The following advice is adapted from NICE Guideline CG170: Autism in under 19s: support and management [http://www.nice.org.uk/guidance/cg170]
The first line of intervention for sleep problems should be a sleep plan rather than medication.
Sleep medication should only be considered if the sleep plan has been unsuccessful, or if the sleep problems are having a negative impact on the child/young person and their carers. Sleep medication should
- only prescribed in consultation with a paediatrician or child psychiatrist with expertise in autism or paediatric sleep medicine
- be used in conjunction with non-pharmacological approaches
- be reviewed regularly.
When assessing sleep problems in a child with autism, the following should be taken into account:
- what the sleep problem is (for example, delay in falling asleep, frequent waking, unusual behaviours, breathing problems or sleepiness during the day)
- day and night sleep patterns, and any change to those patterns
- whether bedtime is regular
- the sleep environment including
- the level of background noise
- use of a blackout blind
- a television or computer in the bedroom
- whether the child shares the room with someone
- presence of comorbidities especially those that feature hyperactivity or other behavioural problems
- levels of activity and exercise during the day
- possible physical illness or discomfort (for example, reflux, ear or toothache, constipation or eczema)
- effects of any medication
- any other individual factors thought to enhance or disturb sleep, such as emotional relationships or problems at school
- the impact of sleep and behavioural problems on parents or carers and other family members.
If the child snores loudly, chokes or appears to stop breathing while asleep, refer for assessment of sleep apnoea.
Develop a sleep plan with the parents/carers.
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