Neurological and Developmental Disorders & Sleep

Many people have difficulties with sleep at some point in their life but for those who have neurological and developmental disorders, such as Autism Spectrum Disorder (ASD) and Attention-Deficit Hyperactivity Disorder (ADHD), sleeping can be particularly challenging.

What are some of the common sleep issues these children may struggle with?

• Winding down and falling asleep

• Waking in the night and struggling to get back to sleep

• Insomnia which may be caused by increased anxiety of social situations

• Gastrointestinal issues and discomfort possibly caused by food allergies

• Hypersomnia (sleeping too much) which may be caused by increased exhaustion from the anxiety of social situations

• Irregular secretion of the sleep hormone, melatonin which regulates sleep

• Having an atypical circadian rhythm (internal body clock)

• Neurological conditions such as epilepsy

• Lack of understanding social cueing around bedtime, where there is a lack of understanding of others in the home going to bed and having a need for sleep.

• Sensory sensitivities, such as sensitivity to blue light from digital devices.

• Bedwetting

How can you support their sleep ?

Being Close

If you know that you will need to support your child in the night, being close to them can make it easier and quicker to respond to their needs which means there is a higher chance that they won’t wake fully and that you can help them back to sleep quickly.

Sleep Hygiene

Having a consistent and predictable bedtime routine which happens every night and ends in quality connection time is important for sleep. What you do in your bedtime routine will depend on your child’s temperament and age. It may be that you do a physical activity (like dancing or rough housing) or that you have more of a calming activity (like drawing or cuddling) before having something like stories or a lullaby, drawing the curtains, perhaps turning on a sound machine and then supporting your child to sleep.

Sleep Environment

Ensure that your child’s sleep environment is set up for sleep and calm. Ideally it will be pitch black or have a red light night light if your child is afraid of the dark. Check that your child has a comfortable temperament as being too cold or too hot can cause more wake ups. If your child tends to get cold at night because they throw the covers off, you can try using a sleeping bag, tucking a larger duvet under their mattress or try using duvet clips .

If your child is sensitive to noise and can be easily woken, playing something like continuous white noise or flowing water can help. But be aware that these can also make sleep more difficult for those who are sensitive to such monotonous sounds.

Studies have shown that children with ASD and/or ADHD are more likely to experience bedwetting than their neurotypical peers. If your child often wets the bed or their nappies/pull ups/night pants leak, waterproof sheets are crucial for improving sleep.

Removing labels from bedding and night clothes, or trying out bedding and nightclothes made from other materials can help those children who are sensitive to the feeling of texture.

If your child is sensitive to smells, reduce any smells which may migrate to where they sleep by closing doors and, or trial the use of scented oils to see if your child finds these relaxing and aids their sleep.

Emotional Regulation

Supporting your child with emotional regulation throughout the day will enable calmer bedtimes and will support night time sleep.

The following aids may help with emotional regulation by supporting your child’s sensory needs and enabling calm:

• Sensory toys can help children who feel comforted by having things in their hands or mouths

• Chewable jewellery - especially useful for children who chew hair, clothing or nails.

• Weighted blankets - can be very calming as they provide proprioceptive input. For safety they should be the right weight for your child. An occupational therapist can help with this.

• Weighted vest - these help children to feel grounded

• Therapeutic listening - certain tracks are specifically designed to support calming and reduce anxiety

• Yoga ball - rocking and bouncing can be very calming

• Wobble Cushion - can help those who find sitting still difficult

Melatonin

Melatonin is a hormone made by the body, which triggers the feeling of sleepiness. Research in 2016 found that lower levels of melatonin corresponded with increased difficulties with their autism. Melatonin may be an option for your child if they struggle to fall asleep, stay asleep or achieve enough sleep and all other strategies are not working. In the UK it requires a prescription and is commonly only prescribed for ASD, ADHD, neurodevelopmental disorders, severe insomnia, visually impaired children or teenagers with a delayed circadian rhythm disorder. It is usually only prescribed for a short time (6-12 months) and then reviewed. Not many studies have examined the long term impacts of melatonin, although the studies which have been done seem to suggest no adverse effects.

Sleep Diary

Creating a simple sleep diary where you record the time your child falls asleep and wakes up in the morning as well as any naps and number of wake ups in the night can help to establish any unusual patterns of sleep and identify factors which may be influencing your child's ability to sleep.

Your Sleep

Getting enough sleep for yourself is incredibly important but often hugely difficult when you have a child with neurological and developmental disorders. You may have been given the advice that you should sleep when your child sleeps but that won't necessarily be convenient or possible, especially if you have others to care for.

Caring for children with complex needs overnight can be exhausting, if you are struggling, do ask for help. You may be eligible for some additional support through community care and respite services.