News and Notes from The Johnson Center

Q & A: My child with ASD won’t sleep. What should I do?

JCCHD | Thu, July 19, 2012 | [Autism Treatment][Q and A ]

Sleeping on the stairsAlong with eating a healthy diet and exercising daily, getting a good night’s sleep is the best thing we can do to improve health and well being. The National Sleep Foundation recommends 10-11 hours of sleep per night for children 5-10 years of age. The benefits of sleep have repeatedly been confirmed in the scientific literature.  Insufficient sleep can increase inflammation and negatively affect growth and maturation [1-3]. Additionally, memory and attention are often affected by poor sleep [4]. Multiple studies have identified correlations between difficulties in sleep and decreased sleep duration with increased attention-deficit/hyperactivity behaviors [5-6].

Whether there are problems with sleep maintenance (maintaining sleep through the night) or sleep latency (time it takes to fall asleep), it is essential that children with Autism Spectrum Disorders (ASD) get the best night’s sleep possible.

Often a good night’s sleep starts with good sleep hygiene. Sleep hygiene refers to the routines and practices that take place prior to going to bed. (Environmental factors such as room temperature and the amount of light in a bedroom are included when speaking of sleep hygiene.)

Here are some sleep-hygiene recommendations that could improve both the latency and maintenance of sleep:

  • Set up a bedtime routine:  Following the same routine every night provides children with appropriate expectations and can help with transitions. Think of a realistic sequence of events your family can perform to prepare for bedtime. Will everyone brush their teeth together or will they take turns? When will you change into pajamas? After deciding the steps you want your child to learn and associate with bedtime, plan a schedule, including:
    • Bathing 1-2 hours prior to bedtime:  Although bath time is an exciting time for some children, bathing can produce physiological changes that benefit sleep. The cooling of the body following a warm bath in the evening signals the body and brain to prepare for sleep. Consider adding Epsom Salt to nightly baths—many parents have reported calming effects from using this product.
    • Provide a small, healthy bedtime snack:  Some children have a hard time maintaining a healthy blood sugar level through the night. A small snack like celery or apple slices with peanut or nut butter, avocado pudding, or sunflower seeds can help with this, and also help to settle the stomach if supplements and/or medications are given at bedtime.
    • Limit exercise and physical activities in the evenings:  Although daily exercise improves sleep, exercising too close to bedtime can create problems with sleep latency.
    • Avoid electronics, including television, computers, and video games, before bed. These are stimulating activities that your child will be reluctant to leave behind and can lead to overexcitement. Researchers are currently looking into how electronic screens can disrupt the body’s natural rhythm, leading to sleep problems.
    • Sit down with your child to do a calming activity, like assembling puzzles or reading a book. Let your child know how long they have to play or how many books you will read, giving them reminders along the way to make for a smoother transition to bed.
  • Consider the physical environment of the room. Is it too bright? Is it noisy? Are there electronics in the room? Are there too many distractions, such as accessible toys? The sleeping area should be as calming as possible.

    • If your child prefers a nightlight, consider the type that gradually turns off throughout the night; don’t select a light that represents a favorite character, as this could be a distraction.

Social stories may be helpful in both learning the bedtime routine and setting expectations.  While learning a new routine, it is important to reinforce the absence of problem behaviors. For example, if screaming is a behavior you frequently encounter at bedtime, be sure to have a reinforcer prepared, such as a favorite story. You can use the language, “Thanks for brushing your teeth so quietly! Let’s go read Good Night Gorilla.”

If sleep issues continue after sleep hygiene and environment have been addressed, speak with a medical professional. A number of medical conditions such as obstructive sleep apnea, seizure disorders, gastrointestinal issues, and allergies can negatively affect sleep. The use of medical therapies, supplements, and/or medications can greatly resolve many sleep issues. If it is found that sleep issues are not associated with a medical condition, then discussing the problem with a behavioral therapist could be beneficial.

Providing children with the right tools – a healthy diet, daily exercise, and good sleep - produces healthier and happier children.  Practicing good sleep hygiene and addressing health issues that may be disrupting sleep could produce benefits in development that cannot be obtained by any other means.

1. Kim, J., et al., Inflammatory pathways in children with insufficient or disordered sleep. Respir Physiol Neurobiol, 2011. 178(3): p. 465-74.
2. Luyster, F.S., et al., Sleep: a health imperative. Sleep, 2012. 35(6): p. 727-34.
3. Lazaratou, H., A. Soldatou, and D. Dikeos, Medical comorbidity of sleep disorders in children and adolescents. Curr Opin Psychiatry, 2012.
4. Taylor, M.A., K.A. Schreck, and J.A. Mulick, Sleep disruption as a correlate to cognitive and adaptive behavior problems in autism spectrum disorders. Res Dev Disabil, 2012. 33(5): p. 1408-17.
5. Paavonen, E.J., et al., Short sleep duration and behavioral symptoms of attention-deficit/hyperactivity disorder in healthy 7- to 8-year-old children. Pediatrics, 2009. 123(5): p. e857-64.
6. Wang, X.Y., et al., [Quantified research about the effects of sleep quality on attention in class and acadamic achievements in primary school children]. Zhongguo Dang Dai Er Ke Za Zhi, 2011. 13(12): p. 973-6.