There is a lot of division and polarizing views when it comes to sleep and things like sleep training. Sleep training is not a necessity, but many families want to approach it and want to know what the evidence does or doesn’t show. I welcome Sujay Kansagra who is a pediatric neurologist and sleep medicine physician at Duke who has dedicated his life to helping kids (and their parents) sleep better. He knows sleep and the importance of it.

 

He joins me to discuss:

• Terminology and what sleep training is or isn’t
• What data and resources we do have surrounding sleep training and various methods
• Misconceptions surrounding sleep training

 

Resources:

Review on Sleep Training Data

Controlled Cortisol and Sleep Training Research Study

“Sleeping Through the Night” Article

Wide Range of Normal Sleep Article

PedsDocTalk Podcast Cry Babies: Cortisol Research and Secure Attachment

 

To connect with Dr. Sujay Kansagra follow him on Instagram @thatsleepdoc and check out all his resources at https://linktr.ee/thatsleepdoc.

 

Our podcasts are also now on YouTube. If you prefer a video podcast with closed captioning, check us out there and subscribe to PedsDocTalk TV.

 

We love the sponsors that make this show possible! You can always find all the special deals and codes for all our current sponsors on the PedsDocTalk Podcast Sponsorships page of the website.

00;00;00;03 – 00;00;17;06
Dr. Sujay Kansagra,
And when we dive into that research. People are saying, well, there’s a there’s a huge debate on social media when it comes to the studies that have been done in a robust manner. There’s really not a lot of debate. You know, like, and it is fine for us to have that. Everybody is going to feel really strong and have emotions regarding this.

00;00;17;06 – 00;00;28;12
Dr. Sujay Kansagra,
And I get it. Raising children’s is it is filled with emotion. It’s filled with questions. Questioning ourselves. No. Questioning everything that we know. When it comes to objective data, there’s really just not that much debate out there.

00;00;28;15 – 00;00;53;04
Dr. Mona
Hello, it’s Doctor Mona, and welcome back to the show. I hope you’re having a glorious day. And before we dive into today’s conversation, I want to take a quick moment to talk about gratitude. Now that my son is almost five, he has really started to understand the concept of gratitude. We started introducing the concept around four, and he’s seen me put slips of papers with grateful moments into my gratitude jar that’s in the kitchen, and he’s come around to the concept.

00;00;53;06 – 00;01;17;13
Dr. Mona
We started with giving examples in our own lives of what gratitude is, and he’s finally latched on. And so now every night we talk about what makes him grateful. And I have been solo parenting two weekends in a row while my husband works in the E.R. and listen, those solo parenting weekends can be draining, and he told me over the weekend that he loved Mommy Fun Days, that he was grateful to have those days.

00;01;17;13 – 00;01;41;29
Dr. Mona
And also when I woke him up in the morning. So pure. And to be clear, mommy, fun days are not anything elaborate. We went to the park. We played inside. We did a dance party. He watched some Bluey. I usually heat up leftovers or get takeout to simplify the day and we just laugh and have fun. And it’s just a gentle reminder that even on the most mundane days, your kids really appreciate your time.

00;01;42;01 – 00;02;01;07
Dr. Mona
They really appreciate what you do. So if you’re having a not so glorious day today, I encourage you to ask yourself. Ask your partner. Or even ask your child if they’re old enough. What are you grateful for? What made you happy today? Because even on the most difficult days, those little glimmers can really fill you with love and remind you that everything is going to be all right.

00;02;01;09 – 00;02;22;06
Dr. Mona
And with that, let’s get to today’s episode. I invited one of my favorite followers on social media, Doctor Sujay Kansagra, who is a pediatric neurologist and sleep medicine physician at Duke and on social media as at that sleep doc who has dedicated his life to helping kids and their parents sleep better. He knows pediatric sleep like it’s his job because, well, it is.

00;02;22;09 – 00;02;40;17
Dr. Mona
And he has also written a book called My Child Won’t Sleep that We Are Giving Away, along with a PDT course that has many sleep resources. So if you want that, check out my Instagram reel from the date of debut of this episode. We discuss sleep training, what the evidence does or doesn’t say, and our hope is to provide resources and reassurance.

00;02;40;17 – 00;02;51;29
Dr. Mona
If sleep training is something you wanted to do with respect and understanding that it’s not every parent’s cup of tea. Let’s get to it. Thank you so much for joining me today. Doctor Gonzaga.

00;02;52;02 – 00;02;54;02
Dr. Sujay Kansagra,
Thanks so much for having me. Excited to chat.

00;02;54;05 – 00;03;06;26
Dr. Mona
Well, tell us more about yourself if anyone is not familiar with who you are and also you have a very popular TikTok Instagram account at that sleep doc. So tell us more about yourself and why you started that account on social media.

00;03;07;03 – 00;03;24;20
Dr. Sujay Kansagra,
Yeah, your intro was spot on. So I’m a child neurologist by trade. I did a year of sleep medicine fellowship after that, and so I specialize in sleep disorders for children. I’ve been at Duke for, gosh, 12 years on faculty now, but did most of my training between USC and Duke, the two rivals. It is basketball season, so I have.

00;03;24;20 – 00;03;42;19
Dr. Sujay Kansagra,
Yes. And that, but yeah, I do I’ve done research on sleep and a lot of education based stuff as well, and most recently have dived into social media because that’s where I feel like we can reach the biggest audiences. And so when it comes to writing a bunch of research papers versus being on social media, I feel like more of my impact I can have on social media.

00;03;42;19 – 00;03;43;13
Dr. Sujay Kansagra,
So so here I am.

00;03;43;18 – 00;04;03;13
Dr. Mona
I completely agree with that same origin story. For me. I think it’s wonderful and it’s amazing how you’ve grown. I love your content. You’re humorous. You’re also very educational. So I, I get to learn more. Deep dive into sleep myself as a general pediatrician, but I also really get a good laugh out of a lot of your a lot of your content, especially your TikTok videos.

00;04;03;13 – 00;04;27;12
Dr. Mona
So really, thank you for bringing that humor, but also that really important education. And I know you don’t only do sleep training, I know that’s what we’re discussing on this episode today. Obviously you have a breadth of information and knowledge in all areas of pediatric sleep medicine, but I chose to talk about this because I know you spoken about it on other podcasts, but also, on your content as well.

00;04;27;12 – 00;04;50;23
Dr. Mona
And this is sort of like debunking, but sort of kind of normalizing. What do we know? What don’t we know? And maybe if we don’t know how a parent can approach, if they’d like to sleep, train. And before we get started, myself and Doctor Cassandra, we do not need everyone to sleep train. But I think there’s a misconception around pediatricians that they’re going to come and tell my baby and tell me that I got to do this.

00;04;51;00 – 00;05;08;15
Dr. Mona
This is for families who are like on that fence or like, I don’t know if it’s something that is useful. I don’t know if I want to do it, and we’re here to just give you that information. So if this is not your cup of tea, that’s fine. But I hope that if you are against sleep training or you look at it in a negative light, that maybe you’ll learn something too.

00;05;08;15 – 00;05;13;28
Dr. Mona
So that is kind of what I wanted to preface it, because I know you also talk about that on a lot of your content as well.

00;05;14;00 – 00;05;29;05
Dr. Sujay Kansagra,
Correct? Absolutely. You know, it’s one of those parenting choices. And my goal and part of being on social media is to make sure parents are empowered with the choices and understand the information behind the various choices they have. And there’s no one right way to raise a child. I think there’s something that all of us emphasize. There are a million different ways to do it.

00;05;29;08 – 00;05;34;21
Dr. Sujay Kansagra,
We want to make sure that you have the options and the information behind the options to make the right choice for you, your family, and for your job.

00;05;34;23 – 00;05;53;26
Dr. Mona
And so I’ve been a pediatrician for nine years now. I can’t believe that. I know you said you’ve been practicing for 12. Obviously going through fellowship, training and all that nine years. And it wasn’t until I got on social media that I saw how polarized everything was, especially the baby sleep space. You know, in my office, I meet my families.

00;05;53;26 – 00;06;14;00
Dr. Mona
There’s trust. We talk about things. And then I had parents coming in saying, well, I read online that this is harmful or this is that co-sleeping is superior. No, sleep training is what’s important. No, don’t do try it out. Yes, it’s okay. And I mean, as a parent trying to do the best that parents are trying to do, I think it can be very overwhelming.

00;06;14;00 – 00;06;35;19
Dr. Mona
And I see this especially in that sleep training conversation. We have some sleep experts and I’m putting posts in the air, saying don’t do it. Some that say do it, some that go on very polarized opinions. And there’s also psychologists that come on social media and say, don’t do it. It’s harmful. Crying is harmful. This and that.

00;06;35;22 – 00;06;46;18
Dr. Mona
So how does a parent even know where to begin and who to trust when it comes to all of this polarizing information, especially as it comes to sleep training?

00;06;46;21 – 00;07;04;21
Dr. Sujay Kansagra,
Well, you should trust me and only me document it not. You know, I, I think this is this is a problem with social media, which is everybody’s saying you have to trust me. And I have all the information and the magic beans to grow the beanstalk. And so just just listen to listen to me. Well, I say, don’t listen to me.

00;07;04;21 – 00;07;22;01
Dr. Sujay Kansagra,
Don’t listen to people. Just look at look at this. Look at the data. You know, this is from data, which is where we try to find as much objective truth as possible within the limitations of what’s, you know, within research studies, we know that all resources have limitations, but we make a whole hearted effort to try to find the answer based on objective data.

00;07;22;04 – 00;07;43;19
Dr. Sujay Kansagra,
And that’s where I like to always begin. And and the good thing about, you know, when it comes to sleep training or these what we call behavioral insomnia techniques and treatments to help with parents. Yeah. There’s a robust amount of literature, actually, that’s out there. And when we dive into that research, people are saying, well, there’s a there’s a huge debate on social media when it comes to the studies that have been done in a robust manner.

00;07;43;22 – 00;08;03;00
Dr. Sujay Kansagra,
There’s really not a lot of debate, you know, like it is fine for us to have that. Everybody is going to feel really strong and have emotions regarding this. And I get it. Raising children is it is filled with emotion, is filled with questions, questioning ourselves, you know, questioning everything that we know. When it comes to objective data, there’s really just not that much debate out there.

00;08;03;00 – 00;08;09;25
Dr. Sujay Kansagra,
And I like to emphasize that to say, you know what is fine? Let people debate. Let’s just go back to the data and tell us what. It’s just what the data shows.

00;08;09;28 – 00;08;30;13
Dr. Mona
Well, I, I would love to dive in a little bit to some data. Obviously, we could talk for a whole podcast about all the, all the data. And yeah, before we get into that, for anyone who’s not familiar with what sleep training is, how would you find sleep training to a parent who’s unsure of that terminology and what that actually means?

00;08;30;13 – 00;08;35;05
Dr. Mona
And it may be different definition for you or me, I just I’m just curious what you think about that definition.

00;08;35;08 – 00;08;59;26
Dr. Sujay Kansagra,
Yeah. No, it’s great. There’s there’s no formal definition of for sleep training. It’s a term that has been kind of closely used to describe any sort of approach that you take to help a child learn how to sleep better through the night. And for me, it’s any technique that helps with what I call sleep onset associations. Sponsor associations is anything that you associate with the process of falling asleep that’s there in your external environment that may or may not be there when you wake up during a normal awakening at night.

00;08;59;28 – 00;09;14;22
Dr. Sujay Kansagra,
And so the best example I can give for adults is having the TV on. Some adults say I have to have the TV on to fall asleep. That’s the sleep onset association you’re using that to associate, you know, falling asleep and your brain learns that’s what it needs. Infants have the same thing. They’re very smart and very early in life.

00;09;14;22 – 00;09;32;07
Dr. Sujay Kansagra,
They learn, yeah, this is what’s in my environment. This is how my brain goes from wake to sleep oftentimes is some sort of caregiver involvement. So seek training. This involves trying to reverse that and say, okay, you know what? Let’s help teach the infant how they can go to sleep without having external things that are helping them, relying on their own abilities to fall asleep.

00;09;32;08 – 00;09;55;16
Dr. Sujay Kansagra,
And there are a variety of approaches that everybody’s like, oh, cry it out of sleep training. No. If there’s one thing you take away from this, there are really four core techniques that have data to support them to help teach your child these these, you know, self-soothing skills and cry it out is on one end of that spectrum, which most sleep docs actually and pediatricians have over time, just kind of drifted away from, you know, there’s data to support it.

00;09;55;16 – 00;10;07;00
Dr. Sujay Kansagra,
And it’s and it’s safe. We’ve kind of just drifted away from it just because nobody likes leaving a child cry. And and so yeah, so it’s a wide range is, I think, the take away for sleep training.

00;10;07;03 – 00;10;22;27
Dr. Mona
I love it that is actually my definition too. And I love that you brought up, the wake ups. Right. Because there is a lot of misconception that, oh, with the sleep train child, they will not wake up. But every body wakes up. We talk about it when we, you know, we toss and turn, we shift positions.

00;10;22;27 – 00;10;47;00
Dr. Mona
That’s us moving through sleep cycles and the beauty of sleep training, if a family chooses to do it, is that the child won’t look for that sleep association. If they’re used to having being fed to go to sleep or, you know, needing to be rocked, we slowly or quickly, depending on the method, the family chooses, remove that association so that they can move through the sleep cycles and go to sleep and connected, if you will.

00;10;47;02 – 00;11;22;23
Dr. Mona
I love that explanation. Now, when it comes to the evidence, what do we have or don’t we have when it comes to sleep training and whether it’s appropriate at certain ages? You know, and one of the biggest things I hear, about misconceptions is a child’s inability to self settle early. You you alluded to this, that children are capable and I also know from professional and personal experience that I’ve seen it, that they are very capable of self settling and you don’t have to leave them to cry for hours, like you said that I think there’s a misconception.

00;11;22;26 – 00;11;28;03
Dr. Mona
What do we know about the data and the age and when they’re capable of doing this sort of behavior?

00;11;28;06 – 00;11;54;28
Dr. Sujay Kansagra,
Yeah, it’s a great question. I’ll tell you when it comes to that, the the studies that we have regarding sleep training approaches, when you look at what the average age was, where a lot of these interventions were done, it ends up being around five months of age. We know that typically 4 to 6 months is about the earliest that most sleep physicians will recommend pursuing some of these techniques prior four months of age, like the child, is still a little bit too young, still need some help with those self-soothing kind of, you know, helping calm down and needing to kind of correlate with a caregiver.

00;11;54;28 – 00;12;18;06
Dr. Sujay Kansagra,
But we know that after four months and definitely after six months, if a child is otherwise healthy, born on time, growing and thriving, well, that they can do pretty well with learning some of these self-soothing techniques. Now, it’s also around the age where we start developing more object permanence. So understand that when you ever leave the room, they haven’t dropped off the face of the universe that they’re actually still around, which I think is also an important part when it comes to these techniques in the timing of interventions.

00;12;18;08 – 00;12;37;03
Dr. Sujay Kansagra,
And then when we know that as children are getting older, they’re also physiologically more robust when it comes to needing nighttime feeds. We could have a whole session about nighttime feeding. But I will tell you that sleep training is not equate to night weaning. I think of them as two separate things. But we know that if your child is that age, they’re usually able to make it through the night in many cases without needing a feed.

00;12;37;03 – 00;12;55;15
Dr. Sujay Kansagra,
And sometimes that helps make the sleep training process easier. I’m not saying we’re using sleep training to get rid of the nighttime feeds, I’m just saying that they’re usually able to make it through the night without necessarily needing a feed, which might make the process more straightforward. So those are all kind of reasons and rationale for why we’re waiting until at least four months at the earliest, but typically six months.

00;12;55;18 – 00;13;14;09
Dr. Mona
Now, let’s take a break to hear from our sponsors. Yeah, I’ve mentioned this on other episodes too, and I’m always happy to be transparent in case someone missed another episode where I talked about this. So I worked at a huge practice in Manhattan. I think you may be familiar with the name of the practice. I don’t need to name it here.

00;13;14;12 – 00;13;31;22
Dr. Mona
But at that practice, the owner of the practice and a lot of the families, they’re sleep trained at two months. So this is a thing where we sleep. Trained babies at two months. And I remember coming out of residency in my first job, and I was like, how is this even possible? We didn’t learn about this, and I saw families doing it at two months.

00;13;31;29 – 00;13;54;25
Dr. Mona
I would talk to them about it because that’s what everyone knew when they joined this big, big, cushy practice that, oh, we’re going to sleep in a two months. And I saw it work and I was like, interesting, but not always. And I started to kind of realize when, when it’s going to work and when it’s not. So fast forward when I had my first son, I sleep trained him at two and a half months, and it was very shocking to a lot of people, but it worked for him.

00;13;55;02 – 00;14;11;21
Dr. Mona
It would not have worked if his temperament was different, if he was still feeding a lot at night, you know, there’s so many variables. So when we talk about sleep, I think again, like you mentioned, it is so nuanced, like, well, what’s going on with the feeds? Are they full feeds? How old is the child? What is the temperament of the child?

00;14;11;24 – 00;14;31;28
Dr. Mona
My daughter was it was a clinger in that she needed so much contact to sleep, so I wouldn’t have done a full, like any sort of pry method or any sort of training. At two and a half months, by the blessings of the the sky above, she didn’t need any sleep training because we did a lot of other, you know, things early on, but it’s a valid point.

00;14;32;01 – 00;14;54;09
Dr. Mona
I like to be honest and transparent about that because I know my followers know that I did sleep train early, but it was only because although the data wasn’t there, I saw it work for families and I saw it was something that happened. But prefacing by saying fully that there was no data and it went by clinical and what we saw and that can be sometimes hard for families.

00;14;54;09 – 00;15;10;24
Dr. Mona
And I know that’s that’s not always a good thing, but I’m very transparent about, okay, this was not data driven. This was a clinical experience. And I don’t know if you find there is some nuance there. Like do you find that some families are making choices where there may not be data to always support, or how do you approach it when it comes to sleep training?

00;15;10;24 – 00;15;28;00
Dr. Sujay Kansagra,
Yeah, I think a lot of what we do in pediatrics ends up being somewhere in the in the gray regions, you know, when it comes to what we have regarding evidence, you know, I will tell you that it’s, you’re right. It’s it gets very, very nuanced. And I have heard lots of other practices saying that, oh, yeah, we can do this very, very early.

00;15;28;02 – 00;15;46;24
Dr. Sujay Kansagra,
You know, whenever I’m giving information on social media, you know, and you are in the same way, we have to we have to be a little bit careful because we’re speaking to broad audiences when there’s lots of potential. You know, we talked you talked about temperament, etc.. And so we’re giving kind of generalities which we think are going to apply to the vast majority of individuals out there.

00;15;46;26 – 00;16;04;09
Dr. Sujay Kansagra,
And we know that, you know, that that age range that we’re discussing for sleep training at 4 to 6 months will apply to the vast majority of individuals out there. We also know that based on data, that there are children that start to self settle and soothe without needing any type of sleep training intervention whatsoever. And this is why you jump on social media and your friend down the road.

00;16;04;15 – 00;16;22;20
Dr. Sujay Kansagra,
Her baby is sleeping 12 hours at you know, eight weeks of age and you’re pulling your hair out saying, what am I doing wrong? You know, or your own child, right? You have one child that’s an amazing sleeper. Your first one, you’re like, oh, we’re doing everything perfect. And that’s why we got this lined up. And your second child dropkicks you in the face and you’re like, well, we did everything the exact same way.

00;16;22;20 – 00;16;44;23
Dr. Sujay Kansagra,
And we have a completely different sleeper. Let’s because one every child is different. Even two children in your own home are going to be completely different. They’re going to have different temperaments, different, you know, sleep, neurotransmitter, milieu, etc. and so you can’t compare one to the other. So we know that when it comes to general population around those ages 4 to 6 months, the majority of children are safe.

00;16;44;23 – 00;16;47;18
Dr. Sujay Kansagra,
To be able to try to learn some of these self-soothing techniques.

00;16;47;20 – 00;17;04;24
Dr. Mona
I love it, and I don’t think we don’t need to go into detail of that four main sort of categories. I know you mentioned there’s like four different types of sleep training, but maybe just name them off. You don’t need to explain how sure that’s one on the show, but I know you also have a book project that maybe goes through all that as well.

00;17;04;27 – 00;17;20;14
Dr. Sujay Kansagra,
Yeah, I have a it’s called My Child Won’t Sleep. It was I wrote it actually during my PhD when I first, after my first child was born in the throes of like sleep deprivation, I’m like, why don’t we just have a book that has, like, step by step, every single, every single method, instead of cut out all the fluff and just get to the methods?

00;17;20;16 – 00;17;45;16
Dr. Sujay Kansagra,
Yes, yes. So it’s like it’s like in 20 minutes you can read through all the techniques, but extinction is the cry it out, you know, graduate extinction a.k.a. the Ferber method. We have, camping out, which is it has different names to the chair method of the sleep lady shuffle, etc. then schedule awakenings, which is one that we don’t typically use all that often because it involves waking the child up at certain times and spacing out those awakenings.

00;17;45;16 – 00;17;49;21
Dr. Sujay Kansagra,
Those are the four main techniques, regarding data to support them for sleep train.

00;17;49;23 – 00;18;17;01
Dr. Mona
Wonderful. And if you want more information, I know there’s that book there. And again, I would love for our listeners to get balanced information about sleep. And what I mean by that is, you know, I can tell you that just from your credentials and also just the way you approach sleep, it’s not just the fact that you have these degrees, it’s the fact that you understand not only by being a father yourself, but also understanding, like you’ve already said, the difference in temperaments, the difference in sibling one versus sibling two.

00;18;17;05 – 00;18;39;00
Dr. Mona
I think when a person who is giving information understands that every child is different, and also maybe a family situation might change, maybe the baby right? Maybe yes, maybe they had no problem doing the, you know, whether it’s co-sleeping or whether whatever it is. And then second baby, they’re like, I need I need something different. So everything always evolves.

00;18;39;00 – 00;19;09;25
Dr. Mona
We always need to pivot and get the good resources from people who understand the evidence, but also the, you know, real life clinical experience, like like you do. So I will be linking that that book and all of the resources at the end of this conversation. Going into more of like things that I’ve heard on social, and I’m sure you have heard as well and are constantly debunking and getting attacked about, is this common narrative that sleep training isn’t possible for infants because a baby’s prefrontal frontal cortex isn’t developed?

00;19;09;27 – 00;19;19;24
Dr. Mona
This is what I commonly hear. So is there evidence to support that there’s harm and maybe diving into that narrative and maybe, you know, even why and how it started.

00;19;19;27 – 00;19;44;07
Dr. Sujay Kansagra,
Yeah, I it’s it’s interesting. It’s social media is like the ideal breeding ground for using scientific lingo in a way that really just makes no sense. You know, it’s it’s just because these types of things, you know, get a lot of buzz and then people spread it quickly and all the prefrontal cortex is and develop so the child can’t learn something, you know, and and you know this and you’ve commented on this, you know, the prefrontal cortex isn’t fully developed to rule 20 something, right?

00;19;44;07 – 00;20;09;22
Dr. Sujay Kansagra,
I mean, we’re just not going to teach children anything until the 20 something. And, so no infants, everyone can learn a lot at various stages of their life, regardless of development and various parts of the brain, the prefrontal cortex. We, you know, it’s great for executive function and, you know, emotional regulation, etc.. But when it comes the process of turning your brain off and falling asleep, yes, you can learn that at ages that we discussed already.

00;20;09;22 – 00;20;25;19
Dr. Sujay Kansagra,
So, there’s no evidence to say that children are unable to to self-soothe. And we know this because many children do it without any sleep training whatsoever. Right? I mean, right, I mean, we look at the data at, you know, 10% of children, even at one month of age, are sleeping, quote unquote, through the night, getting it like up to an eight hour stretch.

00;20;25;22 – 00;20;41;11
Dr. Sujay Kansagra,
And we know that they’re waking up multiple times and self-soothing. But how to sleep train them. They just do it naturally. So of course, you know, millions of children are doing it as we speak right now, self-soothing themselves. And sleep, you know? So, so, yes, it happens. And you don’t necessarily need a, a fully developed prefrontal cortex for that.

00;20;41;13 – 00;20;47;16
Dr. Sujay Kansagra,
You also don’t need a fully developed prefrontal cortex for high school and for calculus. It’s just, you.

00;20;47;18 – 00;21;13;27
Dr. Mona
Know, I, I that was a recent one that I saw, and I’m like, wait, what is happening? I’m like, again, I love how you, phrase that because taking very common and buzzworthy science lingo, and when you don’t understand the science and what that actually means and just using it to create fear, it’s not a good tactic. And I’m very defensive of this, on social and I know you may be, but I’m very defensive because in my opinion, again, we talked about it all being parental choice.

00;21;13;27 – 00;21;30;16
Dr. Mona
We talked about whatever a parent wants to, however they want to approach. But what happens is and I get mothers, fathers, mainly mothers that come into my office who are like, well, I read that this is harmful and I can’t, I now I can’t get it out of my head, but I’m so, yeah, sleep deprived and I want to approach it.

00;21;30;16 – 00;21;58;01
Dr. Mona
Whether it’s one of those four methods that you mentioned. And I’m afraid, I’m afraid that even if I let my baby cry for 3 to 5 minutes, you know, sometimes, you know, again, you don’t have to let your baby cry for 45 minutes. It’s long. But if you’re using pausing, if you’re using extinction, graduate extinction. I know from personal experience, how amazingly impactful it has been for both of our children who have very different temperaments that I’m like, hey, I know it’s hard.

00;21;58;01 – 00;22;14;15
Dr. Mona
I’m not saying that it’s going to be easy hearing a baby cry if you if you choose a graduated extinction method, for example. But just wait. And if you need to go in, you’re going to go in. It’s not like all or nothing. It’s not like, well, I decided to let them cry, so now I can’t even check in.

00;22;14;15 – 00;22;24;26
Dr. Mona
No, you’re going to watch them on a monitor. You’re going to see if they’re escalating. You can go in. It’s not a hard or fast rule here. And I think people forget. That’s right. Who wants to?

00;22;24;28 – 00;22;44;24
Dr. Sujay Kansagra,
That’s right. You can there’s no there’s no replacing a parent. There’s no replacing parenting. You’re going to go in and make the parenting decisions that you think are best for your baby. And there are so many modifications to all these techniques that you can use to do something that you feel comfortable with, you know? And if there’s two caregivers in the house, you know, you have to have agreement between caregivers, has to be some give and take and, you know, a compromise.

00;22;44;24 – 00;22;58;28
Dr. Sujay Kansagra,
But yeah, you know, people are saying, oh, I don’t want to leave my baby alone in the room. And I say, okay, don’t, you know, like stay in the room and, you know, you can you can be right there and do it gradually. Extinction with parental presence. And, you know, there’s there’s so many, like, caveats, all these techniques.

00;22;59;02 – 00;23;15;14
Dr. Sujay Kansagra,
I can’t wait five minutes, you know? So that’s what the Ferber book tells me. Don’t wait five minutes. Start off with one minute, you know. Yes, I. And every two minutes if you want. It’s all kind of arbitrary. You can you can mix and match to what works for you in your family. But there’s these techniques again you can modify them.

00;23;15;14 – 00;23;37;02
Dr. Sujay Kansagra,
You can change them a bit. The whole goal here is that when your child’s eyes go from open to close and they fall asleep, that they have done so without you actively intervening, that’s all. Without any active kind of rocking or padding. They’ve done that without that active intervention. And that’s that’s the whole goal. And I say that is if it’s, so easy and I, I, I get it.

00;23;37;03 – 00;23;54;08
Dr. Sujay Kansagra,
You know, I, we did this for my first child. It was hard. It was emotional. As a sleep doctor after, you know, two days of this, if, you know, if I, if I wasn’t asleep, doc, I’d probably give in to all the things that I might hear in social media about how terrible it is and say, forget it, I’m not going to do it.

00;23;54;13 – 00;24;15;21
Dr. Sujay Kansagra,
And then what came out on the other end was this amazing, just happy, just settle child that would go for 11 hours stretches, wake up so happy, so refreshed, and everybody was sleeping and it’s just like night and day difference. You know, our world was just completely, you know, it was just it’s like, I want to offer this to people, you know, like I want to make sure people understand that there is there’s light at the end there.

00;24;15;21 – 00;24;32;21
Dr. Sujay Kansagra,
There’s hope. And at the same time, also, people understand that if you feel like you can’t sleep, train based on everything you’ve heard or it’s just a personal preference and you don’t want to, that’s okay to, you know, what you’re going to tell you and you’re here to tell people, you don’t have to do this. You don’t have to do this.

00;24;32;23 – 00;24;51;22
Dr. Sujay Kansagra,
If if we had data that said, at five years of age, your child would be unhealthier because they’re not getting a seat that they need because you didn’t sleep trained, then then we’d be have a different conversation. Yes. Based on the long term data we have, it’s all a wash by the time you’re five and six. When we look at all the metrics when it comes to sleep, everybody’s about the same, whether you sleep trained or not.

00;24;51;25 – 00;25;11;12
Dr. Sujay Kansagra,
And so long term, yeah, it’s all kind of a wash and you’re you’re going to be fine. But do you see pain or not. The clear short term and medium term benefits for your child’s sleep and for lots of other metrics maternal mood scores and maternal depression scores, we know for sure improve, when it comes to parental, you know, bonding with their child.

00;25;11;12 – 00;25;28;19
Dr. Sujay Kansagra,
This is something that we talk about the opposite. People say, oh, if you sleep train, your child is going to hate you. Well, the data actually shows the opposite. Bond can actually improve, which is only natural. Everybody’s sleeping and well rested that the bond is going to be better. Marital satisfaction is so many things improve short and medium term that I have to I have to offer this to you.

00;25;28;19 – 00;25;32;20
Dr. Sujay Kansagra,
You know, I have to tell you this is an option because we do have data to support benefit.

00;25;32;22 – 00;25;50;21
Dr. Mona
Now let’s take a break to hear from our sponsors. Oh yeah. I mean, and again, you’re taking a holistic approach to sleep, right? I think we tend to focus on the baby needs to sleep versus okay, it’s good for the parent. But it is it is healthy for everyone in his sleep. Doc and someone who is a pediatrician who loves to talk about sleep.

00;25;50;27 – 00;26;13;14
Dr. Mona
I just think it’s so important that we know that it’s it’s going to benefit many people in the long run. I have never had a family come into my office, tell me, hey, I regret sleep training or regret teaching my child’s self settling skills. It’s usually the opposite. Hey, why didn’t I do the sooner? You were right, it worked and now we’re all sleeping.

00;26;13;14 – 00;26;34;16
Dr. Mona
And at that point that you made that baby woke up happy. One of the things that makes me just so like, oh guys, when people talk about the lack of bond and the fact that they’re going to feel sleep deprived or that they’re going to just shut down, we’ll talk about that next set when they if we choose a cry method, for example, whether it’s Ferber or Full Extinction, they’re just going to stop crying because their brain shut down.

00;26;34;23 – 00;26;57;16
Dr. Mona
And I’m like, okay, if that was the case, they would not be able to have any affect. They would not have any bond with the caregiver during the day. We don’t see that. Like we don’t see that at all. Like there is 100%. There’s affection. So let’s talk about that more. I mean, that idea of if we choose a cry method that that baby just gave up and that’s that’s how some people throw out the word trauma.

00;26;57;22 – 00;27;03;29
Dr. Mona
And I hate when people throw out the word trauma for things that are not trauma. As someone who sees trauma. So let’s talk about this.

00;27;04;01 – 00;27;30;05
Dr. Sujay Kansagra,
Yes, absolutely. Well, I’ll tell you that, you know, people apply this, this, this theory of learned helplessness. Oftentimes in sleep training. And, that’s not what sleep training is. And it all goes back to most likely, you know, Eastern European orphanages, like Romanian orphanages. They notice that it’s eerily quiet when they walk in, you know, into these orphanages and and that’s then the theory here is that children have learned to stop crying because no one’s coming to help them over, you know, months and years of neglect and likely abuse.

00;27;30;06 – 00;27;50;00
Dr. Sujay Kansagra,
Right? Right. And that’s again, this is just a theory. There’s probably many reasons why a child in that situation wouldn’t cry. Perhaps they don’t have enough nourishment to actually, you know, be able to generate crying. Perhaps they’ve learned if they cry, they actually, you know, are subject to terrible things, right? And when they cry. So there could be many reasons why a child in that situation is not crying.

00;27;50;00 – 00;28;15;09
Dr. Sujay Kansagra,
But let’s, let’s, let’s say maybe this is learned helplessness. They’ve learned that even if they cry, no one is coming to help them. So they stop crying. Your child in a loving home with a loving caregiver that is fed, that’s clothed, that’s comfortable, that has a clean diaper, that has temperature control in your home. Yeah. Is not undergoing learned helplessness and it’s not undergoing trauma.

00;28;15;11 – 00;28;35;25
Dr. Sujay Kansagra,
And and to equate the two, I think, is a slap in the face to children that have actually experienced two trauma and read much like what you’re saying. It’s it’s hurtful. It’s it’s that people use and try to correlate the two. You know, it’s it truly shows that the extent that people go, go to, to try to dissuade folks from sleep training, that’s not what’s this is not what sleep training is.

00;28;35;27 – 00;28;56;26
Dr. Sujay Kansagra,
And even the theory behind learned helplessness, we can dive with the nuance in the experiments that were done. But the whole premise of learned helplessness is that you are then taken into a new situation, not the one that you were in where you learned helplessness, but then you apply that same, you know, lack of response in your new situation where you feel like you can’t escape whatever harm is coming to you in experiments.

00;28;56;26 – 00;29;15;21
Dr. Sujay Kansagra,
That was electric shock to dogs, which is where they experiment in the first place. And they didn’t they didn’t leave this area. They’re like, oh, I’m going to be shocked. And they just they said they’re infants that undergo sleep training. Do not then completely shut down, as you mentioned, when they need help, they still ask for it. If they’re teething and they’re in pain, they will still fuss and they’ll cry.

00;29;15;26 – 00;29;32;06
Dr. Sujay Kansagra,
If there’s a lightning storm and they’re scared, they’re going to fuss, they’re going to cry, right? And during the day when their needs are not being met for whatever reason, emotionally or for they’re hungry, etc., they’re still going to fuss and cry and get your attention. If it was learned helplessness, they would just sit there and do absolutely nothing for the entire day right?

00;29;32;06 – 00;29;55;28
Dr. Sujay Kansagra,
And that’s that’s just not what this is. And it’s again, it’s taking like a one off kind of but sound scientific and, and, you know, attention grabbing and applying the situation where it just does not apply. And just like you, the fear mongering just really hurts because as a parent, if you I’m fortunate enough to have that medical background, you know, I can look at some of these, this information, say that is complete bunk and feel really confident in that.

00;29;56;00 – 00;30;20;15
Dr. Sujay Kansagra,
I can even look at a research study that’s published in a peer review journal. And this is what often gets people to understand that there is a range when it comes to peer reviewed literature out there where some research, just because it’s published in the journal, does not make it fact, you know? Yeah, it’s hard to understand if you’re not like we had Journal Club this morning where we are just tearing into articles and saying, this is these are the caveats for this particular set of data may not apply more generally.

00;30;20;15 – 00;30;36;21
Dr. Sujay Kansagra,
And these are the seven of the research articles that we know of that were done in a more robust way. So we’re able to do all that. And so so I’m very fortunate in that. And I try to I try to kind of get that throughout to my social media channels as well, that, well, this is that this is the data that we have and we don’t have.

00;30;36;24 – 00;30;54;03
Dr. Sujay Kansagra,
But I totally understand why people would be scared out of their minds based on what they hear on. And it’s just doesn’t apply in this situation. You know, we gotta we’ve got to try to stop the fear mongering. I think parents just so each other under the bus on social media like I yeah, you know, all these parents are like, oh, we want to take care of our infants.

00;30;54;03 – 00;31;08;03
Dr. Sujay Kansagra,
And they’re just tearing each other apart. And I’m like, why are we doing this to each other? You know, like, why are parenting is not a bloodsport? You know, like, we can understand that we’re doing things differently and still actually coexist, man. Yes.

00;31;08;04 – 00;31;25;07
Dr. Mona
No, it’s well, I mean, that’s that’s exactly where I get my my defenses up. I’ve become very like, okay, I’m not going to get inflammatory. I’m not going to get like this on social. But when it’s people posing themselves as experts and maybe they’re not, but posing themselves as, hey, this is what I know. Here, let me link this article.

00;31;25;11 – 00;31;51;25
Dr. Mona
When we know that in captions you can’t even link articles because you can’t click on it. So you’re just doing this to psychologically show people that you know what you’re talking about, but you don’t even know the nitty gritty like you just mentioned beautifully that not all research is the same. And I’m going to have a guest come on in the future to talk about research studies in general and what people should know when they are consuming content like that online, from content creators that don’t have an educational background in this type of stuff.

00;31;51;27 – 00;32;12;11
Dr. Mona
And it’s so important because it leads to, like you said, that division that, well, I’m superior, you’re superior, and you do a great job of this as well as myself. I feel in that we are not touting things as superior. We’re saying, here’s a resource, here’s what you can do. But it’s not like if you don’t do it, your kid’s not going to ever sleep alone.

00;32;12;13 – 00;32;32;12
Dr. Mona
You had alluded to before that, you know, by age of five, you know, there’s obviously their kid is going to be the most likely there’s they’re going to be sleeping fine. You know, I do see cases, eight, nine year olds who are still sleeping with the parent. They’re in chat, they’re in school. It’s becoming an issue. And so for me it is important for me to talk to the family.

00;32;32;12 – 00;32;46;23
Dr. Mona
By the time the kid is going into school age, by the time the kid’s getting older and say, hey, mom, dad, are you ready to have this conversation? Because I think it’s for the best interest of your child, too, that they learn this very foundational skills.

00;32;46;25 – 00;33;01;18
Dr. Sujay Kansagra,
Yep. And I always say, you know, it all comes down to is it a problem for for the family? It is a problem. The child is a problem for the parents and, the parents and the family unit gets to decide what a problem is. You know, social media doesn’t get to decide that for you. Is it a problem?

00;33;01;25 – 00;33;20;27
Dr. Sujay Kansagra,
And if so, if you’re willing to explore solutions, there are there are numerous solutions. But it all comes down to yes it is. Is there a problem? And you know what you define as a problem? We like to, you know, of course, set up age appropriate expectations for what normal is and what it isn’t. And so, you know, we have to sometimes make sure that understand that, yeah, you know, your child is going to wake up multiple times.

00;33;20;27 – 00;33;44;02
Dr. Sujay Kansagra,
The first six weeks are going to be a complete, you know, crap show. And, you know, when the first child’s first born and things will improve. But, yeah. Is it a problem is question number one. And if it is, let’s look at the range of solutions. The problem I find document. It is when we try to take a level approach and try to say, well, these are all the options and it and try not to be inflammatory.

00;33;44;02 – 00;34;07;03
Dr. Sujay Kansagra,
The very nature of social media is that a catered it caters towards inflammatory, you know. Yes, it’s people that are out here. That’s right. People that are saying, oh monoxide, the hydrogen is is infesting our homes right now. It’s everywhere. Your children are consuming it in these plastic bottles. And it’s, you know, monoxide that hydrogen is you know, it’s leaking out of our faucets and you’re like, well, that’s that’s water.

00;34;07;05 – 00;34;32;15
Dr. Sujay Kansagra,
You know, monoxide, the hydrogen is water, you know, and but when people say things with such conviction, such information, it everybody pours in the comments, you know, either a support or against. And they just get escalated, elevated on these platforms when we’re here saying the boring things like, oh, well, here are your options. And this is what the data shows and we don’t feel strongly about, you know, this word other you know, it’s people just yawn and kind of move on and they’re like, okay, thanks for the information.

00;34;32;15 – 00;34;51;27
Dr. Sujay Kansagra,
But it doesn’t spread millions. And so that’s why I’m glad there are more creators like you that have the audience to then show people, this is the range, and we don’t have to be inflammatory about it. Let’s just give you some options and I hope there are more creators. And I’m actually just made a recent, recent post about let’s get more docs on this platform, you know, trying to fight misinformation.

00;34;51;29 – 00;35;00;02
Dr. Sujay Kansagra,
This is where we can really be useful to share things that are level, that are balanced, and let people empower people with true options that are safe in the sector.

00;35;00;04 – 00;35;17;02
Dr. Mona
Oh, don’t get me wrong, there’s many times where I’m like, I need to create more clickbaity stuff because I look at, I mean, in all aspects of the parenting space on social, there’s a lot of obviously clickbait that goes viral because of that. Exactly what you said, either in agreement or disagreement. But of course, that elevates that platform.

00;35;17;05 – 00;35;43;28
Dr. Mona
The last thing which I’m sure we can talk about even more than just this is the insight into the thought that sleep training leads to the increase in cortisol levels that are damaging, and we don’t need to go into really heavy detail. I do have an episode that I did solely on cortisol and sleep studies, but just kind of from your basic understanding and how you would explain it to a family who’s concerned about that sort of misinformation surrounding cortisol spikes, and that’s damaging to the child’s brain?

00;35;44;00 – 00;35;59;05
Dr. Sujay Kansagra,
Yeah, I would sum up in one sentence and I can give you a little bit more details. The whole cortisol in sleep training thing is a whopping nothing burger. That would be my one liner. You know, it’s a whopping nothing burger. You know, it’s people love again that diving into them, taking a little bit of science and just going crazy.

00;35;59;07 – 00;36;20;17
Dr. Sujay Kansagra,
The initial study that got all this started, if you read the study and I encourage anybody that has that kind of research just to read over that study, you know, it’s it’s it was a small group, 25 infants. It was a complete extinction approach. It was done in a hospital based scenario. The child was separated from the mother at nighttime and had, like a nurse, that single room with them.

00;36;20;19 – 00;36;40;06
Dr. Sujay Kansagra,
There are so many reasons for a child’s cortisol to be elevated in that scenario. You know, they’re taking salivary samples of, of, of of cortisol and, and there and the whole premise was, look moms and babies cortisol started here. Moms cortisol you know, after three days drop to here. But baby’s cortisol is still here, you know. So day one of sleep training cortisol was here.

00;36;40;06 – 00;36;55;04
Dr. Sujay Kansagra,
Day three. It’s still right around here. Why isn’t it dropping? Well, for all of those reasons, you know, and there are even lots of caveats to even why we’re using cortisol as a measure of stress. People are surprised to learn that it waxes and wanes throughout the day in a circadian fashion. That has nothing to do with stress.

00;36;55;06 – 00;37;18;11
Dr. Sujay Kansagra,
But, you know, but let’s let’s pretend it was a perfect marker of stress. Why didn’t the babies drop? Well, if you look the study, the question was what was the baby’s baseline before you even started sleep training? And they didn’t even share a baseline like that. Yes. You know, and so when it comes to just basic rigor of scientific research, you know, you gotta have baseline if they are telling people where it’s going to go.

00;37;18;13 – 00;37;33;26
Dr. Sujay Kansagra,
And, and so it didn’t change, it didn’t go up because everyone’s like, oh, cortisol rises. No. Even the initial paper like and everybody worried about this cortisol never went up. This is that moms drop. And so if mom had remained equally stressed there would be no paper. So maybe the answer was we just need to stress mom out more.

00;37;33;26 – 00;37;51;21
Dr. Sujay Kansagra,
You know, there’s no there’s no paper. Right. But that doesn’t make sense. And so we said, oh look, it’s different. And that’s no good because baby’s cortisol stays high. And now mom’s not going to respond to it. That’s you know, that’s where we’re stretching things a bit. Future studies have shown cortisol levels decrease after sleep training. Yeah.

00;37;51;22 – 00;38;16;17
Dr. Sujay Kansagra,
Long term there’s no difference in cortisol levels. I could use that data and come out here and be like oh my gosh you’ve got to sleep. Train. Look cortisol levels actually drop. I will never do that. I will never do that. Even though I actually have more rigorous science to, to say the other narrative to say, yes, cortisol is an issue and you should consider sleep training because I don’t think that it really has any clinically, clinically meaningful relevance at the end of the day.

00;38;16;19 – 00;38;19;22
Dr. Sujay Kansagra,
No. And so, yeah, so that’s the cortisol story.

00;38;19;24 – 00;38;45;08
Dr. Mona
I talked to someone who researches cortisol and was involved in a lot of that study was an old episode I did when I first started my podcast. It’s called crybabies The Research Behind Cortisol and Sleep Training. So I’ll link that in the show notes to for anyone who’s interested. But exactly what Doctor Cancellara just said, about the study design and cortisol and how it’s a naturally occurring hormone and it exists and that, you know, we’re really not allowing ourselves to see the full picture in that study.

00;38;45;15 – 00;39;03;27
Dr. Mona
Well, this was an amazing conversation. I loved the evidence that you provided. Maybe I will also be linking maybe some articles that you feel, would be useful for people to run in our show notes. Yes, I’ll get that from you. As well as, your, you know, Instagram handle on TikTok. But what would be a final message for everyone listening to their take home?

00;39;03;29 – 00;39;22;17
Dr. Sujay Kansagra,
I would please encourage you to understand that as long as you are keeping your child safe and, happy and, thriving, there are a million right ways to do it. And when it comes to sleep, when it comes to feeding, when it comes to all the things that we equate with parenting, there are a million right ways to do it.

00;39;22;19 – 00;39;31;00
Dr. Sujay Kansagra,
And your child will still turn out 100% okay. Just love your child. Yeah, keep yourself safe. It’s going to be okay. It’s going to be okay.

00;39;31;04 – 00;39;52;18
Dr. Mona
Yes. Yeah I mean, I love this. This is so great. Thanks for taking into consideration. Obviously, all the research that, you know, but also just again, the temperament of the children, the different siblings, I love that conversation. And adding all that nuance is so needed. And I hope people listen to this from both sides. You know, the anti can’t do anything regarding sleep training whether it’s cry or not.

00;39;52;25 – 00;40;06;11
Dr. Mona
And then also people who are on the fence and people who are pro. I sleep trained and it was the best thing ever so that we can really appreciate that nuance. Thanks again for joining. And where can everyone stay connected and learn more about your resources and all that amazing information?

00;40;06;17 – 00;40;14;25
Dr. Sujay Kansagra,
My handle anywhere social media is consumed, I’m there. That sleep doc, you know that TikTok, Instagram, YouTube, Facebook. Yeah, you can find me there.

00;40;14;27 – 00;40;19;27
Dr. Mona
Love it. Well, thank you again for joining me today and I’m hopeful to have you on for a future episode too.

00;40;19;29 – 00;40;23;03
Dr. Sujay Kansagra,
Sounds great. Ready whenever you are.

00;40;23;05 – 00;40;50;19
Dr. Mona
When it comes to the world of infant and toddler sleep, there is a lot of division and polarizing opinions, and it’s so important to approach it with a balanced view and decide what aligns with you and your parenting philosophies without judging others. As long as you keep into consideration safety. How you approach sleep is really up to you and our goal on this episode was to offer some myth busting on some common concerns surrounding sleep training and what the evidence shows.

00;40;50;22 – 00;41;09;26
Dr. Mona
If you love this episode, please comment on our real share this episode on social media and leave a review and I’ll catch you all next week where I chat with Zach Kasabo who’s a school counselor with a master’s in education, and we chat about the fine balance between encouraging positive behaviors in children without enabling the things that we don’t want.

00;41;09;28 – 00;41;13;00
Dr. Mona
Make sure to tune in and have a wonderful week and stay well.