1
24th February 2019
It is only by having a holistic understanding that sleep challenges can be dealt with gently and in a way that respects children. For some, the issue isn't behavioural - either fully or at all. A number of issues can masquerade as a behavioural sleep problem - one of those issues being sensory-integration challenges. In this article I discuss what sensory-processing is, and how it affects sleep.
Sensory input is all around us – sights, sounds, smells, how we respond to touch…the list goes on. For 19 out of 20 people, this information will be received and processed fairly seamlessly, barely noticed a lot of the time. For the other 1 in 20, the process of sensory integration operates differently – either over and/or under-responding to some or all sensory input. Being able to appropriately process and manage our response to sensory input is a vital part of our ability to self-regulate. For the 5% of people who are more sensitive to sensory input, the sensory system is overwhelmed, dysregulated or under-stimulated, and they find normal experiences distracting, disorientating or stressful. This will impact the sympathetic nervous system which governs the body’s fight, flight, freeze response.
We all have sensory needs – the question is whether an individual’s response to sensory input impacts their daily life.
Sensory-processing challenges exist on a scale. Whilst sensory-processing difficulties often do coexist with a diagnosis of ASD or ADHD, there are also children who struggle with sensory-processing as a stand-alone issue. It is therefore important to avoid pathologising sensory-sensitivity which may be clinically normal. Responses to sensory input which impact day-to-day life should always be discussed with a doctor and/or occupational therapist.
Sensory input abounds as soon as a child enters the world. These stimuli take their toll on a little one who is unable to articulate how the environment makes him feel. Some babies will crave certain types of touch, pressure or movement, finding them calming and grounding, whereas others will find those sensations over-stimulating and stressful. This is an example of the difference between what can be termed “sensory-seeking” and “sensory-avoidant” responses.
In my practice, I see a disproportionate number of children who are more sensitive around their sensory input than is considered average. In contrast to the 5% of children in the general population whose sensory-integration impacts their day-to-day life, approximately 40% of the parents I work with report behaviours that suggest their little one is particularly sensory-seeking or avoidant. What I actually see most-commonly, is a little one who displays tendencies towards being simultaneously sensory-seeking and sensory-avoidant. As an example, a child who seeks opportunities to spin, swing and bounce more than the average child but finds certain noises unusually distressing.
Sensory-seeking children seem to have the hardest time with sleep – which is unsurprising given that night-time and sleep are usually devoid of multiple sensations. As sensory-seeking children need these sensations in order to feel calm and regulated, the quiet and dark environment can cause stress – the nemesis of sound sleep! For sensory-avoidant children, the feel of night-clothes or bedding, nightlights, mobiles or noise from within or outside the house may trigger similar feelings of stress, making sleep very difficult indeed.
It is really important to view each child as an individual, and not have too fixed an idea of what will help. Often, children with increased sensory needs are vulnerable to being stereotyped and provided with the same strategies. There are however some broad generalisations that can be applied to children with sensory sensitivities. For example, continuous background white noise is usually less disruptive than intermittent breakthrough noise (such as doors slamming, dogs barking and toilet flushes), and firm, still pressure is usually more regulating than light stroking touch – which can be irritating.
Children with significant sleep challenges combined with sensory-processing sensitivity should always see a paediatrician and/or a paediatric occupational therapist. Some simple strategies a family can try to promote restful sleep whilst awaiting referral are detailed below.
Sense |
Sensory seeking strategies |
Sensory avoiding strategies |
Touch |
Bedtime massage A soft/textured blanket or comforter Weighted blanket (only on the advice of an occupational therapist) |
Cotton bedding and avoiding synthetic fibres Removing labels from nightwear |
Smell and taste |
Room scent (lavender works particularly well) |
Ensuring cooking and/or outdoor smells do not penetrate child’s room |
Oral |
Providing something to chew (but do be careful regarding choking risk) |
Discuss with dentist whether teeth can be wiped rather than cleaned to minimise stress |
Movement |
Rocking crib Use of sensory diet in the day (see below) Plenty of exercise |
Avoid rocking cribs Settling baby in their sleep-space to avoid the movement from arms to crib unsettling them |
Sound |
Continuous white or brown noise Guided meditation/soft music as baby falls asleep |
Keeping the bedroom quiet once bedtime routine complete and child is settling to sleep |
Vision |
Red nightlight |
Black out blinds. No nightlight, crib mobile or heavily patterned/decorated walls/curtains |
Behaviour |
Use of sensory diet (see below) A consistent period of wind-down time before bedtime |
Model emotional regulation from a young age Eliminating daytime sensory-stress as much as possible |
As with most sleep challenges, for a child who is sensory-sensitive, the daytimes are actually a huge part of enabling him to sleep well. Proprioceptive activities can help a sensitive little one to calm and regulate themselves. Arguably all children benefit from the incorporation of proprioceptive activities into their daily routine – not least because they involve physical exertion which is typically great for sleep! So, try incorporating them into your child’s daily routine and see whether you notice a difference when it comes to sleep.
Proprioceptive activities help us to orientate our body. Good options for toddlers are trampolining, soft-play, swimming, gymnastics, play-wrestling and ball games. For older children, skipping, handstands, hammering and climbing might be incorporated. Remember that these activities should be fun so it will be a case of tapping into what your individual child enjoys. Spreading proprioceptive activities throughout a child’s day as much as possible affords plenty of opportunity for them to sense how their body feels within a space and in turn to meet their sensory needs and to regulate.
For children who exhibit significant sleep challenges and their responses to sensory-input impacts their day-to-day functioning, it is vital to discuss your observations with your GP. For many little ones who are sensory-sensitivity, things can be improved significantly utilising age-appropriate strategies – identifying the need for these is the first step to helping a child.
