Attention Parents with an Autistic Child: Is a Sleep Clinic in Order?

Nothing could be more challenging, exhausting and rewarding than raising an autistic child. Not only is the situation difficult for doctors and parents alike, but it's manifested in oh-so-many ways across a spectrum of symptoms and to varying degrees in different children. One of the most commonly experienced problems, however, is trouble sleeping.

So I applaud the sleep counselors at a special school in Manchester, England, who are helping autistic children and their parents deal with disturbed sleep patterns.

Typically, an autistic child can:

• Have erratic and prolonged settling down routines.


• Have the need to perform rituals prior to going to bed, such as going up and down stairs a certain number of times, or repeatedly check on other family members.


• Have trouble learning to sleep alone in a room.


• Wake frequently and require time to settle back down with the help of an overtired parent.


• Be very sensitive to light and sound.


• Be tactilely defensive to sheets, PJ's and covers.

All of this makes for overtired children and parents. Not a good thing for the health and wellness of either. This exacerbates an already difficult situation, affecting an autistic child's ability to perform and learn in school, as well as a child's ability to gain the upper hand on a sleep-deprived mood. Any parent who has had to endure endless nights of little sleep can attest to their own package of consequences: poor concentration levels, low tolerance for coping with the challenging behaviors of their children, and high stress. And I know those are just a few examples in the litany of negative effects to chronic sleep deprivation.

Establishing a firm routine appears to be the magic bullet to helping autistic children. This strategy actually works for helping anyone become a better, sounder sleeper. It lies at the core of sleep hygiene.

My hope is that the trend in addressing the sleep needs of autistic children expands and reaches the shores of us here in American. I'm not aware of any sleep clinics that focus chiefly on autistic children and their parents, but it wouldn't surprise me to see them pop up soon enough.

Ask your doctor in the meantime - and remember that the practice of good sleep hygiene can be helpful and rewarding to anyone, whether you're dealing with autism or not.


Sweet Dreams,

Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

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Trouble Keeping Up with Your CPAP?

It's widely known in sleep medicine circles that the most common - and helpful - treatment we have these days for patients with Obstructive Sleep Apnea (OSA) is the CPAP machine, short for Continuous Positive Airway Pressure. If you've been diagnosed with OSA, then you know exactly what I mean.

The problem with CPAP therapy is that not a lot of people are good about using it on a routine basis. Or, like trying to start a ambitious exercise program, they are compliant at the start and then slowly drop off. Within a few months, they are rarely found using their CPAP. And sleeping poorly as a result.

But there's hope: new research that just surfaced and was presented last week at a conference in San Diego has revealed that when patients are prescribed just a two-week course of a certain sleep aid (the one marketed as Lunesta), they are more apt to be using their CPAP in six months.

Lunesta is one of the more popular prescribed sleep aids, which can help you to fall asleep and stay asleep by enhancing the activity of a sleep-friendly chemical called gamma-aminobutyric acid (GABA). My guess and experience is that many of the sleep aids in this category would work as well.

So I ask you:

• Do you have OSA?


• Do you have a CPAP collecting dust in your closet or beside table?


• Are you tired of being tired?


• Have you ever heard about apnea and how it can affect your health and relationship?

If you answered yes (and I know there are a lot of you out there) then you may want to take up this conversation with your doctor. Using a sleep aid for a short period of time in conjunction with a CPAP appears to be able to help you set an important pattern in your nightly routine. You'll get used to using the CPAP, and feel the difference a good night's sleep brings.

I know, the CPAP isn't the sexiest of devices, especially for a bedroom. But it can transform an OSA-sufferer's sleep. OSA is associated with some pretty unwanted health consequences - from heart problems to mood and memory problems, and even weight issues. Yet there's no consequence to using a CPAP machine other than better sleep, better health...and a happier bed partner who doesn't have to listen to your episodic breathing (and probably snoring) all night.

It's time to put OSA to bed.

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctor

This article about Obstructive Sleep Apnea is also available at Dr. Breus's official blog, The Insomnia Blog.

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• Sinus, Snoring, Sleep Apnea: Jordan S. Josephson, MD
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Why Little Kids Need Big Sleep

Photo Credit: Gareth Saunders

If sleep weren't such a necessity during those tender years, then you wouldn't see babies snoozing most of the day, and you wouldn't have your toddler take afternoon naps so there's a semblance of sanity in the home. We all need sleep as much as we need water and food, but how much is enough? What's the difference between the needs of a baby and that of a toddler or nine-year-old? What are the rules of disengagement from the world when it comes to children under 10?

Shifts in Rhythms, Changes in Bedtimes
One of the most profound changes that occurs in a developing human is the shift in biological rhythms. Everyone's body clock or circadian "pacemaker" ticks at a different rate, but as you age your pacemaker will speed up or slow down, thus altering how your body responds to that 24-hour cycle. Babies don't get a rhythm going until about 6 months of age, at which point they establish a rhythm that matches closely with the 24-hour day. This is explains why newborns maintain irregular sleep schedules. But even once they establish a rhythm and have a regular sleep-wake cycle, sleep remains the dominant theme here as they develop and grow. Sleeping a total of 10.5 to 18 hours around the clock with periods of one to three hours of wakefulness, a newborn's cycle is primarily based on the need to be fed, changed, and nurtured. A lot is going on developmentally and at the cellular level, for which sleep is the ideal environment.

By six months of age, many infants don't need to be fed during the night; 70 to 80 percent will sleep through the night by nine months of age. Infants typically sleep 9 to 12 hours a night and take 30 minute to two-hour naps, one to four times daily. Naps become fewer as they reach their first birthday.

By the age of two, most children have spent more time asleep than awake. A child will spend about 40 percent of his or her childhood asleep. Why? Because it's critical for their development both mentally and physically.

Trouble Beings During Toddler and Preschool Years
Virtually everyone has witnessed the tantrums of toddlerhood. It is during this stage in life when trouble can set in to the achievement of high-quality sleep, which is why napping should be carefully planned so it doesn't occur too close to bedtime. In general, toddlers need about 12 to 14 hours of sleep in a 24-hour period. By the time they are 18 months old, toddlers nap only once a day for about one to three hours.

As many parents can attest, toddlers' rapidly growing sense of independence coupled with their expanding motor, cognitive, and social skills can make for difficult bedtimes. They may not want to go to bed when they are supposed to, and can also show signs of separation anxiety from mom and dad. Nightmares can also become a common experience, intruding on a toddler's sleep. It helps to remember that a child's imagination is also springing into action at this age, which can further complicate restful sleep. Toddlers who are unusually sleepy and cranky during the day may not be getting enough sleep.

Photo Credit: katrinket

Those between the ages of 3 and 5 typically sleep 11 to 13 hours nightly, and most don't nap after five years of age. As with toddlers, difficulty falling asleep and waking up during the night are common. With further development of their imagination, preschoolers commonly experience nightmares and a general fear of the night. Sleepwalking and sleep terrors peak during these years.

There's nothing more frustrating for a parent than a sleep-deprived child-at any age. Bedtimes are important, and not just for kids. As parents, we need to set examples and be open with our kids about the value of sleep. To that end, here are a few pointers:

• Make sufficient sleep a family priority. It's important for the health of all family members.


• As parents, you need to determine the amount of sleep each family member needs, especially if you have a household with mixed ages, and take steps to ensure individual needs are met.


• Establish regular bedtime routines, creating a quiet and comfortable bedroom. Help your toddlers prepare for bed by making sure they disengage from stimulating activities at least 30 minutes prior to bedtime. Reading, for example, is much more relaxing and sleep-inducing than watching TV.


• Learn to recognize sleep problems. The most common sleep problems in children include difficulty falling asleep, nighttime awakenings, snoring, stalling and resisting going to bed, having trouble breathing, and loud or heavy breathing while sleeping. These sleep problems can be evident in daytime behavior such as being overtired, sleepy or cranky.


• Talk to your child's doctor about sleep - even if your doctor doesn't breach the topic.

Remember: little kids need big sleep. It's during these critical years that they are rapidly developing physically, socially, and psychologically. Sleep plays a huge role in this development and will continue to do so as they get older and learn new things. If they can enter their preteen and teenager years "well-rested," they will be all the more prepared and ready for whatever life brings. Which is sure to get more challenging.

Sweet Dreams,

Michael Breus, PhD
The Sleep Doctor

Related Topics:

• WebMD Video: Helping Baby Sleep Well
• Baby Sleep Problems: Getting Your Baby to Sleep Through the Night
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