Monday, July 11, 2011

Overcoming Sleep Issues


The is post is part of Best of the Best, Edition 8: Sleep Issues & Bedtime and Special Needs Kids. If you check the above link on about July 14, you'll find a whole host of similar articles by other authors.

Sleep issues are very common for children and adults with Aspergers Sydnrome. I've talked about these before but last time it was a bit of a "scientific" post. This time, I want to be more practical. I want to look at why children with Aspergers Syndrome and Autism have sleep difficulties and what you as parents can do to improve their sleep.


Some Reasons for Sleep Issues
First of all, I want to look at some reasons why sleep may be difficult for children (and adults) with aspergers sydnrome;

The Sleep Ritual
Like many aspergers activities, sleep is a matter of ritual. If you get the ritual wrong, or out of order, then sleep can become much more difficult. The aspie can stress over the ritual instead of sleeping. A case in point is my youngest son (7.5). One part of his ritual concerns dessert and should a parent send him to bed without any, trouble is sure to follow.

My wife will often say; "You don't have dessert every night" but that's not true. In his mind, it's an accepted part of the ritual. In his mind, he DOES have dessert every night. Though at least we've mandated "eating your dinner" first. If we break this ritual, he will stress over the lack of dessert. It might seem like a small thing but it's enough to keep him awake.

This puts us into a positive parenting dilemma. Is giving him dessert really "giving in" to him? Sometimes it is but sometimes it's just a case of picking your battles. Is dessert unhealthy? Are we encouraging unhealthy rituals? Perhaps... but then, maybe if we could come up with a healthier dessert, such as fruit, it would be less of a problem. In any case, a small dessert is not as unhealthy as lack of sleep.


Constant Thinking (No brain quiet)
Aspies have a lot of trouble calming their brains. We tend to think over things, solve problems and allow our minds to wander into excessive detail on our special interests. When I was younger, I'd lie in bed and code computer programs. I'd wake up in the morning with reams of code and amazing solutions in my head but I'd suffer from lack of sleep. Talking to my older son (10.5), he designs lego creations in his head while he's attempting to fall asleep. Of course it's obvious - if you're using that much brainpower, you're not going to fall asleep. Aspie brains tend to seize quiet time and use it to its full potential.

If this is your issue, then you need to find a way of removing that quiet time. Have your child do a regular activity when going to bed. It needs to be something which can occupy their thoughts but must be in one direction only (ie: computer games are out). Watching television in bed is one option, though it's probably not the best habit. Listening to quiet music or audio books is better and reading books or comics is best of all.

If your child is concentrating on the story, they won't be stewing over other things. There's a good chance that they will fall asleep while reading. That's good. At least they've fallen asleep.


Reviewing
Even when aspies aren't actually dreaming up new concepts, they're busy reviewing the events and conundrums of the day. Some aspies are word-based, some are picture-based and some, like me, tend to be more events-based. I find that I play back whole conversations over and over again looking for hidden meanings, gestures, tones etc. All of the stuff that I didn't notice during the actual conversation. After all, I did "take it all in". I just couldn't process it during the conversation. Word and picture based aspies will also tend to review their day using their preferred mental facilities.

Again, the solution for this problem is to remove the quiet time. Don't let your aspie use sleep-time to reflect on their day. Give them a certain time for that before bed but make sure that once they're in bed, they are mentally occupied.


Compounding the problem
It's clear that sleep is a problem for people with aspergers on normal days but there are a few things which can really compound the problem;

Extraordinary Stress
A stressed child will find sleep even more difficult. Lots of things can cause stress, deviation from routine, sensory issues and day-to-day problems. You need to communicate with your child regularly to find what things stress them out.


Social Problems
The more social problems a person has, the more time they'll need to spend reviewing their day. Sometimes it's better as a parent to spend some time before bed putting their social problems to rest. Then, when it's time for them to sleep, distract them with a book.


Medications
Many stimulant medications (most notably ritalin/concerta) have side effects which reduce the patient's ability to sleep. If the medication is still active in a child's body, it will prevent sleep. Check the dose and the time it takes to wear off. If you've given your child a tablet later than usual, don't expect them to fall asleep at the normal time. In fact, if the medication is still in your child's body, don't send them to bed. You'll only make the bedroom into a place of frustration.

You can counter these medications with a natural product called Melatonin but don't automatically assume that "natural" means safe. Melatonin can cause irritability and may have other side-effects too.


Food
There are lots of side effects from food including allergies and discomfort. Some foods such as chocolate and soft drinks have a stimulant effect which keeps kids awake and some foods, particularly those which are high in carbohydrates will cause the body to spend the night processing it rather than relaxing.

The evening meal should really be consumed about four hours before bedtime but today's busy lifestyle means that it's often only a matter of minutes between the meal and sleep. Don't forget too that lying down after a big meal can create reflux problems (and the acid in reflux can damage a child's teeth while they are asleep).


Comfort
Children with Aspergers Syndrome often cite discomfort as a barrier to sleep. This can be a matter of temperature regulation or of difficulty getting comfortable due to bed linen. For example, most people love the feel of freshly laundered linen but many aspies will find the clean linen to be too "scratchy". Sometimes it's to do with the fabric softener you use and sometimes it's to do with specific scents within your detergent.

Distractions
Make sure that your child's room is free of distractions. Ideally, close the blinds against lights, remove toys and make the rest of the house reasonably quiet but not silent. Make sure that your child can't see the television from their doorway. In our case, we have to check the drawers of my son's bedside table regularly because he likes to sneak toys up into his room. If a distraction is present, your children will take advantage of it rather than sleep. Don't forget to check the stuffed animals in the bed as many modern toys will talk, laugh and writhe.

Anxiety and nightmares
Sometimes children won't sleep due to anxiety or nightmares. You might think that you're doing them a favour by not letting them watch scary television shows but you'll find that kids will quickly find alternative things to be scared of. Instead of dracula, they'll be scared of the count on Sesame street. Instead of some space alien, it will be the "spider in my room". Anxious children will always find something to be anxious about so instead of trying to block every experience from their sight, start trying to teach them about liklihood (how likely is it that a bad spider could get up here) and fiction (these things aren't real).

My mother always told me that a nightmare was just my body trying to wake me up to go to the toilet. I found that once I accepted this, I became much less disturbed. If all else fails, remember that you can provide younger children with night-lights and older children with lamps. My own nightmares mostly stopped once I had a bed lamp that I could turn on at any time to dispell the dark.


Things to do?
I've been dropping specific hints throughout this post but here are a few more general things you can try.

Return to Sender....
I think that most people are familiar with the supernanny's tactics and sometimes they work really well. It's always worth trying her tactics at the start of a new set of sleep issues, just to make sure that the issue is inability to sleep rather than sheer wilfulness.

Once you've figured out that your child can't rather than won't sleep, it's time to retire those supernanny tactics otherwise you'll start to exacerbate the bedroom issues. Instead of sleep, consider giving your child a chance to do some low thinking things (reading again). You might consider letting your child out of bed for a while too because sitting in a bed reading will make the bed linen feel too hot and could exacerbate any sensory issues.

Don't be tempted to lock your child's door (though many parents, myself included) will still try it. This won't help your child and may increase their sleep anxiety or simply, as was the case with us, result in the need to purchase a new door. We were certainly surprised that our child could throw things hard enough to put holes in the door.


Quiet before bed
It might seem like a no-brainer but having kids run around excitedly just before bed doesn't actually help them to sleep. It's a pity because "just before bed" is usually "dad time". It's the time when the "big toy" comes home from work and wants to play with the kids.

It's a shame to cut this time out because it's important bonding time so instead, make "dad time" an early priority. Dads should come home, and rumble with the kids for at least 30 minutes, then transition to slower and gentler play.

It's hard because mothers really want some "dad-time" of their own but if you can just get the kids out of the way first, you'll increase your chances.

The same goes for storybook time. Some dads like me are quite animated storytellers and give their characters all manner of accents and sound effects. This is fine but sometimes it stirs the kids up. If you can at least make rules to prevent your children from jumping around during storytime, you'll be able to make the story exciting without the consequences.

14 comments:

Anonymous said...

Thanks for this post, very timely for us. Our girl has always been a great sleeper, but since starting prep at school she is really struggling to fall asleep, its genuine, she really feels tired and says she wants to go to bed but just cant nod off. (Once she is alseep an Earthquake wouldnt wake her). I feel so sorry for her, I remember as a kid (Im NT) lying in bed for what seemed like hours trying to sleep but, just as you describe, the thoughts and events of the day prevented it. I think this issue of sleep is not much different b/w NT and AS. I think the main problem for our girl is the nightmares and being on her own - she hates being on her own at any time. I find I have to tell her what noises around the house she might hear, "I.e, The dishwasher is on, dads showering in 30 minutes". We have tried many things but in the end its something we have to live with, I just feel for her. We let her watch a movie in bed on her little ipod because trying to sleep when its just not going to happen is Hell. I just wish she wastn so afraid of everything all the time, it must be so difficult for her, and all I can offer is reassurance.

krex said...
This comment has been removed by the author.
krex said...

Two things that helped me as a kid was surrounding myself with my stuffed animal guards . I slept wedged in the middle of a fuzzy hug . When I got older, reading about how to create lucid dreaming to control them made them less scary...you can train yourself to do it .

Having a notebook to write down those annoying ruminating thoughts helped as well since my brain tended to go in circles . (you can find a pen with a little light on it and keep it by the bed . ) I still can't stop all the rehearsing imaginary conversations that I might have the next day...(infective because those we interact with never seem to follow my well planned scripts) .

The best solution was working overnights...now I can sleep 8-12 hours, just not on the rest of the worlds schedule . I think some light yoga stretching and relaxation tapes while going to sleep or white noise machines (or a fan) really help with those spooky house noises ).

milliemodern said...

Thanks for this post, and your whole blog!

I am mum of 4yr old daughter with Asp, and sleeping has always been such a problem for her - right from when she was born. We haven't had a full night's sleep in nearly 5 years!

She has lots of trouble 'winding down', and also severe separation anxiety - one of us is in her little bed with her most nights. We don't know whether giving in and sleeping with her, to get her to sleep most of the night, is a good long term strategy - do we just accept that it's what she needs, or do we get firm and try to separate???

Gavin Bollard said...

milliemodern,

Unless you plan to spend the rest of your parenting days sleeping (or being otherwise connected to) your daughter, you'll need to overcome those separation anxiety issues. You'll also find that not spending quality couple-time together will eventually take its toll.

Obviously you can't simply "dump your daughter and run". You'll have to have a plan and it may take several weeks to conclude.

There's no need to get firm. A gentle routine should make it possible to separate without too much trouble.

Start by doing more or less what you already do and establish a firm routine. You'll probably want to read a bedtime story and then lay near your daughter while she falls asleep. Make the first rule that you don't talk after storytime. Just lie there quietly and refuse to be engaged in conversation. Also, make sure that the bedroom door is left open (this will become important later).

After a couple of days, don't lie down but simply sit on the bed and progressively sit further and further towards the end of the bed. Again, do not engage your daughter in conversation after storytime.

The next step is to put a chair in the room and sit on that, near the bed. Each night, you should move the chair slightly further away from the bed and towards the door. Eventually you'll be sitting the doorway.

Wait until your daughter is comfortable with this move before starting on the next step because it's difficult.

Move the chair outside the doorway but keep it in sight. Then move to half-sight, then to being able to see her only if you lean back.

You'll eventually move completely out of sight but should be in earshot.

This would be a good time to have your partner join you on another chair so that you can talk quietly. Your daughter will be reassured by the sound of your voices and (hopefully) won't feel the need to keep calling for you. Again: do not engage her in conversation.

You should be able to slowly start moving your chairs further away towards the living areas of the house but be sure to keep talking.

Bird said...

Great post. This is something I deal with as an Aspie and with a son who is an Aspie too. I think the racing thoughts are the toughest parts for us. I go through my day over and over again, especially if there were any social interactions. It is quite stressful. I also think up wonderful things at night (I write poetry and essays so it seems that everything comes into my head at night- I think things through all day long, but I would like to be able to "turn it off" at night. My son just can't settle down. I have to get him away from the computer and such before bedtime or he'll just go through the game he just played over and over in his mind sometimes, but I think worries of the day keep him up a lot and his OCD.

Martianne said...

Wow! as I read your post a question i thought had been answered is stirring in my mind again. Is my son aspie, not just ADHD/SPD. He has been dx'd with the latter, but laypeople sometimes tell me (insist) that he seems more ASD/aspie/pdd-nos. As I read your post, so much of what you talk about rings true of my son, I wonder...

Thx for the helpful sleep issue ideas.

Kelly Edwards said...

My son, asperger/adhd diagnosis, definitely struggles turning off his brain to sleep. I like your suggestions! We have noticed that he tends to sleep better if he falls asleep to his music or with a book. But once he has a nightmare, it's hard to transition him back to sleep. I'm going to try putting a light by his bed as you suggested teaching him some new ways to perceive bad dreams. He also has to sleep completely wrapped up in his blankets, from his whole head down to his toes. It's always been disconcerting to me, but he insists on it! Thanks again for the tips!

Lane said...

I enjoy your blog. You write very useful information. It’s debatable about whether or not I have Aspergers. I know without a doubt, however, that I am sensory defensive and have a sensory motor disorder. I have had sleep issues all my life. Everything you wrote fit me to a tee. I have to read myself to sleep. Otherwise it’s futile. And if I wake up in the middle of the night I have to read myself BACK to sleep. Any sound, light, smell can wake me up. The feeling on my skin can wake me up. Sometimes I have to get up and take a shower before I can go to sleep. Or change the pillowcases. The past few years I can’t read fiction, it’s too interesting. I have to read moderately stimulating nonfiction. I have learned a couple of new tricks recently. If I wake up in the middle of the night, I can put a clean pillowcase over my eyes to shut out all light and press pillows against my ears. Besides shutting out sound, the pressure of the pillows tight against my head is calming.

myra said...

My son also has had trouble falling asleep. All his anxieties come out at bedtime. He just started hating to be alone and his roommate little brother usually deserts him for my bed. Usually it will be almost 9 PM and I have to warn him that if he isn't sleeping within 30 minutes he isn't going to school the next day. It works every time. Except once when he was hungry. He does need a heavyweight blanket and I turn on a story cd to quiet his mind. Usually the ones for his age have some scary parts and that just makes it worse. He also has white noise although that hasn't seemed to help.

Anonymous said...

I have a 4 year old son, who is currently undergoing assessment for High Functioning Autism. He ticks the majority of the boxes for Aspergers and it is likely he will get diagnosed with it.
My son has never had a problem sleeping, quite the opposite. However, he has always had a strict routine when going to bed and any deviation from it, would disturb him.
We have to put the teddy's in the right place and they have to be neat before he will rest. He has had a music piano playing in the back ground in his bedroom for near 12 months and more recently a fan, due to the heat.
We have had times, when he has got up in the early hours and we have found him to be asleep outside our bedroom door on the floor, although this had not happened for a while.

However, since starting kindy a few weeks ago, we have been getting up in the morning to find him asleep on the sofa in the living room. We had assumed he had got up maybe half an hour before us and as we were still sleeping, he took the time to rest. That was until recently, when I got up in the early hours 2:30am to get a drink, to find him asleep on the sofa. I carried him back to bed, but an hour later he was back on the sofa. This went on for several nights and it concerned me, that he could harm himself, whilst being young and alone in the living area.
For the following 2 nights, we decided to secure him in his room, in a bid to break the habit. This came with yet more problems. He would scream until we opened the door, he would switch his electric piano on really high and with other children asleep in the house it was disturbing everyone else. He would rattle the door and bang on it, adding to the noise. He would also switch his bedroom light on. After 2 nights of no sleep, it became unbearable. We had wondered whether it could be his bed, maybe he had outgrown it. So we purchase a new bed and made a big sing and dance about his new BIG BOY bed. He was/is delighted with his bed and loves getting in it at night and falls asleep instantly. However, he is still getting up in the early hours to sleep on the sofa. I have now taken up residence myself on the sofa, to enable me to take him back to his room. As you can appreciate, this isn't ideal. But I am hoping, in time he will realize that getting up is not going to get him anywhere, other than a trip back to bed. I speak very little to him when I do take him back and with a very low tone, to ensure I do not wake him. The routine of him sleeping on the sofa, seems to stem more so since he started kindy. It is difficult to tell if he is conscious and aware when he gets up, because he cooperates and has his eyes open.

Gabriela Solan said...

Hi, My son is 7 and has struggle with separation anxiety since he is 9 months.
I have try this and he gets very agresive if I don't talk back to him.
Unfortunately he sleeps in the middle of me and my husband which is getting harder on my body. I try to offer toys in exchange for him to try but he tells me he can't because of the monsters in his brain. The times he has try he always comes to my bed as soon as I turn the lights off. He takes melatonin but even with this he doesn't sleep well at all if he is on his bed because he is constantly checking on us so be midnight he is back in my bed.... Any ideas on this, I really need help

Anonymous said...

You forgot to mention quitting your job and living life on your terms. People with Aspergers are the normal ones. Its the people calling them not-normal that theirs a problem with. Think about it. Why would someone care what someone does in a free and open society when they are not harming themselves or anyone else for that matter. Sounds to me like a lot of so called "normal" people have control issues.

Aspgergers people have a different circadian clock, that is out of harmony with the insane society. If they follow the cycles of the sun they turn out fine. Anything else really is a psychotic break from reality. Such a shame we label the normal and smart ones as crazy.

Its the same reason they are most likely more afflicted by seasonal affective disorder. Its not that their lazy, their body is adapting in harmony with the environment i.e. cycles of the sun. Theres a lot going on physiologically here so I would not expect the author to understand. Most psycho-chologists dont even know what they are dealing with. You should probably stop writing about stuff like this on the internet.

Anonymous said...

I Completely agree with Anonymous. My ex is a teacher and thinks she knows what's best for our son. I have lived with being aspie my whole life. In fact I didn't even understand why everyone else was weird until I was about 30 and learnt about Asperger's!

I hate the fact that she insists on getting extra 'assistance' for our son in school and labelling him as different.. Just let him be and he will be fine. I turned out OK.