Crying It Out: A Sleep Doctor’s Attempt at Sleep Training
I knew the question was coming. After giving the same lecture to thousands of pediatricians and parents, I knew to expect it. As soon as I finished my final slide, a hand would shoot up from the back of the crowd, always accompanied by a slight grin.
I was just starting my career at Duke Medical Center as a pediatric sleep disorders specialist. My most popular lecture addressed sleep training techniques for infants that wouldn’t sleep through the night. Over the course of the hour, I explained the science behind sleep.
“No human being sleeps through the night”, I’d explain. “We all wake up, and it’s a normal part of sleep. So an infant waking up at night isn’t the problem. It’s that they can’t go back to sleep on their own.”
We would discuss how infants often come to rely on sleep associations to fall asleep.
“Sleep associations are essentially anything in the environment that helps children fall asleep, such as rocking, feeding, singing, etc. If an infant is falling asleep with a caregiver’s help, then the child will expect the same thing after a normal nighttime awakening.”
Heads would shake affirmatively in the crowd. It made sense.
I followed with an explanation of the various sleep-training techniques that teach children to fall asleep on their own. This way, when they wake up at night during a normal awakening, they will simply go back to sleep. We also discussed how to create a great sleeper and avoid sleep training all together. The common advice was to put infants to sleep while they are still drowsy so they learn how to self-soothe. “If you do this from the very beginning, you won’t have to ever sleep train your child”, I’d say. Easy enough.
Perhaps I was making it all look too easy, because the dreaded question came from almost every audience…
“Dr. Kansagra, do you have any children?”
They knew the answer before they even asked.
“No, I don’t have any kids”, I’d explain sheepishly. “But I treat hundreds of children in my clinic. And the evidence is clear. The techniques for sleep training are safe and effective.”
But no, I didn’t have my own children. I knew this undermined my credibility. Knowledge is one thing, experience is another.
Fast forward a few years. It’s 2AM, and I’m waking up for the third time to my infant’s cries. I drag myself out of bed, while my wife rolls over and lets out an audible sigh.
“My turn”, I say and make my way to his crib. For the next 30 minutes, we perform the same orchestrated routine in which I feed him, rock him, sing to him, and hold him at just the right angle in order to make him fall asleep. When he is finally sleeping, I ever-so-carefully stand up, and painstakingly make my way to his crib. My muscles start to burn as I awkwardly begin his slow decent to the mattress, praying that he remains asleep. The final step is un-wedging my hand from between his head and the mattress, and just as I think I’m finally free, the crying begins again. We repeat the entire process. Typically after three rounds of this, he stays asleep.
This was our new normal. Every night our two-month-old would wake up three times like clockwork. “How did this happen?” I’d often wonder. From the day he was born, I was intent on putting him down when drowsy, hoping to never create sleep associations and never need to sleep train. Unfortunately, he would go from wide awake to fast asleep in two seconds. Where was this magical drowsy period I had heard so much about?! As time went on, my wife and I found ourselves relying on the same associations I had vowed to avoid. Perhaps this was a cosmic signal that I needed to change careers.
The day he turned four months of age, we decided to start sleep training. That night, we performed our typical nightly routine. We bathed him, fed him, and read a story. Finally it was time. This would be my defining moment. The sleep doctor was going to sleep train. I knew the stakes were high. Failing would be an embarrassment, both personally and professionally. I held my breath as I gently laid him down in his crib. Not a second later, the crying began.
This was expected. Most sleep training techniques involve some crying. I sat there next to him, listening to him cry. Every fiber of my being wanted to pick him up and soothe him, but I waited. My wife was in the next room, also crying it out.
My son cried for 52 straight minutes. And then suddenly, he seemed to take a deep breath, stopped crying, and drifted off to sleep.
The second night, he cried for six minutes. The third night, he didn’t cry at all. And he slept through the entire night for the first time. We had done it! No longer was I the bookish lecturer. I had a child, and that child was sleep trained!
The fourth night he began crying again.
The next few weeks were a series of ups and downs as he began teething and caught a series of seemingly endless colds from daycare. Each time he was ill, we would help him sleep again, leading to small regressions in his ability to self-soothe. With each bump in the road came questions about whether this was working and if we were doing the right thing.
But over the course of a month, it became quite clear that he was going in the right direction. We were finding it easier and easier to get him back on track after each set back. By five months of age, he was consistently falling asleep on his own and sleeping eleven straight hours through the night. We could simply put him in his crib and walk away. There was a feeling of relief at this new-found liberation. Suddenly we found ourselves with more time on our hands, a well-rested child, and a much happier day for all of us.
I know there are lots of strong opinions on sleep training. If I wasn’t a sleep doctor, perhaps some of these opinions would have swayed us against sleep training during that tumultuous month. The doubts would have eventually eroded our confidence. “He’ll just outgrow it,” we would have eventually said, and resorted back to helping him fall asleep with each awakening. The same nightly grind may have continued for months or years. Thankfully, we stuck with sleep training.
Was it as easy as I thought it would be? Certainly not. Did it work? Yes. Do I understand why parents often give up on sleep training? Absolutely.
My second son proved that this magical “drowsy” phase does exist. He clearly had one, allowing us to avoid sleep associations from the beginning, and thankfully, also avoid sleep training. My experience taught me that every child is different. Infants don’t read the sleep textbooks. Sleep training is a dynamic process that has to be adjusted to the child and family over time. But it works.
“Do you have children, Dr. Kansagra?”
“Yes, yes I do. And they are great sleepers.”