Sleep problems
Difficulties in sleeping are extremely common, both in childhood and adolescence, and most of us will struggle with sleep at times.
In early childhood, separation anxiety or bedtime fears are common causes of difficulties getting off to sleep, due to a fear of being left alone.
In teenagers, sleep difficulties are often due to phase shifts in sleep waking, as they may prefer to be awake at night, then sleep further into the day. Drinking too many caffeinated or energy drinks later in the day or the use of some drugs can impact sleep.
The most important step to manage sleep problems is to establish a regular sleep routine. Try to go to bed and waken at the same time every day. Try to avoid any stimulants, such as caffeinated drinks or chocolate for several hours before going to bed. Have a calm down routine before bed, which may include a light snack and milky drink. It may be worth trying a banana at night, as these contain tryptophan which has been found to regulate sleep.
A bath can be part of a relaxing wind down routine, then try a calming exercise in bed, such as relaxing breathing techniques or listening to relaxing music or sounds. Some young people find having smells associated with calmness, such as lavender, or writing down their worries on a notebook before bed also helps. Make sure your sleeping area is warm, dark and comfortable. Avoid using your phone or any electronic device and relax instead by reading a book.
Recent research has found that exposure to natural daylight when you wake up is important to reset your body clock and helps to shift back a delayed sleep cycle. Remember, it takes at least five days to establish a routine in behaviour, so continued efforts to maintain the same routine are essential to develop a new sleep pattern.
Mental health difficulties can often cause sleep disruptions. Young people with depression, trauma and anxiety often struggle to fall asleep or stay asleep and this can be a sign of worsening mental health. In these cases, it is important to treat the associated mental health disorder and establish a good sleep practice and routine.
This resource from the Mind website explains the link between sleep difficulties and mental health, gives practical advice and links to various other resources for support, including the Mental Health Foundation and Royal College of Psychiatrists.
Neurodevelopmental diagnoses, such as Autism Spectrum Disorder (ASC) and Attention Deficit Hyperactivity Disorder (ADHD) are often associated with longstanding sleep difficulties. Studies have shown up to 86 percent of children with neurodevelopmental difficulties struggle with difficulties falling asleep (sleep onset latency), night awakenings or short sleep duration. Some medications prescribed for ADHD can worsen sleep difficulties, particularly if taken later in the day.
Behavioural interventions are the first line treatment, and the most successful therapies use a gradual approach, such as gradual withdrawal, rather than an abrupt change. Parental/carer involvement is critical in improving the child’s sleep problems and parent/carer group-based training has proven effective. Use of a weighted blanket has also been found to help with sleep. If behavioural methods have been tried and not proven effective, there is some evidence that some medications, such as Melatonin and antihistamines can improve sleep. The website of the National Autistic Society website is an excellent resource for advice and support for children and young people with ASC and sleep difficulties.
Children with intellectual disabilities frequently struggle with sleep difficulties and this can have a profound effect on quality of life. Large meta analyses have shown that young people with intellectual disabilities experience poorer quality and shorter sleep duration than typically developing peers. Additional medical problems in children and young people are also associated with poorer sleep, especially pain, seizures, coughing and constipation.
The Scope website has information and advice on managing sleep difficulties, including telephone and email support and a sleep podcast. Another excellent resource is the Cerebra website, which has a downloadable sleep guide and sleep cards for many sleep problems, as well as contact details for the sleep team who provide 1 to 1 support.
Most Child Development Centres in each locality have a neurodevelopmental team who provide sleep support for children and young people with ASC, ADHD and intellectual disabilities, including behavioural advice and Melatonin medication if clinically indicated. There are also local organisations in many boroughs who provide direct work and support for families with neurodevelopmental concerns and sleep difficulties.