Brief Report: Caregiver‐Reported Effects of Sensory Safety Beds on Paediatric Sleep Quality

ABSTRACT

Background

Children with neurodisabilities, including those with intellectual and developmental disabilities (IDD), autism and other complex needs, frequently experience sleep disturbances, impacting their health, behaviour and caregiver well‐being. This study evaluates the effectiveness of Cubby Beds, sensory safety beds designed to improve sleep quality and safety for children with neurodisabilities.

Methods

A survey of 225 caregivers assessed changes before and after Cubby Bed adoption using multiple‐choice and Likert‐scale questions. A Wilcoxon signed‐rank test was used to analyse key outcomes.

Results

Caregivers reported significant improvements in sleep duration (median increase from 4–6 to 8–10 h per night, p < 0.001) and reductions in self‐injurious behaviours, minor injuries and elopement incidents (p < 0.001). Effects on medical procedures, seizures and life‐threatening events were mixed.

Conclusions

Findings suggest Cubby Beds enhance sleep and safety for children with neurodisability. Further research is needed to assess long‐term impacts and integration into healthcare strategies.

Summary.

• This study surveyed 225 caregivers of children with neurodisabilities who use Cubby Beds, specialised sensory safety beds designed to support sleep and nighttime safety. Caregivers were asked to report on their children's sleep patterns, safety incidents and well‐being both before and after adopting the bed.

• Caregivers reported that median sleep duration increased from 4–6 to 8–10 h per night (p < 0.001), and nighttime awakenings decreased from 5–6 to 1–2 per night (p < 0.001).

• There were also significant reductions in minor injuries (p < 0.001) and elopement incidents (p < 0.001), improving safety for children with neurological and cognitive disorders.

• These improvements in child sleep and safety may help ease some of the demands on caregivers, although caregivers were not directly measured in this study.

• Findings support non‐pharmacological sleep interventions, but objective validation and long‐term impact studies are needed.

1. Introduction

Children with neurodisabilities often face significant challenges in achieving adequate sleep, which is a cornerstone for overall health and well‐being (Ogundele and Yemula 2022). Neurodisability is a non‐diagnostic umbrella term for long‐term conditions arising from brain or neuromuscular impairments that affect functions such as movement, communication, learning and behaviour (Roldán‐Pérez et al. 2023). Clinically, it encompasses diagnoses like cerebral palsy (CP), autism spectrum disorder (ASD), epilepsy and intellectual disability (Roldán‐Pérez et al. 2023). Sleep disturbances in this population are multifaceted, stemming from a combination of physical, behavioural and environmental factors (Ogundele and Yemula 2022). Children with ASD frequently experience sensory sensitivities and anxiety, leading to difficulty falling and staying asleep (Jamioł‐Milc et al. 2021; Tzischinsky et al. 2018). Similarly, children with CP or epilepsy may contend with pain, muscle spasticity, or nocturnal seizures, further disrupting their sleep cycles (Dutt et al. 2015; Newman et al. 2021). These sleep disturbances not only exacerbate the primary condition but also contribute to secondary complications, such as behavioural problems, impaired cognitive development and increased caregiver stress (Richdale and Schreck 2009; Kotagal and Broomall 2012).

The scope of the problem is substantial, affecting a large and growing population of children with neurodisabilities worldwide. An estimated 50%–80% of children with ASD and up to 40% with CP or other neurological conditions are affected (Souders et al. 2009; Newman et al. 2021). Poor sleep is associated with increased healthcare utilisation, including more frequent emergency department visits, hospitalisations and medication reliance (Solomon et al. 2024). Families also face emotional strain, as caregivers often lose sleep, leading to burnout and reduced capacity to provide care (Mannion and Leader 2023).

Despite their importance, sleep interventions for this population remain largely limited to pharmacological treatments and behavioural therapies, both with notable drawbacks. Medications like melatonin or sedatives may offer short‐term relief but often lack consistent dosing guidance and long‐term safety data (Bruni et al. 2019; Händel et al. 2023). Behavioural approaches can be effective but require intensive training and consistency, posing challenges for families (Malow et al. 2014). While these interventions may account for environmental factors like sensory sensitivities and safety, these are often not the primary focus.

Emerging evidence suggests that sensory safety beds may offer a novel and holistic solution to improving sleep quality in children with neurodisabilities (Frazier et al. 2017). These beds create a calming, secure environment with features such as sound machines, circadian lighting and protective barriers. Preliminary studies show promising parent‐reported improvements in sleep quality, duration and reduced nighttime awakenings (Mazurek and Petroski 2015).

However, a critical gap in the existing literature is the lack of comprehensive studies examining the broader impacts of sensory‐based interventions (Mische Lawson et al. 2022). Research on sensory sleep interventions is limited, often focusing narrowly on sleep duration while overlooking safety, self‐injury and caregiver burden. While weighted blankets have been studied for their potential to improve sleep in children with ASD, evidence on their impact on safety and caregiver stress is inconclusive (Gringras et al. 2014). Similarly, sensory integration therapies have shown promise in reducing self‐stimulatory behaviours but lack robust data on their effects on sleep‐related safety concerns (Case‐Smith et al. 2015).

The Cubby Bed is an enclosed sleep system used by children with neurodisabilities, featuring physical safety elements (e.g., soft tensioned walls, zippered doors and safety sheets to reduce the risk of entrapment), sensory‐adaptive components (e.g., dimmable lighting, quiet operation, soft materials) and integrated monitoring (camera, 24/7 continuous recording, high‐quality video with night vision, two‐way audio and motion/sound detection with customisable alerts). This report presents the first peer‐reviewed evaluation of Cubby Beds, examining caregiver‐reported outcomes related to the sleep quality and safety of children with neurodisabilities. It builds upon existing literature demonstrating that other tools, such as white noise machines (Papadopoulos et al. 2022), controlled lighting (Böhmer et al. 2022) and physical barriers (Golem et al. 2019), have shown measurable improvements in sleep for this population.

2. Methods

2.1. Survey Design

A survey questionnaire was utilised to gather caregiver‐reported data. Survey questions were designed to assess the impacts of Cubby Bed usage on the sleep quality, health and well‐being of children and adolescents with neurodisability. Data collection was conducted between September 16, 2024 and October 4, 2024, using Qualtrics (https://www.qualtrics.com). The survey instrument consisted of multiple‐choice questions developed based on a review of prior research on children with neurodisabilities (Halstead et al. 2021; Papadopoulos et al. 2022) and input from child psychologists and industry experts to ensure relevance and comprehensiveness in capturing caregiver‐reported outcomes. The survey aimed to evaluate caregivers' perspectives on Cubby bed users' sleep duration, number of wakeups per night and incidence of self‐injurious behaviours. Wakeups per night were measured on a 5‐point Likert scale: (1) Less than once a night, (2) One to two times a night, (3) Three to four times a night, (4) Five to six times a night and (5) Seven or more times a night. Responses assessing the frequency of self‐injurious behaviours were on a 5‐point Likert scale as follows: (1) Less than once a month, (2) One to two times a month, (3) Three to four times a month, (4) Five to six times a month and (5) Seven or more times a month. The definitions of self‐injurious behaviours provided to respondents are included in Appendix A.

2.2. Participants

Participants were the caregivers of children and adolescents aged 0–18 years who currently utilise a Cubby Bed. Inclusion criteria for survey respondents were: (1) being over the age of 18; (2) being a primary caregiver to a Cubby Bed user; (3) the Cubby Bed user had received a diagnosis of one or more of the following: ASD, Down syndrome, epilepsy or seizure disorder, intellectual disability, CP and/or other neurodisabilities; and (4) the ability to complete the survey in English. Participants were recruited through Cubby Beds' user mailing list.

A total of 565 participants were recruited, of whom 227 properly completed the survey. This resulted in an accurate completion rate of 40%. Of the 227 complete responses, respondents for whom the Cubby Bed user was over age 18 were excluded, which reduced the final sample size to 225. Demographic information about users, such as age, primary healthcare insurance, length of ownership of a Cubby Bed and neurodisabilities (singular or multiple) was collected and is displayed in Table 1 below.

TABLE 1.

Sociodemographic characteristics of the users.

Sample characteristics	n	%
Age
0–4	97	43.1
5–7	74	32.9
8–11	37	16.4
12–14	13	5.8
15–17	4	1.8
Condition(s)
Autism or autism spectrum disorder	190	84.4
Cerebral palsy	16	7.1
Down syndrome	12	5.3
Intellectual disability	77	34.2
Other	51	22.7
Primary payer
Medicaid	146	64.9
Private (employer‐sponsored)	63	28.0
Other	16	7.1
US Census region
Northeast	18	8.0
South	96	42.7
West	42	18.7
Midwest	52	23.1
Time with Cubby Bed
< 6 months	100	44.4
6 months to 1 year	66	29.3
1–2 years	40	17.8
2–3 years	14	6.2
3+ years	5	2.2

Note: N = 225.

Caregivers were compensated with a $20 gift card for their time and effort in completing the evaluation. All recruitment and study procedures were approved by the Institutional Review Board (IRB) at New York Medical College (IRB number 22946), and informed consent was obtained from all survey respondents before their participation.

2.3. Data Analysis

The data from the questionnaire were analysed in R Version 4.3.1 (R Core Team 2024) using the ‘rstatix’ package (V0.7.2; Kassambara 2023). In the initial phase of the data analysis, participant responses were explored and visualised using descriptive statistics.

Differences across sleep outcomes before and after a period of Cubby Bed use were then examined using a paired Wilcoxon signed rank test, a non‐parametric alternative to the paired t‐test. This test is recommended when data are ordinal and not normally distributed, which is common in questionnaire‐based research. In this study, each caregiver responded to identical sleep‐related questions regarding their child's sleep in the 3 months prior to and during Cubby Bed use. These behaviours were measured using 5‐point Likert‐type items (e.g., ‘Less than once per night’ to ‘Seven or more times per night’) and coded from 1 to 5 to facilitate ranking of within‐subject differences. The Wilcoxon test assumes ordinal or continuous paired data and a symmetric distribution of difference scores—assumptions that were considered reasonable given the nature of the data. All comparisons were conducted on matched responses from the same individuals, preserving independence between participants.

3. Results

A paired Wilcoxon signed‐rank test indicated a significant increase in users' perceived sleep duration after adopting the Cubby Bed compared to the 3 months prior (W = 19,065.5, p < 0.001). The median score on a 5‐point Likert scale increased from 2 (indicating 4–6 h of sleep per night) in the 3 months prior to 4 (indicating 8–10 h of sleep per night) after adopting the bed. A significant reduction was also observed in the frequency of users' nighttime wakeups (W = 349.5, p < 0.001). The median score decreased from 3 (indicating 5–6 wakeups per night) in the 3 months prior to 1 (indicating 1–2 wakeups per night) after adopting the bed.

For self‐injurious behaviours, the magnitude and significance of the effects varied. The largest and most statistically significant reductions were observed for minor injuries (W = 63, p < 0.001) and elopement incidents (W = 184.5, p < 0.001). In both cases, the median score decreased from 2 (indicating 1–2 occurrences per month) in the 3 months prior to 1 (indicating less than one occurrence per month) after adopting the bed. Full results, including effect sizes and additional outcomes, are presented in Table 2.

TABLE 2.

Results of two‐sample Wilcoxon signed‐rank test.

Variable	Median		p	W	r
	pre (SD; Qs)	post (SD; Qs)
Sleep suration	2 (1.0; 1.3)	4 (0.85; 3.4)	< 0.001***	19,065.5	−0.995
Wakeups	3 (1.09; 2.4)	1 (0.78; 1.2)	< 0.001***	349.5	0.959
No injuries	1 (1.63; 1.4)	1 (1.82; 1.5)	0.975	711.5	0.006
Minor injuries	2 (1.43; 1.3)	1 (1.1; 1.1)	< 0.001***	63	0.964
Moderate injuries	1 (0.72; 1.1)	1 (0.71; 1.1)	0.004**	65	0.630
Severe injuries	1 (0.27; 1.1)	1 (0.46; 1.1)	0.624	27	−0.200
Medical procedures	1 (0.27; 1.1)	1 (0.42; 1.1)	0.807	20	0.111
Elopement	2 (1.49; 1.4)	1 (1.21; 1.1)	< 0.001***	184.5	0.894
Seizures	1 (0.89; 1.1)	1 (0.62; 1.1)	0.052	91	0.440
Life threatening events	1 (0.59; 1.1)	1 (0.35; 1.1)	0.004**	22.5	0.737

Note: N = 225. In the Median column, pre = the 3 months prior to using the Cubby Bed; post = the period using the Cubby Bed, SD = standard deviation, Qs = first and third quartiles, W = Wilcoxon test‐statistic, r = effect size. **p < 0.01. ***p < 0.001.

4. Discussion

This brief report provides compelling preliminary evidence that the use of a Cubby Bed improves sleep duration and reduces wakeups and certain self‐injurious behaviours in children with neurodisabilities.

4.1. Interpretation of Findings

The observed improvements in sleep duration and reduced frequency of nighttime awakenings are consistent with previous studies indicating the potential benefits of sensory‐safe environments for children with neurodisabilities (Frazier et al. 2017). Specifically, the median increase in sleep duration from 4–6 h to 8–10 h per night represents a substantial improvement in achieving adequate rest, with cascading benefits for cognitive, emotional and overall health outcomes. Furthermore, the median reduction in nighttime wakeups from 5–6 to 1–2 per night represents a significant improvement in sleep continuity. Though not directly assessed in this study, prior research links sensory‐adapted sleep environments to reduced disruptions in children with sensory sensitivities and anxiety (Mazurek and Petroski 2015).

Observed decreases in self‐injurious behaviours, particularly minor injuries and elopement incidents, further underscore the role of Cubby Beds in enhancing safety. The median reduction in elopement incidents from 1–2 occurrences per month to less than 1 per month highlights a critical advancement in safety, reducing stress for families and enhancing the overall security and quality of life for users. Caregivers' reports of improved sleep and reduced injuries suggest broader family benefits, including less sleep deprivation, stress and burnout, reducing the emotional and financial strain from medical or emergency interventions.

4.2. Limitations

The analysis has several limitations that warrant consideration. First, caregiver‐only survey data may be subject to reporting bias, influenced by expectations, recall, limitations or the long gap (over 3 years for some) between pre‐ and post‐Cubby Bed use. Future studies could strengthen these findings by incorporating objective measures of sleep quality, such as actigraphy or polysomnography, to validate caregiver reports, recognising the complexity of these types of evaluations.

Second, the sample included only families who had used the Cubby Bed for at least 6 months, introducing a potential degree of selection bias. Families who discontinued use—potentially due to limited effectiveness or other factors—were not represented. Future research should examine experiences among both sustained and discontinued users to better understand the full range of responses to the intervention.

Third, the study's cross‐sectional design limits causal inference. Although significant associations were identified between Cubby Bed use and certain outcomes through a Wilcoxon signed‐rank test, this non‐parametric method does not account for potential confounding variables or interaction effects. The survey did not gather data on concurrent therapies (e.g., medications, behavioural interventions and CPAP), limiting the ability to attribute observed changes solely to Cubby Bed use. Finally, the sample was limited to families already using Cubby Beds and who agreed to be on the mailing list, which may not represent the broader population of children with neurodisabilities.

5. Conclusions

This brief report offers preliminary evidence that Cubby Beds is an effective, non‐pharmacological intervention for improving sleep quality and safety outcomes in children with neurodisabilities. While additional research is needed to address limitations and explore broader impacts, findings suggest sensory safety beds could enhance care for this population. Although caregiver well‐being was not directly measured, reported improvements in child sleep and safety may have downstream benefits such as reduced caregiver stress and medical reliance. Further research is needed to understand whether such improvements translate into reduced healthcare costs, emergency care utilisation or caregiver burden.

Author Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Chelsea Marlborough, Katja Lemermeyer, Garrett Sharp, Chris Madsen and Adam E. Block. The first draft of the manuscript was written by Chelsea Marlborough and Katja Lemermeyer, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Ethics Statement

All recruitment and study procedures were approved by the Institutional Review Board (IRB) at New York Medical College (IRB number 22946).

Consent

Informed consent was obtained from all individual participants included in the study. The participants provided informed consent to the publication of their data.

Conflicts of Interest

Caleb Polley receives a salary from and has an ownership stake in Cubby Beds. The other authors declare no conflicts of interest.

Appendix A.

Full descriptions of self‐injurious behaviours were provided in the survey questionnaire as follows:

1. Minor injuries (e.g., bruises, scratches due to unsafe sleep conditions) requiring first aid only.

2. Moderate injuries (e.g., cuts, sprains, due to unsafe sleeping conditions) requiring medical attention but no hospitalisation.

3. Severe injuries (e.g., fractures, concussions due to unsafe sleeping conditions) requiring hospitalisation.

4. Medical procedures (e.g., stitches, X‐rays resulting from injuries due to unsafe sleeping conditions).

5. Elopement incidents during sleep, resulting in minor injuries or interventions.

6. Seizures occurring during sleep, resulting in injuries or medical intervention.

7. Life‐threatening events (e.g., eating non‐food due to unsafe sleeping conditions) requiring emergency medical services.

Marlborough, C. , Lemermeyer K., Coletti D. J., et al. 2025. “Brief Report: Caregiver‐Reported Effects of Sensory Safety Beds on Paediatric Sleep Quality.” Journal of Applied Research in Intellectual Disabilities 38, no. 4: e70096. 10.1111/jar.70096.

Data Availability Statement

Data have not been shared in a public data sharing repository but are available upon request from the authors.