Module 2

Sleep Scheduling

Understanding how much sleep your child needs, and when they should be sleeping, can be difficult. The focus of this module is on how to select a developmentally appropriate bed- and wake-time (i.e., sleep schedule), and the steps that you can take to reach that goal.

This module covers:
  • The role of circadian rhythms and sleep pressure
  • Recommended sleep times
  • A faded bedtime procedure
  • The Role of Circadian Rhythms and Sleep Pressure

    Circadian rhythms

    Everybody has a circadian rhythm or “body clock” which helps to ensure that our body functions in a consistent daily pattern, e.g., sleep at night, awake during the day. A key biomarker of this rhythm is the hormone melatonin, which signals to the body when to initiate sleep. Melatonin typically increases at night and decreases during the day, following a 24-hour rhythm that is aligned with the light and dark cycles of the environment.

    For some Autistic children, sleep difficulties such as delayed sleep onset latency, night wakings and early morning waking, may be linked to neurobiological differences in melatonin regulation. As a result, their melatonin levels may become misaligned with their sleep needs or the demands of daily life. However, inconsistent bed and waketimes can also disrupt and exacerbate this rhythm, making sleep difficulties worse. Therefore, to optimise the functioning of the body clock, it is recommended to maintain similar bed and waketimes each day, including school nights and weekends.  

    Sleep pressure

    Even if all of the recommended conditions are in place (e.g., your child’s bedroom is dark and quiet), your child will need to feel sleepy to fall asleep, or experience what is called sleep pressure (i.e., the urge to sleep). The longer your child has been awake, the more sleep pressure builds. Therefore, your child will generally be likely to fall asleep faster and stay asleep throughout the night when they have been awake for a long period of time. By contrast, the longer your child has been asleep, the less they may feel like they need to sleep. This may result in difficulties falling asleep and staying asleep through the night. For example, if your child has a nap close to bedtime, they may struggle to fall asleep at bedtime, and if your child wakes early in the morning (e.g., 4.30am), they may struggle to get back to sleep.

    Catching up on sleep: When your child doesn’t get enough sleep, they may not wake until later in the morning, nap during the day, or go to bed earlier the following evening to “catch up” on missed sleep. Although, this can make them feel more refreshed in the short term, in the long term it can maintain sleep difficulties, as there may be less sleep pressure at the times it is needed (e.g., at the set sleep schedule).

    In order to reset the cycle, it is important for your child (> 5 years of age) to get up at a very similar time each day and stay awake until bedtime (unless they’re sick of course). For guidance on age-appropriate sleep/wake times, refer to the recommended sleep durations below. But remember, your child is an individual so they may not exactly match these guidelines.

    Sleep for teens

    Sleep often changes when children become teenagers. This can be because the biology of sleep changes (e.g., hormonal changes, change in circadian rhythm, sleep pressure builds more slowly) or it can be due to changes in social and psychological factors such as peer influence, social media use, school pressures and mental health. As a result, there is a strong tendency for teenagers to be “night owls”, staying up later at night and sleeping in longer in the morning. However, on weekdays teens have school, which means they have to wake earlier in the morning and may get less sleep overall. As a result, teens often “catch up” on missed sleep on the weekends. This can result in a big difference between their bedtimes and waketimes across the week. Difficulties can arise as this can result in a shift in their body clocks every few days. This can create a “jet lag” like effect and make it hard for them to fall asleep at night and get up early in the morning for school. To reset our body clock and keep it working most effectively, it is best to keep bedtime and wake time as similar as possible on school nights and non-school nights. We understand that late nights can happen. When they happen, your child should go back to the sleep schedule that works best with their routine and be consistent from there, to reset their rhythm.

    For example: If your teen wakes for the day at 7.00am and goes to bed at 9.00pm on weekdays but goes to bed at midnight and wakes for the day at 10.00am on weekends there is a 3-hour difference in their sleep schedule which they will have to adjust for each week. This would be the equivalent of flying to Sydney (i.e., a place with a 3-hour time difference) and back every weekend. After waking at 10.00am on a Sunday they might have trouble falling asleep at 9.00pm that night given they have only been awake for 11 hours and likely haven’t built up sufficient sleep pressure.

    As discussed in Module 1, when young people don’t sleep well, it can have a cascade of effects. Poor sleep quality and/or quantity can worsen feelings of stress, worry and low mood, which are common among teens. Stress, worry and low mood can then make sleep worse by keeping teens up at night, and repeating the cycle. This cycle can extend and affect other areas of teen’s lives. Hence, it is important your teen maintains a consistent and developmentally appropriate sleep schedule, among other things.


    Recommended Sleep Times

    Research conducted by the National Sleep Foundation provides a guide to total sleep times for each age group. This is useful in determining an appropriate bedtime and wake time for your child or teen. These are as follows.

    AgeRecommended sleep duration
    0 – 3 months14 to 17 hours
    4 – 11 months12 to 15 hours
    1 – 2 years11 to 14 hours
    3 – 5 years10 to 13 hours
    6 – 13 years9 to 11 hours
    14 – 17 years8 to 10 hours
    18 – 64 years7 to 9 hours
    65+ years7 to 8 hours

    For infants and toddlers (1-4 years), the specified length includes both day and night-time sleep. Children >5 years of age would typically be awake all day and have all their sleep overnight.

    How to work out appropriate bed and wake times

    Making changes to your child’s sleep/wake schedule is often a great starting point for a sleep programme. To determine an appropriate bedtime (i.e., time of lights out, post any pre-sleep activities such as reading, personal time etc) and waketime for your child, you can follow these simple steps:

    1. Find the recommended sleep time (i.e., the approximate number of hours your child should sleep for) for the age of your child (in table above).
    2. If your child is between the ages of 0-4 years and has daytime naps, take away the daytime nap length (or the total length if they have more than one nap) from the recommended sleep time.
    3. Choose an appropriate wake time that works in with your child’s schooling and/or daily routine, and ensure your child gets out of bed at that time.
    4. Take away the recommended sleep time (excluding the nap duration if they nap) from that wake time to work out an appropriate bedtime.
    5. Keep bed and wake times consistent (i.e., within 30 minutes) daily, including weekends.

    For example:

    Calculating a sleep/wake time for a 9-year-old

    Calculating a sleep/wake time for a 2-year-old

    An excel spreadsheet template to calculate your child’s sleep schedule is provided below.

    It is important to note that sleep needs are unique to each individual and so your child may need more or less than the average person depending on how tired they appear during the day. In other words, if after some time (>7 days) of consistently implementing the sleep schedule your child appears tired during the day (e.g., is struggling to stay awake until their bedtime, is groggy upon waking), you may wish to alter their bed and/or waketime so that they have an extra 30 minutes in bed, and then re-evaluate that new schedule. Overall, the most important thing is that bedtimes and waketimes are kept as consistent as possible. 


    A Faded Bedtime Procedure

    In addition to changing the child’s bed and waketime in accordance with the recommendations above, there are other sleep scheduling strategies, such as a Faded Bedtime Procedure. This procedure aims to align a child’s circadian rhythm with yours and your child’s goal bedtime. It is especially helpful for children who struggle to fall asleep at night but can also help those who consistently wake early, due to a shift in the sleep schedule and increase in sleep pressure.

    Steps of a faded bedtime procedure:

    1. Determine the time at which your child is currently falling asleep*. To do this, you can refer back to your sleep diaries (refer to Module 1 for a template) and then calculate the average time that they fall asleep. *Note – this is not the time that they are put to bed, it is the time they fall asleep.
    2. Determine an age-appropriate goal bedtime (refer to recommended sleep times above).
    3. Adjust your child’s bedtime so that they are put to bed within 15 minutes of the time that they usually fall asleep (as in Step 1).
    4. If your child falls asleep within 15 minutes of going to bed over 3-4 consecutive nights, the bedtime can be moved forward by 15 minutes (i.e., from 8.30pm to 8.15pm), or less if a more gradual approach is preferred. If your child does not fall asleep within 15 minutes following this shift, then delay your child’s bedtime by a further 15 minutes the following night (i.e., from 8.30pm to 8.45pm).
    5. Repeat step 4, until your child is consistently falling asleep within 15 minutes of the goal bedtime. This may take some time depending on the time between the initial delayed bedtime and the goal bedtime. You may find your child may struggle to fall asleep within 15 minutes once they reach the goal bedtime. This could indicate that the goal bedtime is too early for your child, and the bedtime at the previous step (15 mins later) may be more suitable.
    6. It is very important that your child continues to be woken at a consistent time every morning (even after nights of disrupted sleep e.g., long night wakings), to successfully adjust their rhythm and ensure sufficient sleep pressure when they’re put to bed the following evening.

    If you feel unsure about where to start or whether to use this strategy, then starting simply by implementing a consistent sleep and wake time is a useful first step. You may also consider altering time frames to help your child cope with the many changes that occur in such a procedure. For example, instead of 15-minute increments consider smaller increments, and/or spend longer than 3-4 nights at each stage (i.e., bedtime).