There was a moment in the first few months of my son’s life when I caught a glimpse of perspective about my sleep-deprived desperation. I remember it as the middle of the night, but it might have been the middle of the afternoon—the black garbage bags we had duct-taped in a patchwork quilt of gloom over each of our bedroom windows offered little distinction. All I know for sure is that my husband and I were hovering over either side of a HALO® Bassinest® Swivel Sleeper, a vibrating $250 device we had purchased at a steep discount on Craigslist. My son was cocooned in a velcro-ed HALO® SleepSack®, one of several different brands of sleep sacks bought on Amazon in the middle of several different sleepless nights.
I rolled the baby onto his side so that my husband could pat the very middle of his back in the “quite firm” fashion advocated for in the latest in a growing stack of rush-ordered baby sleep books. At the same time, we both made the loud and highly particular “shh-ing” sound instructed by the manual—like “the whooshing of air or a faucet on full force, not the slow chug-chug of a train.” Our designated baby-sleep guru of the moment—Tracey Hogg, the so-called Baby Whisperer—had told us to do this for seven to 10 minutes, and a stopwatch was running on my iPhone. We paused only to lick our drying lips and desperately suck in air.
A few minutes in, we made the mistake of making eye contact with each other as we pushed every last bit of air from our lungs, our bodies folding over the bassinet like hastily deflated pool floats. We started to grin and then sputter. Laughter was interrupting our unified wave of “shh”—a definite deviation from the book’s instructive to “convey a feeling of confidence”—and then there were tears leaking out of the corners of my eyes. It was all just too much: the robotic patting, the signature shh-ing, the glowing timer that would not go fast enough. Then I was collapsing onto our bed, and then onto the floor, in a fit of barely suppressed giggles. “THIS IS FUCKING RIDICULOUS,” I whisper-screamed-slash-laughed. It seemed so clear in that moment: The baby sleep advice industry was having its way with us.
But the next day I was contemplating a $39 e-book promising a miracle infant sleep schedule—and then a $79 e-course from a woman known as The Sleep Lady®. I wanted sleep, now. (A few days before, I had been so fatigued that a slight trip on the sidewalk—the kind of thing that normally would have caused me to only stumble—managed to land me flat on the pavement.) But I also wanted to get it right. I had heard the many warnings—in the form of baby sleep advice blogs and first-person horror stories—about parents with babies needing pacifiers replaced all night long or sleepless grade-schoolers engaging in what can be best described as advanced torture techniques. The subtext often being: These parents—usually moms—had gotten it wrong. There but for the grace of the right e-book-peddling sleep expert go I.
Entering into parenthood, I knew there was a massive market for sleep books. Pre-baby, I had gotten my fair share of recommendations for classics like The Happiest Baby on the Block and Healthy Sleep Habits, Happy Child. But I hadn’t realized that the market no longer consisted of just old-school big-name gurus like Harvey Karp, Marc Weisbluth, and Richard Ferber. There was also a thriving online marketplace of “sleep coaches” selling trademarked baby sleep schedules, e-books that cost as much as a college textbook, and $500 online consultation packages.
Just as with popular baby sleep books, these experts had trademarked soothing strategies, including very particular approaches to patting or shushing. One company even sold a $12.99 album of “perfect” noises for baby sleep. There were e-courses and message board memberships and Skype sessions and email consultation packages—all with a hefty price of admission. In one case, a well-known sleep coach advertised her personal consultation services for $25,000—“by invitation or referral only.”
So much of it targeted those same delirious early months when my husband and I found ourselves guffawing over the bassinet. But as I found—after our baby eventually started sleeping through the night and I got my brain back—there is only a handful of strategies that have been shown to be effective in those first months. Most of those things are basic and intuitive—like, keeping the lights low and reducing stimulation at nighttime, starting a bedtime routine, and trying to put a baby to bed while drowsy but awake, so that they have a chance to learn to fall asleep on their own. The evidence for rigid sleep schedules, branded shushing, and SignaturePattingStrategies™? Not so much.
After six months of age, experts generally agree that formal sleep-training—which is any method that teaches a baby how to fall asleep alone, and which often involves some degree of crying—can begin. (Although, some argue that it can start earlier.) That’s when the well-documented strategies really kick in. But that first half a year is the prime time for reaching parents at their most desperate, sleep-deprived, and, at least in my case, intellectually compromised.
The inconvenient truth about young infants—who vary widely in their total amount of sleep—is that they simply have to frequently wake up to eat. “The fact is that it’s not only common but physiologic that babies will have fragmented sleep throughout the night in the beginning,” said Lori Feldman-Winter, a professor of pediatrics at Cooper Medical School of Rowan University. “Babies may not sleep any more than two-to-four hour stretches for the first few months after going home.” But, as they grow, so do their organs and their ability to go for longer periods in between feeds, which means they—and their parents—are able to have more uninterrupted sleep. “A lot of it is just anticipating that the first four-to-six months are going to be really hard,” she said.
Of course, that flies in the face of experts who explicitly promise fast results—like Suzy Giordino, The Baby Coach™ and author of Twelve Hours’ Sleep by Twelve Weeks Old, a book I definitely purchased because I am a sucker.
In addition to the basic physiology of babies, there are also fundamental differences in temperament, which can lead to more fragmented sleep among some infants. “That just is how different people are wired,” said Feldman-Winter. “We know just among our close friends and family that people have different sleep habits, and that’s as individual as personality in some ways,” she said. In other words, it’s not necessarily that these babies’ parents have failed to find the right sleep guru.
But no parent with a 3-month-old wants to hear that they have to wait it out, or that they just happened to get one of those night-owl babies. Our pediatrician had offered things early on that we might try—including nixing the makeshift blackout curtains so that our baby could be exposed to more light during daytime naps—but didn’t purport to have any quick fixes. As I went down my list of sleep-related questions each appointment, she sighed and tilted her head, calmly and confidently explaining that things would simply get better with age. She responded to my middle-of-the-night emails in a similar fashion. Our doctor was delivering the evidence-based truths that I didn’t want. I wanted magic solutions.
Sleep coaches, who offer online and in-person services, can feel like a magic solution. It’s a field that has exploded in the last few years—and caught the attention of pediatric sleep researchers. “Sleep coaches aren’t licensed or regulated by any kind of board,” said Sarah Honaker, an assistant professor of pediatrics at Indiana University School of Medicine who has studied baby sleep extensively. “The quality is gonna vary quite a bit.” She gives the example of her own credentialing as a psychologist: She’s licensed by an independent board run by the state—and if she fails to meet certain criteria, she could lose her license. “That equivalent doesn’t really exist for sleep coaches,” she said. “It’s not regulated.” That is in stark contrast to similar providers, like lactation consultations, who are credentialed by an independent board.
In 2017, a panel of medical experts published a commentary in the journal Clinical Pediatrics expressing concern about this lack of formalized guidelines. The year before that, the Board of Directors of the Society of Behavior Sleep Medicine released a statement suggesting caution in using sleep coaches, given the uncertainty around education and training. Thanks to this lack of formalized guidelines, sleep coaches come from a broad range of backgrounds. A 2015 survey of sleep coach websites found that 44 percent didn’t report an educational background at all, and 70 percent did not report having any previous medical experience.
But that clearly hasn’t prevented high priced services. That same survey found that the average cost of an in-person consultation was $368 and $314 for phone and online consults. It’s easy, though, to find base rates closer to $600 for in-home and $400 for online.
Then there are the celebrity sleep coaches, like Kim West, The Sleep Lady®, who offers a coaching package for parents for $995, which includes a 60-minute Skype or phone session and eight followup phone calls. West sells an e-course for the first six months (the $79 one mentioned earlier), which she emphasizes is sleep coaching, not sleep training. In that early period, she focuses on basic advice around things like exposing babies to light during the day and not depriving them of naps (she says some parents mistakenly believe that keeping a baby up during the day will make them sleep at night). But a lot of what she offers in those first months is the management of parents’ expectations around sleep.
West has also developed a Gentle Sleep Coach® training and certification program—in other words, part of her business is training others to enter into the business with her branded stamp of approval. Her training program comes with a price tag of $5,995 and is marketed toward mothers. “As a working mom myself, I know how busy you are!” reads the training website. “So I structured this basic training to be flexible – where you can work at your own pace and in your own free time…. whether its during nap time, your lunch break, after the kids are in bed or on the weekends…it’s up to you.” She also has an affiliate program that allows people—say, “mommy bloggers”—to get a commission from promoting her products.
West says she started training people eight years ago—in part because of what she was seeing in the industry. “I was really concerned by the poor quality advice online and people saying, ‘I sleep trained my child and now I’m going to help these other people,’” she said. West told me that she is in favor of independent oversight of sleep coaches, just as in similar fields, and added, “I hope what won’t have to happen is somebody gets hurt before there is regulation.”
At one point in those very early months, my moms’ group started passing around a pilfered copy of a $39 newborn sleep program made by Little Ones, an Australian company that sells five different age-pegged e-books, along with the aforementioned “perfect” baby sleep soundtrack. It has to be emphasized: It’s a 144 page electronic document that costs four times the price of your average $9.99 e-book, and it only applies to the first three months of a baby’s life. Although, it does also give access to an online support group, as do most of these kinds of e-books and e-courses. It also comes with an audio file of the “Baby Sleep Shhh Audio Track.”
One of the moms in our group had been successfully targeted with an ad on Facebook and then she shared the ebook with the rest of us, along with a style of self-disparaging disclaimer that had by then become familiar to me—essentially, yeah, they suckered me, but it’s kind of working and it’s something to try! It was the same attitude I’d had talking with other parents about a particular brand of rush-ordered miracle swaddling sleep sack.
The e-book is marketed as a tool for parents of a newborn who is “catnapping in the day,” “difficult to settle for naps and at bedtime,” “sleeping well in the day but is up all night,” “refusing to settle or sleep in their own bed,” or “having an unsettled period in the early evening.” In other words, it’s marketed to anyone with a human baby. The site promises that its programs will result in a “happy content” baby who is “naturally ‘sleep[ing] through’ at a young age.” The main idea behind the program is scheduling daytime naps—and waking the baby if necessary—in the service of a longer stretch of sleep at night. There’s also a particular soothing-to-sleep method that involves “quite forcefully” patting the baby’s bottom “in an upwards motion” and playing a “loud white noise.”
Shalini Paruthi, co-director of the Sleep Medicine and Research Center at St. Luke’s Hospital, says that this particular e-book, which I shared with her, does generally follow medical and behavioral guidelines. “Sometimes it’s hard to know where to start with a sleep schedule and their suggested schedules are a reasonable place to start, provided parents pay attention to their baby’s individual cues and make reasonable adjustments,” she said. The e-book does advocate for parents making tweaks if necessary, particularly if a newborn is hungry before a scheduled feeding.
But Paruthi does point out that some research has raised concerns about white noise machines and “hazardous sound pressure levels” (which just so perfectly illustrates the minefield that parents walk—the best-practice guidelines and scientific evidence are constantly changing, and are often enough in contradiction with both expert advice and popular mainstream products). And, of course, there are no peer-reviewed studies on the “quite forceful” upward butt pat.
My moms’ group friend deployed the whole strategy quite successfully and felt that it “worked like a charm”—until she and her husband went back to work and could no longer dedicate their lives to managing their baby’s sleep schedule. With a little bit a perspective, she referred to the $39 purchase as “desperation money.”
In general, there is no evidence—of the scientific, peer-reviewed kind—to support specific infant sleep schedules, according to Honaker. “The idea that there’s a best schedule for this age, I think is problematic,” she said, although she declined to comment on specific programs. While there are general rules of thumb about how long a young baby needs to be awake before feeling tired, there is also “huge normative variability,” as Honaker puts it—meaning, there is a broad range of normal. Because of babies’ advanced circadian rhythms, we know that they often do better with earlier bedtimes—but that is a far cry from a prescriptive schedule.
Honaker specifically calls out the schedule promoted by On Becoming Baby Wise: Giving Your Infant the Gift of Nighttime Sleep—which focuses on parental control of the baby’s eating, playing, and sleeping regimen, as opposed to loosely feeding on demand, which the American Academy of Pediatrics (AAP) recommends. The book currently sits at number one in Amazon’s “children’s health” category—but, ironically, pediatricians have actually raised health concerns about the book and linked its advice to dehydration and “failure to thrive” in infants. (The book’s defenders have countered that it has been updated several times since its more controversial edition.)
Feldman-Winters explains the concern about rigidly scheduled sleep patterns in the first couple months: “If you’re not being responsive to the baby’s cue-based feeding patterns ... because you’re so concerned about having a baby on a sleep schedule, then chances are something’s going to give and more than likely it’s going to be the feeding.” In other words, a baby could start getting less to eat than they truly need, which could also impact the mother’s milk supply. “Really, the first six months is not the period of the time to have some expectation that you can schedule the baby’s sleep cycle,” she said.
After six months, there is a world of evidence behind—and various guru-guided approaches to—sleep training. There is the “cry it out” or “extinction” method, which involves putting the baby to bed and not returning to them for a set period of time, and which continues to stir up intense judgment and expert debate. Although Honaker says, “I think it’s pretty clear that it’s an effective approach for most infants, and that it’s not harmful.” (Full disclosure: We did it. Would do it again.) For parents who prefer a “softer” approach, there are strategies that involve checking on babies at gradually increasing intervals or providing a decreasing amount of crib-side consoling—with the aim of teaching the baby to eventually fall asleep alone.
From that six-month age milestone onward, there is still plenty of parental desperation—and “desperation money” to be grabbed— it’s just that there is so much more that can actually, scientifically, be done to help.
The thing about the baby sleep advice industry—as well as parental conversations around it—is that it can offer support, but it can also convey the sense that it’s your fault your baby isn’t sleeping. “I do think that part of the problem is the large amount of unrealistic expectations and sort of mommy-shaming that happens on blogs—‘Oh, well, my baby slept for x, y, z amount of time, you must be doing something wrong,’” said Feldman-Winters. As Honaker puts it, “Parents can feel a lot of pressure to do things quote-unquote the right way when it comes to sleep.” But it isn’t necessarily clear that there is a “right way,” especially early on. In fact, following strict guidelines for baby care has been linked to poor mental health in mothers.
In 2017, researchers at Swansea University in Wales conducted a study that attempted to look at the impact of the multi-million-dollar baby book industry. As the paper’s abstract put it, “The transition to motherhood can be challenging. The baby book market has taken advantage of this, publishing a range of books that suggest adopting strict routines for infant sleep, feeding, and general care.” Researchers surveyed more than 350 mothers with babies under 12 months of age on measures of postnatal depression, stress, and something researchers called “maternal self-efficacy”—and they also looked at whether the moms had used “infant parenting books that promote strict routines.” What they found was that “use of the books was associated with increased depressive symptoms and stress, alongside lower self-efficacy.”
Of course, it’s not necessarily causative. It might be that these books push moms to a bad place mentally, or it could be that moms who are inclined toward such books are susceptible to poorer mental health. But it does raise the question of how we should look at this industry filled with unproven methods.
There is the cynical take: Savvy marketers are exploiting sleep-deprived parents in their most vulnerable and desperate moments with overpriced products of dubious utility—and potentially doing harm to parents in the process. Or you might look at the lack of evidence around sleep strategies in those early months and see that as the injustice—as a failure on researchers’ part to adequately address the sleep concerns of parents (and perhaps moms, especially). From that perspective, you might see the lack of evidence as what is cheating parents, not the sellers of sleep products and services, who are trying to offer options and support.
There’s also the middle ground take: This market gives new parents things to try—some of which might be helpful, despite the lack of hard evidence, and some of which might be ineffective and yet at least give parents a sense of hope that makes those hardest months pass more quickly. At the end of those first six months, I actually felt something almost like gratitude for the discarded stack of baby books, because they had given me something—and then another thing, and another, and yet another—to believe in. They had allowed me to convince myself, all evidence to the contrary, that I had control over my new baby-run life. That fantasy kept me going until things got better with time.
Just as with sleep strategies, you can basically find evidence—or “evidence”—to support whichever take on the industry speaks to you.
It is hard, however, to ignore the fact that the desperation with which parents approach baby sleep is only fueled by the political reality of parenthood, and motherhood in particular, in this country. The United States is the only developed country to not mandate paid parental leave. Federal law mandates 12 weeks of job-protected parental leave for eligible workers—but it does not require that time to be paid. When parents are lucky, their employers voluntarily offer some of that time with partial or full pay—but rarely do companies offer anything close to the six months paid maternity leave that is now law in more than 50 countries.
As Feldman-Winter points out, it can be particularly difficult for breastfeeding parents. “Babies just want to be nursing when their moms are home and that tends to be in the evening and nighttime so they might actually be awake more at bedtime so that they can nurse and sort of snuggle with their mothers,” she said. “ It’s double whammy—the mom is going back to work and tired form working and then coming home and not able to sleep at night.”
If parents weren’t forced to return to work so soon, baby sleep would surely still be a serious concern—I wasn’t rushed back to work and yet I was still going a little cray—but perhaps not quite so desperate, and perhaps not such a driver of industry. In a society where moms have a year of paid leave, they’re napping during the day when the babies are napping,” said Feldman-Winter. But a society with abysmal parental leave is fertile ground for an industry of alleged fixes in those early months. “I wish there was a magic solution,” she said, “but I think it’s really just changing our society, which is probably the hardest thing to do.”