Karen Wang
Parenting
A Special Needs Guide To Bedtime
What is bedtime like at your house? It’s serious business at my house. Lockdown starts at 7pm, and the lights are usually out by 9pm. Both of my children have problems with falling asleep and staying asleep - for different reasons. And when I say "problems," I'm talking about extreme hyperactivity, meltdowns lasting 90 to 120 minutes, self-stimulation including slapping their own faces to stay awake and good old-fashioned tossing and turning all night. So my husband and I developed an evening routine to maximize everyone’s chances of getting a restful night of sleep. I know that my family is not alone. Difficulty falling asleep, insomnia, night-waking and other sleep disturbances are common with all types of neurological differences such as brain injury, ADHD, autism, epilepsy and chronic migraines. Sleep deprivation can lead to mood changes, diminished immune response and impaired cognitive abilities. Fortunately, it’s possible to tackle the problem from many angles.1. No-Cry Sleep Solution
No medical or psychological organization recommends allowing a child to cry to sleep, because there is no medical or psychological benefit to this practice. Elizabeth Pantley, author of The No-Cry Sleep Solution, suggests keeping a journal of a child’s sleep habits and changing moods for a few days, then using this information to initiate gradual changes in the family’s evening routine. Pantley notes that one of the most frequent mistakes is putting off bedtime until the child is fussy and overtired - and resistant to sleep. With an earlier bedtime, a child is more likely to be able to sleep through the night and be in a better mood the next day.2. Nutritional Deficiencies
Most Americans are deficient in vitamin D, and insomnia is a possible symptom of vitamin D deficiency. Deficiencies in other nutrients, such as magnesium or omega-3 fatty acids, may contribute to restlessness and disturbed sleep. Always consult with a physician before starting nutritional supplements due to the risk of overdosing, especially in young children.3. Sensory Issues
Hypersensitive people may awaken from the slightest noise, movement or change in light in their sleeping area. My younger son was distressed by the feeling of dizziness and weightlessness just before falling asleep, so I used to hold him tightly to help him feel anchored. Now at age 5, he falls asleep hugging his teddy bear. The following items can improve the sensory environment for sleep:- A white noise machine, fan or air cleaner
- A non-bouncy mattress (we use latex mattresses from IKEA)
- Quiet sheets and blankets
- Some WD-40 on the door hinges to prevent squeaking
- Blackout curtains and dark-colored paint on the walls
- Weighted blanket
- Bed tent or homemade "cave"
- Extra-long body pillows or stuffed animals for squeezing
4. Strict Routine
Individuals with some types of neurological differences may prefer a strict written or visual schedule. My older son takes a bath every night at exactly 7:10pm. Then he finds his favorite pajamas, listens to a bedtime story, writes in his diary and says his prayers. These are all comforting activities that allow him to have special time alone with each parent and reflect on his daily experience - and he falls asleep with a smile. A schedule can be written out and posted in the home so that it can be referred to often, or it can be a picture schedule using PECS or photos. A social story written in the first person is another way to explain the expectations of an evening routine.5. Social Cues
Some children with special needs have difficulty picking up on the unspoken social cues that surround bedtime. So start talking about the cues! In my home, we all take turns taking a bath or shower, brushing our teeth and putting on pajamas. We turn off lights and electronic devices “because it’s bedtime.” When bedtime becomes a group effort, it’s easier for everyone.6. Circadian Rhythm and Hormonal Imbalance
Medical studies have shown that many people with autism have elevated levels of melatonin, a hormone that causes drowsiness, during the day, and lowered levels of melatonin at night when it is needed. To reset the body’s circadian rhythm, try to spend at least ten minutes outdoors in the early morning, again at noon and finally at dusk. I used to take my children for “pajama walks” in our neighborhood just before bedtime. I found this to be a highly effective method for preventing or ending bedtime meltdowns. If one child was in the stroller or front carrier, he was usually asleep by the time we got back home. Limit the use of electric lights or screens after sunset - a darkened home will stimulate the body’s natural production of melatonin.7. Self-Regulation
The biggest obstacle that my older son had in learning how to sleep was that he did not recognize or understand the feeling of drowsiness. (He also didn’t understand hunger, thirst or pain.) So I had to teach him in the simplest, most repetitive way I could think of: stroking one part of his body at a time, I would repeat, “Your fingers are quiet. Your fingers are soft. Your arm is quiet. Your arm is soft. Your shoulder is quiet. Your shoulder is soft.” I talked to him about slowing down; I instructed him to think about things that were soft and quiet like clouds and pillows. Rhythmic language and music have a calming effect on the human brain, so I sang lullabies to him in a whisper. I recited long, repetitive prayers to him in a whisper. After several years, he learned to regulate himself so that he put himself to sleep. Children's books, such as Goodnight Moon by Margaret Wise Brown and A Quiet Place by Douglas Wood, model the need to slow down in simple terms that a young child can comprehend. For a better understanding of what self-regulation is, read this article.8. Severe Anxiety
Individuals with neurological differences often experience heightened anxiety, which is directly linked to all types of sleep issues. Here are some methods to reduce anxiety, and books that explain each method:- Play therapy: Engaging Autism by Stanley Greenspan
- Cognitive-behavioral therapy: Your Anxious Child by John Dacey and Lisa Fiore
- Positive visualization exercises: Starbright by Maureen Garth
- Relaxation techniques: The Relaxation and Stress Reduction Workbook by Davis, Eshelman and McKay
- Herbal Remedies: Herbs for Reducing Stress and Anxiety by Rosemary Gladstar
9. Medical Issues
In the world of special needs, medical issues are often the cause for insomnia and night-waking. Here’s an incomplete list of possible causes that require medical attention.- Acid reflux: sometimes sleeping on the tummy or elevating the head of the bed is enough to ease reflux, but sometimes prescription medicine is necessary.
- Constipation: encourage bowel movements before bedtime to avoid nighttime abdominal pain.
- Leg cramps: may be caused by dehydration or potassium deficiency.
- Restless legs: the irresistible urge to move one’s legs can prevent sleep. A nutritional supplement with iron or a weighted blanket may help.
- Chronic headaches or Chiari malformation: see a neurologist.
- Apnea: Periodic pauses in breathing make it impossible for a person to sleep through the night. A dental appliance or CPAP machine may regulate breathing, but in severe cases, a physician may recommend surgical removal of the tonsils and adenoids to open the airway.
