Research shows that over half of children with Autism - and possibly as many as four in five - have one or more chronic sleep problems. Even adults on the spectrum have increased incidence of insomnia. These sleep issues may interfere with learning, mood and overall quality of life.
Our Becca is no stranger to sleep problems. When she was a baby, it would take her exactly three hours from the time she went into her crib to settle down and finally fall asleep. It didn't matter whether she napped or not, or what time she napped, or what time we put her in the crib. It always worked out to three hours of crying and my husband and I taking turns and singing with her or rocking her and trying any and every thing for her to fall asleep. At one point, we thought that she just might not be ready for sleep, and we took her out and tried again an hour later. That didn't work - all it did was delay the three hour struggle by an additional hour.
As she got a little bit older, falling asleep got much easier. The struggle became staying asleep through the night. Becca has a lot of sensory sensitivities, so if the temperature of the room wasn't quite right, or if we didn't use the right blanket, or if she happened to turn around while asleep there was a chance she would wake up. And once she is awake, she is awake and has a hard time falling back asleep. We started experiencing "split nights", where Becca would fall asleep at a decent time, sleep for about three or four hours, wake up for about four or five hours, then fall back asleep. Split nights started to wreak havoc on our daytime routine which also derailed the nighttime routine and caused a vicious cycle of sleeplessness. By the time Becca started preschool at age 3, she was having split nights more often than not, and my husband and I were getting very little sleep. And not only were we getting very little sleep, Becca was missing a lot of school, since I couldn't possibly send her to school on days where she only fell asleep at 6am and had only gotten three hours of sleep prior. And because Becca was missing school, she was missing out on her therapies, and I would have to work from home while functioning on only one or two hours of sleep.
Becca is now five years old, and while her sleep has gotten much better, we still experience split nights a few times in a given month. While the situation is nowhere near as severe as it was a year ago (and I am grateful for the progress Becca has made in this area), sleep disturbances can have an adverse affect on learning, concentration, mood, behavior, and school attendance and progress - and not to mention the negative effects on parental functioning. Some studies have suggested that as many as 85% of parents of children with sleep disturbances present with poor sleep patterns themselves, and that indicators of stress, anxiety, depression and diminished quality of life are more common in parents of children with sleep problems.
School is starting this week, and while I would be dishonest if I said that I wasn't nervous about Becca's sleep disturbances and how they will affect her attendance this year, I will also say that we have learned a lot as we have navigated this issue over the last few years and that taking a few steps can help to mitigate some of the effects of sleep problems both for Becca and for her mommy and daddy.
Have a consistent sleep routine. We have found that sleep disturbances increase when Becca is taken out of her routine. While we can't always adhere to routines perfectly (for instance, vacations necessarily take us out of our normal routine), we try to adhere to the nighttime routine as much as possible. This is easier to achieve during a staycation, but not impossible when we are away. Packing familiar blankets, preparing her nighttime leche just the way she likes it, having her nighttime music - all of these can help send the cue that it is time to start winding down for sleep.
Many have asked me about the use of melatonin and sleep aids - specifically, why we have opted not to use these. We did use melatonin for some time, but the issue with melatonin is that as the child's body gets used to melatonin, increasingly higher doses are needed to achieve the desired effect. Prolonged use of melatonin is also associated with side effects; namely, it may actually prevent the child from falling asleep which is the exact opposite of what we need. These days we are using Hiya Kids' Bedtime Essentials which is made from a blend of natural ingredients that combine to promote calm, focus, and improved brain health. Their formula includes natural amino acids that promote relaxation and support REM sleep quality. This combination of amino acids works to promote relaxation before bedtime and naturally improve the child’s sleep habits, rather than putting the child to sleep. What really sets Hiya apart is that it is one of the only kids’ supplements on the market that’s used for bedtime but contains zero melatonin. And we have found that since switching over, Becca falls asleep with less fussing and crying than she used to when she was taking melatonin.
NOTE - Every child is different and what works (or doesn't work) for Becca doesn't work for everyone. Some children need medication to fall asleep and stay asleep and not everyone has the kind of employment or family situation that's conducive to staying home with the children if they had a sleep disturbance. These are very real decisions that are specific to individual family circumstances and the health situation of each child. Each family needs to assess what works or doesn't work for their child and their overall family functioning.
Try to avoid naps after a certain time. If Becca starts to fall asleep earlier than usual, I do very engaging sensory activities to keep her awake, and then give her a soothing bath and start winding her down closer to the time that I want her to fall asleep. Of course, if she absolutely needs the nap, I won't deny it but I try as much as possible to keep her on schedule.
Check the sleeping environment and make sure that it meets your child's needs. Lighting, temperature, bedding - it all plays a role and so you want to make sure you've created the right sleeping environment to increase the chances that your child feels comfortable enough to sleep through the night.
This is for the caretakers - try to resist the urge to stay up for a few hours after your child falls asleep. This can be tough because I need time to unwind after Becca falls asleep but I have learned to limit this time so that in the case that Becca is awake after three hours, I have at least some sleep on me. Some parents have told me that they actually sleep through their child's sleep disturbances - so the child is awake and they have some safeguards in place such that they can stay asleep while the child is awake. That wouldn't work in our case because (1) Becca is still very young and (2) she requires substantial support and supervision. So if you are also in our situation and can't sleep while your child is awake, then it makes sense to try to sleep as close to when your child sleeps as possible. Too many times, I have had the experience that Becca woke up before I turned in for the night, and so I wound up being up all night. So now, I try to limit my "unwinding" time to about an hour after Becca falls asleep. I am no good if I can't function.
If you have other caretakers in the home who can assist, you can discuss having sleep shifts if the child wakes up, so that each caretaker is only up for part of the split. This will allow you to still get some sleep even if the child is awake, and the child is still being supervised.
Seek medical advice. Becca has a sleep specialist and we are waiting on a date for her sleep study which should help us find additional ways to support her in getting quality sleep.
Be honest with your child's school about any sleep challenges your child may be experiencing. Document any absences and provide medical documentation whenever relevant. The school may have additional resources to help and they will also be kept in the loop in the case that your child is missing school due to sleep disturbances.
You may find that you do everything you can - take the right supplements, prepare the right environment, keep the right routine - and there is still a split or other kind of sleep disturbance. I find that they can't always be avoided. We still have them a few times in a given month (down from multiple nights in a given week a year ago, so I'm happy). If it still happens, encourage the child to go back to sleep, avoid screen time and keep the lighting suitable for sleep, but if it's been some time and it doesn't happen, just let the child be. He/She will go back to sleep eventually, and no sense frustrating the child and yourself trying to force that child to do what he/she is not ready to do. Just grab your largest mug of coffee and enjoy the party!
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