Day 17: 7 Steps to Better Sleep for Autistic, ADHD, and SPD Kids

7 Steps to Better Sleep for Autistic, ADHD, and SPD Kids

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This is Day 17 in the series: 31 days on Living with ADHD, Autism and Sensory Processing Disorder: What We Have Tried, What Has Worked, What Hasn’t Worked, and Never Giving Up. 

Getting most kids to sleep is tough even if they don’t have autism, ADHD or SPD (sensory processing disorder).  If they do have one of these conditions it makes it even more likely you will have sleep battles.

Just like with picky eating, sleep has a lot to do with the temperament of the child.  One of my twins is an awesome sleeper!  Miss Princess will put herself down for naps and go to bed when she is tired.  Miss Tomboy on the other hand fights naps especially.  She tends to get more and more wound up until she is a crying mess unless we start her bedtime routine before she is overtired.

Some info on autism, SPD, and ADHD children and sleep:

“44 to 83% of children with autism have suffered from sleep problems, which include difficulty falling asleep, staying asleep, or early morning awakenings.” according to autism speaks.org

“Overall, looking at all children in this study, behavioral and physiological measures were able to predict good sleepers versus poor sleepers with 85.7% accuracy, suggesting that atypical sensory behaviors are important to consider in relation to sleep deficits in children (ReynoldsLane, & Thacker, 2011).”  spdfoundation.net

“For example,  one recent study found that children with ADHD had higher rates of daytime sleepiness than children without ADHD. Another study found that 50% of children with ADHD had signs of sleep disordered breathing, compared to only 22% of children without ADHD.  Research also suggests that restless legs syndrome  and periodic leg movement syndrome are also common in children with ADHD.”  sleep foundation.org

If you have an Autistc, SPD, and/or ADHD child most likely you are exhausted as a parent.

I know I am!  Mr Rockstar as a baby would wake himself up as he was falling asleep because of the “feeling” of falling.  I didn’t know this at the time but on retrospection that clearly is what was happening.  He had to be in a dead sleep before I could lay him down otherwise as he fell asleep he would startle himself back awake.  Pretty quickly I gave up and just started co-sleeping with him.  I LOVED co-sleeping and wish I had done it from day 1 with him.  Even though the twins could have slept on their own I co-slept with them for quite a while too.

At 12 months old we had to transition Mr Rockstar out of our bed.  He was waking me up and I was waking him up.  Up to that point I did a TON of soothing to get him to sleep at night and naps.  After much research I decided to try cry-it-out.  I had vowed I never would let my kids CIO but at some point exhaustion set in.  I wish I had read Bringing Up Bébé: One American Mother Discovers the Wisdom of French Parenting (now with Bébé Dayby Day: 100 Keys to French Parenting) before Mr Rockstar was born (though I don’t think it had been written yet LOL).  In this book, Pamela describes the French Way of getting a baby to sleep through the night.  Basically, once the baby starts making noise you wait 5-10 minutes before going into their room to see if first they will fall back asleep on their own.  You start this at about 2 months old.  This gives them the chance to practice self-soothing so you aren’t left with the extreme of either eternal co-sleeping or cry-it-out.  Anyone try this?  It makes sense to me….

Cry it out worked just fine and for the most part I think Mr Rockstar was an ok sleeper off and on.  We would go through periods when he would go to bed without a fuss and sleep through the night.  The older he got though the worse his sleep seemed to get.  At some point he started having periods of extreme insomnia where he would be awake and wired and there was no getting him to bed.  Also, his wake up times got to be more erratic.  It seemed like all I could rely on was that he would wake up at a different time every day.  And of course he also would go through periods of regular old night waking where we would have to return him to his bed multiple times a night.

I started reading all the sleep books I could get my hands on.  My personal favorite was “Healthy Sleep Habits, Happy Child“.  I like all the data it has on what the average sleep patterns for kids are at each stage of development.  I also like that the author gives multiple solutions to try for each problem at each age.  He didn’t say the only solution was CIO, or the only solution was co-sleeping, etc.  He just gives the data both good and bad for each possible solution.  Using this book I could tell when Mr Rockstar’s sleep strayed far from normal.

Over the years it seemed like each sleep episode Mr Rockstar had just got worse and worse.  We would have an ok few months with him going to bed without a fight and only having semi weekly night wakings of 10-20 min….though his wake-up time continued to vary from 5am-8am being completely unpredictable.  Just about the time we thought we had it all together Mr Rockstar would have a major insomnia battle.  Out of the blue he would go from going to bed at 9pm to it taking us HOURS to get him to sleep.  He would only sleep an hour or two and then it would take us a few more HOURS to get him back to sleep.  These bouts of insomnia appeared to be triggered by major stresses, seasonal changes (changes in daylight), and getting off our routines.  This is what we have tried that has helped:

7 Steps to Better Sleep

1. Consistent Bedtime

We all need a consistent bedtime to maintain proper sleep rhythms.  While I feel like I can get away with occasionally staying up late, keeping Mr Rockstar out late almost always is a disaster.

Make sure you know what an appropriate bedtime is for the age of your child.  If you keep them up too late they may be getting a second wind.  I have noticed if we miss Mr Rockstar’s bedtime by 30 min then it usually takes us a couple more hours to get him to bed.

2. Have a Set Routine

Have a consistent bedtime routine that is calming.

Our bedtime routine looks like:

  1. Announce the Kitchen is closing in 5 min (this staves off the endless requests for more water and food.  If the kids ask again we just say “I am so sorry.  The kitchen is closed.  I can get you water first thing in the morning.”
  2. Serve chamomile tea and a small snack (usually pb&j)
  3. Take vitamins and brush teeth
  4. Do a soothing activity such as give Mr Rockstar a bath with lavender or pull him around in the Body Pod Sensory Sock or swing him in a Lycra Swing
  5. Read Books
  6. Say Goodnight

At least this is how I dream it should go every night LOL.  We always have steps 1, 3, 5 & 6 but some nights we miss tea time and soothing activity if it is getting too late.

3. Color Changing Alarm Clock and Reward System

When Mr Rockstar was 3 he still needed a nap most days.  Even if he didn’t take a nap I wanted him to at least have a quiet time so I could get a break!  These color changing alarm clocks have worked great for us.

This was the first one we tried:

It worked just fine but it will only let you set one time for the color to change to green.  So you have to pick either nap time or morning wake-up time ….otherwise you have to reprogram it twice a day (which we did do at times!). Once the alarm clock changes to green the child knows it is ok to get up.  Obviously if they are still asleep the clock won’t wake them up (unless you want to also set the alarm).

When the girls got older I got this one for them:

Mr Rockstar was still using his so I figured I would get another one to try.  I like this one more.  It has a nap setting as well as morning wake-up.  The girls like the visual of seeing bunny asleep and then bunny wake-up.  Another nice feature about this alarm clock is it has a countdown in the display once it is getting close to changing times.  Not only does it have the countdown but it also shows a sun slowly starting to rise.  So if the girls see the sun about to rise they know they just need to wait a few more minutes.

These are great but how to you actually get your kids to use them?  First explain to your child mommy needs to rest (or work) and so they need to stay quiet in their room until the clock changes colors.  Second, if they are too loud they will lose a toy from their room (my kids don’t have many toys in their rooms but usually they have a stuffed animal or two in their bed).  Third, I offer an incentive for successfully staying in their room until the appropriate time.  Whatever the child is dying to do I try to set that up as the reward for staying quiet until their clock changes color.  For instance Miss Tomboy loves playing with our pet hamster.  If she does a good job taking her nap then she can play with the hamster when she wakes up.  Mr Rockstar’s reward is stickers for his reward chart if he stays in bed during the night and doesn’t wake us up too early.

4. Environment

At nap time and bedtime, try to have a quiet house plus some white noise.  We almost always have fans running at night and during nap time.  Turning on the fan also acts as a cue that it is almost bedtime.  When we travel I use a sound machine app that has a “fan” sound.  This helps a ton.

The less light the better.  In the summer we use room darkening curtains in the kids bedrooms.  Mr Rockstar goes through phases when he wants a nightlight and when he doesn’t.  I let this be something in his control.  I try to give him plenty of night light options and usually that keeps him from asking to have his overhead light on.  Every few months, he swings from wanting his room pitch black to having it totally lit up at night.

I like to use lavender in a diffuser in the kids rooms.  Lavender is calming plus I can take the smell of bedtime with us when we travel.

Because of his sensory issues Mr Rockstar likes heavy comforters.  Some people make their children weighted blankets (visualize a hundred bean bags sewn together to make a blanket).

Make sure the temperature is right.  Mr Rockstar tends to get hot so it is a good thing his bedroom is downstairs! or we would all freeze.

Check for allergens to dust mites, etc.  Thankfully Mr Rockstar isn’t allergic to anything that would be in his bedroom.

5. Quiet Return to Bed

If your child wakes up in the middle of the night or leaves their room after you have said good night then use the “Quiet Return to Bed” technique.  This is trickier than it sounds.  If you display any emotion (positive or negative), make eye-contact, cuddle, have aggressive body language, etc it will mess up quiet return to bed.  You need to envision yourself as a parent robot.  Gently hold the kid out at arms length and return them to bed without any eye contact, any body contact, or any body language.  Can I just say this is really hard to keep up for an hour or two when you first start implementing this?  It just is hard.  It might take a few hundred times of returning your child to bed but (normally) eventually they will get worn out and the “game” won’t be any fun after a while and they will just go to bed.  When Mr Rockstar is habitually waking us up at night this technique works well.  If he is having an insomnia episode this technique just sparks aggression from him until we are forced to step in.

6. Natural Supplements

All of these supplements have helped Mr Rockstar to some degree or another.  Lets start with the least controversial.

  1.  Chamomile Tea has been known to be calming for hundred of years.  Plus with a spoon of honey it doesn’t taste too bad either.  Mr Rockstar’s psychiatrist suggested this as a natural sleep aid.  Thus we started an evening tea time routine  We already had an evening snack time as our way of avoiding nighttime water/kitchen battles.  We added tea to this snack time and it made it a nice family ritual.  When you first start this ritual you can even read the story of Peter Rabbit to give the kids some inspiration to drink their tea.
  2. Lavender has also been used for generations for soothing.  You can put a drop of essential oil in their bath, rub a drop diluted with some coconut (or other) oil on their feet, or diffuse it in their bedroom.
  3. Valerian Root Tea has a very sedating effect.  It tastes awful though.  This is another one recommended by Mr Rockstar’s psychiatrist.  If your child can swallow capsules then that is the way to go.  I tried them to see how they worked.  I found if I took two or three I got the same effect as taking a Benadryl so it does have a pretty strong sedating effect.  Mr Rockstar’s doctor thought besides helping him fall asleep, the Valerian Root would help him stay asleep through the night.
  4. Iron – if your child has an iron deficiency it can contribute to “restless legs” and cause sleep disturbances.  When Mr Rockstar was little the developmental pediatrician checked his ferrite level and said it was too low.  He had Mr Rockstar take an iron supplement on top of his daily multivitamin with iron.  This did help his sleep quite a bit.  He took the iron supplement for about a year and ever since his iron levels have been fine.
  5. Melatonin is pretty controversial.  I know in my circle of moms it is generally looked down on to give your child melatonin.  I agree it should be a last step and not a first.  If a child isn’t sleeping because we have failed as a parent at establishing a good bedtime routine with a consistent bedtime then I think using melatonin is inappropriate.  If, however, you have tried EVERYTHING else and your child is still have wildly erratic sleep patterns PLUS your doctor recommends it then I won’t allow myself to feel guilty about using it.  The problem with melatonin supplements is there haven’t been many studies to show what if any negative longterm effects it might have on children.  On the flip side there have been some studies, according to Autism Speaks, that show melatonin helps improve sleep with kids with autism with virtually no side effects.  We reserve the use of melatonin for when we are traveling or if Mr Rockstar is having a bout with insomnia and his doctors recommend it.  One note on the use of melatonin: it only is effective when given at the right time in the evening to promote the natural sleep rhythms.  If you give them melatonin in the middle of the night if they wake up it will do NOTHING.  Also, I have tried it once with Mr R when I thought he really needed a nap and it did nothing except make him cranky.  So a word to the wise only use it in the early evening.

7. Mindfulness

These mindfulness exercises are so relaxing.  They are designed for kids but I find myself listening to them too!  They help me stay calm when I am up at 2am with Mr Rockstar trying to help him fall back asleep.  Mr Rockstar’s psychiatrist recommended Sitting Still Like A Frog:

It talks children through being aware of their feelings, how to let go of raving thoughts, how to focus on breathing to relax and ultimately fall asleep.  It has a cd that has segments on all sorts of topics that mindfulness is useful for.  We first started using it in the mornings before starting school to help Mr Rockstar calm down and focus.  Soon he was requesting “Sitting Still Like a Frog” when he would wake up at night.  Often times his mind is wound up and hyper but his body is tired.  Lately when this has been the case, listening to some of the mindfulness exercises have helped him relax enough to fall asleep.  I have been really impressed at how helpful these exercise have been.

Summary

If you are having sleep battles try a consistent age appropriate bedtime, a consistent soothing bedtime routine, and  sure check that their bedroom has a conducive environment for sleep.  If you are still having sleep issues try mindfulness exercises, quiet return to bed, and natural supplements such as chamomile, lavender, and valerian root.

If after trying all this your child is still struggling then talk to your doctor.  While there is an unknown risk of using melatonin, lack of sleep is probably far more damaging developmentally than the risk of taking the melatonin.

One quick side note about ADHD and sleep.  If your child is on a stimulant medication such as Ritalin (we just started Mr Rockstar on Ritalin about a month ago) it interferes with their sleep and it can be very hard for them to go to sleep.  So usually they will also be on another medication such as clonodine to help them sleep.  Mr Rockstar has been doing much better behaviorally on the ritualize + clonodine.  I wonder how much of this improvement isn’t due to his sleep being much more consistent than it has been in years.

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