It is found that up to 83% of children with autism have sleep disturbances-- That is an epidemic! Katz explains that "sleep is needed to remember what we learned, organize our thoughts, engage in tasks of executive functioning, react quickly, work accurately and efficiently, think abstractly, and to be creative," (2010). These apply to all individuals with and without disabilities. Newborns need up to 20 hours of sleep per day, toddlers need 13 total hours, school-aged children need 10 hours, and adolescents should get at least 9 hours of sleep per night to feel rested and perform at their best the following day.
There are ways in which our environment cues us when it is and is not appropriate for sleep or when to be tired, these cues are called zeitgebers and literally mean "time givers." Zeitgebers include light, time cues, and social demands. Zeitgebers almost get tossed out the window for children with autism because of sensory integration disturbances, inability to tell time, and inability to pick up on social cues; thus resulting in the high percentages of sleep troubles for these families. Beyond zeitgebers, children with autism also experience sleep rhythm and neurotransmitter abnormalities as well as anxiety.
A study by Malow in 2006 found that changes in sleep can result in decreased social withdrawal, decreased anxiety, and decreased emotional reactivity. So, the question is, "how do we improve our sleep?" The first place to start is in behavioral and environmental strategies including, but not limited to the following:
- Rewards for sleeping through the night
- Consistent wake time (yes, even on the weekends)
- Elimination of naps
- Increased physical activity during the day
- Increase in natural light during the day
- Consistent bedtime (even on the weekends)
- Consistent bedtime routine
- Participation in calming activities within 2 hours of bedtime
- Reduction of light within 2 hours of bedtime
- Use of a visual schedule
Make sure you are aware of your child's bedroom environment. Pay attention to the temperature, amount of light and noise in the room. A bedroom should be used for sleep only. If a child's bedroom is also their play room, then they will associate that space with what is most motivating and rewarding-- Play.
Also, consistency is key in both falling asleep and staying asleep. What a child falls asleep to needs to be consistent throughout the night in order for them to stay asleep. Everybody falls asleep and wakes up every 90 minutes throughout the night, naturally. If your environment is not consistent throughout the night, then it could be difficult to fall back asleep. For example, if a child only falls asleep in your arms, their body will wake them up throughout the night and that child will crawl back into your arms in the middle of the night to feel that same comfort they felt at the beginning of the night.
A great behavioral intervention I have found to be very helpful is "The Bedtime Pass," (Katz, 2010). Children can use a bedtime pass to leave their bedroom during their bedtime, whether it is to use the bathroom or crawl into bed with mommy and daddy. Parents are in control of how many passes they allow their child and are able to reduce the number of bedtime passes as their sleep gets progressively better and more consistent. If the child did not use all their bedtime passes and stayed in their bed throughout the night, they can turn in their pass in the morning for a prize. This program if very rewarding and effective for children young and old, with and without disabilities, who are having trouble falling asleep and staying asleep throughout the night.
Another intervention that should be discussed with your doctor is the addition of melatonin or serotonin supplements. Melatonin and serotonin are naturally produced in the body, but it has been said that children with autism have disturbances in the production of these chemicals. Melatonin tells the body when it is tired and serotonin is necessary for the body to produce melatonin. So, if you try a melatonin supplement and you don't see any results, speak with your doctor about serotonin supplements.
Use these strategies intending on trial and error. Make sure you keep a sleep diary so that you are able to track what works and what doesn't work. Gradually you will see an increase in improved sleep and thus an increase in your overall quality of life.
References:
Katz, T. (2010). Behavioral Treatments for Sleep Problems in Individuals with DS-ASD. Denver, Colorado: Annual DS-Autism Connection Conference.
Until next time, BLOSSOM!
Lauren Thome, M.A.
