ADHD and Sleep
Have you ever walked into your child’s room to find them sleeping on the floor? I mean, you put them in bed, and you find them curled up on the floor. Or, if you’re like me, you feel like your autistic child is sleeping too much.
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.
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.”
First, let me tell you that I am militant about sleep, for all members of my family. I also want to remind everyone that I am not a doctor nor do I play one on the internet.
Lack of adequate sleep has been linked to everything from obesity, diabetes, heart disease and more.
Sleep has so many health benefits, including:
- Reduce inflammation which can lead to cancer
- Improve memory
- Cell repair–so your body goes through repair and restoration
- Can reduce stress and depression
I mean, think about it. As adults, we feel like crap when we don’t get enough sleep, right? So why would we expect our kids to respond any differently?
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.
Autism and Its Effects on Sleep
Researchers are just beginning to uncover how autistic individuals differ neurologically when it comes to sleep.
But, if a child is neurodiverse, and processes stimulation differently during the day, why would we think that it would be any different in the overnight hours?
Seek Professional Help for Autism and Sleep
The first thing you want to do is reach out to your child’s pediatrician. They may refer you for a sleep study, or ask for one.
A sleep study is often a joint effort between a pulmonologist (who handles sleep apnea) and a neurologist (will evaluate the brain’s activity).
If you are referred for a sleep study, it is likely they will ask you for a sleep diary. I have provided a free printable sleep tracker at the bottom of this post for you to get started. You can print it today and start working on it while you’re waiting for your appointments.
What causes sleep problems with autism?
First, you want to rule out anything medical. As stated above, please rule out anything medical. Many people don’t know this, but there are about 40-50 different types of seizures. Many of them happen while a child is sleeping. There is even a phenomenon known as ESES, which is a type of sleeping seizure activity.
Not all seizures are the “grand mal” kind we think we know. Many are invisible, except on an EEG or sleep study. Approximately 30% of autistic individuals also have some kind of seizure activity.
I can’t stress enough how important it is to get this checked out. Please follow up on it.
Also, if your child has global hypotonia, that means they have low muscle tone everywhere–INCLUDING their breathing passage. Low tone can lead to sleep apnea.
Sleep and Sensory Issues
During the day, our kids process information and sensory input differently than we do. This would include their interoception. (click that link if you don’t know what interoception is)
So, at night, even while lying in bed, it would make sense that they are still processing information differently than we do. Some examples could be:
- The hum of a ceiling fan or furnace may be unbearably loud.
- They may be too hot, too cold, too uncomfortable.
- Some kids need closure and cannot rest until a particular activity has been completed.
- They may feel and hear things that we typically can ‘tune out’ but they do not have that skill set.
In addition, our kids’ neurodiversity doesn’t end at 9:00 every night. My child actually stims in his sleep and always has. Looking back on my pregnancy, he never stopped moving. You’ll never convince me that he wasn’t stimming in utero.
- They may struggle with the transition from active to inactive.
- The quiet time may bring anxious fears to the surface (like it does with many adults)
- My child does some of his stereotypy even while he is sleeping; active hand and body movements that I see during the day.
My Autistic Child is Sleeping Too Much
Our bodies require a certain amount of sleep to perform adequately. The specific requirement varies by age, health status and a few other factors.
Some people are just wired to require less sleep. It is rumored that people like Martha Stewart and Apple CEO Tim Cook only sleep 4 hours a day.
Autism and Sleep
My son actually sleeps 12 hours a day, 7-7, every day. And, he’s a teenager. We’ve tried a lot of different things and have seen many specialists. Here are some tips to get you started with some autism sleep help.
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 be 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.
- Cognitive issues-Insufficient sleep is linked to poor memory skills and much more. School performance may improve if you can improve their sleep.
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.
- Make sure your child gets ample exercise throughout the day – about 3 to 4 hours of physical activity is awesome but not reasonable for most households. Aim for 60 minutes and go from there. You can find ideas and resources on the Play 60 website.
- 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.
But our kids may be experiencing things during the day (and at night too!) that just make them more tired than the average person.
- If a person has ARFID or a very selective diet, nutritional deficiencies may make them more tired than usual. Ask your pediatrician or a RD about this.
- Seizures during the day or at night make a person more tired than usual.
- Dehydration can make you tired. Encourage water drinking during the day.
- Just “being” you; when you have autism and have to work extra hard either to process information, or filter out information, that can make you tired.
- Low muscle tone, lack of fine motor skills and other physical issues means it takes more work just to get through the day, and you’ll be more tired at night.
Sleeping on the Floor
My son loves sleeping on the floor and often will resist moving to the bed. I have noticed that when he is asleep on the floor, he hardly snores at all. Whereas, in the bed, he snores a LOT. He’s had multiple sleep studies and refuses to wear a CPAP.
He knows that he gets better sleep when he’s on the floor, and I can’t argue with him. He does. We’ve purchased special pillows, special mattresses, a flat board instead of a box spring…he still prefers the floor.
As best as they can communicate, ask them why they prefer the floor. See what you can replicate with a firmer mattress, different kinds of pillows, more/less/different blankets and so on. Maybe try a futon, or a thick yoga mat like pad on the floor.
And, if everything else fails…who cares? As long as the floor is clean, safe and comfortable for them, does it really matter?
Autism Sleep Help
Look, I don’t want to give you the same tired information of “make sure you have a bedtime routine” and stuff like that. But, the truth is, a lot of that stuff can work. It also can backfire.
I remember when K was small, I had this Putumayo Dreamland CD. It was calming music I’d put on to bring him to a calm level and ready for sleep. When he was in a ‘resist bedtime’ phase, whenever I’d put that CD on, he’d howl and scream and throw a fit. It wasn’t calming at all to him–it signaled that bedtime was coming and he didn’t want bedtime.
Still, I would try everything out there in addition to seeing specialists.
- See a doctor and specialists to check out the possibility of sleep apnea and seizures.
- Always ask your doctor before trying herbal supplements like melatonin and chamomile, especially if they take other medications. They may have dangerous interactions for your child.
- Try a routine, but use your child’s input as much as possible. What calms them?
- Make fresh air and outdoor activity a part of your daily routine.
- Limit screens for 90-120 minutes before bedtime. Blue light from screens can affect rem sleep.
- In addition to the sleep tracker, keep a diet diary so you can look for food interactions. Some food additives and sugars can affect sleep.
- Work with a GI doctor if your child has GI issues. An uncomfortable GI system and full bowels can disrupt sleep.
- Sure, browse online for things like special pillows, sleepy time lights, music, and stuff like that. But, first, don’t bankrupt your family trying things. And second, know that some things like a weighted blanket can cause pain rather than comfort.
- Use your child’s input to the maximum extent possible–they know what is comfortable to them.
Most importantly… allow yourself to think outside the box. Look, I love my bed and my flannel sheets and my down comforter. But not everyone loves what I love, or is comfortable sleeping the way I sleep.
We all have preconceived notions of what comfortable, soothing sleep “should” look like. If I could replicate my son’s comfort and sleep position in his bed, I would. But, the positioning he uses to sleep on the floor would put him at severe suffocation risk if we replicated it on the bed.
So, I leave him on the floor.
I know of some kids who sleep with noise canceling headphones on. I had a client who preferred to sleep with his shoes on.
What matters is that they are comfortable and getting enough sleep.
“Let it Go” 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 baby gate 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!
Printable Sleep Tracker
Here you go, print as many as you need! This will be helpful for when you go visit specialists.