Sleep: Autism and Beyond
Why is Sleep Important?
Sleep is an essential skill for children to learn in order to be healthy and ready to participate in all that life has to offer. Optimal sleep helps to ensure children are able to learn, play, grow and participate in daily activities either at home, school or in the community.
How Much Sleep Should a Child Get?
| Age | Night-Time Sleep (hrs) | Naps | Total Sleep (hours) |
| 0-2 months | 8-9 | 7-9 (3-5 naps) | 16-18 |
| 2-4 months | 9-10 | 4-5 (3 naps) | 14-16 |
| 4-6 months | 10 | 4-5 (2-3 naps) | 14-15 |
| 6-9 months | 10-11 | 3-4 (2 naps) | 14 |
| 9-12 months | 10-12 | 2-3 (2 naps) | 14 |
| 12-18 months | 11-12 | 2-3 (1-2 naps) | 13-14 |
| 18 months-2 years | 11 | 2 (1 nap) | 13-14 |
| 2-3 years | 10-11 | 1-2 (1 nap) | 12-14 |
| 3-5 years | 10-11 | 0-1 | 10-12 |
| 5-12 years | 10-11 | N/A | 10-11 |
Children with Autism Spectrum Disorder (ASD) are at greater risk of sleep problems (40-80% in comparison to 20% of children without a diagnosis). Problems can include all aspects of the sleep process, including trouble falling asleep, waking frequently throughout the night, and waking early in the morning hours. Given what we know about how sleep impacts our attention, emotional regulation, and socialization, it is that much more imperative that we help our children with ASD be well rested.
How Does this Influence a Child with ASD?
Difficulties with sleep can create several challenges for an individual with ASD.
1) They may have difficulty maintaining a calm state due to their difficulty with emotional regulation skills and this can greatly impact both their daytime AND nighttime behaviors. Some children with ASD engage in sensory seeking behaviors which make it difficult to settle down and impedes their ability to fall asleep. Other children, may have sensory sensitivities and may negatively react to the material of the bedding or pajamas, unexpected noise or even lighting levels which will also contribute to sleep challenges.
2) They may have challenges in preparing for sleep due to their difficulty transitioning from preferred or stimulating activities to sleep.
3) They may have difficulty developing routines that prepare them for sleep as they may not understand that it is time for sleep or the importance of sleep due to their decreased language and communication skills.
What Can We Do?
Occupational Therapy (OT) is one of the most utilized services for individuals diagnosed with ASD. However, OT’s are also frequently utilized for individuals with sleep difficulties with other diagnoses OR no diagnosis at all! A variety of approaches are used by OT’s to help problem sleepers, some of which include:
1) Bedtime Scheduling- collaborate with parents to establish a sleeping schedule and keep the times for naps and bedtime consistent
2) Positive Bedtime Routines- children with ASD typically respond in a positive way to routines and schedules. A nightly routine is established with mild variations of calming activities (including brushing teeth, reading a story, etc.)
3) Bedtime Fading– used when a child has an excessive sleep onset time (length of time it takes to transition from full wakefulness to sleep) and therefore this decreases the number of hours they actually sleep. This process involves measuring the length of time it takes the child to fall asleep and then keeping the child up that much later the following night so they can be put to bed at a more optimal time and decrease the length of sleep onset.
4) Sensory Strategies- provide child with several calming activities during bedtime routine. These could include using a vibrating toothbrush while brushing teeth, playing soft music, dimming lights, slow rocking while reading a bedtime story, using calming scents (lavender, vanilla, cinnamon, peppermint), using 100% cotton sheets or pajamas, using weighted/ heavier blankets in bed, providing child with several pillows to obtain deep pressure (proprioceptive) input while sleeping, etc.
5) Limiting screen time- avoid iPads/tablets, smart phones, computer screens and televisions at least one hour before bedtime as these have stimulating effects on children and can interfere with their melatonin (sleep hormone)production.
6) Adapting bedroom environment- limit visual stimuli. A child’s bedroom should be calm, uncluttered and have very few toys to limit the amount of visual stimuli present in their environment. Lights can also be dimmed while getting ready for bed to signal that bedtime is approaching and to aid in lowering their arousal.
Written by Dara Burke: Occupational Therapist at Simone Friedman SLS
Sources:
Skundberg, K & Phelps, K (2013). Effective interventions addressing sleep as an occupation for children with autism spectrum disorder. ProQuest Dissertations Publishing, 1552921
http://www.babyzzz.ca/how-much-sleep-does-your-child-need/
https://www.autismspeaks.org/science/science-news/new-government-survey-pegs-autism-prevalence-1-45
