Autism and Sleep
A guide for parents and carers of children with autism experiencing difficulty sleeping.
Educational resource for parents and caregivers provided as a service by Flynn Pharma Ltd.
A guide to supporting children with autism who have difficulty sleeping. This leaflet describes why sleep is important for children with ASD and provides tips on what can be done to improve sleep behaviour and hygiene.
WHAT IS AUTISM SPECTRUM DISORDER?
Autism Spectrum Disorder (ASD) is a persistent disorder, present from early childhood that affects how a person communicates with, and relates to, other people and how they experience the world around them. There are around 700,000 autistic people in the UK – that’s more than 1 in 100. Whilst all autistic children share certain difficulties, being autistic will affect each child in different ways. Some signs of ASD may include:
• Difficulty communicating and interacting with people
• Not able to understand other’s viewpoint or feelings
• Having fixations or intense interests on certain objects or activities
• Being rigid and not able to handle change
• Sensitive to noises, touch, smell or food textures
• Repeatedly saying or doing the same things
WHY IS SLEEP IMPORTANT?
Many people on the autism spectrum are likely to suffer from disturbed sleep patterns at some point in their lives. As sleep helps our brain work properly and plays a vital role in health and well-being throughout life, it is important to address any difficulty sleeping. Sleep also helps support the body’s growth and development. Lack of sleep can raise the risk for some chronic health problems. Sleep deficiency or poor-quality sleep can also result in significant problems with memory, attention, mood, tiredness and daytime sleepiness.
HOW MUCH SLEEP DOES YOUR CHILD NEED?
It is important to note that every child is different. The amount of sleep required changes with age and the hours below are only a guide. It is
more important to focus on sleep quality, not quantity, and establish a good bedtime routine.
1 to 12 months old: 14 to 15 hours per day
1 to 3 years old: 12 to 14 hours per day
3 to 6 years old: 10 to 12 hours of sleep
7 to 12 years old: 10 to 11 hours per day
12 to 18 years old: 8 to 9 hours per day
SLEEP AND AUTISM
Many children experience sleep difficulties, but these are particularly common in up to 80% of children with autism. Some reasons could include behavioural, emotional, sensory, medical or a combination of multiple conditions:
• Difficulty getting to sleep and staying asleep, waking at night frequently and not being able to get back to sleep and early morning waking
• Some are not able to recognise or misinterpret the social cues such as siblings going to bed or staying wide awake when sun shines early during summer months
• Lacking bedtime routine, having a busy mind, not being able to switch off at bedtime or refusing to go to bed
• Reduced secretion of the sleep hormone, melatonin at night and having a disturbed sleep-wake rhythm (body clock)
• Having sleep terrors or nightmares
• Some may have sensory overload in the sleeping environment which can contribute to their sleep difficulties, such as increased sensitivity to light (e.g. blue light from the screens), noise (certain sounds or white noise), room temperature and touch
• Not able to relax, feeling anxious and/or having a low mood
• Some children experience food allergies, discomfort/pain from reflux, constipation or have neurological problems such as epilepsy
WHAT CAN YOU DO TO HELP YOUR CHILD SLEEP BETTER?
1. Keep a sleep diary
A sleep diary, such as the SNappD sleep and nap diary app, can be very helpful to identify your child’s sleep pattern and any underlying problems. Record your child’s sleep and wakefulness throughout the day and night over the period of two weeks. This will enable a healthcare professional to develop a sleep plan to establish a regular night-time sleep pattern for your child. The sleep diary may include the following details:
• bedtime and wake up time and if this is consistent
• night waking
• sleep duration
• snoring, abnormal behaviour or body movements
• daytime sleepiness, nap, irritability or tiredness
2. Encourage and establish good sleep hygiene
BEFORE BEDTIME
a. Avoid caffeinated drinks which can stimulate the child’s brain and keep them awake
b. As much as possible, limit your child’s screen time with gadgets (TV, tablet, games console, smart phone) 1 to 2 hours before bedtime. In addition, blue light from the screens can affect the secretion of natural sleep hormone, melatonin, making it difficult for them to sleep
c. Use relaxation techniques for example, gentle exercise, a warm bath, massage, reading or listening to soft music
BEDTIME ROUTINE
d. Explain sleep. Children can have difficulty understanding the need for sleep. Stories can also be used to reassure your child that they are safe when sleeping or alone.
e. Keep to the same bedtime and wake time if possible
f. Use visual timetables to help with transition as some children can be extremely resistant to change
BEDROOM
g. Ensure your child’s bedroom is comfortable, safe, and not cold or hot
h. Keep the bedroom free from toys and clutter which can be very distracting. Remove electrical devices such as television, games consoles and smart phones from the bedroom
i. Many children with autism have sensory problems. Reduce noise levels for example, shut doors completely, move your child’s bed away from walls where noise may travel and use earplugs if needed. Block out light using dark curtains or black out blinds. Ensure comfortable bedsheets and night clothes and cut off labels if your child finds them itchy
j. Reduce smells coming into the room by closing the door fully, or by using scented oils that your child finds relaxing
k. A weighted blanket can mimic the feeling of being held or hugged, encouraging feelings of safety and security that may benefit children with anxiety, autism or insomnia
FURTHER HELP AND SUPPORT
Do see your GP for a check-up and advice. They may recommend a full assessment of any sleep problem to determine its nature and any factors that might be contributing to it, such as the sleep environment, co-morbidities (other conditions) and current medication. Your child may be referred to see a paediatrician/specialist nurse or mental health team for assessment and support.
SUPPORT GROUPS AND RESOURCES
www.sleepfoundation.org
www.sleepscotland.org
www.autism.org.uk
www.researchautism.net/issues/1/sleep-and-autism
www.sleepcouncil.org.uk
SNappD is a simple-to-use sleep and nap diary app that allows you to record sleep statistics and the impact of poor sleep.
For further information on SNappD – the Sleep Nap Diary app, please visit the iOS or Google Play app stores.
BOOKS
Sleep Well on the Autism Spectrum: How to recognise common sleep difficulties, choose the right treatment, and get you or your child sleeping soundly. Kenneth J Aitken, 2014 (Jessica Kingsley Publishers)
ACKNOWLEDGEMENTS
Dr. Chinnaiah Yemula, Consultant Community Paediatrician, Bedford
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