- Journal List
- Can Fam Physician
- v.64(1); 2018 Jan
- PMC5962992
As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsem*nt of, or agreement with, the contents by NLM or the National Institutes of Health.
Learn more: PMC Disclaimer | PMC Copyright Notice
Can Fam Physician. 2018 Jan; 64(1): 41.
PMCID: PMC5962992
PMID: 29358251
Christina Korownyk, MD CCFP
Associate Professor in the Department of Family Medicine at the University of Alberta in Edmonton.
Adrienne J. Lindblad, ACPR PharmD
Knowledge Translation and Evidence Coordinator for the Alberta College of Family Physicians and Associate Clinical Professor in the Department of Family Medicine at the University of Alberta.
Copyright and License information PMC Disclaimer
Clinical question
What is the evidence for infant sleep training?
Bottom line
Sleep training improves infant sleep problems, with about 1 in 4 to 1 in 10 benefiting compared with no sleep training, with no adverse effects reported after 5 years. Maternal mood scales also statistically significantly improved; patients with the lowest baseline depression scores benefited the most.
Evidence
Sleep training, or controlled crying, is where parents respond to their infant’s cry at increasing time intervals to allow independent settling.
A 6-week RCT of 235 infants with a mean age of 7 months, with 2 or more awakenings per night on 5 or more nights per week, found the following1:
-For sleep training versus safety education, there were statistically significant reductions in parental reports of severe infant sleep problems (4% vs 14%, number needed to treat [NNT] = 10); reductions in the number of infants with 2 or more diary-recorded awakenings per night (31% vs 60%, NNT = 4); and improved parent fatigue, sleep quality, and mood scale scores.
A cluster RCT of 328 families reporting infant sleep problems (mean age 7 months) examined a tailored sleep intervention with sleep training versus usual care. The following was found for the intervention group2:
-At 10 months, there was statistically significant reduction in maternal reports of infant sleep problems (56% vs 68%, NNT = 9) and a non-significant reduction in mothers with depression (Edinburgh Postnatal Depression Scale score > 9; 28% vs 35%).
—Those with baseline scores above 9 had statistically significant numerical improvement in depression scale scores (subgroup analysis).
-At 2 years, there were fewer reported depression symptoms (15% vs 26%, NNT = 9).3
-At 5 years, there was no difference in any of 20 outcomes including child behaviour, relationships, and maternal mental health.4
Recent smaller studies5,6 and systematic reviews7,8 support sleep training interventions for sleep and improved parental depression symptoms.7
Context
Infants’ sleep problems are associated with parental depression,9,10 psychological distress,11 and poor health.11
Increased infant sleep is associated with good temperament, adaptability, and low distractibility.12
Allowing the baby to “cry it out” was similarly effective, although parents often find this method more stressful.7
Sleep training is simple and can begin at 6 months.
Implementation
There is no exact formula to sleep training. Most suggest putting the baby to bed while he or she is drowsy but still awake and leaving the room. If the baby cries, caregivers should not respond for 2 to 5 minutes. Responding involves brief reassurance without picking the baby up. The caregiver does not return for another 2 to 5 minutes. This interval is gradually extended by 2 to 5 minutes until the baby falls asleep. Although parents might initially find this method distressing, the infant’s sleep usually improves within 1 week.5
Notes
Tools for Practice articles in Canadian Family Physician (CFP) are adapted from articles published on the Alberta College of Family Physicians (ACFP) website, summarizing medical evidence with a focus on topical issues and practice-modifying information. The ACFP summaries and the series in CFP are coordinated by Dr G. Michael Allan, and the summaries are co-authored by at least 1 practising family physician and are peer reviewed. Feedback is welcome and can be sent to ac.cpfc@ecitcarprofsloot. Archived articles are available on the ACFP website: www.acfp.ca.
Footnotes
Competing interests
None declared
The opinions expressed in Tools for Practice articles are those of the authors and do not necessarily mirror the perspective and policy of the Alberta College of Family Physicians.
References
1. Hall WA, Hutton E, Brant RF, Collet JP, Gregg K, Saunders R, et al. A randomized controlled trial of an intervention for infants’ behavioral sleep problems. BMC Pediatr. 2015;15:181. [PMC free article] [PubMed] [Google Scholar]
2. Hisco*ck H, Bayer JK, Gold L, Hampton A, Ukoumunne OC, Wake M. Improving infant sleep and maternal mental health: a cluster randomized trial. Arch Dis Child. 2007;92(11):952–8. [PMC free article] [PubMed] [Google Scholar]
3. Hisco*ck H, Bayer JK, Hampton A, Ukoumunne OC, Wake M. Long-term mother and child mental health effects of a population-based infant sleep intervention: cluster-randomized, controlled trial. Pediatrics. 2008;122(3):e621–7. [PubMed] [Google Scholar]
4. Price AMH, Wake M, Ukoumunne OC, Hisco*ck H. Five-year follow-up of harms and benefits of behavioral infant sleep intervention: randomized trial. Pediatrics. 2012;130(4):643–51. [PubMed] [Google Scholar]
5. Gradisar M, Jackson K, Spurrier NJ, Gibson J, Whitham J, Williams AS, et al. Behavioral interventions for infant sleep problems: a randomized controlled trial. Pediatrics. 2016;137(6) pii: e20151486. [PubMed] [Google Scholar]
6. Symon BG, Marley JE, Martin AJ, Norman ER. Effect of a consultation teaching behaviour modification on sleep performance in infants: a randomized controlled trial. Med J Aust. 2005;182(5):215–8. [PubMed] [Google Scholar]
7. Mindell JA, Kuhn B, Lewin DS, Meltzer LJ, Sadeh A, American Academy of Sleep Medicine Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep. 2006;29(10):1263–76. Erratum in: Sleep 2006;29(11):1380. [PubMed] [Google Scholar]
8. Ramchandani P, Wiggs L, Webb V, Stores G. A systematic review of treatments for settling problems and night waking in young children. BMJ. 2000;320(7229):209–13. [PMC free article] [PubMed] [Google Scholar]
9. Hisco*ck H, Wake M. Infant sleep problems and postnatal depression: a community-based study. Pediatrics. 2001;107(6):1317–22. [PubMed] [Google Scholar]
10. Cook F, Giallo R, Petrovic Z, Coe A, Seymour M, Cann W, et al. Depression and anger in fathers of unsettled infants: a community cohort study. J Paediatr Child Health. 2017;53(2):131–5. [PubMed] [Google Scholar]
11. Martin J, Hisco*ck H, Hardy P, Davey B, Wake M. Adverse associations of infant and child sleep problems and parent health: an Australian population study. Pediatrics. 2007;119(5):947–55. [PubMed] [Google Scholar]
12. Spruyt K, Aitken RJ, So K, Charlton M, Adamson TM, Horne RS. Relationship between sleep/wake patterns, temperament and overall development in term infants over the first year of life. Early Hum Dev. 2007;84(5):289–96. [PubMed] [Google Scholar]
Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada
