Sleep Well on the Autism Spectrum

Introduction. Section A: You Think There is a Problem, so What Can You Do About It? 1. Sleep Problems. 2. What Sorts of Sleep Problems Are There? 3. How Common Are They? 4. How You Can Work Out What Might Help. Being 'a bit of a Sherlock Holmes' - the art and science of problem solving. So, what is the problem you need to try and sort? Looking through your evidence. What sorts of things might make sleep problems more common in ASD? 5. Finding Out About Your Problem. Getting a baseline. If you think: 'This feels too much like schoolwork, maybe I'll just skip it'. Looking through your Evidence. Trying to understand the problem. i) Finding out what else is going on. ii) Describing the sleep problem. Finding a Pattern. Why it can be so difficult to do what would work. What if there is a problem but you are still strugging to see a pattern? In a nutshell. 6. Ways to Sort Out Sleep Problems. Doing a basic sleep clean-up. Basic 'sleep hygiene' - getting a good nighttime routine. What you should aim for: In children. In adolescents. Using Social Stories to encourage a good nighttime routine. Deciding on a plan. In a nutshell. 7. Why Are Sleep Problems More Common in ASDs? How common are sleep problems in ASD? Do you really need to do anything about them? Sleep problems are more common in ASDs - do we know why? Section B: Specific Sleep Difficulties - The Different Sleep Problems, What They Are, and What Can Help. The most common sleep difficulties in ASDs. How sleep problems are classified. 5.1-5.4. Difficulty Getting to Sleep, Staying Asleep and Problems with Excessive Tiredness. 5.1 Insomnia. Peter can't seem to get to sleep - we hear him up at all hours.' What is it? How common is it? Does insomnia tend to get better with time? What can be done to treat it? How likely is Insomnia to respond to treatment? In a nutshell. 5.2 Difficulties with Settling to Sleep and Frequent Night-Waking. 'He never goes down to bed and he's up and down like a yo-yo all night long.' What is 'difficulty settling to sleep'? What is 'frequent night-waking'? Do these two problems tend to go together? How common are they? Do settling and night-waking tend to get better anyway? So what can be done to treat them? How well do they to respond to treatment? In a nutshell. 5.3. Restless Sleepers. 5.3.i. Restless Legs Syndrome. 'Fidgity Philip - he never seems to stop' What is it? How common is it? Does it tend to get better over time anyway? What can be done to treat it? How likely is it to respond to treatment? In a nutshell. 5.3.ii. Nocturnal Seizures. 'He gets hot and sweaty, shakes in his sleep and usually wets his bed. We can always tell when one is coming.' What are they? How common are they? Do they tend to get better anyway? What can be done to treat them? How likely are they to respond to treatment? In a nutshell. 5.3.iii. Sleep-Related Rhythmic Movement Disorder / Periodic Limb. Movements in Sleep. 'Why on earth does he keep doing that?' What is it? How common is it? Does it tend to get better in any event? What can be done to treat it? How likely is it to respond to treatment? In a nutshell. 5.3.iv. REM Sleep Behaviour Disorder. 'The boy who fought with his dreams.' What is it? How common is it? Does it tend to get better anyway? What can be done to treat it? How likely is it to respond to treatment? In a nutshell. 5.4. Short Nighttime Sleep ('Hyposomnia'). 'Why doesn't she sleep?' What is it? How common is it? Does it tend to get better anyway? What can be done to treat it? How likely is hyposomnia to respond to treatment? In a nutshell. 5.5-5.9. Problems During Sleep: The "common PARASOMNIAS of ASD". 5.5. Nightmares. 'Exit, pursued by a bear.' What are nightmares? How common are they? Do they tend to get better anyway? What can be done to treat nightmares? How likely are nightmares to respond to treatment? In a nutshell. 5.6. 'Night Terrors'. 'He just seems to wakes up and scream and scream- nobody knows why.' What are night terrors? How common are they? Do they tend to get better anyway? What can be done to treat them? How likely are they to respond to treatment? In a nutshell. 5.7. Bedwetting (Nighttime enuresis). 'His bed is always saturated and he refuses to wear anything at night. We're sure he does it just to annoy us.' What is it? How common is it? Does it tend to get better in any event? What can be done to treat nighttime eneuresis? i) Behavioural Interventions. ii) Medications. iii) Alternative and Complementary Treatments. How likely is nighttime enuresis to respond to treatment? In a nutshell. 5.8. Sleepwalking (Somnambulism)/ Sleeptalking (Somnliloquy) / Sleep groaning (Catathrenia). 'We often pass him in the hall on our way to bed, walking around the house but fas asleep and oblivious to anything we say.' What are sleepwalking, sleep talking and sleep groaning? How common are they? Do they tend to improve without treatment? What can be done to treat them? How likely are they to respond to treatment? In a nutshell. 5.9. Excessive Daytime Sleepiness/Tiredness (EDS/'Hypersomnia'). 'He seems to be tired all the time no matter what we do.' What is it? How common is EDS? Does it tend to get better anyway? What can be done to treat it? How likely is EDS to respond to treatment? In a nutshell. 5.10-5.14. Other, less common sleep issues seen in ASDs. 5.10. Excessive Nighttime Sleep. 'Sometimes we start to think he'll never wake up.' What is it? How common is Excessive Sleep? Does it tend to get better anyway? What can be done to treat it? How likely is it to respond to treatment? 5.11. Night-time Eating Disorders. 'It's as if he can't stop eating and he just ignores us when we ask him why.' What are Night-time Eating Disorders? How common are they? Do they tend to get better anyway? What can be done to treat them? How likely are they to respond to treatment? 5.12. Sleep Bruxism (Tooth-grinding while asleep). 'We can hear her through the whole house, it feels like someone is using a drill in the house next door.' What is it? How common is it? Does bruxism tend to get better anyway? What can be done to treat bruxism? How likely is bruxism to respond to treatment? In a nutshell. 5.13. Obstructive Sleep Apnea (OSA). 'He could snore for us in the Olympics.' What is OSA? How common is OSA? Does it tend to get better in any event? What can be done to treat OSA? How likely is OSA to respond to treatment? In a nutshell. 5.14. Narcolepsy. 'Everything is going along fine, then sometyhing happens like a balloon popping or a car backfiring and we find him collapsed in a heap on the floor.' What is it? How common is it? Does it tend to get better in any event? What can be done to treat it? How likely is it to respond to treatment? In a nutshell. How to decide if all your hard work has been worthwhile. Maintaining improvements. Section CL Sleep: What Is It and What Do We Know About It? What is sleep? Why do we sleep? Do we know why we dream? What happens to us while we sleep. Electrical brain activity. Changes in body chemistry that happen while we sleep. Why good sleep is important for you and your brain. How our sleep-wake patterns change as we get older. The Brain at Rest. Sleep and diet. Alcohol consumption. Diet, Genetics and Brain Development. Social Interaction and Sleep. Why mum's laughter is probably one of the best medicines for the growing baby. Mother-Infant Co-sleeping. How babies calm themselves. Other factors that can affect sleep. How much sleep is normal? Do we need to sleep at all? What is a normal sleep pattern for a child? What is typical night's sleep? Section D: Some of the Reasons Sleep Problems Can Happen. Sleep and mum's mood. The biology of sleep. Differences in the chemical that triggers tiredness. Visual impairments and their link to poor sleep. Oxytocin. Why you yawn. Diet, Sleep and ASD. Physical factors that can affect sleep. Other Factors that can Influence Sleep. Sleep deprivation and brain growth. Brain injuries. Attention-Deficit Hyperactivity Disorder. Physical growth and sleep. Obesity. Genetic Conditions with high rates of sleep problems. 'Clock Genes'. Conclusion. Glossary of Terms. References. Further Suggestions for Reading. Appendix 1: Enuresis alarms and Epilepsy Sensors. Appendix 2: The Main Medications used in sleep disorders. Appendix 3: Complementary and Alternative Treatments. Appendix 4: Western Herbs used in sleep disorders. Appendix 5: Chinese Herbs used in sleep disorders. Appendix 6: Assessment Tools for Sleep Problems. Appendix 7: Preparing for Medical Procedures. Appendix 8: Troubleshooting. Appendix 9: Further Suggestions for Reading.