Response-Based Sleep Training Methods Work
Many people believe that sleep training automatically means cry-it-out or extinction based approaches. Do those methods work? Sure. But, is that your only option? Definitely not!
Cry-it-out sleep training methods are commonly spoken about among parents, recommended by pediatricians, criticized by people who advocate against sleep training, and also a focus of research in the area of infants and sleep. Because extinction-based methods are widely researched and other sleep training approaches are not as represented in research, it’s been difficult to “prove” that other sleep training methods can be successful. HOWEVER… Let’s dive into some research that shows that response-based approaches to sleep training ARE effective!!
“Response-based sleep intervention: Helping infants sleep without making them cry”
The Response-Based Approach
Mother’s chose to participate in a residential sleep program which was based on their reports of having a baby with “significant sleep problems defined as multiple overnight wakings, infant distress at day and night sleep settling times, and a history of extended settling periods.” Babies in the study ranged from 4-11 months old.
Day 1-3 of the intervention took place while the baby-mother groups stayed at a residential facility for a sleep program. The program included education for the mothers about sleep patterns and nutritional needs of their babies, and an overall focus on responding to their infant’s needs during the day and night. The facility’s staff assisted and coached the parent to follow their baby’s cues and signals.
For sleep specifically, mothers were taught about using sleep routines before sleep and, again, to respond to their baby’s cues and behaviors. Parents were taught to respond in a progressed manner, starting with a low level of support and gradually increasing support, if needed. This started out as responding with things like quiet talking or gentle touches to help comfort the baby, and if the baby continued to show cues of needing more comforting (e.g., still crying) after giving about 15-30 seconds of comfort at the lower level, the parents were taught to increase their level of comfort. This could mean continuing to progress until the level of soothing led to picking the baby up, cuddles, or feeding. (This approach may sound familiar - it is commonly called The Soothing Ladder.)
Mothers were instructed to follow the same approach for night wakings. You may have noticed the mothers were not instructed to leave the baby to cry. Hence the name, RESPONSE-BASED - mothers were responding to their baby’s cues and behaviors (their communication), which included responding to cries.
What was measured?
Infant- Total Sleep Time
The researchers looked at each baby’s total sleep time before intervention to have as a baseline comparison. They then looked at total sleep time on Day 1, 2, and 3 of the intervention. Then, a final calculation of total sleep time on day nine of the program was collected. Baseline measures of total sleep time were taken by mothers for two days before beginning in the sleep program while they were at home. Total sleep time during the program was collected by mothers and nurses while at the facility, and after returning home the times were again collected on Day 9 by the mothers.
Infant and Mother- Cortisol Levels
Beginning on Day 1 of the study, both baby and mother participants’ cortisol levels were tested at the following times: while the baby was awake (wake), at the beginning of the baby’s nighttime sleep routine (pre-sleep), and 20 minutes after the baby fell asleep (post-sleep).
If you’re interested in why conversations around baby sleep may include the topic of cortisol, we have a blog on Stress, Cortisol, and Infant Sleep Training.
Mother- Mental Health
Two assessment tools using rating scales were completed by the mothers themselves to assess the mother participants’ mental health related to depression, anxiety, and stress:
Edinburgh Postnatal Depression Scale (EPDS) - used to identify risk for depression for mothers who are antenatal and postnatal
Depression, Anxiety, and Stress Scale 21 (DASS-21) - used to measure the intensity of risk for symptoms of depression, anxiety, or stress
The Results
The main question of the study:
Is a baby’s total sleep time increased by a response-based sleep intervention by parents?
What the researchers found:
Total sleep time increased throughout their participation! Total sleep times shows an increase from prior to the study to Day 1-3 of the study (when the baby-mother participants were at the sleep program facility) to the 9th day of the study (when the baby-mother participants were back at their home).
A couple other things the researchers were checking out:
Are increases in a baby’s total sleep time observed when implementing a response-based sleep intervention for babies with mother’s that are dealing with reported symptoms of depression, anxiety, or stress?
Will decrease in cortisol levels for baby and mother be observed when using a response-based sleep intervention?
More findings:
Overall, total sleep time increased for babies both for mothers who did and did not score in the symptomatic ranges for depression based on the EPDS and for depression, anxiety, or stress based on the DASS-21. No significant differences were identified for total sleep time of babies who had mothers who scored above or below the cutoff ranges.
Mothers’ cortisol levels collected at their baby’s pre-sleep phase showed a decrease from Day 1 compared to levels on Day 9 (at home). No difference in mothers’ cortisol levels were identified for samples collected at wake or post-sleep points across the study days.
Infants’ cortisol levels collected at pre-sleep were higher for Day 2 compared to Day 9 (at home) - meaning a decrease in cortisol levels were noticed. Infants’ post-sleep cortisol levels were higher for Day 3 compared to Day 9, and Day 1 levels were lower than Day 2.
What does all this mean about this response-based sleep training method?
You made it through all that research talk! Or, maybe you jumped to this section to get the quick version of what this study tells us about response-based sleep training approaches. Keep in mind that every research study is going to have limitations, but here are the take-homes from this article:
Mothers participated in this study because they reported that their infants were not great sleepers.
Mothers learned to respond to their babies’ cues and behaviors during both the day and at sleep times. At sleep times, mothers responded by gradually increasing their intervention until their baby was comforted.
Using the response-based approach resulted in increased total sleep times for babies.
The response-based approach increased baby participants’ total sleep time for mothers that scored across a range for depression, stress, and anxiety.
Babies' total sleep time CAN be increased without using an extinction-based approach.
Extinction-based sleep training methods may not be a preferred approach for some families. This article supports that THERE ARE EFFECTIVE, RESPONSE-BASED OPTIONS FOR SLEEP TRAINING! Families who want to take a responsive approach to sleep training can feel at ease knowing that they can do just that!
If you are hesitant to sleep train your baby because you feel limited in options and none that you are aware of appeal to you, know that there are options and your feelings do matter! If you would like an individualized plan for sleep training your little one that YOU feel comfortable with, it would be my pleasure to help you. Schedule a 15 minute consult call with me to chat about how I can help you reach your sleep goals.
