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For people with Down syndrome, family members, caregivers and professionals.

Addressing Challenges with Falling or Staying Asleep

August 2020 | Brian Chicoine, MD and Katie Frank, PhD, OTR/L - Adult Down Syndrome Center

We frequently receive questions about sleep. Individuals with Down syndrome and/or their families report that they have difficulty falling asleep or staying asleep. In this article, we will share strategies to help individuals with Down syndrome: fall asleep, avoid waking up in the middle of the night, and/or fall back to sleep if they wake up in the middle of the night. 


Strategy #1: Practice good sleep hygiene. 

Sleep hygiene can be defined as a series of healthy sleep habits that can improve your ability to fall asleep and stay asleep. This includes refraining from activities that promote excessive evening alertness or interrupt the natural process of falling asleep. 


Good sleep hygiene habits include:

  • Allowing time for our bodies to digest dinner. 

  • Falling asleep at the same time each night. 

  • Setting up a healthy sleep space. 

  • Establishing a bedtime routine. 

  • Waking up at the same time each morning.

  • Drinking water as soon as you wake up.

  • Walking/stretching within the first hour of waking up.

Sleep habits to avoid include:

  • Consuming caffeine and/or sugar before bed. Some individuals have to stop consuming caffeine earlier in the day than others or not consume it at all. 

  • Drinking alcohol before bed.

  • Watching TV in bed.

  • Using phones or tablets in bed.

  • Lingering in bed in the morning. 

Visual supports can be helpful when working on improving sleep hygiene. Several visuals related to sleep are available in our Resource Library. Some individuals also benefit from tracking their sleep using a smart watch, app, CPAP report, etc. It can be a form of accountability as well as a way to recognize the impact that poor sleep can have on mood and behavior.


Strategy #2: Do relaxing activities or use sensory strategies before bed.

Relaxing activities and sensory strategies can help us calm down before bed. These can include: 

  • Reading
  • Writing in a journal
  • Praying
  • Drinking warm tea
  • Taking a warm bath
  • Meditating
  • Stretching
  • Taking deep breaths
  • Using essential oils
  • Listening to slow music
  • Turning on white noise
  • Dimming the lighting
  • Massaging your muscles
  • Using a weighted blanket or object. Please note: We do NOT recommend sleeping under a weighted blanket, especially if there are concerns with seizures, asthma, sleep apnea, etc. However, a weighted blanket could be used as part of the bedtime routine in order to calm before falling asleep. 

Strategy #3: Review your medications with your healthcare provider.

Some medications can negatively impact sleep. For example, taking thyroid medications like levothyroxine in the evening can prevent some individuals from falling asleep. We recommend taking it in the morning to avoid this issue. If you notice a change in sleep after starting a medication, ask your healthcare provider if difficulty falling or staying asleep is a side effect of the medication. Changing the time of day at which the medication is taken or trying a different medication may be options. 


Strategy #4: Work with your healthcare provider to address medical and psychological issues that may be contributing to sleep disturbances. 

A range of medical and psychological issues can negatively impact sleep. One common issue for individuals with Down syndrome is sleep apnea. When individuals with Down syndrome experience excessive daytime sleepiness or indicate they have difficulty sleeping, we often recommend that they get a sleep study to determine if sleep apnea could be contributing. Other conditions that can impact sleep include depression, anxiety, obsessive compulsive disorder, gastroesophageal reflux disease, and urinary issues, among others. 


Strategy #5: Consider trying natural products. 

Natural products that may help with falling or staying asleep include melatonin, magnesium, valerian root, and tryptophan. You may also want to consider time release formulas. For example, melatonin comes in this form. It releases some melatonin initially to help you fall asleep and then slowly releases melatonin throughout the night to help you stay asleep. These products are available over the counter at pharmacies and health stores.

Please note: Some of these products can interfere with other medications. We recommend speaking with your healthcare provider before trying these products. 


Strategy #6: Consider asking your healthcare provider about prescription medications.

Some individuals with Down syndrome we have seen benefit from taking prescription medications such as sedatives or trazodone. We recommend trying the strategies listed above before considering prescription medications. 


More information about sleep, including visual handouts for individuals with Down syndrome, can be found in the Sleep section of our Resource Library.

Find More Resources

We offer a variety of resources for people with Down syndrome, their families and caregivers and the professionals who care for and work with them. Search our collection of articles, webinars, videos, and other educational materials.

View Resource Library


Please note: The information on this site is for educational purposes only and is not intended to serve as a substitute for a medical, psychiatric, mental health, or behavioral evaluation, diagnosis, or treatment plan by a qualified professional. We recommend you review the educational material with your health providers regarding the specifics of your health care needs.