Tag Archives: Sleep

Early Rising

Small girl waking her parents early in the morning.

Early rising is a common sleep problem

Our useful checklist gives tips for what you can do if your child is an early riser.
Early rising is a common sleep issue. Have you considered or are you already doing the following?

  • Is your child waking due to a noise?
  • Is the room dark? If not, do you have a black out blind?
  • Is your child going to bed at the same time every night?
  • Does your child have a way of knowing when it’s an acceptable time to get up? ( e.g. a clock of some kind)
  • If your child is over 3, have they stopped having naptime?
  • If your child is under 3, have you tried reducing naptime?
  • Are you unintentionally rewarding them when they get up early by letting them come into your bed or taking them downstairs?
  • Have you tried using a reward chart for your child staying in their room until an acceptable time?
  • Do you have anything in the child’s room that they can do quietly if there is no chance of them going back to sleep?
  • Have you minimised anything in the room that is noisy or overly stimulating for your child?
Download this checklist as a PDF

Cerebra’s sleep practitioners can advise on a range of sleep issues in children, such as settling difficulty, night waking, early rising, sleeping alone, bedwetting, night terrors and anxiety. Visit our sleep pages to find out more.

Books on sleep in our library

Dog with head resting on a book

Books on sleep

We have several books on sleep in our postal lending library. Below is a list.

For kids:

C0166 – What To Do When You Dread Your Bed

Advice for children with disabilities:

L1320 – Sleep Better: a guide to improving sleep for children with special needs
L6325 – Sleep Disturbances in Children and Adolescents with Disorders of Development
L6392 – Sleep Difficulties and the Autism Spectrum
L6367 – A Clinical Guide to Paediatric Sleep
General sleep advice for children:

L6315 and L6531 – Solving Children’s Sleep Problems: a step by step guide for patents
L6107 – The New Baby and Toddler Sleep Programme
L6324 – Teach Your Child to Sleep: solving sleep problems from newborn through childhood

Difficulty Sleeping Alone or Night Waking

Our useful checklist gives tips for what you can do it your child is finding it difficult tbig-yawno sleep alone or waking up in the night.

If your child is waking in the night or finding it difficult to sleep by themselves, have you considered or are you already doing the following?

  • Does your child have a comforter?
  • Have a picture of you near by?
  • Are you being consistent every night?
  • Is your child falling asleep without milk/a dummy/ a tv on?
  • Is the environment staying the same (e.g. if a light is on when they fall asleep, does it stay on throughout the night?
  • Using a reward scheme
  • The gradual withdrawal technique (slowly moving away form your child over a period of time)
  • Being a Robotic parent once the light goes out and avoiding interaction
  • Leaving a night light on
  • Leaving the bedroom door open slightly
  • Talking to your child about their fears ( not just before bedtime)
  • Is everyone that is involved in the bedtime routine doing the same thing?
  • Is your child in pain?
  • Is your child waking due to noise?
  • Is your child waking due to it being cold?

 Download this checklist as a PDF

Cerebra’s sleep practitioners can advise on a range of sleep issues in children, such as settling difficulty, night waking, early rising, sleeping alone, bedwetting, night terrors and anxiety. Visit our sleep pages to find out more.

Bedtime Resistance

father and sleeping babyIf you are having difficulty getting your child to settle at bedtime, our useful checklist may help.

Difficulty in getting your child to settle at bedtime or bedtime resistance is common. Have you considered, or are you already doing the following?

  • Turning the tv off an hour before bed?
  • Is the bed Comfortable?
  • Is the Temperature adequate? (advisable is 19 degrees)
  • Is the bedroom dark and if not, do you have a black out blind?
  • Do you have a set bedtime Routine that lasts between 30 minutes and an hour?
  • Are you starting your routine at the same time every night, including weekends?
  • Is your child going to bed at the same time every night, including weekends?
  • Is your child being woken up at the same time every morning, including weekends?
  • Is the bedroom minimal in terms of toys/other distraction?
  • Do you refrain from using the bedroom for punishment?
  • Does your child have a healthy snack before bed?
  • Does your child have a bath before bed? (If they find it calming)
  • Do you put your child to bed when there are signs of them being tired?
  • Are you keeping interaction with your child to a minimum once they go to bed?
  • Is your child getting enough exercise in the day?
  • Is your child eating healthily?
  • If your child becomes anxious or upset when brushing their teeth, have you tried doing it earlier in the bedtime routine?
  • Is your child having no caffeine near to bedtime?
  • Have you stopped or reduced naps, especially near to bedtime?
Download this checklist as a PDF

Cerebra’s sleep practitioners can advise on a range of sleep issues in children, such as settling difficulty, night waking, early rising, sleeping alone, bedwetting, night terrors and anxiety. Visit our sleep pages to find out more.

Pain, Sleep and ASD

father and sleeping babyThis article examines the relationship between pain and sleep problems in children with Autism.
Research published in the February issue of Autism, suggests that a full assessment of pain and sleep problems in young people with Autism Spectrum Disorders may provide crucial information for medical and behavioural treatment planning.1
Health related problems (e.g. gastro-intestinal problems and asthma) are often found to co-exist with Autistic Spectrum Disorders and may be more prevalent in young people with ASD than in typically developing children. Previous research has suggested that pain and sleep problems are highly co-occurring and may increase the likelihood of a young person with ASD experiencing functional impairments and impact upon their quality of life. Research has shown that sleep problems increase when pain is present in young people with physical and intellectual disabilities.

The study is the first to examine the sleep-pain relationship in young people who are considered by their parents to have ASD, specifically looking at whether children with pain-related behaviours  are more likely to have sleep problems. Researchers anticipated that more pain-related behaviours would predict more sleep problems, as previous research has found for typically developing young people and those with developmental disabilities. Researchers also examined whether the way in which the young person expressed the pain could predict sleep problems.

To investigate these relationships, researchers recruited 63 young people (aged 3-18 years) with Autistic Spectrum Disorders (ASD) to the study. They used the non-communicating children’s pain checklist revised (NCCPC-R), a widely used parent-report measure of pain in individuals with communication difficulties, to identify pain behaviours. Subscales used to measure pain included vocal, social (e.g. seeking comfort), facial, activity (e.g. agitation), body (e.g. protecting body part), physiological (e.g. sweating) and eating/ sleeping (sleep problems or disinterest in food). The Children’s Sleep Habits Questionnaire (CSHQ), a parent report measure, was used to measure behavioural and medical sleep problems, such as bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night waking, parasomnias (e.g. nightmares/night terrors) and sleep disordered breathing.

Sleep problems predicted by pain related behaviours

The analysis of the NCCPC-R and CSHQ data found extremely high levels of both pain and sleep problems in the young people with ASD who took part, with over 90% of respondents scoring at clinically significant levels on both measures. The researchers’ hypothesis proved largely correct: the study found thatmore pain-related behaviours experienced during the previous week indeed predicted more over­all sleep problems. However the study also suggested that not all sleep problems can be predicted by pain related behaviours consistently. The types of sleep problems most consistently predicted by pain related behaviours were problems with sleep duration, parasomnias and sleep disordered breathing.

Pain communication type as a predictor of sleep problems

Sleep problems could be predicted by particular ways of communicating pain. Problems with sleep duration were predicted by social communication of pain, for example comfort seeking. However, the researchers suggest that the social communication of pain may predict shorter sleep duration because of the nature of the social communication behaviour interfering with getting off to sleep.

The presence of parasomnias (nightmares/night terrors) could be predicted by facial communication of pain (the most common observable form of pain behaviour). However the researchers suggest it is possible that the grimacing and gnashing that takes place during parasomnias may increase the likelihood of mothers reporting such behaviour. It is suggested that future research examining this relationship in more depth would be useful.

Sleep disordered breathing was predicted by vocal communication of pain. However like parasomnias, the behavioural presentation of sleep disordered breathing (e.g. gasping), may have some overlap with pain behaviours communicated vocally. The researchers suggest that future studies should further examine how pain-related behaviours are communicated among young people with ASD and various respiratory complaints as compared to those without respiratory complaints.

Clinical implications

Despite the limitations to the study, such as the relatively small sample size, lack of a comparative group and the reliance on parents’ data collection and diagnosis of ASD, the authors suggest that the relationship between sleep problems and pain behaviours has important medical and clinical implications for young people with ASD. Health problems that cause pain or discomfort in young people with ASD may hinder any response to behavioural interventions and pharmacological treatments as well as their day to day functioning. The research suggests that paediatricians and clinicians should take pain-related behaviours into account when assessing and planning treatment for young people with ASD.

The findings are also useful for parents as they may benefit from taking note of their child’s sleep health if the child also has high levels of pain-related behaviour, because sleep disordered breathing, parasomnias and shorter sleep duration tend to be more prevalent in young people with ASD and can have a negative effect on daytime functioning.

The recognition of the relationship between pain and sleep in young people with ASD may help in the design of interventions based on indicators of pain, for example identifying a young person’s socially communicated pain could assist parents and clinicians design interventions (e.g. to improve the young person’s self-soothing abilities).

Future directions

Future studies would benefit from collecting data over multiple time periods. This could help to understand any causal relationships between pain and sleep problems and help to identify factors which may affect them, such as parenting style or parental stress. Utilising comparison groups would also indicate if the relationships between pain and sleep identified are actually unique to young people with ASD. Additionally, more investigation of how pain and sleep problems relate to each other and the effect on daytime functioning of young people with ASD would be able to further inform assessment procedures, and have an impact on the young people’s qual­ity of life.

  1. Tudor, M.E., Walsh, C.E., Mulder, E.C., Lerner, M.D. (2014) Pain as a predictor of sleep problems in youth with autism spectrum disorders. Autism [Online] Available fromhttp://aut.sagepub.com/content/early/2014/01/30/1362361313518994

If you are interested in sleep and Autism, you may find this webinar by Dr Ruth O’Hara, shown on Sfari, an informative watch.

http://sfari.org/sfari-community/community-blog/webinar-series/2013/webinar-ruth-ohara-on-sleep-disorders-in-autism