Are Sleep Problems More Common in Children With Disabilities?

Getting enough sleep is important for everyone, especially growing children. Unfortunately, children with disabilities are at an increased risk of sleep problems. These can range from trouble getting to sleep or staying asleep, to sleeping too much and episodes that interfere with sleep.

Factors that affect sleep in children?

There are plenty of factors believed to affect sleep in children. This includes both physical or psychological issues such as:

• Breathing problems
• Epilepsy
• Physical discomfort at night
• Anxiety
• Low mood
• Over-activity

Sleep problems in children with disabilities can impact not just them but the whole family, as well as having various effects such as daytime sleepiness, impaired performance at school, irritability and behavioural problems due to sleep deprivation.

Neurodevelopmental disorders and sleep studies

According to a study by researchers from the Cerebra Centre for Neurodevelopmental Disorders, there is an increased risk of sleep problems in children with intellectual disabilities including those with neurodevelopmental disorders.

In this study they used parent questionnaires to identity how children with different neurodevelopment disorders (i.e. Smith-Magenis, Angelman, Autism, Tuberous sclerosis) compare with children without disorders in sleep problems.

‘We found that sleep problems occur more frequently and more consistently in certain neurodevelopmental disorder groups.’

In this study, 73% of children with Smith-Magenis syndrome experience severe sleep-waking. The percentage was also high for other neurodevelopmental issues. For example, 46% of children with Angelman and Autism Spectrum also experience severe sleep-waking.

While severe sleep issues don’t affect all children with disabilities, the children in this study scored higher on many sleep disorders when compared to children without disabilities, including:

• Night waking, parasomnias (abnormal behaviour during sleep), and daytime sleepiness
• Children with autism spectrum disorder predominantly experience difficulties with night waking and falling asleep.
• Children with Smith-Magenis syndrome primarily experience night waking, early morning waking problems and behavioural symptoms of sleep-disordered breathing.
• Children with Angelman syndrome primarily experience night waking difficulties, followed by early waking problems and behavioural symptoms of sleep-disordered breathing.

Sleep Science Coach, McKenzie Hyde, says:

Children with developmental disabilities such as autism [have a] reported 80% increased risk of experiencing sleep issues in the form of insomnia, frequently waking up in the middle of the night, and difficulty waking up in the morning.

Physical disabilities and sleep problems

For those with physical disabilities, such as wheelchair users, it’s common to experience back pain and neck pain as a cause of sleep. This is just as true for children but can depend on the disability and the severity of the said disability.

However, physical therapy can really help. Nick Salinas, Doctor of Physical Therapy and owner of Functional Movement Therapy, shared his thoughts:

‘Children with disabilities can have more pain, but not necessarily. Children’s bodies are naturally more resilient (compared to someone in the later stages of life) as they have more space within the joints, higher levels of cartilage, and more elasticity in the skin and soft tissues. Depending on the disability and severity of malalignment can dictate whether or not they have pain and how much progress can be made holistically to correct that.’

McKenzie Hyde. Certified Sleep Science Coach at Amerisleep, also spoke about physical disabilities and how they can affect sleep:

‘Physical disabilities that render children physically in pain and uncomfortable during bedtime opens more opportunities for the development of sleep issues like snoring, teeth grinding, intense tossing and turning, and even sleep apnea. Consequently, these sleep disorders further exacerbate their disabilities by diminishing sleep experiences, ultimately affecting their emotional responses, behaviour, learning, and overall daily waking life.’

Helping your disabled child sleep

Talking to your child to find out if there is something specific bothering or worrying them which is keeping them awake is an important step. A consistent routine however is key to helping your child fall asleep.

Before bedtime:

• Try moving your child’s last nap to before 1 pm.
• Allow an hour for your bedtime routine and start it at the same time each day.
• Make sure all electronic screens are turned off an hour before going to bed as the blue light from these devices disrupts sleep.
• Sit with your child and spend half an hour playing some quiet games, like jigsaws, colouring, threading or hammer beads to have relaxing wind-down time.
• Have a bath half an hour before bed, or earlier if your child finds a bath too exciting.
• Make sure your child has enough food and drink before the bedtime routine starts but stay clear of sugary foods.

At bedtime:

• Put away or cover toys, bright colours and noisy items from the bedroom to make it feel calm.
• Make sure the bedroom is dark enough.
• The best temperature is 16 to 18 degrees Celsius, but try to find out what your child finds comfortable.
• Lay on your child’s mattress to see if it is comfortable. There are specialised mattresses designed for sleep problems, including back pain for example, adjustable beds, memory foam mattresses, and more.

What other treatments are available?

Often, behavioural approaches are the first port of call. They are used for treating children with disabilities but can require a specialist in order to observe the child over time to help identify causes of sleep disturbance. Possible approaches could be:

• For children who struggle to settle – work on conditions that encourage sleep (e.g., a bedtime routine, relaxation skills).
• For children who struggle to settle without parents –parents gradually increase the physical distance between themselves and the child at bedtime.
• For children who find it difficult to stay in their own bed –positively reward your child with something they like (e.g., watch a film, praise) for staying in bed during the night.

In more serious cases, children may benefit from treatment or sleep aids such as sleep hypnosis or melatonin tablets to help aid their sleep. A good place to start is by speaking to your GP. There are factors beyond your control that can affect your child’s sleep for which advice from a medical professional is key. Perhaps seek counselling if your child is in pain, their condition continues to disrupt sleep, or if your child’s medication seems to be having an adverse effect on their sleep.