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Tip of the Week:  SLEEP

It’s very common for individuals with autism to struggle with sleep disturbances. Unfortunately, during this pandemic, sleep disturbances have become even more prevalent, and I have heard about many of you trying to deal with this difficult issue. Below I have outlined steps to help figure out what is causing the sleep disturbance, and ideas as to how to reduce this issue.  
Why does my child have a sleep disturbance?
1.  The first step is to rule out any medical reasons, as sometimes physical discomfort can cause sleep disturbances. You would want to speak with your doctor about this.

2.  If medical reasons are ruled out, the following questions should be answered to figure out the behavioral reasons:

  • What time does s/he go to bed?
  • What is the nighttime routine leading up to bedtime?
  • Is there anything else going on in the home that could be disturbing his/her sleep?
  • What does s/he do prior to falling asleep?
  • What time does s/he wake up in the night? How long does s/he stay awake?
  • What time does s/he wake up in the morning?
  • Does s/he nap during the day?

What can I do to help?
1.  Bedtime routines- create consistent and predictable bedtime routines.  These are routines that should be followed every night so your son or daughter develops this habit.

  • Use a written or visual schedule- BAC is happy to make one for you, so if you need it, please reach out to your clinical supervisor
  • Build in calming activities before going into bed (e.g. reading, drawing, yoga, quiet music)
  • Begin the routine at least 30-60 minutes prior to bedtime
  • If you know what time your son/daughter actually falls asleep, make sure you are not putting them to bed too early.  S/he should associate being in bed with falling asleep so push the bedtime back to make sure they can associate being in bed with actually falling asleep.
  • Initially, you may need to provide reinforcement for each step of the nighttime routine.  Later, your reinforcement could be faded, and could be only given in the morning.

2.  Activities before the nighttime routine begins- if you know what your son/daughter is waking up to do in the night (e.g. playing with a certain toy, singing, etc.), have them do this activity prior to starting the nighttime routine.  The idea is that this will satiate their need to do it in the middle of the night.

3.  Napping- eliminate naps as much as possible during the day to make sure s/he is really tired at night.

4.  Waking up earlier- I know this is not easy, but waking your son/daughter up earlier in the morning may also help him/her fall asleep earlier and stay asleep during the night. You may also want to teach him/her to use an alarm clock to help with this.

5.  Food/drinks- Eliminate all foods and drinks with caffeine 6 hours before bedtime (e.g. chocolate, tea, some ice cream, cereals, soda etc.).  Stick with milk, water, or juice in the afternoon and evening.  Have a light snack before bed.

6.  Exercise- increase exercise during the morning and afternoon, but avoid it in the evening, as this can interfere with sleep.

7.  Screen time- turn off the TV, iPads, computers at least 30 minutes before bedtime.

8.  Comfortable sleep setting- Make sure the room is dark, quiet, calming, and cool.

  • Try leaving a sound machine or fan on.  Keep the noise consistent each night.
  • Set up the sleep area the same every night.  Avoid having too many pillows or objects that can be scattered around throughout the night.
  • Remove any additional objects that may overstimulate.
  • Try different sleep clothes and blankets that makes them the most comfortable.

9.  Escape extinction- If your son/daughter is getting up in the night, you can bring him/her back to bed without providing attention and leave the room.  This may need to be repeated multiple times until they learn that they cannot leave their room.  This will not be possible everyone, since there may be concerns of dangerous behaviors.  A sleep monitor may help to ease this concern.

10.  Scheduled awakenings- if you know typically what time your son/daughter wakes up, go in and wake him/her up about 30 minutes prior to that awakening time.  Then, let him/her fall back asleep.  Do this until they are sleeping through night for at least 5 days, and then start to fade it out.

11.  Bed time passes- For some, it may work to try giving 1 or 2 bedtime passes which s/he can use to get a drink or come see you. When they have no more passes, they must stay in their room.