Dr Elaine Clark Consultant Paediatrician. Sleep disorders and Autism Around two-thirds of children...

Dr Elaine ClarkConsultant Paediatrician

Sleep disorders and Autism

Around two-thirds of children with ASD have sleep disorders. (Richdale 2000)

Children with ASD can have sleep problems from 18 months onwards

Parents of children with autism have more sleep problems that parents of “typically” developing children.

What we will be coveringWhat is normal sleep?What do we mean by sleep problems?Why children have difficulty with

sleeping?How we can help them to sleep?

What is normal sleep?

Teenagers????Natural not to fall asleep before 11pm. Hormonal changes programmed to fall asleep

around 2 hours later.Need around 9 hours sleep.

Consideration of allowing teenagers to start school later.

What we will be coveringWhat is normal sleep?What do we mean by sleep problems?

Why children have difficulty with sleeping?

How we can help them to sleep?

Sleep DisordersDifficulty falling asleep

Difficulty staying asleep

Early waking

Night terrors

Sleeping in parent’s bed

What happens when children are sleep deprived?

Daytime sleepiness?

Sleep monitoring in school age children 2-4th Grade

Fragmented or less sleepMore behaviour problems reported

by parents and teachers

Older students decreased academic performance

What we will be coveringWhat is normal sleep?What do we mean by sleep problems?Why children have difficulty with sleeping?

How we can help them to sleep?

Lack of routineUnpredictabilityBed time differs each nightFalling asleep in various

places

Fear DarknessBeing aloneThe unknownNoiseSilence

DarknessBeing aloneThe unknownNoiseSilence

AnxietyPerseveration of thoughtsThings changing while they are asleep.Occurrences during that day/week/year.Things that are about to happen

Be aware that your own tone of voice, feelings and body language will affect your child.

Social senseWhy we need to sleep?When we need to sleep?Connection between going

to bed and going to sleep.

EnvironmentMoving to their own roomChanges to roomLighting: fluorescent light reported to hurt

eyesNoises: squeaky door, sound of TV, parents

going to bedSmellsTouch: one lady unable to sleep if one leg

was touching the other.Visual: colour, patterns, toys, shadows.

Why children with ASD can’t sleep?"Sleep was not a secure place. Sleep was a

place where darkness ate you alive. Sleep was  a place without colour or light. In the darkness you could not see your reflection. “

"I was afraid to sleep, always had been. I would sleep with my eyes open and I did this for years”

by Donna Williams

ChemicalCaffeine and sugar rich foodsMelatonin: a hormone produced in the brain in

response to reduction in light. Causes drowsiness at dusk in humans. Levels begin to increase 2 to 3 hours before sleep.

Spring time melatonin production starts 20 minutes later than Winter

Children with ASD produce lower levels of melatonin at night time than “normal” Tordjman 2005

? Serotonin ? GABA

Teenagers? Going to bed too earlyEating or drinking too lateComputers/TVMobile phones!!

The average teen sends 97 texts per day!

What we will be coveringWhat is normal sleep?What do we mean by sleep problems?Why children have difficulty with

sleeping?

How we can help our children to sleep?

Every child is different

Establish a RoutineWill respond to structureVaries between individualsSet time for dinner, bath, story and bed.

VISUAL TIMETABLEMay need to breakdown into individual steps

e.g draw curtains, get in bed, cover up, light off.

Include what will happen after sleep finishes!

Relaxation techniquesLavender oil in bath, pillow sprayMassageOne hour’s quiet time before bed

(everyone so not mixed message)MusicLava lampExercise (physical exhaustion)

EnvironmentMay be over or under sensitive to sight,

sound, smell, touch, taste or temperature

Autism friendlySafeCalmNeutralFree from distractionsSmell

Difference in Day and NightTell them “It’s night time!”Different scents for day and nightDifferent musicBedroom should look different at night time

i.e. less playfulAlarm clocks

KID'Sleep clock

VisualFurniture at the sides of room with central

space clearLow arousal colour: creamNo patternsBig plastic box to put toys in to reduce

distraction.Avoid slatted blinds (obsessions and visual

sensory seeking) curtains preferable pull down balck out blind best

LightingAvoid TV screen/ computer screens: these

have been shown to suppress production of melatonin and delay onset of sleep.

Dim lightingAdjustable lightingRed light better than blue/green lightThick curtains/ black out blinds

NoiseDouble glazingCarpets rather than wooden floorOil hingesEar plugsMusic

“ White noise” masks out background noises that may distract.

TouchPillowsMaterialsLabels on night

clothes

Weighted blanketSleep suitsDouble duvet tucked

in

FearsAllow child time to talk about fears

in day.Address specific fears if known.Reassurance.Worry dolls/ beads/ box

Social senseSocial stories to help with understanding of bed

time

A Social Story is a short description of a particular situation, event or activity, which includes specific information about what to expect in that situation and why.

Story books Tell Me Something Happy Before I Go To Sleep Joyce Dunbar. WH Smith (2006) This book is useful for addressing children’s night time fears.

How Will I Ever Sleep In This Bed? Capucine Mazille. Sterling (2007) This book addresses the issues of moving to a ‘big’ bed.

Go To Sleep Daisy Jane Simmons. O’Brien Press Ltd (2000) The story of Daisy Duck who can’t get to sleep because she is

disturbed by the noise of the other animals.

Can’t You Sleep Little Bear? Martin Waddell and Barbara Firth. Walker Books (1998) A bedtime story about a bear who is having trouble sleeping because

of his fear of the dark.

ChemicalsRemoving stimulants: change to decaf, sugar

free or reduce amountNatural remedies

Medication: antihistamines, melatonin,Specific medication for anxiety, ADHD, OCD

MENDS trialLarge study to look at the effect and

safety of melatonin use in children with neuro-developmental disorders. Appleton 2011.

262 children age between 3-15 years 92 children improved with sleep hygiene

measures146 entered into trial Melatonin vs

placebo

ResultsWith Melatonin 0.5mg to 12mgTotal sleep time increased by about 23

minutes (1-45mins)Time taken to get to sleep reduced by

about 37 minutes (55 to 20 mins)

Safety outcomes: No safety concerns

TeenagersKeep environment cool, dark and quietReduce caffeineReduce late fatty foods and snacksDo not allow to do homework too lateTurn off TV/ computer and phone 1 hour

before bed timeDo not allow to sleep with mobile phone

Keep weekends and holidays as consistent as possible.(no more than 2 hours different to normal)

Sleep for parentsYour health and well being affects your

child’s behaviourRelaxation techniquesKnow you child is safe.Consider respite.

SafetyLocks or high handles on cupboardsElectric sockets in locked cupboardsPlug locksBoxed radiatorsSafety glassNon-toxic paint

Reinforce good behaviour/sleepPraiseHugsPictures e.g. happy faceStar charts

Complete solutions section

How we can help

Community Matrons

Paediatrician

Sleep disorder clinic

Health Visitor

How to get more help?Keep a sleep diaryAsk for referral to Paediatrician

Information on sleep for parents at www.dcsf.gov.uk/everychildmatters/earlysupport

Sleep solutions www.sleepsolutions.org.uk 01432 355308