Any ideas how to break this nighttime ritual?

[Galaxymum]

Our DD (almost 6) has Aspergers and is often taken to obsessions and ritualistic habits. During the day we work very well to break certain habits and have worked brilliantly with the school. Since around November she has developed a nightime obsessive ritual when she wakes to go to the toilet. She goes, and one of us gets up with her as she tends to scratch, then she goes into a complete obsession with holes, spots and eyes. It's REALLY difficult to get her out of this, and sometimes we feel we are losing her to it. We have to really work hard to get her attention. Finally after emolients and trying to get her distracted we get her backl into bed. She will then start asking for water, then say she is lonely. We usually try a story to settle and focus her. She will either settle to sleep or continue muttering.

Then five - ten minutes later she will start again saying she needs a wee. Back to the obsessions. This can go on up to 6 times in an hour. Then start again two to three hours later. If we ever try to rush her she gets really upset - oh and she talks at the top of her voice all through this too.

DH and I are shattered. And because it happens from 1 a.m. and anytime to 5 a.m. it's really hard to put in place a strategy as we're exhausted! Affecting us in day and DD when she is overtired. We've tried rewards for good nights.....BUT also we want her to get up when she needs the toilet so can't say Don;'t wake us! We are absolutedly shattered.

Anyone have any ideas how to encourage good toileting in the night but then get her to go back to sleep without entering ritual and then her mind is alert so she keeps us (and neighbours!) awake.

Does she actually NEED the toilet?

Where are the button's etc. Can you make the environment less disturbing or dangerous so that she can take more responsibility for herself?

Have you tried a business-like process? I.e simply take her, acknowledge her for the good wee, wash hands but only discuss things relevant to the task at hand and say that conversations, books etc. Are for the morning?

I find this kind of this easier than most I think coz I have zero tolerance and am obsessed with my own sleep.

Have you thought about an audiobook for her you/she could play quietly instead of needing to read to her. What about having her choose a new soft toy/doll to keep her company if she is lonely and promise her an extra cuddle in the day if that is what she likes. What about a sensory toy of some sort to keep her hands busy rather than scratching herself?

I'm also with Starlight - does she really need the toilet that often? Once in the night is probably reasonable but repeatedly sounds like it is a part of the habit rather than a real need. Definitely try not to interact too much with her when she does go - make it as dull and boring as possible so she has less reason to want to repeat for company. Also have you considered waking her just a bit earlier in the evening instead so she can use the toilet and then hopefully settle down properly for the rest of the night?

Thanks for the suggestions. I do think I should try a timer which works well at school for activities.

No, I doubt she needs the toilet that many times. She usually has a wee twice. I think it's really a scratch she wants as we use eczema clothing pyjamas (to stop her scratching in bed) so she can't get to anywhere except when she goes to the loo.

I'll ponder on the other suggestions on how to change OUR behaviour!

I wonder if there are other things you could try to manage the itching at night? It sounds like it's not clear how much of the difficulty settling back to sleep is due to the desire to scratch an how much to asd behaviours. We have a ds with asd and a dd with severe eczema but need different strategies for each of them when they wake at night.

With dd the key is to get as much emollient as possible on her before bedtime. Although the special pyjamas are great for keeping scratching fingers out the urge to scratch is so strong our dd resented having to wear them.

The most effective method we havefound of keeping the skin from drying out and therefore more likely to get itchy is to use wraps either dry or wet.

Some links here:www.johnpreston.co.uk/pictures/items/3/9/3/100393/Comfifast%20Easywrap%20Flyer.pdf and www.dermnetnz.org/procedures/wet-wraps.html in case you are not familiar with them.

They work as an occlusive layer to keep moisture in and to some extent they will make it harder for little fingernails to get in. They can be used under the special pyjamas if necessary. There is then the whole issue of compliance as they are stretchy and designed to be tight fitting so a bit of a struggle to get on but if you get over that hurdle, they will make a big difference to keeping the eczema under control.

The other medical tactic you might want to consider is using an anti-histamine at a sedating dose at night to help break the pattern of wakefulness. You should be able to discuss this get them on prescription from gp although if they can refer you to a dermatology nurse or similar you will get more specialised advice from them.

From the asd point of view i would agree with other posters re keeping conversation/interaction to a minimum though not always easy to enforce...