The relationships between bedtime routines and preschooler's sleep health and well-being: a cross-sectional survey in Japan.

This study aimed to examine the effects of "adaptive" bedtime routines on a child's well-being, either directly or indirectly through sleep health. A web-based survey was conducted on 700 adults (321 male, 379 female, mean age = 39.98 years, SD = 6.33 years) responsible for preschool children aged 4-6 years old. Results of the mediation analysis showed that the bedtime routines index (BTR-Index[S]) could not confirm any significant regression coefficient with the total disturbance score of the Strengths and Difficulties Questionnaire (SDQ_TDS) (β = -0.063, p = 0.094) and the total sleep disturbance of Children's Sleep Habits Questionnaire (CSHQ_TSD) (β = -0.013, p = 0.736) in a single regression analysis. Sobel's test did not confirm any significant indirect effect (Z = -0.337, p = 0.736). As exploratory examination of the relationships between each of the items of BTR-Index(S) with SDQ_TDS and CSHQ_TSD, multiple regression analysis showed a significant positive partial regression coefficient for "Reading/sharing a story before bed" (β = 0.228, p = 0.006) and a significant negative partial regression coefficient for"Avoiding the use of electronic devices before bed" (β = -0.222, p = 0.011) towards CSHQ_TSD, with no significant partial regression coefficient identified for SDQ_TDS in any of the items. These findings suggest that bedtime routines do not directly either indirectly, through their sleep health, affect a child's well-being. However, caregivers' deliberate attempt to avoid stimuli that increases children's wakefulness before bedtime may serve as protection for the child's sleep health.