alternate that's one of the gentler methods, and can still work at this age. When they get a bit older, and even for some babies at this age, it can be too stimulating. We opted to start with this before moving on to Ferber because our little one is very intense (goes from nothing to hysterical quickly) and spits up when she cries a lot. Co-sleeping also did zero for us, as she didn't care if we were laying down with her, she just didn't want to be laying down for bed at all. Essentially you put them in the crib drowsy, then when they start crying (not fussing) you pick them up and calm them, no longer than 1-2 minutes after that happens, then lay them back down. It's possible that this takes a while, but in our experience it has taken less time each night. She's also just moved back to two feedings (one the past couple of nights!) from a couple of feedings and something like 5 other wakeups. She hit the 4 month regression hard and early, and it lasted around 8 weeks for us. I think that's starting to ease off. People disagree as to whether that can just happen on its own, but it makes sense to me that they should be able to adapt a bit without serious training, as not everyone does training, but kids eventually know how to sleep.
posted by bizzyb at 9:51 AM on July 20, 2014

Also, the Teaching your Baby and Toddler to Sleep group on babycenter is fantastic for this sort of thing, and very pro-CIO. They do go through all the alternatives and different books in their sticky, though.
posted by bizzyb at 9:54 AM on July 20, 2014

I wanted to second The No-Cry Sleep Solution...I wish I had found it sooner when dealing with my son.
posted by christinetheslp at 10:39 AM on July 20, 2014

I'm going to assume that you've tried or thought of swaddling, but if not, that was a definite game-changer for us in helping our children sleep.
posted by SpacemanStix at 10:42 AM on July 20, 2014 [1 favorite]

We had so much trouble getting baby echo to sleep in the beginning. We rocked her to sleep and eventually she started fighting that and finally we just decided to do Ferber. The first time (4-5 months, I think), she cried so much and I couldn't handle it, so we decided to stop and try again later. I just don't think she was ready for it. I read the No Cry Sleep Solution and we started trying to use some of the methods in that book and I think it definitely helped create a calmer sleep environment so that when we decided to use Ferber again (around 7 months, I think), it was much easier. We had 15-20 minutes of whining and no crying and now, at almost 14 months, she will play in her crib for a few minutes and then fall asleep on her own.

One other thing that I think helped was creating a bedtime routine. I think that's something every single sleep "expert" agrees upon. In our case, it's just nursing/bottle + 2-3 books + a little rocking/singing then putting her down in her crib "drowsy but awake" as they say.

Good luck, it's so rough!!
posted by echo0720 at 10:55 AM on July 20, 2014

Oh, I should also have mentioned that baby echo still woke up in the middle of the night for nursing or a bottle after she started falling asleep on her own. Initially, we'd have to rock her back to sleep but eventually started just setting her in the crib awake and she'd fall back asleep on her own then, too. After a while that middle of the night wakeup kept getting later and later until finally she stopped going to sleep after the nursing and we realized that okay, 5:30am is when we're all waking up for the day.
posted by echo0720 at 10:58 AM on July 20, 2014

Weissbluth is the best for baby sleep. He says that graduated checkins and extinction are both fine, but parents feel less cruel with the checkins.

I also recommend him because he gives you great advice for sleep patterns, habits, and expectations at different ages.

I feel like 4 months is a bit young for CIO.
posted by the young rope-rider at 11:07 AM on July 20, 2014 [1 favorite]

Have you talked to your pediatrician about the possibility of reflux? It can disrupt sleep and sleeping on an incline (which your baby prefers) generally relieves it somewhat.
posted by melissasaurus at 11:55 AM on July 20, 2014 [3 favorites]

We did Ferber at four months for bedtime, it went well. I think whatever you try, it's one of those things where you have to be as ready as you think the baby is. If you're not ready to follow the schedule or whatever for at least a week, no biggie; just wait and maybe you'll be ready later. If you're only half ready, you'll probably just drive yourself crazy.
posted by ThePinkSuperhero at 1:16 PM on July 20, 2014

It seems to me that making the baby angry (Ferber's method) is better than making her feel abandoned and scared.

I did Ferber's method at about 14 months, when nursing to sleep during the night stopped working, and it was great. Yes, the small one was super-pissed when I went in but didn't give him what he wanted, but he learned. And the next morning? Super happy to start a new day! Not at all upset by the night before.

The second night was better, the third night was negligible, and by the fourth night he was sleeping all night.

The thing is, you can try progressive extinction for a few nights and see if it works. And if not, you can try again later. You'll know the second night if it's working. It's not a one-time thing. Ferber seems so much kinder.
posted by orange (sherbet) rabbit at 4:18 PM on July 20, 2014 [1 favorite]

We did Ferber at 4 months and it worked well for us. I'm not sure how people know that "it teaches them no one will come/no one cares" - as opposed to just learning that when you're in bed it's time to go to sleep. I got those comments as well when I did it but I can see no sign whatsoever that my daughter doesn't feel cared for, and I wasn't worried about that because my parents did the same sleep training for me when I was a baby and I love them dearly and know that I mean the world to them.

I feel like people know their babies and whether they have the ability to learn how to self soothe - I could see my daughter soothing herself at 4 months using her pacifier and special toys when she wanted to, and I knew she could do it, and she did. There were only 3 hard days and since then she and we have all been much happier and healthier people. re: the comment above, depending on your baby you might not see results by the second night, due to a phenomenon called an extinction burst, not all babies do this but some do.

I also thought the Weissbluth book was very good and would recommend it. I read the No-Cry Sleep Solution and I thought the techniques could definitely be useful for certain children (most did not work well for my baby, but my baby is a little unusual in that she gets very wound up whenever she sees me or her dad and cannot fall asleep if we are in sight or if we are holding her). The thing I hated about the book was her condescending attitude towards anyone who wanted to use another method. She says some pretty cruel things in there about moms who let their babies cry at all in the process of getting to sleep that did not seem to me to take into account that there are many types of babies and many successful ways to parent. I preferred the science-based approach of Ferber and Weissbluth, but then again my career is in science and you may feel differently, and I think that is fine. I had to sleep so I could stay alive on my 45 minute commute, so there was really no question of letting the situation stand or co-sleeping or anything - I am sure those things can be all right for other families though.
posted by treehorn+bunny at 4:25 PM on July 20, 2014 [3 favorites]

I can't remember what this method is but with my son we basically we developed a routine and then kept repeating until he accepted that it was time to go to sleep when we put him in his crib. So every night bath, then bottle, then the routine would start with a book, then a cuddle either sitting in the rocking chair or walking with him while I sang his three comfort songs, then put in crib. If he got up (once he could get up) or wouldn't settle, we'd repeat. Sometimes, but not very often, I'd do this for an hour until he was ready to settle for sleep. But now (16 months) he goes down so easily and will often indicate when he's ready for bed. My main advice is pick a routine and repeat until the baby settles into sleep when you put him in the crib.

Just remember that you're teaching your kid how be comfortable in their crib and how to fall asleep on their own when they're sleepy.
posted by betsybetsy at 4:39 PM on July 20, 2014

Well, just to be the odd one out here here, we actually have Dr. Cohen as our pediatrician. He would've had us sleep train the baby at 8 weeks. We did it more at 4 months, and it was a godsend. My husband did it while I was on a business trip.

I am a fan of the book Healthy Sleep Habits, Happy Child, which has a range of advice but a good underlying point: it is unhealthy for your child not to get a pretty good amount of sleep. I tend to agree with this general philosophy. I also personally believe that a kid does not need to eat multiple times in the night at that age, and if they stop getting fed, they'll almost certainly adjust their caloric intake to make it up during the day. That doesn't guarantee they'll be good sleepers, but don't get up just to feed them.

For me, I could tell when my son went from "crying because he really needed me" to "crying because he was mad etc". This happened around 14 weeks. Was it hard to let him cry as needed? Of course. I don't sleep when he's crying, nor does my husband. But I do not believe it has been cruel to him; on the contrary, we've had a baby that has slept pretty much through the night from ~7-7 for the past year.

If you want to sleep train, you need to get the baby out of your room. No matter what you do, there will be some tears. But if a good night's sleep is important to you, do it.
posted by ch1x0r at 12:15 AM on July 21, 2014

I vote to start with the gentler approach, but it is absolutely true that different babies respond differently, and how they respond changes with time. Believe me, I know how bad you want to sleep train right now (we were there not that long ago with our second). But your baby might not be ready for sleep training yet, and the four month sleep regression may not be the time to do it. This doesn't mean you'll break the baby if you try for a few nights, just that it might not work. Read the stuff on tension increasers vs. reducers linked above - for awhile, at bedtime, our baby was an increaser and the longer you let her scream the more worked up she'd get. Very occasionally I'd let her go for over an hour just to see - she nearly always won in the end. Going in to check on her intermittently made it even worse. Amusingly (not) she is now a tension reducer at bedtime and increaser at naptime.

I can't even remember when we got out of the four month sleep regression. That's what sleep deprivation does for your brain. But for a long while, she *needed* full body physical contact with me to calm down. (She sometimes still does when she wakes up in the middle of the night - standing next to her and patting her only makes her angrier) It was exhausting. But, we kept putting her in her crib at the same time every night, even if she didn't stay there. (Usual pattern: nurse baby, put her in bed at 8:30, baby screams, mom throws hands up and goes to bed with baby at 9, dad sleeps elsewhere). Now when I put her down she grunts and flops a bit while thumb finds mouth, and she's out. If she does need to scream it's only for a few minutes. So, you'll probably get there eventually. If only we could get this to work for naps.

But people above are right. You'll get it figured out and then something will go haywire. We had a perfect little sleeper and then she got really sick, and had a traumatic hospitalization (during which time teeth started coming in) and by the time we got past the PTSD and the first couple teeth she had transitioned seamlessly into the clingy sobbing mess that 9 month old babies often are. We have stuck to the same routine all through it, even though when things are bad she winds up in bed with us well before morning.
posted by telepanda at 8:23 AM on July 21, 2014

Babies are different, and I think this includes being ready for sleep training at different ages. My baby was still not ready for sleep training at 10 months, but sleep trained in 1 night when we tried again at 1 year. Four months sounds crazy young to me, but I know I've heard stories of some babies sleep training that early so it's possible. On the other hand, I also know parents whose kids still didn't sleep train at 2. The book that I found most helpful, and the approach most kind, was the Sleep Lady's Good Night, Sleep Tight.
posted by rabbitrabbit at 9:44 AM on July 21, 2014

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