Sleep

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A majority of children and adults with FASD have sleep disorders. One study found that 82 out of 100 caregivers reported that their children with FASD have sleep issues. Sleep issues can range from night terrors, waking in the middle of the night, having difficulty falling asleep, and sleepwalking.

Sleep Issues In Children With FASD

Sleep difficulties in children with FASD are a common and important problem that can impact daily functioning. Intervention may include cognitive strategies (bedtime stories or other rituals the child uses to mentally prepare for sleep, sensory-based strategies, and medical strategies (such as the over-the counter remedy Melatonin, or prescription medication such as Trazodone or Seroquel).

Providing supportive environmental accommodations often helps children with FASD. This can include strategies such as altering the environment, reducing stimuli, manipulating the sensory input, and self-regulation strategies, such as outlined in the Alert Program™.
A strategy for the FASD-affected child may include the provision of a “sensory diet”; for example, the therapeutic use of sensation via activities embedded in the daily routine to meet the child’s individual sensory needs and preferences. This may include the method for waking the child in the morning (lighting in the room, type of alarm, music). Strategies include:
  • The room should be a calm, uncluttered, safety-proofed space, with dark or low lighting, and room darkening blinds. Use a nightlight as needed.
  • A slow moving, rhythmical, visual tool, such as a fish tank, can also be calming.
  • In some instances, having the child sleep in a small tent can help with limiting distracting visual stimuli and aid sleep.
  • A quiet room that is carpeted for noise absorption is generally preferred.
  • Providing “white noise” from a fan can be calming and can help to block out noises from the environment.
  • Relaxing music, or music with a strong beat, has been recently reported to be helpful for falling asleep.
  • Often removing tags from pajama/nightgown clothing, and softening new pajama/nightgown and sheet and pillowcase material by multiple washings can be helpful.
  • Deep pressure, a calming massage, or sleeping with a weighted blanket may provide needed tactile input.
  • Some children with FASD engage in “picking behavior” which may result in stuffed animals or mattresses being pulled apart. Giving the child "hand fidgets", such as a stress ball or blankets with preferred fabric tassels may help to meet his or her tactile needs.
  • Sleeping in a sleeping bag, or “nesting” with multiple stuffed animals may help a child who feels that his body is "unmoored" in the dark.
  • Slow rhythmical rocking, as in a rocking chair, can be calming before bed and can address the child’s vestibular processing needs.
  • In general, fast movements, such as running or spinning, may cause over-stimulation and should be avoided before bedtime.
  • Children with FASD often have a keen sense of smell. Parents, caregivers, and other adults should be aware of all scents in the environment (for example, laundry soap, fabric softener, toothpaste, body soap, or lotions), as they can be overwhelming, especially before bed.  Determining which scents are calming for the child (for example, vanilla, banana, or lavender) can be helpful.

Sleep Issues In Teens and Adults With FASD

Many adults with FASD have poor sleep patterns. This can be due to irregular schedules, a lack of structure to ensure a reasonable and regular bedtime, and a lack of
self-regulation without assistance. As with children or teenagers with FASD, adults with FASD also may have difficulty with sleep because of an inability to block out sensory information; not being able to understand cause and effect (e.g., do not understand they should get to bed early because they have to get up early in the morning); memory problems; or other brain-based issues.

To avoid conflicts or rushing in the morning which may impact on the entire day, here are some accommodations which may help the FASD-affected adolescent or adult to manage sleep challenges:

  • If possible, arrange work/school schedules to accommodate the person's sleep patterns. For example, some individuals do better sleeping in during the morning and then going to a job later in the afternoon and evening.
  • Provide assistance with ensuring the person has clean clothing, packing lunches, and organizing backpacks, purses, or other items, so that the person avoids being anxious about it the night before or in the morning, and so that the morning routine is as calm as possible.
  • Help the person to establish evening routines and maintain them.
  • Emphasize calm activities to help with relaxation and restful sleep. Keep the bedroom uncluttered and limit stimulating distractions. Use any helpful and healthy strategies (see above) to improve  the person's ability to fall asleep and sleep through the night.
  • Talk about what might help during transitions between sleeping and waking. Decide with the person on creative methods for waking them calmly, to reduce their negative reactions to your assistance.
  • Discuss motivators for getting up and getting ready to help encourage successful responses to wake-up calls. Everyone needs a reason or a purpose to get up in the morning. If a person is engaged in their work/activity, and it’s a good fit, the motivation to get enough sleep and to get up on time is intrinsic.

Useful Links

Chronic Care for Sleep
Sleep and FASD Are Not Friends
Sleepless in FAS Land: How to Help Your Child Sleep Better
Sleep Health Issues for Children with FASD: Clinical Considerations
Sleep Strategies for Children with FASD