By Tracy G. Cassels
We have a real obsession in Western nations, and I’m not sure it’s a healthy one. We are completely, totally, obsessed with sleep. And not in the “I love sleep” kind of way, but in a much more insidious way. Why? Because we focus the attention of our sleep obsession on those too young to stand up for themselves or to tell us how they really feel and what they really need. So we have tons of parents buying books telling them how to sleep train their children, stressing over every minute of sleep, and generally running around anxious as can be if their child isn’t doing what they think they ought to be, worried that this means something horrid will happen to said child. And if you don’t believe that we have a sleep obsession for our children, go to Amazon and look up “child sleep” in books and you will find 26,135 paperbacks. Although I’m positive not all of them really address sleep “problems” in our young, I would bet a sizeable number of them do. And unfortunately, by addressing sleep problems, we are typically talking about sleep training. To put this in perspective, there are only 14,326 paperbacks that tackle the issue of poverty. There are only 9,990 paperbacks on the topic of racism. And yet, here we have nearly the same number of books on child sleep as poverty and racism put together. Is that really how things ought to be? I think we need to change this. And by this I mean the prevalence of sleep training our infants and our unhealthy obsession with their sleep. To do this we must look at some of the thoughts that lead to such an obsession to understand why they are, well, misguided.
Thought #1: Sleep is so important that we must make sure our children sleep get the recommended amount of sleep at the recommended times.
I’m going against the grain on this one, but while sleep is obviously important, most of the time I would say we need not worry – especially at the beginning. Our children and babies naturally know how to sleep and will sleep if left to their own devices. There will be a small number for which this doesn’t work, and yes we should care when there’s a problem and an infant or child is clearly having problems sleeping and showing signs of being sleep deprived, but most infants are not sleep deprived. There are studies in Western cultures that find high rates of pediatric sleep disorders – upwards of 40%[1] – commonly defined by night wakings in infancy and then night wakings and bedtime resistance in childhood. Oddly, even when a “disorder” is given, it’s typically the parents who have a problem with infant sleep, not the infant. Studies looking at infant sleep found that parents didn’t think their children or infants showed signs of sleep deprivation at all, but that their child’s sleep was a problem for them[2][3]. So why are we giving the infant the diagnosis of a disorder? Even if we ignore that, I have to ask, if 40% of a population has a “disorder”, isn’t it time we actually look at our definition of this disorder? While I do believe that there are children who suffer from a sleep disorder, I firmly believe this is a case in which we have a very clear overdiagnosis problem happening.
Thought #2: My child is better off with a parent who is well-rested/I am a much better parent for sleeping through the night.
This is the argument that is typically presented as a reason to sleep train. But you shouldn’t hear this argument and not think about the myriad cultures in which children aren’t sleep trained, parents still work and function, and everyone seems to do pretty well, on average. What is the difference? One could arguably say that co-sleeping has a lot to do with that. In a review of 90 traditional cultures, not a single one had infants sleeping far away from their mothers[4]. Not a single one. In fact, many parents report their amount of sleep and quality of sleep improves greatly when they have their infant either in the room or their bed (remember that co-sleeping is not only bedsharing, but also room-sharing).
There is also more, though. One additional aspect is that this speaks of the total lack of support and community available to parents in today’s Western society. In fact, even in non-Western societies, those that have less frequent community interactions (typically farming tribes) show more similar infant-caregiver patterns and infant behaviours (including crying, fussiness, and distal interactions with the caregiver) to Western societies than those who live in a more tight-knit community[5]. (However, it is notable that their interactions are still far greater than those of the average mother in Western society and they do not complain about infant behaviours, including crying, sleeping, etc., as much as Western mothers.) This is compounded when parents are expected to return to work too early (hello, United States of America). (If you would like to write your State or Federal representative on this, we have a downloadable letter, filled with research, for you here. Just fill in the needed representative information, sign it, and send it off.)
But really, the issue of are you a better parent is a little weird to me. Do you feel a bit better if you get 8 hours sleep? Yep, I bet you do. Are you a better parent? That depends – do you think your child needs you at night? If not, then yes. If you believe that being a parent is a 24-hour job, then perhaps not. Perhaps at some points you are a better parent, but at others you would become demonstrably worse (i.e., when you are “teaching” your child by ignoring his or her needs). There is also the question of comparison. If a certain level of missed sleep is the norm for parenting, then why would we consider it “bad”? If that missed sleep ensures we are more in sync with our child and his or her state, then wouldn’t we be giving that up? So we have to decide what we’re comparing this to. (And remember, we’re not talking about severe sleep deprivation – that is something altogether different – but rather the typical loss of sleep that accompanies parenting. If you are suffering severe sleep deprivation or post-partum depression, you should seek medical help and familial support. And while severe sleep deprivation is serious, it is beyond the scope of this current piece.)
Thought #3: Sleep training is the only alternative in our society when parents are sleep deprived and still need to work.
Yes, there will be people for whom the sleep deprivation is so bad that something needs to be done – as just stated above. I won’t deny that. I believe you are a minority, though, and many others cling to this notion because it’s convenient, not because it’s true. But I also believe people feel they need to do something because it seems like night wakings simply won’t end. Our complete lack of understanding of basic infant physiology means that we expect far too much from them and get unbelievably frustrated, depressed, and helpless when they don’t behave the way we want. So first, I recommend a crash-course in what you really should expect from your infant. (Hint: sleeping through the night at 3 months is not it.)
That said, there is research that suggests a heightened risk of negative maternal mood associated with “poor” infant sleep which serves as a risk factor for maternal depression and family stress[6]. Now, I will not advocate that parents should simply accept depression and greater stress, but I don’t think sleep training really helps matters either. When one actually looks at the studies on sleep training, they come across as rather ineffective (despite your friend or neighbour swearing it’s so great it might as well cure cancer)[7]. And in fact, a larger-scale study suggests that simply implementing a bedtime routine without any behavioural interventions for infants can have significant positive effects for the sleep of the baby and the parents’ well-being[8]. In fact, routines that are designed with the particular infant in mind can be incredibly successful for everyone involved.
There’s also this little practice called co-sleeping. You may want to check it out.
Thought #4: Night wakings are considered sleep disorders thus they must be bad.
Sadly you can read a lot about sleep “problems” like night wakings and nursing or rocking to sleep (see [1]) which serve to make parents feel anxious and nervous about their own behaviour surrounding a sleeping child. But historically, this behaviour was never seen as anything but normal. And it remains that way in cultures around the world and is actually normal in our own culture. A reminder that a review of 90 traditional societies found that not in a single one are infants and parents separated for sleep or experience sleep training as we do it[4] and approximately 40% of children in our own culture regularly wake during the night for the first few years[1][9]. While some will argue that our society is not the same as a traditional one, that ignores the fact that infant biology and physiology is the same. So if left to their own devices, infants seems to expect to be able to wake during the night, stay close to parents, and breastfeed at length (which means breastfeeding during the night too). Folks – THAT is what is normal. Not bad, normal.
Thought #5: We have the privilege of living in a society that CAN worry about sleep and so we can do better for our children.
I actually think this is flat-out wrong. I’ve seen children’s sleep referred to as a first-world problem but I would argue it’s a first-world screw-up. We’ve over-analyzed it, for one, but we’ve also created a society that is less amenable to sleep than traditional ones. We’re not in any privileged position here, but rather a worse one. And in turn, I don’t think we’re doing “better” for our kids. I think we’re doing worse.
Beyond being normal, there are also reasons to believe that these night wakings can be beneficial to infants and even older children. First, as hypothesized by James McKenna, night wakings may help prevent SIDS[10], they are necessary for cue-feeding given the size of an infant’s stomach[11], and may even be an evolutionary adaptation to ensure someone is close by and caring for the infant, ensuring his or her survival. Yet sleep “experts” and some sleep researchers are so focused on the need for an infant to sleep through the night, they ignore the evidence that talks about the benefits of waking. Second, night wakings are intricately related to breastfeeding on cue, which is the biological norm for infants and children, and thus if a child is waking or rousing to nurse (with breastfeeding’s ability to save lives[12]), they are actually getting something very positive from it. Finally, for some children, sleep training creates problems down the line. Parents report that their children at older ages fear sleeping, don’t feel safe, resist bedtime, etc. and many of these parents attribute it to their early sleep training providing anxiety surrounding sleep for their children.
As to the idea that we’re doing better… have you seen the rates of sleep problems in adults in our society? We have over-the-counter sleep aides, prescription pills, sleep clinics, psychiatrists who specialize in sleep problems (and have thriving practices), pills that help you stay asleep, and the list goes on. According to WebMD, “Sleep problems… are common among millions of Americans”. According to the US National Sleep Foundation, 40 million Americans suffer from a chronic sleep disorder. 40 million. If I were a conspiracy theorist, I’d believe that we were intentionally screwing up sleep early to ensure that we have enough patients for doctors and pharmaceutical companies alike. That would be the easy thing to think. But I don’t actually believe that.
Doctors and “experts” have been telling parents to leave children to cry to learn to sleep for at least a couple generations, and yet this is what we have. At the end of the day, we have to ask ourselves, if all this sleep training were really helping kids develop proper sleep habits, shouldn’t we have a society of great sleepers instead of the opposite? So ditch the misguided thoughts, educate yourself on what normal infant behaviour is, and embrace the crazy that comes with being a parent.
[1] Meltzer LJ, Mindell JA. Sleep and sleep disorders in children and adolescents. Psychiatric Clinics of North America 2006; 29: 1059-1076.
[2] His**** H, Wake M. Infant sleep problems and postnatal depression: a community-based study. Pediatrics 2001; 107: 1317-1322.
[3] Loutzenhiser L, Ahlquist A, Hoffman J. Infant and maternal factors associated with maternal perceptions of infant sleep problems. Journal of Reproductive and Infant Psychology 2011; 29: 460-471.
[4] Diamond J. The World Until Yesterday: What Can We Learn From Traditional Societies? New York, NY: Viking (2012).
[5] Hewlett BS, Lamb ME, Shannon D, Leyendecker B, Scholmerich A. Culture and early infancy among Central African foragers and farmers. Developmental Psychology 1998; 34: 653-661.
[6] Sadeh A, Tikotsky L, Scher A. Parenting and infant sleep. Sleep Medicine Reviews 2010; 14: 89-96.
[7]
http://www.isisonline.org.uk/how_bab...arch_evidence/
[8] Mindell JA, Telofski LS, Weigand B, Kurtz ES. A nightly bedtime routine: impact on sleep in young children and maternal mood. Sleep 2009; 32: 599-606.
[9] Weinraub M, Bender RH, Friedman SL, Susman EJ, Knoke B, Bradley R, Houts R, Williams J. Patterns of developmental change in infants’ nighttime sleep awakenings from 6 through 36 months of age. Developmental Psychology 2012; 48: 1511-1528.
[10] McKenna JJ, Thoman EB, Anders TF, Sadeh A, Schechtman VE, Glotzbach GT. Infant-parent co-sleeping in an evolutionary perspective: Implications for understanding infant sleep development and the sudden infant death syndrome. Sleep 1993; 16: 263-282.
[11]
http://www.evolutionaryparenting.com...arch-overview/
[12] Bartick, Melissa, and Arnold Reinhold. The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis. Pediatrics 2009; 125: 1048-56.
