An Overview of Sleep
The Importance of Sleep
Sleep is an important biological process that is central to all aspects of children’s development, health, and wellbeing. Insufficient sleep quality or quantity can be associated with a number of negative outcomes for both the child and their whānau such as physical illness, behavioural difficulties, and poor mental health, meaning it is important to ensure that children receive adequate sleep.
Types of sleep difficulties
There are many types of sleep difficulties. These are often categorised into two primary groups: dyssomnias and parasomnias. Dyssomnia refers to difficulties initiating and/or maintaining sleep or complaints about the quality of sleep (e.g., taking a long time to fall asleep, waking in the night, sleep-related breathing difficulties), while parasomnia refers to those atypical behavioural or psychological events that occur during sleep (e.g., night terrors, sleepwalking, sleep talking). Research suggests up to 80% of Autistic children experience some type of sleep difficulty. This website is focussed primarily on supporting children with difficulties initiating and maintaining sleep (dyssomnia) – the most common presentation.
So, how do you know when your child has a sleep difficulty that requires support? Helpful considerations include:
- Is your child sleeping less than the recommended duration for their age (see Module 2 for a guide)?
- Is your child experiencing excessive daytime sleepiness, i.e., taking naps during the day when this is no longer age appropriate)?
- Is your child only sleeping in a setting that impacts the family routine (e.g., car)?
- Is your child taking longer than 30 minutes to fall asleep each night, over the course of several (e.g., at least three) nights?
- Is your child showing behaviour that may delay falling asleep (i.e., sleep-interfering behaviour) both at the start of the night and following night wakings (e.g., repeatedly calling out, leaving bed, using their device, playing with toys)?
- Is your child waking frequently and/or for long periods throughout the night?
- Is your child waking early in the morning and not re-settling back to sleep?
- Is your child having difficulty initiating and/or maintaining sleep independently (e.g., without a caregiver) which impacts the sleep and routines of the family?
When considering whether your child’s sleep is of concern, it is important to consider your unique family routines and the impact of your child’s sleep difficulties on your child and family. For example, do your child’s night wakings disturb other people in the house? Do they lead to difficulties with daytime sleepiness, and/or negatively impact their learning and behaviour? If so, you may wish to pursue some kind of support.
Tools to Understand and Monitor your Child’s Sleep
Sleep diaries and questionnaires are two common tools that you can use in the home to help you to identify, understand and then monitor your child’s sleep difficulties. These tools are discussed further below. However, if you have significant concerns or suspect a medical cause (e.g., medication use, breathing related difficulties) of your child’s sleep difficulties, it is important to consult a medical professional such as your child’s general practitioner.
Sleep Diaries
Recording sleep diaries is one of the most common ways to gain insights into children’s sleep patterns. They require you to record specific information about your child’s sleep and are usually completed every night for at least 7 nights. Where practical, your child may also record diaries about their own sleep.
Sleep diaries usually include information about your child’s daytime sleep, the time they were put to bed, where they slept (i.e., the sleep setting), the time they fell asleep, the time and length of night wakings, and morning wake time. Importantly, sleep diaries also include information about behaviours you observe in your child and your responses when they are trying to fall asleep or when the wake unexpectedly. This information can be recorded on paper templates or on your smart device; whatever is easier. Below, you’ll find a video overview of how to complete a sleep diary, followed by blank templates for both parents and children.
Sleep diary resources:
- Parent sleep diary template
- How to complete a sleep diary
- Child sleep diary template 1
- Child sleep diary template 2
- Child sleep diary template 3
- The National Sleep Foundation (US) also provide a free online sleep diary: https://www.thensf.org/nsf-sleep-diary/
Questionnaires
There are several questionnaires that have been designed to help identify difficulties relating to falling asleep, staying asleep, daytime sleepiness, and overall sleep health. Common questionnaires used by professionals include for example the Children’s Sleep Habits Questionnaire, Albany Sleep Problems Scale, Sleep Habits Checklist, and the Adolescent Sleep Hygiene Scale. Most of these require training in administration, scoring and interpretation. Unless you have access to these questionnaires, sleep diaries can provide a useful alternative.
Below is a simple questionnaire developed as part of the Good Nights Programme to assess children’s sleep hygiene (i.e., day- and night- time habits – see Module 3):
How to Make Sense of your Child’s Sleep Difficulties
Once you have identified the specific types of sleep difficulties your child is having, it is then important to identify what factors might contribute to and maintain them. Important factors to consider are outlined in the following modules:
Sleep scheduling (Module 2)
- Is your child going to bed and waking at roughly the same time every day (including weekdays and weekends)?
- Is your child’s sleep schedule (daytime naps, bedtime, waketime and total time spent in bed) appropriate for their age and stage?
Habits and conditions (Module 3)
- Is the sleep environment (including the location of sleep, sensory needs etc) consistent and calming for your child?
- Is the bedtime routine consistent and calming for your child?
Understanding of sleep (Modules 4-5)
- Does your child understand the importance of sleep?
- Does your child understand the expectations around sleep?
Your responses to sleep-interfering behaviour (Module 6)
- Are your responses to your child’s sleep-interfering behaviour (e.g., repeatedly calling out, leaving their bed) both at the start of the night and/or following night wakings inadvertently contributing to the difficulty?
This is where your sleep diaries are especially useful! This video walks you through a case example pointing out what to look for in your sleep diaries to identify what might be playing a role in your child’s sleep difficulties.
Other considerations
Finally, it is also very important to consider biological (e.g., different night-time melatonin levels), psychological (e.g., anxiety, depression) and medical factors (e.g., ongoing illness, breathing-related difficulties). If you suspect such factors might play a role, then we recommend consulting with your child’s general practitioner. The strategies discussed on this site are aimed at difficulties with initiating and maintaining sleep that have environmental and behavioural underpinnings such as those described above. However, these strategies may still be useful to implement alongside supports addressing medical, psychological, and physical causes, as there may be multiple factors contributing towards your child’s sleep (e.g., medical and behavioural).