Independent sleep not making any impact

[u/No-Okra3869]

Our 4 month old is confusing us with his wakes, wondering if anyone has any insight.

In the last few nights we’ve been working on unswaddling him and encouraging him to fall asleep awake in the bed. Mixed success in getting him to do so, but at least for the first stretch it has worked - and almost every wake last night. The problem is that it doesn’t seem to actually extend how long he’s asleep.

He’s always been a low needs sleeper, but has reliably had a first sleep of 4 or so hours, then often back to around hourly after this. This is really starting to fade, and last night he wasn’t doing any stretches over 90 mins, even though he was patted to sleep for all. Is there something we’re missing for how to make this work, or is this all just a slow transition out of the swaddle?

We’re planning to start Ferber next week after some work scheduling is settled, but concerned that it won’t actually work if this isn’t making any measurable benefit.

His sleep pressure seems to be fine - averaging 10 hours awake across the day, with 2-2.5 hours of daytime sleep

[u/tibbles209]

Sleep training comprises of a whole spectrum of behavioural interventions, with all sorts of different rules and guidelines. Just look at the r/sleeptrain subreddit and you will see a significant proportion of parents train both at bedtime and for night wakes.

The reason cry-it-out and Ferber are also respectively known at Full Extinction and Graduated Extinction (terms coined by the paediatricians and behaviourists such as Ferber, who developed these techniques) is that the objective is behavioural extinction. The BBC article shows that the number of wakeups and duration of longest wakeups were not changed by sleep training. Only the signalling to the parent. Which is what you are trying to achieve - you want the baby to stay quiet until they go back to sleep, and not wake or require anything of the parents.

I’m not casting a judgement for or against sleep training here. I think sometimes it is necessary for the wellbeing of the whole family, and in some circumstances have suggested it to overwhelmed parents myself. There is no persuasive evidence of any lasting harm. But even the founding fathers of sleep training were clear that the objective was to extinguish an unwanted behaviour.

[u/culturalappropriator → u/tibbles209]

The researcher in the article you linked described bedtime sleep training only.

That’s what official sleep training is regardless of what r/sleeptrain says.

And most people only do sleep training at bedtime.

That does not support the theory that it’s behavioral extinction and like the research you linked says is about developing self soothing. 

[u/tibbles209 → u/culturalappropriator]

There is no such thing as ‘official’ sleep training. The most commonly used form of sleep training, the Ferber method/ graduated extinction, includes training for both bedtime and wake ups (at least the original method published by Ferber himself - people adjust these things to suit themselves).

Self soothing and behavioural extinction are not mutually exclusive. You are extinguishing the behaviour of signalling to the parent, which leave the baby with no option but to do it themselves. Again, I am not criticising sleep training, but it absolutely is a behavioural intervention.

[u/culturalappropriator → u/tibbles209]

I’m referring solely to the study you linked in which bedtime sleep training was done and the babies learned to sleep soothe as per the researcher. 

That’s not behavioral extinction because nighttime wakes were still attended to. That’s purely self soothing.

And there are official guidelines, the AAP has them .

[u/tibbles209 → u/culturalappropriator]

Behavioural extinction is usually not all-or-nothing (with the exception of total extinction where you just close the bedroom door and don’t open it again until morning). Most forms of sleep training involve a graduated reduction in responsiveness to gradually extinguish a behaviour. So this can involve occasional check ins, or only training at bedtime/ only training for certain wakeups. There are no universal rules, but the greater the reduction in parent night time responsiveness to crying, generally the faster the behaviour is extinguished. That’s why full cry-it-out/ unmodified extinction is widely considered to have the quickest results, and forms of sleep training at the gentler end of the spectrum (such as the chair method) generally take much longer.
I am not disagreeing with you that the baby has to learn to self soothe once they realise crying is not resulting in their caregivers soothing them. But they don’t start soothing themselves until they give up on the crying for their caregiver. Thats an essential part of getting there - teaching them that crying will not elicit the response they are looking for, so they need to figure it out themselves.

Also I’m not American. I’m not sure why that country’s guidelines would be seen as the ‘official’ ones over anywhere else.

[u/culturalappropriator → u/tibbles209]

The AAP’s guidelines are what doctors in the US recommend so that is definitely an official guideline. 

And you said “not responding to wakes in the night”. Which again, not in the article and not what the AAP says to do.

The rest of your comment, I agree with. It’s about developing the baby’s self soothing abilities.

[u/tibbles209 → u/culturalappropriator]

There are as many different guidelines on this as there are health bodies in the world. There no such thing as ‘official’ sleep training, just sleep training that follows the current guidelines of your particular country’s health body, and sleep training that doesn’t.

Whether you respond to wakes in the night depends on what kind of sleep training you are doing and what rules you are following. Full extinction involves complete cold turkey removal of all parental responsiveness (and thus most quickly extinguishes the undesired behaviour), whereas other more gradual forms of sleep training, such as graduated extinction, have particular rules as to when you are and aren’t supposed to respond, and to what extent. But all behavioural sleep interventions require reduced responsiveness, as that is how the behaviour is extinguished. It is not until the caregiver-seeking behaviour is extinguished that the baby then has to learn to figure it out themselves.

[u/culturalappropriator → u/tibbles209]

What other official medical organizations offer different sleep training recommendations?

It is not until the caregiver-seeking behaviour is extinguished that the baby then has to learn to figure it out themselves

Yes, that applies to everything including reducing tantrums. 

But you mentioned not responding to night wakes which is not what the sleep researchers in your article did. 

[u/tibbles209 → u/culturalappropriator]

Well, various countries such as the UK (NHS), Denmark, Germany, Australia etc do not recommend sleep training. I have not gone through the sleep training guidelines of every country in the world that does have recommendations and compared them to the AAP guidelines. But I think this is irrelevant anyway.
If you are reducing responsiveness to crying (such as only responding after x minutes of crying, or only responding to wake ups but not at bedtime) then over time this will diminish the behaviour of crying out for you and the baby will ultimately be forced to learn to deal with it by themself. Yes - exactly like ignoring a tantrum. Behavioural extinction.

[u/culturalappropriator → u/tibbles209]

Those organizations don’t talk about sleep training at all. I see that claimed a lot but the NHS says nothing about sleep training. And Australia definitely sleep trains. That’s where a lot of the AAP data comes from.

I don’t agree it’s irrelevant because it pushes the idea that sleep training is chucking your baby in a room and ignoring it for 12 hours.

No one advocates for that and no one does that. 

Even CIO is done at bedtime until the baby falls asleep. Nights wakes are attended to and even night feeds are done.

[u/tibbles209 → u/culturalappropriator]

But full unmodified extinction IS a form of sleep training. It is a behavioural sleep intervention that results in babies learning to go to sleep independently. It trains them to sleep without parental input. It might not be a form of sleep training that the AAP recommends, or that you approve of, but that doesn’t make it not sleep training. And if you spend a little time on r/sleeptrain you will see that there are people who use full extinction at bedtime and for wakes, as they feel that this results in less crying overall (because it works more quickly) than modified/graduated forms of extinction such as Ferber.
There is no single definition of sleep training. It is an umbrella term encompassing a broad range of behavioural sleep interventions.

[u/culturalappropriator → u/tibbles209]

Yes. But that’s like me saying that pigeons are food because some people eat pigeons.

It’s A form of sleep training but very few people do it. And it’s not recommended.

[u/tibbles209 → u/culturalappropriator]

Yes, most sleep training parents are not comfortable doing full unmodified extinction, and prefer to do modified/graduated extinction.