#196 Infant Sleep Training—Rest Easy?

CLINICAL QUESTION

QUESTION CLINIQUE

What is the evidence for infant sleep training?

BOTTOM LINE

RÉSULTAT FINAL

Sleep training improves infant sleep problems, with about 1 in 4 to 1 in 10 benefitting over no sleep training, with no adverse effects reported after five years. Maternal mood scales also significantly improve, with patients having worse baseline depression scores benefitting most.

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EVIDENCE

DONNÉES PROBANTES

Sleep training, or “controlled crying,” is where parents respond to their infant’s cry at increasing time intervals to allow independent settling.
Six week Randomized Controlled Trial (RCT) of 235 infants, mean age seven months, with ≥2 awakenings/night on ≥5 nights/week:¹
- Sleep training versus safety education. Statistically significant reductions in:
  - Parental report severe infant sleep problems: 4% versus 14%, Number Needed to Treat (NNT)=10.
  - Number of infants with ≥2 diary-recorded awakenings per night: 31% versus 60%, NNT=4.
  - And improved parent fatigue, sleep quality, and mood scales.
Cluster RCT, 328 families reporting infant sleep problem, mean infant age seven months. Tailored sleep intervention including sleep training versus usual care.² Intervention group:
- At 10 months:
  - Significant reduction in maternal report of infant sleep problems: 56% versus 68%, NNT=9.
  - Non-significant reduction in mothers with depression (Edinburgh Postnatal Depression Scale >9): 28% versus 35%.
    - Those with baseline score >9 had significant numerical improvement in depression scale (subgroup analysis).
- At two years:
  - Reduced reporting depression symptoms:³ 15% versus 26%, NNT=9.
- At five years: No difference in any of 20 outcomes including:⁴
  - Child behaviour, relationships, and maternal mental health.
Recent smaller studies^5,6 and systematic reviews^7,8support sleep training interventions for sleep and improved parent depressive symptoms.⁷

Context:

Infants sleep problems are associated with parental depression,^9,10 psychological distress,¹¹and poor general health.¹¹
Increased infant sleep is associated with easy temperament, adaptability, and low distractibility.¹²
Complete extinction (allowing baby to “cry it out”) has been demonstrated to be similarly effective, although parents tend to find this method more stressful.⁷
Sleep training is simple and can be introduced at six months. Examples include leaving the room and not returning for 2-5 minutes before responding to crying, then lengthening that interval.