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Sleeping issues can be really hard on children and their parents. There are routines, tips and strategies that can help. 

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When researching a piece, I always start at a basic google to make sure I get an idea of what most people find when they ask Google for help. For this piece, I searched “sleep disorders nz" and Google suggested these:

-   What are the five types of sleep disorders?
-   What are the six types of sleep disorders?
-   What are the seven sleep disorders?
-   What are the four sleep disorders?

This was a pretty big hint that there’s a lot of conflicting info out there!

**So we decided that we’d do a series on Sleep!**

Part one is about trouble sleeping, part two will cover options for treatment and support, part three will cover neurodivergence and sleep, and part four will go over the differences between “trouble sleeping” and diagnosable sleeping disorders.

**Not all sleep issues are the same. **Some find it difficult to get to sleep, others find it difficult staying asleep, and some people seem to be sleeping okay but aren’t actually getting as much rest as they ought to be.

**Common Comorbidities\* with Sleep Issues**

If you or a member of your whanau have some of these health conditions, there may be difficulties with sleep.

-   Chronic pain
-   Diabetes
-   Heart conditions (e.g. high blood pressure)
-   Pulmonary conditions (COPD, sleep apnoea, and so on)
-   Neurodivergent diagnoses (Autism, ADHD, anxiety, and so on)

Unfortunately, these issues can be self-perpetuating – for example, lack of sleep can lead to high blood pressure which in turn makes getting to sleep more difficult. When discussing the treatment and management of any health issues with your doctor, it can pay to ask what impact the health issue and the proposed treatments might have on sleep.

\*the simultaneous presence of two or more diseases or medical conditions in a patient.

**(NOTE: the goal of this piece is to provide advice, but this advice may not be suitable for those with a diagnosed sleep disorder.)**

There is no single reason that people have difficulty getting to sleep and so there is no single solution, but too much stimulation close to bedtime is a common cause of difficulty getting to sleep. External stimulation could include loud or pervasive noise, too much light, being too hot or too cold, or an uncomfortable bed.

Internal stimulation can also keep someone awake and could include recent ingestion of caffeine or sugar, rushing or intrusive thoughts (such as that experienced by those with anxiety or ADHD), and bodily discomfort such as gastrointestinal or bladder issues.

**Creating an Evening Wind-Down Routine really can help, **especially if you suspect your child’s sleeping issues have been triggered by some other disruption in their life.

**Some of this might be known to you already, but it bears repeating.**

**Avoid chemical stimulants: **The obvious ones are caffeine and sugar but endorphins from exercise can also keep you awake. If your whānau go for walks in the evenings, try to do it early enough that everyone’s bodies can return to baseline before trying to sleep.

**Ensure everyone is comfortable: **We sleep best in environments that are cool, dark, quiet, and comfortable.

If curtains are too thin and letting in light (especially in summer evenings), pin a sheet to the window frame to block more light. You can also get blackout curtains, though they can be expensive.

If your bedrooms get afternoon or evening sun, pin up the sheet earlyish so the room has a chance to cool down before bedtime.

Check what your sheets and duvet covers are made of – retailers often sell blends of polyester and cotton which hold the heat in and can feel scratchy. Look for 100% cotton sheets and duvet covers, and cotton or wool duvet inners. Avoid polyester and other synthetic fabrics.

Have a shower or bath before bed, or use a cool flannel to wipe down faces, arms and legs. A cool flannel on the back of the neck for a few minutes can feel heavenly.

**Avoid naps: **Obviously we’re not saying stop your young ones from napping, but if you have an older child who’s started struggling to sleep at night, try to keep them awake through the day so they don’t throw their body off their normal sleeping rhythm.

**Be active during daytime: **Bodies don’t want to sleep if they’re not tired, ergo it’s important that we are active enough that we actually need to rest.

**Get sunshine: **We take our cues from the sun as to whether or not we’re supposed to be awake. Being exposed to the sun during the day helps our brains and bodies recognise that it’s time to sleep when it’s dark.


What to do when you or your child can't sleep

What do you do when your child won't sleep? How do I help my child sleep? Why won't my child sleep? Why can't I sleep?

Having difficulties with bladder control is very common in young children. This is partly due to immature bladder function which will naturally improve with age, but control problems are more marked amongst children with physical and learning difficulties.

**If **your child’s cognitive skills are delayed in language and understanding, it is likely they will need a bit more time and patience to master toileting skills.

Some children are especially anxious about new routines or demands. They might need extra patience, planning and organisation. It will help if you use strategies you know will ease your child’s stress - for example, you could give them choices over aspects of the toileting routine. Ask them if they want to take a toy with them or take their pants off beforehand. You could also explain the process in advance, making it fun by including favourite toy animals or dolls in role-play.

**Body Awareness **– Some children have an over or underdeveloped sense of their body’s needs – such as the need to do a poo or a wee. If your child has reduced body awareness, they may not notice the discomfort of sitting in a wet nappy. Or, if they have heightened body awareness they may go to the toilet repetitively, even when they have little need to do so. You can model listening to your own body signals as well as incorporating body listening into stories and play to help the child build their skills.

**Physical difficulties** – If your child has continuing bladder difficulties they might have an underlying medical condition, such as an infection or abnormalities in their urinary system. Keep a record of the problems they are experiencing and when they occur, before consulting your doctor.

In New Zealand 15 percent of five-year-olds wet their beds regularly, as do five percent of 10-year-olds. It is generally not considered a concern until children are aged seven or older. For children with disabilities or who are neurodiverse, bedwetting can be more long-lasting and can get in the way of school camps and sleepovers. This can be upsetting for everyone.

### **Some tips that might help with bedwetting:**

You’re probably already doing these, but it might help to tick them off and know you’ve covered the basics.

- Keep your child’s fluid intake up during the day – aim for six to seven water-based drinks, at regular intervals during the day.
- Encourage your child to go to the toilet before going to sleep.
- Protect the mattress with a waterproof cover.
- Don’t pick your child up and take them to the toilet while sleeping – it is important they learn to wake up to bladder demands.
- Bed alarms are available which are triggered by moisture in the bed, which helps develop children’s awareness of a full bladder and the need to go to the toilet. Talk to your GP or needs assessor/navigator about a referral to an incontinence nurse.
- Celebrate and praise your child for their toileting wins. Never get angry or punish your child for toileting accidents.

### **Regression and Relapses**

Just when you think you’re over this stage in your child’s life - you find the bed wet again! Regressions and relapses happen. Take a deep breath and don’t panic. It might be a blip on the road to toileting success, or there may be something going on with your child that you need to know about. Remember, behaviour is communication, so find out what your child is trying to tell you.

Firstly, investigate if there are any health issues that are causing the problem – for example if your child has a urinary infection or is constipated this will lead to changes in their toileting behaviour. If all possible medical causes have been investigated and treated and the problem persists, look externally. Perhaps your child is stressed due to changes in the family environment – you’ve shifted house or had a relationship breakdown. The problem could be in their school environment – they don’t like their new teacher or have had a falling out with a friend.

Once you’ve identified the issue it will be easier to provide the calm and supportive environment your child needs.

### **Remember:**

There is usually a reason for children to act in a particular way. It’s our job as parents to figure out what that reason is and do what we can to fix the problem with the help of others.

Try not to let feelings of embarrassment get in the way of talking to other parents and people who can help, about your child’s toileting issues. You’re not alone - toileting issues can be so frustrating and be really hard to manage.

Believe in your child’s ability to learn and celebrate their achievements.



How do I stop my child wetting the bed?

bed wetting disability bed wetting and autism, ADHD and bedwetting, Disabled child bed wetting

Let's talk about how neurodivergence impacts sleep. This is part three of our four-part series on sleep. We've linked those posts below...

### What does Neurodivergent mean?

In this context, the word “Neurodivergent” is an umbrella term that refers to people who exhibit behaviours of a certain ‘family’ of disorders. Broadly speaking, these are conditions where people’s brains develop differently, or diverge, from what’s typical. Neuro = brain, Divergent = difference.

Medically, neurodivergent diagnoses are separate disorders but people diagnosed with one disorder could still have traits of others. The most well-known neurodivergence is autism spectrum disorder (ASD), which is estimated to occur in about 1.6% of people. Other ‘common’ neurodivergencies include attention deficit hyperactivity disorder (ADHD), dyspraxia, dyslexia, and dyscalculia and there are also rarer conditions such as apraxia and multiple sclerosis. Each condition’s symptoms or traits can occur on a spectrum of severity.

Research on sleep disorders in neurodivergent people mostly focus on ASD and occasionally include ADHD, but insight into one condition can still result in tools and supports that are helpful for others. My own approach is to think of neurodivergent diagnoses as “cousin conditions” and take a broad and flexible approach when looking at what accommodations might help. Neurodivergent conditions can also be highly heritable (meaning they run in families) so this info may be helpful for those without an official diagnosis.

### What’s the deal with sleeping?

Most people have a circadian rhythm – they start to wake up approximately when the sun rises and start feeling tired once the sun has gone down. Brains release certain chemicals at certain times of the day to either wake us up or help us go to sleep, and other systems in our bodies adjust their function according to the time of day. These rhythms are governed by genes in our DNA called ‘clock genes’ that keep everything working on the appropriate rhythm. So far, so neurotypical.

However, it has been identified that autistic people have variations in their ‘clock genes’ that affect this rhythm and as a result interrupted sleep, difficulty getting to sleep, and other sleeping issues are reasonably common in people with Autism Spectrum Disorder at all ages. It also looks like it’s somewhat of a sleep-disordered ouroboros – people with ASD sleep badly which makes the symptoms of ASD worse which in turn leads to bad sleep.

### What can disturbed sleeping look like in neurodivergent people?

-   Delayed sleep (going to sleep late in the evening)
-   Short duration of sleep
-   Frequent waking
-   Lower levels of REM sleep

**Note: **This piece is an introduction to common sleep difficulties experienced by neurodivergent people. The next piece in this series will cover the more extreme presentation of sleeping difficulties, where those difficulties have reached the point where they need to be classified as a disorder. Sleep disorders are not exclusive to neurodivergent people, but we may be more susceptible to them.

### What to do though?

Part of my work as a neurodivergent person is recognising that I have to learn to work with my brain, not against it. For those with difficulty sleeping, this means accepting that there may not be a ‘cure’ for sleep issues. However, avoid getting trapped by black and white thinking! We are not looking for perfection, we are looking for improvement. Neurodivergent brains are different, but they are still human brains that need sleep and there are still supports and tools that may be able to assist.

Some neurodivergent people have difficulty identifying what messages our bodies are sending to our brains, so we might not eat until we’re starving, or not realise that we need to go to the toilet until we’re busting. This also applies to not noticing that we’re tired, and it can be managed in ways that are similar to how you might manage food and toileting – by drawing attention to the need in a routine way.

For example, you might set a specific bedtime for when your kid has to be in bed or in their room but allow your child quiet time to read or play. Then you might turn the light off but still allow your child to listen to an audiobook or quiet music. Some neurodivergent children who seek out sensory input may even find it easier to fall asleep when listening to something, either on a small speaker or on soft headphones if they share a room. Quiet time in bed is not sleep but it is still rest.

A routine like this allows for the possibility that their body and brain are literally not ready to sleep at 8pm, but that they might be ready at 9.30pm. There is no expectation that the child will fall asleep immediately. This reduces frustration and tension in parents, and creates a calm environment for kids, ideally allowing their body and brain to work together and recognise when it is time to sleep.

In terms of the sleeping environment, refer back to Part 1 of this series for common suggestions for people who are having difficulty sleeping, especially the section on being comfortable in bed. Heightened senses are common in neurodivergent people and so identifying what’s necessary to create a comfortable sleeping environment is important.

Aside from ensuring there’s low light, cool temperature, and that basic bedding is comfortable, there are other sensory tools that can help.

**Weighted blankets: **steady pressure can have a calming effect and so these are a common suggestion. They’re still reasonably expensive but recent increases in popularity means they’re more accessible than they used to be.

**Weighted toys: **similar to blankets but more targeted. Some people find that the blankets are overwhelming, but a weighted teddy bear can provide limited pressure without feeling suffocating.

**Body Socks/Sleep Swaddles:** these are commonly used for babies already but can be bought for larger children and for adults as well. In summer, one of these might be preferable to a weighted blanket.

**Noise: **white noise is the usual suggestion but there are hundreds of apps out there with different kinds of noise. To be frank, I don’t understand the different colour designations but I also follow the rule of “it’s not silly if it works” so if pink noise works, then it works. You can also try using a fan to create a calming background noise, especially as fans can help keep a bedroom cool.

**Non-traditional beds: **some people might sleep better on harder beds such as futons or thinner mattresses and some people sleep better on couches as they provide support around the body. If your kid can sleep on your couch but not in their bed, you might consider putting a couch in their room.

It’s also worth discussing medication regimes with your doctor to see what effect meds can have on sleep, so you can balance the competing needs. For example, stimulant medication is a common treatment for ADHD and so your doctor can advise you on setting the timing or quantity of an afternoon dose in a way to minimally affect a bedtime routine.



A little girl cuddles up to her teddy in bed.

How autism can impact sleep

Autism and sleep. How do you fall asleep with autism? How autism can impact sleep.  How ADHD impacts sleep. Neurodivergency and sleep.

What are the symptoms of sleep disorders? Is it possible your child has one?

There seem to be a number of different ways of classifying sleep disorders. Illness vs Injury. Too much vs too little. Body health vs mental health. They all have their uses in identifying certain similar-ish groups of disorder and so directing you towards one or more types of treatment...

What can be confusing and frustrating is that it’s possible to have multiple sleep disorders at one time.

By far the most common sleep disorder is **Insomnia **– difficulty getting to or staying asleep. The term is often used casually to describe any trouble sleeping, but there are specific diagnoses for its acute (short-term) and chronic (long-term) forms.

**Acute insomnia** is characterised by difficulty sleeping for a few days to a few weeks.

**Chronic insomnia** can be diagnosed once the disordered sleep behaviours have been present for more than a month. Insomnia is often associated with other medical issues, and stress. Of course, having other medical conditions is often stressful so we’re back to our medical ouroboros.

If you or someone in your family have started having difficulty sleeping, then have a read through parts 1-3 of this series and see if any of the non-medicinal techniques help. If they don’t and interrupted sleep continues for longer than a few weeks, knowing what you’ve already tried will be useful information for your doctor when designing a treatment plan.

Now let’s flip to the other side of the coin.

**Hypersomnia** is sleeping too much or being excessively sleepy during the day. Symptoms can include having difficulty waking up, taking longer-than-normal naps during the day, and feeling unrested.

As with Insomnia, it has a number of causes and is frequently associated with other medical conditions. It might be difficult to differentiate between hypersomnia as a disorder or as a symptom of other disorders.

So, leaving aside how much sleep someone gets, let’s look at when they sleep. As we mentioned in Part 3 of this series, most people’s sleep is roughly aligned with the time of day. However, some people do not follow those patterns and those people might have a **Circadian Rhythm Disorder.**

There are four intrinsic disorders:

**Delayed sleep phase disorder: **In layman’s terms a delayed sleep phase might mean instead of sleeping from, say, 11pm-7am, a person with DSPD tends to fall asleep at 1am and (ideally) wake at 9am. However, life isn’t that simple – the disorder doesn’t always manifest so neatly and, to be blunt, our world isn’t set up for those hours. The delay in sleep phase might be longer or shorter on different days, and so people with DSPD might experience chronic sleep shortage or excessive sleepiness during the day.

**Advanced sleep phase disorder: **As hypersomnia is to insomnia, advanced sleep phase disorder is to delayed sleep phase disorder. People with ASPD feel sleepy earlier and wake earlier than what is considered normal. This is rarer than DSPD and is most common in elderly people.

**Irregular sleep-wake rhythm disorder: **This is where there is no discernible pattern to sleep. Someone with ISWRD will get the right number of hours of sleep, but it will be broken up throughout the 24-hour day. They will likely take frequent naps, find sleep non-restorative, and feel very sleepy during the day. This is a rare disorder and may, initially, look like insomnia or non-24-hour sleep-wake disorder.

**Non-24-hour sleep-wake disorder:** This is when someone’s body doesn’t follow a 24-hour rhythm to their day. The person’s natural rhythm might be 25 or even 26 hours, so their bedtime might change every day. It is most common in those who are totally blind but can occur in sighted people as well. This is also a rare disorder, and in sighted people it is closely associated with DSPD.

So if that’s the brain, what about the body? Here again we reach more classifications. There are some body-related sleep disorders that contribute to the bad sleep, and there are others that happen while sleeping.

The first type includes **obstructive sleep apnoea **(where something blocks the airway, either partially or fully) and **central sleep apnoea **(where the brain fails to signal to the body to inhale). OSA is by far the most common of the two.

Of the second type, these are behaviours that occur while sleeping that are not normally associated with sleeping. This can include somewhat harmless sleep talking but might also include bruxism (the grinding of teeth) and bedwetting. If these behaviours are causing significant disruption to sleep, then speak with your doctor about possible treatments.

It is very common when you’re in the trenches of no, little or severely interrupted sleep to look for a magical pill that will just solve the issue and give you eight hours uninterrupted sleep.

Unfortunately, as disordered sleeping is comorbid with so many other health conditions, treatment is unlikely to be so simple.

However, this also has a flipside – if all of the usual treatments for bad sleep aren’t working, then there’s probably something else going on and you’re unlikely to be fussing over nothing.

Disordered sleep is a big deal and if you or someone you love is suffering, we hope you’ll be able to use some of this information as a jumping off point when dealing with health professionals.


Could your child have a sleep disorder?

What are the symptoms of sleep disorders? Is it possible your child has one? Does my child have a sleep disorder? Sleep disorders children? 




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