Dr Elaine Clark Consultant Paediatrician
Jan 17, 2016
Dr Elaine ClarkConsultant Paediatrician
Sleep disorders and Autism
Around two-thirds of children with ASD have sleep disorders. (Richdale 2000)
Children with ASD can have sleep problems from 18 months onwards
Parents of children with autism have more sleep problems that parents of “typically” developing children.
What we will be coveringWhat is normal sleep?What do we mean by sleep problems?Why children have difficulty with
sleeping?How we can help them to sleep?
What is normal sleep?
Teenagers????Natural not to fall asleep before 11pm. Hormonal changes programmed to fall asleep
around 2 hours later.Need around 9 hours sleep.
Consideration of allowing teenagers to start school later.
What we will be coveringWhat is normal sleep?What do we mean by sleep problems?
Why children have difficulty with sleeping?
How we can help them to sleep?
Sleep DisordersDifficulty falling asleep
Difficulty staying asleep
Early waking
Night terrors
Sleeping in parent’s bed
What happens when children are sleep deprived?
Daytime sleepiness?
Sleep monitoring in school age children 2-4th Grade
Fragmented or less sleepMore behaviour problems reported
by parents and teachers
Older students decreased academic performance
What we will be coveringWhat is normal sleep?What do we mean by sleep problems?Why children have difficulty with sleeping?
How we can help them to sleep?
Lack of routineUnpredictabilityBed time differs each nightFalling asleep in various
places
Fear DarknessBeing aloneThe unknownNoiseSilence
DarknessBeing aloneThe unknownNoiseSilence
AnxietyPerseveration of thoughtsThings changing while they are asleep.Occurrences during that day/week/year.Things that are about to happen
Be aware that your own tone of voice, feelings and body language will affect your child.
Social senseWhy we need to sleep?When we need to sleep?Connection between going
to bed and going to sleep.
EnvironmentMoving to their own roomChanges to roomLighting: fluorescent light reported to hurt
eyesNoises: squeaky door, sound of TV, parents
going to bedSmellsTouch: one lady unable to sleep if one leg
was touching the other.Visual: colour, patterns, toys, shadows.
Why children with ASD can’t sleep?"Sleep was not a secure place. Sleep was a
place where darkness ate you alive. Sleep was a place without colour or light. In the darkness you could not see your reflection. “
"I was afraid to sleep, always had been. I would sleep with my eyes open and I did this for years”
by Donna Williams
ChemicalCaffeine and sugar rich foodsMelatonin: a hormone produced in the brain in
response to reduction in light. Causes drowsiness at dusk in humans. Levels begin to increase 2 to 3 hours before sleep.
Spring time melatonin production starts 20 minutes later than Winter
Children with ASD produce lower levels of melatonin at night time than “normal” Tordjman 2005
? Serotonin ? GABA
Teenagers? Going to bed too earlyEating or drinking too lateComputers/TVMobile phones!!
The average teen sends 97 texts per day!
What we will be coveringWhat is normal sleep?What do we mean by sleep problems?Why children have difficulty with
sleeping?
How we can help our children to sleep?
Every child is different
Establish a RoutineWill respond to structureVaries between individualsSet time for dinner, bath, story and bed.
VISUAL TIMETABLEMay need to breakdown into individual steps
e.g draw curtains, get in bed, cover up, light off.
Include what will happen after sleep finishes!
Relaxation techniquesLavender oil in bath, pillow sprayMassageOne hour’s quiet time before bed
(everyone so not mixed message)MusicLava lampExercise (physical exhaustion)
EnvironmentMay be over or under sensitive to sight,
sound, smell, touch, taste or temperature
Autism friendlySafeCalmNeutralFree from distractionsSmell
Difference in Day and NightTell them “It’s night time!”Different scents for day and nightDifferent musicBedroom should look different at night time
i.e. less playfulAlarm clocks
KID'Sleep clock
VisualFurniture at the sides of room with central
space clearLow arousal colour: creamNo patternsBig plastic box to put toys in to reduce
distraction.Avoid slatted blinds (obsessions and visual
sensory seeking) curtains preferable pull down balck out blind best
LightingAvoid TV screen/ computer screens: these
have been shown to suppress production of melatonin and delay onset of sleep.
Dim lightingAdjustable lightingRed light better than blue/green lightThick curtains/ black out blinds
NoiseDouble glazingCarpets rather than wooden floorOil hingesEar plugsMusic
“ White noise” masks out background noises that may distract.
TouchPillowsMaterialsLabels on night
clothes
Weighted blanketSleep suitsDouble duvet tucked
in
FearsAllow child time to talk about fears
in day.Address specific fears if known.Reassurance.Worry dolls/ beads/ box
Social senseSocial stories to help with understanding of bed
time
A Social Story is a short description of a particular situation, event or activity, which includes specific information about what to expect in that situation and why.
Story books Tell Me Something Happy Before I Go To Sleep Joyce Dunbar. WH Smith (2006) This book is useful for addressing children’s night time fears.
How Will I Ever Sleep In This Bed? Capucine Mazille. Sterling (2007) This book addresses the issues of moving to a ‘big’ bed.
Go To Sleep Daisy Jane Simmons. O’Brien Press Ltd (2000) The story of Daisy Duck who can’t get to sleep because she is
disturbed by the noise of the other animals.
Can’t You Sleep Little Bear? Martin Waddell and Barbara Firth. Walker Books (1998) A bedtime story about a bear who is having trouble sleeping because
of his fear of the dark.
ChemicalsRemoving stimulants: change to decaf, sugar
free or reduce amountNatural remedies
Medication: antihistamines, melatonin,Specific medication for anxiety, ADHD, OCD
MENDS trialLarge study to look at the effect and
safety of melatonin use in children with neuro-developmental disorders. Appleton 2011.
262 children age between 3-15 years 92 children improved with sleep hygiene
measures146 entered into trial Melatonin vs
placebo
ResultsWith Melatonin 0.5mg to 12mgTotal sleep time increased by about 23
minutes (1-45mins)Time taken to get to sleep reduced by
about 37 minutes (55 to 20 mins)
Safety outcomes: No safety concerns
TeenagersKeep environment cool, dark and quietReduce caffeineReduce late fatty foods and snacksDo not allow to do homework too lateTurn off TV/ computer and phone 1 hour
before bed timeDo not allow to sleep with mobile phone
Keep weekends and holidays as consistent as possible.(no more than 2 hours different to normal)
Sleep for parentsYour health and well being affects your
child’s behaviourRelaxation techniquesKnow you child is safe.Consider respite.
SafetyLocks or high handles on cupboardsElectric sockets in locked cupboardsPlug locksBoxed radiatorsSafety glassNon-toxic paint
Reinforce good behaviour/sleepPraiseHugsPictures e.g. happy faceStar charts
Complete solutions section
How we can help
Community Matrons
Paediatrician
Sleep disorder clinic
Health Visitor
How to get more help?Keep a sleep diaryAsk for referral to Paediatrician
Information on sleep for parents at www.dcsf.gov.uk/everychildmatters/earlysupport
Sleep solutions www.sleepsolutions.org.uk 01432 355308