Sleep is a one of our basic needs, lack of sleep impacts on all our functioning. In children lack of sleep can result in aggression, restlessness, increased behavioural problems, irritability and poor learning/cognitive performance. In my experience sleep difficulties usually expand beyond the individual child, their parents are awake to support them and the whole family unit is negatively impacted. The tiredness has a knock on effect on some of the challenges which some of these children may already have. Statistics show that on average 50% of children between the ages of 0-6, and 25% of all children will experience sleep difficulties at some point. Children with Autism Spectrum Disorders (ASD) are particularly at risk to sleep difficulties with studies consistently showing that 50-80% of children with ASD have difficulties with sleep (Richdale & Schreck, 2009). There is not a definitive explanation as to why children with ASD in particular have so much difficulties with sleep.
Identify the problem
Below is a list of the amount of sleep that is recommended for each age group as the children mature to adulthood:
|Toddlers 1-2 years||11 to 14 hours|
|Preschoolers 3-5 years||10 to 13 hours|
|School-aged Children 6-13 years||9 to 11 hours|
|Teenagers 14-17 years||8 to 10 hours|
If your child regularly has difficulty falling asleep or wakes up repeatedly throughout the night, it might be a sign of a sleep problem. It can be helpful to keep a sleep diary for a week or two to track how much and when your child is sleeping. Record details such as snoring or difficulty breathing. Take note of the days or activities that precede a good or bad nights sleep.
Take into consideration that certain stressors or anxieties may impact on the childs sleep but this may not indicate an on-going sleep problem. Also try to define what exactly the problem is; does the child have difficulty falling asleep, staying asleep, or are they only sleeping for short periods?
What could be the reason for this problem?
There are multiple reasons for sleep difficulties. Many children have sensory processing difficulties, these can lead to their body (sensory system) being in a heightened state which is not conducive to sleep. Some studies suggest that because children with ASD have difficulty reading social cues, this leads to them not necessarily understanding bedtime. Other children have difficulty sleeping because of anxiety and their stress/worry increases at bedtime. Each child will be different. We have all experienced being in a heightened emotional state; excited, scared, worried or angry and not being able to sleep. It is when this becomes an on-going problem which is impacting on the child’s ability to engage in their activities of daily living or negatively impacting on the family unit that it needs to be addressed.
What can we do about it?
There are lots of basic strategies that we can use to support a good bedtime and sleep routine. The first thing is to consider the importance of routine itself, in particular for children with ASD. Children with autism thrive in a more routine based environment, pick a realistic bedtime and create a routine which is practical and easy to maintain for your family.
Firstly, think of the environment. We want to create a relaxing quiet atmosphere which is suggestive of sleep. If your child’s bedtime is 8pm, from 6 o’clock try turning off main lights and use lamps, close the curtains to create more darkness. Turn off stimulating devices such as the TV, Ipads or computers. All screens emit a blue light which sends a message to our brain that it is still daytime and this then suppresses natural melatonin production in the brain. Try to avoid games that are very exciting, replace these with story time or quieter turn taking games and puzzles. Use a quieter lower tone when you are speaking engaging with your child. The bedroom should be dark, if the children is nervous of the dark use a night light as opposed to the main light being on. A dark room promotes sleep because it cues the body to finally shut down for the night. Make sure the lights are adjusted prior to entering the room. If the child is having difficulty grasping or following the bedtime routine consider use of a visual schedule.
Consider your child’s sensory needs, for example if they are sensitive to noise the house may need to become a little quieter in the lead up to their bedtime. It may be helpful to liaise with your occupational therapist to help and get a sensory diet in place so as the child’s system is regulated. Deep pressure activities are usually very calming and regulating. These activitis should be slow and repetitive, your occupational therapist can work with you and your child to identify what works for them. Some children can benefit from the use of a weighted blanket, it is important when considering weighted products to carefully follow guidelines. It is recommended that the weight should be no more than 10% of the child’s body weight. In addition to this they generally should not be used for longer than 20 minutes so may be helpful for children who have difficulty falling asleep, but should not be left on the child all night. Other children might really enjoy a foot or back massage before going asleep.
For children who enjoy it, a bath can be very calming. Try to use some nice scented bubble bath such as lavender – again considering the child’s sensory needs, some kids may dislike strong smells. When drying the child try to use slow repetitive heavy touches with the towel, avoid rubbing as this can be alerting for the body.
Calming music can be relaxing for some children, consider having it at a low volume.
There are lots of mindfulness videos for kids available on youtube and via apps. It might work to lie on the bed with the child and together listen to a guided meditation for 10 minutes or shorter depending on your child’s age and attention. Consider where in your bedtime routine this would fit, early in the evening or immediately before bed?
When we need to consider additional options and seeing a specialist.
Naturally, if your child is presenting with on-going sleep difficulties and you are feeling you have explored all your options it is important to consider that there could be a medical explanation for your child’s sleep problem.
Difficulties such as sleep apnoea and epilepsy also impact on sleep. Link with your paediatrician if you have on-going concerns and they should be able to refer you to a sleep specialist.
Richdale, L.R. & Schreck, K.A. (2009). Sleep problems in Autism Spectrum Disorders: Prevalence, nature, & possible biopsychosocial aetiologies. Sleep Medicine Reviews, (13), p.403-411.
Laura Kelly, Occupational Therapist, Sensational Kids
Copyright Sensational Kids CLG 2018