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Help, my child won’t sleep!

Struggles with sleep can be common in Autistic children and adults but they can usually be resolved. Improved sleep will help with performance, learning, skills and mood and will benefit the entire family.

Sleep problems can be varied, ranging from sleeping with parents, trouble falling asleep, waking up too early, waking in the night, and having a hard time getting back to sleep. It is also important to check out any medical or psychiatric issues that may interfere with sleep including medications that may need to be adjusted or given at a different time.

The first place to start in helping your child get better sleep is the time before bed. Many refer to a planned sleep routine as "sleep hygeine." It is helpful to have a set routine that is calming, predictable and specific to the individual's sensory needs. A visual schedule can be used to guide the short order of the steps. Quiet music, low or dimmed lights, switching off electronics or dimming their screens may be helpful. Keeping the routine the same on weekdays as well as weekends can also help.

What happens during the daytime can also affect your child’s sleep that night. Some children are sensitive to bright light, or do not spend much time outdoors. This lack of bright natural light can throw off their internal circadian rhythms. Try to get outdoors as much as possible during the day to help reset that system. Sunglasses or hats may help those that are sensitive to the light as can playing in a shaded area. Regular exercise or movement, especially those that cross the body midline and are repetitive or calming to the sensory system, are most helpful. Try things like walking, swinging, jumping rope, balance beams, and bike riding. Play that provides deep impact to the muscles and joints can also be very helpful to some children. Anything that uses their body weight like jumping, rolling, bouncing, pushing, or pulling can be helpful as can lifting or carrying heavy objects.

There are also social inputs to the pattern of sleeping and waking. The lack of social interactions and peer social cues can throw off the circadian rhythm, so attempt to keep the rest of the family on a sleep routine as well.

Food choices and naps can also affect sleep. Caffeine and naps should be avoided too close to bedtime. A light snack an hour before bed might help some children fall asleep faster. Melatonin may be helpful, but please talk to your child’s pediatrician before trying this, as it may interact with other medications.

At bedtime follow the routine but also give your child choices. Some may prefer reading a story while being rocked in a rocking chair while others may soothe themselves by bouncing on a yoga ball to a favorite song. The sleeping environment can be very important also. A favorite color of nightlight, weighted blankets, a bed tent, pajamas with no seams, a favorite toy or object, or fidget can help bring on sleep.

Children who prefer to sleep in their parent’s bed may need a little extra help when transitioning to their own bed. We started by laying down in our son’s bed with him till he fell asleep. Then every few nights we would move away a little bit, just a few inches. We transitioned to laying on the floor next to the bed and finally to sitting on the floor by the door. Your child may not do well with tiny steps and cold turkey may work better for them. You know your child best. Whatever you choose, keep a calm and positive front when working on it. Any pressure or frustration you show will add to the tension. Try to keep this time as worry and anxiety free as possible.

Remember to work as a team and remove the pressure on the family as much as possible. Maybe a family member or respite worker can help with childcare while you grab a nap if you’ve been up with the child. Take turns with a spouse so one person doesn’t become overly frustrated or tired. One of you can sleep in while the other one gets an afternoon nap.

A referral to a sleep specialist may be necessary for more complex problems like sleep walking or night terrors, anxiety, sleep apnea, restless leg syndrome and insomnia. These issues can be resolved but may require equipment, medication or therapy that is only available from a specialist.

Learning to self soothe and fall asleep on their own are developmental milestones and all children reach those milestones at different times. Some may even regress especially in times of stress. Don’t forget that acquiring new skills can be very stressful as can any changes to the household or therapy. These milestones are unique to them so don’t try to rush anything. They will succeed in sleep at their own pace with your help and support.

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