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Children with Autism and Associated Sleep Disorders

  • Synopsis: Published: 2014-02-07 (Rev. 2017-06-28) - Article examines various sleep related disorders often experienced by children on the autism spectrum. For further information pertaining to this article contact: Thomas C. Weiss at Disabled World.

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"At night, while attempting to relax and fall asleep, the noises your child hears may be overpowering and impossible for them to ignore."

The majority of parents have some experience with a child who has a hard time falling asleep, wakes up often during the night, and only sleeps a few hours every night. Temporary sleep difficulties are perhaps an expected phase of a child's development. Persistent and ongoing sleep disturbances may have a negative effect on a child, parents, and other members of a household. Children with autism seem to experience sleep disturbances more often and intensely than average children. A child's sleep issues may rapidly become a daily challenge for parents.

There are several factors to address when establishing a plan to reinforce a positive sleep pattern. Any underlying medical issues that might be affecting a child's sleep should be assessed. Consider checking for food and environmental intolerances or allergies, seizures, and gastrointestinal disturbances. All of these are more common in people who experience forms of autism. Sleep disturbances may be a side-effect of medications a person takes and need to be taken into consideration as well.

Autism and Sleep Disorders

Sleep disorders that affect people in the general population should also be ruled out for children with autism. Sleep apnea is a disorder that may affect people at any age. It is a disorder in which a person experiences pauses in their breathing when their airway becomes obstructed as they sleep. The most common cause for blockage is enlargement of the person's tonsils or adenoids. Upper respiratory illness or allergies might also contribute to the development of sleep apnea. Along with pauses in breathing, symptoms of sleep apnea in children include:

  • Snoring
  • Sweating
  • Restless sleep
  • Night wakings
  • Mouth breathing
  • Frequent coughing or choking while asleep

Chart showing symptoms associated with sleep apnea in children
Chart showing symptoms associated with sleep apnea in children
Additional sleep disorders to assess in a child include confusional arousals and sleep terrors. Both of these are often referred to as, 'parasomnias.' Parasomnias are disorders of partial arousal that lead to unusual behaviors during sleep. Children with sensory processing difficulties experience more issues with falling asleep and waking during the night. A consultation and assessment with an occupational therapist trained in sensory integration might be important to assess arousal and relaxation troubles and to assist with designing strategies that approach these issues.

After potential medical issues have been addressed, other factors contributing to sleep issues should be considered. Strategies for dealing with the issues should be implemented. Additional issues to consider include bedtime routines, environmental variables and the use of a sleep training method.

Autism, Sleep and Environmental Variables

Following examination of your child's sleep environment more closely, there might be some modifications and adaptations to make to help your child relax at bedtime. Consider whether your child is too cold or hot. Assess the temperature of their room, sleep clothing and bedding to decide what combination is best for your child. Remember that your child's sense of temperature might be different from your own sense. Remember what temperature your child appears to prefer and desire during the day and consider it as you make decisions.

Take into consideration tactile sensitivities that might be affecting your child's ability to sleep. Certain textures may arouse or relax your child. Examine your child's bedding and pajama textures. Your child might prefer their feet uncovered or covered with socks, footed pajamas, or even the blanket. Hot tight or loose their clothing fits and whether or not there is elastic or seams may be an issue for some children. Bedding should provide the optimum level of pressure because it may also affect children with autism.

It is important to consider noises and how they might affect your child. At night, while attempting to relax and fall asleep, the noises your child hears may be overpowering and impossible for them to ignore. Noises such as water running, or a pet scratching, might not bother you or other family members - but they may be disrupting for a child with autism. It may be possible for certain noises around the house to be monitored for the effect on your child. At times a fan, a television, an air filter, or soft music in your child's room may help to mask other noises and provide a consistent sound that is both comforting and soothing for them.

Also take into consideration any visual stimuli that might be causing bedtime issues for your child at bedtime. Ask yourself if your child is afraid of the dark. Some children with autism might prefer dark places during the daytime, but that is different from them being expected to sleep in a large room in a bed at night while it is dark. The moon, streetlights, or car headlights shining into the room at intervals might be affecting your child's ability to sleep. Providing a room that is consistently dark or light might be important depending upon your child's specific needs.

Children with Autism and Bedtime Routines

Bedtime routines are important for most children where establishing positive sleep patterns are concerned, but are crucial for children with autism. Children benefit from a set bedtime; pick a bedtime that is reasonable for your child and one you can provide on a consistent basis. Children with autism need to know what is going to happen next. Establishment of a bedtime routine can provide predictability and a comforting, familiar pattern. For increased structure and understanding, a visual bedtime schedule can help.

A good bedtime routine will help teach a child to calm down, relax, and then get ready to sleep. For example; if bathing is frightening or stimulating for your child, even though you might want them to bathe before bed, it may be best to bathe at an entirely different time of the day. There might also be sensory integration activities that are relaxing for your child during the day that you can use as parts of their bedtime routine.

A bedtime routine should be the same each day and should include activities that are relaxing and pleasing, as well as individualized to fit your child's interests and needs. A bedtime routine should realistically consist of 4-6 steps that do not take more time than is reasonable each night.

Some activities you might consider as a part of a bedtime routine include:

  • Bathing
  • Toileting
  • Brushing teeth
  • Getting pajamas on
  • Singing a favorite song
  • Having a glass of water
  • Listening to calming music
  • Hugging and kissing family members
  • Saying good night to favorite objects
  • Looking at the same book or story each night
  • Engaging in a calming sensory integration activity

On days when you are away from home or are getting home late, it is still important to follow bedtime routines. You can shorten each step and potentially eliminate frustrations due to change. If your child is away from home for a night or two, you might see old sleeping patterns re-emerge. Even in a temporary new environment routines can help. After returning home the bedtime routine will continue to work, although the excitement from the change might take a night or so to fade depending upon your child and how long you have been away.

Sleep Training and Children with Autism

After you have addressed medical issues, environmental variables, as well as bedtime routines - it is time to deal with the hardest piece in establishing positive sleep patterns; teaching your child to sleep through the night. There are a number of versions of sleep training methods. Basically, after the bedtime routine is over and your child is in their bed, leave the room without long and drawn out words or continued attempts to touch your child in any way.

If your child is upset and clearly not sleeping, wait a few minutes and then return to their room to check on them. Checks involve going back into your child's room and briefly - not more than a minute, touching or perhaps giving a thumbs-up or, 'high-five,' or a hug to your child. Gently yet firmly tell your child that everything is alright and that it is bedtime, then leave the room until it is time for the next check or your child falls asleep.

Using this technique on a consistent basis is usually harder on parents than on children. It may take a couple of hours the first few nights. It is important to know that it is very likely a child's behavior will worsen for a few days or more before improving. Your child is testing the change and attempting to bring back their old routine. For some children who are older and not genuinely tired at a reasonable bedtime, a routine of staying in their bed or room quietly might be appropriate. Sleep training methods can still be applied in these situations. A gate or barrier may be needed at the bedroom door to remind your child that it is bedtime and they are expected to stay in their room.

If your child is older and has never consistently slept though the night, you might be completely sleep deprived yourself. Pursue assistance from a doctor, social worker, psychologist, or case manager. It may not be easy to find a knowledgeable professional, but you might begin by asking other parents who may know a professional that has helped them in the past.

If your child seems to regress in their sleeping habits, you might need to consult with professionals. It is best to begin with a medical assessment and continue from there. At times if other medical issues are ruled out, a temporary trial of medication may help in turning around poor sleep patterns and working to establish bedtime routines that work for your child.



Related:

  1. Thomas C. Weiss (Feb 04, 2014). Autism: Complementary and Alternative Medicine
    https://www.disabled-world.com/health/neurology/autism/alt.php
  2. Thomas C. Weiss (Jan 30, 2014). Tactile Defensiveness and the Autism Spectrum
    https://www.disabled-world.com/health/neurology/autism/tactile.php
  3. Thomas C. Weiss (Jan 21, 2014). Autism Myths Surrounding Social Interaction, Humor, and Speech
    https://www.disabled-world.com/health/neurology/autism/interaction.php

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