Autism, ADHD, and Sleep

Raise your hand if you’re a huge fan of sleep. [raises hand wildly] I have always valued sleep and have a history of being pretty militant about bedtimes and sleep. I recently did an informal poll on my Facebook page, asking parents when they put their 12-year-old to be, based on wakeup times. I was floored at how late some kids stay up!

According to a study done by WebMD, as much as 80% of children who have autism or ADHD experience irregular sleep patterns or sleep disturbances. We know that lack of regular, good-quality sleep can lead to such problems as obesity, diabetes, high blood pressure and more.

a young boy with autism asleep in his bed

Since Autism Spectrum Disorder (ASD) is a life-long neurologic condition, this is something I wish the medical community took more seriously. Having approached my own medical teams with concerns about sleep, I know what it’s like to get that shrug and “Yeah, some kids really have trouble staying asleep.”

Silent Seizures

Up to 30% of autistic kids experience seizures. There are many things that I wish I knew about seizures, but one is very important: Seizures can be happening during sleep and you may not know it. Talk to your neurologist if you have concerns.

Managing sleep can make a huge difference in a child’s overall well-being. Read on to know more about how to identify if your child has sleep issues and how to overcome them.

How to Tell if Your Child Has a Sleep Disorder

Sleep disorders are very common in children with autism, about 40%-80% actually. That’s huge! But, should offer parents some consolation in knowing that they are not alone.

How Much Sleep, by Age

For starters, here is a guideline of how much sleep your child should be getting.

  • Ages 1-3: 12-14 hours
  • Ages 3-6: 10-12 hours
  • Ages 7-12: 10-11 hours

Signs of Irregular Sleep Patterns or Sleep Disturbances

  • Sleeps less than normal (time includes naps)
  • Has difficulty falling asleep
  • Stays up very late or wakes up very early
  • Gets up in the middle of the night to play for an hour or more
  • Has disturbed sleep: tossing and turning, head-rolling
  • Has difficulty breathing while asleep, snoring, etc.
  • Very tired during the day despite (seemingly) being in bed all night

It’s a good idea to keep a sleep diary for your child. It would help keep track of their sleeping patterns and disturbances. This information can be used by your doctor to help with a diagnosis. Push for a sleep study or EEG if you suspect seizures! They can be happening without you seeing them.

What Causes Sleep Disorders?

First, you want to talk with your pediatrician or neurologist (or developmental ped) about sleep issues and rule out anything medical. Sleep apnea and other disturbances can happen even if you don’t hear snoring. Before getting a sleep study done on your child, your doctor may recommend that you keep a sleep diary. So I would do that before you ask, so you already have it out of the way.

These are some factors that might be causing a child to have troubled sleep.

  • Daytime habits
    • Not getting enough physical activity during the day
    • Taking long naps (more than 20 minutes) late in the day
    • Eating too much dinner and/or eating too late in the evening
    • Consuming caffeine or sugar in the evening
  • Bedtime habits
    • Exposed to a lot of noise and activity before bed
    • Doing something different every night
    • Falling asleep on the couch or parents’ bed
    • Needing to put a lot of toys beside them on their bed
    • Having a bedroom that is too hot or cold, noisy, and has too much light
  • Social/mental health challenges
    • Not being able to say or ask what they want or need, which keeps them up
    • Anxiety about certain issues or incidents
    • Not noticing social cues like not understanding that it is bedtime when people start preparing for bed
  • Melatonin imbalance
    • Not releasing tryptophan, an amino acid to make melatonin during the night
    • Producing melatonin during the day makes them sleepy

What Are the Effects of Having Sleep Disorders?

Children with ASD who have a poor quality of sleep tend to behave differently than how they normally would. They can be a handful and unruly. You might think that they are just like that, but in reality, they just might not be getting enough good sleep at night. Here are some of the effects that you can see when your child has sleep disorders.

  • Shows signs of aggression – It’s normal for people who lack sleep to be irritable. If your child is grumpy and petulant, it may the effect of not having enough sleep.
  • Shows signs of depression – Since there is an imbalance of chemicals happening in their brain, it may cause them to feel unhappy and stressed.
  • Displays hyperactivity – If your child is unable to keep his attention on one thing, is fidgety and seems like he has to do something all the time, he might be experiencing hyperactivity.
  • Performs poorly in class – Since your child is hyperactive and can’t concentrate on lessons, he is not learning and is unable to follow instructions for the activities. This results in poor learning and bad grades.

If your child is experiencing sleep disorders, chances are, you are not getting quality sleep either.

How to Help Your Child Get Better Sleep

You don’t really need to spend a fortune on medications and therapies for your child to get better. In fact, you can do everything right at home. All you need is patience and persistence to do it every day.

The most important thing to do is build a routine.

  • Keep a daily schedule
    • Determine the time when your child needs to sleep and wake up.

For example, your child is a 5-year-old who needs 10 – 12 hours of sleep. He has to be in school by 8AM. It takes him over an hour to prepare in the morning. This means that he has to be up at 6AM. To get at least 10 hours of sleep, he has to be in bed by 8PM every night, even on days without school.

  • Move your child’s bedtime to the ideal time.

When you start this new schedule, most likely, your child’s sleepy time is different. What you should do is move the time he goes to bed gradually. Every 2 days, adjust the time by 15 minutes until you reach the ideal bedtime. Having a fixed bedtime every day will help your child fall asleep faster.

  • Daytime habits
    • Start the day by giving your child a healthy breakfast or a smoothie with fruits, milk, and yogurt.
    • Just like plants, he needs bright sunlight in the morning to stop his body from releasing melatonin, the hormone that makes him sleepy. This should keep him alert in school.
    • Avoid candies, chocolates, soda, coffee, tea, or energy drinks from late afternoon onwards. These contain caffeine and sugar which keep him up at night.
  • Bedtime habits
    • At least an hour before bedtime, no more stimulating activities, like running around, watching TV, and playing video games.
    • Make your child’s room comfortable for sleeping. Use heavy curtains, thick carpets, and set the thermostat 60 to 67 degrees Fahrenheit (15.6 to 19.4 degrees Celsius).
    • Place the clock somewhere your child will not be able to look at it while in bed.
    • Create a nighttime routine: taking a bath, brushing his teeth, reading a book, etc.
    • Institute a “relaxing diet” much like a sensory diet, in the evening. You can do this by reading a book, practicing deep-breathing exercises, playing soft music in the background, and giving a gentle massage.
    • Monitor your child’s sleep. Make sure there is no snoring, he can breathe normally, and he’s not tossing and turning or sleepwalking.
    • While it might seem silly, think outside the box. If worries are keeping your child up at night, think about something like a worry doll. You just never know what might work!
    • If his sleep is disturbed during the night, patiently put him to sleep by repeating the bedtime routine.

Keeping a routine will help your child with autism get a good night’s sleep and improve his overall well-being. After just 2-3 nights of following a routine, improvements can often be observed. If you don’t see immediate results, don’t fret, for some children, it may take 2-4 weeks. However, if your child still hasn’t improved after 4 weeks, it is better to consult your family doctor or pediatrician for help.

Tough It Out Method

It’s hardly ideal, but we have done this a few times over the years. First, we stuck to all of our nighttime routines. But, we also did a few other things. I made sure that all toys that make noise were either turned off or removed from the room. I also have a video monitor to keep an eye on him during the night (mostly for seizures). But, then I used a babygate and let him go in his room.

If he wants to wake up in the middle of the night and look at books in the dark, and he falls asleep on the floor (usually what happens) then so be it. I just made sure he is safe, keep an eye on him with the monitor, but I don’t fight it. Getting up in the middle of the night a zillion times and returning him to his bed was making us both nuts. Sometimes his nighttime waking happens a few days in a row, sometimes it lasts a few weeks.

But, I just make sure that he’s safe and let it go. I always tell his team when he’s going through one of these spells in case he has extra seizures due to sleep deprivation or is cranky and irritable.

Good luck and hang in there!

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