Useful strategies to help children who have sleep issues
Parenting a child with additional needs can be challenging; parenting a child with additional needs who doesn’t sleep can lead many families into crisis.
There are a number of reasons why children with additional needs may be at risk of developing sleep issues. Often, parents say that they’ve tried everything to improve their child’s sleep patterns and usually they have. Every child is an individual and their sleep patterns are unique as well, so it’s important to establish an understanding of family life and what may be contributing to their sleep problems. Common triggers that are identified include sensory issues, discomfort, hunger, body clocks being out of synchronisation and inappropriate sleep associations that can’t be maintained through the night. Keeping sleep diaries can help to identify patterns and provide families with data to share with professionals.
The importance of sleep hygiene or a bedtime routine, as it is more commonly referred to, is well documented. It is important to develop a routine that your child responds positively to and that also works in line with their circadian rhythm. The circadian rhythm refers to their body clock; children with additional needs often need support in order to keep it on track. Naturally, our body clocks don’t run on a perfect 24-hour cycle; they run a little over which means that we can gradually shift our sleep patterns. Many of the difficulties that families face are around children who are not falling asleep until the early hours of the morning. Keeping the circadian rhythm on track is really important and can be done by following a good routine.
It is important to do the same thing at the same time each day, including waking a child at a regular time, even at the weekends. This helps to strengthen the body clock. Electronic gadgets, including televisions, should be switched off in the hour leading up to bedtime. The light omitted from these can interfere with the body’s production of the sleep hormone melatonin. It is the melatonin that our bodies produce that helps us to fall asleep more easily at night time. A pilot project for families of children with autism, carried out by the Children’s Sleep Charity, found that every family that restricted screen time in the run up to bedtime saw an improvement in their child’s sleep patterns.
Replacing screen time with other activities can be daunting at first. The key is to choose activities that children enjoy. Colouring in, jigsaws, model making or sensory stories are all great to help children to unwind in the run up to bedtime. Giving warnings that screen time is about to end can also be helpful for some children and the use of visual timetables may support understanding. Avoiding physical activity in the evening is also important as this may actually contribute to causing your child’s alertness levels to rise.
Dimming the lights in the run up to bedtime is helpful. Melatonin is sometimes referred to as the “hormone of darkness” and having a darkened room can help its production. Children who are particularly light-sensitive may benefit from blackout blinds, particularly those who are easily woken during the light mornings in the summer months. Children with visual and hearing impairments, however, may find a darkened room disorientating and they may benefit from having a dim but consistent night light on in their bedroom.
When it comes to sleep issues, consistency is key. Many of the difficulties that children experience with sleep are around sleep associations. A sleep association is something that an individual needs in place to be able to sleep well. For many adults, it may be a certain number of pillows or sleeping on a certain side of the bed. Most adults are able to manage their sleep associations independently, while children usually need support to do this. Many children develop sleep associations around falling asleep with a parent next to them. Another common one is falling asleep with the television on. We all wake several times each night, but if the conditions that we fall asleep with are the same, we may reposition ourselves by turning over and then continue sleeping. When things have changed, though, we are likely to wake up. The children who have fallen asleep with a parent next to them are highly likely to wake up fully during the night as the parent has become their sleep association. Liken it to somebody taking away one of your pillows when you are in your deepest sleep; when you come to a point of partial wakening you would probably wake fully, wondering where on earth your pillow has disappeared to.
It is important to ensure that conditions at the start of the night are consistent throughout the night to avoid night time wakings. Examining what is happening at the start of the night can be extremely helpful in analysing why night time wakings may occur.
Children also benefit from having a calm bedroom environment in order to promote sleep. Where possible, decorate in neutral, calm colours. Bright colours can be highly stimulating and are best avoided. Avoid light shows as part of bedtime and consider the temperature of the room; ideally, it should be around 18 degrees. If your child is noise sensitive you may wish to consider using white noise to mask out background sounds.
The Children’s Sleep Charity are currently working on a number of projects to help to support children with additional needs who have sleep issues, including a training package for staff in residential settings. It is important that night staff are trained in sleep issues and understand what constitutes a good routine. Another project is around children with ADHD, many of whom are at risk of suffering with sleep issues.
Vicki Dawson is CEO of the Children’s Sleep Charity and is also a parent of a child with additional needs. Prior to setting up the charity, Vicki was a teacher and worked with children with additional needs in a variety of settings: