“Back to bed” I found myself saying for the umpteenth time. The clock read 9pm, and my preschooler was still wide awake. First it was too dark in the room, then the air conditioner was keeping him awake, and now he was complaining that his pajamas were too “scratchy.” I was convinced this kid was using every trick in the book to stall bedtime or simply wanted to make my hair fall out!
When my son was eventually diagnosed with Autism and sensory processing disorder (SPD), it was like a lightbulb went off. All of the struggles with picky eating, sleep, frequent meltdowns, and sensitivities to noise and bright lights finally made sense. Of all these issues, sleep was the most challenging because, without it, symptoms became worse. But sleeping with SPD is often an uphill battle.
Whether you’re the parent of a child with SPD or you personally experience sensory issues, there are many tools and activities that can help. In this guide, you’ll learn more about what sensory processing is, how it impacts sleep, some signs and symptoms to look for, and tips on how to improve sleep with a sensory-friendly bedtime routine.
What is Sensory Processing Disorder?
Sensory processing disorder (also called sensory modulation disorder, sensory integration disorder, or just sensory processing issues) at the most basic level refers to trouble managing the information coming in through the senses. In individuals with SPD, the brain has difficulty regulating and responding to sensory input.
On top of the five traditional senses – sight, smell, taste, touch, and sound – three other lesser-known senses can cause issues for kids with SPD. Proprioception has to do with body awareness, the vestibular sense involves spacial orientation, and interoception helps you to feel and understand what’s going on in your body. Struggles with these senses can look like not understanding personal space, challenges with potty training, and a heightened or reduced threshold for pain.
Sensory struggles may involve oversensitivity, undersensitivity, or a mixture of both. With oversensitivity, kids become sensory avoiders, avoiding foods, places, or experiences that overwhelm them. On the flip side, being undersensitive leads to sensory seeking, looking for increased stimulation to feel balanced. Many children go back and forth between sensory seeking and sensory avoiding which can make identifying the problem and helping them extra challenging.
In my son, this looks like strong aversions to brushing his teeth because it makes him gag, avoiding clothing with scratchy fibers or tags, and refusing to eat certain foods that have a “funny” texture. It also looks like needing to jump on a trampoline or have tickle fights in order to be able to sleep at night. Like many kids with SPD, navigating the bright and noisy world around him can be a scary and overwhelming experience.
While we might not even register the dog barking in the distance, a child with SPD may instantly experience a reaction similar to a panic attack and continue to be bothered for hours afterward. This emotional upset could trigger more heightened sensory reactions throughout the day and even disrupt sleep that night.
Dr. Jodie A. Dashore OTD, MS (Neurology), HHP is a highly trained specialist in the field of Pediatric Neuro-Sensory Integration and wrote about what sensory experiences are like for kids with SPD.
“What we now know is that these sensory symptoms may be far worse than just a feeling of discomfort with clothing, certain foods, certain sounds, bright light and motor challenges. Some children actually experience increased heart rate, possibly palpitations, feelings of dizziness, nausea, and feelings of impending doom.”
SPD vs Autism
For my son, sensory challenges occur alongside his diagnosis of Autism. In fact, between 60-90% of kids with Autism also have co-occurring SPD and sensory problems were recently added as a diagnostic criterion for Autism in the DSM-5.
But this doesn’t mean that every child with SPD also has Autism or that every Autistic child will also struggle with sensory issues.
The similarities between these two disorders may exist because kids with Autism are known to have dysfunctioning sympathetic and neuroendocrine systems leading to increased cortisol in response to stress. Cortisol is a hormone that is higher when we experience heightened stress or that well-known fight or flight reaction in response to a perceived threat.
For children with Autism, this “threat” could be a busy mall, a new teacher at school, or an unexpected lump in their mashed potatoes. Just like my pulse and blood pressure begin to rise when I see a bug in my bathroom (which I usually respond to with a blood-curdling scream), kids who struggle with sensory dysregulation may experience a physical and an emotional response to sensations they have trouble processing.
As you’ll learn in a later section, sleep disturbances and SPD also go hand-in-hand. Sleep has a direct correlation with behavior in kids, and nearly every behavioral and psychological disorder is associated with sleep disturbances to some degree. For children with Autism, challenges with sleep are common in 40-80% of kids, in many cases increasing the severity of symptoms. [2, 3]
Find Out More: The Link Between Autism and Sleep Disorders
SPD vs ADHD
If you’ve ever seen a child who just couldn’t sit down, plays a little too roughly with others, or is running around and touching things they shouldn’t be, you’ve likely thought “that kid has ADHD.” In some cases, that may be true, but many of these same behaviors can also be examples of sensory seeking when a child craves increased stimuli to maintain an optimal level of arousal.
The problem with distinguishing between ADHD and SPD is that many of the behaviors overlap, and in some cases, the two disorders occur simultaneously. ADHD is a neurodevelopmental condition that can make it harder for children to sit still and to concentrate. Kids with ADHD often appear to have brains that are in hyperdrive, keeping them in constant motion and preventing them from being able to focus or follow directions from a teacher or caregiver.
While children with ADHD often get labeled as “trouble-makers” and are continually reprimanded for not paying attention or acting out, this type of negative feedback can be damaging for a child’s self-esteem. In most cases with sensory seeking behaviors associated with ADHD and SPD, the child can feel just as out of control as they appear, leading to anxiety, guilt, and even depression.
Learn More: The Connection Between ADHD and Sleep Deprivation
How to Recognize SPD
If you’re new to the idea that behaviors may be a direct result of under or oversensitivity to sensory input, reading the signs and symptoms may be an “aha” moment for you. Learning to recognize the sensory seeking or avoiding behaviors is the first step in being able to help your child learn to cope with their sensitivities.
Unfortunately, parenting a child with SPD can take a lot of detective work. While you may quickly be able to identify the various behaviors, understanding what the trigger is or whether your child is sensory seeking or sensory avoiding isn’t always easy. The other challenge is that this can change from day to day or even hour by hour.
The good news is that as you observe your child, you’ll notice a pattern in their response to certain stimuli and you’ll be able to predict (with uncanny accuracy) how they will react in a given situation. Armed with this knowledge, you can begin to advocate for your child and help them learn to recognize their own triggers, building resiliency and improving their self-esteem.
Sensory Avoiding
Sensory avoiding is the most common type of sensitivity and involves an overwhelming response to some form of trigger. Bright lights, loud noises, irritating fabrics, and crowded places can all be examples of triggers.
The reaction can look like covering the ears, bolting out of a busy store, or even a sensory meltdown. This type of meltdown is the most extreme reaction and is often confused with a tantrum, only, in this case, the child has zero control over their behavior.
Here are some common signs to watch for:
- Doesn’t like hugs or cuddling
- Is easily bothered by scratchy fabrics or clothing tags
- Has a strong reaction to smells
- Avoids certain textures or flavors of food
- Easily overwhelmed by busy or crowded place
- Has frequent meltdowns
- Trouble falling asleep, frequent waking, early morning rising
- Overly affected by lack of sleep
- Dislikes change or trying new things
- Heightened sensitivity to pain
- Always too hot or too cold
- Avoids playground equipment and carnival rides
- Frequent tummy aches and vomiting (easy gag reflex)
Sensory Seeking
Kids who are undersensitive often have the opposite situation where they seek out strong sensory stimuli. Every living creature relies on sensory input to be able to function, and without it, we feel lost and unsure of ourselves. Kids who seek out greater stimuli are just trying to find a state of balance so they can make sense of the world around them.
Signs of sensory seeking may include:
- Constantly moving
- Needing the sound turned up higher on TV or other devices
- High pain tolerance
- Trouble falling asleep, frequent waking, early morning rising
- Non-stop energy
- “Wired” instead of tired at night
- Loves to tickle, roughhouse, engage in physical play
- Often unaware they are playing too roughly
- Loves bright lights
- Always fidgeting
- Can’t sit still
- Trouble focusing/concentrating
- Easily distracted
- Touches everything
- Loves strong flavors like spicy or sour foods
- Wants to smell everything
These lists are by no means exhaustive, but they paint a picture of what sensory seeking and avoiding behaviors may look like. If you identify behaviors from both lists in your child, it probably means that they display a mix of oversensitivity and undersensitivity depending on the given day or situation. As you may have noticed, one symptom is the exact same on both lists – trouble with sleep!
Sleep Challenges for SPD in Children
Have you ever had a night where the room felt like a sauna and no matter how hard you tried, you just couldn’t fall asleep? Or has a cup of coffee too close to bedtime kept you wired and awake at 2 am? That’s kind of what it’s like for kids with SPD too, only much worse and nearly every night.
Sleep disruptions are a huge red flag for parents and professionals, and may even be what prompted you as a parent to research sensory issues. Sleep is important for everyone, but it is especially crucial for the growing and developing brains of children. Without it, nearly every aspect of functioning and development is affected.
How SPD Affects Sleep
Children with sensory issues struggle with sleep on every level. Falling asleep may be a challenge because it’s too dark or not dark enough, the sound of the furnace may be keeping them awake, the lumpy mattress could be bothering them, or they can’t stop thinking about something that happened earlier in the day. Likewise, no matter how tired their little bodies are, these same factors can frequently interrupt their sleep at night and cause them to wake up too early in the mornings.
The problem with sleep and sensory issues is that they’re cyclical in nature. Sleep influences everything from motor coordination to attention, cognitive performance, executive functioning, and behavior. For kids who are already struggling with sensory input, this means that their reactions could be even more extreme when they haven’t gotten adequate rest.
While children without sensitivities may be able to easily disengage from sensory stimuli and effortlessly fall asleep, children who struggle with SPD have trouble turning this part of their brains off, robbing them of sleep and further contributing to their increased behaviors.
The Science Behind SPD and Sleep
Research looking at the impact of sensory issues and sleep in children found that tactile (touch) sensitivity was the most significant predictor for sleep difficulties and that both tactile sensitivity and sensation seeking were also the most significant predictors for behavioral problems.
If you’re the parent of a child dealing with sleep challenges and SPD, you already know that when your child doesn’t get the rest they need, their behaviors escalate quickly and it can feel impossible to get them the sleep they (and you) so desperately need in order to better cope.
Another study of nearly 14,000 children found that children with eczema (a painful skin rash) experienced sensory hypersensitivity that resulted in a lower quality of sleep. Supporting these studies, researchers have discovered that impairments in sensory gating are present in poor sleepers during the period when they are struggling to fall asleep. [4] Sensory gating is kind of like the brain’s gatekeeper when it comes to sensory input, controlling its ability to block out irrelevant sensory stimuli. [5]
When scientists investigated sensory gating in typically developing children and those with sensory processing deficits, they discovered that “children with SPD were found to be lacking in their ability to filter out repeated auditory input and failed to selectively regulate their sensitivity to sensory stimuli.” [5] While we still don’t know what causes SPD, a number of neurotransmitters, receptor systems, and various parts of the brain have been identified as playing a role in sensory gating processing.
EEG technology that can measure sensory gating in the brain has found differences in brain processing mechanisms in children with SPD compared to neurotypical children and in the future, this type of technology may even be used to guide clinicians in diagnosing sensory processing issues. [6]
SPD and Nervous System Function
Another unique finding in children with SPD is the role of the parasympathetic nervous system (PNS). This branch of the autonomic nervous system works in tandem with the sympathetic nervous system to regulate the moment-by-moment reactions to what’s going on around us. The sympathetic nervous system activates our fight-or-flight reaction and the PNS works to bring down this stress response.
Children with SPD struggle with self-regulation and the ability to recover after being faced with a stressor or challenge. High PNS activity has been associated with the ability to cope with a wide range of changing stimuli while low PNS activity has been associated with poor behavior and limited flexibility. [7]
A study looking at PNS activity in children with and without SPD found that children who struggled with sensory regulation also had lower baseline PNS activity. The authors believe that:
“These children may have aberrant PsNS activity that underlies their sensory dysfunction…Since they are unable to engage PsNS responses to cope with the typical levels of stimuli in the environment in flexible and adaptive ways, they demonstrate ineffective and atypical behavioral responses to sensation.” [8]
Infants and children with low PNS activity also have a lowered capacity for self-soothing, are less easily soothed by others, have poor emotional control, and have higher behavioral inhibition. So how does all of this relate to sleep? The autonomic nervous system plays an important role in regulating sleep and when it isn’t functioning properly, sleep is directly impacted.
For some kids, this could mean that they are so tired and lethargic all day that they can’t help falling asleep on the bus ride home, making it harder for them to fall asleep at bedtime. For other kids, this may mean the feeling of their pajamas or sheets keeps them tossing and turning for hours after the lights go out.
While it can be easy as a parent to brush off requests for a different blanket or view wanting someone to lay with them as stalling bedtime, a child with SPD is just trying to balance their extreme sensory reactions so they can actually fall asleep.
I used to get so upset when my son would come out of his room for the tenth time complaining of something else that was bothering him. Now, I know what his sensory needs are around sleep and have learned to tailor his bedtime routine and bedroom accordingly.
To an outsider, sensory processing issues can look a lot like misbehavior or even defiance. After all, most kids struggle with transitioning to bedtime, transform into gremlins when they’re overtired, and resist sleep with all their might. The difference with kids who experience sensory overload is that no matter how badly they want to, they can’t regulate their reactions.
Questions for the Pediatrician
Could my child have sleep apnea?
Could my child have sleep apnea?
If your child is struggling with sleep, it’s important to rule out medical conditions that may be keeping them awake at night. Sleep apnea is a type of sleep-disordered breathing that can impact children of all ages. While snoring and pauses in breathing are two of the tell-tale signs, waking tired in the morning and challenges with mood and behavior are also common.
Does my child need medication?
Currently, there are no specific medications that are used to treat SPD. In some cases, prescription medication may be used to help control behavior and minimize anxiety in kids with SPD. If lack of sleep is significantly impacting daytime functioning, your pediatrician may suggest a short-term prescription for sleeping pills.
Could there be side effects worsening sleep?
In some cases, medications to improve mood and behavior can have side effects that worsen sleep at night. Sometimes, this is a temporary effect and will wear off as your child’s body adjusts to the medication. If sleep continues to worsen, speak to your pediatrician about what can be done to help your child get the sleep they need.
Preparing Your Child's Bedroom
Adults often spend a lot of time researching and investing in a comfortable mattress, soft bedding, a supportive pillow, and perhaps even a fancy alarm clock. When it comes to our kids, we tend to choose bedding and pajamas based on what superhero or princess they’re currently into rather than what’s the comfiest and least likely to cause sensory reactions. For kids with SPD and sleep issues, the bedroom is the best place to start.
What Pajamas are Best?
Kids that are over-responsive to tactile input may not like the feel of pajamas touching their skin. An oversized cotton t-shirt may be more comfortable since it is loose and airy.
For kids who need more tactile input, try a compression shirt which is a seamless, tagless shirt that provides deep sensory pressure compression.
What Blankets Should I Choose?
If your child always throws off their blankets at night, they may sleep better without them. For kids who crave being “tucked in” or want someone to lay with them in bed, a compression bed sheet or a weighted blanket could help. Both provide deep compression therapy which gives the feeling of a big hug and may allow your child to sleep without needing you there (hurray)!
Other Bedroom Considerations
Go into your child’s room tonight and play detective, looking for any sensory triggers that could be keeping them awake. Bright night lights, a ticking clock, and a room that is a little too warm could all be clues.
I’ve found that a white noise machine, room darkening blinds, and a ceiling fan have all been extremely useful tools in helping my son overcome some of his sleep challenges.
Ideas for Bedtime Sensory Activities & Tools
One of the concepts you may have read about for children with SPD is the idea of a “sensory diet” that incorporates tools and activities that are unique to your child’s sensory needs. Using their individual hypo and hypersensitivities, this “diet” can help to provide balance and promote sleep. While these strategies have worked for a lot of children, they aren’t right for everyone and it is important to speak to your pediatrician about what may be the most helpful for your child.
Blowing Bubbles
Blowing bubbles can be a calming experience because it requires children to take a deep breath and fully empty their lungs. Similar to deep breathing exercises used in yoga and meditation, blowing bubbles can help children to relax and calm their bodies.
Try Essential Oils
Many essential oils have relaxing properties that can very useful for helping children sleep. Some companies even have specific bedtime blends made just for children. Essential oils can be sprayed on a pillow, rubbed onto feet, or delivered through a diffuser.
Cuddle Swings
Similar to a hammock, cuddle swings look like a heavy sheet that is hung from the ceiling and completely envelops the child. This sensory experience can provide deep pressure therapy and stimulate the vestibular system by swinging them back and forth.
Weighted Blanket
A weighted blanket is a heavy blanket that has multiple pockets sewn in with weighted pellets made from plastic or glass. This provides a gentle restraint, similar to the feeling of being hugged or held. This form of deep pressure therapy can be very useful in helping children with SPD sleep at night.
View Our Guide: Weighted Blankets for Anxiety and Insomnia
Pillow Fort
Kids who are sensory seekers tend to have excess energy at the end of the day. For tired and weary parents, this is the time of the day when you’re the least energetic and creative when it comes to play. One easy way to get all their energy out is to have them build a pillow fort using extra blankets and pillows (you may even find them sleeping in it once their construction work is done).
Noise-canceling headphones
Some children can’t tune out the world around them long enough to fall asleep at night. Even the sounds of the air conditioner and wind blowing could be enough to leave them tossing and turning hours after bedtime. Noise-canceling could be useful in blocking out all that ambient noise so they can focus on one task – sleep.
Want to see more? Check out our best headphones for sleeping guide.
Advice for Adults with SPD
Living with sensory processing issues as an adult can be even more challenging because of societal norms and pressures. In some cases, symptoms improve with increasing age, but may never fully go away. SPD can very be isolating in adults, with everyday tasks like work, shopping, and even relationships being a challenge.
Most adults have developed coping mechanisms to mask their symptoms and help them manage, but they also may be more set in their ways and resistant to change. Thankfully, adults are even more responsive to therapeutic interventions than children as long as they are open to help. If you’re an adult living with SPD, talk to your doctor about getting a referral to a therapist that specializes in this condition.
Conclusion
It takes time, patience and a lot of detective work to identify your child’s sensory needs around sleep, but as you learn what their individual triggers are, you’ll be able to find solutions to help them cope. Does your child always need to have someone lay with them in bed? Maybe a weighted blanket or stuffed animal could help!
Nobody knows your child better than you do, which means you are the most equipped when it comes to creating a sensory-friendly bedtime routine tailored to their unique needs. While you may not be able to fully switch off the heightened sensory parts of their brain, you can help to dim things a little so that everyone can get the sleep they need.
