Sleep Better!

A Guide to Improving Sleep for Children with Special Needs

Revised Edition

by

V. Mark Durand, Ph.D.

University of South Florida St. Petersburg

Baltimore • London • Sydney

Contents

About the Reproducible Forms ... xi

About the Author ... xiii

Preface to the Revised Edition ... xv

Preface to the First Edition ... xvii

Acknowledgments ... xxi

I The Nature of Sleep and Its Problems ... 1

1 An Overview of Sleep ... 3

• How Much Sleep Do We Need?
• When Are Owls and Larks Not Birds?
• What Is Sleep?
• What Is Our Biological Clock?
• How Does Temperature Affect Sleep?
• Conclusion

2 Sleep Problems ... 15

• How Common Are Sleep Problems?
• How Serious Are These Problems?
• When Does Sleep Become a Problem?
• Insomnia
• Trouble at Bedtime
• Night Waking
• Feeling Tired Throughout the Day
• Hypersomnia and Narcolepsy
• Breathing-Related Sleep Problems
• Sleep Schedule Problems
• Nightmares
• Sleep Terrors
• Sleepwalking and Sleep Talking
• Periodic Limb Movements
• Bed-Wetting
• Tooth Grinding
• Rhythmic Movement Problems
• Conclusion

II Assessing Sleep Problems ... 41

3 Identifying the Sleep Problem ... 43

• Steps to Understanding the Problem
• Sleep Diary
• Behavior Log
• Sleep Interview
• Sleep Habits Questions
• Bedtime and Night Waking Questions
• Sleep Schedule Questions
• Nightmare Questions
• Sleep Terror Questions
• Hypersomnia and Narcolepsy Questions
• Breathing-Related Questions
• Sleepwalking and Sleep Talking Questions
• Limb Movement and Rhythmic Movement Questions
• Bed-Wetting Questions
• Tooth Grinding Questions
• Anxiety and Depression Questions
• Daytime Behavior Problem Questions
• Other Possible Causes
• A Parent’s Dilemma
• Conclusion

4 Identifying Obstacles to Successful Treatment ... 59

• Interfering Thoughts
• I Have Little or No Control Over This Situation
• I’m Not Sure How Best to Handle This Situation
• In This Situation, Others Are Judging Me Negatively as a Parent
• In This Situation, Others Are Judging My Child Negatively
• My Child Is Not Able to Control This Behavior
• My Child’s Disability or Condition Is Causing or Contributing to This Problem
• This Type of Situation Is Always a Problem for My Child
• This Will Never Get Better or May Become Worse
• I Will Never Have Time for Just Me
• My Child Is Doing This on Purpose
• This Situation Is (Spouse’s, Partner’s, Family Member’s, or Other’s) Fault for Not Handling This Like I Suggested
• It Is My Fault that This Is a Problem
• Why Am I Always Responsible for My Child’s Behavior?
• Conclusion

III Strategies for Change................................................... 65

5 An Optimistic Approach to Improving Sleep.............................. 67

• Disputation
• Distraction
• Substitution
• Conclusion

6 Good Sleep Habits........................................................................ 75

• The Good Sleep Habits Checklist
• Bedtime Routines
• The Dos and Don’ts of Bedtime Routines
• Regular Sleep Times
• Finding Sleep–Wake Times
• Caffeine
• Alcohol and Tobacco
• Sleep and Diet
• Exercise, Activity, and Sleep
• Exercise and Activity Suggestions
• The Bed and the Bedroom
• Conclusion

7 Help for Bedtime Problems......................................................... 95

8 Sleeping Through the Night....................................................... 113

9 Sleeping at the Wrong Times..................................................... 139

10 Nightmares, Sleep Terrors, and Other Related Problems........ 155

11 Excessive Sleepiness................................................................... 167

12 Other Nighttime Difficulties..................................................... 179

13 Daytime Behavior Problems ... 195

14 Sleep and Medications ... 209

15 Preventing Sleep Problems ... 219

Notes ... 227

Appendix A Support Groups and Associations ... 233

Appendix B Internet Sleep Resources ... 239

Appendix C Accredited Sleep Disorders Centers ... 243

Appendix D Thoughts Quiz ... 245

Appendix E Self-Talk Journal ... 247

Appendix F Sleep Diary ... 249

Appendix G Behavior Log ... 251

Appendix H Albany Sleep Problems Scale (ASPS) ... 253

Index ... 257

About the Author

V. Mark Durand, Ph.D., is known worldwide as an authority in the area of autism spectrum disorder. He is Professor of Psychology at the University of South Florida St. Petersburg (USFSP), where he was the founding Dean of Arts and Sciences and Vice Chancellor for Academic Affairs. Dr. Durand is a fellow of the American Psychological Association and has received more than $4 million in federal funding to study behavior problems in children with disabilities.

Good Sleep Habits

We now know that what and when we eat and drink can affect our sleep and that our sleep can be affected by when we exercise, the temperature in our bedroom, any noise, and even what we do in bed. Everyday activities that we tend to take for granted can impact how well we go to sleep and if we stay asleep. Along these lines, there are a number of good sleep habits that should be followed if sleep is disturbed.

The Good Sleep Habits Checklist

• Establish a set bedtime routine.
• Develop a regular bedtime and a regular time to awaken.
• Eliminate all foods and drinks that contain caffeine 6 hours before bedtime.
• Limit any use of alcohol.
• Limit any use of tobacco.
• Try drinking milk before bedtime.
• Eat a balanced diet, limiting fat.
• Do not exercise or participate in vigorous activities in the hours before bedtime.
• Do include a weekly program of exercise during the day.
• Restrict activities in bed to those that help induce sleep.
• Reduce noise in the bedroom.
• Reduce light in the bedroom.
• Avoid extreme temperature changes in the bedroom (i.e., too hot or too cold).

Figure 6.1. The good sleep habits checklist.