Universe has given us a beautiful system of day and night. Days are given for working hard for our goals in life, and nights come with a massage of importance of taking breaks and having rest while working hard towards the goals of life, so that we will be rejuvenated and ready to work harder for next morning again. Unfortunately stories are opposite for parents with child on ASD.
Ajay (age 12)
It would always take him more than two or more hours to sleep every night. When he finally closed his eyes and slept it never lasted long. He would be up every few hours before rising for good around 4:30 am. He looked tired every morning. He often felt asleep in school hours. And it affected him in other ways too. He was irritated. Most of time would yell, strike out other family members. His sleepless nights also affected other family members as no one could sleep properly until he was awake.
Swati (Age 5)
Swati always had a hard time in getting into bed. She always slept late in night. Her parents just didn’t got time to spend together as she had restless sleep. She would wake up crying and screaming after every few hours of sleep. She would wake up immediately even if her mama get out of bed for washroom or something and would take more than an hour to go back to sleep.
Shilpa (Age 10)
Shilpa would sleep for three hours a day sometimes even in school. She would bang her head and has difficulty in staying calm always in schools. When teacher tries to engage her in activities she becomes more irritable and start jumping or banging her head.
One of the darkest shade of spectrum is explored by most of parents is about having sleepless nights without any purpose. Which also result in heavy mornings for them with red, bleary eyes! Also makes them difficult to focus on work during the day.
Sleep disorder is common among the children with ASD.
It presents as:
Difficulty falling asleep Inconsistent sleep routines for example waking up in night frequently and lying awake until very late in night.
Restlessness or poor sleep quality like waking up even with small noise or movement in bed.
Waking up early and frequently at irregular intervals in night
Why can’t he just sleep in spite of remaining hyperactive all day!!!
- Parents of Child with ASD.
Though there are many assumptions by scientists who are researching on sleep disorder in Autism, following are the most common causes which affects sleep quality of children with ASD:
Dependency on habits/routine:
Children on ASD have great affinity for their set routine and rituals and they cannot bear even a smallest change in those set routine. For example, a child on ASD who has a habit of sleeping in particular place or at a particular corner of bed will not settle for any other place and have hard time in falling asleep.
Communication difficulties:
Children on ASD have difficulties in expressing themselves. So even if child is awake for something, he might not express about his needs. Most of the time children on ASD also fail to understand the social cues. For example when child on ASD watches family members around him changing night dress he may fail to understand that they are getting ready to go to bed or child may misinterpret it as something else.
Hypersensitivity:
Increased sensitivity to the auditory and touch senses is the common reason for the poor sleep quality of children with autism. Child may wake up abruptly even in middle of sleep as they hear any kind of minimal voice like opening door of washroom or even if mother is getting out of bed for washroom.
Hormonal Disturbances (Melatonin):
According to the researches hormone melatonin helps in maintaining normal sleep wake cycle. Typically melatonin levels rise in response to darkness and lower in daylight. According to the studies children on ASD don’t have correct levels of melatonin according to normal day night cycle. They have high levels of melatonin during daytime.
Dependency on screen:
Any form of light emitted by the screen especially before bed time suppresses the melatonin levels. This is significant barrier to developing regular bed time routine. Apart from disturbing melatonin levels screen dependency also affects negatively to the cognitive functions and verbal memory of child.
Other possible medical issues:
Anxiety and the hyperactivity contribute majorly to the poor quality of sleep. Children on ASD have lot of anxiety which makes them awake for long in night. Because of hyperactivity child remain energetic even during night time and have hard time in settling in bed.
When child on ASD suffer from cold or ear infection or chronic illnesses like asthma, epilepsy they have hard time in sleeping at right time in night.
How to Manage sleep problems:
There are chances that inability to follow normal sleep cycle is not part of ASD and its just the behavior issue which can be handled strategically like any other child who have problem in sleeping at correct time in night. Managing a child on ASD itself needs lot of patience and time and same applies while managing sleep problems with ASD. There is no particular time tested formula to get your child into routine. You have to consider things which will work best according to his or her sensory needs and work on it.
Following are the some strategies which can be followed to manage sleep problems.
Expose to bright light in morning:
Exposing your child regularly for particular period of time helps in regularizing melatonin levels in the body. Apart from this even body of your child becomes aware of the surrounding.
Positive bedtime routine:
Bedtime routine is series of certain pleasurable calming activities before going to bed which helps child to recognize that it’s time to go to bed. Keeping a routine simple and specific is the key here. Activities of bedtime routine have to be calming.
Consistency in habits:
Setting up a regular age appropriate bedtime should be first target. It should be the time when child feels sleepy but not overtired. Being consistent in habits is the important in following the bedtime routine for at least initial six months. Even a gap of one day in set bedtime routine can prompt your child to get into old habits.
Clear and repeated communication:
Make sure you give your child plenty of warning that bedtime is approaching. If your child doesn’t like to change activities with little warning, he might get upset if you suddenly decide it’s time for bed. Be consistent in how you warn your child that bedtime is approaching. You could use a cue like a clock or an appropriate picture to show your child it’s nearly bedtime. Choose something you can use or do wherever you are, including when you’re on holidays or at someone else’s house. If your child gets upset and gets out of bed, quietly and calmly put her back to bed. You might need to do this many times, especially if you’re trying to develop a new bedtime routine. Many parents of children with ASD say that returning their child to bed helps when dealing with sleep problems.
Minimizing Distractions:
Minimizing or eliminating distractions and stimulants can help in great ways to regularize sleep routine of your child. As evening approaches become a boring parent and stop playing games or activities which requires lot of energy or can excite your child. Avoid giving caffeine or sugar before a bedtime. Shut down television, video games, and other stimulating activities at least an hour before bedtime. To prevent sensory distractions during the night, put heavy curtains on your child's windows to block out the light, install thick carpeting, and make sure the door doesn't creak. You can also make sure that the temperature of the room and choice of bedding fit with your child’s sensory needs.
Deep Neutral Pressure to Body:
Deep touch pressure to body is one of the therapeutic techniques used as part of sensory diet to calm down the overactive sensory processing system of child. Deep Pressure Stimulation (DPS) is firm but gentle squeezing, hugs, or holding that relaxes the nervous system. This pressure can be applied with the hands, special massage tools, or products that your child can wear or wrap around themselves to provide pressure.
Done properly, this therapy triggers a chain reaction in the body that releases an overall sense of calm and peace. It releases some feel good neurotransmitters of the brain which help in motivations, impulse control, sleep and digestion. So why not use this amazing technique as a part of bedtime routine.
(Kindly follow the link for detail about deep pressure technique) and help child to sleep calmly.
Role of medication:
Before trying medication, it’s best to try the behavior solutions suggested above. But medication has been found to be helpful for some children with autism spectrum disorder (ASD).
For example, melatonin supplements help some children with ASD fall asleep faster. These supplements might also help children sleep for longer and/or wake up fewer times in the night. Melatonin might help improve daytime behavior in some children with ASD, but the improved daytime behavior might also be because children are sleeping better at night.
Only a doctor can prescribe melatonin. Your child shouldn’t take melatonin without medical advice and supervision.
With consistent efforts and little bit patience it is possible to develop nice and regular sleep routine for your child. it is not necessary to follow all the tips mentioned above to develop sleep routine. Being parent you the best person to know what suits your child. Identify sensory needs of child and go accordingly you will definitely succeed!
Happy Care giving!
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