No one debates the fact that young children need a lot of sleep. Yet the difficulties in getting them to do it have spawned a mini-economy of parenting books focused solely on sleep, written by a number of competing experts, each of whom claims to know best. Richard Ferber, a pediatrician at Children’s Hospital in Boston, wrote one of the landmark books of the field in 1985: Solve Your Child’s Sleep Problems. Before then, sleep was barely mentioned in the standard child-rearing guides.
Ferber became interested in sleep in the 1970s, shortly after the birth of his own children. As he spent night after night rocking his son to sleep in his arms, only to watch him wake up the minute Ferber placed him in his own bed, Ferber began to wonder why it was difficult for a child to fall back to sleep on his own. He slowly came to the realization that infants simply don’t know how to do it by themselves. Gradually, Ferber began weaning his children from what had become the family bed by letting them cry for progressively longer periods of time before he or his wife would check in on them. Ferber hoped that his son would no longer associate falling asleep with being rocked or held and would learn that a parent will not always be available to attend to every one of his cries. Instead, his son would begin to develop the ability to calm himself down. “A baby cannot count sheep,” Ferber later told an interviewer. “So we have to find a way to help them. To teach them in a simple, gentle way that they need to sleep. And that they need to do it all by themselves. It really isn’t so hard for them, either. Babies love to learn.”
The philosophy, which became known as either the sleep-training or the cry-it-out method, became so popular that Ferber’s name morphed into a verb. New parents began asking their friends whether they, too, were “Ferberizing” their children, and whether it was working. The drill itself was fairly simple. A parent would place a child down in his or her own bed, and come back to the room at longer and longer intervals to soothe the child. Ferber advised parents to steel themselves against the sound of their children wailing and to stick with the sleep-training plan. With time, a child wouldn’t need help. In the first editions of his book, Ferber noted that sharing a bed with a child would likely make the process of developing effortless sleep more difficult. “Although taking your child into bed with you for a night or two may be reasonable if he is ill or very upset about something, for the most part this is not a good idea,” he wrote. Parents were also warned that co-sleeping could slow the emergence of a child’s sense of independence. “If you find that you actually prefer to sleep with your infant,” Ferber wrote, “you should consider your own feelings very carefully.”
Part of the appeal of sleep training is that it is designed to allow parents to sleep. In his practice in Boston, Ferber consistently heard from a steady stream of parents about how sharing a bed with their child meant that they never slept for more than an hour or two at a time. They described living in a half-asleep daze, woken up by every cry, and resenting the fact that they felt inadequate at both work and home. This form of chronic sleeplessness has an outsized effect on mothers. One poll of twenty thousand working parents conducted by a team from the University of Michigan found that women are two and a half times more likely to interrupt their sleep to care for a child compared with men. Once a mother is awake, she tends to stay that way for an average of forty-four minutes. When a father wakes up to attend to a crying child, however, he is often able to fall back asleep within a half hour. These moments of male alertness were short and rare. Nearly one out of every three mothers said that they woke up to care for their infants every night. Just one out of every ten men did so. “Obviously, the child-rearing responsibilities maybe slanted at first due to breast-feeding,” one of the lead researchers said. And yet “the responsibilities are never renegotiated,” she added.
The effects of poor sleep build and quickly manifest in working mothers’ lives. Some have difficulties functioning at their jobs, an important concern given that most professionals see their greatest salary increases during their late twenties and early thirties—a time when many working women head home to a young child. The side effects of a crying child in the middle of the night aren’t limited to sleepy mothers fighting the urge to nod off at their desks. As one study found, the quality of a child’s sleep often predicts maternal mood, stress levels, and fatigue. It’s a very simple equation: the more sleep a child gets, the healthier the mother will be.
If Ferber’s method was as simple in practice as in theory, then its promise of painless sleep would do a lot to improve the lives of working adults. But it’s not simple. The excruciating first nights of the Ferber approach can require listening to a child’s searing screams go on for well past what seems safe or healthy. That leads many parents to William Sears, a professor of pediatrics at the University of California, Irvine, School of Medicine, whose approach to sleep is almost the exact opposite of Ferber’s. The father of eight children, Sears has become one of the leading voices of what is known as attachment parenting. He believes that through sharing a bed with an infant, parents not only develop a stronger bond with their child but also respond to their needs better. Many parents who subscribe to Sears’s approach do so out of the worry that allowing a baby to cry for too long sets in motion a range of long-term health effects. One article in Mothering magazine gives a general idea of how far this line of thought goes. “But there is no doubt that repeated lack of responsiveness to a baby’s cries—even for only five minutes at a time—is potentially damaging to the baby’s mental health,” it warned. “Babies who are left to cry it out alone may fail to develop a basic sense of trust or an understanding of themselves as a causal agent, possibly leading to feelings of powerlessness, low self-esteem, and chronic anxiety later in life.” James J. McKenna, a professor of anthropology at Notre Dame, has argued that mothers who share a bed with their child are more likely to breast-feed. These babies, when they do inevitably wake up, may also fall asleep faster when their parents are right next to them. With better-quality sleep, the brain would then have more energy to devote to cognitive or physical development.
In many ways, co-sleeping prods parents into reverting to an approach to sleep that was widely practiced in the United States a few generations ago, and remains common in African-American and Asian-American households today. Until the start of the twentieth century, most American babies were placed in a cradle in the same room as their parents or a live-in nurse. Once old enough, young children graduated to sharing a bed with siblings of the same sex. But, as Peter Stearns noted in a paper published in the Journal of Social History, children’s sleep habits changed more dramatically between 1900 and 1925 than at perhaps any other time in history. Noisy new inventions like radios and vacuum cleaners entered the home for the first time and gave parents a reason to segregate their children into a quiet place at night while adult life went on. Women’s magazines, meanwhile, ran articles written by experts who argued that traditional sleeping habits were dangerous and unhygienic. And if those concerns weren’t bad enough, a shared bed began to cause a sort of class anxiety. Middle-class parents, in particular, began to worry that their children’s sleeping arrangements said something about the financial condition of the family. Many parents believed that a move out of the city and into the suburbs meant that they had to provide their offspring, even infants, with their own rooms. One sleep expert I spoke with said that some middle-class parents remain adamantly opposed to bed sharing because they see it as a step down the economic ladder, especially if their infant doesn’t have his or her own room. “Parents now tell me, ‘Oh my God, it’s going to be a huge problem that my children are going to have to sleep in the same room,’ ” she told me. “It’s not the question of ‘How do I deal with it?’ Now it’s ‘Should I move?’ ”
In recent years, sleep scientists have begun to join pediatricians and anthropologists in the contested field of children’s sleep. What they found may surprise you. Jodi Mindell is the associate director of the Sleep Disorders Center at the Children’s Hospital of P
hiladelphia, the first pediatric hospital in the United States and among the best in the world. There, as part of a team that cares for conditions ranging in complexity from narcolepsy to extreme fussiness, she treats about fifty patients a week. Mindell realized one day that she didn’t know the answer to a basic question: how do babies around the world sleep? She could do little more than guess whether parents who put their baby down to sleep in San Francisco did so at the same time or in the same way as their friends in Tokyo.
Along with Avi Sadeh of Tel Aviv University and others, Mindell polled nearly thirty thousand parents of infants and toddlers in Australia, Canada, China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand, the United Kingdom, the United States, and Vietnam. It was one of the first, and most extensive, surveys of global infant sleep patterns. All of the subjects in the study lived in conditions that roughly corresponded to a middle-class lifestyle in the United States. Each household featured electric lights, televisions, refrigerators, running water, and other comforts. Mindell gave the families a list of basic questions that any parent would be able to answer easily: What times does your child go to sleep? Does your child sleep alone or in a bed with you? And, does your child have a sleep problem?
To say that the answers were unexpected is an understatement. Families on different continents didn’t even seem engaged in the same activity. In New Zealand, for instance, the average bedtime for a child under the age of three was 7:30. In Hong Kong, it was 10:30. But bedtimes were not the only difference. Nearly everything that made up the children’s sleeping habits depended on their location, a triumph of culture over biology. In Australia, 15 percent of parents said they regularly shared a bed with their child. Almost six thousand miles away in Vietnam, nearly 95 percent of families did so. In Japan, children slept for an average of eleven and a half hours each night. The average infant in New Zealand slept thirteen hours. And, perhaps most surprising, 75 percent of parents in China, a country in which most families are co-sleepers, reported that their children had a sleep problem.
Any hope that a global survey of children’s sleep habits could provide an answer to the sleeping-training versus co-sleeping debate vanished. There were simply more variations than researchers thought possible. “I thought that there would maybe be a ten- or fifteen-minute difference in bedtimes and that would be about it,” Mindell told me. “Instead we got this eye-opening understanding that sleep is dramatically different in babies throughout the world.” She was left with more questions than answers. “We don’t know why there are those differences in sleep and what the impacts of them are,” Mindell continued. “Maybe someone could argue that Korean babies are getting less sleep and that’s because they are going to bed too late. But maybe there’s a true biological difference and Korean babies simply need less sleep. That’s a very different question and there are a lot of theories out there. It’s a whole career to figure it out.”
Cultural approaches to sleep work for the most part until toddlers get their first taste of globalization. To illustrate this point, Mindell tells the story of a mother who grew up in England, went to college in the United States, and eventually moved to Hong Kong for work. All of these destinations more or less followed the same Western approach to children’s sleep, segregating an infant into his or her own room from an early age. Once in Hong Kong, Mindell’s patient hired a nanny to care for her three children while she was at work. The nanny was from a rural area in China and approached each of her charges like she would a child in her own home. That meant that the children didn’t go into the expensive crib in the nursery or into their own beds when it was time for sleep, but instead were held in her arms or placed on the mattress next to her. This co-sleeping approach functioned reasonably well during the week. But when Mindell’s patient had solo charge of her children over the weekend, the crib regained its starring role. It was a nightmare. The mother couldn’t get her children to stop crying no matter what she tried. She asked her nanny to have the children sleep in their cribs or beds, but the nanny refused. After all, she argued, the kids liked it better her way.
At first glance, the point of the story appeared to be that co-sleeping worked better for this family. But Mindell says that wasn’t the issue. The children were stuck between East and West, sleeping next to someone one day and sleeping alone the next. It wasn’t sleep training versus co-sleeping that was the problem, she says, but consistency. “Children are more likely to be relaxed throughout the bedtime rituals if they have a good idea of what’s coming next,” Mindell told me. In the case of her patient in Hong Kong, either approach to sleep could have been effective if it was followed regularly.
When it comes to children’s sleep, routine is a better predictor of quality than whatever choice the parent makes regarding co-sleeping. Consistently following the same nightly script makes bedtime less of a battlefield. In one three-week study, Mindell investigated the effects of a nightly routine on four hundred mothers and their children, who ranged from newborns to toddlers. During the first week of the study, all of the mothers were told to follow their usual approach to sleep. After that, half of the mothers were given instructions on how to follow a specific plan. Each mother was advised to pick a consistent time that she would place her child in his or her crib or in the family bed each night. Thirty minutes before this bedtime, she was to give her child a bath, followed by a light massage or application of lotion. Then, she was to do a calming activity like cuddling, rocking, or singing a lullaby. Within thirty minutes after the bath, the child was to be in the spot where he or she usually slept, with the lights out. Each mother followed the instructions for two weeks and then reported any changes. By every measure, routines led to calmer nights. Children fell asleep faster, woke up fewer times during the night, and slept longer. When they did get up the next morning, they seemed to be in better moods. Parents improved their sleep quality as well, with the mothers feeling better able to handle their daily challenges.
Mindell’s work suggests that the advocates of co-sleeping and those of the cry-it-out method are both a little right and a little wrong. If consistency is the most important predictor of sleep quality, then it doesn’t necessarily matter if a child like Abigail sleeps in her family’s bed when she is two years old. There are signs that other professionals are softening their dogma when it comes to children’s sleep. Ferber, the guru of sleep training, revised his views on co-sleeping in a 2006 update to his best-selling book. He now advises parents that sharing a bed with their children can be a safe and effective option, as long as the parents follow basic guidelines to prevent accidentally harming their infants.
Eventually, almost all children decide to sleep in their own bed when they are given the option. Without prompting, Abigail has begun referring to the bed in her room as her “big-girl bed.” Her parents think that it won’t be long before she moves out of their bed. But calming their child’s ambivalence toward sleep is only part of their job. Soon, Abigail’s brain will be developed enough to experience a truly strange aspect of sleep. Abigail, you see, is about to have her first dreams.
5
What Dreams May Come
Alice had lasagna with her dead father last night and is upset that he didn’t like the food. She says this while sitting on a metal folding chair in a cramped room in the middle of Manhattan. Outside, the streets are filled with tourists trying to find their way to the Christmas tree in Rockefeller Plaza. Inside, four of us are arranged in a semicircle facing a plastic fern in a bright-blue pot. We have come to this second-floor counseling center on a Sunday afternoon to spend two hours discussing our dreams. Alice is the first up to bat. She lets out a volley of coughs and proceeds to tell us that her father, who died two decades ago, popped up in her dreams several times last week, walking around and criticizing her cooking.
“How did that make you feel?” the woman to the right of me, who is leading the group, asks her.
“Awful. I had
planned everything just so,” Alice replies.
“What do you think the message of that dream was?” the group leader asks.
“I think that I wanted to tell myself that I wasn’t meeting the expectations of my life,” Alice responds.
The group nods encouragingly while Alice goes into detail about her dream. I spend the time getting more and more nervous, rehearsing in my head what I am going to say, like an actor reviewing his lines minutes before showtime. I have come armed with two of the few recent dreams that I can remember. The first features a plot that would make for an anticlimactic heist movie. In it, I robbed a bank with three of my friends from high school and then sat eating pretzels in a Florida airport while we waited for our getaway flight. I decided to go with this dream because it was more exciting than the other one, in which I bought a green-and-white cocker spaniel puppy and named him Sprite.
Dreamland: Adventures in the Strange Science of Sleep Page 6
