Sleep Care Essentials: Supporting Better Sleep for Autistic Individuals
Overview: This article supplements the article “Autism and Sleep” with specific sleep hygiene and intervention strategies. To best utilize the lessons in this article, complete the “Sleep Toolkit.” Download the toolkit at the end of this article.
It is well established that sleep is critical to overall health and wellness, and that autistic individuals tend to struggle more with sleep than their non-autistic peers. To stave off the myriad potential physiological, psychological, and social problems that arise from sleep disturbances, it is important that autistic individuals and their families endeavor to sleep as consistently and soundly as possible. ALL has coaches available and trained in establishing an individualized sleep routine utilizing some combination of the following recommended approaches:
Sleep Routine
Many people are at their best with consistency in daily routines, including sleep. A healthy routine includes the following:
1. Wake-Up Time
The time should be 30-60 minutes before daily obligations begin allowing sufficient time for morning hygiene and breakfast.
2. Sleep Time
Set a time at which you should be fully asleep approximately seven to nine hours prior to wake-up time. For example, if your wake-up time is 8:00am, then you may want to be asleep by 11:00pm.
3. Bedtime
This is a period during which you prepare your body and mind for sleep, usually 30-60 minutes before sleep time.
4. Bedtime Routine
Bedtime is meant to include a relaxing routine of hygiene and calming activities such as reading, listening to soothing music, journaling, or practicing relaxation exercises. It is best to avoid screens during this time as blue light can interfere with melatonin production.
5. Repeat
It is best to keep this routine consistent throughout the week so as to establish a reliable internal clock which makes sleep more predictable and less elusive.
Sleep Environment
Autistic people, particularly those with sensory sensitivities, are especially susceptible to physical discomforts or sensations that can interfere with sleep. It follows that a supportive and comfortable sleep environment is an essential part of the successful sleep strategy. Creating a healthy sleep environment may include:
1. Darkness
Darkness signifies to the body and brain that it is time to sleep. Eliminate all unnecessary light using black out shades or eye covers if necessary. If darkness is an issue or uncomfortable, consider using a red-light night light, rather than white colors which too closely resemble daylight.
2. Quiet
Eliminate unnecessary noise and distractions. Tools such as ear plugs or white noise machines can help to eliminate distraction from other sounds.
3. Temperature
Most people sleep better in a slightly cooler environment. A fan or mattress cooler can help to lower body temperature in warmer locations. With cooler ambient air, many people find it comforting to have something warm next to their body, such as a hot water bottle, low-setting heating pad, or microwavable warmer.
4. Covers
Deep pressure on our bodies, like a loved one’s hug, helps alleviate or reduce autonomic stress that can interfere with sleep. Weighted blankets can emulate this feeling and have been found helpful for many individuals struggling to fall or remain asleep.
Daytime Routine
It seems counter-intuitive, but getting a healthy night of sleep starts first thing in the morning. The activities and actions of the day build on one another and contribute to healthy sleep hours later. It is important that daily behaviors be geared towards healthy living and quality sleep later in the night. Healthy daily behaviors for sleep include:
1. Diet
Healthy eating is necessary for overall physical and mental fitness and is in fact critical for sleep. Large meals, caffeine, and alcohol are known to disrupt sleep and should be avoided within two to three hours before bedtime
2. Hydration
Water has been called the essence of life, and for good reasons. Maintaining hydration throughout the day will significantly aid the body to fall and stay asleep. But because a restless bladder can interfere with sleep, it is best to stay hydrated during the day and reduce fluid intake in the hours before bed in order to minimize nighttime bathroom trips.
3. Physical Activity
Daily exercise is an essential contributor to good sleep. A body that is active throughout the day grows tired and a tired body simply rests better. Adding a slight bit of exercise sometime before dinner will foster a good night’s sleep, and if the exercise occurs in natural light, i.e., outdoors, it will assist the body to differentiate between day and night which also aids sleep.
4. Cognitive and Emotional Regulation
High levels of stress, anxiety and emotions interfere with sleep. It is helpful to make time to process, contemplate, feel and manage unresolved thoughts and feelings in the hours before bed. Incorporating a journal as part of the bedtime routine is a good way to foster this process, so long as you allow time to move towards more neutral, calming thoughts as your sleep time approaches.
5. Naps
For those lucky individuals who can nap without waking up cranky, naps can be helpful as a midday rejuvenation. Naps should not exceed 30 minutes or occur too late in the day, or they can interfere with nighttime sleep.
Sleep Aides
The world is full of pills, potions, and remedies marketed as sleep aids. While many are effective for short and long-term use, many more can be habit forming and disruptive of certain sleep patterns. Any long term or prolonged use of a sleep aid should be done under the care of one’s physicians. Common sleep aids include:
1. Pharmaceuticals
Medications like Ambien, Sonata, Restoril, and others offer help in falling asleep. Some have extended-release formulas that also help a person to stay asleep. Many are habit forming and can lead to dependence on the medication. These types of medications are best used for short periods to avoid dependence and long-term sleep interruption. Ideally, use of these medications is limited to a month or two to develop healthy sleep habits, but then stopped to avoid dependence.
2. Melatonin
Melatonin is a naturally occurring hormone that regulates sleep-wake cycles and circadian rhythms. Melatonin can be taken as a supplement to help reset or set sleep cycles. The research on whether it causes dependence varies, but like pharmaceuticals, it is best when used for limited periods to help develop healthy sleep habits, but then stopped to avoid dependence.
3. Vitamins and Supplements
Substances such as GABA, Valerian, Lavender, Kava, Magnesium, and CBD have all shown varying levels of effectiveness in helping people to fall and stay asleep. Individuals have differing degrees of success with these supplements, and like other aids they should only be used for a short period as a tool to develop good sleep habits, but not become part of the pattern.
Nightmares
Nightmares are a common form of sleep disturbance. The cause of nightmares is as varied as the individuals that struggle with them, and so is the treatment. For prolonged or severe nightmares professional help is often beneficial and may even be necessary. Coaches at the Autism Learning Lab are trained in helping identify and address the cause of nightmares and sleep terrors.
Conclusion
Falling and staying asleep is much easier to read about than to do (although, this article may have put you to sleep already). For many people it takes consistency and mindful effort throughout the day to build good sleep habits. Hopefully the information and tools provided herein will start you on the path to healthy restorative slumber. Good luck and goodnight.
