A mom in my LLLC Group forwarded an article reviewing the rise of the 'sleep
training' industry.  It's well worth reading and sharing but too long to
post here (I've included a few 'teaser' bits below).

If someone would like the PDF of the article , let me know and I can send it
directly.  Among the important points made:

PEDIATRIC MEDICINE, THOUGH A MEDICALLY-DRIVEN FIELD, [accepts the]
UNDERLYING ASSUMPTION THAT SLEEP PROBLEMS DIRECTLY RESULT FROM NON-OPTIMAL
BEHAVIOR ON THE PART OF THE INFANT OR THE PARENT, AND ARE ONLY RARELY
ORGANIC IN NATURE (Bayer et al., 2007; Mindell et al., 2007).  Like advice
in earlier decades, experts and researchers suggest that the 'problem' is
easily remedied with the appropriate application of behavioral science (i.e.
the removal of both contextual cues for waking and the reinforcement for the
undesired behavior) (France & Blampied, 1999).

Infant sleep behavior is considered the domain of pediatric medicine.
Indeed, much of the research and discourse proceeds from a medicalized
paradigm that increasingly views nightwaking--a BIOLOGICALLY NORMATIVE
phenomenon--as a potentially disordered behavior (Rowe, 2002; Stearns, et
al., 1999).

Developmentally-based empirical research on the physiological or
psychological effects of unmodulated crying before sleep could NOT be found
(Gordon, Hill 2008). Parents are nevertheless reassured by experts that they
are not injuring the infant, but are instead promoting their health by
encouraging proper sleep habits (France, Henderson, & Hudson, 1996).

Ingrid

Parenting advice about sleep: Where have we been? Where are we going?
Macall Gordon, M. A. & Sheri L. Hill, Ph.D.
Paper presented at the Biennial Conference of the Society for Research in
Child Development, April 2-5, 2009, Denver, Colorado.

   At one time, sleep deprivation was a hallmark of early parenting
[unnecessarily!]. Haggard parents, pacing the floor with a small infant
represented a difficult, but temporary, phase of childrearing. Today,
"sleeping through the night" has grown in both importance and urgency.
Contemporary research contends that failure to establish consolidated
solitary nighttime sleep by 6-months of age may result in poor daytime
behavior (Minde et al., 1993), family stress (Ferber, 1987; Richman, 1981;
Scott & Richards, 1990), and sleep problems in the long-term (Kataria,
Swanson, & Trevathan, 1987; Pollock, 1992). A popular parent-targeted book
on sleep also suggests that lack of proper sleep can impair infant brain
development.

Advice further suggests that disrupted adult sleep may put parents at risk.
Parenting Magazine submits that fragmented adult sleep can dramatically
decrease daytime concentration and over time, can impair immune function
making mothers "more susceptible to hormone-related diseases like diabetes"
(Colino, 2003, p. 128). 

Early, all-night sleep is therefore represented, not merely as a desired
goal, but as an urgent and necessary priority.

Certainly, the concern over infant sleep is not new. The characterization of
infant sleep as both critical for development, as well as problematic,
however, is a construction unique to 20th century United States and Northern
Europe. The overriding perception that knowledge and advice about sleep is
scientifically-based obscures the reality of its embeddedness within a
sociocultural, historical context (Cushman, 1995). Insufficient attention is
currently paid to the way in which research and advice about sleep are
shaped by cultural values and assumptions, as well as socioeconomic and
demographic shifts (Grant, 1998; Jenni & O'Connor, 2005; Stearns, Giarnella,
& Rowland, 1998; Young, 1990).

Culture organizes and regulates sleep, configuring the spatial (i.e. where,
with whom) (Cromley, 1990), social (i.e. with whom), and temporal (i.e.
when, how long) arrangements of sleep (Williams,2005). Culture also
determines what constitutes problematic sleep (O'Connor & Jenni, 2005), the
reasons why it occurs, and what the appropriate remedy should be.

In the United States and northern Europe, the cultural emphasis on autonomy,
self-reliance and individuality is reflected in the ways that sleep is
"done" (Morelli, Rogott, Oppenheim, & Goldsmith, 1992; Wolf, Lozoff, Latz, &
Paludetto, 1996; Valentin, 2005). In Japan, the doing of sleep reflects
values of interdependence and community (Kawasaki, Nugent, Miyashita,
Miyahara, & Brazelton, 1994). In Italy, sleep is secondary to fostering
family ties (New & Richman, 1996, Wolf, Lozoff, Latz, & Paludetto, 1996).
Indeed, across cultures, sleep practices show tremendous variation (Morelli,
Rogoff, Oppenheim, & Goldsmith, 1992; New & Richman, 1996; Williams, 2005;
Wolf, Lozoff, Latz, & Paludetto, 1996; Worthman & Brown, 2007; Worthman &
Melby, 2002).

As noted, sleep in many other cultures is constructed in a wide variety of
ways. Sleep may be communal (involving a variety of different groupings of
gender, age, or relationship), discontinuous (not consolidated into one
nighttime bout, but including awakening during the night, or napping during
the day), and fluid (involving shifting between sleep-wake states, like
dozing or daydreaming) (Morelli, Rogoff, Oppenheim, & Goldsmith, 1992;
Williams, 2005; Worthman & Melby, 2002). Certainly, sleep in other cultures
is also not nearly as problematic as it appears to be in the U.S. 

Cultural Variations in Sleep

The concern over infant sleep behavior is also not universally shared by
parents across cultures, but is unique to Euro-American societies. Indeed,
in Japan, sleeplessness is not a matter for concern or professional
consultation (Stearns, et al., 1996). Families routinely share sleeping
space in order to bring the infant, believed to be born as a separate being,
into the interdependent family circle (Morelli, et al., 1992) Italian
parents feel that infants will sleep when they are ready to do so. They
further consider nightwaking to be an expression of the infant's need for
the mother, which is accepted and accommodated (Kawasaki, Nugent, Miyashita,
Miyahara, & Brazelton, 1994; New & Richman, 1996; Wolf, Lozoff, Latz, &
Paludetto, 1996). Infants and children do not have fixed bedtimes, but are
allowed to stay up amid the family's activities and fall asleep in arms
(Jenni & O'Connor, 2005, Stearns, et al., 1996). In Italy, the fostering of
family connections and relationships supercedes the acquisition of
independence in sleep.

The American emphasis on early consolidated and solitary sleep is not a
biophysiological mandate, but is strongly informed by cultural expectations
about what constitutes both "healthy" and "disordered" sleep (Jenni &
O'Connor, 2005; Super & Harkness, 1986; Trilling, 1989).  From a historical
perspective, the sleep configuration currently considered normative is, in
reality, a very recent phenomenon.

The American baby and current advice on sleep: Where are we now?

The emerging field of infant sleep medicine has codified problematic infant
sleep behaviors into diagnostic categories under the heading of behavioral
insomnia of childhood, including sleep onset association disorder (requiring
rocking, feeding or parental presence to sleep) and limit setting sleep
disorder, which is a parental "problem" of responding to nighttime signaling
(crying) (American Academy of Sleep Medicine,2005). 

Though a medically-driven field, the underlying assumption is that sleep
problems directly result from non-optimal behavior on the part of the infant
or the parent, and are only rarely organic in nature (Bayer et al., 2007;
Mindell et al., 2007). Like advice in earlier decades, experts and
researchers suggest that the problem is easily remedied with the appropriate
application of behavioral science (i.e. the removal of both contextual cues
for waking and the reinforcement for the undesired behavior) (France &
Blampied, 1999).

Parents' Experiences with Infant Sleep Advice

   While increasing amounts of research and advice exist about infant
development, little is known about how parents experience the confluence of
evidence that may be, at times, conflicting. Gordon and Hill (2008) examined
how first-time parents of infants perceive and use the sleep advice they
encounter. 

The subset of parents using a behavioral (crying) approach for nightwaking
were significantly more worried how well they were managing sleep, than they
were about the sleep itself. Parents who used a positive routines (no
crying) approach reported being equally very worried both about sleep and
managing sleep. Only cosleepers reported low levels of worry both about
sleep and how they were managing it. It is of note that a large proportion
of survey respondents reported trying several different approaches over
time. 

Further, many respondents in both the behavioral and positive intervention
categories, reported feeling less confident that their approach was working.
(Gordon & Hill, 2008).

Research on infant sleep intervention needs to extend beyond the question of
whether or not it works. It needs to ask: WHO does it work for?

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