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7 Sleep Lessons from a Stanford Pediatric Sleep Specialist

June 18, 2014 |  by  |  parenting
meeting with raphael pelayo

Last week I had the opportunity to enjoy some of the gentle joys of California which included beautiful desert flowers, outstanding wine, and a lovely meeting with leading pediatric sleep and apnea specialist Rafael Pelayo from the Stanford School of Medicine.

You should also know Rafael is often interviewed by O (for Oprah) Magazine. So according to the transitive law of mathematics, my blog is as cool as O Magazine. You cannot argue this point, because math.

Rafael generously spent a few hours with me and we covered topics ranging from the best rock band to how to make limoncello. Thus it would be impossible for me to come up with one comprehensive post on what I learned from Rafael. But I learned a lot, so here are the highlights (which are mostly about babies!):

Our Big Kids Aren’t Getting Enough Sleep and it’s Worse Than You Think

There are a number of good research papers show that lack of sleep is a risk factor for suicide and it makes people impulsive. Suicide is the #3 cause of death for teens.

National Sleep Foundation did a survey of teenagers and found that 25% of teens sleep in class at least 1X a week and parents aren’t notified because it’s “normal”. Little kids don’t fall asleep in class and if they did, you would be notified because it would be unusual. There’s a misconception that teens are falling asleep because they’re bored. When little kids are bored they don’t fall asleep, they misbehave. Teenagers falling asleep because they’re chronically sleep deprived.

This is both serious and real. We need to look at tactical solutions to changing the schedule of teenagers so that they can get enough sleep because the consequences can be severe.

Ignoring All the Baby Sleep Rules?

Because he is at heart a scientist, Rafael decided to break ALL of Ferber’s sleep rules when his first child was born. He would rock her to sleep, have her sleep in her own bed, co-sleep, vary when her bedtime was. Essentially he would experiment with various scenarios just to see what would happen.

She slept fine!!!

He met Dr. Ferber at a pediatric sleep panel and told him, “My baby sleeps just fine and I’m breaking all your rules!” To which Ferber replied, “That happens sometimes.”

Have you ever seen stories where people proudly state that they nurse or rock their baby to sleep and everybody happily sleeps through the night? Well now you know the truth. “That happens sometimes.”

You know what else happens sometimes? Rainbows. And they’re glorious. But you don’t want to count on them happening because most times, they don’t happen.

Getting your Child to Sleep is Hard (Even for Experts)

When Rafael’s second baby was born it was hell – this baby cried all the time and rarely slept. His wife was upset saying, “I can’t deal with this anymore.” But where could they go for help? They’re both sleep doctors!

You are not a failure at parenting. Even pediatric sleep doctors struggle with this stuff.

Don’t Panic

When his second son was crying (always) he had a brand new CD by Bob Dylan. When he played it the baby stopped crying and he figured he had stumbled upon an amazing scientific discovery, “Bob Dylan is the answer to baby sleep!”

Nope. What was happening was that the music was calming Rafael down and that helped the baby calm down. Because he was calm.

Babies pick up on our cues. Figure out how to calm yourself down first. Be mindful of your own emotional state.

Kids Aren’t Fragile

When kids are sleeping poorly is it physical or behavioral? When it’s behavioral, if you give in to the behavior they want, it stops. If they’re in pain, regardless of what you do it won’t stop.

Most of the time kids cry about things that are negotiable. Let’s say your child is curious about what happens if they stick a fork into an electrical outlet. There’s no amount of crying that will get you to let him stick it in the outlet. It’s non-negotiable and they’ll figure that out.

The key is to consistently let your child know what is and isn’t negotiable.

Sleep is Learned

Babies are born eating and sleeping randomly. We impose rhythms on them – when we eat and when we sleep. And that rhythm is a learned skill. Yes mammals do wake up in the middle of the night. But we can be taught to go back to sleep.

How Long Can Your Baby Go Without Food?

What is the longest stretch your child has ever gone without eating? Often this happens after getting shots at say 4 months. Baby goes home and sleeps 7-8 hours. Did the child go into glycemic shock? Of course not. Now you know, this is a child who can comfortably fast for 8 hours.

If at any point your child goes X hours without food, you know that biologically they can go that long.

Debating Sears

It was really interesting to hang out in Rafael’s garden in the shade of his plum tree listening to his stories. He knows everybody who wrote the books you’ve read (Ferber, Mindell, Sears). A few years ago he got into a heated debate with Dr. Sears on an NPR panel. I was desperate for details but he was reluctant to share. “I got upset. Nobody can hear what you’re saying when you get upset. I wish I had handled things differently.”

Fair enough. But I would still love to hear the story. Maybe next time.

Key Lessons for Me

Sometimes I struggle personally with giving advice about sleep. I’m not a doctor, I have no official training. Rafael does, and he doesn’t have all the answers either. I find this immensely reassuring.

And also I think we all sometimes need reassurance that babies aren’t fragile. That every small parenting decision we make is not as momentous as we think. Sure I can say this. Or your neighbor. Or mother in law. But it’s great to hear it from a fancy PhD from Stanford.

So next time you’re feeling guilty about something you did or didn’t do, remember that Rafael struggled to get his baby to sleep too. And that babies aren’t as fragile as we think.


28 Comments


  1. I love the last 2 sentences. I felt so alone at times with my little one and felt like everyone had all the answers but me (but my daughter is now almost 2 and a champion sleeper). Can’t wait for your book!

    • Truthfully I felt really alone too. Although statistically we are in the VAST MAJORITY so it’s silly that we feel like everybody had answers because in truth nobody does 🙂

      PS. Thanks for the kind words. I’ll be sweating away (literally it’s very hot here) on finishing it up all summer and am THRILLED to have the budget to make it happen. Yay!

  2. Okay, so I have this pet theory that a LOT of what is wrong with us as a society has to do with lack of sleep (adults included) and, related to that, lack of downtime, so your first point gives me that weird sensation (there must be a German word for it) of simultaneous satisfaction of feeling right combined with not wanting to be right. Anyway. I wasn’t joking when I said I’m waiting for your book on sleep for older kids next. I know, I know… first book comes first! On which note, I better stop staring at a bright screen and wind down…

    • Why is is that the Germans have all the great words for strange feelings? We Americans are left with useless terms like “awesome” and “perplexed.” There’s probably a good German word for my frustration with this fact.

      I’m pretty sure you’re right – lack of sleep and lack of free play time. Have you ever heard Scott Noise talk (I adore him BTW). He says we are robbing kids of their free play time and that’s when they get into the “flow.” And 90% of everything you learn happens when you’re in “the flow” – and kids aren’t getting that opportunity anymore.

      • Hi Alexis, I’m really keen to follow up on how to let my son have more free play – but I can’t find anything about Scott Noise. Would you mind including a link to where I can find him?

  3. Your website has changed my life! My son has eczema and we have absolutely catered to his every whim, fearful that he is in pain or uncomfortable. It got to the point where my son was waking every 45 mins all night long and would only sleep for 30 mins without me and we held him for naps!

    I love the distinction you gave of behavioral vs physical sleep problems. It has been a hard journey for us because we sometimes couldnt differentiate between the two. Everytime our son would stop crying and go back to sleep if I pick him up and nurse him, so we decided it is mostly behavioral. We can’t leave him alone because of the eczema, so we stayed with him and held him down while he CIO. He now sleeps for 2 hours on his own and wakes every 2-4 hours. It’s not great, but it’s a million times better. Time to figure out what our next steps are…

    • Phew – I can’t imagine how bad things were that “waking every 2 hours” is a million times better. So sorry for you all!

      I guess all I can do is send positive wishes your way that his eczema clears up (maybe with the added humidity of summer?) so you can all get on a path of better sleep!

      • Thank you for the kind words. We definitely don’t have relaxed conversations about sleep in our house! Next time my husband and I are hazy-eyed and having a trying-not-to-argue conversation about sleep, I will suggest a fairy infestation.

  4. I love the light-hearted nature of this post! I think it’s both reassuring and frustrating. No one has all the answers with baby sleep! But at least posts like this help us to take a relaxed look at it.

    • Thanks Laura! Raphael was pretty awesome. Although truthfully it’s easy for me to be relaxed about it because my kids aren’t up at night anymore. If I were like Alicia (above) waking up every 2 hours all night long I would probably be 0% relaxed about it 😉

  5. At 11 months old, my son still fight sleep…every single night. I do not know anyone else that has had any similar experience (as bad) and it is so frustrating. He seems to be “just fine” according to doctors during the day, but they are not there during his 3, 4, or 5 hour marathon crying stretches during the night. I wish I could be fine on 4 hours of sleep like he seems to be. Some day I hope this resolves itself, and I will be reading your book even if it can no longer help me.

    I am off to go buy a Bob Dylan cd… =)

    • Viva la Bob Dylan!

      And wow – that sounds unusually hard for you guys. If the Doctors say he’s just fine I can only assume he IS. But if it helps at all I’ll throw out some random things that could hypothetically be feeding into such little sleep at night:
      – tummy issues (reflux and/or food allergies)
      – apnea (does he snore or sleep with an open mouth?)
      – restless leg syndrome (super rare but)
      – too long in bed (bedtime is too early so he can fall asleep but not STAY asleep)
      – terrible fairy infestation

      None of that probably helps but sending positive thoughts your way!

    • I had similar issues with my first child. She was hypersensitive to sensations (sensory processing disorder) and hated the sensation of feeling drowsy. Nothing physically wrong and she eventually grew out of it, but it took a couple of years. Try ‘Raising your spirited child’ and see if that book resonates…

  6. I think toddler sleep habits are more mystifying than baby ones. Example: yesterday, my daughter took a random nap in the car from 4 to 5pm, and STILL went to sleep without complaint at 7. Today, she took a nap at her normal time (1:30-3:30), and screamed for 45 minutes before finally falling asleep at 7:45.

    I’d LOVE for someone to crack that nut!

    • See above:

      Fairy infestation. Stupid fairies!

    • I was a bit mystified of late until I figurd out with my little one who is 18 months old – eg if he runs alot in the park, or goes swimming, or if my inlaws are here on the weekends (which is twice amonth – araggh) he gets tired really quick. If he doesn’t eat properly at the meal before the alloted nap, he is crabby and tired within 2 hours (usually he makes it to about 4 hours after wakeup time before he needs a nap). And if he had a crap sleep the night before he won’t make it past 10am before he needs his head down. But when things are good during the day and he isn’t over stimulated running around like a little rocket for too long, gets some good quiet play time in the afternoon and eats really well I get a textbook toddler. Personally I think toddlers are more like grownups with sleep than we realise – some days are good, some not. I mean.. think about it..are you always on your A game every single day without fail?

      • I am on my game EVERY SINGLE DAY (or at least this is what I would like you to believe so let’s just go with that ;).

        Yes getting the toddler stars to align is challenging. And it doesn’t get any better. For example my older kids are perfectly capable of skipping snacks. But they NEED snacks and are cranky trolls without 2X snacks a day. So snacks have devolved into borderline treats (goldfish et al) in my desperate efforts to keep the train on the tracks.

        The only difference is that a cranky 5 year old is a lot more reasonable company than a cranky toddler 😉

        • 🙂 I wish I could say I was with it everyday! Yesterday was totally brilliant and I was zipping around with this kid like a rocket. Today it rained from 5am until 7pm. I was exhausted by 10am. But thankfully there is Nespresso.

          Dear lord, please tell me things improve and they start understanding the words – ‘no don’t smack your grandmothers french polished glass cabinet with the remote control’..?!?!

          But I do concur…… the snacks thing I have just learnt – or rather a lovely mum neighbour educated me about. With late teeth and still transitioning to solid food/real meal times I wasn’t aware he was supposed to get snacks. Eek. I have a stock now. Fingers crossed I get it right for the next transition.

  7. Just read about your new book. If we keep fostering I’m buying it. 😉

    One thing I noticed on this site is that it’s for normal parents. There’s not much out there for those of us helping precious littles deal with the effects of their birth parents choices.

    Preemie, reflux, & sensory issues are among them as well as the somewhat random category of “other drug induced unknowns” that are affecting sleep. 🙂

    • Totally. I looked into the possibility of getting medical experts to go into some of these things and truthfully, it’s just too darn expensive. And legally complicated. So…it’s probably not going to happen.

      I will be talking about preemies a bit though (as 30% of us have them) and reflux. But some of the other sensory issues, impact of autism, fetal alcohol syndrome, etc. is going to be out of bounds for where I can realistically go 🙁

      I do hope you keep fostering though. There are so many beautiful babies out there who need your care. I don’t have the strength to do it (I could never let them go – it would break me). But I’m so impressed with those of you who do.

  8. Love reading success stories! I can definitely relate to this mama (I am between nap time check ins as I write this). We’ve made so much progress after reading articles on this site. Baby went from waking 4-6 times a night to sleeping through most nights. He’ll wake up about once a week (teething)

    Now I’m working to make his overnight stretch longer from 9.5 hours to 10+ (11 hopefully). He’s been sleeping from ~8pm-5:30am. Trying to get him to fall asleep earlier and sleep later. Fingers crossed!

  9. We followed much of your advice and had great success until…our son was hospitalized! One way to destroy a baby’s sleep schedule is to get stuck in the hospital for days. After 4 months of in-and-out hospital/doctor visits (MRIs, spinal tap *what?!*, and EEGs–which mean planned sleep deprivation! eek!) they finally chalked it up to a viral infection that caused meningitis which led to him having seizures. Whew! So today we are back on the bandwagon after months of not terrible but not great sleep, especially naps. My final straw was spending the last month (2 weeks with the whole family sick with a cold) stuck with him in my arms for two naps a day. Yep, ridiculous. I thought I was being a sweet mom when he wasn’t feeling well and he took full advantage of that one 🙂 For a week or more now, we needed to start over again. So, today I jumped in. At naptime he cried for 30 minutes, I went in, (which I didn’t do the first time we tried sleep training–he was too young to stand up at that point in time), laid him back down, and pat him. As I predicted, he cried even harder when I left. After ten minutes he finally quit. To be honest I think it was out of shear exhaustion. It sucks and I wish I didn’t have to do CIO! (1) I guess I am hoping for reassurance that I am still a loving, nurturing mom despite the need to ignore his pleas for comfort and that somehow even though the road isn’t paved in gold, it will lead to something better. (2) He will be starting a daycare program in the fall while I study for the MCAT. I am terrified this will create more sleep turmoil. Any advice or links to advice on that topic?

    • Wow what a rough go of it you’ve had. SUPER stressful for all involved!

      Clearly you are a loving nurturing Mom otherwise you wouldn’t even think to question it. And clearly you need a better path because this wouldn’t fly at daycare – you need to establish better habits NOW to have a fighting chance at a successful transition to daycare in the fall.

      Will daycare create a turmoil? It hugely depends upon the kid and the daycare. But the more consistent you are (routine, schedule, healthy sleep associations) now the better set up for daycare success you will be.

      Good luck with the MCATs!

  10. I have returned to this site for a bit of motivation and support. I started doing sleep training when my little boy was 8 months old and I have never looked back. We lost it a bit around the 12 month mark but we were subjected to unusual living conditions and sleeping in one room. 🙁 But I accepted it and then when things got back to normal I used the sleep training again and at around 14 months he was sleeping THROUGH THE NIGHT from 7pm until am with only a little cough for his lovey at around 11pm. I cannot tell you how much my life changed overnight. He is now 18 months, teething constantly and had vaccinations last week but I am a big advocate of letting these bubs figure out how to sleep on their own now and I don’t crumble at the sound of a cry or scream now! Interesting that sleep and suicide were linked because I can tell you right now, before sleep training I wasn’t sleeping and was almost ready to throw myself under a bus some days due to the exhaustion. The first full night of sleep I got – I rose a different mammabear. Happy, calm and most importantly able to handle anything my little one threw a

    • Right there with you. There is a sense that trying to get an older baby or toddler to sleep better is selfish or “all about you” and that couldn’t be farther from the truth! Good parents get good sleep. It’s almost impossible to be the parent you want to be while you’re exhausted. (Personally I go full-banshee after just a few days of not sleeping, as evidenced by our camping trip last weekend 😉

      Congrats on getting things sorted out!

  11. Hi Alexis’s I just have a really quick question but my daughter self settles for every single sleep and has done the last month, she feeds every 4hrs and goes down after 1.5hrs awake time in the day (she’s now 4months old) she sleeps well in the day but is now waking every 2-3hrs in the night sometimes every 1.5hrs. I am at a complete loss what to do as the only thing she wants is a quick suckle everytime she wakes, overnight I even put her back in bed wide awake and she puts herself to sleep again so why could she be waking up so often? I have tried settling her back to sleep but that doesn’t work as she self settles the only way she knows how to go to sleep is in her bed. Is she too young to leave in bed and cry? I don’t mind waking twice in the night to feed her if she needs it but I know she doesn’t need it and only looking for some comfort…any suggestions?

  12. Very Very informative post!

    I was actually wondering could we host this post over on our site?

    Or could we partner up for a guest post?

    It will be very resourceful and helpful as you already can see.

    Best Regards, Lisa

  13. Loved this post!
    But there’s one subject that I would like to comment on.
    I am also a doctor, not a sleep doctor, but nonetheless, I’m used to reading scientific articles. And the affirmation that sleep deprivation is a risk factor for suicide, and therefore kids should sleep more so they would reduce the chances for suicide, to me it’s not correct. They might be associated factors but not necessarily sleep deprivation causes suicides. People who have depression usually have altered sleeping patterns. Sometimes they can sleep too much, or change day for night… So maybe kids sleeping in class might be a sign of depression.
    I would have to read the study you mentioned to understand better what they really meant to conclude, and if the study design actually permitted that kind of affirmation.
    I am just saying this so people don’t start freaking out to put there kids to sleep as much as possible.
    But nonetheless, great post!
    My son sleeps terribly and he is one year old already. I guess it’s my fault for breaking all the rules. I hate to see him cry, it breaks my heart. After one year of motherhood I am starting to deal better with cries though.
    I am gonna keep reading your blog for more information to help me.
    Congrats on you blog.
    Best regards.

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