Autism and sleep: How to help your autistic child sleep

Autism and sleep often do not go well together. Many autism parents can relate to the exhaustion and frustration of trying to get a full night’s sleep for themselves and their child on the spectrum. If you’re wondering why your child can’t sleep, you’re not alone. Nearly 80% of autistic preschoolers have trouble sleeping through the night, and many autistic individuals of all ages have insomnia.¹ Many autistic individuals have difficulty falling – and staying – asleep. In fact, autistic people take an average of 11 minutes longer to fall asleep, spend nearly half as much time in restorative and much-needed REM (Rapid Eye Movement) sleep, and experience more frequent awakenings throughout the night, than neurotypical people.¹

 

Why can’t my autistic child sleep?

More research is needed to understand the link between sleep disturbance and autism, but there are a few possible reasons why autistic children have difficulty sleeping.²

 

Co-occurring conditions. Coexisting medical conditions like ADHD, anxiety, or sleep apnea (when you stop breathing multiple times throughout the night), environmental allergies, and gastrointestinal upset (like constipation), can negatively impact sleep.

 

Sensory sensitivities. Sensitivity to lights, sounds, and touch (think textures of blankets and clothing) can disrupt sleep.

 

Medications. Often autistic children are prescribed medications to address various concerns like hyperactivity, anxiety, or aggression. Many of these medications may contribute to sleep problems. Adderall, Focalin, and Vyvanse are examples of stimulants prescribed to children on the spectrum to treat hyperactivity, impulsivity, and inattention, that can cause insomnia. Abilify and Risperdal (medications commonly prescribed for autistic children who have severe irritability, aggression, and/or self-injurious behaviors) may cause some children to become very sleepy.  However, each person responds differently to medications. (Pro tip: Keep channels of communication open with your doctor so that you can find the best medication to help your child that least affects sleep.)

 

Neurobiological differences. Some research suggests autistic people may not produce the same levels of neurotransmitters (such as serotonin) or hormones (melatonin) important for sleep regulation, and may also experience disruption in circadian rhythms.³ In addition, low muscle tone can contribute to sleep-breathing disorders, such as sleep apnea, which also affects the quality of sleep and can lead to increased inattentive and hyperactive symptoms during the day. These behaviors, in turn, make it more challenging for the child to participate in therapies and activities. 

 

What happens if my child doesn’t get enough sleep?

Like anyone else, when children on the spectrum don’t get adequate sleep, they may find it difficult to self-regulate during the day. But there’s another consequence – autistic kids who don’t get enough sleep can experience an increase in stimming, irritability, inattention, difficulty socializing, and keeping up in school.³ They may also face challenges with increased hyperactivity and lack of impulse control. In short, lack of sleep can intensify your child’s existing challenges.

 

The same goes for parents, too. It’s hard for you to keep your cool and be fully present when you aren’t well-rested.⁵ As you’ve already found out, good sleep is crucial for everyone in the home.

 

How can I improve my autistic child’s sleep?

Know that each child on the spectrum is unique, and what works for one child may not work for another. Here is a comprehensive list of expert strategies and tips to try so that your child can get the rest you both need.

 

Perfect your child’s sleep environment by making it sensory-friendly. You know your child’s sensory needs better than anyone – so really take a look around their room. Is it too bright? Can they hear the washing machine running? Is the paint color or decor too stimulating? Do they need a weighted blanket, looser pajamas, or a different pillow? Is the temperature right? Ensure your child is set for sleep success by making the sleep environment as comfortable for them as possible.

 

Choose a bedtime wisely and stay consistent. Most humans are prone to a “second wind” just before bed, but for a child with autism, that second wind can become hours of trying to cajole them back to bed. Many parents think going to bed earlier will allow their child to sleep longer, but that’s not always the case. In some cases, going to bed earlier can cause your child more difficulty sleeping! Some children with autism seem to require less sleep than a neurotypical child (10-11 hours), so to avoid that second wind, choose a time that allows your child to get an adequate amount of sleep for them, and keep it consistent.⁶ If you find that it takes hours for your child to fall asleep at their current bedtime, try starting their bedtime routine 30 minutes later, and so on, until you land on the right bedtime for them. 

 

Create a predictable, relaxing bedtime routine. Routines and patterns are important to kids on the spectrum, so it makes sense they’d find comfort in having the same wind-down routine every night. This routine will look slightly different for every child, but you’ll want to incorporate relaxing activities (such as taking a warm bath or reading a book), rather than stimulating ones (watching TV/tablet or roughhousing). It’s also important that everyone in your child’s life is on the same page and conducts the routine in the same order. A great bedtime routine will include using the restroom, connecting with you, and very little stimulation. Using a picture schedule can make bedtime routines easier, and for some kids, it may be helpful to let them choose which order they want to complete their bedtime activities (such as pointing to the picture for “bath” first).

 

Reduce activity before bed. Experts recommend reducing stimulating activity 1-2 hours before bedtime, however, some say 15-60 minutes. Our recommendation is to begin 30 minutes before bedtime and increase that by 15-minute increments as needed for your child. During this time, you’ll want to take things down a notch and begin their nighttime routine. This includes avoiding any heavy meals, roughhousing, vigorous activity, or screen time (if possible).⁶ In fact, try to avoid the use of screens at least 30 minutes before the start of the bedtime routine, as blue light suppresses the production of melatonin and can significantly shift circadian rhythms. Also, if you know that stopping screens is a trigger for your child to become upset, do not use media close to bedtime. Use sensory-friendly wind-down techniques, such as deep pressure (e.g., massages) and quiet, calm music.⁶ You want to avoid stimulating your child before bed, as that can make it difficult to fall asleep and encourage their “second wind”.

 

Good nights begin with great days. Your child’s good night of sleep begins with making great choices throughout the day. You’ll want to examine your child’s diet (reduce or eliminate sugar and caffeine), make sure they’re engaging in enough physical activity to get their energy out, and be mindful of their nap and bedtimes.⁶ Some children may benefit from eliminating their daily nap, but keeping nap and morning wake times the same every day is crucial for building a fruitful sleep schedule.

 

 

Introduce one new change every few weeks so that you don’t overwhelm your child. You can expect to experience a bit of trial and error until you figure out what works best for your family, and that’s okay. Reach out to your child’s care team, including pediatricians, behavioral therapists, and occupational therapists, for recommendations and support. It can take weeks for you to see the impact of these changes, which is why it’s important to introduce them one at a time.⁶ If something isn’t working, you can stop it and try something different. Think of it a bit like creating a new recipe – a pinch here, a dash here, a taste there, until you get the perfect combination of ingredients.

 

Speak with your child’s doctor. A visit to your pediatrician can help you rule out any medical issues that may be preventing your child from sleeping well. Autistic kiddos often have co-occurring conditions like ADHD or gastrointestinal upset that can affect sleep. They may also take certain medications, like stimulants, that can make sleep difficult. Your child’s doctor will have better insight into why your child is having trouble sleeping and may recommend supplements (like Melatonin) or medications to try out.⁶ They may also recommend a sleep study to rule out more significant sleep breathing disorders. We know some parents swear by CBD, but our experts say there’s no good data to support the use of CBD for kids, especially not children who already experience developmental delays. Please speak with your child’s doctor before beginning any supplements or sleep aids.

 

When should I consult my child’s doctor? 

Speak with your doctor if you have concerns – especially if you notice your child snores or gasps in their sleep, grinds their teeth (bruxism), sleeps with their mouth open/drools, or is very sweaty during sleep, as these are potential signs of sleep apnea. It can be helpful to keep a log of concerns, including when the child falls asleep, how many times they wake up, when they wake for the day, and any unusual behaviors (e.g., an unusual number of sleep terrors, recurrent nightmares, sleepwalking, sleep talking, unusual hand movements, lip-smacking). Research shows that pediatricians are sometimes unaware of the severity of sleep issues in autistic children, so please continue to advocate for your child if you have concerns.⁴

 

Conclusion

Making sure autistic kiddos get enough rest is a big concern for many parents. By making wise choices throughout the day, perfecting your child’s sleep environment, and sticking to a bedtime routine that works for them, you can set your child up for a good night’s sleep. Trial and error is an expected part of this process, so don’t stress if it takes a while to find the ideal solution for your child. Check out more helpful tips from other neurodiverse families and doctors here.