7 Great Ways to Secure a Good Night’s Sleep With Autism
Two out of three adults in the United States are sleep-deprived, a deficit that led the Centers for Disease Control and Prevention (CDC) to designate sleeplessness as a public health epidemic in 2016. Surveys report that up to 83% of children with autism spectrum disorder (ASD) experience trouble sleeping, rendering you as parents one of the most stressed and exhausted factions of our already sleep-deprived population.
It’s easy to feel caught in an endless cycle of stress and sleeplessness with little hope for balance, much less a sound night’s sleep. Poor sleep has a detrimental effect on your ability to perform and your child’s ability to function. Studies repeatedly show that sleep problems in children on the spectrum are correlated with worsened social skills, stereotypic behavior, irritability, hyperactivity, and aggression. Sleep is essential for learning, memory, creativity, decision making, socialization, and emotional regulation. It is the backbone of your wellbeing and the foundation of your child’s growth and development.
Whether your child struggles to fall asleep or stay asleep, it can be difficult to know how to begin rectifying the situation. Along with behavioral interventions and medical consultation, it is important to address sleep hygiene, the habits that create a framework for deep and consistent sleep. Adopting these strategies will equip you and your family with the environment and routines necessary to obtain the sleep you need:
1. Establish a routine
The most effective thing you can do to improve your child’s sleep is to maintain a consistent schedule. This is sound advice for the neurotypical adult population, and it’s imperative for individuals on the spectrum. Our bodies operate on biological clocks and depend on environmental cues as pacemakers. Consistency is key; it begins the moment your feet hit the ground in the morning and continues until you and your little ones are back in bed at the end of the day
A good rule of thumb is to keep bedtime within the same hour every night, weekends and weekdays alike. The same goes for morning wake-up call. The National Sleep Foundation recommends 11 to 13 hrs of nocturnal sleep for preschool children and 10 to 11 hours for school school-age children. Up until the age of 24, the need for sleep clocks in at a whopping 9.25 hours. Set a realistic bedtime to accommodate this need.
Nightly routines minimize novel and excitatory stimuli that may inhibit drowsiness. Whether it’s bath time or story time, incorporate rituals to calm the brain and body for sleep onset.
2. Fade problematic sleep associations
In the process of establishing bedtime rituals, it’s common for children to become dependent on conditions and sleep associations that involve the presence of a parent or caregiver, such as being rocked or fed. This becomes problematic when it inhibits you or your spouse’s sleep. Every 60 to 90 minutes throughout the night, the body experiences a brief period of arousal between sleep cycles, sometimes leading to wakefulness. The average person awakens between two and three times each night due to these arousals and other disturbances.
When a child is dependent on their parent to get them back to sleep, their night wakings are prolonged, and the parents’ sleep is repeatedly disrupted. Consult with your BCBA to devise a plan for fading caregiver sleep associations and teaching self-soothing techniques that will enable your child to fall asleep independently.
3. Create a sanctuary
Take a close look at your child’s bedroom environment to ensure the absence of “sleep thieves.” Think quiet, dark, and cool. Soundproof the room from household noises, pets, and noisy traffic. You might consider a “white noise machine” which produces a mixture of frequencies, thereby neutralizing sound disturbances and promoting deep sleep.
Eliminate light sources by covering windows with heavy shades and blacking out pilot lights with electrical tape. You can even paint the room a dark neutral tone to decrease brightness and reflection. If your child requires a nightlight for comfort, avoid LEDs and choose an incandescent bulb that emits soft, warm light.
The optimal, sleep maintaining bedroom temperature is 65-67⁰F. Body temperature plummets during sleep onset and bedroom temperatures that keep it elevated can inhibit deep sleep and cause restlessness and nightmares. Moisture-wicking bed sheets, pillowcases, and pajamas can all help in maintaining cool body temperatures as well.
4. Get the right light
The body’s natural circadian rhythm is synced with light and darkness. Daylight spectrum light represses the synthesis and release of melatonin, the sleep-inducing hormone. It is vital to avoid electronic screens and bright light sources within an hour of bedtime to allow melatonin to prepare your brain and body for sleep. If you or your child is irreparably accustomed to pre-bedtime “screen time,” look for screen covers or glasses that block blue daylight spectrum light.
It’s equally important to get adequate light exposure during the day, especially first thing in the morning. Ideally, this means sunlight exposure, but bright “blue light” emitting lights have a similar effect. You can use gadgets such as a Litebook to get the light exposure necessary to sync your circadian rhythm and kickstart your day.
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5. Make sense of melatonin
Melatonin is often misused as a sedative rather than a supplement. Available in 3 to 10 mg portions, even the smallest supplemental dose is 20 times more melatonin than a healthy body produces on its own. As a result, many people experience grogginess and lethargy the following day. Ideally, a well-balanced diet and appropriate light exposure prompt the average adult’s pineal gland to produce an adequate supply of melatonin in the late evening, priming the body for sleep.
However, levels of melatonin are often below average in individuals with ASD. Use of supplemental melatonin has been found to significantly improve quality and quantity of sleep in children on the spectrum and improve daytime function with minimal to no side effects. Consult with your physician to determine an appropriate dose if, in fact, your child could benefit from supplementation.
6. Allow growth hormone to dictate your day
Growth hormone, as the name suggests, is a key player in bodily growth and restoration. It helps adults repair and maintain tissues, and it helps children grow and develop. Growth hormone is most abundant from birth until the age of 24 and makes its appearance during the middle of the night.
Its benefit is apparent, but there’s a catch. A working hypothesis suggests that growth hormone, secreted in adolescents around midnight, blocks the release of melatonin, inhibiting sleep into the wee hours of the morning. This accounts for why teenagers’ sleep phases lag behind adults’ by about three hours. Ideally, adolescents should sleep well into the morning in order to get the sleep they need.
Unfortunately, society hasn’t caught on yet. Schools, daycares and work days are scheduled to start in the middle of an adolescent’s circadian night. It’s unlikely that you can reschedule life to accommodate a hormone, but do your best to give growth hormone the (hopefully late-morning) time of day.
7. Know when to discuss with your doc
If you feel as though you’ve tried it all and your little one is still struggling to sleep deeply through the night, consult your pediatrician or visit an accredited sleep lab. The incidence of sleep disorders is elevated in children with ASD. If excellent sleep hygiene doesn’t cut it, you may be a candidate for more substantial intervention. Do your best to document sleep patterns and disturbances for a couple of weeks prior to your appointment. The more information you can share with your practitioner, the more accurate their appraisal will be. Be sure to do your research and get second opinions before using medications and sleep aids, as pharmaceuticals are often addictive and likely accompanied by a host of side effects.
In the landscape of a busy family household, there’s no singular formula for efficiency and success. You as a parent know the parameters of your child’s comforts and needs, but integrating even one of these strategies into your routine will increase the likelihood that you and your children will get the sleep you need to meet your potential and function optimally during waking hours.
Margaret Liederbach is Research Director at Sleep for Success and has a background working in behavioral therapy. Margaret and Dr. James B. Maas are co-authoring the forthcoming book “Sleep Made Simple: Everything You Must Know About Sleep But Are Too Tired to Ask.”
This article was featured in Issue 79 – Managing Everyday Life