Sleep issues are very common in children with autism spectrum disorder (ASD). In fact, studies show that between 50-80% of children on the spectrum suffer from sleep problems, compared to 25-50% of typically developing children. There are several reasons why sleep can be particularly challenging for children with ASD.
First, many kids with autism have difficulty regulating their emotions and behavior. They tend to experience heightened anxiety, irritation, hyperactivity and impulsivity. This makes it very difficult for them to wind down at the end of the day and transition into a relaxed, sleepy state. Bedtime routines that work for neurotypical children, like taking a bath, reading a story, singing lullabies, often backfire for kids on the spectrum and further agitate them.
Children with autism also commonly struggle with sensory sensitivities. They may be overly sensitive to sound, light, touch or movement. At bedtime, things like the sound of the fan or hum of electricity, the feeling of pajamas or sheets, or the presence of lights can overwhelm their sensory system and make it impossible to fall asleep. Creating a sleep environment with minimal stimulation is crucial but very difficult for these kids.
Many children on the autism spectrum also have communication and social deficits. They have trouble expressing their needs around sleep routines like clearly articulating when they are tired or communicating what helps them fall asleep. Lacking language and social skills also makes bedtime anxiety much more intense for nonverbal or partially verbal children. Not being able to voice fears or call for parents exacerbates night wakings and difficulty self-soothing back to sleep.
Additionally, circadian rhythm irregularities are common in autism. Melatonin is the hormone that regulates sleep/wake cycles and some research indicates malfunctioning melatonin systems in those with ASD. This causes inconsistent sleep patterns, difficulty falling asleep and staying asleep. Children on the spectrum tend to have lower levels of melatonin which makes initiating and maintaining quality sleep very challenging without supplements or medications.
Children with autism are also more likely to suffer from comorbid conditions that disrupt sleep like gastrointestinal issues, seizures, tics, ADHD, anxiety and depression. For example, conditions like acid reflux or constipation cause discomfort that interferes with rest. Seizures also often occur at night and disturb sleep. Stimulants taken for ADHD that haven’t fully worn off can also impede sleep onset.
The need for structure and routine intrinsic in autism makes irregular sleep-wake cycles even more problematic. Most kids on the spectrum strongly prefer consistency in their schedule. Frequent night wakings or inconsistent bedtimes throughout the week disrupt this need for sameness and further exacerbate difficulties falling and staying asleep.
Finally, the ability to self-soothe and fall back asleep independently is an important sleep skill that many children with ASD lack. They struggle managing sleep transitions, whether falling asleep or returning to sleep after a night waking. Instead of being able to self-settle, children call out or get out of bed looking for parents to help put them back to sleep. This results in frequent night wakings and shortened sleep duration.
In summary, sleep challenges in autism stem from a variety of factors – sensory sensitivities, emotional and behavioral dysregulation, communication deficits, comorbid conditions and inconsistent sleep-wake cycles. While every child on the spectrum is different, these issues make initiating sleep, maintaining sleep and settling back to sleep very problematic for most kids with ASD. Improving sleep requires a multi-pronged approach tailored to each child’s unique needs. Patience with applying various behavioral strategies, adjusting the sleep environment, establishing structured routines and often supplementing with medications is key to improving sleep in children on the autism spectrum. With time and consistency, the whole family can hopefully start getting some much needed rest.