Management of Sleep Problems of Autistic Individuals

Sleep problems are very common in the autistic individuals. Researchers found that about 40%-80% of children with autism have sleep difficulty at night. They either do not sleep most of the time at night or wake up after sleeping sometimes at the first half of the night and never sleep again. Some autistic individuals go to sleep late and do not get up from the sleep in the early morning.

“Sleep disturbance seems to be a main feature of autism.”—Takanori Yamagata, Professor of Pediatric Developmental Medicine at Jichi Medical University in Simotsuke, Japan.

The parents of the autistic individuals need to help their children to ensure a normal sleep pattern as good sleep is the cornerstone of good health. Individuals’ sleep problems can be managed in two ways, by pharmacological treatment, and through behavioral intervention. Before giving any medicine, the parents must apply different techniques to change their behavioral pattern to ensure their normal sleep at night. Medicine should be the last resort to apply to change their sleep pattern.

My son Ferdous Mahi is 21 years old autistic boy. He had severe sleep problems since his childhood and he would not sleep almost the whole night. He used to sleep in the morning and frequently missed the school bus. Sometimes he used to sleep at day time to cover up his night sleep. We have been trying to manage his sleep problems since long. He has been improved a lot but not yet normal.

In this article, I would like to discuss the sleep requirement, and causes, effects of sleep problems and different behavioral intervention techniques for management of sleep problems of the autistic individuals.

I would also like to show you a routine which has been followed by my autistic son Ferdous Mahi and received much improvement.

Requirement of Sleep in Human Life

Sleep at night is not a luxury, it is a very basic human need like food and water. It is an important factor of life to keep an individual fit for the next whole day. Every individual needs to sleep at night sufficiently to maintain a good health and happiness. In a developing child, sleep serves multiple functions including energy conservation, brain growth, memory consolidation, and cognition. All individuals need to sleep a considerable amount of time in every night. Recommended sleep range (hours) by the National Sleep Foundation (NSF) for the individuals of different ages in a day are given below.

• Newborns (0-3 months): 14-17 hours each day
• Infants (4-11 months): 12-15 hours
• Toddlers (1-2 years): 11-14 hours
• Preschoolers (3-5): 10-13 hours
• School age children (6-13): 9-11 hours
• Teenagers (14-17): 8-10 hours
• Younger adults (18-25): 7-9 hours
• Adults (26-64): 7-9 hours
• Older adults (65+): 7-8 hours

Common Causes of Sleep Problems

There are many reasons for sleep problems of the autistic individuals. Being autistic individual they have some inherent sleep disorders. The sleep disturbance of autistic individuals is a common phenomenon. Followings are the common causes of sleep disorders of autistic individuals.

• Anxiety. Anxiety is the condition of feeling uneasy (fear or worry) for various reasons. In the autistic children, anxiety comes for the unknown reason.
• Hyperactivity. Generally, hyperactivity is a common feature in the autistic children. If somebody is hyperactive, he might face sleep problems.
• Any medical issue. When an autistic child becomes sick, he might face sleep problems like any other normal individuals.
• Routine problems. If there is any deviation in the normal routine of an autistic child, then he might face sleep difficulties.
• Communication problems. Communication is a common problem for the autism individuals. If they find any difficulties in communication, they can not sleep at night comfortably.
• Sleeping alone. Some of the autistic individuals can not sleep alone in a single room. My son can not sleep alone in a room though he is 21 years old. By chance, if he sleeps alone in a room, at the mid-night he will get up, start shouting and run to the parents’ room.
• Effect of Melatonin. Melatonin is a kind of hormone which is responsible for the sleep cycle of every individual. The melatonin level in the body of a normal person rises during the darkness of the night which indicates that the body needs sleep. But for the autistic individuals, the melatonin level becomes higher at day time and lower at night. So, they don’t feel sleepy at night.
• Sensory Problems. Most of the autistic individuals are either over-sensitive or under-sensitive to light, sound, touch, temperature etc. So if any of these sensory issues irritate them at the time of sleep they are likely to feel a disturbance.

Effects of Sleep Problems

Due to sleep problems at night, the autistic individuals might show different behavioral problems at day time and might have a serious effect on learning. Sleep disturbance has a serious impact on individual’s mood, energy, efficiency and ability to handle stress.

“Sleep disturbance impacts cognition, it impacts mood, and it impacts behavior.”—Ruth O’hara, Associate Professor of Psychiatry and Behavioral Sciences, Stanford University.

In typical development, sleep disruption is associated with emotional and behavioral problems such as internalizing and externalizing symptom.

Sleep disturbance of autistic individuals at night do not create problems for them only, it also creates problems for the parents, siblings, and neighbors. If the autistic individual in a home is awake, the parents and the siblings present in the home can not sleep. It has very bad effects on the day time activities of them.

My son used to shout at the top of his voice at night when he had severe sleep disorders. It used to create a nuisance and disturb the neighbors.

Managing Sleep Problems

We will discuss here the behavioral intervention of autistic children for their sleep problems. If any autistic individual faces sleep disturbance at night, it will have a serious negative impact on his different activities throughout the day. Most importantly, it will have a serious impact on his learning. The basic principles of sleep hygiene include selecting appropriate bedtime and set routine, minimizing television watching, and reducing emotional and behavioral stimulation at night.

Following actions may be taken to improve upon the sleep disorders of your autistic children:

• Establish a Routine. If an autistic child suffers from sleep problems every day, the parents need to adjust his sleep routine or habit. The parents need to make a simple bedtime routine and be rigid to follow it. The routine should cover his/her bed time, waking time, meal time, play time, nap time and so on. Necessary arrangements should be made so that s/he can hit the bed at a pre-determined time, all lights go off and s/he falls to sleep.
• Sleeping Environment. When an autistic child is facing sleep problems every day, the parents need to change his sleeping environment. It is to be ensured that all members of the family go to the bed early at night. Nobody should talk or whisper when he is in the bed. Since most of the autistic individuals have problems with light, all lights of the home are to be put off. The curtains of the windows are to be adjusted properly so that no light enters the room. Try to keep the bedroom as much as dark and cool before the bed time. Avoid charging mobile in the bed room as it shows green light which is irritating for sleeping.
• Turning Off Televisions, Computers, Tabs, and Phones. Research shows that watching Television has a direct impact on the sleep of an individual. So, do not keep the television in the bed room. Use bedroom exclusively for sleep. The Televisions, Radios, and Computers are to be switched off at least one hour before your autistic child goes to the bed. Everybody should stop talking over the phone to ensure his/her sleep. Ensure that your child can not play any video game before one hour s/he goes to bed. If you are exposed to blue light late at night – from a computer or television screen or a digital clock near your bed – it can wreak havoc with your body clock making it harder for you to go to sleep and to get up in the morning.
• Daytime Exercise. A day time exercise of your autistic children is to be ensured so that he gets tired and sleeps automatically when he goes to the bed.
• Nighttime bath. The parents can arrange bathing of their children before hitting the bed. It will make him/her fresh for night time sleeping.
• Food for sleep. The autistic children should eat foods high in magnesium, like halibut, almonds, cashews, and spinach, and foods high in vitamin B complex, like leafy green vegetables, nuts, and legumes.
• Ensure s/he visits toilets before bedtime. Ensure that s/he visits the toilet before hitting the bed, so that s/he needs not to wake up from sleep at the midnight for toileting.
• Use the right type of bed/mattress/pillow. Provide her/him the best type of bed, mattress, and pillow so that s/he feels comfortable during sleeping. For example, my autistic son needs 3 pillows for sleeping.
• Avoid Daytime Sleep. Actually, the daytime sleep reduces the requirement of night sleep. So, do not allow him to sleep at day time. At best s/he can have a day time nap.
• Avoid large meal in the evening. Do not provide any meal at dinner so that s/he does not feel problem in sleeping.
• Avoid drinking caffeine. Caffeine prevents sleep. So, do not allow autistic individuals to drink anything containing caffeine before sleeping at night.
• Watch out about bed wetting. If your child has a habit of bed wetting, watch out about it. If required, change the bed cloth to ensure his/her sound sleep.
• Minimize disturbing noises. If the people need to move inside the room, move very carefully so that s/he does not wake up. The alarm clock and other electronic devices which produce sound should not be kept inside the bed room of the autistic individuals during his sleep time at night.
• Reducing emotional and behavioral stimulation. The parents should ensure reduction of the emotional and behavioral stimulation of the autistic children before his sleep time.
• Arrange Sleeping alone. Try to help your child to sleep in a separate bed, even in a separate room. At first, arrange a separate bed in the same room. Then arrange a separate bed near your bed room. Finally, arrange a separate bed in a separate room.

Routine of our Autistic Boy to prevent Sleep problems

I have already mentioned that my autistic son Mahi had serious sleep problems. Earlier he had continuous sleep problems and most of the time at night he used to sleep at 3-4 am. He used to shout at mid night at the top of his voice, which was very much disturbing for the family members and the neighbors. To manage his sleep problems, at first we studied his sleep pattern, then we have tried to observe what are key problems of his sleep problems. We observed some of the problems regarding his sleep pattern.

• Earlier almost all members of our family used to sleep at 1-2 am.
• The television was kept on till 1 am.
• We were not that much aware of his sleep disorders.
• We used to insist him to go to bed when all family members were going to bed. It is very difficult to take him into the bed at that time.

Now, we have made a bed time routine for him.  At the evening he generally enjoys his favorite TV programs every day. At about 11:20 pm he goes to take bath. Then he brushes his teeth and wears the sleeping dress. Before going to the bed he himself cleans his bed perfectly, arrange the pillows and goes to the bed at about 00:00 mid night. His sleep problems have reduced a lot and he sleeps now just after going to the bed. Now, occasionally, he suffers from sleep problems.

Mahi’s Daily Routine:

Conclusion

Sleep problems are the source of many problems for the autistic individuals. The duration of sleep at night dictate their behavior at the day time. The autistic individuals suffer from behavioral problems that aggravate due to their sleep difficulties at night. As such the parents need to ensure their proper sleep at night.

The sleep disorders need either pharmacological treatment or behavior intervention or sometimes both together. We have discussed here some of the ways of behavioral intervention to prevent sleep disturbance. If any medicine is required the parents may contact the specialist doctors.

In the behavioral intervention, the parents need to make a routine for the sleep of their autistic individuals, ensure proper sleep environment, and sleep hygiene so that they can comfortably go to the bed and sleep without any interference. This will help them to have nice sleep at night, good behavior at the day time and to achieve an effective learning capability throughout the day. If the routine of the autistic individuals can be executed for few days, they will be habituated to it.

I have prepared a routine for my autism angel Ferdous Mahi to overcome his sleep difficulties. He is following it and getting a good result. But I do not suggest others to follow this same routine as two autistic individuals are not identical. However, I suggest every parent prepare a routine suited for their children after consulting the doctors, teachers, and caregivers and apply it to their everyday life and overcome the sleep problems at night.