Settling and Waking Problems in Children on the Autism Spectrum
"My son has a terrible time getting to sleep, but then in the mornings, I have a terrible time getting him up and out the door for school. Any suggestions?"
Unfortunately, it seems that virtually all kids with Aspergers and High-Functioning Autism (HFA) are likely to suffer from disturbed sleep patterns at some point or another. Sleep problems can be divided into three main categories: (1) settling problems, where the youngster has difficulty going to sleep at the appropriate time, (2) waking problems, where the youngster wakes repeatedly during the night, and (3) arousal problems, where the child has a hard time waking up in the morning due to such a restless night.
Coping with settling/waking/arousal problems will require consistent reassurance on your part -- and a creative approach to your youngster's needs. Here are some tips:
1. Allergy and food sensitivities: Kids on the autism spectrum are perhaps more likely than their peers to be sensitive to foodstuffs (e.g., sugar, caffeine, additives, etc.), which can keep them awake. If your youngster frequently has sweet or caffeine-rich drinks and foodstuffs near bed time, then it is worth checking whether this could be disturbing his sleep.
2. Medication: Medical interventions are typically seen as a last resort in treating sleep disorders in kids because they can be habit-forming and do not treat the root cause of the problem. As a general rule, it is better to minimize the medication your youngster is on, but at certain times it may be desirable to have a mild sedative on hand (e.g., going on vacation). Some moms and dads have also found that using medication in tandem with a behavioral approach can help to restore a good sleep pattern. The combination is crucial, because without the behavioral intervention when the medical treatment ends, the youngster is likely to return to his old sleep patterns.
3. Melatonin: This is a hormone secreted by the pineal gland which has been shown to regulate sleep patterns. In kids with the disorder, their patterns of melatonin secretion may be irregular, so it is not that they don't produce it, but that they don't produce it at the right times of day. Some foods are rich in melatonin (e.g., oats, rice, sweet corn, tomatoes, plums, bananas and Brazil nuts).
4. Natural remedies: Many of the natural remedies available from health food stores are supposed to treat insomnia and other sleep disorders. These may have similar effects to conventional medicines but carry less risk of side-effects than conventional sedatives. You could also try contacting a homoeopath.
5. Removing stimulants from the diet: Changing your youngster's bedtime routine can be stressful, and if they are used to having certain drinks or snacks near bedtime, suddenly switching to something different may be counter-productive. However, you could change to decaffeinated drinks, replace ordinary chocolate with sugar-free chocolate bought in health food stores, use carob powder to replace cocoa and chocolate, switch to sugar-free drinks or replace sugar in drinks with sweetener or fruit sugar, which may help some kids. Alternatively, you could try gently phasing certain foods out over a period of days or weeks so that your youngster is consuming less and less sugar and caffeine overall without having anything suddenly taken away from them.
6. Lack of social sense: Kids with Aspergers and HFA may have difficulty understanding why and when they need to sleep. Problems with social cueing (i.e., learning why and in what order things should happen) are common in these children, and this may mean your youngster doesn’t make the connection between his family going to bed and his own need to sleep.
7. Establishing a routine: Kids on the spectrum respond well to routine and structure because it allows them to feel safe and in control. Whatever routine you try to impose needs to be something you feel comfortable implementing and that your family can agree on. It may take several weeks for it to alter your youngster's sleep patterns. It can help to present this routine visually, using a timetable for example, so your youngster knows exactly what to expect, including getting up in the morning. If the routine needs to be altered, it can then be explained visually. It may be that your youngster's timetable needs to be more detailed so that he is told exactly what to do when going to bed, for example, draw the curtains, get in to bed, turn light off, lie down, pull cover up, etc. It may also be worth setting aside some 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.
8. Using relaxation techniques: Kids with Aspergers and HFA may not be able to articulate their need to unwind and relax, and they may feel more anxious and confused around bedtime. Relaxation techniques can be introduced in low-key, non-intrusive ways. Some possible techniques are as follows:
Coping with settling/waking/arousal problems will require consistent reassurance on your part -- and a creative approach to your youngster's needs. Here are some tips:
1. Allergy and food sensitivities: Kids on the autism spectrum are perhaps more likely than their peers to be sensitive to foodstuffs (e.g., sugar, caffeine, additives, etc.), which can keep them awake. If your youngster frequently has sweet or caffeine-rich drinks and foodstuffs near bed time, then it is worth checking whether this could be disturbing his sleep.
2. Medication: Medical interventions are typically seen as a last resort in treating sleep disorders in kids because they can be habit-forming and do not treat the root cause of the problem. As a general rule, it is better to minimize the medication your youngster is on, but at certain times it may be desirable to have a mild sedative on hand (e.g., going on vacation). Some moms and dads have also found that using medication in tandem with a behavioral approach can help to restore a good sleep pattern. The combination is crucial, because without the behavioral intervention when the medical treatment ends, the youngster is likely to return to his old sleep patterns.
3. Melatonin: This is a hormone secreted by the pineal gland which has been shown to regulate sleep patterns. In kids with the disorder, their patterns of melatonin secretion may be irregular, so it is not that they don't produce it, but that they don't produce it at the right times of day. Some foods are rich in melatonin (e.g., oats, rice, sweet corn, tomatoes, plums, bananas and Brazil nuts).
4. Natural remedies: Many of the natural remedies available from health food stores are supposed to treat insomnia and other sleep disorders. These may have similar effects to conventional medicines but carry less risk of side-effects than conventional sedatives. You could also try contacting a homoeopath.
5. Removing stimulants from the diet: Changing your youngster's bedtime routine can be stressful, and if they are used to having certain drinks or snacks near bedtime, suddenly switching to something different may be counter-productive. However, you could change to decaffeinated drinks, replace ordinary chocolate with sugar-free chocolate bought in health food stores, use carob powder to replace cocoa and chocolate, switch to sugar-free drinks or replace sugar in drinks with sweetener or fruit sugar, which may help some kids. Alternatively, you could try gently phasing certain foods out over a period of days or weeks so that your youngster is consuming less and less sugar and caffeine overall without having anything suddenly taken away from them.
6. Lack of social sense: Kids with Aspergers and HFA may have difficulty understanding why and when they need to sleep. Problems with social cueing (i.e., learning why and in what order things should happen) are common in these children, and this may mean your youngster doesn’t make the connection between his family going to bed and his own need to sleep.
7. Establishing a routine: Kids on the spectrum respond well to routine and structure because it allows them to feel safe and in control. Whatever routine you try to impose needs to be something you feel comfortable implementing and that your family can agree on. It may take several weeks for it to alter your youngster's sleep patterns. It can help to present this routine visually, using a timetable for example, so your youngster knows exactly what to expect, including getting up in the morning. If the routine needs to be altered, it can then be explained visually. It may be that your youngster's timetable needs to be more detailed so that he is told exactly what to do when going to bed, for example, draw the curtains, get in to bed, turn light off, lie down, pull cover up, etc. It may also be worth setting aside some 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.
8. Using relaxation techniques: Kids with Aspergers and HFA may not be able to articulate their need to unwind and relax, and they may feel more anxious and confused around bedtime. Relaxation techniques can be introduced in low-key, non-intrusive ways. Some possible techniques are as follows:
- Adding a few drops of lavender oil to your youngster's bath or pillow.
- Giving your youngster a massage.
- Introducing an hour's quiet time before the youngster's bedtime.
- Providing the youngster with a set time to talk about their day or their worries as part of the evening routine.
- Physically exhausting your kids is a good way of ensuring that they sleep! Many kids with Aspergers and HFA enjoy rough and tumble play, and although this may seem to be the opposite of the points made above regarding quiet time, it might be more effective for some kids.
- Relaxation aids such as music and yoga can be very useful.
- Some moms and dads have reported having lighting (e.g., a lava lamp) in the bedroom can be helpful.
9. Dealing with sensory issues:
- It’s worth considering if smells in the room, or coming from other parts of the house, may affect children with heightened senses.
- Some kids are exceptionally sensitive to light, so sleeping when there is even a very dim light on could be very difficult for them. Putting up thick curtains will block out as much light as possible in your youngster's room.
- Some moms and dads have found that their kids can be woken by very slight sounds at night. Ear plugs, or music playing on headphones, could be used to block out noise for those kids who are comfortable with wearing these.
- The layout of the room may need to be adjusted. Although it may be comforting for some kids to have lots of their belongings around them, it may serve to be quite distracting for others. Even the colors of the room or pictures on the wall may be disturbing.
- Touch sensitivity is extremely common in Aspergers and HFA. Some kids experience certain types of touch as physical pain. Labels on bed clothes and different materials can also be uncomfortable. Some kids respond well to a weighted blanket, which is made from thick blanket material like a quilt with the pockets filled with beans.
10. Keeping a diary: If you think your youngster may have a sleep disorder and you want to get an idea of the extent of the problem, it is a good idea to keep a sleep diary as the initial step to solving the problem. If you decide to try any routines or behavioral modifications to help your youngster to sleep, then the sleep diary will allow you to see if what you are doing is working consistently, sporadically or not at all.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's
==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism
==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance
==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism
==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook
==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book
==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism
