Sleep disturbances in children with neurodevelopmental disabilities and Autism are common and persistent. They have a profound effect on the quality of life of the child, as well as the entire family. Here we explore what sleep hygiene is and how an Occupational Therapist can help.

Sleep difficulties are associated with negative outcomes for the child or young person. Including challenging behaviour and impaired educational or work performance. The family often experience increased stress and relationship difficulties.

Although interventions for sleep difficulties often involve a combination of behavioural strategies and medication. An essential first intervention for behavioural sleep problems is sleep hygiene education. This advises parents and carers on creating optimal sleeping conditions for their child and exposes them to activities and cues that prepare them for and promote appropriately timed and effective sleep.

We teach the families to be able to unpick and problem solve the sleep issues so that they can manage them more effectively.

Despite the importance of sleep-hygiene principles, many clinicians often lack appropriate knowledge and skills to implement them, particularly within the SEND and Disabilities community.

How Occupational Therapists can support sleep hygiene

Restful and adequate sleep provides the foundation for optimal occupational performance, participation, and engagement in daily life.  The impact of sleep on function and participation is incorporated into the repertoire of occupational therapists and addressed across the lifespan. Prevention and intervention strategies to address individual and family needs lie within the scope of practice for occupational therapy and represent another way in which the profession approaches clients from a holistic perspective to help them live life to its fullest.

Occupational therapists use knowledge of sleep physiology, sleep disorders, and evidence-based sleep promotion practices to evaluate and address sleep disorders on occupational performance and participation. Sleep difficulties are addressed with all clients and framed from the perspective of health maintenance and health promotion. Here is a case study of how occupational therapists may address sleep difficulties with a child with Autism.

Case Study – Children with Autism Spectrum Disorder

Occupational therapists working with families of children with an autism spectrum disorder or another developmental disorder explore the impact of sleep deprivation on the family unit and the child’s and caregivers’ ability to function effectively during the day. We support families to systematically trial changes in bedtime routines, habits, and patterns. Cognitive or behavioral therapy interventions, or strategies to address sensory avoiding or sensory seeking behaviours are used.

James is a 14-year-old with Autism, he is minimally verbal, has high sensory needs and can present with challenging behaviour. James has been taking Melatonin in increasing doses since he was 6 and at the time of initial assessment was taking 3-4 hours to settle for bed and waking multiple times per night. When awake James was at risk of absconding, risky behaviour and usually woke the rest of the house.

Preteen tween boy covering ears with his fingers in bed, ADHD, sleep disorder, mental health in children, wake up for school

For James, intervention involved:

  • a social story, with supporting pictures depicting his bedtime routines,
  • loose, lightweight pyjamas with soft waistband,
  • use of a weighted blanket at night,
  • addition of white noise and a fan to drown out distracting sensory stimuli,
  • a sensory calm down programme to regulate the sensory systems before bed,
  • removal of iPad an hour before bedtime, replaced with audio books played in his bedroom,
  • introduction of a gro-clock and symbol system to signal to James when he could get up and when he needed to stay in his bedroom,
  • door sensors to alert parents if James leaves his room.

Managing the physical environment and enhancing observation skills help parents anticipate reactions to changes in clothing, toys, or family schedules. Calming activities and routines that do not burden the family and can be consistently carried out may facilitate sleep.

Some tips you can try to support your families sleep habits:

  • Set a wind down routine that is followed strictly – this provides prompts and cues to the young person about the upcoming bedtime.
  • Try turning off screens at least 30 minutes before sleep.
  • Calm activities such as reading, puzzles and fine motor skills activities work well.
  • Avoid caffeine – drink water, juice, squash or milk where possible.
  • Have a light snack such as toast, or bananas, cherries and oats are particularly full of melatonin or support the body to produce it.
  • Use of deep pressure and calming sensory strategies to support the wind down routine.
  • Getting enough physical exercise is also important during the day. We recommend 20-30 minutes of exercise three to four times a week. Exercising in the morning or afternoon is best to promote sleep. Exercise too close to bedtime can interfere with sleep due to the adrenalin release.

For more sleep strategies, sleep hygiene education or for bespoke support to manage yours or your child’s sleep, get in touch with us to discuss with an OT.

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