By the time her baby was four months old, Zara, a psychologist and executive coach from Surrey, was able to open a bottle of wine and have “a bit of an evening”. He was sleeping in four-hour stints, waking twice in the night. Then, at four and half months, his sleep pattern changed: “It was five wakes, then six, then eight,” Zara says. She was so exhausted she ended up Googling “can you die from sleep deprivation?”.
“I was broken, emotional, confused, sleep-deprived and catastrophising,” she says. “He wouldn’t be down for longer than 20 minutes, and I was losing my mind. Using a sleep consultant was the best money I’ve ever spent; £250 to give me the confidence to trust my child to get himself to sleep without me.”
Another mother from Surrey, Heike, who works for a beauty brand, enlisted the help of the same sleep consultant, but couldn’t have had a more different experience: “I was so disappointed – shocked, really. I was left feeling a complete failure, but also very angry and lost,” she says.
When you dig into the world of sleep consultants, it’s a familiar story. Some, like Zara, see them as “guardian angels”. Others are left feeling judged, criticised, and as if they’ve wasted their money.
The industry is burgeoning, though, thanks to word-of-mouth recommendations at antenatal groups, and via the social media accounts of “experts”, filled with images of angelic babies sleeping soundly – understandably tempting to any parent sitting up with a wide-eyed, screaming baby night after night. According to the website of the London School of Childcare Studies (LSCS), which runs a “sleep practitioner” course, it’s “an unregulated industry and qualifications are not required to start working”, although they state that most parents would be more comfortable employing someone appropriately qualified. The LSCS offers a short course, about 12 weeks, comprising six weekly sessions in person, followed by another six of assisted self-study (although during the pandemic training has been mainly online), for £945.
Rosey Davidson, founder of Just Chill Baby Sleep, is one of the biggest success stories, with 165,000 Instagram followers. Her LinkedIn page mentions her LSCS qualification. However, many high-profile sleep consultants focus more on their experience working as nannies or maternity nurses, and raising their own children.
Like most sleep consultants, Davidson has a social media feed full of tips, videos and inspirational quotes. She offers a range of services, from basic resources (£49.50 for an online foundations of sleep course) to more expensive comprehensive programmes (£395 for a two-week personalised plan). Similar online courses from the Night Ninja or Care It Out cost less than £20, but the higher-level services, in which a parent might get a personal consultation, a plan and four weeks of support, may charge as much as £650.
“Everyone in the world of sleep medicine is aware of sleep consultants,” says Dr Dimitri Gavriloff, who runs the paediatric non-respiratory sleep disorders service at Oxford University Hospitals. “Often they have a semi-clinical background – a nurse or someone who has worked in healthcare – and they’re keen to do something to improve the health and wellbeing of children and their parents, so we start from a really positive perspective. There are, however, people who are less well-informed; as this is a period where parents are particularly anxious, capitalising on that can be potentially negative.” Gavriloff points out that sleep is vital to the physical and mental health of both parents and children. “You want someone who is appropriately trained, using evidence-based intervention in a way that is not exploitative.”
This vulnerability is something Heike picks up on: “I was insecure and vulnerable when we reached out, and the consultant made me feel so guilty, as if I hadn’t done my job as a mum.” Annabelle, a writer from Gloucestershire, had a similar reaction: “Our time working with a sleep consultant was one of the hardest of my life. I felt as if she didn’t understand my son’s sleep issues, and she kept repeating the same advice without listening to me. It all came down to letting the baby ‘protest’, ie cry, and not picking up, rocking or feeding him. That meant being up with him for hours through the night. He would just stand in his cot and cry. It wasn’t sustainable. The pressure was so intense I was crying all the time. One night, it took me three hours to get my son to sleep. I contacted her the next morning and she told me I was obviously doing something to overstimulate him.”
Heike found her sleep consultant rigid and critical. “She questioned everything we did, from the music we played, to the lavender scent we used in the diffuser, to our baby’s toys.” Gavriloff is clear: “If you have someone who is vulnerable and desperate, you don’t go in there in a punitive fashion with ‘shoulds’ and ‘should nots’. Support should be compassionate, understanding and well informed.”
Lindsey, from Bristol, who runs her own HR business, enlisted a sleep consultant when her daughter was four months. “I was feeling a little out of my depth, with two children under four, especially if I was alone at bedtime to put them both down,” she says. Lindsey says her consultant came over (before the pandemic) for an hour to discuss their routine and highlighted areas for improvement. “I was bathing them every other night, blaming her sensitive skin, but in reality, I just found it hard bathing two together. The consultant told me to buy a sit-in bath seat for my baby so I didn’t have to worry about her slipping or getting knocked by her big brother. She called us out in a nice way. It gave me the reassurance and confidence I needed.”
Interrupted baby and infant sleep isn’t always a problem; it can be a normal part of development. “Maybe 30% of infants and toddlers will have the symptoms of insomnia disorder, which is repeated night wakings, or needing to be rocked or suckled to sleep,” Gavriloff says. Do some parents unwittingly encourage problems? He is at pains to be sympathetic: “There’s nothing worse than feeling crap as a parent – it’s an awful place to be emotionally, and it changes the relationship you have with your child. But it’s absolutely possible to overcome sleep problems.”
Parents have an important role to play in child sleep. “Some children are able to self-soothe innately, but in many children it’s a learned behaviour,” Gavriloff says, explaining that if parents routinely put their child to sleep by rocking or feeding them, the child develops a “sleep onset association”. “It’s helpful to associate sleep with a quiet room, a soft duvet, a teddy bear – these are able to facilitate sleep onset independently. Negative associations are feeding or rocking a baby to sleep, singing them a particular lullaby or rubbing their back. They’re really common and they’re not a sign of anything pathological per se. The point at which it becomes a clinical issue is when it becomes a problem for people – if the child or the parents aren’t getting enough sleep.”
One of the most controversial aspects of sleep training is the “cry-it-out” method, where babies are left to cry for certain lengths of time ranging from one minute to 15. Many people will have first heard of this technique, also described as “controlled crying”, in 1999, via Gina Ford’s bestselling The Contented Little Baby Book. While some see it as a parenting bible, others feel “training” a child this way is distressing and impossible. The topic has proved so contentious that in 2007 Ford sued parenting website Mumsnet for defamatory comments about her. Comments were removed and the case was settled out of court.
Unsurprisingly, many modern sleep trainers say they avoid the cry-it-out approach, but all the mothers I speak to for this article say that ultimately they were encouraged to try it. “I was assured that cry training wasn’t the only method the sleep consultant used, but it was,” Heike says; she had expressed her desire not to use that method, saying, “We wanted to tend to our baby.” Annabel echoes this: “The ‘one method suits all’ of letting the baby ‘protest’ just didn’t suit us. My personal view is that the only reason it works is because the baby doesn’t cry because they know nobody will come for them.”
Lindsey had a different experience: “My daughter had a story; she went down with a soft teddy under her arm, near her cheek; I’d say goodnight and leave the room, even if she was crying, and wait outside. If the crying ramped up and she sounded distressed, I’d go in and lay her back down then leave again without talking. You repeat that process until they get bored, basically. We just needed not to buckle.”
“Evolutionarily, crying is an effective mechanism to get you to do something,” Gavriloff says. “But we’re not distressing children – we’re making them feel safe enough to fall asleep by themselves.” He, too, recommends what’s referred to as the “extinction” method – letting a child cry themselves to sleep. (“It sounds awful, but it’s a behavioural term,” he adds). “Cold turkey would be to put the child to sleep drowsy but awake, and leave them until the next morning. There’s no evidence that leads them to develop a mental health problem later on, or that it ruins their attachment style, but it’s very difficult for parents to do.”
He found it too hard with his own daughter, so instead he used “graded extinction”. “You notice the cues the child is sleepy – rubbing their eyes, yawning – and put them to bed in the same place, day or night. That develops an association. The child will initially cry, and what they’re saying is: ‘I didn’t get the memo on this.’” You then leave the child for a set period – it could be one minute, or 15 – before going back. “You don’t pick them up, but you show them that you’re there, with a neutral or what we might call a ‘robot parent’ facial expression – no anger or distress and no overt effusiveness. You leave the room again and wait a set period until you go back.” In a matter of days, or weeks, if you stick to these patterns, the baby should be able to self-initiate sleep, and when they have brief wakings in the night they will no longer need to be resettled.
He also explains that sleep regressions are normal, usually “when there’s some kind of developmental milestone – they’ve learned to pick things up, they’re sitting up by themselves, or the world has suddenly become more perceptually exciting, neurologically.” He advises not to change the sleep routine and the regression will right itself. Infants waking every couple of hours is normal, too. “The important thing is whether they can go back to sleep independently,” he says.
It may feel exploitative to charge sleep-deprived parents hundreds of pounds, but consultants and coaches are clearly answering a need. “Whether you’re a medical doctor, a psychologist, a midwife or a nurse, you don’t get more than about an hour of training in sleep,” Gavriloff says. “When people turn to their GP or a health visitor for help, they’ll probably get something quite succinct.” He argues that sleep training should be better integrated into antenatal courses, paediatric reviews and health visitor appointments.
A good night’s sleep shouldn’t be a privilege enjoyed only by the affluent. “If you can’t afford an online programme, if you don’t have the internet to have a Zoom call, how can you get the help you need?” he asks. He recommends the book Sleeping Through The Night, by Jodi A Mindell, which he says offers more guidance than you will ever get from a sleep consultant. His advice to any struggling parent? “Don’t beat yourself up. This is essentially about being a loving parent. Choose the right approach for you, get everyone on board, and take it a day at a time.”
For Zara, three nights of cry-it-out saw her baby sleeping through the night. While she says listening to him cry felt like an eternity, his longest cry was actually five and a half minutes. “We’re more and more separated from community parenting, there’s so much pressure, and discussions around sleep feel quite judgmental,” she says. “I just wanted to find my own way.”
Yawning glory: how to tackle childhood sleep problems – from tots to teens
By Dr Dimitri Gavriloff, clinical psychologist and sleep medicine specialist
Babies and infants
Create a sleep haven Use comfortable bedding and blackout blinds, and ensure the room is around 18C. The bedroom should be associated with relaxation and sleep, so avoid using it for stimulating activities, including time-outs. Transitional objects, such as teddy bears, can help a child feel safe and relaxed.
Establish a routine A consistent bedtime routine provides strong behavioural cues. Follow the same sequence of relaxing activities nightly, for example: bath, pyjamas and teeth, story, kiss goodnight. Keep it relatively brief, 30 to 45 minutes. Predictability helps children wind down.
Time it right Watch for cues that your child is sleepy (rubbing their eyes, yawning) and use this to guide your timing. If you’re having to wake your child each morning, they’re probably not getting enough.
Give them the confidence to self-soothe Once in the cot, keep your involvement to the minimum. Once they’re able to do this at the start of the night, they will stop needing you in the middle of the night, too.
Don’t give up! When you’ve established an approach, stick to it.
Older children and adolescents
Know their needs Developmentally, sleep and wake timings often get later during adolescence. For many young people, this makes both waking up and getting through the day extremely difficult. Try negotiating bedtimes that are in line with the earliest point at which the young person could fall asleep naturally.
Be sensitive around screens Remove tablets, TVs and mobile phones, which are associated with fun and enjoyment, from bedrooms – but do it sensitively. Explain the stimulating effects of technology, rather than confiscating devices, which feels like a punishment.
Set up useful habits If a young person is unable to fall asleep within 15-20 minutes, it may be more helpful to get up and read quietly somewhere comfortable and dimly lit. When sleepiness returns, they can get back into bed and try again. Long periods spent in bed not sleeping can erode a strong bed/sleep association and may lead to worry, exacerbating the problem.
If a problem persists despite your best efforts, ask your GP for help.