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

Study Objectives: To evaluate the efficacy of bedtime fading to reduce sleep disturbances in preschool aged children by using a group parent education format. Design: A repeated-measures design (pretreatment, treatment, post-treatment and two year follow-up). Setting: Flinders University Child and Adolescent Sleep Clinic, Adelaide, South Australia. Participants: Participants comprised 21 children (M age = 3.0 +/- 0.80 years, range = 1.5-4.0 years; 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 that included basic sleep education (sleep needs, sleep architecture, and 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, and these variables were measured using two week maternal report sleep diaries. Immediate improvements were observed over pretreatment to treatment in average SOL per night (M = 23.2 +/- 11.3 min vs. M = 13.0 +/- 7.3 min, d = 0.91), average WASO per night (M = 32.4 +/- 23.1 min vs. M = 24.0 +/- 18.3 min, 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 two year follow-up. Mothers rated bedtime fading high in terms of usefulness and satisfaction, and they reported that could successfully reimplement the 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 at home with little instructions, resulting in improvements in sleep and bedtime tantrums. (C) 2018 Elsevier B.V. All rights reserved.