Sleep

Many children with ASD will experience difficulties with sleep at some point, especially getting off to sleep

Difficulties
Routine

When a child has difficulty sleeping, it means the whole household has difficulty sleeping which can lead to a tired, irritable family. Children may have problems getting to sleep or may wake periodically throughout the night. The child may catch up on sleep during the day or may seem to require much less sleep than the rest of the family.

Many children display behavioural problems during the day purely because of tiredness and a lack of sleep during the night.

Often sleep problems can be rectified with behavioural interventions, sometimes even a small change can make a big difference. It is easy to ‘give in’ to behaviours in the night in order to settle the child for the whole house to get some sleep.

Individuals with ASD often prefer to have predictable routines. Ad hoc times and routines of going to bed can cause anxiety which will in turn cause the individual to have difficulty in sleeping. Busy environments can also cause difficulties in settling to sleep, especially if the child has sensory issues.

Children who need support to get off to sleep with for example a dummy, TV, cuddles or a parents’ presence might have more sleep difficulties because when they wake up in the night they might not be able to get back to sleep on their own without these things. It can be challenging to make changes to the bedtime routine of a child with autism, and you may need to persevere and expect that it might take longer.

Many children become excitable during the late evening because they are overtired, if a child is not in bed early enough they will have more problems settling to sleep.

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Top tips for sleep difficulties - click to expand

managing sleep difficulties
- Set up a regular night time routine and stick to it. Try to start ‘winding down’ at least an hour before bed time. Baths, stories and a milky drink will all help your child to relax before bed. Avoid stimulating, exciting activities such as TV, computer games and physical play.
- Create a non-stimulating bedroom where possible. Switch off or dim lights and try to control noise. Remove TV/electronic devices from the bedroom.
- Encourage your child to settle alone in their own bed. If you usually cuddle your child to sleep, gradually change this. Each night withdraw yourself a little more; sit next to the bed, away from the bed, in the doorway, on the landing etc until your child can settle alone.
- Repeat these steps if your child wakes in the night
- Have clear rules and explain them to your child eg ‘you must stay in your own bed’, ‘you are not allowed to watch TV after 6pm’
- If your child is sleeping in your bed, consider whether you want your child to sleep in your bed long term, as it can be hard to change in the future.
- Encourage your child to stay in their own bed by using a reward chart
- If problems persist, speak to your Health Visitor, Family Worker, Social Worker or GP etc for more help

Support for sleep is delivered by:

Health visitors and family workers in the first instance
Community support sleep service if difficulties persist

If despite these interventions your child is still having difficulties getting to sleep then you can discuss the option of Melatonin medication with these professionals.

Melatonin

Melatonin is the hormone produced by the pineal gland in the brain during night in response to darkness to regulate sleep wake cycle and improve sleep. It may be helpful particularly treating delayed onset of sleep in children with autism. Sleep hygiene measures should be implemented before considering treatment with melatonin. It is also important that the child’s sleep is monitored on melatonin with trials off medication for a couple of weeks at least twice a year and see if the child is able to manage sleep without the medication.

Sleep

Top tips for sleep difficulties - click to expand

managing sleep difficulties

Cambridgeshire Children and Young People's Services

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