When does a lack of sleep become a problem?

• When a lack of sleep affects a young person’s life
• Can’t get up in the morning
• Experience problems with mood
• Feel constantly tired
• Be unable to concentrate
• Changes in behaviour and irritability

BUT We are all prone to develop poor sleep at times but some of us more prone than others and circumstances out of our control might make it worse.

• Genetics, it may run in families
• Circumstances, living in a noisy home
• Someone who worries a lot
• Feeling anxious or stressed
• Moving house, school or a change in circumstances
• Unhelpful daytime and nighttime routines
• Not doing enough during the day
• Not having any wind down before bed, and we can’t switch off
• A lack of regular routine, and sleep being unpredictable
• A racing mind and not able to switch off
• Engaging in stimulating activities, being on the internet.
• Having arguments about bedtimes, conflict before bedtime can disrupt sleep and increase anxiety

What to do:

• Try not to take over
• You can’t force your child to sleep
• Remain positive
• Don’t expect change to be quick
• Note small change
• Try to understand bedtime stalling
• Transitions aren’t easy, visual plans and prompts might help
• Develop a good sleep environment, make sure the sleep environment is dark, quiet and cool.
• Naturally produced Melatonin affects the sleep, wake cycle and its production is affected by evening and night time light exposure. Try to block out light in the bedroom to block out outside light. Another source of light are from phones, laptops and other devices , the light coming from these can be stimulating. Try to cut back on screen time 2 to 3 hours before bed or turn the device to the low light mode.
• Loud sounds will startle, trying using ear plugs if you live somewhere noisy or try white noise.
• When we sleep at night our body temperature naturally drops, if your room is too warm, your child might find it hard to get to sleep, use a thin sheet or duvet or turn down radiators.
• Find out if there is medical reason for reduced sleep, pain and ill health can be a factor
• Some medications have side effects of insomnia to check medication information for details.

5 top tips for parents to do

1. A good sleep environment
2. A helpful nighttime routine
3. Only use bed for sleep
4. A regular getting up time
5. Try not to worry

5 top tips for parents to look out for

1. Gaming and socialising online at bedtime
2. Diet
3. Use bed for sleep
4. Encourage exercise during the day
5. Set up routines and try not to break them

Most importantly, look after yourself.

Other Sleep difficulties can include:

• Some children and young 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 children and young 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.
• Reduced secretion of the sleep hormone – melatonin at night, and having a disturbed sleep – wake rhythm, known as the body clock.
• Lacking a bedtime routine, having a busy mind, not being able to switch off bedtime, or refusing to go to bed.

Sleep is one of the building blocks of the developing mind and is important for:

1. Happiness
2. Improved emotional regulation
3. Attention and alertness
4. Cognitive performance
5. Mood
6. Developing speech
7. Learning and Memory
8. Motor Skill development
9. Growth
10. Concentration
11. Planning and attending to tasks

How can sleep differ in a neurodivergent child or young person?

• Lack of understanding about day and night. When is it daytime and when is it time to sleep. Visual timetables might help.
• Hunger- might need to have an evening snack. Make sure that communication aids support communicating hunger, or for children who don’t experience feeling hungry, timetables about food and the need eat might reduce hunger at night.
• Allergies/food sensitivities- children and young people who are neurodivergent can be more sensitive to foods, additives, caffeine which can cause wakefulness
• Melatonin- natural melatonin secretion might be interrupted or irregular. Melatonin rich foods might help to adjust levels, including plums, bananas, Brazil nuts are rich in melatonin.
• Lack of Routine
• Lots of stimulation- Hypersensitivity to touch, visual stimuli, sound, smell, and an overstimulating room might not create a restful environment. Noise even outside of the home might seem very loud to a child or young person and prevent sleep or be distracting.
• Light- use black out curtains to make the room darker
• Clothing- a loose and airy cotton shirt might feel better than pyjamas, without tags
• masking or camouflaging 
• stimming  
• a sense of not meeting other people’s/society’s expectations

Further thoughts

• Support the child/young person to enjoy a healthy diet and adequate fluid intake during the daytime.
• Encourage regular exercise that the child/young person enjoys eg. football, running, jumping on a trampoline. Include exercise in their daily routine (not right before the bedtime).
• Keeping a sleep diary can be a good way to establish how much sleep they are getting and any patterns or factors impacting on the quality and amount of our sleep. If child regularly spends the night elsewhere (e.g respite or another family member’s house) ask them to complete the sleep diary as well. You might find that the child/young person has a different sleep experience there. Keep a sleep diary for 2 weeks to see any patterns. Keep in mind any changes in routine including 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.

Night terrors and nightmares

Nightmares can be frightening for toddlers, who have a harder time distinguishing what’s real and what’s not. Children often wake up from nightmares. If this happens, offer them reassurance and gently put them back to sleep.

Your child may scream and bolt upright during a night terror, but they won’t usually wake up or remember the incident in the morning. The best thing you can do is make sure your child is safe, trying to keep them in bed if possible. There’s no need to wake them up or worry if your child experiences the occasional night terror, but if they become very frequent or if they’re causing daytime sleepiness, they’re worth mentioning to your GP or health visitor.

www.sleepfoundation.org