An open trial of bedtime fading for sleep disturbances in preschool children: a parent group education approach

Abstract

Study Objectives: To evaluate the efficacy of bedtime fading to reduce sleep disturbances in preschool aged children, using a group parent education format. Design: A repeated-measures design (pre-treatment, treatment, post-treatment and 2-year follow-up). Setting: Flinders University Child & Adolescent Sleep Clinic, Adelaide, South Australia Participants: Participants were 21 children (mean age=3.0±0.80 years, range=1.5-4.0 yrs; 60% girls) identified as having difficulty initiating sleep, night waking, or a combination of both, and their mothers (M age=36.1±4.2 years). Interventions: Mothers attended two group sessions which included basic sleep education (sleep needs, sleep architecture, sleep homeostasis) and bedtime fading instruction. Measurements and Results: Primary outcome variables were sleep onset latency (SOL), wake after sleep onset (WASO), and bedtime tantrums, measured using 2-week maternal report sleep diaries. Immediate improvements were observed over pre-treatment to treatment in average SOL per night (M=23.2±11.3min vs M=13.0±7.3min, d=0.91), average WASO per night (M=32.4±23.1min vs. M=24.0±18.3min, d=0.41), and number of bedtime tantrums per week (M=1.7±3.0 vs. M=0.4±0.7, d=0.43). Treatment gains were maintained at 2-year follow-up. Mothers rated bedtime fading highly in terms of usefulness and satisfaction, and could successfully re-implement treatment when needed. Conclusions: Bedtime fading is a brief and promising intervention for pre-schoolers’ sleep difficulties. This simple intervention can be easily implemented by parents in the home with little instruction, resulting in improvements to sleep and bedtime tantrums.