Gilbert is 5 years old and was recently diagnosed with Asperger syndrome. His mother is concerned that Gilbert’s sleep is very disrupted. After school he is always very tired and goes to bed happily at his usual time (7.45pm). However he generally wakes up at about 11pm and seems highly stressed. He is then usually awake for 3-4 hours and only falls asleep when he is utterly exhausted, usually on his bedroom floor rather than in his bed. Interrupted nights are exhausting him and his family and they are desperate for help.

Strategies

• Ask Gilbert’s parents to keep a sleep diary. This should include Gilbert’s bedtimes (when he is expected to be in bed and sleeping) and his actual sleep times (including planned or unplanned naps), in order to establish his natural sleeping pattern and needs.
• Ask parents to monitor Gilbert’s food and drink intake during the afternoon, evening and night, in order to identify foods or drinks that may be over-stimulating for him. This can also be a starting point for introducing foods or drinks that help to calm and relax.
• Using the information gained from the above as a starting point, develop a set evening routine for Gilbert that follows his natural sleep pattern and includes wind-down time for him. This might include a long bath or massage time in order to help Gilbert physically relax.
• ASD is commonly associated with unusual sleep patterns for a number of reasons and it will be helpful for Gilbert’s parents to be made aware of this and referred to information, resources and support groups.
• Gilbert may be confused about what is expected of him at night-time, especially if he has grown used to being awake for hours at a time in the middle of the night. Bedtime stories that allow opportunities to talk about night-time and people going to sleep can be useful. There are also children’s clocks that can be programmed to ‘go to sleep’ and ‘wake up’ at specific times and these can useful in guiding the child’s behaviour.
• Gilbert’s parents should be encouraged to continue the sleep and food diary for as long as possible. Progress may be slow and it is helpful to see even small improvements. Children on the autism spectrum can also experience setbacks so that progress can be ‘one step forward, two steps back’. The diary can be a useful reference point for revisiting strategies that have worked in the past.
• There are medications such as melatonin that can be helpful but these should only be considered when it is clear behavioural interventions would be ineffective and that the sleep problems would persist and have a negative impact on the child, family and carers.