We’ve written before about the terrible sleep quality of our eldest son in infancy. His sleep quality has improved greatly since then, but today, at the age of seven and a half, his sister at the age of six, and his brother at the age of four and a half (also diagnosed ASD, but the nature of his sleeping is different), we still don’t get a full night’s sleep yet. And we are expecting a baby very soon. Why don’t they sleep? How do you teach a child to sleep when they have special needs? What we have already done, and what else can we try?
A few weeks ago, during a big family dinner, Shira went to the E.R. and stayed in hospital for two nights. Our eldest has been very nervous ever since. We feel it more at night. He gets up from his bed, refuses to go back there, and demands to lie next to Mom.
Regular sleep is essential for brain development, metabolism and growth and daily functioning. Most rehabilitation processes in the body are done during sleep, so it is essential that we and our children sleep as normally and continuously as possible according to common medical recommendations.
Common sleeping problems in autistic people, and how to teach an autistic child to sleep
With many children, there is a lack of sleep hormone production (the most famous of which is melatonin, but is definitely not the only one), or a problem with the neurotransmitters for those hormones. The distinction between them can be made in two ways:
A. Sleep lab, where you take blood tests for hormones.
B. Trial and error. Try to give hormonal substitutes, at different doses, and see after a few nights if it helps. With young children, consult a doctor first. For example, melatonin can be purchased in Israel through the HMO, in syrup or pills. It can be purchased through supplement companies such as *iHerb* in gummies that are more pleasant for children, in several doses and flavors or in liquids and capsules. Please note that if you enter *iHerb via the links on this page*, you will receive a 5% discount.
It might be necessary to find a hormonal balance, before you can start to teach a child to sleep.
Using sleep medications is sometimes permanent for life, but every once in a while, it is a good idea to check with your regular doctor, whether it is possible to decrease the dosage, or whether it is necessary to raise a dosage. For young children, it may improve with age or worsen. One way or another, it is mandatory to inform your doctor of any dietary supplement or medication. Especially in children, do not start treatment without a doctor’s opinion.
Daily routine with a fixed sleep ritual
Your daily routine must be organized, and must not be deviate from it, except in emergencies, especially for young children. It is recommended to work on a daily routine program, with a professional, but choose one that is sensitive to your needs, and does not dictate rules for you to traumatize children, and cause you mental distress. Sleep preparation should be customized for your children, and should be requires at least a full hour from the time you announce getting ready for sleep, until actual sleep. If the child can fall asleep in less time, that’s wonderful.
The sleep ritual can include steps such as: dinner (if it’s not followed by playtime), a shower, dressing for sleep, a story or a good night song, a hug and cuddling, and ending with shut eyes and sleep. At first, it will take a long time, but with consistent practice it will be reduced to a reasonable time. Keep in mind that your children may never go to sleep like a normal child, and be prepared for it.
The order of the sleep ritual is consistent. Choose what you think should be in it in advance, and try not to deviate from its sequence. If the order of the ritual is: food, shower, story, sleep, then be consistent with that, at least until your children practice and establish sleep regularly. Avoid unplanned sleep disruptions. Make sure whoever replaces you knows what they need to do. We, for example, take care to take our two older children to pee at a regular time, in the middle of the night (part of night weaning), but our little one doesn’t need it. And so when his grandparents accidentally took him to pee at night, they ended his sleep that night.
Use visual aids to help the routine
In many cases, you add a visual navigation card for the sleep ritual: images/illustrations of the order of actions in the sleep ritual.
(Providing melatonin or other sleep medications, should be timely and satisfying before the planned moment of sleep so that no stage of the ceremony will surprisingly get cut off)
Sensory regulation problems
Before getting around to teach a child to sleep, you will want to remove as many sensory interruptions from the child’s bedroom
Sensory regulation is the physiological mechanism that makes our bodies remain organized in terms of turning on and shutting down our senses: vision, hearing, touch, taste and smell. When there’s a problem with the way these senses regulate, they turn on and shut down at different intensities. Sometimes together and sometimes separately, unable to control them. That is the meaning of a sensory regulation problem, or a problem with sensory processing. Everyone has their own sensitivities, whether they have a problem in this area or not. The difference is the amount of sensitivity and intensity. When it comes to continuous sleep – wakings or in ability to fall asleep, can reside in problems with sensory regulation. There are a number of solutions, technological or behavioral, that may help you put your children (and yourself) to sleep, and get better sleep quality.
Various regulating accessories
1. Regulation with lighting: Can be a relaxing light presentation distributed by a special lamp, soft colored night lights are an important part of shutting down our senses. Darkness is also a form of regulation. Try to figure out what’s best for your child.
2. Weighted blanket – For some children, a weighted blanket can help regulate their sense of touch. A weighted blanket helps relax by creating deep pressure stimulation. This type of blanket can help anyone, but make sure you are allowed to use one. The weight of the blanket should be about 10% of the body weight and cover the entire body from the feet to the neck.
3. Vibration Mattress: Helps children who need movement to relax. You need to order a custom vibration mattress, to the size of the child’s bed, and adapted for long use. Meaning, coated in anti-wetting plastic. It should be equipped with a number of vibration plans, that should last at least to the child’s shut eye time. The mattress should be activated immediately upon entering the bed, until after the child has fallen asleep, and again if the child wakes up at night. Our mattress has a fixed time limit of 30 minutes, so we usually have to start the program again.
4. Relaxing music – you can put white noise in the background or a recording of relaxing music. It helps some children, and while others it don’t relax with music. It’s worth it to try and see.
A social story about sleep as a means of supporting sleep
A good night story, can also be a social story that you created, and describes the sleep process, and helps you teach your child to sleep (it is advisable to present it several times before the bedtime ritual, and can also be the sign of opening the sleep ritual). It can also be part of the bedtime stories. The story must describe the child’s situation and explain to him what is to come. You can read here: How to make a social story.
Emotional difficulties that impair sleep quality
The Nightmare Age
At a certain age and naturally, children wake up because of bad dreams. Whether your children are able to explain that this is what happened or not, it is best to address the child’s emotional state when they wake up. Children who has wake up disturbed are not children who wake up simply because they finished their sleep cycle. Nightmares start around the age of 4, so pay attention. If you think your children wake up like this, verbalize it for him. “Maybe you had a bad dream?” “Never mind it’s just a dream. Mom/Dad’s here and everything’s going to be okay.” Gently try to put back to sleep, paying attention to sensory regulation, if necessary, and comfort the child.
Distress over what’s going on around in the child environment
For example, a family member who goes in and out of hospitalization (as our children are now experiencing because of the expected birth). The sleep quality is likely to be undermined, and if we pay attention, we can easily predict it.
Be sure to make it clear that going to sleep is not something that can be given up. There’s room for flexibility to a degree. Pay attention to their feelings. Expect more awakenings and perhaps bed wetting, which may have previously disappeared and will come back with higher stress levels. A social story can be used to explain the situation at home.
Any divergence in the daily routine, should be treated as a cause of distress. Whether small or large, and especially if it’s emotionally difficult for the child. It could be from the end of the school year, or even a sibling getting to sleep outside the house. This, of course, varies between child to child. Try to anticipate situations like this and prepare the child in advance.
Note unusual signs of distress that arouse suspicion, especially if it is a child who is not verbal. Keep a notebook or mobile record of the behavior. Try to find an explanation. A child who sleeps well, but is now having trouble, attests to some kind of distress. Be alert and try to find out if something happened at school or anywhere not visible to you.
Difficulties with changes from a previous sleep arrangement
Moving from a cot, small bed, or co-sleeping is another process that we need to help our children go through. It may be helpful if during the transition, you may want to incorporate some elements of the previous sleep arrangement, then slowly remove them.
From the moment of your child’s birth, he was accustomed to sleeping in a certain way. Any change in bed placement or shape (to help a child disconnect from their parents, become more mature, or fit to grow), even if it is small, will require slow adjustment.
For example, a switch from a baby cot to a toddler bed or a full size bed. Some of the elements that exist in the bed, such as the mattress (perhaps place it on top of the new mattress), his favorite blanket, and so on, can be taken and incorporated as a supporting accessory for transition to the new bed.
Transitioning from a co-sleeping arangement
Transitioning from co-sleeping with a parent also requires getting used to. When you sleep with a child, the child feels the parent lying next to him all the time. This gives him emotional support, and sometimes allows for better sleep for the child. Co-sleeping is part of the principles of a child-rearing method called the continuum concept, which talks about a continuum of contact between the parent and the baby/toddler during the day. If your child grows up using a similar concept, you will need to take into account the sleep learning process, in his or her need for physical closeness. When considering room design, consider a larger bed, which will allow co-sleeping (at least until the child falls asleep), and for emotional level, if the child needs contact to fall asleep, allow your normal routine, and slowly attempt to transition to independent.
These processes take time, and do not need to be accelerated. When you don’t address the physical change in sleeping arrangements, you may encounter your children’s resistance to a new arrangement, and you may unintentionally sabotage the process.
End of Sleep cycles
When the child’s sleep cycle ends in the middle of the night (one of our personal nightmares, because we have such a child): A situation in which a child gets up after a few hours to “inform” us that that sleep is over, and he has no intention of going back to sleep. It can happen at any time of the night, and it’s worth trying to figure out if the child can be put back to sleep, or if there’s just no point.
Try to put the child to sleep.
Make sure that the child’s self entertainment solution is nearby, so that when necessary you can hear if anything unusual has happened. This is reminder to lock the kitchen and doors, and child proof the house, as much as possible to protect from small disasters that can happen, like the child reaching into the garbage can, and pouring out all its contents.
Make sure to have a quiet but long lasting activity that will allow you, the parents to sleep or at least take a nap. It is a good idea to prepare in advance, the activity should take place within your hearing and/or sight range. The bigger the child, the further away you can keep him occupied. If possible, come to an agreement with your children, for what is allowed or not, at night time and what is expected of them. If not, then decide the plan for them.
Make sure to get enough sleep for you and your child even throughout the day. If you don’t get enough sleep, you will find out very quickly that you will start to function very poorly. Like you, a child who does not sleep, is less focused. Try to find out when your child sleeps best, and arrange bedtimes accordingly.
In summary – how to teach a child with special needs to sleep
Read about the characteristics of autism, and adapt the sleep routine to your child’s regulation and emotional needs. It’s very hard to change our children to suit our needs. It’s our jobs as parents to find out what works for them, and try to build a suitable plan. You can work with professionals, but they must be professional, and work with your child’s requirements.
For a child with autism, you will need guidance that is tailored to his special needs. His chronological age may be [X]-years, but according to his diagnosis, he’s probably functioning like a [Y]-year-old.
Physiologically, too, his body is probably not built for regular sleep cycles for any number of reasons. It’s hard to diagnose exactly what leads to disrupted sleep cycles, so the road to good sleep is long, filled with trial-and-error, and requires a lot of patience, perseverance, and energy drinks.
Avoid sleep counselors who are unpracticed with children like yours. They have no idea what to do with you anyway, and besides frustrating you, they can do real damage and give advice that isn’t right for you. It happened to us, and it took us years to change things.
Easy sleep for everyone
Other articles on teaching a child to sleep
In a spectrumnews.org article, the average time for falling asleep (from the child’s entry into bed to shut eye) of 58 minutes in 80 children before training, and 39.6 minutes after professional guidance. In the cited study, they teach and accompany parents on how to teach a child with autism to sleep. What amazed me was the timings. It’s just exhausting to fight with the kid to lie down, relax and sleep. The figure of almost an hour on average, explains why it’s so exhausting.