Aspergers Children and Sleep Problems

Question

I'm a single mother and don't know how to deal with my 13 yr old anymore. He doesn't want to go anywhere or do anything which is hard when you have to, and I am now homeschooling him due to trouble going to school. A big problem right now is sleep issues… he is so active at night and tired during the day. At the moment he is not falling asleep till about 1 or 2 am, and I've tried waking him up earlier to reset his body clock but I can't get him out of bed. I don't know how to get him back into a healthy sleep routine.

Answer

Studies find that approximately 73% of kids with Aspergers (AS) experience sleep problems, and these problems tend to last longer in this group than they do for kids without ASPERGERS. For example, kids with ASPERGERS are more likely to be sluggish and disoriented after waking. Laboratory research has begun to describe the unique physiological presentation associated with sleep problems in kids with ASPERGERS, including disruptions in the sleep stage most associated with cognitive functioning (i.e. REM or Rapid Eye Movement sleep). In addition to physiological differences, some of the sleep difficulties in this population may be related to anxiety.

The impact of poor sleep is unequivocal. Poor sleep negatively impacts mood and exacerbates selective attention problems commonly found in kids with ASPERGERS, as well as impairing other aspects of cognitive function.

There is no one panacea to manage sleep problems in kids with ASPERGERS. However, there are many interventions that are likely to be helpful. In general, moms and dads need to understand and be prepared for resistance to change that these kids often show. Moms and dads should also be prepared for problems to get worse before they get better as kids often initially challenge but then gradually become accustomed to new routines.

A good place to start an intervention targeted at improving sleep is changing lifestyle behaviors and environmental conditions that can influence sleep/wake patterns. These include exercise, napping, diet, and aspects of the bedroom and sleep routine.

Exercise & Activity—

The goal is decreasing arousal as bedtime approaches. To achieve this it may be useful to have a scheduled period before bedtime (approximately 30-45 minutes) in which the aim is calmness and relaxation. During that period, media such as television, computers, electronic games, and music should be limited as they can stimulate the youngster through activity, sound, and light. The availability of VCR and DVR technology makes it easier to control when kids can watch particular shows, thereby avoiding conflict over missing favorite programs that are shown in the late evening. The presence of televisions in kid’s bedrooms has been consistently associated with sleep problems and should be avoided at all costs. Likewise, computer access in a youngster’s bedroom is discouraged for sleep as well as for safety reasons.

In general, exercise during the day is associated with better sleep. However, exercise within 2-4 hours of bedtime can lead to difficulties in falling asleep, as it can disrupt the natural cooling process of the body that leads to rest at night. Having the youngster soak their body, particularly their head, in a calm bath that is as warm as can be tolerated 90 minutes before bedtime may be useful too. When the youngster gets out of the bath, core body temperature will drop rapidly; this is believed to help them to fall asleep faster. Using a waterproof pillow and avoiding the pulsation associated with showers is recommended. The use of progressive muscle relaxation, deep breathing and imagery exercises is the most widely researched treatment for insomnia in kids and may be useful for kids with ASPERGERS as well.

Napping—

Controlled and limited (e.g. 20-30 minutes) napping is generally positive. However, longer daytime sleeping can be negative in that it makes it more difficult for the youngster to fall asleep at the ideal time in the evening. If the youngster’s sleep problems are associated with falling asleep, which is common for kids with ASPERGERS, it is advisable to avoid daytime napping.

Diet—

It is recommended that kids with sleep problems avoid all caffeine, alcohol, tobacco, high fat food, and monosodium glutamate (MSG). In contrast, food rich in protein may promote better sleep. Large meals within 2-3 hours of bedtime should also be avoided. A small carbohydrate/protein snack, such as whole wheat bread and low-fat cheese or milk before bedtime can be helpful to minimize nighttime hunger and stimulate the release of neuro-chemicals associated with falling asleep. For kids who often wake during the night to use the bathroom, and then have trouble falling back asleep, limited fluid intake in the 2 hours prior to bedtime is also recommended.

Melatonin is a natural brain hormone associated with sleep onset. There is some evidence that natural production of melatonin may be reduced in ASPERGERS kids. While melatonin supplements may be useful, a common side effect may be increased sluggishness in the morning. As discussed above, this is already a common problem for kids with ASPERGERS. Use of melatonin and other alternative remedies should be discussed with a physician.

The Bedroom—

It is important that the bed and the bedroom are associated with sleep and are not associated with activity. When kids have sleep problems, it is highly recommended that their bed and bedroom activity be limited to sleep only. It is important to make sure that extreme changes in temperature are avoided during the night. Increasing light is associated with decreases in the release of the neuro-chemical melatonin which triggers sleep onset. Thus, it is important to get the sunlight flowing in the youngster’s room as soon as possible in the morning. Conversely, darkening the room at night is critical. When a youngster’s fear of the dark is an issue, behavioral psychotherapy may be necessary. We also recommend moving the clock so that the youngster is not watching the time while lying in bed.

Sleep Routine—

Setting and maintaining a regular time to sleep and wake may be critical. Moms and dads often make the mistake of allowing their kids to sleep much later on non-school days to “make up” for sleep. While this may be useful to a certain extent, allowing the youngster to sleep late in the day makes it difficult for them to fall asleep at an ideal time later in the evening. It is easier to wake a sleeping youngster then to force an alert youngster to go to sleep. Thus, we recommend that you keep your youngster on a regular schedule on non-school days and avoid drastic changes in the time that the youngster wakes. Likewise, having your kids go to bed when they are not tired conditions them to be awake in bed. It is recommended that you let your kids stay up until they are tired while maintaining their waking time in the morning. Then once they begin falling asleep within 10 minutes of going to bed, begin to move bed time earlier by 15 minutes at a time.

With carefully monitoring and patience, many moms and dads can make changes in a youngster’s life that promote better sleep. Improved sleep supports better mood, sustained attention and general health. However, for many families professional consultation is often necessary to design or maintain the appropriate intervention. When you need help, speak with other moms and dads of ASPERGERS kids about their experiences and ask your primary care doctor for referrals to a sleep expert.

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and Tantrums in Aspergers Children