When my son was diagnosed with autism at the age of three, sleep was amongst our greatest concerns. From the time he was born, our son had issues falling asleep and staying asleep. Never did we sleep through the night for more than three straight nights (once we went through the circus act of getting him to fall asleep). I even remember one week when my husband and I were both sick and every time one of us needed to sneeze or blow our noses, we would run to the basement so the noise would not wake him. We were exhausted! Over the years, we have learned a thing or two about sleep, so let’s see what I can pass along!
A variety of studies have shown that children with autism experience sleep disturbances of some sort between 40-80% of the time. For some, these issues linger into adulthood, but there are strategies worth trying that can make a big difference. Sleep issues come in various forms, including sleep resistance, difficulty with sleep onset, sleep maintenance (staying asleep) and early waking.
First Line of Defense – Behavioral Interventions
Square one when tackling sleep challenges, especially as they relate to sleep onset, is to create a good bedtime routine and establish visual supports surrounding the going-to-bed routine. A good bedtime routine will include avoiding electronics before bed, incorporating soothing activities, and sticking to the same bedtime each night. For us, our routine included a bath, toothbrushing, putting on pajamas, and reading a few books while snuggled together. Visual schedules and social narratives are both strategies to support adherence to a good bedtime routine. Visual schedules can help someone anticipate the upcoming transition to the bedtime routine and outline all the steps in preparing for bedtime. Social narratives can help create expectations surrounding the bedtime routine. If you need help in setting up the structure needed to support sleep onset for your child, you can reach out to the ASNC Rapid Response Clinical Consultation team for guidance.
Accommodations to Calm Active Bodies
Sometimes our kids’ bodies cannot physically shut down in order to sleep. Warm baths and quiet bedtime stories can help but making changes to the environment can also help. These include using a small, dim lamp in the room during the final bedtime moments. A weighted blanket can help organize a nervous system that is still awake. A white noise machine can calm an active mind and block out the sounds in other parts of the house where people are still awake. We even went so far as to make our son’s bed highly appealing, with a yellow blanket (his favorite color) and pillowcases with trains on them. He also had a favorite stuffed bunny that he could only snuggle when he was in bed. It never left his room.
Sometimes Medical Intervention is Needed
If you have had a good, consistent bedtime routine supported by visual strategies in place and you have adjusted the environment to maximize the potential for sleep to occur for your child, but you are still awake most nights, then it may be time to talk to a neurologist. Neurologists that understand both autism and sleep can help determine if there are reasons other than autism impacting sleep. If you need referrals to neurologists near you, reach out to the ASNC Autism Resource Specialists serving your area.
A note about melatonin: Melatonin is a hormone that is integral to sleep onset and maintenance. It is readily available at your neighborhood pharmacy. But that said, it is important to consult with either your child’s pediatrician or a neurologist before using this over-the-counter sleep aid. And it should not be considered until interventions and accommodations have been given a full trial.
Sleep may seem illusive and lack of sleep for the individual with autism impacts the entire family. But most people with autism can learn to sleep adequately with supports and strategies in place to assist their bodies and minds to settle down and get a good night’s sleep.
ASNC Resources
Webinar – Visual Schedules: The Strategy that Keeps on Giving
Social Narrative – Going To Bed
Social Narrative – Getting a Good Night’s Sleep
ASNC Rapid Response Clinical Consultation
ASNC Autism Resource Specialists
Nancy Popkin can be reached at npopkin@autismsociety-nc.org. Autism Resource Specialists are available to help individuals and families in every county of North Carolina. To be connected to the Autism Resource Specialist near you, please fill out this form.
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