Q: Our 14-month-old son constantly awakens during the night and won’t stop crying unless we hold him for long periods of time. We have tried “following the book” and ignoring his cries but he just doesn’t stop and after 30-45 minutes plus, we just can’t take it anymore. It is affecting everyone’s sleep and the whole family is becoming irritable. Why does this happen? Any suggestions on how to stop it?

A: Infant Sleep Disturbance is so common that it has come to have its own official name and corresponding acronym (ISD). Most of the information I’m about to share with you came from a major research review article published late last year. Probably 20 to 30 percent of all infants will experience this problem of waking up after being asleep. Actually nearly all infants (through the first two years of life) wake up during the night. Infant sleep is apparently very different from that of older children and adults in that it has a high proportion of what is referred to as REM (rapid eye movement) sleep and this presents in short cycles. Infants frequently awaken at the end of the cycle, fuss a bit, and fall asleep again. Obviously, a significant number of infants fuss a whole lot more and don’t fall back to sleep within a reasonable period of time.

Many of these infants arrive with a temperament that predicts an increased likelihood of ISD. This seems to be especially true for high-activity infants as well as infants who are hypersensitive to sound or touch, highly irritable or moody, or seem poorly self-regulated (don’t easily establish eating and sleeping schedules). In many cultures, such fussy infants would simply be kept in the parents’ bed or bedroom until they became more settled. Our culture, with its fear of dependency and stress on autonomy, urges parents to push for the separation. If your infant is in this category, you may simply choose to ignore the advice of Western pediatrics and just share a bed with your baby. However, there are alternatives.

You tried “extinction,” i.e., ignoring the crying infant, which is the primary technique. It often works after just a few nights of simply letting the baby cry and not intervening. Three problems arise with this approach. One, some infants are incredibly resistant to being ignored, the crying intensifies and may go on for exceptionally long periods of time; two, some infants, after appearing to have resolved the problem, demonstrate something called “the post-extinction response burst,” i.e., the problem returns and is actually worse; third, many parents are just too uncomfortable with this approach and can’t carry it out effectively. By the way, research on the effects of using extinction has shown no negative outcomes; contrary to the fears of many parents, the children show improved demeanor and security.

In response to parental resistance to using extinction, researchers have come up with some alternatives that appear to be effective. Mostly they are just modifications of the basic approach. One is to re-enter the infant’s room every five minutes during the sleep disturbance, simply restore his/her sleeping position, say”goodnight,” and leave. Research demonstrated this to be effective in ending the ISD. Another study had a parent sleep in the infant’s room for a week but not interacting with the infant when the latter is crying. This also proved effective. Both of these studies were based on a belief that the ISD was symptomatic of the infant’s separation anxiety. These techniques are designed to increase the parent’s presence without creating extra attention that might prolong the problem.

A third form of modified extinction is to ignore the infant until you feel uncomfortable (even if it’s just 10-15 minutes in the beginning) and then, every second night, wait five minutes longer. When you go in to the infant’s room, once again the recommendation is a brief interaction, no more than 30 seconds, place the infant in the sleeping position, and leave. The emphasis in all these techniques is to try to avoid getting drawn into elaborate rituals of extended periods of physical contact and attention.

Naturally, if your infant has developed a sleep disturbance, you should always consult with your pediatrician before trying any of these techniques to make sure there is nothing medically wrong. Some physicians, especially with very severe cases, may recommend using a sedative, typically an antihistamine. The research shows very limited effectiveness of this approach with infants. In some cases there was short-term relief and then the problem returned. In others, it was successful; often it didn’t help very much, if at all.

The key points here are that sleep disturbances in infants are quite common, there are several techniques that can work, and just keep reminding yourself that this too shall pass!