We all know how important sleep is but for individuals with Autistic Spectrum Conditions (ASC) falling asleep and staying asleep can be a real problem. At I AM we get many calls to our Help and Advice line from families about this problem.
Surprisingly there is relatively little research on this issue although what there is suggests that it can be a common problem for over 50% of individuals with ASC. A study in 2019 in the USA with children aged 2 – 5 years old clearly identified that “We clearly know that kids with autism are at high risk for sleep problems,”.
Other studies suggest that it can take 11 minutes longer for ASC individuals to fall asleep and that when asleep they spend about 15% of their time in REM sleep compared with 23% of non-ASC individuals. REM sleep is important because it is the restorative part of our sleep cycle.
The co-occurrence of other things such as ADHD, sensory issues, repetitive behaviours and anxiety or depression can all combine to make sleep an elusive commodity for someone with ASC. There is also some research that suggests that people with ASC can also have irregular melatonin levels which is a hormone associated with sleep. Some individuals may not notice the social cues associated with bedtime and sleep or may have food sensitivities that cause gastric discomfort. This lack of sleep can then result in exacerbating behaviours associated with ASC not to mention causing great stress for families.
- Stick to a routine – this may sound obvious and may be particularly hard at the moment but having a good bedtime routine, that may need to be longer than you think given it takes longer for ASC individuals to fall asleep, can be helpful
- Give advance warnings before the bedtime routine is going to start at say 15 minutes, 10 minutes and 5 minutes so that it doesn’t suddenly land on the individual as a surprise.
- Stick to regular bedtime and wake up times, this helps to get the brain into a regular sleep pattern
- It goes without saying that it is probably not a good idea to allow your child caffeine or sugary drinks or snacks before bed
- Try and ensure that the individual gets plenty of fresh air, natural light and exercise during the day
- Address any sensory issues around light, smell, noise, temperature, clothing and bedding. Some individuals may find things like a weighted blanket, sleep tent or white noise helpful, but this will depend entirely on the individual
- Consider keeping a sleep diary to identify not only the triggers for poor sleep but also what has caused good sleep so that they can be repeated
- Maybe use a social story so that an individual understands the concept of bedtime.
- Try using a visual timetable that includes all the activities that are involved in bedtime. Remind your child to follow their timetable and interact with it by ticking off items or pointing to each one before they are completed and after they are done and so they can also see what comes next
- Offer rewards for following the routine and staying in bed/asleep
- Limit screen time, there is some evidence to suggest that the light associated with screens can inhibit melatonin release
- Try to identify and address any particular anxieties that might be occurring at the moment and address these if you can
- Try not to do stimulating activities in the run-up to bedtime instead choose calming activities, the types of activities that are calming will vary depending on the individual but could include, rocking, swinging, reading, aromatherapy, listening to soothing music, etc.
- Use relaxation techniques such as massage or yoga to help the individual to wind down
- Maybe try a “bedroom pass” that allows your child to leave their bed (but ideally only once using the bedroom pass) but if they don’t use it they can have a reward in the morning clearly this may not work if there are also toileting issues
- Safety proof your child’s room so that you can also get good sleep without worrying too much if they wake up during the night
- “Tag Team” sleep deprivation is exhausting for everyone so try to find a friend or partner that can take over some nights to allow you to get a good night’s sleep, you need sleep as much as your child does
- If the problem is ongoing and leading to wider issues seek medical advice