Comparing the Best Sleep Training Programs

The Extinction Method, infamously known as Cry-It-Out, teaches parents to facilitate a regular bedtime, put their child in bed drowsy or awake, and then leave the room until the preferred morning wake time. This method most often involves letting your child cry at bedtime, during any night wakes, and in the early morning without any presence or engagement from parents. The goal is that a child will learn to sleep more independently because there is no other option. When the Extinction Method works, it is often the fastest way to see improved results in a child’s sleep.

Caregivers often represent a safety bubble for a child, so when that safety bubble is removed at bedtime and through the night (one of the most vulnerable times for a child), children seek out a new safety anchor. Cry-It-Out methods can work because a child is forced to recognize that their environment is unchanging, and therefore, it must be safe enough to sleep. There is also often an exhaustion factor when Cry-It-Out succeeds. The distress, crying, screaming, etc., often causes a child to crash from exhaustion rather than a conscious decision to sleep. For some children, Cry-It-Out never works, and parents never see the improved sleep they had hoped for.

Not every child makes the same connections during Cry-It-Out. For some children, it creates a parent-child disconnect, breaks trust, impacts communication behavior, and simply escalates a child’s cry threshold.

For the children that do see improved sleep with Cry-It-Out, there are often bumps along the road following any kind of change. Cry-it-out methods teach children that when it comes to sleep, they will not receive a response if they cry. Subsequently, if children get sick or have a tough day, parents need to make a difficult decision: give additional support and risk undoing all the sleep habits that have been formed, or remain disengaged even though their child may be in need of support. That same parenting decision predicament will arise with any environmental changes, from changing beds to vacations to moving houses. Children will re-test their boundaries in new environments, which often requires parents to sleep train all over again.

Graduated Extinction Method | Modified Cry-It-Out

The most popular Graduated Extinction Method is the Ferber Method, also referred to as “Ferberizing.” This modified cry-it-out method teaches parents to facilitate a regular bedtime, put their child in bed drowsy or awake, leave the room, and then come back into the room to check on the child at timed intervals. The time intervals between “check-ins” are shorter at first and then gradually increase as the process continues. Similar to the Extinction Method, this method most often involves letting your child cry at bedtime, during any night wakes, and in the early morning without much engagement from parents. The goal is that a child will trust the timed parental presence without needing any parental engagement or comfort, and they will learn to sleep more independently.

As mentioned with the Extinction Method’s function, caregivers often represent a safety bubble for a child, and when that safety bubble is removed at bedtime and through the night, children seek out a new safety anchor. Modified cry-it-out methods can work as children recognize the pattern: a parent or caregiver comes in, but their presence is not a response to the crying. While some additional parental presence can help reassure the child, the need for the parent to disengage and not respond to their child remains the same. Extreme fatigue may also play a role in the process, as the distress and crying may cause a child to fall asleep from exhaustion.

As with the Extinction Method, not every child makes the same connections during modified cry-it-out sleep training. For some children, the check-in process is unsupportive and confusing. Some children escalate further during the parent check-in process, increase their cry threshold, and begin to associate the parent presence intervals with a spike in bodily stress. For some children, modified cry-it-out never works, and parents never see the improved sleep they had hoped for.

For the children that do see improved sleep with modified cry-it-out, future changes often lead back to poor sleep. Anything from a change in parent engagement, travel, or developmental leaps can regress their perception of sleep once more. The reason is that what the child has learnt is that crying doesn’t get a response. When something changes, they retest those boundaries.

Since the child learned that a lack of change allowed them to sleep in the first place, anything from a change in parent engagement, travel, or developmental leaps can regress their perception of sleep once more. Some families struggle to ever reintroduce bedtime cuddles or physical comforts in the first few years without also reintroducing regression and sleep difficulties.

A Scientific Note on Cry-It-Out

When a person is in distress, their heart rate increases, and their body is flooded with Cortisol, a stress-related hormone. For an adult, once the distress passes, their brain then helps their body re-regulate itself. However, for babies, the process differs as they are natural co-regulators. Babies have not fully developed their hippocampus or prefrontal cortex yet, so once the distressing experience passes, their brains don’t have a way of telling their body to come down from the fight or flight state. This means that when they are left to cry it out, they don’t have the capacity to practice a supportive stress response or re-regulate themselves once they are ready to settle again. Most babies need a caregiver’s response to support them through healthy stress response and regulation (Buhler-Wassmann).

For these physiological reasons, families who use Cry-It-Out sleep training methods may report sleep improvement without seeing the underlying internal effects. An Extinction Method clinical trial found that “infants’ physiological and behavioral responses were dissociated in this [Extinction method] experiment. They no longer expressed behavioral distress during the sleep transition, but their cortisol levels were elevated” (Middlemiss). This indicates that Cry-It-Out methods may reduce or inhibit a child’s stress communication at bedtime or through the night rather than reducing the sleep-related stress itself.

Fading | Fade-Out

Fading Methods, also known as Fade-Out Methods, teach parents to facilitate a supportive bedtime, maintain engagement and presence with their child to help them settle to sleep, and then gradually fade the unsustainable engagements involved at bedtime or night wakes over a period of time. Fading Methods are newer but have become quite popular in recent years as they offer a gentler approach to sleep training. Well-known Fading Methods include the Camp Out Method, the Chair Method, the Pick Up & Put Down Method, and the Sleep Lady Shuffle. While all of those methods are Fading Methods, they all function differently.

Some methods gradually move parent presence further and further away, some decrease parental engagement little by little, and some slowly increase the time between taking their child out of bed to offer comfort. These more gradual, gentle methods still often involve your child crying at bedtime, during night wakes, and in the early morning, but a parent is more present to respond during the learning and sleep training process, which can help to minimize the cries. The goal is that a child will learn to sleep more independently as their parent supports them in weaning off previous unsustainable sleep associations. Unlike cry-it-out methods, fade-out methods often require more time until a child can choose to sleep independently.

Caregivers and the comforts they provide often represent a safety bubble for a child. Depending on a child’s sleep history, they may associate safe sleep with contact and proximity, movement and rocking, a full belly of milk, or other previously introduced comforts. Fade-out methods can work because a parent slowly weans unsustainable sleep associations while still offering their child specified support during the learning process. This helps a child decouple previous associations from sleep, trust that the gradual disengagement from parents is safe, and eventually choose to sleep independently. Depending on how the fade-out method is implemented, fatigue from the weaning and crying during the process may still cause a child to fall asleep from exhaustion.

There are various forms of fade-out sleep training, and not every child responds well to the gradual disengagement each program or method advises. The majority of fade-out methods still eventually disengage from responding to the child, and that final disengagement can lead to a break in trust towards the end of the sleep training process. Seeing as fade-out methods often have greater time commitments than cry-it-out methods, this can be very difficult for families to manage while balancing the rest of life.

Unlike Extinction methods, proper parental engagement is extremely important in fade-out methods. These methods often rely on consistency, predictability, and co-regulation, so it’s vital that a parent offer that throughout the process to help their child succeed. Maintaining intentional engagement with a child while sleep training can be especially difficult because a child may still cry in their parent’s presence, and parents need to maintain a level of supportive composure.

Complete Presence and Engagement | The Anti-Sleep-Training

For the sake of categorization, we will refer to this as ‘Complete Presence and Engagement,’ but there is no particular name or method to identify this. For most, ‘Complete Presence and Engagement’ is the same as ‘doing nothing’ in regard to sleep training. These ‘anti-sleep training’ methods or philosophies support parents to do whatever is needed to soothe their children, get their children to fall asleep, and avoid any crying or distress during the process. Likewise, for false starts at bedtime, night wakes, early mornings, or any other needs, parents are immediately responsive and do whatever is necessary to soothe and get their children back to sleep once more. For some families, this may involve co-sleeping. The hope is that eventually and naturally, children will need less engagement from parents to support sleep. When a ‘Complete Presence and Engagement’ approach works, it is often the slowest way to see improved results in a child’s sleep.

Caregivers and the comforts they provide often represent a safety bubble for a child. Depending on a child’s sleep history, they may associate safe sleep with contact and proximity, movement and rocking, a full belly of milk, or other previously introduced comforts. The continuous support and comfort that Complete Presence and Engagement approaches offer can strengthen parent-child connection and trust until a child naturally seeks independence around sleep. The natural transition to independent sleep is largely impacted by a child’s development, personality, and parenting styles used during daily interactions.