Autism & Sleep: A Comprehensive Guide For Parents
Autism is a developmental disorder that affects the way the brain processes information. While autism spectrum disorder (ASD) affects both children and adults, the prevalence of ASD in children is rising — with 1 in 54 children diagnosed in the US. Furthermore, boys are more likely to be diagnosed with ASD, as the rate for ASD in boys is 1 in 34 (as opposed to 1 in 145 girls).
Children diagnosed with ASD may experience difficulty with communication and social interactions, as well as repetitive behaviors or special interests. One of the more common difficulties for children on the autism spectrum is sleep problems, which can manifest in different ways depending on what type of ASD they have been diagnosed with.
Sleep difficulties and deficiency will affect anyone's physical and mental health and propose an additional challenge to those diagnosed with ASD. It will be vital for the parents and families of a child screened and diagnosed with ASD to understand how autism affects sleep and why children with ASD are more vulnerable to sleep problems.
How Autism Affects Sleep
Those with autism often suffer from altered sleep patterns and insomnia. They may find that simply getting enough sleep is difficult, having to fight through the daily sensory overstimulation they face.
Many of their sleep problems arise from the inability to self-soothe and fall asleep. This is due in part to the hyperarousal they feel, as well as difficulty with anxiety. Depending on the child and what type of ASD they are suffering from, many factors may challenge healthy sleep habits.
- Difficulty With Sleep Onset and Falling Asleep: One of the most common sleep problems children with autism experience is difficulty with sleep onset or falling asleep. This can be due to hypersensitivity to noise and light and anxiety or fear of the dark.
- Sleep Maintenance and Staying Asleep: Many children with autism experience difficulty with sleep maintenance or staying asleep throughout the night. This is due to overarousal and hypervigilance. For many children with autism, it can be challenging to maintain a healthy sleep routine. Some may have trouble falling asleep at bedtime, while others may find themselves waking up frequently during the night or frequently entering a parasomnia state.
- Waking Up Too Early: One common symptom of children with ASD is early morning waking. This can lead to daytime sleepiness and a lack of concentration, as well as general cognitive deterioration. Many parents will notice that their children with autism will wake up very early in the morning, sometimes as early as a couple of hours after bedtime. Parents often have trouble getting their children to fall back asleep to get an adequate amount of sleep, which then contributes to the morning waking cycle.
- Short Sleep Duration: Short-duration sleeping is a common trait of people with autism and one that causes stress. They often experience sleep onset insomnia, where they have difficulty falling asleep. Short-duration sleeping can lead to early morning waking cycles, contributing to daytime sleepiness and lack of concentration. Many children with autism experience parasomnia states, as well as general cognitive deterioration.
- Sleep Fragmentation: Sleep fragmentation, a lack of overall sleep quantity, is often experienced by children with autism. This is because these children have to constantly move into different positions to stay comfortable throughout the night. These children also have difficulty falling asleep or staying asleep, which can be attributed to the abundance of sensory stimuli they encounter daily.
- Hyperarousal: A hyperarousal, or an increased level of anxiety around bedtime, is also seen in children with autism. This could be because these children have difficulty getting comfortable and do not find the bed to be a "safe" place. These feelings and perceptions could have been developed over time through a series of sensory experiences. Research has revealed that children with autism prefer sleeping surfaces that are harder in texture.
Another contributing factor is the social aspect of bedtime; many parents report that their children with autism will exhibit behavior problems around bedtime, such as resisting going to sleep or staying asleep. This heightened anxiety level makes it so difficult for these children to fall into a deep sleep and stay there throughout the night.
- Excessive Daytime Sleepiness: The combination of fragmented sleep and hyperarousal could be the reason for excessive daytime sleepiness. It has also been suggested that the excessive daytime sleepiness experienced by children with autism may be a secondary effect of the standard medication used to treat this behavior — antihistamines.
- Sleep Anxiety: It can be difficult for children with autism to fall asleep. Anxiety can bring about feelings of worry or apprehension that can hinder sleep.
- Food Allergies that Cause Sleep Problems: Food allergies may cause or worsen autism. Some believe that certain foods, such as gluten may break down in a child's body and increase behavioral changes. Whatever the case, a person with autism who is also food-allergic may be experiencing the worst of both worlds when going to sleep — experiencing heightened anxiety and complications from particular food consumption.
Why Children With Autism Struggle With Sleep
There are many reasons why children with autism have a higher chance of experiencing sleep problems. Children with autism require special consideration for sleep, as their behaviors and minds are unique. Children with ASD often have unique behavioral, mental, physical, and even genetic attributes that contribute to sleep issues.
Difficulty Reading Social Cues
Children with autism spectrum disorder (ASD) have a difficult time reading social cues. They cannot intuitively grasp nonverbal cues and emotions, making it challenging for them to attach meaning to their behavior or the behaviors of others.
Because they cannot correctly determine their level of tiredness, they may not know when it is time to sleep. Additionally, they may not understand the cues of bedtime from parents and family — settling down for bed, relaxing, and turning the lights off to sleep.
Abnormal Melatonin Production
Children with ASD may have abnormal melatonin production due to genetic differences. Melatonin is a hormone that helps regulate sleep and wake cycles, so if levels are missing or off-balance, getting a child to sleep at night can be difficult.
Because an individual needs to understand their internal clock to establish a routine bedtime and wake-up time, children with autism often suffer from disrupted circadian rhythms. Interference with your circadian rhythm can make it challenging for anyone to get rest.
Children with ASD can have abnormalities in their genetic makeup that relate to sleep. For example, genes related to serotonin — a chemical involved in regulating mood and behavior (and which melatonin also helps regulate) — may be problematic. Imbalances in specific pathways involving serotonin can cause children to experience anxiety, aggression, restlessness, or insomnia.
Physical and developmental issues can make it difficult for an individual to fall asleep. Children with autism lag behind in fine and gross motor skills, speech or language development, mental abilities, self-help skills, and more. Children with developmental issues who are irritable or easily frustrated may have problems getting into bed and staying asleep due to the sounds of their environment.
Insufficient Physical Activity
Children with autism or ASD tend to be less active than their peers. While physical activity is essential to healthy development and good sleep habits, children with autism may avoid exercise or prefer sedentary activities. This lack of appropriate exercise can cause the child to feel too tired in the daytime, disrupting their ability to fall asleep at night.
Heightened Sensory Experiences
Many children with autism spectrum disorder (ASD) have sensitivity to sensory stimuli such as light, sound, and touch. This can make it uncomfortable for them to sleep — they may be unable to fall asleep, or if they fall asleep, they could wake up frequently during the night. Difficulty regulating sensations can also cause children with ASD to be excessively active because their bodies cannot produce the chemicals that put them in a state of restfulness.
Common Sleep Disorders Affecting Children and Adults With Autism
Sleep complications are common for both children and adults with autism. The symptoms of ASD can lead to sleep disorders, which include difficulties in falling and staying asleep and problems with regulating senses. There are many types of sleep disorders that people with ASD may experience, including sleep apnea, restless leg syndrome, and more.
Children with autism are more likely to develop GERD because the disorder can be caused by several factors, including special diets and over-sensitive senses. An individual's sensory perception may be dulled, foods may not be as pleasurable, or they may eat less than they should.
This can cause them to experience acid reflux at night while lying down. This often causes disruptive sleep that makes it difficult for people with ASD or those with related disorders to feel rested when they wake up in the morning.
Sleep apnea is a disorder that disrupts breathing while sleeping. While several factors can cause sleep apnea, people with autism and ASD are more likely to experience sleep apnea than their peers because of their respiratory problems. This could make it more difficult for them to fall asleep or stay asleep throughout the night.
Sleepwalking & Night Terrors
Sleepwalking occurs when a person is in a state of arousal during their sleep cycle but has not yet reached the REM (rapid eye movement) stage. Without any control over their own body, they can trip and fall out of bed or walk around while still asleep. A child with autism may be more prone to sleepwalk if they have difficulty sleeping at night due to sensory dysfunction, general lack of comfortability, or an inability to stay asleep for long periods.
Sleep terrors are similar to sleepwalking, except that individuals experience panic symptoms such as screaming, sweating, and rapid breathing while walking, making it even more difficult for them to navigate their surroundings safely without hurting themselves or others.
Restless Leg Syndrome
Restless leg syndrome (RLS) is a disorder that causes discomfort in the legs and an irresistible need to move them. It can be caused by stress, anxiety or boredom, as well as sleeping issues. This can make it difficult for people with autism or ASD — especially children — who cannot fall asleep comfortably to stay asleep through the night because their bodies require constant movement to feel comfortable and at rest. Hyperarousal and lower physical activity levels may also contribute to RLS.
A study published in the Journal of Pediatric Urology Company revealed that children with ASD showed increased rates of nocturnal enuresis — also known as bedwetting. This is especially common in children with delayed speech skills and lower levels of cognitive function, which makes it difficult for them to communicate their needs during the night.
If they are unable to communicate their discomfort or needs, they may urinate in their beds at night. Since bedwetting can lead to stress and embarrassment — increasing anxiety — families must learn how best to handle this issue, often with the help of a pediatrician.
Hypersomnia, or excessive sleepiness, is common in people with autism Spectrum Disorders (ASD). Researchers are uncertain whether this is caused by an underlying physiological problem associated with autism. It may be sensory processing issues that prevent the child from falling asleep due to heightened stimulation, inability to cope with their environment and anxiety about social interactions, or even a combination of both.
Insomnia can be characterized as having difficulty falling asleep, staying asleep, waking up too early on school days, and generally having trouble functioning during the day. In addition to frequent disruption of sleep patterns, many children with autism suffer from anxiety and/or behavioral problems, leading to further difficulties getting a good night's sleep.
Seizures are a common issue for adults and children with autism spectrum disorders. The Epilepsy Foundation says, "nearly one-third of individuals with ASD also have epilepsy." Epilepsy is a disorder that causes seizures due to nerve cell activity being disrupted. Researchers are not sure what the connection between the two is, but some theories attempt to explain it. Still, the current scientific view is that shared neurological mechanisms contribute to both ASD and epilepsy.
Anxiety is perhaps the most common comorbid condition in children and adults with ASD. About 40% of children with ASD have at least one anxiety disorder. Anxiety is also highly comorbid with depression, oppositional defiant disorder, and other behavioral problems. Young children with ASD show physical symptoms of distress such as avoiding eye contact, facial flushing, skin-picking behavior, rage reactions, and tantrums.
It is pretty typical for a child with ASD to develop behavioral problems due to anxiety issues. As they grow older, children may continue to experience various levels of anxiety-related issues that may improve or become worse depending on several factors, including social support from their family members and friends, and if everyone involved understands how to handle sleep for those with anxiety.
Circadian Rhythm Disturbances
Those with ASD experience disturbances in their circadian rhythm because they cannot regulate their internal biological clocks. The circadian rhythms are the natural body cycles for sleep and wakefulness. Many other factors contribute to how a person's circadian rhythms work, including genetics, social factors, diet, and exposure to bright light during the day. This is why some people with ASD can be night owls or morning people.
It has been found that there are certain types of activities that may help keep a person with ASD’s circadian rhythm on track. For instance, avoiding caffeine and physical exercise could help those with ASD get back on track with their circadian rhythm.
Helping Children With Autism Get Better Sleep
"How can I help my child with autism sleep better?" is a common question for parents of children with ASD. These children have various issues that affect their ability to sleep soundly and peacefully, and helping them go back to sleep without incident may take some time and effort on your part. You can help your child with these issues by learning more about them and making appropriate lifestyle, diet, medicinal, and sleeping habit adjustments that will help your child learn how to relax into a peaceful sleep state.
Making the Bedroom More Comfortable
A comfortable sleeping environment can help a child with ASD by guiding them to sleep. Think about a room temperature that is comfortable for your child and AC/fans that aren't too distracting. Consider your child's lighting as well. The room shouldn't be too bright because this can interfere with sleep, and it shouldn't be too dark either because it can promote negative feelings such as anxiety, fear, or depression.
Room décor is also essential to your child's happiness while relaxing in their bedroom, so make sure they have things like posters of their favorite characters on their walls or toys with which they enjoy playing. When they are happy while lying in bed, they will feel sleepy quicker and go right to sleep without any incident.
Lastly, you may need to reassess the mattress your child is sleeping on. If they are uncomfortable, you may need a new mattress to give them a better chance at sleep. If your child moves around frequently in their sleep or complains they are too hot to sleep, you may need a mattress that flexes to support their position and is breathable for a better temperature. Depending on your child’s age and sleeping preferences, you may want to explore different mattress dimensions to better suit them.
If your child has autism, it can be hard to figure out what they should be eating to help them sleep. There are several different diets that people with autism may benefit from. For example, the gluten-free and dairy-free diet is being used by more and more people with ASD who are having difficulty digesting these foods.
Often these foods can reduce gastrointestinal reflux. There are many other diets that someone with autism may benefit from, so make sure to speak with a medical professional before starting any new diet. Another consideration helping your child sleep better is ensuring they aren't consuming too much sugar and caffeine before bedtime.
Medications and Supplements
A pharmacological approach can address sleep disturbances in children with autism. Most medications and supplements used to make a child sleepy include melatonin, antihistamines, hypnotics, and sedatives.
Melatonin is commonly used and promotes sleep in children with autism as it increases the duration of deep sleep and reduces night wakings. Antihistamines are taken for their sedative properties. Other sedative medications include barbiturates and benzodiazepines such as clonidine, clonazepam, and lorazepam. They are effective at reducing anxiety in individuals with autism. However, they can be abused. There is also a risk of addiction and drug withdrawal. It is always advised to speak with your family doctor or a professional before giving your child medicine.
Establishing Bedtime Routines
When a parent establishes a routine time for bed, it gives their child continual cues for when bedtime is. Knowing when they're supposed to be in bed and when everyone else is supposed to be sleeping helps them learn how their own body works, too.
This allows them to fall asleep independently and not rely so much on someone else putting them to sleep. If you have a bedtime routine that puts your child into a sleepy mood, then they'll be more likely to go off to bed at their scheduled time without any trouble. It is also best to only use your child's bed for sleep — eliminating electronics or toys to play with in their bed with so they know that their bed is only for rest.
Many of the recommendations above are behavioral changes. Bedtime routines, bedroom changes, medicines, and dietary adjustments can all change a child with ASD’s sleeping habits. Other considerations could be to make sure your child has comfortable clothes they like to relax and sleep in, avoiding screen time before bed, using essential oils such as lavender to help your child relax and soothe anxiety, and facilitating more physical exercise during the day.
- Sleep Training: Sleep training refers to a series of strategies to help children self-soothe to fall asleep on their own. As children with ASD often can experience sleep regression, it will be essential to implement some sleep training techniques to provide a relaxed sleep setting. These techniques will help establish a bedtime routine, stick to a regular bedtime, teaching your child to fall asleep alone, and encourage healthy daytime behaviors.
You can purchase many products to help your child with ASD get a good night's rest. Parents can get a leg up on common sleeping problems their child might have, from proper bedding to sleeping apparatuses.
- Waterproof Mattresses and Bedding: Protecting a mattress from becoming soiled is essential for families with children who have bedwetting issues. It can save money and alleviate your child's anxiety that bedwetting isn't seen as an embarrassment but rather as just a cleanup.
- Bed rails and floor pads: For children with insomnia, parasomnia, and sleepwalking issues, bed rails and floor pads are available to protect them in case of a fall. Putting a child to bed with the awareness that they need to sleep, but having them wake up and get out of bed is common for children with ASD. Putting in place security measures to help keep your family members safe at night can be helpful.
- White noise machines: To help maintain calm and reduce anxious reactions to familiar sounds in the house, it can be helpful to purchase a white noise machine. This will cancel out other background noises and allow your child to relax, fall asleep, and remain asleep.
- Anti-snoring devices and behavior changes: Snoring prevents you from getting adequate sleep. There are techniques to help reduce snoring; however, these techniques may not work in the case of a child with ASD. In some instances, you may need to consider anti-snoring devices. To ensure the effectiveness of these devices and techniques, you may also consider a sleep tracking app. This will tell you when your child falls asleep and wakes up during the night to analyze their sleep patterns further.
- Weighted blankets: Weighted blankets are an excellent solution for people with ASD. They're known to reduce stress, anxiety, and restless leg syndrome while promoting relaxation — all things that can lead to sleeping issues.
- Light therapy: Light therapy is a medical treatment for mood disorders such as seasonal affective disorder and can treat sleep problems. It involves exposure to artificial or natural light in the morning and evening. People with ASD may also benefit from this process, as light therapy may reduce irritability and other behaviors triggered by light-sensitive children with ASD.
Getting Enough Sleep Yourself
Lastly, parents, families, and caregivers need to be mindful of their sleep. To take care of your child, you need to be at your best, and a lack of sleep will do no help. Establish healthy sleep routines for you and your child for better success at reducing sleeping problems for both of you.
Additional Autism and ASD Resources
- The Autism Society of America (ASA): is a leading advocacy organization for children and adults on the autism spectrum. The ASA's mission is to eliminate autism spectrum disorders; increase awareness about ASD, its symptoms, and effective treatments, and empower people on the autism spectrum in their communities. The ASA provides information, training, and support to parents, families, and professionals who work with people with ASD.
- Autism NOW: is a nonprofit organization dedicated to increasing the awareness and knowledge of autism spectrum disorders. It works with families, children, adults with ASD, professionals, and society to improve their understanding of autism spectrum disorders.
- Operation Autism for Military Families: Operation Autism was started by the Navy SEAL Foundation and is the first program that provides free, comprehensive autism care for military families. It serves more than 925 children annually from all service branches across the United States, including spouses, dependents, and retirees.
- Autism Speaks: is another leading autism science and advocacy organization. Funded by individuals, foundations, and corporations, Autism Speaks was founded by Suzanne and Bob Wright, the grandparents of a child with autism.
- American Academy of Child and Adolescent Psychiatry (AACAP) Autism Resource Center: AACAP is committed to enhancing the ability of all individuals, regardless of age or disability, to achieve their full potential and live a meaningful life within their families and communities.
Additional Sleep Resources
- American Academy of Sleep Medicine: The mission of the American Academy of Sleep Medicine is to promote sleep health, awareness, and advocacy by encouraging high-quality patient care, educating physicians and other healthcare professionals, and the public. They support sleep-related research, communication, and education.
- American Sleep Association (ASA): The inspiration for the ASA came about to further knowledge concerning all aspects of sleep. The ASA promotes research related to sleep disorders, encourages effective treatment modalities, and improves public health by fostering education on obtaining adequate quality nightly sleep.
- National Sleep Foundation (NSF): The NSF is the nation's largest nonprofit organization dedicated to sleep health and safety. NSF is a volunteer-driven organization that has pioneered efforts to encourage awareness about the importance of sleep health.