Why The Possums Sleep Programs are the original, genuinely evidence-based revolution in baby and toddler sleep
It's true that nothing similar to The Possums Sleep Program could be found in the research literature or other 'grey' literature, or in any other clinical or educational approach to infant sleep, until the publication of the Neuroprotective Developmental Care Contextual Model of Infant Sleep, also translated into broad brushstrokes of The Possums Sleep Program in the same publication, in 2014.
You can find out about the development of The Possums Sleep Program here. The table below details the elements of The Possums Sleep Program which are unique. Some of these were referred to in a publication in the journal Sleep Medicine, here.
Please make contact and let us know at education@ndcinstitute.com. au if you have information which shows any of the claims below to be inaccurate!
| Clinical observation | Relevant research searches across multiple disciplines (see references in published NDC systematic and metanarrative reviews ) | Clinical observation + research translated into each novel clinical/educational component of The Possums Sleep Program, below |
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| Very disrupted infant sleep patterns are widespread, and seem worse in families exposed to sleep training methods, due to resultant disruption of circadian clock settings. | Until I published The Possums Sleep Program and its underlying theoretical model with Dr Whittingham in 2014, there was no distinction in research literature between what is normal amounts of night waking and what reflected unnecessarily fragmented or disrupted sleep patterns, often due to iatrogenic circadian rhythm disruption inherent in sleep training methods. I analysed large cohort studies which showed highly variable durations of infant sleep and the wide range of biologically normal amounts of night waking. I concluded that estimates of wake windows and advice about required sleep durations were not evidence-based, and translated this research to make a clinical distinction between excessive night waking and developmentally normal night waking. | In the Possums Sleep Program, based on the research, I defined "excessive night waking as when baby wakes every hour or more often for some or all of the night, in a pattern over time." I defined "normal night waking as every couple of hours or so throughout the night - adding the phrase: don't watch the clock - just get everyone back to sleep quickly." |
| Parents did not have strategies to help mitigate excessive night waking, which typically resulted when parents were focussed on prolonging the amount of sleep their infant received due to the sleep training belief that 'sleep breeds sleep'. | In the 2000's, Jenni & teams translated new understandings of the adult sleep regulators (circadian clock and sleep-wake homeostat) into the context of infant sleep. However, this work did not examine clinical implications, did not attempt definitions of excessive vs normal night waking, and did not translate into clinical approaches or programs. | From 2011 (first research publication 2014) The Possums Sleep Program was the first to translate this research into specific clinical approaches which 1. educated parents about the functions of the sleep regulators in infant sleep; and 2. developed various specific interventions for excessive night waking which worked with the body clock and sleep pressure over a one to two week period, utilising three pressure points, to reset the infant's body clock. |
| Babies sleep easily in context of #1 frequent flexible breastfeeds, and #2 rich and diverse sensory motor experience (Australian First Nations Peoples) | Cross-cultural studies, evolutionary biology, anthropology suggest that this is the case for a range of cultures within the global majority. However, the concept or theoretical framing of sensory motor nourishment and also the concept or theoretical framing that sensory motor nourishment is associated with dialled down behaviour does not occur in the research or other literature, prior to my own work. Similarly, the popularly used concept of "demand breastfeeding" was and is in important respects quite different to the NDC model of frequent, flexible breastfeeds. | "The two tools", also referred to as "the two baby- or toddler-sleep superpowers". "Your have two tools or superpowers to make the days and nights as easy as possible: #1 frequent flexible breastfeeds (adapted for bottle feeding), and #2 rich and diverse sensory motor experience". |
| Babies less likely to cry when receiving responsive care. Parents often feel as though they're failing when their baby cries if the SNS-HPA is referred to as the stress-response system. Therefore, to optimise care of families, research needs to be translated using clinically sensitive metaphors. | Responsive infantcare optimises developmental outcomes. Stress response settings may be permanently altered life-long by high levels of chronic SNS-HPA hyperarousal in very early life. The concept of the dial on the SNS was an innovative metaphor in the first versions of The Possums Sleep Program, not used elsewhere in infantcare at the time. | "The dial on the SNS" is a neutral, task-focused metaphor. "If you live the days and nights using your two tools to dial your little one down as best you can, sleep looks after itself". |
| Babies who cry and have trouble sleeping are often diagnosed with medical conditions, such as reflux, allergy, lactose problems, gut problems, or tongue-tie | These medical diagnoses have never been supported by the research data as explanations for baby sleep problems (despite authors' interpretations of their own data). | "It's very upsetting when the dial on our baby's SNS dials up [explanations given of how baby behaves when SNS dials up] but your baby isn't in physical pain." |
| Babies quickly become conditioned into a distressed response to certain stimuli (e.g. breast, bottle, cot, waking alone in night if parent response is unpredictable) | This conditioned distress or fear response is often inappropriately medicalised. Please see my various research publications which analyse the research literature and explore inappropriate medicalisation, through the lens of the Neurobiological Model of Infant Crying. The concept of conditioned dialling up to NDC and this term was not found in the research literature or other education programs prior to my own publications. It uniquely proposes that conditioned dialling up explains infant distress across multiple domains, not just feeds, and the model of conditioned dialling up is uniquely translated in NDC into various clinical solutions. | "Conditioned dialling up" |
| "Breastfeeding on demand" as a construct in breastfeeding clinical support and advocacy is often accompanied by unhelpful beliefs and explanatory models about infant behaviour | See Table 2 page 4 in my research publication which lists citations for specific elements of the NDC concept of frequent flexible breastfeeds, here, synthesised from an analysis of the research literature. This theoretical model of frequent and flexible breastfeeds and feeds, which de-emphasises feeds as meals but focusses on the function of sucking in breastfeeds/the bottle/milk in dialling babies down, had not been developed elsewhere and is unique to the NDC work. | "With frequent flexible breastfeeds, you use the breast to keep your baby dialled down. Most women find they need to offer each breast at least 12 times in a 24-hr period (without looking at the clock). Never feel you can't offer the breast again, even if you've just offered it. Breastfeeds are often very short. You don't have to worry about getting certain amounts of milk in each feed." |
| Feeding problems and infantcare practices such as burping after feeds or not allowing the baby to feed to sleep dial babies up and make sleep harder than it needs to be. | See my various research publications and my book on infant feeding, for novel concepts linking the dial, the interfering obstacles, and easy sleep, emerging out of my analysis of the research literature. | "Feeding to sleep is biologically normal. We need to remove the obstacles that get in the way of easy sleep." |
| Parents often struggle with unhelpful or inaccurate cognitions about their own sleep once they have a baby | Research at time of early development of The Possums Sleep Program increasingly demonstrated CBTI to be effective for adult sleep problems. The research literature addressed chronobiology and application of circadian medicine with respect to adult insomnia using Cognitive Behavioural Therapy for Insomnia, but not for infants and children. The Possums Sleep Program uniquely integrated the key principles of CBTI into an infant sleep program. CBTI was proven to be effective by 2019. Also, the principles now referred to as 'balanced time perspective', and which have been demonstrated in the research to help with sleep disruption in the perinatal period, were integrated into The Possums Sleep Program from the beginning. | Unhelpful beliefs about sleep are addressed using principles of Cognitive Behavioural Therapy for Insomnia and by the principles of Balanced Time Perspective. |
| Very disrupted infant sleep patterns are widespread | I reviewed Borbely's two-process model of sleep regulation, and Jenni et al's work demonstrating that the two-process model of sleep is relevant in infants and children. Jenni et al 2007 conclude: "A misalignment of the two processes may lead to problems at sleep onset, nocturnal wakings, difficulties awakening in the morning, or daytime sleepiness, the four most common sleep problems during childhood." There was nowhere in the research literature, or other programs available, which addressed possible clinical or educational translations of the two-process model into interventions aimed at helping parents who were dealing with these proposed misalignments in infants, until I published The Possums Sleep Program with Dr Whittingham in 2014. | "We need to reset your little one's body clock, to deal with [nature of sleep problem addressed e.g. excessive night waking, evening bedtimes, wake-up times]. We have three pressure points which we can use". Please see here, here and here. |
| Babies dial down with rich and changing sensory motor nourishment, which makes sleep easy. But parents are advised by sleep training approaches to avoid overstimulation | The advice to avoid overstimulation has classically cited just one very methodologically weak study. Until I published The Possums Sleep Program with Dr Whittingham in 2014, there was no research or infant sleep program available which focused on providing the infant with rich and changing sensory motor stimulation. However, growing amounts of research demonstrate the importance of rich and changing sensory motor stimulation for optimal infant development, synthesised through the lens of NDC in my research publication here. | "Use the second tool, rich and changing sensory motor stimulation, alongside your first tool for dialling your baby down, to make the days as easy as possible. This will keep your baby dialled down as his sleep pressure rises. Then sleep looks after itself." See relevant material in The Possums Sleep Program. |
| Rich and changing sensory motor stimulation is achieved through social prescribing, and nature prescribing (which were integrated into The Possums Sleep Program before these were widely used as terms.) | ||
| Parents try very hard to do the best by their baby and are naturally defensive if it's suggested that they are doing anything 'wrong' | The Possums Sleep Program is an attachment and emotion-focussed approach to infant sleep, and drew foundationally on this research literature. | The Possums Sleep Program integrates communication strategies (taught to health professionals as verbal "scripts") which empathically acknowledge parents' ways of making sense of their baby's behaviour and sleep, strategies for shifting way parents make sense of infant sleep, acknowledgement that parents know their own baby best, and that experimentation with new ideas is a powerful source of psychological resilience. |
| Parent emotional and mental wellbeing is negatively impacted by infant sleep problems and sleep deprivation | Acceptance and Commitment Therapy (ACT) and Compassion-focused Therapy offer evidence-based strategies for supporting parent mental health whilst dealing with sleep problems. The Possums Sleep Program did not use traditional CBT because of the postnatal tendency to repetitive negative thinking and the risk that CBT's disputation of irrational thoughts would worsen this. | Parents are taught ACT and self-compassion strategies. |
A few words about ethical use of The Possums Sleep Program
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If a sleep program or health professional or educator approach to infant sleep (that's not sleep training) looks like The Possums Sleep Program, it will be derivative. If it is an unauthorised and adapted version of The Possums Sleep Program, it is not genuinely evidence-based and may not be effective. The Possums Sleep Program has been demonstrated to be effective in five preliminary university-based studies to date.
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To be ethical, any commercial, business, non-profit organisation, and any freely available promotion of clinical practice or infant sleep information which has been significantly influenced by Possums or NDC requires foregrounded acknowledgement of the NDC or Possums work as source material.
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To deliver The Possums Sleep Program accurately, safely, effectively and ethically requires educational courses and continued updating through current membership of The NDC Institute. This also ensures that The NDC Institute can continue its research and education work.
Our aim is to have The Possums Sleep Program available as an option for all families with babies or toddlers, as we join together to grow joy in early life.
Recommended resources
About the development of The Possums Baby and Toddler Sleep Program (from 2011 ongoing)
How have the steps of implementation science been used to develop The Possums Sleep Programs?
What is the Neuroprotective Developmental Care Contextual Model of Infant Sleep (NDC-MIS)?
Timeline of development of The Possums Sleep Program
Selected references
Ball H, Taylor CE, Thomas V, Douglas PS, Sleep Baby and You Working Group. Development and evaluation of ‘Sleep, Baby & You’ - an approach to supporting parental well-being and responsive infant caregiving. Plos One. 2020;15(8): e0237240.
Ball H, Douglas PS, Whittingham K, Kulasinghe K, Hill PS. The Possums Infant Sleep Program: parents' perspectives on a novel parent-infant sleep intervention in Australia. Sleep Health. 2018;4(6):519-526.
Borbely A. The two-process model of sleep regulation: beginnings and outlook. Journal of Sleep Research. 2022;31:e13598.
Closson L, Flykt M, Bringen Z. Evaluation of possums sleep intervention: a pilot feasibility study. Journal of Nursing Education and Practice. 2020;10(2):https://doi.org/10.5430/jnep.v5410n5432p5415.
Douglas PS. The need to acknowledge similarities between the 2022 D'Souza and Cassels and the 2014 Whittingham and Douglas contextual models of infant sleep. Sleep Health. 2023;9:797-800.
Douglas PS. The Possums Sleep Program: supporting easy, healthy parent-infant sleep. International Journal of Birth and Parent Education. 2018;6(1):13-16.
Jenni OG, O'Connor BB. Children's sleep: an interplay between culture and biology. Pediatrics. 2005;115:204-216.
Jenni OG, Deboer T, Achermann P. Development of the 24-h rest-activity pattern in human infants. Infant Behavior and Development. 2006;29:143-152.
Jenni OG, Carskadon MA. Sleep behavior and sleep regulation from infancy through adolescence: normative aspects. Sleep Medicine Clinics. 2007;2(321-329).
Muench A, Vargas I, Grandner MA, Ellis JG. We know CBT-I works, now what? Faculty Reviews. 2022;11(4):https://doi.org/10.12703/r/12711-12704.
Ozturk M, Boran P, Ersu R, Peker Y. Possums-based parental education for infant sleep: cued care resulting in sustained breastfeeding. European Journal of Pediatrics. 2021;180:1769-1776.
Sobol M, Blachnio A, Calderan M, Degasperi G. Balanced time perspective as a factor mitigating the negative consequences of sleep disruptions in the perinatal period. Chronobiology International. 2025:DOI: 10.1080/07420528.07422025.02490499.
Whittingham K, Douglas PS. Optimising parent-infant sleep from birth to 6 months: a new paradigm. Infant Mental Health Journal. 2014;35:614-623.
Whittingham K, Palmer C, Douglas PS, Creedy DK, Sheffield J. Evaluating the 'Possums' health professional training in parent-infant sleep. Infant Mental Health Journal. 2020;41(5):603-613.
