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How improving sleep can improve the brain and body health of your autistic child

Thursday 11 April, 2024

by Suzanne Goh (Ohio & St John's 1997)

Suzanne Goh

Dr Suzanne Goh is a pediatric behavioral neurologist, neuroscience researcher and author of Magnificent Minds: The New Whole-Child Approach to Autism.

Sleep is as essential to life as food and water. Even though we think of sleep as a time of rest, the body is busy repairing and restoring it­self. The brain is especially busy, processing what’s happened during the day and storing important information as memories. Recently, researchers have discovered that during sleep the brain also cleans out waste that has built up from the day. This biological housekeeping makes the difference between waking up with brain fog or a clear mind. Over time, how well we sleep has lasting effects on our ability to think, learn, communicate, and remember.

Between 50 and 80 percent of autistic children have trouble get­ting to sleep or staying asleep. Sometimes the reason is a co-occurring medical condition, like epilepsy, heartburn (also called acid reflux), or an obstruction to the upper airway (which can lead to snoring and a condition called sleep apnea). Researchers have found biological differences in autistic chil­dren that can also contribute to sleep difficulties, like differences in brain chemicals and hormones, including serotonin (a neurotrans­mitter that influences mood and sleep), melatonin (a hormone that helps control the sleep-wake cycle), and cortisol (a hormone involved in the body’s response to stress).

Whatever the cause or causes may be, there are many ways to help. For most children this means making a number of changes to daytime activities, the bedtime routine, and the sleep environment. Your doctor may also recommend certain medical tests, like an EEG, sleep study, or blood tests. Sometimes changes to the diet, adding nutritional supplements, or starting a medication can help. The one thing that enables all of these steps to go well is your positive energy and mental clarity. That’s why it’s essential to make sure you’re get­ting enough sleep. As you learn about creating a sleep improvement plan for your child, you can apply any of the steps to enhance your own sleep, too.

Sleep Improvement Plan

How much sleep a person needs is highly individual. There’s no magic number that works for everyone. Most preschool-age children need about eleven to thirteen hours of sleep a day, including naps. School-age children need about nine to eleven hours, and teens need about eight to nine hours of sleep each day. Signs of sleepiness during the day, like yawning, drowsiness, and irritability, probably mean that your child would benefit from better sleep. Working with a doc­tor is important to determine whether medical conditions might be interfering with your child’s sleep, but there are many steps you can take on your own, too.

First, get a full picture of your child’s sleep by tracking daytime activities, the bedtime routine, and other information for several days. Once you’ve taken a record of your child’s sleep, look for oppor­tunities to make improvements in any of these areas:

Daytime Activities

  • Add physical exercise and other activities that move the body and increase the heart rate. More physical activity during the day promotes better sleep at night.
  • Increase the time your child spends outdoors in natural sun­light, especially during the morning and early afternoon. This helps regulate hormones in the body that promote a healthy sleep-wake cycle.
  • Reduce stress and exposure to events that may increase anxi­ety. These kinds of experiences activate the body’s stress re­sponse and can make sleep more difficult.
  • Keep an eye on the amount of time your child naps during the day. Shorten naptime or discontinue napping if your child doesn’t seem to need it. Try to end naps by 4 p.m.
  • Eliminate food and drinks that contain caffeine.


Evening and Bedtime Activities

  • Before bedtime, reduce activities that are physically or mentally stimulating, like playing sports, doing homework, playing video games, and other exciting or energizing activities. The evening should be a time to settle down and begin preparing for sleep.
  • Add relaxing activities, like listening to calming music, read­ing, listening to stories, taking a warm bath, or engaging in quiet play activities. What helps one child relax may not help another, so adapt the evening routine to include those things that are relaxing for you and your child.
  • If your child gets hungry at bedtime or during the night, con­sider a small evening snack. Try to choose a snack that has more protein, fat, and complex carbohydrates, rather than one that mainly provides simple carbohydrates. Some good choices include foods with whole grains, avocado, nuts or nut butter, hummus, beans, or eggs.
  • Reduce bright lights and screen time. These can suppress levels of melatonin in the brain and make it harder to sleep.
  • Keep a consistent bedtime routine that includes simple activi­ties that lead up to sleep, like changing into pajamas, brushing teeth, using the toilet, getting a small drink of water, saying “good night,” and going to bed. Signal that bedtime is ap­proaching by keeping lights dim, reducing noise, and moving activities closer to the bedroom.
  • Select a bedtime based on when your child naturally gets sleepy. If your child routinely falls asleep at a certain time, it’s best to have them get into bed at around that time. This helps avoid long periods of lying awake in bed.

Sleep Setting

  • The best place for your child to sleep depends on what works for your family and how your home is set up. Whether your child sleeps in their own room or in a shared room, it’s impor­tant for them to fall asleep where you want them to sleep the rest of the night. And, if possible, have your child sleep in their own bed, alone.
  • Conditions that tend to promote sleep are a cool room tem­perature, comfortable bedding, quiet surroundings (or steady background noise like a fan or white noise machine), and as little light as possible (a dim nightlight or a hallway light may be needed for children who fear the dark). Any objects in the room or on the bed should be ones that promote comfort and sleep. If possible, remove any objects that might encourage your child to be awake and active at night. 

During the Night

  • Being able to fall asleep on one’s own is an important skill that all children need to learn. If your child needs a lot of support to fall asleep, like being rocked or held, having someone lie in bed with them, being driven around in a car, or other strategies that rely on you or another caregiver, try fading this over time so that your child can learn to fall asleep on their own.
  • If your child can fall asleep without you present, they’ll be much more likely to go back to sleep on their own if they wake up during the night. Waking up briefly during the night is a natural part of sleep. Most of us go right back to sleep. This is a skill you can teach your child. Many children have a habit of looking for a parent when they wake up at night. A good way to help your child stay in their own bed at night is to show them what you’d like to happen by creating a story. The story should have your child as the main character and describe how they carry through with a sequence of actions.
  • Other strategies you can try include using a clock that lights up at a certain time in the morning and teaching your child to stay in bed until the light goes on, or sleeping on a mattress outside your child’s bedroom door for a few nights so that if they try to come out, you can tell them to go back to bed. As your child is learning to sleep on their own through the night, keep any interactions as short and uninteresting as possible. Keep your voice soft and avoid anything that might stimulate your child and make it harder for them to go back to sleep. 
  • Ensuring safety during the night sometimes requires a way to monitor your child’s room by video, a way to hear if your child leaves their room at night, and a way to secure any dangerous items in the house and any exits from the house. Some children sleep well in a safety bed that has a zipper enclosure to keep them from leaving their bed at night.

If putting in place a sleep improvement plan feels daunting, pick just one action that feels the easiest and give it a try.

Sleep is one of my favorite areas to work on with families because dramatic, unexpected improvements can happen quickly. A child who starts to sleep well is like a new child, and this gives everyone else at home a real shot at sleeping well, too.

Reprinted from Magnificent Minds by arrangement with TarcherPerigee, an imprint of Penguin Publishing Group, a division of Penguin Random House LLC. Copyright © 2024, Suzanne Goh

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