Having this random problem as well. I have the iPhone XS Max with the latest iOS and this happens to me about once or twice a month. My routine is exactly the same every time. I always have the ringer switch set to silent because of the ridiculous amount of spam calls, I haven’t changed the Bedtime settings since I set them up when I got the phone, all the volumes are always at reasonable levels, and yet the alarm is randomly silent. This morning it was silent, but I did nothing different from the day before, and it worked then.
I really don’t think this is user error. There are so many people with the same issue, going back a couple years and on several different devices.
Also, I have nothing Bluetooth hooked up. My phone physically plugs in to my car for Car Play and I don’t have any Bluetooth devices. Since the last time the alarm failed to sound I have turned off Bluetooth on my phone, so hopefully it helps, but the issue is so random that it’s hard to tell.