The following information and resources have been provided courtesy of The Lurie Center for Autism, a program of Massachusetts General Hospital and Mass General for Children.

The Lurie Center for Autism is committed to advancing treatments for and knowledge about Autism Spectrum Disorder (ASD) and other developmental disorders, and translating these discoveries into exceptional clinical care. A program of Massachusetts General Hospital and Mass General for Children, The Lurie Center is a multidisciplinary treatment, research, training, and advocacy organization dedicated to supporting individuals and their families across the lifespan.

This resource is intended to provide information so that you can be better informed. It is not a substitute for medical advice and should not be used to treat any medical conditions.

This information is also available in Spanish. Click here to view this resource.

Authors: Nicole Simon, EdM, LABA, BCBA & Diana Wasserman, MD.

‍

Sleep is essential to our physical and mental well-being. Up to 89% of children with Autism experience difficulties with sleep. When a child has problems with sleep, the entire family can be impacted!

Sleep hygiene

Sleep hygiene is daily practices that can influence a person's ability to fall asleep and stay asleep. These tips apply to all of us!

1. Establish consistent bedtimes and wake-up times. Use a sleep diary to document sleep patterns and be flexible when thinking about the right bedtime. Limit daytime naps to help with nighttime sleep duration.
2. Establish a bedtime routine:
   
   • Typically, 30 minutes before bedtime.
   • Keep the routine consistent each night, use visual aids, pictures or checklists as needed.
   • Encourage calming activities (bath-time, reading) and avoid activities that may cause conflict. Avoid TV and video games before bed.
   • Do not extend the bedtime. ("One more story...?")
3. Ensure the bedroom temperature, noise level, light, bedding, etc. are all comfortable and conducive to sleeping (not too hot/cold, not too noisy, not too light/dark).
   
   • The bed should be associated with sleep; not playing, jumping, etc.
   • Pay attention to noise outside of the room – is the TV too loud?
4. A well-balanced diet can help with sleep. Avoid meals or large snacks right before bed. Avoid caffeine (chocolate, soda, etc.) before bed – it can stay in your system for up to 6 hours! Light snacks (milk and carbs are ok). Do not go to bed hungry!
5. Regular exercise, especially aerobic activity, can help with sleep. Avoid exercise 4–6 hours before bedtime.

Sample behavioral interventions

There are a number of behavioral interventions that can be used to improve sleep patterns. Examples are Extinction, Graduated Extinction, Faded Bedtime, Sleep Restriction and Scheduled Awakenings. Each method has pros and cons and is used to address different types of issues.

Things to consider before employing a sleep intervention:

1. Address sleep hygiene first.
2. Gather information before implementing a plan to help assess and properly treat the issue.
3. Make sure the timing is right for your family. Sometimes things get worse before they get better and the key to success is patience and consistency!
4. Take data! The more information you collect about awake/asleep patterns, the easier it will be to know if the situation is improving.

What if our child is still having sleep problems?

Should these strategies not help to improve your child’s sleep, consider speaking with a medical professional to discuss medical reasons that could be contributing to sleep disturbance as well as whether or not medication is indicated. Your child’s doctor may recommend that you speak with a sleep specialist.

Medication:

How do you know if your child needs medication to support sleep?

• Is your infant or toddler getting 12–14 hours of total sleep?
• Is your preschooler getting 10–12 hours of total sleep?
• Is your elementary aged child getting 10–11 hours of total sleep?
• Is your teenager getting 8–9 hours of total sleep?

Melatonin:

• The body regulates sleep wake cycles with melatonin production by the pineal gland.
• Melatonin is a natural occurring hormone.
• Children with ASD may have lower levels of natural melatonin than those who do not have ASD.
• Use of synthetic melatonin given 1–2 hours before bedtime may help your child fall asleep. If frequent waking is a problem, long-acting melatonin may be of benefit.
• Dose of 1–6 mg, higher doses for some children.

Did you know that the blue light of computer screens may inhibit melatonin production by the body? Block blue light from electronic screens in the evening hours.

Sleep resources and references:

• Autism Tool Kit: Strategies to Improve Sleep in Children with Autism Spectrum Disorders www.autismspeaks.org ATN tool kits
• Book recommendation: Sleep Better! A Guide to Improving Sleep for Children with Special Needs by V. Mark Durand
• Accredited Sleep Disorders Centers: http://www. sleepeducation.com/find-a-center
• http://www.webmd.com/brain/autism/helping-your-child-with-autism-get-a-good-nights-sleep