Sleeplessness affects children with autism, Attention Deficit Hyperactivity Disorder (ADHD), Sensory Processing Disorder (SPD), Cerebral Palsy (CP) and other conditions, which can cause difficulties in learning and produce challenging behavior in the child. Most often, poor sleep occurs due to problems in achieving an appropriate sleep-awake cycle. There can be various causes for sleep problems, such as the need to sleep more, discomfort while sleeping alone, and separation anxiety issues while sleeping in a different room than parents.
Arousal, defined as a state of the nervous system that relates to our alertness levels, is the most common factor of poor sleep. It is the state of arousal that outlines the amount of an individual’s focus and attention on a particular task. If the person has optimum (moderate) arousal levels, he might be able to focus well in any setting (home, classroom, mall or crowded places); however, inefficient arousal levels leads to distractibility, hyperactivity, and impulsivity. An insufficient amount of sleep leads to these low levels, which is why a typical child may have difficulties in coping with tasks the next morning.
As sleep has different phases, a child with ADHD might not get into a deep sleep due to reduced arousal levels, waking up at short intervals of time. This is the reason a child with ADHD, SPD, or autism may have difficulties coping with tasks the next morning. If a hyperactive child is awake from deep sleep, he might stay cluttered, unhappy, grouchy, and ill-humored throughout the day. He will not respond positively to any instructions or activities.
Minimal to moderate amounts of noise, the odors of different environmental objects, and visual sensitivities toward fluorescent lights are some of the examples that do not bother a typically developing child while working or sleeping. A neurotypical child’s body “tunes itself automatically” and becomes adapted to environmental demands. However, in an a typically-developing child, the “tuning” component does not work well, causing the child to struggle every moment since his/her body has to “tune itself manually” to get adapted to environmental demands.
Taking Melatonin has proven to be successful medication for children (aged 2-18 years), as stated in research (Melatonin for insomnia in children with autism spectrum disorders, published in Journal of Child Neurology, 2008). However, it might have some side effects, too. Using sensory strategies is the safest, non-pharmacological and innovative approach to making child sleep.
There are several essential sensory strategies that may or may not be helpful, as each child is different and has distinguished sensory needs. Implementing these suggestions consistently, however, may be beneficial. Observing a child’s behavior and his/her response to specific or generalized strategies will help parents to reinforce a better night’s sleep.
Auditory Issues and Strategies
Children with auditory hypersensitivities or other hypersensitivities may not get in a deep sleep due to minimal to moderate noise, such as road traffic, the television sound in the next room, or noises from the extractor fan running in the kitchen.
- Doors and windows should be shut to block the noise.
- A child can have soft music before going to bed or while trying to sleep.
- The television should be switched off one hour before the child goes to bed in order to create a quiet home environment.
- Earplugs can be beneficial.
- Noise pollution cannot be completely eliminated if one stays near the airport or along a busy roadside; however, it can be reduced to an extent. White noise can be created by the vacuum cleaner, air purifier, fan, or blower that reduces or blocks background sounds.
Tactile Issues and Strategies
Similarly, tactile sensitivity toward clothes can be the big reason for poor sleep. The room’s temperature or the texture of the bed cover, duvet, nightwear, or pillow covers can be the possible cause of a disturbance or aversion. According to the National Sleep Foundation, a bed should be clean, comfortable, and neat. Pillows and mattresses should be cozy with comfortable sheets. Keep the room cool in summers by blocking the sun and shutting windows.
- A weighted blanket provides tactile-proprioceptive input, which can be very calming. In research done by Ackerley R et.al (May 2015), it has been concluded that a weighted blanket is a non-pharmacological approach beneficial in reducing insomnia among teenagers and the elderly.
- Deep, firm pressure provided before sleep can be calming, such as a blanket burrito or a sensory snug.
- A pillow wrapped in the soft cotton towel under the head and between the legs can be used.
- A vibrating mattress or the use of vibrators before sleep can help to improve the quality of sleep. They can be useful around the arms and legs; however, they should be applied under the supervision of an occupational therapist who is sensory integration-trained.
- A light back rub before sleep is recommended.
- A massage of the hands and feet with magnesium oil or body oil can be used.
- Close the blinds and curtains if the temperature is higher outside.
Visual Issues and Strategies
Visual sensitivity can cause a lot of stress to the eyes as well as the brain. Children with visual hypersensitivities commonly complain about headaches by the end of the day since there is too much information for them to take in and retain. Factors like fluorescent lighting system within classrooms, the use of electronic gadgets, or increased screen time can contribute to high arousal levels.
- To create a sleep-friendly bedroom, the colors of walls should be chosen with the care. It should be soothing and elicit warmth and calmness.
- Reduce screen time as it activates the brain.
- Keep electronic gadgets (phones, tablets, laptops, etc.) away from the child’s room.
- Declutter the room. The room should be neat and clean, keeping all things organized. An untidy room creates more anxiety, so make sure when a child comes to sleep, his bed and room looks clean.
- Let the child use night-lights in the bathroom during late evenings and night times.
- All the sources of light should be blocked using curtains and blinds. Shut all windows and doors to block light.
Gustatory Issues and Strategies
If the child ingests caffeinated drinks before going to bed, then there is a chance of sleep disturbance. According to National Sleep Foundation, caffeine is the most popular drug in the world and people use it as a stimulant after waking up in a morning or in order to stay alert during the day.
- Caffeinated drinks should be consumed only if extremely necessary. More importantly, caffeine is not recommended for children since it affects child’s nutritional component negatively and also acts as an appetite suppressant.
- A bedtime snack can be introduced to substitute the drink. Sometimes children with autism face gastro-intestinal issues (constipation or passing of gas), which can lead to poor sleep.
- High water consumption 45 minutes to 1 hour before going to bed leads to a better night’s sleep.
- Reduce iron levels in the diet to avoid restless legs syndrome.
- High consumption of fruits and vegetables throughout a day with no intake of preservatives and dyes is also beneficial.
Proprioceptive-Vestibular Issues and Strategies
As a baby or toddler, the child might have struggled while sleeping. Usually, cuddling, rocking, swaddling, and swinging helps a child to relax, calm down, and sleep well. This may not be true with children with autism and ADHD children due to poor proprioceptive and vestibular sense. When a child has a poor relationship with the gravity, then sensory issues related to over-responsivity and under-responsivity are common.
- Use a hammock or cuddle swing for sleeping.
- Try linear swinging during bedtime after consulting with an occupational therapist.
- Joint compression and traction can be valuable for optimizing arousal levels and calming the child. Head and shoulder compressions are helpful during sleep. This should be also done after an occupational therapist’s consultation.
- Brushing can be another calming technique that has the tactile effect.
Olfactory Issues and Strategies
Sometimes olfactory (smelling sense) sensitivities can be a possible cause of limited sleep, coming from the odors from perfumes, the deodorants of adults, the toilet, food, cosmetics, or any household items. It is important to identify and realize that an atypical child is slightly different from other children and therefore needs special attention and care in areas that have minimal or no relevance for others.
- Use unscented shampoos and detergents.
- Avoid cooking when a child is about to sleep.
- To avoid allergies, wash beddings frequently in hot water.
- Vacuum and clean child’s room regularly.
To learn more about children-related sensory issues and integration strategies, please visit: http://shriaditi.blogspot.co.uk/
Aditi Srivastava is a London-based pediatric occupational therapist who has been working with special needs children for five years. She has her master’s degree in pediatric occupational therapy and her certification in sensory integration from Sensory Integration Network, United Kingdom. She has authored an information booklet on dyspraxia that aims to educate parents and promulgate dyspraxia awareness at her workplace. Besides being a dynamic occupational therapist, she is also the author of the blog called ‘Rising Horizons,’ where diverse child-related subjects are discussed. Aditi writes on significant sensory issues and sensory integration strategies, parenting tips, classroom suggestions, and anger management problems.
This article was featured in Issue 53 – Working Toward The Future