Dyspraxia and Sleep
Dyspraxia and Sleep: What’s the Problem?
Throughout my life on and off I have struggled with sleep. Getting off to sleep, waking up in the night and waking up too early or struggling to wake up in the morning. I’ve come across much anecdotal evidence that other people with Dyspraxia have the same issues. Frustratingly, we also seem to need more sleep than our peers. Possibly because life is more mentally and physically challenging for us day-to-day, we need longer processing time whilst asleep to wake up feeling refreshed. When I don’t sleep well, my Dyspraxia is much more difficult to manage. I am more likely to fall, my senses become more sensitive, my working memory gets even worse and I’m much more likely to feel stressed out and overwhelmed.
Dyspraxia and Sleep: What Else Could It Be?
First things first, if you have a new or substantial difficulty with sleeping, it’s worth checking that it isn’t a medical problem.
Various undiagnosed medical problems can impact on sleep and fatigue; for example people with anaemia, or thyroid dysfunction, or sleep apnoea, may all experience difficulties with sleep, which is why it’s important just to check in with your GP. Other known medical problems can impact on sleep, such as restless legs syndrome (interestingly this is known to be more common in those with ADHD), or the effects of a chronic condition or pain. For example, my husband has severe eczema and struggles to sleep when his eczema is not as well controlled because of the itchiness. Another contributor to poor sleep can be the timing of medication, some medication is alerting and best taken in the morning, whilst some can make you quite drowsy.
It’s important to check that none of the above applies, or else you’ll be desperately trying to sleep with very little luck!
Another main cause of disrupted sleep is artificial stimulants (these can have a different effect on people with ADHD, so if you have comorbid ADHD the following may not be the case for you). Artificial stimulants are substances like caffeine, nicotine, energy drinks, alcohol and drugs. People are often surprised how something as seemingly innocuous as a cup of tea and a night-time cigarette plays havoc with their sleep cycle. Alcohol can make it easier to get off to sleep but results in less time in the deeper parts of the sleep cycle, explaining why you feel you haven’t rested well by morning.
There’s also a growing body of evidence that links the light emitted by electronic devices (mobiles, tablets, computers) to ‘alerting’ our brains and disrupting sleep. And that’s without the ‘alerting’ effect of all those late night news stories and being constantly connected to everyone. Turn it off, or at least switch it to ‘night mode’ to give your brain the best chance to relax.
Dyspraxia and Sleep: What’s the Link?
I’m not aware of specific research as to why Dyspraxia is linked to sleep problems. However there is some evidence around ADHD and Autism and difficulties with sleep. These studies have suggested there are some biological differences in how the brain manages (or rather doesn’t manage) sleep in ADHD and Autism. The problems that people with ADHD and Autism experience with sleep have seemed pretty similar to those with Dyspraxia that I’ve come across, so I wonder if in time we will discover that there are some brain differences in controlling sleep in Dyspraxia too. A good article that looks at the link between ADHD and sleep is here.
So in addition to some possible underlying brain differences which have been discovered in other neurodiverse conditions, there are other reasons we Dyspraxic people are less likely to sleep.
Having Dyspraxia gives you so much to think about! It never stops. Your brain is constantly wondering about what you might have forgotten, what you need to do next, whether you may have said the wrong thing, and on it goes distracted and absorbed by something else until you’ve lost track of time completely. . Often I’ve found myself awake running through all the possibilities for tomorrow and to-do list, trying to think about how to prevent any Dyspraxic disorganisation impacting on my life. In a way, it’s natural to want to spend time running through everything, particularly when you are aware this is a ‘safety mechanism’ to stop you getting into difficulties from missing or forgetting things. Unfortunately to the brain, night-time seems like an ideal time to go wild with this. You aren’t distracted by other things, and you have a lot of processing the day and preparing for tomorrow to do. Argh!
2. Sensory difficulties
People with Dyspraxia often have different sensory over and under sensitivities. One that is notorious is our poor sense of proprioception (where our bodies are in a space). But it also makes sense that our other sensory systems are different too. This means we have to get the environment ‘just right’ more so than others to prevent ourselves being distracted and unsettled by unpleasant sensations. This is difficult to achieve all the time, making it another reason why we find it more difficult to sleep.
Interestingly, our body also has internal sensors for things like hunger and thirst, or when we need to use the toilet. I’ve often wondered if these senses are also poorer in Dyspraxia, so meaning we wake up in the night more because we don’t instinctively meet these needs during the day as well as other people.
I’m not a fan of exercise because my motor skills are so poor. I spend a lot of the day sitting down and don’t really move that much (except when I’m working with younger children!). People with Dyspraxia aren’t as likely to tire their bodies out during the day because they are less keen to move and exercise, because it’s more difficult.
4. Aches and Pains
With moving less and having poorer muscle tone and posture, we tend to be more prone to muscular pain. A lot of people with Dyspraxia also have hypermobility (I do) and this also predisposes you to pain because you often over-stretch the joints and/or hold them in the wrong position which stresses the muscles supporting them as well as the joints themselves.
5. Anxiety and depression
Both anxiety and depression seem to be more common in Dyspraxia. Both of these affect sleep. Anxiety makes it even more difficult to switch off the night-time processing. Depression can either make you sleep at inappropriate times (thus disrupting your body clock) and/or makes it more difficult to sleep altogether. It’s known for making people wake up in the early hours and struggle to get back to sleep too.
Dyspraxia and Sleep: What Can I Do?
With all these things making it more difficult for us to sleep, it’s a wonder any of us with Dyspraxia sleep at all!
Getting into a routine.
The brain has rhythms and cycles to control sleep and wakefulness, which it’s important to respect. This is why we find night shifts difficult, or get jet lag. Our brains already have a cycle programmed, and then we are disrupting this cycle and expecting ourselves to sleep as usual. On a day-to-day level, this means it’s important to try to go to bed and wake at the same time. And not nap during the day (or at least not from mid-afternoon onwards). The brain can take some time to get into the new routine, but it’s more likely to be able to do so if you aren’t constantly changing the goalposts with late nights and sleeping during the day time.
Dyspraxic brains in particular seem to like routines, probably because it takes the strain for recalling all the steps in a sequence out of the working memory (which is usually weaker) and puts it into the longer term memory (which is usually stronger). Relying exclusively on working memory is usually anxiety provoking because it is weaker, which isn’t what is needed just before bed. So getting into a familiar night-time routine is essential for people with Dyspraxia. It can even be helpful in this regard to write out a routine to follow (and put it somewhere visible) until it becomes more familiar.
Doing some exercise.
Our modern lives don’t tire out our bodies, which doesn’t make for great sleep. Every little helps here, even a quick walk around the block. I have a Fitbit which reminds me when I’m totally absorbed in something that actually I haven’t moved at all in the past hour! I find it a useful prompt to bring me back to what my body needs to do regularly.
Finding an exercise that you actually like is important too particularly when you have Dyspraxia. I like swimming as I really dislike getting too hot. And horse riding is my favourite exercise, it is therapy for my Dyspraxia too, but it took me many years to discover that!
Sometimes a lot of exercise right before bed is too awakening, you have to find what works for you.
Offloading thoughts and anxieties, getting in the right frame of mind for sleep.
A couple of basic things I do to tackle this night-time thinking myself is have a time of day I do planning - it's an hour in which I address all of these thoughts and make all of the plans I need to. I purposefully don't do it that close to bedtime. I have it at a set time (as much as possible) so that when a planning related thought pops in I can dismiss it by saying 'I'll come back to that during today/tomorrow's planning session'. To stop me from worrying that I may forget about it in the meantime I have a whiteboard by my bed and I just note the concern on it to be dealt with at a later time.
Or I put it on a list on my phone if I'm out and about. This all acts to train my brain into dealing with organisation and planning at a specific appropriate time, rather than when I'm trying to sleep - it takes a while to get used to it, but I do find that it helps. I also have a written routine for the key tasks I have to do each day for work, so I don’t have to panic at night thinking ‘did I check my emails and what about that voicemail’.
I have also found Cognitive Behaviour Therapy (CBT) quite helpful. Resources tend to focus on negative or anxious thoughts but I don't see why they can't be adapted for Dyspraxic thoughts! I'd say the main bits I found great benefit from were 'thought challenging' exercises, based around finding and rating evidence for and against thoughts. If you get into the habit of doing it on paper, then it becomes a bit more second nature to do at night - it's useful for challenging those 'what if' and 'how will I cope if I don't sleep' mind circuits you get into late at night. A good explanation of the CBT basics is here.
Lastly I do use the Headspace app for mindfulness meditations. Because of how I think I find it difficult to relax when I’m not listening to something, silence seems to be no way to meditate for me and I need prompting back because I often drift off to thinking about something else. I find Headspace the right approach for me. You can try it for free, and although it does cost you can often get it discounted one way or another and for me it works out as ‘worth it’ for the amount of use it gets. The creator of Headspace has also written some books, including a good one introducing mindfulness and meditation in an accessible way.
Adjusting the environment.
You may already know what you do and don’t like with in terms of your sensory experience. However a lot of people don’t, and therefore aren’t able to make use of easy-to-make changes that would help them sleep. If that is the case, now is the time to experiment!
Some sensory considerations with sleep (and examples of how I use my own answers to best help me sleep) are:
Light – do you need total darkness using black out blinds and an eye mask, or do you prefer sundown and sunrise lighting?
I don’t need total darkness and wouldn’t be able to tolerate an eye mask at night. I have a Lumie lamp which I set to gradually darken for half an hour after I go to bed and lighten for half an hour before my alarm goes off. It means I’m less shocked and difficult to wake in the mornings. (Also my husband brings me my fave cereal, which helps too!)
Temperature – do you find it difficult to regulate temperature, preferring warm or cold surroundings?
I need a cool room with a fan as I seem to not be able to manage my temperature especially at night and I overheat easily which prevents me sleeping. It’s also why having a hot bath right before bed doesn’t seem to help me.
Noise – are there certain noises you like or don’t like? Do you need total silence, and if so can you tolerate ear plugs?
I actually find total silence quite distracting but I also wake easily in the night with noise. I find the noise of a fan is a happy medium for me.
Smells – are there any smells that you find relaxing?
I love the smell of ThisWorks deep sleep spray and so it’s part of my bedtime routine.
Touch and pressure – do you prefer lightweight covers, certain materials, or more weighted items?
I have to have pressure on me via covers even in the middle of summer and I have a weighted blanket which I’ve found really helpful.
Dyspraxia and Sleep: A Summary
Dyspraxia is anecdotally linked to sleep difficulties, research has linked other neurodiverse conditions with biological differences in the sleep-wake cycle so it’s possible this is the case in Dyspraxia too.
It’s important to rule out medical causes of insomnia, particularly if it is a new or substantial problem.
Evenings need to be caffeine, alcohol, drug and electronic device free as much as possible to prevent disruption to the sleep cycle.
Dyspraxia gives us less chance of sleeping well because of our processing style, sensory differences, and difficulties with our bodies and exercise.
Being aware of the above and taking practical steps to help sleep gives us the best chance.
However there is no magic cure and even with the best efforts sleep eludes everyone with (and without!) Dyspraxia sometimes.
Dr Emma Tremaine trained as a medical doctor and psychiatrist before starting up a social enterprise specialising in comprehensively supporting adults and young people with Dyspraxia (The Dyspraxic Doctor). She also provides regular emotional and social skills therapy for children and young people who have a neurodevelopmental diagnosis (including Autism/Aspergers and ADHD). Dr Emma has Dyspraxia herself and is a passionate writer and speaker about neurodiversity, mental health and her own experience becoming a doctor with a hidden disability. She also enjoys horse riding, yoga, amateur sewing and making people laugh.