Sleep issues are very common in children with autism spectrum disorder (ASD). Studies show that 44-83% of children with autism experience some type of sleep disturbance compared to 25-40% of typically developing children. Lack of sufficient sleep can negatively impact a child’s behavior, learning, and overall health. As a parent of a child with autism, it can be distressing to deal with chronic sleep problems. The good news is there are many strategies you can try to help your child get the restorative sleep their growing body and mind needs.
Why Sleep is Challenging for Kids with Autism
There are several reasons why sleep is difficult for many children on the spectrum:
- Irregular Melatonin Levels – Melatonin is the hormone that regulates sleep/wake cycles. Studies show atypical melatonin profiles are common in autism. Melatonin levels may be deficient at night resulting in difficulty falling asleep. Or melatonin may be elevated during the day causing excessive sleepiness.
- Circadian Rhythm Abnormalities – The circadian system controls the timing of periods of sleepiness and wakefulness during a 24-hour period. Circadian disruptions are frequently seen in autism, making it hard for kids to feel drowsy at an appropriate bedtime.
- Hyperarousal – Many children with ASD experience chronic hyperarousal of their nervous system. Their brains have trouble calming down and entering a relaxed state needed to transition into sleep.
- Anxiety – Anxiety disorders are common in autism. Worries and fears at bedtime can trigger anxiety which interferes with falling asleep.
- Sensory Issues – Kids with autism are prone to sensory sensitivities. Tactile sensitivities can make certain pajamas or bedding uncomfortable. Noise and light sensitivities may prevent children from sleeping through the night.
- Gastrointestinal Discomfort – Constipation, acid reflux, and stomach pain are more prevalent in autism and can disrupt sleep. Food sensitivities may also cause discomfort at night.
- Neurological Impairments – Differences in brain anatomy and connectivity in autism can undermine sleep regulation mechanisms. Impaired melatonin signaling, abnormal gamma-aminobutyric acid (GABA) neurotransmission, and dysregulated neural circuits may make sustaining sleep difficult.
- Medication Side Effects – Certain medications used to treat co-occurring conditions like ADHD, anxiety, or epilepsy in autism may have insomnia or agitation as side effects which undermine sleep.
- Maladaptive Sleep Associations – Children with autism tend to be more behaviorally rigid. Sometimes maladaptive bedtime rituals and sleep associations developed early in childhood prevent development of healthy sleep habits.
- Comorbid Conditions – Many conditions that frequently occur with autism like epilepsy, restless legs syndrome, sleep disordered breathing, nighttime seizures, and sleepwalking/talking can also significantly disrupt sleep.
Sleep Hygiene Tips for Your Child with Autism
While every child with autism is unique, establishing structured sleep hygiene practices can help most children improve their sleep. Important sleep hygiene tips to implement for your child include:
- Set a Consistent Bedtime and Wake-Up Time – Establish a set bedtime and wake time 7 days a week. Sticking to a schedule will reinforce the circadian rhythm. Avoid letting your child sleep in more than 1 hour later on weekends.
- Implement a Predictable Bedtime Routine – Do the same sequence of calming activities before bed every night like take a bath, put on pajamas, read a book, get a massage. Routines help cue the body it’s time to sleep.
- Create a Restful Sleep Environment – Ensure the bedroom is cool, dark and quiet. Consider blackout curtains if early morning light is an issue. Use white noise if ambient sounds interrupt sleep. Remove electronic devices and distractions.
- Limit Daytime Naps – While napping is important for young children, longer/late daytime naps make falling asleep at night harder. Limit naps to 1-2 hours before 4 pm.
- Avoid Caffeine, Large Meals & Rigorous Exercise before Bedtime – Caffeine, heavy meals, and stimulating activity close to bedtime can interfere with sleep onset.
- Establish a Bedtime Wind-Down Period – Unwind with quiet, soothing activities like light stretching, listening to soft music or reading before bed. Start winding down 1 hour before bedtime.
- Use Social Stories to Teach Bedtime Routines – Write simple stories explaining the sequence of bedtime steps. Go over these daily to help reinforce sleep expectations.
- Keep Bed for Sleeping Only – Don’t let your child watch TV, play video games or eat in bed. This helps strengthen the association between bed and sleep.
- Expose Your Child to Daylight and Physical Activity – Exposure to bright light during the day and exercise helps reinforce the circadian clock.
- Avoid Screen Time before Bed – The blue light emitted from screens suppresses melatonin secretion making it hard to fall asleep. Turn off screens 1-2 hours before bed.
Specialized Sleep Interventions for Autism
If sleep hygiene strategies don’t resolve your child’s sleep problems, speak to your pediatrician or neurologist. There are also specialized interventions that may help including:
- Melatonin Supplementation – Melatonin is a safe, non-habit forming sleep aid. Timed-release doses given at bedtime often improve sleep onset and duration.
- Weighted Blankets – Deep pressure touch stimulation increases serotonin which has calming effects. Weighted blankets provide comfort that facilitates falling asleep.
- Cognitive Behavioral Therapy for Insomnia (CBT-I) – CBT-I is a psychotherapy that effectively treats bedtime resistance. It helps modify maladaptive thoughts/behaviors about sleep.
- Bright Light Therapy – Exposure to bright light in the mornings can help reset the circadian clock. Light boxes and natural sunlight discourage late sleeping.
- Functional Behavior Analysis (FBA) – FBAs determine triggers and functions of bedtime disruptions. This informs development of an effective behavioral intervention plan.
- Medication Adjustments – If sleep disruptions stem from medication side effects, adjustments in timing or discontinuing problematic medications may be warranted.
- Treatment of Underlying Conditions – Assessing and treating conditions like GERD, constipation, epilepsy and restless legs which compromise sleep.
Getting adequate, restful sleep every night is pivotal for the health, learning, and behavior of growing children. The wide prevalence of sleep disturbances in the autism population requires parents take proactive steps to reinforce proper sleep habits for their child. Consistency with sleep hygiene practices along with open communication with your child’s doctor when problems persist, will help identify options to restore healthy sleep patterns. With time and persistence, your child with autism can develop the ability to consistently achieve the peaceful, restorative sleep they need to thrive.