Insomnia in Kids with High-Functioning Autism and Asperger's

“What do you suggest for my 4-year-old boy who has a hard time getting to sleep at bedtime, but can’t take melatonin? He has an allergic reaction to that supplement (gives him headaches). And why does it seem that so many high functioning autistic children have trouble going to sleep – even when they are exhausted?”

Researchers don't know for sure why HFA kids have problems with sleep, but they have several theories. Here are the main ones:
  1. Anxiety: Stress or anxiety is a possible condition that could adversely affect sleep. HFA kids tend to test higher than other kids for anxiety.
  2. Low levels of nighttime melatonin: Melatonin normally helps regulate sleep-wake cycles. To make melatonin, the body needs an amino acid called tryptophan, which research has found to be either higher or lower than normal in kids on the spectrum. Typically, melatonin levels rise in response to darkness and dip during the daylight hours. Studies have shown that some kids with HFA don't release melatonin at the correct times of day. Instead, they have high levels of melatonin during the daytime and lower levels at night.
  3. Sensory sensitivities: HFA and Aspergers kids may have trouble falling asleep or awaken in the middle of the night due to an increased sensitivity to outside stimuli (e.g., touch or sound). While most kids continue to sleep soundly while their mother opens the bedroom door or tucks in the covers, the youngster might wake up abruptly.
  4. Ignoring social cues: Most “typical” kids know when it's time to go to sleep at night thanks to the normal cycles of light and dark and their body's circadian rhythms. But they also use social cues (e.g., kids may see their siblings getting ready for bed). These kids may misinterpret or fail to understand these cues.

Sleep problems are some of the most common problems moms and dads face with their children. Most Aspies have sleep difficulties, and many are actually going through their days sleep-deprived. 

Here’s how you can help your child with Aspergers (High-Functioning Autism) get to sleep in a reasonable amount of time – even if he can’t take melatonin:

1. An hour before bedtime, avoid all physically stimulating activities (e.g., running, jumping, climbing, etc.).

2. An overnight sleep study may be recommended for your son, especially if he has excessive daytime sleepiness or problems staying asleep. The sleep study will help determine if he has a diagnosable problem (e.g., pure snoring, obstructive sleep apnea, restless legs syndrome, etc.). These disorders may require specific therapy that your son’s doctor will prescribe.

3. Avoid feeding your son big meals close to bedtime, and don't give him anything containing caffeine less than six hours before bedtime.

4. Avoid scary stories or TV shows prior to bedtime.

5. Establish a consistent and relaxing bedtime routine that lasts between 20 and 30 minutes and ends in your son's bedroom. Maintaining a predictable and soothing bedtime routine is critical with Aspergers children. Bathing, brushing teeth, singing lullabies, and reading books are some suggestions for a nightly routine.

6. Feed your son bedtime snacks that contain the amino acid “tryptophan.” Tryptophan helps the body to produce the sleep-inducing chemical serotonin. Tryptophan-containing foods include dairy products, whole grains, poultry, rice, eggs and sunflower seeds.

7. Give your son tools to overcome his worries. These can include a flashlight, a spray bottle filled with "monster spray," or a large stuffed animal to "protect" him.

8. Have him get used to falling asleep with a transitional object (e.g., a favorite blanket or stuffed animal).

9. If your son calls for you after you've left his room, wait a few moments before responding. This will remind him that he should be asleep, and it'll give him the chance to soothe himself and even fall back asleep while he is waiting for you.

10. If your son comes out of his room after you've put him to bed, walk him back and gently - but firmly - remind him that it's bedtime.

11. It's better to read a favorite book every night than a new one because it's familiar.

12. Keep the bedroom as quiet as possible for your son. If outside noise is unavoidable, use a sound machine or stereo to block noise.

13. Make sure your son has interesting and varied activities during the day, including physical activity and fresh air.

14. Make sure your son is comfortable. Clothes and blankets should not restrict movement or be too itchy, and the bedroom temperature shouldn't be too warm or too cold.

15. Put some thought into finding your son’s ideal bedtime.  In the evening, look for the time when he really is starting to slow down and getting physically tired. That's the time that he should be going to sleep, so get his bedtime routine done and get him into bed before that time. If you wait beyond that time, then your son may get a second wind.  At that point, he will become more difficult to handle and will have a harder time falling asleep.

16. Remove the television from your son's bedroom. Television stimulates the brain, making sleep difficult to achieve.

17. Set up a reward system. Each night your son goes to bed on time and stays there all night, he gets a star. After three stars, give him a prize.

18. Talk to a sleep psychologist about bright-light therapy. Exposing your son to periods of bright light in the morning may help regulate the body's release of melatonin.

19. To prevent sensory distractions during the night, put heavy curtains on your son’s windows to block out the light, install thick carpeting, and make sure the door doesn't creak.

20. Warn your son that bedtime is in five minutes or give him a choice, for example, "Do you want to go to bed now or in five minutes?" …but do this only once.

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