Why sleep difficulties occur and what we can do about them
Most parents will at some time experience sleep deprivation. Lack of sleep can lead to feelings of depression, ill health and poor functioning. Usually, sleep deprivation occurs only for a short period of time but for some families, particularly those where the child has SEN, sleep deprivation can continue for many years.
What are the affects of sleep deprivation?
If a child is not getting enough sleep, they cannot function to the best of their ability. Over-tired children can even present as being hyperactive. The immune system can be affected by lack of sleep, leading to a child becoming ill more frequently. Sleep deprivation can impact negatively on mood and behaviour; a tired child is generally not a happy child.
It should also be noted that when a child has sleep difficulties the impact is felt by the rest of the family. Parents may be struggling to manage on less sleep than they need and siblings can also be affected.
Why do children with SEN have sleep difficulties?
All children are individuals and their sleep problems are unique too. There are, however, some common themes that can be identified when working with children with SEN. If you are going to begin to work on solving a sleep difficulty, it is essential to understand what is causing it. Some of the common reasons include:
- lack of routine
- difficulty understanding the difference between day and night
- medical issues, for example medication, feeds given during the night or epilepsy
- continence issues
- visual impairment, which can affect the circadian rhythm (body clock)
- sleep apnoea, which is particularly prevalent in children with Down’s syndrome
- inability to settle.
Acknowledging sleep problems
Parents often feel judged if their child is not sleeping well. As children get older, the presumption is that they will sleep for longer periods at night.
Parents are often worried about seeking help for fear of being judged as a failure. Siobhan shares her experience: “My son used to be up and down all night, it was horrendous. He has a visual impairment and I never realised that this could impact on his sleep. I talked to the health visitor but she didn’t give me any advice. In desperation, I went to see my GP and explained the problem. He lacked empathy for my situation and told me that he thought that I should go away, as he certainly would not prescribe anything to tranquilise a healthy child. I’d not been asking for medication, I just needed some advice. I went home feeling like the worst mother in the world. After that incident I never admitted to another professional that my child had a sleep problem.”
It is extremely important that sleep problems are acknowledged and that parents have somewhere to share their concerns. Many parents report feelings of isolation when their child has a sleep difficulty and most feel that being given the opportunity to share their problems is helpful.
Solving sleep problems
There are some simple steps that parents can take to help to solve their child’s sleep difficulty. Medical advice should be sought to ensure that sleep problems do not require medical intervention. Sometimes it is necessary for children to spend time in a sleep lab where their nocturnal activity can be closely monitored.
A bedtime routine is important and should be implemented with all children. Televisions and computers should be turned off an hour before bedtime and substituted with more relaxing activities, such as jigsaw puzzles, massages or craft projects. The same sequence of events should occur at the same time each night.
Visual timetables can be an extremely useful tool to aid the bedtime routine. Children can use a visual timetable to see exactly what comes next in their routine. Many children with SEN respond extremely positively to visual timetables and they are also useful for keeping the bedtime routine on track.
Keeping a sleep diary can be an excellent way of working out whether a child is napping too much in the day and establishing whether there are any patterns to the sleep difficulties. It is also worth checking with school and escorts on transport to find out if the child is having any additional naps during the day. Sleep diaries are also useful to share with professionals. A sleep diary should note the time the child goes to bed, how long it takes them to settle, any night awakenings and what time they wake each morning.
Establishing the difference between day and night is vitally important. Sometimes children with SEN need some extra cues to help their sense of time to emerge. Playing a set piece of calming music each night to indicate that bedtime is approaching can be helpful. The environment should be dark to increase the production of the child’s melatonin, which helps them to sleep. Blackout blinds and curtains can help with this. Telling the child that it is night time and what this means, using a simple sentence such as “it is night time; go to sleep”, is a useful strategy. Scents can also be used to give an additional sensory cue; lavender is a favourite to use at night time. Ensure that morning time contrasts by playing a piece of rousing music; brass band music is ideal. Open the curtains to let the light into the room and state, “it is morning; time to get up”.
Victoria Dawson is a trained sleep practitioner and teacher and has worked with families of children with SEN for the last fifteen years. She is co-author of a number of books, including Special Needs: A Parent’s Guide, and Special Needs Child: Maintaining Your Relationship:
If your child is under five years old, you may seek the support of your health visitor for sleep problems.
This article was first published in issue 49 of SEN Magazine (Nov/Dec 2010).