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Improving your
child’s sleeping
This includes:
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establishing a bedtime routine for your child;
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helping your child to learn to fall asleep alone;
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helping your child to stay in his bedroom at night.
Sleeping difficulties are common in young children. They are also much more
common in children of all ages who have physical and learning difficulties, including
autism. Children with such difficulties take longer to learn the ‘rules’ of appropriate
bedtime behaviour. Their limited use and understanding of communication makes
them more difficult to teach. Other reasons why children with autism may be more
prone to sleeping difficulties include; anxieties about the dark or being left alone,
hyperactivity, and difficulty in moving from one activity to another, for example,
moving from watching a video to going to bed.
Children with autism are often more susceptible to changes in routine caused by
holidays, illness or the change from summer to wintertime. Their sleep patterns
quickly become disordered. They may have also failed to learn that they should be
sleeping through the night.
Although they may have difficulty understanding language and communicating they
are generally able to understand and respond to frequently repeated and visually
reinforced routines. In this way the majority of children with autism can be helped to
develop and maintain more regular sleep patterns.
Sleep problems divide broadly into
settling problems and waking problems.
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Settling problems are difficulties in
getting your child to bed and settled to
sleep. Some children will not go to bed
and settle to sleep alone, and instead
fall asleep downstairs or go to bed at the
same time as their parents. Some will only
go to sleep if the parent lies down with
them or if they are being rocked. Others
keep coming downstairs or insist on a
prolonged bedtime ritual.
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Some children find it hard to go to sleep.
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Waking problems occur when sleep is
disrupted after the child has gone to bed.
Sometimes children wake up frequently
during the night and disturb their parents
by calling for attention. Sometimes they
wake only once or twice, but cannot be
resettled easily. Some children keep
coming into their parents’ bedroom and
creeping into their bed.
Sometimes waking up after
you have gone to sleep is the problem.
What you need to know about your child’s sleeping
u Keep a sleep diary* for at least two weeks. This will help you to see precisely when,
where and for how long your child sleeps. You can use this information to decide
on an appropriate plan of action. This ‘baseline’ information will also be helpful in
determining what progress is being made.
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Consider your child’s sleep history. Think about the following questions.
When did the problem start? Has it existed from birth or did it start after a significant
event such as an illness or moving house?
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What time does your child normally go to bed/go to sleep?
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Does he usually keep to a regular routine?
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What activities does your child usually do in the hour before bedtime?
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Does he have a regular bedtime routine? If yes, how long does this last?
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How long does it normally take him to fall asleep?
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Does he have trouble settling to sleep? If it takes longer than half an hour for him to fall
asleep, what does he do during that time?
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What do you do when he won’t settle?
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Has he ever learnt to go to sleep alone?
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Does he fall asleep somewhere other than in his own bedroom? If so, where?
*
See page 75
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What does he need around him in order to fall asleep? For example, one parent lying
on the bed, being rocked or held, special toy, dummy, bottle, television on.
After he has gone to sleep, does he wake up again? How many times does he wake
each night? How long is each awakening?
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If he wakes at night, are certain activities carried out to get him to fall asleep again?
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Does he still have drinks or a bottle at night?
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Does he exhibit any unusual behaviours or movements during sleep?
Does he walk in his sleep, bang his head, have frightening dreams?
Does he snore loudly during sleep?
What time does your child wake in the morning? Does he wake unusually early?
Does he wake spontaneously or is he woken? How does he feel on waking; tired,
bad-tempered, happy?
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Is he unusually sleepy during the day?
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Does he nap during the day? How many naps? For how long?
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What is your child’s total sleep time?
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Consider your child’s medical history and any medication he may be taking.
For example, some medication may cause sleeping difficulties.
Setting the scene for good sleeping habits
The bedtime routine
Regular routines seem to have a calming effect on most children and help them
to associate this time with sleep.
Ideas for bedtime routines could include the following.
u Make at least the last thirty minutes before bedtime a regular routine. Some children
will need a longer settling time but when a routine is established the time can
gradually be reduced.
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Include activities such as dressing for sleep, washing, reading, listening to a tape
of calming music. This routine could possibly be reinforced with a photographic
timetable. For some children a special toy or a security object can help them settle.
Keep the order and timing of the activities about the same each night, although
if you feel rituals are developing around the routine, it will be a good idea to vary
the routine slightly such as change the order of activities slightly.
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Do not include activities that could cause
conflict, such as picking clothes for
the next day.
Once established, avoid extending the
time for the bedtime routine. Although
children who are very active may require
a longer bedtime routine initially. Start at
an hour and then gradually try to reduce
this to half an hour.
Carefully consider the effect of television
on your child, as watching shortly
before bedtime can interfere with some
children’s sleep.
Try to encourage your child to fall
asleep alone. If your presence is always
necessary for him to fall asleep, when
he wakes in the night alone he will have
difficulty going back to sleep without you.
Your child can practise the skill of falling
asleep alone at naptime for example.
Jonah’s bedtime routine: toilet, pyjamas,
story and bed.
Michael, aged four-and-a-half years old, wouldn’t go to sleep in his own bed. He
refused to stay in his own bedroom or even his parents’ bedroom. Instead, Michael
liked to fall asleep in his parents’ arms as they sat on the settee downstairs. Very
gradually Michael’s parents moved his sleeping spot from the settee, up the stairs
and into his bedroom. Once Michael was able to fall asleep in his parents arms in
his own bedroom, they gradually moved further away from him in his bedroom, but
remained in the room until he had settled. To help Michael feel safe and happy his
mum and dad provided one of their old jumpers for Michael to sleep on. It took about
a month for Michael to fall asleep in his own bedroom by himself and following this
they gradually cut off pieces of the jumper so in the end he only needed a small piece
of the jumper to hold.
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Regular sleep times
Try to find out how many hours sleep a night your child needs to feel rested and
calm the next day. As a guide, Lyn Quine, an expert in helping children with sleeping
problems, suggests in her book ‘Solving children’s sleep problems’ * the following
sleep and nap times for young children:
Daytime sleep
Night-time sleep
2 years
1hr 15 mins
11hrs 45mins
3 years
1hr
11hrs
4 years
No nap
11hrs 30mins
5 years
No nap
11hrs
Use a sleep diary to determine how much sleep your child is getting. Daytime naps,
especially in the afternoon may result in a misleading impression of how much sleep
is required at night. Some children have the ability to recharge their batteries for the
evening following a very short nap. Some children with autism seem to need very
little sleep, while others don’t seem to get enough sleep and really benefit when a
more regular pattern is established.
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Determine a good wake time that fits with you and your child’s schedules.
Move backwards from your desired wake time the number of optimal sleep hours to
find the best bedtime (for example, 7: 00am minus 11 hours equals 8:00pm bedtime).
Try to stay with this sleep-wake schedule every day, including, for example,
weekends, when changes of routine are more likely.
Quine, L. (1997). Solving children’s sleep problems. A step-by-step guide for parents.
Beckett Karston, Cambridge.
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Diet
It is important to be aware of foods and drinks that contain caffeine and to avoid them
in the hours prior to bedtime. Caffeine, acting as a stimulant, may stay in the digestive
system for up to six hours. Some soft drinks such as ‘coke’ contain caffeine.
Some children wake many times in the night and cannot return to sleep without a
bottle or drink. It is likely that he has learnt to associate feeding with falling asleep
and returning to sleep, and that he wakes out of habit because he has come to expect
feeding during the night. Discomfort from a wet nappy or wet bed may also cause
him to wake. There is generally no physical need for night-time feeding after a child
is six months old so try to gradually wean your child off this habit by, for example,
substituting water for milk in the cup.
The bedroom
Spend some time in your child’s bedroom to determine if anything may be interfering
with sleep, for example, the noise of the television, dishwasher, sound of voices,
buzzing radiator. Is the room too light; are there unusual reflections or shadows? Is
your child irritated by the texture of the duvet fabric or blanket? Is it too hot or cold?
The bedroom needs to be associated with sleep. Avoid using it as a place to send your
child if he has been naughty or a place where there are stimulating toys and activities,
(a computer or television). If he plays in the bedroom, perhaps the toys could be kept
on the floor and the bed kept for sleep.
Jane was four-years-old and had usually slept very well once she had gone to bed.
Her mother was rather puzzled when she started to have difficulty going to sleep
and was waking up very early. She then realised that the clocks had just gone
forward and it was therefore lighter in the evening. Jane’s mum decided to make
Jane’s bedroom as dark as it had been previously by hanging heavy curtains at the
windows. With this remedy Jane quickly returned to her usual sleeping pattern.
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Exercise
It seems to be worth incorporating some exercise as part of your child’s day as
there have been a number of studies reporting the positive effects on behaviour
of physical exercise.
u Encourage your child to engage in aerobic exercise four to six hours before bedtime,
such as running in the garden, or swimming. Aerobic exercise is vigorous exercise;
you get hot and your heart beats faster, so you may also pant a little.
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Discourage your child from exercising or engaging in vigorous exercise just
before bedtime.
Look for ways to decrease boredom and increase activity throughout the day.
Improving your child’s sleeping
u Think carefully about your child’s present sleeping pattern. What does your child do
at night-time that you regard as a problem? What would you like him to do instead?
Try to be specific. For example, Bill takes two hours to fall asleep every night. The
target behaviour would be for Bill to go to sleep in thirty minutes, although the
first step might be to fall asleep in one hour fifty minutes. If there is more than one
problem behaviour, you will need to decide which is causing the most difficulty.
You can then work on that problem and deal with the others later.
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Fill in a sleep diary for at least a fortnight to record how frequently the problem
behaviour occurs. The sleep diary also provides some space to write about how
you reacted to the sleep difficulties. This information will be useful in planning a
programme to help your child sleep better.
Provide the conditions that encourage sleep, a bedtime routine and a bedroom that
is a place for sleep.
You may find it easier to start a programme of gradual change. For example, if your
child refuses to go to bed unless you are rocking him, you could first lie beside him
on his bed, then sit beside the bed holding his hand, then very gradually move your
chair across the bedroom until you are outside the door. Interaction during this
time should be minimised; the only purpose of you being there is just to reassure
him. Remember that change will take place very gradually over a period of weeks so
ensure that each stage is well established before moving on.
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Provide positive reinforcement for good bedtime behaviour. You will need to think
about the kinds of things your child enjoys. For some children a music tape may be
a reward for completing a bedtime routine. You may like to consider allowing your
child to play in your bed in the morning as a reward for not sleeping with you at night.
However, be wary of rewards that are stimulating at night.
Achievements in sleeping
1. Can usually sleep for up to three hours at a time.
2. Can usually sleep for up to five hours at a time.
3. Falls asleep at around the same time every night.
4. Has a daily nap at around the same time every day.
5. Wakes at around the same time every morning.
6. Associates a certain place in the house with falling asleep.
7. Associates cues on a regular basis with going to bed and sleeping
(bath-time, a comfort toy).
8. Goes to bed at more or less the same time every night.
9. Follows a regular bedtime routine.
10. Falls asleep in own bedroom with parent present.
11. Falls asleep alone in own bedroom.
12. Falls asleep within 30 minutes.
13. Goes through the night without eating or drinking.
14. Wakes no more than once a night.
15. Wakes no more than once a night but remains in own bedroom.
16. Gets up in the morning at an acceptable hour.
17. Follows a regular bedtime routine that lasts no longer than forty-five minutes.
18. Sleeps for more than seven hours at a time.
19. Settles and sleeps away from home, for example, grandparents’ house.
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How long was child awake altogether?
How many times did child wake?
Time went to sleep
How long to settle?
Time went to bed at night and where
Time started preparing for bed
Time and length of nap(s) in day
Time woke in the morning
Day 1
Name
Day 2
Week
Day 3
Day 4
Day 5
Day 6
Day 7
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What sort of week did you have?
Which was the best night? Why?
Which was the worst night? Why?
Any other comments
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