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Autism and Sleep: Common Issues and Solutions

May 24, 2024

Among many challenges that autism brings, sleep issues are a common one that most children on the spectrum live with. Autism and sleep difficulties manifest in many ways and can be challenging to deal with for both parents and their children with autism.

What are some common sleep issues in autism? Does your child have autism and a sleep disorder on top of it? How can you help them get some well-deserved rest? We’ll answer all of your questions – and more!

If you’d like to learn more about how you can help your child with autism sleep better, make sure to download your free guide here:

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Is There a Connection Between Autism and Sleep?

A 2018 Journal of Developmental Disorders study investigated sleep issues in children with neurodevelopmental disorders. Researchers studied children aged 2-15 with different conditions, including autism, and compared them to 47 neurotypical peers.

Using a sleep questionnaire, the study aimed to identify specific sleep patterns in different disorders for more targeted treatments. The findings revealed that children with autism had a 30% higher likelihood of difficulty falling asleep and a 43% higher likelihood of struggling to maintain a healthy sleep rhythm.

While children with ASD were less prone to severe night walking and early morning waking than those with other neurodevelopmental disorders, they still exhibited higher rates than neurotypical children.

All neurodevelopmental disorders studied showed increased instances of:

  • night walking,
  • daytime sleepiness,
  • nightmares, and
  • night terrors.

Variations in sleep disruption severity were linked to additional symptoms like gastro-oesophageal reflux, overactivity, and poor impulse control.

Why Do Children with Autism Have Trouble Sleeping?

Understanding and addressing sleep problems in autistic children requires considering key factors, such as:

  • melatonin dysfunction,
  • sensory sensitivities, and
  • anxiety.

Melatonin typically rises in the evening, signaling the body that it’s time to prepare for sleep, and decreases in the morning, allowing for wakefulness. However, this hormone may be disrupted in autistic children, affecting their overall well-being.


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Sensory sensitivities can make it challenging for autistic children to relax before bedtime due to heightened sensitivity to stimuli like sounds. For example, someone with autism who is sensitive to sounds may be easily disturbed by background noises or sudden loud sounds.

Anxiety disorders are relatively common among children with autism, with research suggesting that up to 40-70% of people with ASD are affected by it. Anxiety can disrupt sleep patterns, making it difficult for children to fall, stay, or experience restorative sleep. 

Common anxiety-related sleep problems include:

  • insomnia,
  • night sweats,
  • nightmares, and 
  • frequent waking during the night.

Common Autism and Sleep Issues

Sleep issues among individuals with autism vary in severity, ranging from minor disturbances to coexisting sleep disorders. Common sleep problems in autism include:

  • sleep apnea,
  • night terrors,
  • nightmares,
  • bedwetting, and
  • chronic sleep deprivation.

Sleep Apnea in Autism

Research indicates that about 10 percent of children with autism experience obstructive sleep apnea. This condition manifests in symptoms such as:

  • snoring,
  • gasping during sleep,
  • bedwetting,
  • daytime sleepiness,
  • behavior problems.

Possible treatments include weight management, nasal steroids, and adenotonsillectomy.

Night Terrors and Nightmares

Night terrors and nightmares can be distressing for parents of children with autism. Nightmares, though occasional for most people, can disrupt sleep and cause mild discomfort.

Night terrors, on the other hand, are more intense episodes during which the child may cry, shake, scream, or flail. These episodes typically occur 90 minutes after falling asleep and may last several minutes.

Although the child may not remember the episode the next morning, it can lead to a restless day.

A boy in bed having a nightmare
https://www.autismparentingmagazine.com/autism-and-sleep/

Bedwetting in Autism

Bedwetting is another sleep issue for children with autism, often persisting beyond the age when daytime toilet training is achieved. Heavy sleep and poor nighttime bladder control, especially in those taking sedating medication, contribute to this problem.

It is crucial to avoid shaming the child, as bedwetting is a behavioral response, not intentional behavior. Anxiety and shame can damage a child’s self-esteem and contribute to an exacerbation of bedwetting.

Sleep Deprivation in Autism

Chronic sleep deprivation in children with autism can impact various aspects of their lives, including:

  • eating habits,
  • mood,
  • behavior, and
  • academic performance.

Establishing a consistent bedtime routine, starting an hour before bed with relaxing activities and familiar transitions, can help promote better sleep for your child.

How to Help Your Child With Autism Sleep Better

Helping a child with autism sleep better can be challenging, but it’s essential for their overall well-being and development. Children with autism often experience sleep difficulties, such as insomnia or irregular sleep patterns.

Here are some practical strategies to improve your child’s sleep:

  1. Practice Good Sleep Hygiene:

Sleep expert Sujay Kansagra, MD, identifies four components as crucial to good sleep:

  • routine,
  • schedule,
  • environment, 
  • the avoidance of sleep disruptors.

According to her, these components contribute to good sleep hygiene.

  1. Limit Screen Time:

Keep your child’s pre-bedtime routine to about an hour, and consider reducing screen time. Blue light from screens can interfere with melatonin production. Replace screen time with calming activities like yoga or reading.

Young boy using a phone in bed
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  1. Create a Sleep Routine:

Establish a consistent bedtime routine, especially beneficial for children with autism who thrive on routines. Use a visual chart to help your child understand and follow the routine. Keep activities calming, limit bright screens, and aim for a 20-30-minute routine.

  1. Establish a Sleep Schedule:

Despite deviations in sleep patterns, create a regular sleep schedule. This provides structure and predictability and helps regulate internal clocks, reducing anxiety.

A consistent schedule improves:

  • sleep quality,
  • cognitive function, and 
  • overall well-being.
  1. Focus on a Comfortable Sleep Environment:

Identify the best room temperature and lighting for a comfortable sleep environment. Consider the child’s sensory preferences, recognizing that deviations from conventional recommendations may be necessary for their comfort.

  1. Use Sensory Tools:

Introduce weighted blankets or comfort items to help your child relax and reduce sleep-related anxiety. Be mindful of fabric or texture sensitivities when choosing sheets and pajamas.

Little girl wrapped in a blanket
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  1. Sleep Medications:

If your child with autism is still having trouble sleeping, talk to their doctor about suitable sleep medications. Common options include a low dose of melatonin.

If sleep problems persist, ask the doctor about other options like clonidine, risperidone, or donepezil. You can also discuss the possibility of trying different medications or seeking a referral to a sleep psychologist.

Embracing Progress for Good Night’s Sleep

In the journey of addressing sleep issues in children with autism, remember that each step forward, no matter how small, is a triumph. Your effort to create a supportive sleep environment, establish routines, and explore solutions is a testament to your dedication and love.

Embrace the progress, celebrate the victories, and don’t give up. When it gets hard, don’t get discouraged. Talk to a professional, find comfort in your community, and both you and your child will get the rest you deserve.

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Help Your ASD Child Sleep Better Now

FAQs

Q: How does autism affect sleep?

A: Autism can impact sleep in various ways, with common challenges including disruptions in melatonin production, heightened sensory sensitivities affecting bedtime routines, and a higher prevalence of anxiety disorders contributing to difficulties in falling and staying asleep

Q: How many hours of sleep do autistic adults need?

A: The optimal amount of sleep for autistic adults, like any adults, can vary, but most experts recommend between 7 to 9 hours of sleep per night for overall well-being. It’s important that you listen to your body and get the rest you need for optimal functioning.

Q: How many hours of sleep do autistic children need?

A: The amount of sleep needed varies for each autistic child, but generally, they require a similar amount of sleep as neurotypical children, which is around 9 to 11 hours per night, depending on their age.

Q: How can you help a toddler with autism and sleep issues?

A: To help toddlers with autism sleep issues, establish a consistent bedtime routine, create a calming sleep environment, and limit screen time before bedtime. Consider consulting with a pediatrician for personalized advice.

References:

Modified Simonds & Parraga Sleep Questionnaire (MSPSQ)
https://eprovide.mapi-trust.org/instruments/modified-simonds-parraga-sleep-questionnaire

A cross-syndrome cohort comparison of sleep disturbance in children with Smith-Magenis syndrome, Angelman syndrome, autism spectrum disorder, and tuberous sclerosis complex
https://jneurodevdisorders.biomedcentral.com/articles/10.1186/s11689-018-9226-0

An update on the cause and treatment of sleep disturbance in children and adolescents with autism spectrum disorder, 2021
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8688794/

Melatonin and Comorbidities in Children with Autism Spectrum Disorder
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6096870/

Sleep disturbances are associated with specific sensory sensitivities in children with autism
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872526/

Prevalence of Anxiety in Autism Spectrum Disorders
https://www.sciencedirect.com/science/article/abs/pii/B9780128051221000028

A systematic review of sleep disturbance in anxiety and related disorders
https://www.sciencedirect.com/science/article/abs/pii/S0887618515300384

Acute sleep deprivation disrupts emotion, cognition, inflammation, and cortisol in young healthy adults, 2022
https://www.frontiersin.org/articles/10.3389/fnbeh.2022.945661/full

Nightmares in Children with Foetal Alcohol Spectrum Disorders, Autism Spectrum Disorders, and Their Typically Developing Peers, 2021
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8482126/

Sleep problems in children with autism spectrum disorder: a multicenter survey, 2021
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365936/

Evaluation of behavioral change after adenotonsillectomy for obstructive sleep apnea in children with autism spectrum disorder
https://www.sciencedirect.com/science/article/pii/S0891422217301087?via%3Dihub

The relationship between autism spectrum disorder and sleep, 2021
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8848524/

Cognitive behavioral treatment of insomnia in school-aged children with autism spectrum disorder: A pilot feasibility study
https://onlinelibrary.wiley.com/doi/abs/10.1002/aur.2204

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