Question 1

What does the evidence say about sleep training for infants? Do these kids have better sleep down the track?

Candice Alfano · Accepted Answer

Sleep training can mean different things, but on the whole, the phrase refers to teaching your infant that they are capable of falling asleep independently. Although the term is sometimes used synonymously with the ‘cry it out’ method popularized by Dr. Richard Ferber, there are, in fact many ways to help an infant learn to fall asleep on their own that do not involve crying all night. Specific techniques parents use should be informed by the needs and desires of the individual infant and family. You can find great sleep training advice from pediatric sleep experts at https://www.babysleep.com/advice/sleep-training/. There are currently no well-conducted studies showing either long-term risks or benefits to sleep training. However, short-term improvements have been observed in multiple domains, including maternal sleep and mental health.

Question 2

Can you use CBTi with school-aged children?

Candice Alfano · Accepted Answer

Absolutely. In fact, cognitive behavioral interventions are the treatment of choice for children who struggle with insomnia and other behavioral sleep problems. By comparison, there are no FDA-approved medications for sleep problems in children at this time. It is important to remember that sleep is a behavior; and just as any behavior can be learned, it can also be unlearned. Changes in routine or residence, stressful/adverse events, normal nighttime fears, and maladaptive pre-bed habits are just some of the reasons children might ‘unlearn’ how to sleep. CBTi therefore teaches children (and parents) specific strategies for getting sleep on track.

Question 3

Is it common for parents of young children to sleep separately so that someone can sleep with the child? At what age should parents stop doing this and sleep together again?

Candice Alfano · Accepted Answer

This is a topic surrounded by anxiety and angst for many couples, but the truth is that there are no ‘shoulds’ when it comes to how a family decides to sleep. Rather, the most important question is, what works best for your family. My colleague and friend, Dr. Wendy Troxel recently published a wonderful book on this topic (https://www.wendytroxel.com/sharing-the-covers). She emphasizes that there is simply no one-size-fits-all sleeping arrangement for couples and families. The belief that partners should sleep in the same bed is actually a relatively recent, entirely socially constructed idea. In fact, many couples choose to sleep independently because they prioritize the health of their sleep and their relationship. So sleep in whichever way works best for your family.

Question 4

Why do tired babies and toddlers refuse to go to sleep?

Candice Alfano · Accepted Answer

It is a well-known (and often frustrating) paradox that children who are sleep deprived often resist sleep or become hyperactive. The physiological reasons for this are not well understood, but experts believe that this occurs due to a combination of children’s high energy levels combined with the effects of sleep deprivation on the young brain’s ability to regulate (or control) behavior. When dealing with this problem, it is important that parents set limits and create environments that invite sleep. Keeping regular sleep-wake schedules, using dim lighting, turning off electronics, introducing a transitional object, and re-directing active behavior to calming activities can be very helpful.

Question 5

Can babies be born with insomnia/sleep disorders?

Candice Alfano · Accepted Answer

While some infants (just like adults) are better sleepers than others, no one comes into the world with insomnia. A newborn’s sleep is primarily shaped by their need to eat – this is why they sleep a lot but in relatively short blocks. Still, young infants often need some caregiver assistance in falling asleep, commonly in the form of swaddling, holding or rocking. One of the most important things you can do is to establish a consistent sleep schedule for your infant as soon as feasible. If all efforts fail to assist your little one in getting good sleep, you should talk with your pediatrician. You can also check out www.babysleep.com for some more expert advice.

Behavioral Treatment for Insomnia in Children