Sleep

This section refers to your child as the content is geared towards caregivers, but it may also be useful for adults on the autism spectrum.

Sleep disorders

How do you define a sleep disorder?


All children are likely to have brief periods of poor sleep after illness, during holidays and festivals like Christmas or during periods of particular stress such as exams or if somebody close to them is ill. After events such as these, a normal sleep pattern should be established again within a few days.

If your child is regularly unable to sleep or has a period of good sleep which is disrupted, they may have a sleep disorder.

We recommend keeping a sleep diary to record when, where and for how long your child sleeps. This can be a first step in addressing any issues. If your child is at pre-school or school, speak to staff so that they know about the problem and can offer support. Approach your family doctor as well, and ask about a referral to an expert in sleep disorders.

What causes sleep disorders?


The answer to this is likely to be different for every person. Unfortunately, it seems that virtually all children with autism are likely to suffer from disturbed sleep patterns at some point or another, but we don’t know why.

Sleep problems can be divided into:

  • settling problems, where a child has difficulty going to sleep
  • waking problems, where a child wakes repeatedly during the night
  • social cueing problems, where your child doesn’t make the connection between the family going to bed and their own need to sleep
  • melatonin issues
  • sensory issues
  • problems caused by allergy and food sensitivities
  • hypersomnia – sleeping too much.

Settling and waking problems


Donna Williams, who has written extensively about living with an autism spectrum disorder, describes her fear of falling asleep in her autobiographies:

Sleep was not a secure place. Sleep was a place where darkness ate you alive. Sleep was a place without colour or light. In the darkness you could not see your reflection. You couldn’t get lost in sleep. Sleep just came and stole you beyond your control. Anything that robbed me of total control was no friend of mine.
Somebody somewhere, Donna Williams

In Donna’s case her fear of the unknown prevented her sleeping and this may well be true for some children with autism. For most children with autism this is unlikely to be the only explanation. Many children will have disturbed sleep as a result of a number of root causes.

Waking problems may in some cases be a continuation of settling problems – like the child who wakes up to go to the toilet but then finds it difficult to fall asleep again. In very young children waking problems are an indication that they still haven’t developed mature sleep patterns. As babies they woke up to feed every couple of hours and this pattern has persisted. In the older child with autism there may be an indication that they suffer from sleep disturbances. This could mean anxiety making it difficult for them to fall into a deep sleep or acute nightmares waking them up.

Although many experts would suggest approaches to settling and waking problems which require the parent to gradually give less and less attention to the child, we would suggest that attention is unlikely to be the main motivation for a child with autism. Instead, coping with waking problems may require consistent reassurance on your part and a creative approach to your child’s needs.

Social cueing problems


Children with autism may have difficulty understanding why and when they need to sleep. Problems with social cueing – that is learning why and in what order things should happen – are common in autism and this may mean your child does not make the connection between their family going to bed and their own need to sleep. Some children may find the transition from sleeping in their parents room to their own room by themselves difficult. This can be related to difficulty with change but also the need for reassurance around bedtime and sleeping.

Melatonin


This is a hormone secreted by the pineal gland. It has been shown to regulate sleep patterns in animals and that taking melatonin supplements can help to ward off jet-lag. It is also thought that patterns of melatonin secretion may be irregular in children with autism. It isn’t that they don’t produce it but that they don’t produce it at the right times of day.

Sensory issues


Children with autism can have significant problems with hypersensitivity to touch, visual stimuli or sound. This can be both distracting and distressing and make the process of falling asleep very difficult.

Food and drink


If your child has caffeinated drinks close to bedtime, such as tea, coffee or cola, this might disturb their sleep. Some people with an ASD also have gastrointestinal problems, so they may experience discomfort during or after eating, such as wind or constipation, which might disturb their sleep.

Hypersomnia – sleeping too much


If you keep a sleep diary, you may find that your child sleeps for far longer than you would expect. This is a condition known as hypersomnia. Contact your GP for advice or a referral to a paediatrician.

For some children with autism, their bed or bedroom may simply be a place where they feel comfortable and relaxed. You could try cues or incentives for getting up, eg

  • Making waking up sessions as gentle and relaxed as possible. One suggestion from the Parent survival manual came from the family who woke their son up by sending their pet cat into his bedroom. This meant he got up in a good mood. You could try doing something similar with your child’s favourite toy or glove puppets.
  • Playing gentle music at around the time your child is waking up.
  • Using breakfast or other reward as an incentive.
  • Sticking to the same structured routines each day.

Older children and teenagers are especially likely to have motivational difficulties. They may have very real fears about the day ahead, or be experiencing depression. Excessive sleep in this age group could signify psychological problems and it is important to investigate.

What can we do?

Keep a sleep diary


Sleep diaries can be useful for a number of reasons:

  • They can help to establish any unusual patterns of sleep.
  • If you do decide to try any routines, behavioural modifications or dietary changes to help your child to sleep, then a sleep diary will allow you to see if what you’re doing is working consistently, sporadically or not at all.
  • You can show a sleep diary to professionals involved in your child’s life, such as teachers, GPs or social workers, to give them a clearer idea of the impact your child’s sleep patterns are having on your son or daughter, and on you and your family. People may assume you’re exaggerating if you tell them you only get an average of two hours sleep a night but if you can show them charts with times specified they may take more notice.
  • A sleep diary can act as a visual reminder for more able children with autism of their disruptive sleep patterns. They can then be used to establish incentives for staying in bed and trying to sleep, eg a gold star for every night when the child doesn’t get out of bed plus a small reward if the child doesn’t get out of bed for three nights in a row.

Establish a routine


Children with autism respond well to routines because they allow them to feel safe and in control. Create a routine that you can use every day and anywhere. If you make playing on a particular climbing frame part of the routine, this will be a problem if you stay overnight somewhere else. Here’s an example:

  • 6:00pm dinner
  • 6:30pm quiet time
  • 6:45pm drink
  • 7:15pm bath
  • 7:25pm clean teeth
  • 7:30pm bedtime/sleep
  • 7:30am waking up/getting up.

A new routine can take time to get used to. It may help to present the routine visually and you could include quite a lot of detail, for example: close the curtains, get into bed, turn the light off, lie down, pull the cover up. It may also be worth setting aside time to prepare for the next day in the routine. This could include getting the school bag ready or making a list/timetable of things that need to be done the next day.

Consider changes to food and drink


Changing bedtime routines can be stressful and if your child is used to having certain drinks or snacks near bedtime, suddenly switching to something different may be counterproductive. However, you could try changing to decaffeinated tea, coffee and cola, or reducing the amount of the food which could be causing wind or constipation.

Alternatively, you could try gently phasing certain foods out over a period of days or weeks so that less and less is consumed overall without anything suddenly being taken away. For example, you could offer one biscuit instead of two, or mix decaffeinated and caffeinated drinks together.

Some people advocate making radical changes to a child’s diet like completely eliminating caffeine. We suggest that this is only worth doing if you have already tried a more moderate approach. We also suggest that you visit a dietician before introducing any major changes just to check that you’re continuing to offer your child a balanced diet.

Use relaxation techniques


Children with autism may feel particularly anxious around bedtime and not be able to articulate their need to unwind. Relaxation techniques can helpful. Here are some examples.

  • A few drops of lavender oil to your child’s bath.
  • A gentle foot, hand or scalp massage.
  • An hour’s quiet time before bedtime. Doing a quiet activity could help your child to unwind. It also provides a social cue: if everyone in the house is quiet and relaxed then it is time to get ready to sleep. You could mark the quiet time on a daily timetable so the child knows what to expect and becomes familiar with this routine.
  • Gentle exercise, such as yoga.
  • Gentle lighting in the bedroom.
  • Time each evening when your child can talk about their day. It may help to have a “worry book”; so your child can write down or draw any concerns before they go to bed.
  • Rough and tumble play. Although this is the opposite of quiet time, it might be more effective for your child.

Make sleep more comfortable


Your child might find being in bed uncomfortable. Some children are very sensitive to light, sounds, smells and touch. Here are some ideas that could help.

  • Block out light using dark curtains or black-out blinds.
  • Reduce noise using thick carpet, shutting doors fully, turning off appliances, and moving your child’s bed away from a wall with activity going on on the other side.
  • Block out noises by letting your child use ear plugs or listen to music through headphones.
  • Remove labels from bedding and night clothes, or try bedding and nightclothes made from other materials.
  • Reduce smells coming into the room by closing the door fully, or by using scented oils that you child finds relaxing.
  • Use a weighted blanket – these are made from thick material with bean-filled pockets “ which some people believe can calm children with autism by allowing them to better feel their movements and understand where their bodies are in space.
  • Remove distractions, such as toys on the bed and pictures on the wall (unless your child finds these relaxing), and consider a different colour on the walls.

Medication


Medical interventions are typically seen as a last resort in treating sleep disorders in children as they can be habit-forming and they don’t always treat the root cause of the problem. For further information you should consult your GP.

Natural remedies


Health food stores offer “natural” remedies which claim to treat insomnia and other sleep disorders. It’s important to consider how such products might interact with any other medication you child is taking. If you are thinking of trying a natural or alternative remedy, you should discuss this with your GP first.

Some foods are rich in melatonin such as oats, rice, sweetcorn, tomatoes, plums, bananas and brazil nuts, but current research is not clear whether a melatonin-rich diet could be effective in helping children to sleep.

Reproduced by kind permission of The National Autistic Society “ www.autism.org.uk.