Consistent Bedtime Routines are Linked to Better Sleep Outcomes: Why?

Results from nationwide studies estimate that between 81 and 95% of parents in the United States with young children use bedtime routines. This is auspicious given that the use of a consistent bedtime routine is linked with better sleep quality. Indeed, the use of bedtime routines has been determined to have “strong” empirical support for addressing bedtime behavior problems (e.g., bedtime resistance) and for improving children’s sleep. However, it is unclear how, or through what mechanism(s), that a consistent bedtime routine is associated with positive sleep outcomes. We evaluated compliance near bedtime and anxious distress at bedtime as possible mechanisms (i.e., mediators) linking bedtime routines and sleep quality. To that end, we recruited 160 parents of a child between the ages of 3 and 5 through Amazon’s Mechanical Turk (Mturk) to complete questionnaires assessing the frequency of bedtime routines, compliance near bedtime, anxious distress near bedtime, and sleep quality. We found a significant indirect effect of bedtime routine consistency on sleep quality through anxious distress near bedtime even after controlling for child race, child sleep medication status, and co-sleeping status. Contrary to hypotheses, compliance near bedtime was not supported as a mechanism linking bedtime routine consistency and sleep quality once covariates were taken into account. An exploratory analysis revealed that this was due to co-sleeping status explaining a large portion of the variance in compliance near bedtime. In addition, in a serial model, the consistency of bedtime routines was related to sleep quality through first anxious distress and then compliance near bedtime. Moreover, exploratory part correlations revealed that the going to bed at a consistent time each night was the facet of bedtime routine consistency that most strongly correlated with child sleep quality. Clinically, these results may suggest that if parents can employ strategies to alleviate and manage their child’s anxiety before bedtime through consistent routines, compliance around bedtime and a good night sleep will likely follow. Findings are discussed in light of parental accommodation, intolerance of uncertainty, and parental acquiescence of disruptive behaviors. Areas for future research and limitations of the current study are also considered