Put Sleep Issues To Rest

Of all difficulties associated with autism, ADHD and related disabilities, sleep disturbances are among the most vexing. In order to best address sleep problems, it’s important to first define them.

Problems going to sleep. Chronic trouble can occur if your child has no consistent bedtime routine, including a specific bedtime and clearly defined sleep location. Intermittent problems with going to sleep can arise from a long daytime nap, fears (like monsters in the dark), too much stimulation just before bedtime or a medication side effect.

Problems staying asleep. If you allow your child to fall asleep in one location and then transfer him to another, or if you remain in the room until after he falls asleep, he awakens to an environment different than when he went to sleep. This can be disconcerting and make it difficult for him to fall back to sleep.

Hunger or thirst during the night, medication side effects, illness, daytime stressors that cause bad dreams or unexpected external noises can all contribute to wee-hours wakefulness.Sleep phase problems (the hours the child is asleep). Problems can result from excessive stimulation, letting a child decide when to go to go to bed or changes in her natural sleep cycle (Circadian rhythm). Disruptions during sleep can be caused by sleepwalking, bed-wetting, teeth-grinding, head-banging and night terrors.

What To Do

Keeping a sleep diary in which you document exactly when and how often the problems occur can help you find ways to restore a peaceful sleep routine. As you record your child’s sleep progress, consider taking these steps.

• Look for physical or behavioral problems that can impair sleep.
• Set up a regular bedtime routine and stick to it. Visual cues or a visual schedule can help.
• Avoid excessive stimulation before bed. This includes rough or energetic play (you think it will wear him out, but it often has the opposite effect), stimulating foods such as chocolate or high-sugar drinks or snacks. The last hour before bed should be free of electronics — no TV, computer, games or DVD player.
• Allow your child only to fall asleep in bed, the one location meant just for sleep. Maintain the same sleep environment when the child is falling asleep as will exist when the child stays asleep or wakes in the middle of the night. That means parents should resist staying in the room until the child falls asleep.
• Discourage use of his bed as a daytime play space. Create a sleep environment — a quiet, dark space, with a controlled temperature that is not too warm — and a comfortable bed and linens.
• Gate the doorway or install a Dutch door with the top open and the bottom locked if the child often wanders out of his room.

Sensory Issues

Sensory issues can also contribute greatly to sleep difficulties. Here are some tactics that can help.

The sleeping space. A child with vestibular issues may need more tightly definited boundaries of her sleeping space. Downsize it with a tent, canopy or hanging curtain around the bed. A mummy-style sleeping bag or weighted blanket might also help, but consult an occupational therapist before using.

Pajamas. The gentle pressure of long-johns may comfort tactile-sensitive children. Beware of possibile irritants: nightgowns that ride up, loose pajamas, fabrics that scratch or pull, buttons, ribbons or embroidery that scratch or produce bumps and elastic around ankles, the waist or neck.

Sensory-disturbing items. Survey the room for clicking clocks, tree limbs that scratch against the window or side of the house, the on/off hum of the heating or cooling unit outside or next door, the feel of the sheets or the pattern.

Beware of scents. Rubbing your child with lotion before bed can be calming, but beware of perfumes and scents. Competing scents from soap, shampoo, lotion or toothpaste can combine for a nauseating effect.

Taking a “lovey” to bed. This is a common practice, but the usual teddy bear or dolly may not be your child’s lovey of choice. We know one child who adored his whisk broom and took it to bed with him every night. However odd, accommodate her preference, as long as it’s safe.

This article is adapted from 1001 Great Ideas for Teaching and Raising Children with Autism Spectrum Disorders by Ellen Notbohm and Veronica Zysk (Future Horizons, $24.95). Re-printed with permission of author.