Why Do Children With Autism and SPD Suffer From Sleep issues?

 Children with autism or sensory processing disorder can find relaxing into sleep more difficult than most. Of all the issues that affect families of SEN children, sleep can be one that impacts them the most.

Why does my child with Autism and/or SPD have trouble sleeping?

• There are varying and common issues that can affect children with autism, sensory processing disorders and other SENs.  These might include:
• Finding it hard to wind down, settle and prepare for rest and sleep.
• Being extra sensitive to the blue light in electronic devices that can keep us awake.
• Extra sensitivity to caffeine, cocoa, sugar, or other stimulants that might keep us awake.
• Difficulty settling without support from a caregiver.
• Extra sensitivity to noises or other disturbances at night, ability to hear things inside and outside the house beyond our range.
• Finding it hard staying in their bedroom, or being restful, due to high levels of activity and movement, as with ADHD, sensory seeking or ADD.
• Waking frequently, or still active and restless in their sleep.  Nightmares, night terrors, sleep walking.
• Being woken by frequent toileting needs, bedwetting, anxiety or OCD issues.  Having trouble going back to sleep when they wake in the night.
• Waking too early and not understanding that it is not time to rise.
• Sensitivities to clothing and bedding.
• Attachment to rituals that get in the way of sleep.  Needing certain toys, lights or stimuli to get to sleep.
• Having high levels of anxiety around bed, bedroom, dark, sleep, being alone.
• Not understanding that they need to sleep, or that others need to sleep, or the importance of enough sleep.
• Body clock or circadian rhythms that are disrupted and not in tune with daily sleeping and waking times.  Impaired secretion of melatonin, the hormone which regulates sleep patterns
• Other neurological or health conditions such as restless leg syndrome, insomnia, iron deficiency, acid reflux.  Gastrointestinal issues caused by sensitivities to food, or PICA
• Severe resistance to routines and requests such as PDA, or other disruptive or challenging behaviours.
• Limited communication may make it difficult for young people to express their worries, feelings and needs.
• It is worthy of note that some people with Autism or SPD sleep too much as they are overwhelmed and exhausted from stimulus during the day, and are hard to wake.

How to help regulate their sleeping pattern

Keep a diary for a period of time, preferably a month or more.  Note everything relevant to the challenges preventing sleep.  When tired it is hard to remember what happened yesterday, let alone last week or last month!  The added benefit to keeping these records is that you have factual information to help during visits with Social Worker, or making applications for PIP, Universal Credit or other benefits.  Over time you will see trends.  You might for example see tummy issues disturbing the night and then start to also note what was eaten during the days running up to see if there are certain foods causing issues.

Establishing a routine 

The next step is to establish a regular and reassuring routine that hopefully works for all members of the family.

It is important that the signals around night and day are clear.  Consistent and predictable times help set the scene.  Introduce a sleepy transition program at the end of the day to signal the change in tempo. You might want to switch the whole house to lower light and sound levels at a regular time.  Definitely aim to switch off all screens at least an hour before bedtime, don’t be hard on yourself if you need screen time for the kids, but try to reduce gradually.  If visual stimulation is required try light projectors or other relaxing sensory lights.  Relaxing timers like sand timers or bubble tubes can also measure time in a more relaxing way. 

Bedtime routines might include bath time, massage, stories, yoga, meditation, deep breathing techniques.  Have low light and quiet in which to relax before bed. You might introduce a ‘choose’ option during one part of the evening routine to help those who are more oppositional to being directed. This might involve listening to a story, soothing or quiet music, using weighted blankets or being wrapped tightly (swaddling), rhythmic movements like swinging or rocking in a chair are also particularly soothing for some children.

Visual supports can prompt the stages of preparing for sleep, and for the different activities around it like bathing.

Things to avoid at and before bedtime

Avoid sugary or stimulating foods before bedtime. Aim to have any large meals at least two hours before bedtime routine starts, but a small low-sugar supper snack might be part of bedtime routine.

Avoid sleep in the day if possible. If naps are still needed, keep them timed and not in the afternoon.  Consider using melatonin to help kids who find it difficult to drop off into sleep.

Don’t assume that your child will understand the need for sleep. Books, social stories and other age and understanding appropriate explanations of why sleep is important may help.

Listening to them and taking their needs into consideration

Consider their anxieties and fears.  What can we do to provide reassurance?  How can we increase their feelings of safety?

Some children, especially those with SPD do not get the correct signals from their joint receptors, resulting in issues judging where their body is in time and space.  When they shut their eyes it can feel like falling.  These children might benefit from compression sheets or weighted blankets.

Remember - sensory differences mean that your child’s experience of what is relaxing may be very different to yours.  Be prepared to try things over time, taking the lead from your child’s response and pace.

Creating an environment to aid sleep

Darkness stimulates melatonin release so use dark curtains or black out blinds.  If your child doesn’t like darkness, use sensory lights or projectors.  If it is hard to achieve darkness try an eye mask for sleep.

If you live in a noisy household make sure doors shut properly, keep the child's bed away from walls where noise is on the other side. If your child is safe to use earplugs or headphones alone they may help.  Curtains and carpets, low level music or white noise will help muffle sounds from elsewhere. 

Where possible get seamfree, seamless, soft or label free sleepwear.  Some children may need light compression clothing or compression sheets. Lay in your child’s bed space and see what is distracting.  You may choose to move pictures, change wall colour, remove noisy toys and devices from the bedroom.

Some children may benefit from a clock that shows them when they should be in their room, and what time is wake up time.  Some alarm clocks have a function where they reduce the light levels going towards sleep and gradually increase light levels in the morning.  

Essential oils such as lavender, sleep sprays, pulse point oils can help.