The Exhausting Journey of Autism and Sleep
Autism Spectrum Disorder (ASD) is on the rise. Once thought to affect 1 in every 100 children, it is now 1 in every 68 children [1, 2]. If you don’t already have a child with autism it is likely that someone close to you does. Nearly 70% of children with autism suffer from sleep problems [3]. Sleep, bedtimes, naptimes, middle of the night wakings and early morning wakeup times can all be a struggle for parents to manage. Plus, add in that each autistic child needs a different formula for help, which will likely be a trial and error process for the parents as they navigate their specific sleep issue.
As a marriage and family therapist and baby sleep consultant, I have a unique understanding of the challenges associated with ASD and sleep. In this article, I hope to outline some of the best practices for toddlers and young children who struggle with ASD and sleep. These are general recommendations because ASD varies wildly from child to child. Though I have made this list as thorough as possible, you may need to consider some individual help if more personalized intervention is needed. I offer a free 15-minute consultation to help answer any questions and to help you decide if my services are right for you.
What does autism look like in a baby or toddler?
While this list should not be used to self-diagnose your child with autism, these warning signs warrant further investigation with your child’s pediatrician.
If by 6 months your baby is not offering big smiles or other warm and joyful expression;
If by 9 months your baby is not sharing sounds, smiles or other facial expressions back and forth with you and or others;
If by 12 months your baby does not respond to his name, there is no babbling or baby talk, no back-and-forth gestures, such as pointing, showing, or waving;
If by 16 months there are no spoken words;
If by 24 months there is no meaningful two-word phrases from your baby that don’t involve imitating or repeating [4].
What would sleep problems look like in an autistic child?
Your autistic child might have a sleep problem if he or she has trouble falling asleep and/or wakes up repeatedly throughout the night, has early morning wakings, or restless or poor-quality sleep [5]. To know for sure, you can schedule an appointment with me or your child’s pediatrician to assess sleep behaviors.
How can I help my child sleep better?
These suggestions are geared towards children up to about age 6. If your child is past the age of 6, these suggestions may be helpful, but you may want to begin looking at resources for older children and eventually teens as they approach 12 and up.
Feeling Safe
Feeling safe and secure is vital for good quality sleep for a child with autism. There are a few different ways to help your child feel safe in their sleeping environment depending on their age and preferences.
Use a Crib. While a crib might feel like a cage for us, a toddler and young child actually feel safest in a crib. The crib walls provide physically boundaries that tell the child they are in a safe and in secure place. Having these physical boundaries is a strong reminder to your child to stay in his bed. I recommend all toddlers stay in cribs until at least 3 years of age. With an autistic child, I recommend staying in the crib as long as you can. As your child develops, he will begin to display improved impulse control and moving out of the crib is an option. At this point many children still need strong physical boundaries to feel safe in bed. I recommend either a bed net or a bed railing. Both of these barriers allow the child to get up and leave if they need to while providing clear, touchable boundaries for the child.
Stay in the Room. This is a suggestion I only make to help an autistic child feel safe going to bed. The least amount you have to do to help your child fall asleep, the better, but having a parent near may help a child relax enough to fall asleep. You may be able to just sit near the door, or perhaps you will lie on the floor near your child. Feeling safe is a prerequisite to falling asleep; therefore, your goal is to help your child feel safe and not necessarily soothe him to sleep.
Pets Could Increase Safety. More and more research is confirming there is an association between dogs and social improvements in an autistic child [6, 7, 8, 9, 10]. More research is needed to completely understand this relationship, but many autistic families are moving forward and noticing huge improvements in their child. There may even be a possibility that the benefits of a pet would transfer over to sleep. This pet could provide some sense of safety and security for your child while falling asleep and even during nighttime wakeups. While this theory is not researched based, I have had families report that when the pet dog sleeps in the autistic child’s room the child does sleep better.
Routine Is Key
I recommend a clear and consistent routine for all children, and the need for routine and consistency in routines is even greater for an autistic child. Routines allow the child to feel in control. A child can know what to expect and transition more easily from one activity to the next when there is a clear routine to follow.
Picture Chart. A picture chart allows your child to have a clear picture of what is coming and allows him to prepare for the transition.
Timer. A timer that allows your child to see how much time he has to complete different tasks can help him remain calm and focused on the routine. It will also be important to allow your child sufficient time to complete the routine. Feeling rushed will increase anxiety, tantrums, and end up taking much longer to get your child settled down. I like this timer.
Sensory Help
Sensory issues are common in children with ASD. Whether your child is hyper- (more) or hypo- (less) sensitive to light, sounds, or smells some of these sensory suggestions may prove helpful for your child to calm down enough to fall asleep.
Weighted Blanket: There are so many potential benefits to using weighted blankets with your ASD child. Weighted blankets have been shown to increase serotonin levels [11], improve in-seat behavior at school [12], decrease self-stimulating behavior [13], reduce anxiety [14], and improve night sleep for those who suffer from insomnia [15]. Weighted blankets have proven to help in a wide variety of situations, and there is reason to believe they will offer the same benefits for ASD. In my experience, the weighted blanket helps children to continue to feel safe and secure while sleeping and decrease night wakings.
Noise Machine: Noise machines can help any child sleep through disturbances. Likewise, for a child that has ASD and is hypersensitive to noises, a noise machine is a must for keeping your child asleep when a loud truck drives by, or the birds start singing in the morning, and especially when someone in the house has to get up to use the bathroom. This is my favorite noise machine because it has an actual fan inside, which sounds infinitely better than computerized white noise.
Tight Pajamas: Tight pajamas are much easier on our senses. Loose pajamas can tug and pull on certain parts of your body. This may not seem like a big deal, but to a child who is hypersensitive to any stimuli, this can be the difference between sleep and no sleep.
Vibrating Pillow/Small Toy: A small toy that vibrates can help a child to focus on that one feeling and object in order to be able to turn the rest of his mind off and fall asleep.
Dim Night Light: Often children with ASD will desire to be able to see at night. Once any child can request some light in his room, it is usually appropriate to provide some. If your child is non-verbal but at least 3, it would be appropriate to try a dim light. Make sure the light you choose is an orange light, which will actually increase melatonin in the body. You will want to stay away from blue lights and screen lights that decrease melatonin and tell your brain not to sleep.
Lavender Oil/Spray: Lavender has long been said to have a calming effect. If your child enjoys smells, this is a great way to offer a scent and promote relaxing and soothing to sleep.
Silky or Soft Comfort Item: Different textures in bed can allow busy hands the chance to stop and touch, to soothe themselves with new textures, and focus on those textures instead of being drawn out of bed.
No Screen Time Before Bed: Limit screen time for 2 hours before bed. The blue lights in screens tell our brains to stay awake. Avoiding screens before bed can help a child soothe into sleep better and faster.
Blackout Curtains: Blackout curtains can help a child sleep better during the lightest sleep cycles of the early morning. Darkness helps us sleep and the light wakes us up. The longer we can keep the bedroom darker the greater chance sleep will continue.
Pressure Touch: Lotion massage, on the back or legs and arms, can often be soothing and relaxing for a child with ASD.
Melatonin
One reason children with ASD could struggle sleeping at night is because their bodies may not release a sufficient amount of melatonin at night [5]. You could talk to your pediatrician about your child and if a melatonin supplement might help your child sleep as well. While there are a few natural ways to increase melatonin levels (cherry juice, magnesium oil), there is also research to support that a melatonin supplement can improve sleep, without negative side effects. Eighty-five percent of children reported melatonin use solved or improved their sleep concerns in just 2 months [16]. You will want to make sure the dosage is appropriate for your child’s age. This is my personal favorite melatonin supplement. It is dosed appropriately for children, and the ingredients are all natural with no preservatives, food dyes, or processed sugar.
Avoid Sugar, Caffeine, and Processed Foods
Often sugar, caffeine, and processed foods spike our energy up. Obviously, this can cause problems if given right before bed, but you may want to consider cleaning up the diet throughout the day if sleep is particularly troublesome for you. Foods that can promote sleep include warm milk, bananas, and cinnamon.
Personal Experiences
Below you will find some personal examples of sleep disturbances from ASD and what those families did to find their sleep solutions.
Kandace Zobell
“I have an autistic son who is 4 years old. Sleep has been very challenging for us and I feel like it will always be a challenge for him, but we have made a lot of huge improvements over the last 2 years. We have had a mattress set up on the floor next to my son’s bed for almost two years now. We first put it in there because the only way my son would stay in his toddler bed was if we were in there with him. On average, it would take him between 1-2 hours every night to fall asleep. Some nights we weren't getting out of his room till 11:30 PM. He just had a very hard time calming down, turning off his mind to actually fall asleep. We decided to try melatonin out of desperation. We started with a very low dose and every few weeks used less and less at night. After a few months, we finally got him on a regular bedtime schedule and were able to stop using the melatonin. It saved us! “Even after getting him on a good bedtime schedule, we still had the problem of him waking up 5 times a night. My husband would end up taking him back to bed and staying on the mattress in his room all night rather than go back and forth all night. He got more sleep just staying in there. After not sleeping in the same room for about 5 months straight we knew we needed to do something else. We did a little research and decided to get our son a dog. He is not a trained therapy dog, but we got a breed that is great kids. The dog sleeps on our son’s floor every night. My husband went from sleeping in my son’s room every night to now only doing it at most 3 times a week and not all night. PROGRESS!!! This was huge for us!”
Carly Winsor
“My 2 ½ year old has always struggled with sleep. We have to follow a very specific routine to get her to initially fall asleep, and then she wakes up 2-3 times during the night, often experiencing an autistic meltdown. We have found that a weighted blanket has helped her calm down to sleep again. We just started melatonin supplements and haven’t really noticed any big changes yet.”
Andrea Ashton
“Once we opened up our son’s methylation/detox pathways and eliminated allergen causing foods he started sleeping through the night. When our son was 3 and 4, he was often up for hours each night. Thank goodness we found answers to help his body heal so we could all sleep again!”
Conclusion
As you can see managing autism and sleep is not only difficult, but unique from child to child. It can often feel overwhelming to try and decipher what is helping your specific child and what might be hurting sleep. If you feel stuck, overwhelmed, or lost trying to navigate sleep with your autistic child, please visit my website [www.littledreaemers.us] to schedule your free 15-minute consultation and begin your journey to better sleep.
https://www.webmd.com/brain/autism/news/20091218/autism-jumps-57percent-in-just-4-years
https://www.webmd.com/brain/autism/news/20160331/us-autism-rate-unchanged-at-1-in-68-kids-cdc#1
https://www.webmd.com/brain/autism/news/20091012/melatonin-helps-autistic-kids-sleep#1
https://www.helpguide.org/articles/autism-learning-disabilities/does-my-child-have-autism.htm
https://www.webmd.com/brain/autism/helping-your-child-with-autism-get-a-good-nights-sleep#1
https://link.springer.com/article/10.1007/s10803-014-2267-7
https://link.springer.com/article/10.1007/s10879-014-9274-z
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0057010
http://online.liebertpub.com/doi/abs/10.1089/acm.2011.0835
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0041739#s3
http://www.tandfonline.com/doi/abs/10.1300/J004v24n01_05
http://journals.sagepub.com/doi/abs/10.1177/1088357608330753
https://www.ncbi.nlm.nih.gov/pubmed/12959227
http://www.tandfonline.com/doi/abs/10.1300/J004v24n01_05
https://www.jscimedcentral.com/SleepMedicine/sleepmedicine-2-1022.pdf
https://www.autismspeaks.org/science/science-news/melatonin-shows-promise-improving-sleep-problems-children-autism
