If your reading this article, you’ve probably heard of sleep training and considered if it is the right idea for your family. We made the decision to sleep train after 11 months of disrupted sleep. Graeme and I were very tired, and sometimes grumpy throughout the day because we just couldn’t get a good nights rest with our little one. We decided to sleep train, but there are many happy thriving families that did not require sleep-training and were able to cope with getting their baby to sleep. In my family medicine practice, I have many patients not quite sure exactly how to sleep train.
What is important to know before you start sleep-training, is that you need a consistent bed-time and nap routine first. When Madi was 6 months old, we started a healthy bed time routine to try and encourage a good nights sleep. Its important to know that even a consistent bed time and nap routine didn’t help Madi sleep through the night.
Sleep-training step 1: establish a bed time routine
1. Establish a consistent bedtime: When Madi was 0-18 months, we put her to bed around 7pm. It’s important to stick to the same time every single night. Otherwise, you might disrupt the body’s natural sleep rhythms, which makes it more difficult to get your baby to sleep.
2. Establish a relaxing pre-bedtime routine: This should not include stimulating activities like iPads and games. This relaxing routine should last 20-45 minutes and include 2-3 soothing activities such as taking a bath, changing into PJs and reading stories. The introduction of a sleep association toy or blanket may also be used. When Madi was 11 months, this was her bedtime routine:
- 6:45 I would tell Madi it was “sleepy time.” This will help her start to connect the dots with this time of evening meaning she is getting ready to go to bed.
- Then, Madi “brushes” her teeth, (or Graeme and I do it for her)
- Next, we either give Madi a bath or a cloth wipe down of her face and hands
- We put Madi into a sleeper (she always wears a sleeper for bedtime).
- Find her “sophie” (“sophie is a very small blanket with a little giraffe head on it and it sleeps with her every night).
- We give Madi milk, or breastfeed her, then cuddle (ideally this step should not be here). We do give Madi a bottle at bedtime, but some sleep experts suggest not giving a bottle at bedtime as it gives an association with eating at bedtime, and therefore a child may not be able to fall asleep without feeding. There are also maybe dental concerns with giving milk/formula at bedtime. Feeding Madi at bed time works for us, but if you are able to eliminate feeding in your bedtime routine that may be helpful.
- Then my husband or I will sing her a song and then put her into the crib, turn off the light and say good night, we love you, see you tomorrow.
- Wake up time around 7am. We eat breakfast and then play until nap time.
Step 2: Establish your nap times and have a routine
When we started our new bed time routine, we considered how much time Madi needed for napping. At 6 months, some infants may require 2 naps while others may require 3 naps. Madi only required 2 naps. The amount of time your baby needs for night time sleep and napping depends on their age. Please see my post on how much sleep your baby needs to help determine this
- Nap 1 is around 10am -11:30am. Once Madi wakes up from her nap we have lunch and play. We often have playdates arranged for lunch time.
- Nap 2 is around 3pm-4pm/4:30pm. After nap 2 we wake up and play, then have dinner.
- After dinner, we start getting ready for bed around 6:45pm.
For you and your baby, these steps may be helpful:
- Establish how much time your baby needs to sleep per night by adding up their total nap time hours, with their total night time sleep. Compare this to the guidelines recommended from the National Sleep Foundation to make sure they are not getting too much, or too little sleep.
- Chose a bed time, and stick to it every night.
- Chose a wake up time, and try and stick to it every day.
- Determine how many naps your child is taking, and figure out what times of day are best for your child. Stick to these times every day for your naps.
- Have a consistent bed time routine.
- If your child’s sleep was good and now is becoming disrupted, consider if your child’s sleep needs have changed as they are now older. If they have modify their nap times, or bed times as needed.
Step 3: Now you can start sleep-training
When you have established a consistent bed time routine, and nap time routine, and your infant is at least 4-6 months old, now you can start your sleep-training techniques.
Chose a method of either Graduated Extinction, or unmodified extinction, and Bedtime Fading. I wrote this article to describe the most popular sleep-training methods including Graduated Extinction, Unmodified Excitation, and Bedtime Fading.
In Graduated Extinction, when you put your baby to sleep, make sure they are already sleepy or drowsy (but still awake). Make sure they are comfortable in their crib, and leave them alone in their room. Then, wait until your baby cries. When your baby does start to cry, wait before checking on your baby. In Graduated Extinction, each time you go check on your baby, you wait longer and longer periods of time. With Graduated Extinction, every night that passes you should try to gradually increase the time that you take from when your baby starts to cry, until when you check on your baby.
In Unmodified Extinction, or the “cry it out” method, put your baby into their bed after her normal bedtime routine, and let her “cry it out” until she fell asleep. Refrain from saying anything, picking up your baby, or breastfeeding your baby. Simply put your baby to sleep, say your “Goodnights” and exit the room. You can watch your baby on the monitor to see how much time it takes for her to settle. Over time, she will gain skills to self-soothe and this time will be less and less each night.
Positive reinforcement is key when sleep training
Use positive reinforcement: Positive reinforcement is a style of parenting and discipline that has been shown through medical evidence to be very effective and appropriate at all ages.
Positive reinforcement can also be used with sleep, but typically with older children. For example, if the child sleeps in their own bed all night they get a sticker in the morning that they can put on their special sticker board. For older children, the reward can be modified to the child’s interest. Make sure your toddler knows that she is behaving positively when she is able to soothe herself to sleep at night.
Children’s sleep needs change throughout their life-time
If your child is having difficulty falling asleep, consider if their sleep needs have changed. Your child’s sleep needs will change as they get older. There is a method called Bedtime Fading, which is used when the child is in bed for a prolonged period of time and is not sleeping. This may indicate that the child is going to bed too early.
Bedtime fading involves advancing the child’s bedtime over time to eventually align with the child’s new sleep onset time when the child is more biologically ready for sleep. For Madi, we gradually moved her bedtime from 7 pm to 8:30pm and then instead of waking up at 5am she woke up at 7am.
Every child’s sleep times may be different, but this routine worked for my schedule and with Madi’s circadian rhythm.
Please note: If your child has continued difficulty falling asleep or maintaining sleep, it is important to see your doctor to ensure that the infant is not suffering from pain, sleep disorder, or medical problem.
Learn more from Dr. Mom
- Foley LS, Maddison R, Jiang Y, et al. Presleep activities and time of sleep onset in children. Pediatrics 2013; 131:276.
- Falbe J, Davison KK, Franckle RL, et al. Sleep duration, restfulness, and screens in the sleep environment. Pediatrics 2015; 135:e367.
- Hale L, Guan S. Screen time and sleep among school-aged children and adolescents: a systematic literature review. Sleep Med Rev 2015; 21:50.
- Brockmann PE, Diaz B, Damiani F, et al. Impact of television on the quality of sleep in preschool children. Sleep Med 2016; 20:140.
- Carter B, Rees P, Hale L, et al. Association Between Portable Screen-Based Media Device Access or Use and Sleep Outcomes: A Systematic Review and Meta-analysis. JAMA Pediatr 2016; 170:1202.
- Cooney MR, Short MA, Gradisar M. An open trial of bedtime fading for sleep disturbances in preschool children: a parent group education approach. Sleep Med 2018; 46:98.
- Owens JA, Babcock D, Blumer J, et al. The use of pharmacotherapy in the treatment of pediatric insomnia in primary care: rational approaches. A consensus meeting summary. J Clin Sleep Med 2005; 1:49.
- Cortese S, Brown TE, Corkum P, et al. Assessment and management of sleep problems in youths with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2013; 52:784.