Is There a Best Method for Sleep Training?

Emily Oster

7 min Read Emily Oster

Emily Oster

Is There a Best Method for Sleep Training?

What about a best age?

Emily Oster

7 min Read

There are few things in parenting more likely to provoke strong feelings than sleep training. Online —especially on Instagram — you can see a huge range of feelings. Depending on who you ask, sleep training is either completely necessary to raise a competent child or a sure-fire way to create an attachment disorder. Most of these claims are not evidence-based. In the data, whether you sleep train your child or not does not drive long-term outcomes.

I’ve written about this extensively before, in Cribsheet and in this ParentData post. There, I focused on the number one question that people ask: Will sleep training damage my baby and ruin our attachment? The answer is no. I discuss an extensive array of randomized trials that follow kids up to early childhood and evaluate both child and parental functioning. Overall, sleep training programs improve infant sleep, lower parental depression, and seem to have no long-term impacts on children.

This post is not about those questions. It is, instead, about the sleep training details. Many people are sold on the idea of sleep training, but then there is the how? When do you start? Is there a better method?

These questions are not answered with large randomized trials, I am sorry to say. You could imagine such a study — recruit people, randomly encourage some to sleep train at three months, some at six, some at nine, and follow their success and their children over time. It’s not that it would be impossible to do it, but a really good study like this would take a long time and be expensive. Funding for such studies in general pediatrics is not great. In addition: based on what we do know, it seems unlikely that there would be any very large differences. This means that either you need a huge sample size or you would find nothing.

In lieu of this, we can ask for a “second best”: at least an understanding of what other people do. Today I will surface some new data on that question. First, from a recent study based on people using a sleep monitor. And second, from a survey I ran of you all. Will this tell you precisely what you should do? No. But it will give a sense of how others are implementing sleep training, and I’ll try to bring it together with some thoughts at the end.

Note: If you are not a parent or a regular reader of this newsletter, “sleep training” as colloquially used refers to using some kind of “cry-it-out” approach to encouraging babies to fall asleep on their own. Researchers tend to call these “behavioral sleep interventions,” or BSIs. For today, we’ll go with “sleep training.”

Quick theory on sleep training

A general piece of advice you can find around the internet is that it’s good to wait until four to six months for sleep training, since that is the age at which babies can better self-soothe (suck on their hands, etc). This may have some theoretical basis, but there isn’t some written-in-stone tablet that says that four months is a magic moment when this will be possible/easier. Plenty of advice suggests earlier (the Tribeca Pediatrics network famously pushes sleep training at eight weeks) and other people say wait (or never do it).

Babies differ in their temperament as well. We had planned to wait to sleep train Finn, but at about 10 weeks it became completely clear that we were making his sleep worse by rocking him to sleep. The first night we left him alone, he cried for much, much less time than he had the previous nights when we were there.

Bottom line: we can’t really use theory alone here.

Nanit study

The Nanit baby monitor is one of the Teslas of baby monitors. It tracks your baby’s sleep, breathing, etc. No, you do not need it. However, the fact that people own these is a great opportunity for the company to do research on sleep.

In November, this team published a paper in the Journal of Pediatrics with findings from one such study.

For the study, they recruited 2,090 parents of children 3-18 months who used a Nanit. The participants completed a survey about infant sleep, their use of sleep training techniques, and their own sleepiness and depression and parent-infant bonding. The researchers collected data from the monitors to try to evaluate infant sleep objectively. [Note: Unsurprisingly, the sample in this study is disproportionately higher-income and white, relative to the U.S. population.]

The most interesting data, to my mind, is in what parents are doing: 64% of parents report some sleep training, and they do it at an average of 5.3 months of age. The authors distinguish between three approaches: “unmodified extinction” (cry it out without checks), “modified extinction” (cry it out with checks), and “parental presence” (cry it out with parents in the room). Modified extinction was the most common approach (43% of people try it), followed by unmodified extinction (28%) and parental presence (10%).

There are three primary results to pull out here.

First: Modified and unmodified extinction work better than parental presence. They take fewer days (as reported by the parents), and the objectively measured sleep is better for these groups of infants. Unmodified extinction looks slightly better than modified, but those differences are not significant.

Second: These approaches can take longer than some people hope. For both extinction approaches, improvement was seen within nine days on average, but with a wide range. For parental presence, the time to improvement was 15 days on average. This doesn’t mean no one was successful in a few days, but it’s not always immediate.

Third: There doesn’t look to be a large difference in success or outcomes depending on when the sleep training is occurring. Earlier or later than the norm doesn’t matter.

This paper also looks at differences in things like parental depression, exhaustion, and their reports of bonding. The researchers see no differences across groups in these outcomes. They read this as positive in the sense of suggesting no impacts on parent-child bond. This seems like a plausible conclusion, but the reality is the data we already have on this is much better.

Bottom-line findings here: The average age of sleep training is 5.3 months (though with a wide range); it seems to work; and either of the extinction methods are better than the parental presence approach.

ParentData survey

As a second source of data, I crowdsourced information on how you all have done sleep training. Here, I specifically asked for people who had done some sleep training. I asked about the age, about the method, and about your perceptions of success. Importantly, I asked here about all kinds of sleep training — encouraging falling asleep at the start of the night, and also sleeping through.

The survey had about 6,400 responses. [I did not ask about demographics, but this sample likely skews in the same way the Nanit sample does.]

The pie chart below shows the share of people reporting sleep training in each range. Roughly 60% of respondents were in the range of four to seven months. A sizable chunk of people (30%) reported sleep training at ages younger than four months, and a slightly smaller share after seven months. There were people who reported sleep training at under four weeks, but this group was very small.

The methods used also echo the Nanit data, as shown in the chart below. Modified extinction is the most commonly used method — at all ages — and parental presence is the least commonly used.

I was especially interested in perceptions of success. Unsurprisingly for a sample of people who reported sleep training, the overall perception of success was extremely high. On a scale from 1 to 10, where 10 is the highest, the average was 8.7 overall. What I found more interesting is that there was almost no variation across age. Those who sleep trained under 16 weeks averaged their perceived success at 8.9, versus 8.7 for those between four and seven months, and 8.5 after. In other words, at all of these ages, success was high and it did not vary much.

Where there are differences in perceived success is across methods. The parents who reported the “parental presence” approach reported only a 7.6 for average success out of 10, versus 8.6 and 8.7 for the modified extinction and extinction methods.

The bottom line here is very similar to that in the Nanit study. Sleep training age is five months on average, though with a wide range, and there is stronger evidence for success from extinction approaches than parental presence. Oh: and noting that the number one recommendation in the comments was the program Taking Cara Babies.

Tying together

It’s not a big, awesome randomized trial, but I think we do learn something here from these two data sets.

First: People sleep train successfully at a wide range of ages. Four to five months is the average, but plenty of people are doing it earlier or later, and generally with similar levels of success. So there is a lot of freedom to choose your own adventure.

Second: The parental presence approach really doesn’t seem to work well. I do not find this surprising, in part because it is very hard to do consistently. Sleep training is a challenge for many parents, and consistency is key to success. It’s hard to avoid responding when you’re in the room. The most successful approach — though differences are small — seems to be the cold-turkey close-the-door, likely due to the same logic: it’s easiest to follow through on.

I also learned something in reading the comments in the ParentData survey. Many people talked about the huge value sleep training brought them: “Sleep training saved my sanity and marriage!”; “Highly recommend sleep training! It was a godsend for us (parents) and our infant at the time”; “I would literally be dead without sleep training.”

But some people said otherwise: “It amped up my PPA/PPD suffering considerably for months after. The message that this works for all babies if you just ‘do it right’ is toxic and implies that if your baby won’t sleep, you have failed”; “I deeply resent everything I read about this during this time, which basically said if it’s not working, it’s because you’re not being consistent and strict enough and are folding to your weak maternal sympathies.”   

This is important to surface. Sleep training can be a great option, but it is not for everyone. Just as people can feel judged for sleep training, they can feel judged for not doing it. Engaging in any parenting behavior because it’s what’s expected of you is not a good idea. If sleep training isn’t for you, then it isn’t for you. Period.

So: Go forward with what works for your family. If that’s sleep training, make a plan and implement it. Hopefully this data is helpful. If it’s not, that’s okay too. Either way, Happy New Year, and happy sleeping.

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If you have a fever during pregnancy, you should take Tylenol, both because it will make you feel better and because of concerns about fever in pregnancy (although these are also overstated).

The evidence that suggests risks to Tylenol focuses largely on more extensive exposure — say, taking it for more than 28 days during pregnancy. There is no credible evidence, even correlational, to suggest that taking it occasionally for a fever or headache would be an issue.

People take Tylenol for a reason. For many people, the choice may be between debilitating weekly migraines and regular Tylenol usage. The impacts studies suggest are very small. In making this decision, we should weigh the real, known benefit against the suggestion of this possible risk. Perhaps not everyone will come out at the same place on this, but it is crucial we give people the tools to make the choice for themselves.

#emilyoster #parentdata #tylenol #pregnancy #pregnancytips

If you have a fever during pregnancy, you should take Tylenol, both because it will make you feel better and because of concerns about fever in pregnancy (although these are also overstated).

The evidence that suggests risks to Tylenol focuses largely on more extensive exposure — say, taking it for more than 28 days during pregnancy. There is no credible evidence, even correlational, to suggest that taking it occasionally for a fever or headache would be an issue.

People take Tylenol for a reason. For many people, the choice may be between debilitating weekly migraines and regular Tylenol usage. The impacts studies suggest are very small. In making this decision, we should weigh the real, known benefit against the suggestion of this possible risk. Perhaps not everyone will come out at the same place on this, but it is crucial we give people the tools to make the choice for themselves.

#emilyoster #parentdata #tylenol #pregnancy #pregnancytips
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In the future, before hopping onto the latest trend, check the data first. Unlike Cabbage Patch Kids, parenting trends can add a lot of unnecessary stress and challenges to your plate. What’s a recent trend that you’ve been wondering about?

#parentdata #emilyoster #parentingtips #parentingadvice #parentinghacks

Parenting trends are like Cabbage Patch Kids: they’re usually only popular because a bunch of people are using them! Most of the time, these trends are not based on new scientific research, and even if they are, that new research doesn’t reflect all of what we’ve studied before.

In the future, before hopping onto the latest trend, check the data first. Unlike Cabbage Patch Kids, parenting trends can add a lot of unnecessary stress and challenges to your plate. What’s a recent trend that you’ve been wondering about?

#parentdata #emilyoster #parentingtips #parentingadvice #parentinghacks
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I’m so grateful you’re all here as a part of this, and I want to thank you! If you’ve been waiting for the right moment to sign up for full access to ParentData, this is it. ⭐️ Comment “Link” for a DM with a discount code for 20% off of a new monthly or annual subscription to ParentData! 

Thank you again for being the best community of readers and internet-friends on the planet. I am so lucky to have you all here.

#parentdata #emilyoster #expectingbetter #cribsheet #familyfirm #parentingcommunity

As of this week, 1 million copies of my books have been sold. This feels humbling and, frankly, unbelievable. I’m so thankful to those of you who’ve read and passed along your recommendations of the books.

When I wrote Expecting Better, I had no plan for all of this — I wrote that book because I felt compelled to write it, because it was the book I wanted to read. As I’ve come out with more books, and now ParentData, I am closer to seeing what I hope we can all create. That is: a world where everyone has access to reliable data, based on causal evidence, to make informed, confident decisions that work for their families.

I’m so grateful you’re all here as a part of this, and I want to thank you! If you’ve been waiting for the right moment to sign up for full access to ParentData, this is it. ⭐️ Comment “Link” for a DM with a discount code for 20% off of a new monthly or annual subscription to ParentData!

Thank you again for being the best community of readers and internet-friends on the planet. I am so lucky to have you all here.

#parentdata #emilyoster #expectingbetter #cribsheet #familyfirm #parentingcommunity
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Just eat your Cheerios and move on.

Just eat your Cheerios and move on. ...

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With this in mind, it’s worth asking why this recommendation continues at all — or at least why the AAP doesn’t push it back to four months. They say decreased arousals from sleep are linked to SIDS, which could mean that babies sleeping in their own room is risky. But this link is extremely indirect, and they do not show direct evidence to support it.

According to the data we have, parents should sleep in the same room as a baby for as long as it works for them! Sharing a room with a child may have negative impacts on both child and adult sleep. We should give families more help in navigating these trade-offs and making the decisions that work best for them.

#emilyoster #parentdata #roomsharing #sids #parentingguide

The AAP’s guidelines recommend sleeping in the same room as your baby “ideally for the first six months.” However, the risk of SIDS is dramatically lower after four months, and the evidence in favor of the protective effect of room sharing is quite weak (both overall and even more so after four months). There is also growing evidence that infants who sleep in their own room by four months sleep better at four months, better at nine months, and even better at 30 months.

With this in mind, it’s worth asking why this recommendation continues at all — or at least why the AAP doesn’t push it back to four months. They say decreased arousals from sleep are linked to SIDS, which could mean that babies sleeping in their own room is risky. But this link is extremely indirect, and they do not show direct evidence to support it.

According to the data we have, parents should sleep in the same room as a baby for as long as it works for them! Sharing a room with a child may have negative impacts on both child and adult sleep. We should give families more help in navigating these trade-offs and making the decisions that work best for them.

#emilyoster #parentdata #roomsharing #sids #parentingguide
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Watch the full segment at the link in my bio 🔗

#tamronhall #tamronhallshow #emilyoster #parentingsupport #workingparents

It was an absolute pleasure to be featured on the @tamronhallshow! We talked about all things data-driven parenting and, in this clip, what I call the plague of secret parenting. To balance having a career and having a family, we can’t hide the fact that we’re parents. If mothers and fathers at the top can speak more openly about child-care obligations, it will help us all set a new precedent.

Watch the full segment at the link in my bio 🔗

#tamronhall #tamronhallshow #emilyoster #parentingsupport #workingparents
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My guest on this episode, @everodsky, has come up with a solution here, or at least a way for us to recognize the problem and make our own solutions. I’ve wanted to speak with Eve for ages, since I read her book Fair Play. We had a great conversation about the division of household labor, one I think you’ll get a lot out of!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#emilyoster #parentdata #parentdatapodcast #parentingpodcast #householdtips #fairplay #invisiblelabor

Invisible labor. It’s the work — in our households especially — that has to happen but that no one sees. It’s making the doctor’s appointment, ensuring birthday cards are purchased, remembering the milk.

My guest on this episode, @everodsky, has come up with a solution here, or at least a way for us to recognize the problem and make our own solutions. I’ve wanted to speak with Eve for ages, since I read her book Fair Play. We had a great conversation about the division of household labor, one I think you’ll get a lot out of!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#emilyoster #parentdata #parentdatapodcast #parentingpodcast #householdtips #fairplay #invisiblelabor
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Good news: fancier vitamins are not better.  Folic acid is the most important prenatal ingredient. Iron (with vitamin C) and DHA are also nice to have. Other included ingredients have only weak or no evidence to support their use. (If you do not consume animal products, add B12, plus a few others depending on your diet.)

Vitamins are just vitamins. Any prenatal vitamin that contains these is enough. 

Comment “Link” for a DM to an article with everything you need to know about prenatal vitamins.

#emilyoster #parentdata #prenatalvitamins #pregnancydiet #pregnancytips

Prenatal vitamins 💊 If there is any product that seems designed to prey on our fears, it’s this one. You’re newly pregnant and you want to do it right. Everyone agrees you need prenatal vitamins, so you get them. But do you want to be that person who just… buys the generic prenatal vitamins?

Good news: fancier vitamins are not better. Folic acid is the most important prenatal ingredient. Iron (with vitamin C) and DHA are also nice to have. Other included ingredients have only weak or no evidence to support their use. (If you do not consume animal products, add B12, plus a few others depending on your diet.)

Vitamins are just vitamins. Any prenatal vitamin that contains these is enough.

Comment “Link” for a DM to an article with everything you need to know about prenatal vitamins.

#emilyoster #parentdata #prenatalvitamins #pregnancydiet #pregnancytips
...

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#parentdata #emilyoster #newborncare #parentingadvice #parentingtips

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#parentdata #emilyoster #newborncare #parentingadvice #parentingtips
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The first edition of Hot Flash is out now! Comment “Link” for a DM to learn more about the late-reproductive stage.

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🔥 Hot Flash from ParentData is a weekly newsletter on navigating your health and hormones in the post-reproductive years. Written by Dr. Gillian Goddard, Hot Flash provides all of the information you need to have a productive, evidence-based conversation about hormonal health with your doctor.

#emilyoster #parentdata #hotflash #perimenopause #womenshealth

The first edition of Hot Flash is out now! Comment “Link” for a DM to learn more about the late-reproductive stage.

There are times when we expect hormonal shifts. Our reproductive lives are bookended by puberty and menopause. We discuss those changes often because they are definitive and dramatic — a first period is something many of us remember clearly. But between ages 13 and 53, our hormones are changing in more subtle ways. During the late-reproductive stage (in your 40s), you can expect a lot of changes in your menstrual cycle, including the length and symptoms you experience throughout. It’s an important time in our lives that is often overlooked!

🔥 Hot Flash from ParentData is a weekly newsletter on navigating your health and hormones in the post-reproductive years. Written by Dr. Gillian Goddard, Hot Flash provides all of the information you need to have a productive, evidence-based conversation about hormonal health with your doctor.

#emilyoster #parentdata #hotflash #perimenopause #womenshealth
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Now tell me in the comments: what’s a parenting move you’ve made recently that feels right to you?

#parentingcommunity #parentingsupport #parentingquotes #emilyoster #parentdata

There are plenty of reels telling you how to parent. Plenty of panic headlines saying that “studies show” what’s best for your kid. Even good data, from a trusted source, can send us into a spiral of comparison. But I want you to remember that no one knows your kid better than you. It’s important to absorb the research, but only you will know the approach that works best for you and your child. 💙

Now tell me in the comments: what’s a parenting move you’ve made recently that feels right to you?

#parentingcommunity #parentingsupport #parentingquotes #emilyoster #parentdata
...

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Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #parentdatapodcast #emilyoster #emilynagoski #comeasyouare #cometogether #longtermrelationship #intimacy #relationships

Let’s talk about sex (after) baby! Today on the podcast, I was lucky enough to speak with @enagoski about her new book on sexual connection in long-term relationships. Especially after having kids, this is something many people struggle with. Emily tells us to stop worrying about what’s “normal” and focus on pleasure in its many forms.

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #parentdatapodcast #emilyoster #emilynagoski #comeasyouare #cometogether #longtermrelationship #intimacy #relationships
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Comment “Link” for a DM to an article on another common formula question: should you throw away old formula powder?

#emilyoster #parentdata #babyformula #babyfeeding #parentingstruggles

Ever wondered if you can safely use leftover baby formula? 🍼 The CDC says to throw out unused formula immediately because of the risk of bacterial growth. However, research suggests that bacterial concentrations do not appreciably increase after 3, 12, or even 24 hours at refrigerator temperatures. Good news! This means there’s not a strong data-based reason to throw out formula right away if you store it in the fridge.

Comment “Link” for a DM to an article on another common formula question: should you throw away old formula powder?

#emilyoster #parentdata #babyformula #babyfeeding #parentingstruggles
...

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#emilyoster #parentdata #parentingtips #parentingadvice #newparents #parentingcommunity

What’s the most important piece of advice for new parents? Here’s one answer, but I want to hear from you! Share your suggestions in the comments ⬇️

#emilyoster #parentdata #parentingtips #parentingadvice #newparents #parentingcommunity
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What's in the bag of a Vagina Economist? 👀 Someone please tell me this looks familiar to you.

What`s in the bag of a Vagina Economist? 👀 Someone please tell me this looks familiar to you. ...