Many children with a neurodevelopmental condition are likely to suffer from disturbed sleep patterns at some point in their lives. Sleep helps our brain work properly and plays a vital role in health and well-being. Throughout life it is important to address any difficulty with sleep. Sleep also helps support the body’s growth and development. Lack of sleep can raise the risk for chronic health problems. Poor quality sleep can also result in significant problems with memory, attention, mood, tiredness, and daytime sleepiness. Children with poor sleep often have poorer attention and are more anxious. A lack of sleep at night can also affect motor skills and concentration leading to being more accident prone, behavioural problems and poor performance at school and have an impact on family time together and relationships.
It’s important to have the correct amount of sleep to build up enough energy for the day’s activities. Sleep needs change as children get older, and as all children are unique, some will need more or less sleep than others. Sleep is vital to children’s health, wellbeing, learning and development. Daytime naps can help prevent young children becoming overtired but not a prolonged nap too close to bedtime.
Why do we sleep:
- To restore and regenerate our body and brain
- To clear our mind and process events of the day
- Sleep helps to regulate our emotions
- Once we’ve had good night’s sleep we wake up feeling restored and refreshed
- If we haven’t had a good night’s sleep, we might wake feeling tired and grumpy
- We might find it hard to concentrate and learn
- Sleep is as important as eating, drinking and breathing
- Lack of quality sleep reduces pain threshold
- Adults need between 7 and 9 hours sleep a night
- A giraffe needs 2 hours sleep
- A dolphin needs about 10 hours sleep
- A tiger needs 16 hours sleep
- Bats are one of the sleepiest animals and they tend to sleep for nearly 20 hours in every 24 hours but they sleep during the day
- The amount of sleep children need changes as they grow.
Setting consistent times for sleep and wake will help children and teens stick to a regular sleep schedule. Keep in mind that children and teens have different sleep needs:
Preschoolers (3-5 years) 10 to 13 hours
School-age children (6-13 years) 9 to 11 hours
Teenagers: (14-17 years) 8 to 10 hours
Adults: (18+ years) 7 to 9 hours
Also, it’s helpful to consider that children’s biological sleep and wake time (sometimes called their chronotype) change with age. As children get older, their natural sleep/wake schedule will shift so they get both sleepy and wake up later. This normal shift to a later schedule is biological and reaches a peak in their early 20s.
Keeping these natural tendencies in mind can help to balance how long and when children need to sleep, with their daily routine.
Help each of your family members by modelling good sleep habits during the day and night. It’s important that children and teens understand the importance of sleep for their health.
During the day:
- Spend time in natural light, especially in the morning. Whether outdoors or inside, daylight may help you feel alert.
- Aim for 30 minutes physical activity a day (like playing outside) to encourage to sleep at night as well as reduce stress and improve mood.
- Eat meals at consistent times
- Avoid stimulants like sugary foods, some medication and caffeine, before bed.
- Use a consistent bedtime routine with a relaxing wind down to help get the sleep your child needs.
- Put the devices away an hour before bed and sleep in an environment that suits your child.
The first part of the night is our deepest sleep, its usually when we process most of the information from the day. Our sleep becomes lighter throughout the night. We have a natural internal system to regulate sleep and wakefulness over a 24 hour period, we sometimes call this our body clock. We have evolved to be more awake when the sun is shining and sleepier when it is dark. This is also known as the circadian rhythm. The body clock can be influenced by lots of things. Many of us are “night owls” or “morning people”. This is often genetically programmed, but our age is also an important factor.
In the early childhood years, sleep cycles get longer as children get older. In children aged three years, sleep cycles are about 60 minutes. By about five years, sleep cycles have matured to the adult length of about 90 minutes.
Difficulties with sleep are common for neurodivergent children and young people. Research has suggested that over 50% of children who are autistic suffer from at least one form of sleep disturbance and this can be even higher for children with a dual diagnosis of ADHD. Consequently, parents often report higher incidences of challenging behaviours throughout the day, such as trouble paying attention and difficulty coping with everyday stressors. Lack of sleep can affect the whole family and impact on relationships within them.
For many neurodivergent children, picking up and noticing the ‘sleep cues’ for sleep and bed is much more challenging. Therefore, realising it is bedtime, being triggered to begin to ready themselves for bedtime, and triggering enough melatonin to be ready for sleep, are all real challenges.
Problems with sleep can amplify several traits including hyperactivity and repetitive behaviours.
- Difficulty getting to sleep and staying asleep, waking at night frequently and not being able to get back to sleep and early morning waking.
- Some people are not able to recognise or will misinterpret the social cues such as sibling going to bed or staying wide awake or when the sun shines very early during summer months.
- Some people may have sensory overload in the sleeping environment, which can contribute to their sleep difficulties, such as increased sensitivity to light (eg. blue light from the screens), noise (certain sounds, or White Noise), room temperature and touch.
- Not being able to relax, feeling anxious and/or having a low mood.
- Some children and young people, experience, food, allergies, discomfort/pain from reflux, constipation, or having a neurological problem, such as epilepsy which impact sleep quality.
- Reduced secretion of the sleep hormone – melatonin at night, and having a disturbed sleep – wake rhythm, known as the body clock or circadian rhythm.
- Lacking a bedtime routine, having a busy mind, not being able to switch off bedtime, or refusing to go to bed.
Causes of disrupted sleep for children who are deurodivergent
Sensory needs and sleep
- A sleeping bag provides an additional feeling of ‘pressure’ for some children
- A hot water bottle, but not too hot.
- White noise suits some children, not too loud, background noise
- If a light must be left on, make sure it’s not too bright
- Flannel sheets are often suggested, but make sure sheets are not scratchy or with tags
- Bath time, lavender drops or calming soothing smells.
- Checking the mattress isn’t lumpy
- Blackout blinds
It can take weeks to see any patterns. Keep in mind any changes to schedule due to school days and holidays.
Children/young people who do not have ability to verbally communicate their sensations and feelings might not be able to tell you that they are feeling tired. Watch out for their body language or particular behaviours that indicate fatigue and need for rest.
Establish what helps the child/young person to relax before bedtime. Can these activities become a regular part of their evening routine?
Have a think about what activities might be making sleep more challenging. Can these be avoided or replaced with more relaxing activities in the evening?
Some of us can worry more in the night-time as we are no longer distracted from our worries by day activities. Mindfulness and relaxation strategies (eg paced breathing, progressive muscle relaxation) can help the body and mind to slow down, calm and gradually prepare for night-time rest. Support the child/young person to use some of the emotional regulation strategies during the daytime and so reduce the possibility of them becoming overcome with worries in the night.
Explore and teach the child/young person variety of soothing strategies (mindfulness, breathing, gentle massage, stories, relaxing music). When introducing new skills do this slowly and gradually and ensure that the child/young person is comfortable with the strategy first and only then incorporate it into their bedtime routine.
If there are any physical health difficulties (eg pain, sleep apnoea) that make sleep challenging please discuss these with GP and healthcare professionals.
Some children/young people might have difficulties understanding the need for sleep. They might not recognise the signals from their body telling them that they are tired or need to rest. Some children might not make the connection between people going to bed in the evening and the need to sleep. Social stories can be used to explain biological need for sleep.
A social story or visual schedule can also be helpful in providing an accessible explanation of evening routine. Knowing what steps and which tasks need to be completed before bedtime can reassure the child and provide them with a sense of predictability and familiarity.
Encourage the whole family to observe a calming evening routine. This way the child/young person can simply follow and learn everybody’s routine and does not feel different by having a set routine themselves.
Changes to daily routines (eg. school holiday or transition back to school) and changes to demands placed on us (eg learning new skills) can lead to temporary changes in sleep patterns. Work with the child/young person to establish a new daytime-bedtime routine that will meet their present needs and provide feeling of safety and predictability.
Sleep difficulties such as having problems getting to sleep or waking in the night are common in children with neurodevelopmental conditions. Weighted blankets are sometimes suggested as an intervention to help improve sleep. However, information available online about weighted blankets can be mixed and confusing. The aim of this factsheet is to briefly summarise current scientific research about whether weighted blankets improve sleep in children with neurodevelopmental conditions. This factsheet is not intended to replace the advice of expert clinicians, but we hope that this summary of evidence will help parents and carers who are considering whether a weighted blanket might be appropriate for their child.
Click for info on Weighted Blankets
Drinking caffeine late in the day has long been known as a potential sleep disrupter for many people, since it’s a stimulant designed to keep you alert. But be aware that caffeine can be hidden in other foods as well, such as cola drinks, energy drinks, cold remedies, chocolate, tea and even ice cream, so check the ingredients.
The importance of sleep for parents too
Balanced sleep is really important for good mental health but it can also be a really useful self-care tool for when you need a break to get away from your thoughts or situation for a bit. Trying to establish good sleep routines for your children can be the first step to giving you time at night to relax and allow you to get a good night sleep for yourself. This may be harder with babies and infants but even with older children you may benefit from allowing yourself a power nap in the daytime whilst they are at school.
How well did you sleep last night?
Most parents cope with a certain level of tiredness. But if you’re feeling low, bad tempered and unable to cope or enjoy things, you need to find a way of getting more sleep, or at least more rest.
Try to rest when your child sleeps. It might be tempting to use this time to catch up with housework or other chores, but sometimes getting rest is more important. Set an alarm if you’re worried about sleeping for too long.
Try to go to bed really early for, say, 1 week. If you can’t sleep when you go to bed, do something relaxing for half an hour beforehand, such as soaking in a hot bath.
If you have a partner, ask them to help.
Ask friends and relatives for extra support. You could ask a relative or friend to come round and look after your child while you have a nap. If you’re on your own, you could see if a friend or relative could stay with you for a few days so you can get more sleep.
Although we have suggested that you sleep when your child sleeps, this won’t necessarily be convenient, especially if you have other people to care for and it can also be difficult to ‘switch off’ on demand. By the time you have got your child to sleep, particularly if they needed calming down, you may feel too wound up to sleep yourself.
Find out more about community care and respite services. All parents of children with disabilities are entitled to be assessed to see if they’re eligible. https://www.autism.org.uk/advice-and-guidance/topics/physical-health/sleep/parents