Implementation of a nightly bedtime routine: How quickly do things improve?

Abstract

Background: Institution of a consistent bedtime routine has been demonstrated to improve sleep in young children within two weeks. However, no studies have investigated the rate of this change and when most change occurs. The purpose of this study was to examine the nightly change in infant sleep and maternal perceptions after implementing a bedtime routine.

Methods: Mothers (n=134) and their infant (8-18 months) were randomly assigned to implementation of a bedtime routine intervention for a two-week period.

Results: Two-level piecewise linear growth models showed that the intervention resulted in the most rapid change in the first three nights of the intervention across sleep outcomes, including sleep onset latency, the frequency and duration of nighttime awakenings, sleep consolidation, and maternal perceptions of bedtime ease, sleep quality, and infant mood. No significant additional improvement in sleep onset latency emerged after these first three nights, whereas small additional improvements occurred for all other outcomes throughout the remainder of the intervention period.

Conclusions: These results indicate that sleep disturbances in infants and toddlers can be quickly ameliorated within just a few nights after implementation of a consistent bedtime routine, including a bath, massage, and quiet activities. Future research should consider the potential mechanisms behind these relatively fast improvements in sleep, such as reduced household chaos or physiological changes (e.g. core body temperature, cortisol).

Keywords: Bedtime disturbances; Bedtime routine; Behavioral intervention; Infant; Night wakings; Sleep; Toddler.

Conflict of interest statement

Conflicts of interest

Dr. Mindell and Dr. Leichman serve as research consultants for Johnson & Johnson Consumer Inc.

Ms. Lee and Dr. Walters are employees of Johnson & Johnson Consumer Inc.

Copyright © 2017 Elsevier Inc. All rights reserved.

Figures

Fig. 1.

(a) – Sleep onset latency. (b) – Night waking frequency. (c) – Night waking duration. (d) – Longest stretch asleep. (e) – Maternal perception of bedtime ease. (f) – Maternal perception of how well child slept. (g) – Maternal perception of child morning mood.