An Open Letter to the Author of “Our Sleep Training Nightmare”

This is a response to this article, “Our Sleep Training Nightmare,” published in the New York Times 10/7/16, by Lisa Selin Davis. Thanks to Justin Smith AKA the Doc Smitty for bringing this to my attention.

Dear Lisa,

Thanks so much for sharing this article, painful as it must have been. I routinely care for children who have struggled with sleep since early infancy. It’s not clear why some children struggle with sleep more than others. In infancy, sleep problems may have to do with temperament, which is the word used to describe personality traits which may be present from birth. The fact is, most good sleepers are born, but some kids needs some help. Most of these kids will have improvement in their sleep behavior by kindergarten. Some, like your daughter, may continue to struggle and are failed by conventional advice. I routinely see teenagers with a similar history in clinic. As you point out in your article, this takes a huge toll on the child and the family.

I have a couple of thoughts after reading your article:

1. I have never recommended locking a child in a room. My mentor Dr. Judy Owens taught me never to recommend this. I think this is really scary for kids who are struggling with insomnia and anxiety. I’m sorry that you received this bad advice.
2. I would not equate sleep training simply with a cry-it-out (CIO) or extinction based approach. In fact, I don’t routine recommend CIO in children who are no longer sleeping in cribs, especially at your daughter’s age. (Don’t get me wrong— CIO has it’s place among sleep training methods, especially for younger children, and it can be very effective if done correctly). Other methods, including positive reinforcement or the “Excuse-Me Drill” may work better. If you want a great example of how to institute a practical and effective positive reinforcement program, I highly recommend this book by Dr. Alan Kazdin (affiliate link). One size fits all sleep advice DOES NOT work for children with long standing difficulties around sleep.
3. In your article you don’t mention any investigation into “medical” causes of insomnia. (Although you do mention that you saw a sleep doctor, so forgive me if this was already addressed). If you were seen in my clinic with this story, I would look for signs of restless leg syndrome and consider ordering an overnight sleep test to make sure that we are not missing an underlying medical problem which could be making this problem worse for your child. It is most likely that this is behavioral in origin, but it doesn’t hurt to make sure that there is not another hidden factor leading to these difficulties. That being said, I suspect that this is probably due to sleep onset association difficulties.
4. In my clinic, I sometimes will try melatonin or even a short term trial of a prescription medication, coupled with a behavioral plan, with the goal of using the medication as a bridge to help the child transition to more independent sleep. Obviously, not every parent is comfortable with this, and I get that— I am very cautious about using any agents to promote sleep. But sometimes some kids need a little extra help.
5. Finally, this needs to be said: good sleep looks different for every family. If you have reached an equilibrium that works for you, your husband, and your children, that’s wonderful. I love this passage: “At night, after stories and turning out lights, both girls and I lie in bed, listening to the fan whir. There is no greater joy than this, the puzzle pieces of those two bodies fitting perfectly into mine. Maybe tonight they will stay here, all night, and accept the beautiful medicine of sleep. This is parenting, then: trying and failing and reaching and missing and sometimes getting it right, and always loving.”

I really appreciate your candor in sharing this article. Hearing about the struggles of others really helps other parents out. It also helped me get more insight into the difficulty that my patients and their families face.

Craig