Table 1: Recommendations for Sleep Health.

General considerations

Children with FASD frequently have a melatonin deficiency which leads to disturbed sleep patterns
Sleep disturbances should be treated early and appropriately as they lead to neurocognitive behavioral and health difficulties
Intervention services may be ineffective when sleep deprivation is present
The functioning of children with FASD is highly variable; therefore developmental evaluations are helpful to understand their strengths and weaknesses
Sleep hygiene practices designed for typical children are often not useful for those with FASD as interventions need to be tailored to individual abilities
Caregivers and involved professionals should work together in a team
Modifying the environment, protection from over-stimulation at home, in school and in social situations are important principles in the general management of children with FASD
The rich learning experience that is required for typical children may lead to over-loading and disturbed sleep for children with FASD
Sleep hygiene interventions are increasingly hard to enforce and less effective in children with more severe cognitive loss.

Sleep environment

The children’s reactions to the environment should always be carefully observed
The bedroom needs to be quiet, comfortable (temperature, non-irritating clothing and bedding), familiar, secure, consistent and unexciting (minimal furniture without clutter, strong odors, bright lights and colors)
Do not use the bedroom for punishment or play.

Preparation for sleep

Calming behaviours and wind-down rituals promote sleep
Beverages containing caffeine or chocolate, excessive mental and physical behaviors, TV and video games should be avoided in the evening to minimize alertness and delayed sleep onset
Bedtime activities require supervision with emphasis on general hygiene which is often poor in later life.

Sleep scheduling

Enforcing rules, structure, routine and consistency are important not just at bedtime but all day
Times for bed and getting-up need to be consistent, even during weekends and holidays
Melatonin replacement therapy for the child combined with sleep health promotion techniques may be useful to establish sleep scheduling.

Sleep hygiene for the caregivers

Raising a child with FASD is a difficult task, thus the sleep health and the emotional needs of the caregivers must always be considered
Caregiver sleep patterns are linked to those of the child. Treatment of the child’s sleep disturbance with melatonin may lead to better sleep health of the caregivers and reduced burden of care.