Sleep deprivation – top tips for parents!
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Mandy Gurney
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Former Director of the Sleep Clinic at the NHS St Charles hospital in London and Director of Millpond Sleep clinic. She also works as an NHS Sleep educator to health professionals across the UK.
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Baby Sleeping

Should I leave my baby/ toddler to cry at night?

When coping with a new baby, there's no doubt that one of the most difficult aspects is the stress and tiredness brought about by sleep deprivation.
Video Tutorial
In Short
Researchers have found that when babies are left to cry on their own, even when they have stopped crying and settled, were often still actually as stressed as they would have been if they’d continued crying. For this reason, the Essential Parent sleep expert does not recommend leaving small babies to cry on their own.

Sleep deprivation

When coping with a new baby, there’s no doubt that one of the most difficult aspects is the stress and tiredness brought about by sleep deprivation.

It’s normal for babies to wake in the night (as it is with puppies and all baby mammals) and parents need to work around that and it can be unhelpful when ‘gurus’ convince new parents that very little babies can and should sleep through the night from an early age.

A baby which is waking several times in the night will naturally wake their parents, and this will have an ongoing negative effect throughout the next day. There’s no doubt that bringing a new life into the world is one of the most exciting and joyous things you can do, but it also has to be accepted that dealing with a newborn baby whilst in a constant state of exhaustion is a daunting proposition.

Finding a sleep routine

Many parents find themselves feeling guilty that they’re not ‘enjoying’ their baby as much as they should and this guilt, in turn, merely serves to create more stress and anxiety.

There are almost as many plans, methods and approaches to settling a baby’s sleep routine as there are babies themselves, and finding the one which matches your own parental attitude is often a matter of trial and error. Friends, your own parents and other relatives will be only too keen to throw in their own advice and experience and the plethora of conflicting opinion can often be very confusing. That’s why the presence of any official research into the subject can be seen to be incredibly useful.

Using the research to make your decision

This is an area into which personal prejudice and firmly held opinion often intrude, with some people recommending a certain approach, whilst others insist that this self-same approach would be disastrous. Faced with this, it’s handy to be able to consult carefully conducted research which is based on facts, not opinion, and which can easily be taken at face value. Such research into the method known as ‘controlled crying’ has recently been published. It throws an interesting and informative light upon this approach to the task of settling a child into regular sleep patterns.

What is controlled crying?

In its most basic terms, controlled crying consists of leaving a baby to cry for increasing periods of time and providing minimal comfort at regular intervals until the baby ‘settles’ to sleep by themselves.

In time, such babies eventually settle themselves to sleep without being comforted and, over a longer period of time, they seem to establish a set sleeping pattern. Wendy Middlemiss, of the University of North Texas, has recently undertaken research on the effects of this approach on both the children and their mothers.

Research into stress during controlled crying

The research was based around babies aged from four to ten months, and consisted of researchers measuring the presence in the babies system of the hormone cortisol. Cortisol is generally referred to as the ‘stress hormone’ since its presence in the body, at any elevated level, indicates that the person in question is experiencing heightened levels of anxiety. The hormone is released into the bloodstream in order to boost the so-called ‘fight or flight’ response, and has effects such as a quick burst of energy and a lower sensitivity to pain.

During the research, the babies’ cortisol levels were measured as they cried themselves to sleep without being comforted. Researchers found that, on many occasions, babies who had stopped crying and settled were still actually as stressed as they would be if they’d continued crying.

Studying the length of time taken to fall asleep

Another part of the research consisted of monitoring the length of time it took the children to fall asleep on consecutive nights, and here it was found that, by the third night of the study, the babies were crying for a shorter length of time before settling. Despite this, however, the levels of cortisol in their saliva remained high. At the same time, the cortisol levels of the mothers waiting nearby was tested, and it was noted that this fell in line with the length of time the babies spent crying, meaning that the mothers relaxed as soon as they felt their offspring were settling to sleep.

According to the researchers “on the third day of the program, results showed that infants’ physiological and behavioural responses were dissociated. They no longer expressed behavioural distress during the sleep transition but their cortisol levels were elevated.”
Wendy Middlemiss, in charge of the research, stated that although the infants exhibited no behavioural cue that they were experiencing distress at the transition to sleep, they continued to experience high levels of physiological distress, as reflected in their cortisol scores. Overall, outward displays of internal stress were extinguished by sleep training. However, given the continued presence of distress, infants were not learning how to internally manage their experiences of stress and discomfort.

What does this mean for parents?

Research is now being done into the way that the cortisol levels are affected over a longer period of time, as infants sleep patterns become more settled. Whilst no single piece of research can ever totally decide a discussion such as this, the information could be borne in mind by parents considering using the controlled crying approach when attempting to establish a settled sleep routine.

References and further reading

Teach Your Child To Sleep, Millpond / Hamlyn, Revised 2016.

Sleep Faring, Jim Horne / Oxford, 2006.

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Take Charge of Your Child’s Sleep, Judy Owens and Jodi Mindell / Marlowe and Co, 2005.

Healthy Sleep Habits, Happy Children, Dr Marc Weissbluth / Vermilion, 2010.

Sleeping Better, A Guide to Improving Sleep for Children with Special Needs V Mark Durand / Brookes Revised Edition 2014.

Outcomes at six years of age for children with infant sleep problems:

Longitudinal community-based study Anna M.H. Price, Melissa Wake, Harriet Hiscock et al, Sleep Medicine 13 (2012) 991–998

Short Nighttime Sleep Duration and Hyperactivity Trajectories in Early Childhood,Tourchette et al. Pediatrics. 2009.

Sleep and Depression in Postpartum Women: A Population-Based Study; Dorheim SK et al, Sleep 2009; 32(7): 847-855.

Fragmented maternal sleep is more strongly correlated with depressive symptoms than infant temperament at three months postpartum. Goyal D, Gay C, Lee K, authors Arch Women’s Ment Health. 2009;12:229–37.

Sleep problems in young infants and maternal mental and physical health, Jordana K Bayer, Harriet Hiscock, Anne Hampton and Melissa Wake, Journal of Paediatrics and Child Health, vol 43, issue 1-2, January/February 2007.

Longitudinal analysis of sleep in relation to BMI and body fat in children: the FLAME study. BMJ 2011

Short sleep duration is associated with increased markers in European adolescents

International journal of Obesity (2011) 35, 1308-1317 M Garaulet et al.

Sleep and the epidemic of obesity in children and adults; E Van Cauter & K Knutson, 2008.

The use of MElatonin in children with Neurodevelopmental Disorders and impaired Sleep: a randomised, double-blind, placebo-controlled, parallel study (MENDS),Re Appleton, AP Jones, C Gamble, PR Williamson, L Wiggs, P Montgomery, A Sutcliffe, C Barker and P Gringras. Health Technology Assessment 2012; Vol. 16: No. 40 DOI: 10.3310/hta16400

Kids’ behavior impacted by lack of sleep, Jase Donaldson, Insight Journal, Feb 13 2006.

What affects the age of first sleeping through the night? S M Adams, D R Jones, A Esmail and E A Mitchell, Journal of Paediatrics and Child Health, vol 40, issue 3, March 2004.

Behavioral Treatment of Bedtime Problems and Night Wakings in Infants and Young Children; An American Academy of Sleep Medicine Review, Jodi A. Mindell, et al SLEEP, Vol. 29, No. 10, 2006

References are reviewed on a regular basis and are updated when applicable.

Sleep Training NHS staff since 2007
If you or your colleagues want to know more about children’s sleep and how you can help the families you are working with, Millpond Sleep Clinic run one-day Sleep Workshops aimed at health care professionals.
These highly engaging sessions are based on proven research and years of experience and are suitable for all staff working directly with the families of babies through to school aged children.
The workshop is fully certified and approved by The CPD Certification Service.
If you would like to find out more about the sleep workshops please contact Millpond direct on:
Tel: 020 8444 0040

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DISCLAIMER
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Essential Parent has used all reasonable care in compiling the information from leading experts and institutions but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details click here.