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Sleep is central to our health. For children, the quality, regularity, and depth of their sleep influences all aspects of their functioning. This includes but is not limited to: increased risk for illness, poor emotional regulation/challenging moods and behaviors, poor attention, focus, learning, and even chronic illnesses such as hypertension and obesity. In older children and adolescents, many studies have repeatedly found insomnia in teens associated with depression, suicidal ideation, attempts, and suicide completion. In addition, adolescent sleep deprivation is associated with declining academic performance and increased absenteeism. When sleep improves, the rate of depression and suicide decreases significantly. Regardless of the age of your child, sleep is critical for our everyday functioning, and it is important to help your child establish restful sleep at a young age.

It is important to first assess whether the child has a sleep disorder—meeting diagnostic criteria for a disorder (such as sleep apnea or narcolepsy)—or has disordered sleep, such as difficulty falling asleep, frequent night waking, or bed-wetting. It has been reported that up to 40% of children experience a sleep problem between infancy and adolescence.  Seek a pediatric health care provider if you have concerns about your child having a sleep disorder.

Many children with sensory processing difficulties do not sleep well, and thus neither do their parents. Occupational therapists can work with the families of children with sleep problems to explore the impact of sleep deprivation on the child and the family. OTs assist families in implementing changes in bedtime routines, habits, and sensory strategies. They also incorporate behavioral therapy interventions as needed to better support both the child and shape the physical environment to facilitate improved sleep.

Children with sensory challenges may lack adequate rest for many reasons. Potential reasons may include difficulty lowering the arousal level of their central nervous system to achieve a calm state necessary to fall asleep,  difficulty filtering out sounds (both those inside and outside the house), a low tolerance for the tactile sensation of pajamas, sheets, or even the mattress, and emotional factors such as fear of being left out from night-time activities or fear of bad dreams.

I have gathered some sensory-friendly strategies that can help both typically developing children and those children with sensory processing challenges work towards more restful sleep.

  • Just as newborns love to be swaddled tightly in a blanket, many children respond positively to deep pressure input to feel safe and secure. Weighted blankets can be a useful tool for bedtime, as well as rolling your child in a blanket like a burrito and providing firm pressure throughout their body, or holding your child close and providing a back massage while reading a bedtime story.
  • Place a white-noise machine or a fan in the child’s room. Repetitive white noise can be calming for many children as they begin to fall asleep, and it assists in blocking out other sounds that may startle and wake them.
  • Just as infants love the warmth of their parent to snuggle into for sleeping, many children find a warm sensation calming before bedtime. Consider throwing your child’s favorite blanket or comforter in the dryer a few minutes before bed, or providing a cozy microwaveable stuffed animal for bedtime to help your child drift off to sleep.
  • Consider your child’s clothing and bedding. Avoid using fabric softener because it leaves a residue that some children cannot tolerate. Use unscented laundry detergent for children with heightened sense of smell. Most children prefer all-cotton bedding and cotton or fleece pajamas with the tags/labels removed. Try a variety of pajamas; some children prefer extra snug pajamas, while others prefer extra loose. Respect your child’s sense of temperature in regards to pajama choice.
  • Some children respond well to visual input. Focusing on a soothing visual input can help some children relax and fall asleep. Try using a lava lamp as a night light or sit and watch the fire in the fire place for a few minutes before bed.
  • Assess whether a warm bath or shower is relaxing or overstimulating for your child. For some children the warm water can be very relaxing, especially when Epsom salt or essential oils are added. However, for other children, the experience can be too overstimulating for just before bedtime. In this case, move bath time to the afternoon or early evening.

In addition to these sensory specific strategies, consider these general strategies to improve your child’s sleep.

  • Build a bedtime routine with consistent wake up times, seven days a week if possible. Allowing a child to sleep late on the weekends confuses the body’s natural internal clock and can cause insomnia and difficulty falling asleep.
  • During the bedtime routine, incorporate frequent warnings/heads-up about transitions (e.g. “after this book we are heading upstairs to put on pajamas”, “after pajamas we brush our teeth”). Children do better when they know what is coming up next to which increases cooperation and decreases resistance to bedtime.
  • Avoid caffeine, especially in the evenings. Even small amounts of caffeine can result in irritability and difficulty falling asleep.
  • Light is the most powerful external signal in regulating and re-setting our circadian rhythm. Many sleep specialists recommend keeping the room dim between sunset and sunrise and specifically eliminating the 470 nanometer wavelength which suppresses the release of melatonin. Specialized light bulbs are available that do not contain the 470 nanometer wavelength.
  • Remove the TV from your child’s (and your!) room. Turn off electronic screens an hour before bedtime. Electronic screen devices (TV, tablets, smart phones) are designed to emit a bright blue light to be able to be viewed in even the sunniest settings. Unfortunately, this blue light confuses our brain as it causes it to stop producing melatonin, the hormone that gives our body “sleep cues”. Because of this, use of screens before bed can disrupt our sleep cycle, making it more difficult to fall asleep and stay asleep. Apple iPhone now has a setting called Night Shift that automatically pulls the wavelength out of screens as research has repeatedly shown how these wavelengths hinder our ability to fall asleep.
  • Incorporate a light, nutritious snack and small drink before bed. Provide just enough to satisfy your child’s hunger so they do not go to bed hungry, but not so much food and drink that your child will need to use the bathroom during the night.
  • Encourage physical activity earlier during the day, as this can greatly support the regulation of your child’s sleep cycle. Exercising later in the night can make it more difficult to wind down and fall asleep.

The Sleep Pass – for ages 3-9 years

Some parents struggle to get their child to stay in bed, as every night the child wakes up and comes into the parent’s room. One strategy to address this issue comes from Dr. Alan Greene, a pediatrician. He recommends using a “Sleep Pass” for children ages 3-9 years old. Take a small piece of paper and put their name on it and the words “Sleep Pass”, then laminate it. Make a big deal about the sleep pass and create a little ceremony about your child receiving the card. Explain to the child that if they wake up in the middle of the night, they can come see you but only once. They get one free pass to visit you in the night. When they use their pass (make sure they give it to you), they get a hug and a sip of water; they are able to connect with you briefly like they desired, but then they must go back to bed. Explain to the child that if they come back to your room more than once they will go right back to their room without a word, without eye contact. You will just walk them right back to their bed. Typically, the first few nights every child will test the limits of the free pass. The child will come in many times to see if you are truly serious about the free pass. But if you remain consistent, giving them a big hug and warm welcome the first time and then quietly walking them back the rest of the times, after a few nights the child learns to hold on to the free pass and keep it all night long, because they wake up and think, “I might need this more later”, and then learn to go back to sleep.

 

Giving children the gift is sleep is one of the best gifts we can give them as parents. Well-rested children are more attentive, learn more quickly, and are able to better regulate their moods and responses to joys and disappointments. My hope is that one of the tips and tricks above may help you and your child experience more nights of restful and uninterrupted sleep!

 

Tip Sheets

American Occupational Therapy Association – Bedtime Routine Tip Sheet

National Health Service – Sensory Sleep Strategies 

 

References

Green, A. & Breus, M. (2016). Sleep Success Summit – Kids’ Sleep. [Audio webinar].

Goldstein T.R, Bridge, J.A, Brent, D.A.(2008). Sleep disturbance preceding completed suicide in adolescents. Journal of Consult Clinical Psychology, 76:84–91.

Liu X (2004). Sleep and adolescent suicidal behavior. Sleep. 27:1351–1358.

Owens J.A. (2005).  Epidemiology of sleep disorders during childhood. Principles and Practices of Pediatric Sleep Medicine. Philadelphia, PA: Elsevier Saunders, 27–33.

Wolfson, A.R, & Carskadon, M.A. (2003) Understanding adolescents’ sleep patterns and school performance: a critical appraisal. Sleep Med Rev. 7:491–506.

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About the author

Sarah is the founder of Great Kids Therapy and the clinic’s director of Occupational Therapy. She has 35 years of experience as an Occupational Therapists with a specialization in pediatrics for over 28 years, including 6 advanced certifications and around 2,000 hours of continuing education. Sarah has clinical experience in a variety of pediatric settings such as: neonatal intensive care, private practice early intervention, mainstream preschool and elementary education, developmental centers [non-inclusion charter schools for disabled children], and outpatient hospital treatment. Sarah is a cancer survivor, an exercise and healthy eating enthusiast; as well as, a wife, and mother of three children.