What to do about sleep? A survey of parents' experiences with sleep interventions and popular advice. Gordon,
M. D., & Hill, S. L. (2008, March). Poster presented at the
International Society for Infant Studies, Vancouver, British Columbia.
Click for a pdf of the poster (Formatted for 11 x 17 paper)
Abstract: BACKGROUND:
At one time, sleep deprivation was synonymous with early parenting.
Today, sleeping through the night has grown in importance and urgency
and parents increasingly turn to the popular media for guidance
(Simpson, 1997). Such sources, however, can be inconsistent and even
inaccurate in matters concerning child health and development
(Impicciatore et al., 1997). In fact, an examination of parenting books
and magazines on infant sleep reveal stark differences in reported
sleep milestones, appropriate age for starting, and amount of crying to
allow. Further, advice content stresses the critical importance of
extended sleep for infant brain and behavioral development. It is not
surprising, then, that parents may be stressed and anxious about sleep.
This survey aims to assess how popular advice influences what parents
know and do about infant sleep, and whether there are differences in
experience and outcomes based on their chosen approach.
METHODS:
First-time parents of infants under 11 months were recruited via
targeted email and search engine ads. The survey included questions
about the infant's current sleep behavior, parental use of sleep
advice, and implementation of the intervention. Parents' perceived
levels of infant sleep difficulties, as well as worry, stress or
conflict around sleep were also assessed. Based on answers to key
questions, respondents were placed into one of three groups: Cry
approaches, No Cry approaches, or Cosleeping. Descriptive statistics
for the sample as a whole were calculated. Intervention subgroups were
compared for differences in parental perceptions of advice,
implementation and experience.
RESULTS: Survey respondents (N=142)
are predominantly white, married, well-educated mothers. 31% (N=44)
were classified as Crying, 19% (N=27) as No Crying, and 50.0% (N=71) as
Cosleeping. Data analysis indicated that parents use a wide variety of
sources of information and advice. They overwhelmingly indicated that
there was too much advice that was inconsistent between sources. Both
Cry and No Cry groups felt that the information, however, was
more influential in their choice of sleep intervention than Cosleepers. The data revealed no
significant differences between groups in parents' use of sleep advice or
knowledge of infant sleep development.
While there were no differences in the number of awakenings or duration of nighttime sleep between groups, other significant differences were found. Both Cry and No Cry groups were more worried about how well they were managing sleep (p<.001). They also believed their infant's sleep was more problematic than Cosleepers (p<.001). The Cry group was also less convinced that the approach fit with their parenting values (p<.001) or was working well (p=.001).
It is interesting to note, however, that on several variables, the No Cry group
expressed the highest level of stress/concern. There was some evidence that underlying beliefs about adapting to the baby and responding to crying may underlie the choice of sleep intervention. Cosleepers were more likely to believe in quick response and adapting to baby. The Cry group fell slightly more toward delaying response a bit and balancing adapting to baby with adapting baby to the family. The No Cry group resided between these two. These relationships were all significant (p<.001). Qualitative data was gathered from open-ended questions. Parents clearly struggle with conflicting sleep advice and the limitations of the information available in books and at their pediatrician's office.
CONCLUSION: Parents encounter a variety of types of advice and information on sleep. This advice, they report, is frustratingly inconsistent and overabundant. While infant
nightwaking is a known stressor for parents, it appears that sleep advice and sleep
interventions themselves may also be a source of increased worry and stress for parents. Indeed parents expressed significant worry about how well they were managing sleep, indicating that perhaps infant sleep has become, not only a developmental milestone for infants, but a measure of parental competence as well. The question arises about whether infant sleep is truly problematic or has the pressure increased on parents so that even normative sleep is increasingly perceived as problematic? Future research should be undertaken to assess the affects of advice on parental stress and outcomes for infants.