I have taken some useful tips from a great book called 1000 Great Ideas for Teaching and Raising Children with Autism Spectrum Disorder by Ellen Notbohm and Veronica Zysk for parents to try with their kids if the child is having trouble sleeping at night. It may take a little bit of time for you to notice a difference, so make sure to be patient and give each tip at least 2 weeks.
It’s important to understand the different sleep disturbances and how best to help them.
· Problems going to sleep generally occur because of lack of a bedtime routine, lack of specific bedtime, or lack of a clearly defined sleep location, including both a bedroom and a bed. Intermittent problems going to sleep can arise from a long daytime nap, fears such as a monster in the dark, too much stimulation just before bedtime, or a medication side effect.
· Problems staying asleep can be cause by falling asleep in one location and being transferred to a regular bed, a caregiver leaving the room after the child has fallen asleep, needing to eat or drink at night, medical effects, medical illness (ear infection), daytime stressors that cause bad dreams, or unexpected external noises.
· Problems with sleep phase (the time when the child normally falls asleep and awakens the next morning) result from excessive stimulation, letting a child decide when to go to bed, or changes in the Circadian rhythm. Disruptions during sleep can be caused by sleepwalking, bed-wetting, teeth grinding, head-banging, and night terrors.
Ten strategies to help restore sleep
1. Start a sleep diary and document exactly when and how often the problems occur.
2. Look for physical problems that can impair sleep.
3. Look for behavior problems that can impair sleep.
4. Set up a regular bedtime routine and stick to it; use visual cues or a visual schedule if needed.
5. Avoid excessive stimulation before bed.
6. The child should fall asleep in the location that is meant only for sleep- his bed.
7. Create a sleep environment—quiet, dark, controlled temperature, and a comfortable bed and linens.
8. If the child often wanders out of his room, consider gating the doorway or installing a Dutch door with the top open and the bottom locked.
9. Survey the room for disturbing items: clicking clocks, tree limbs that scratch against the window or side of the house, the on/off hum of the heating or cooling unit outside or next door, the feel of the sheets or the pattern.
10. Maintain the same sleep environment when the child is falling asleep as will exist when the child stays asleep or wakes in the middle of the night. That means parents should resist staying in the room until the child falls asleep.
Children with autism may have atypical proprioceptive and/or vestibular issues contributing to their sleep difficulties. Here are some tactics that take those characteristics into account:
· Pajamas: Long-john type pajamas provide gentle pressure all over that may be comforting. Loose pajamas, nightgowns that ride up, fabrics that scratch or pill, buttons, ribbons, or embroidery that scratches or produces bumps, and elastic around ankles or neck are all possible irritants.
· His sleeping space: Is his sleeping space so big he might not feel boundaries? Try a tent, canopy, or hanging curtain around the bed.
· A sleeping bag or weighted blanket (consult an occupations therapist before using these) might help.
· Taking a “lovey” to bed is a common childhood practice, but the usual teddy bear or dolly may not be your child’s lovey of choice. However odd, accommodate his preference, as long as it’s safe. We know one child who adores his whiskbroom and took it to bed with him every night.
· Rubbing your child with lotion before bed can provide great proprioceptive input, but beware of perfumes and scents that may bother him as he tries to go to sleep. Be especially aware of competing scents such as soap, shampoo, lotion, and toothpaste, all from the bedtime routine, may each have different perfumes that combine for a nauseating effect.