It may be no surprise to you to learn that about 87% of children with ASD have at least one sleep issue compared with 12.5% of NTD children (Cavalieri, 2016). As I sit with my son, who was up past midnight and awake again before four this morning, I found myself researching ways to help him sleep. I found Cavalieri’s article, which cited some research-based methods of reducing sleep issues in children with autism.
Why Does Sleep Matter?
As Cavalieri (2016) states, sleep issues do not just have an impact on the family members of a child with autism. It seems my husband and I are currently on shifts when it comes to watching my son while he doesn’t sleep. But, more importantly, Cavalieri states that my son’s sleep problems have a huge impact on his overall functioning in the following areas:
- Executive function
- Social Interactions
While many of these areas as already impacted by autism, the sleep problems can exacerbate the issues. So, it’s important to find some ways to help him sleep.
7 Researched-Based Ways to Reduce Sleep Issues in Autistic Children
The following methods presented by Cavalieri (2016) are non-pharmacological in nature, as the use of medication is the last resort in treating sleep disturbances. Some affiliate links to appropriate resources may be included, which help fund this website so that I can bring you great articles like this one!
If you’re like us, sleep hygiene is already one way you’re trying to increase positive sleep behaviors in your child. The following interventions are included in sleep hygiene in order to reduce sleep issues:
- Setting an appropriate bedtime each night, including on the weekend
- Developing bedtime rituals, which may include reading books, bathing, and dimming lights prior to bed.
- Avoiding stimulation from television, cell phones, video games and active play an hour before bedtime. Make sure there is no TV in the child’s bedroom!
- Tactile-friendly pajamas, blankets, and toys
- The use of white-noise machines
- Limit any daytime naps to 20 minutes (sleeping during the day = less sleep at night)
- A cool bedroom temperature
The standard method of extinction calls for ignoring all calls and cries from children until they fall asleep. You would return your child to bed if he/she gets up without talking and repeat this method until the child falls asleep. However, you may prefer the graduated method, which means ignoring 1-2 minutes, then attending to the child with as little talking and comforting of the child as possible. Delay the response to cries for help by 1 minute for each call each night. The idea here is that decreasing attention for behaviors related to the sleep issues can increase sleep time.
Find out when your child falls asleep and fade the time every night by 15 minutes. So in our case, we may determine our son goes to sleep around midnight. So, we’d try to put him to bed at 11:45 until he falls asleep at the new time, then move the time to 11:30, and so on until he finally falls asleep at the desired time. For this method, it is essential that the child is awakened at the same time every morning with no oversleeping!
If you co-sleep, this method suggests ways to end the cycle, including sleeping on a floor or mattress near the child but slowly moving away or out of the child’s bedroom each night. This way, your child can learn to sleep on his/her own.
For this method, you pretty much do the opposite of the faded bedtime routine by decreasing the total sleep time at first, slowly increasing afterward. In our case, if our son goes to sleep at 11:45, we’d restrict his sleep until 12:15am, keeping him awake and then wake him up the same time every morning with no naps allowed. Once he begins to fall asleep without any difficulty at a certain time, we’d set bedtime for 15 minutes earlier and practice the faded bedtime routine.
To resolve sleep issues with scheduled awakenings, you would wake your child up an average of 30 minutes prior to any night terrors. You should only use this one if your child experiences night terrors and consistently wakes up the same time with them.
While questionable in effectiveness, weighted blankets, massage, and massage aromatherapy may also be used as a method to help your child sleep. Sometimes some lavender essential oil in a diffuser with calming LED lights helps my son sleep and sometimes it doesn’t. Use these as a last resort prior to medication if all the above doesn’t work. I would consult with my child’s OT specialist prior to using weighted blankets to ensure the appropriate weight is utilized.
The Last Resort for Sleep Issues
As a last resort, Cavalieri suggests that medication as an intervention could be discussed with the child’s pediatrician. Melatonin has been studied extensively and, while still not FDA approved, studies show that melatonin is safe and can be effective, increasing the total sleep time from 20 minutes to 1 hour and 20 minutes (so a gain of 1 hour of sleep) without any side effects. If melatonin doesn’t work (it doesn’t on my son), there are medications to help with sleep, including clonidine and niaprazine which should be used at the discretion of your child’s provider.
We all know that sleep is important and that lack of sleep can cause all sorts of issues. As parents, we want to ensure our children get the recommended amount of sleep, but we also want to make sure that we get the same in order to parent effectively. If you’re having trouble getting your child to sleep and have tried all of the above methods (as applicable), it may be best to discuss these issues with the pediatrician and mention what you have tried to resolve the sleep issue.
For common sleep issues, try reading this article on tips to get your little one to sleep.