The Link Between Autism and Sleep Issues

If your child with autism has trouble falling or staying asleep, you're not alone. In fact, studies suggest that well over half of people with autism, adults as well as children, have significant sleep issues. These issues can be severe and can lead to serious challenges both for parents and for the autistic individuals themselves. Fortunately, there are some tools for helping individuals with autism with sleep problems; unfortunately, those tools are not always successful.

The Link Between Autism and Sleep Issues

An article on the Scientific American website reports that "at least half of children with autism struggle to fall or stay asleep, and parent surveys suggest the figure may exceed 80 percent. For typical children, the figures range from 1 to 16 percent."

A study conducted at the Center for Sleep and Circadian Neurobiology at the University of Pennsylvania found that sleep issues for children with autism result in significantly more severe behavioral and learning problems during the day. Children who slept fewer hours had more severe social problems, mainly trouble with peer relationships. Those children also had more compulsive rituals that served no purpose. That was true even when researchers took age and intelligence into account. Less sleep was linked to more instances of challenging behavior, attention deficit disorder, depression, and obsessive-compulsive disorder.

And, according to another 2016 study, sleep disturbance is associated with behavioral dysregulation among children with ASD. Of note, night awakenings had the most consistently strong association with daytime behavior problems, even after controlling for the effects of age and sex.

Sleep issues don't disappear as autistic children grow up, though they may improve. In fact, adults with autism may have more trouble than neurotypical adults with issues such as insomnia and sleepwalking. Even when they do sleep through the night, studies suggest that autistic adult sleep is less refreshing than that of their neurotypical peers.

Causes of Sleep Issues in Autism

As with so many symptoms of autism, the causes of sleeplessness are not well understood. A few possible (but unproven) theories include:

• Genetics: The genetic causes of autism itself may have some impact on the ability of people with autism to fall asleep, stay asleep, and awake refreshed.
• Sensory issues: Most people with autism are hyper-responsive to sensory input; perhaps they have a harder time sleeping because they can't easily block out noises and sensations that disturb their rest.
• Lack of melatonin: Some studies suggest that people with autism produce less melatonin at night (a sleep-related hormone) than do neurotypical people.
• Physical or mental illness: In addition to sleep-related challenges, many people with autism have other physical and mental illnesses that may impact sleep; sleep apnea, acid reflux, seizure disorders, obsessive-compulsive disorder, ADHD, and anxiety can all make it harder to sleep.

In addition to these possible causes, people with autism may also find it harder to just "let go" of the day's cares and interests.

Tips for Improving Your Autistic Child's Sleep

Many of the best tips for improving an autistic child's sleep are similar to those used for neurotypical children, with a few exceptions. Here are some of the most effective techniques, according to researchers:

• Keep the bedroom as cool, dark, and quiet as possible to avoid sensory challenges. If possible, use blackout curtains; do your best to keep outside sound to a minimum.
• Establish a regular bedtime routine that starts at least an hour ahead of time. Turn off all electronics, and provide a clear, repetitive routine that includes putting on pajamas, brushing teeth, reading together, or whatever is most relaxing for your child (and you). Some children respond well to a warm bath and snack before bedtime. Many children with autism are attached to particular stuffed animals or other toys, and these can be incorporated into the routine. Stick with the routine even during vacations and weekends if at all possible.
• Create a predictable transition from waking to sleeping hours. Give warnings 15, 10, and 5 minutes before it's time to start the bedtime routine. Practice the process of (for example) turning off the TV and heading to the bathroom. You can use visual timers or auditory alarms if that seems to work better for your child.
• Work with your child to help him fall asleep without you in the room. If this is an ongoing issue, you may have to take the process very slowly, starting with sitting at the other side of the room and slowly moving farther away until you're actually outside the door.

In addition to these basic techniques, children with autism may also benefit from some special attention to sensory and physical issues. For example:

• You may want to record your child's bedtime response to specific foods and exercise. Does she have more trouble falling asleep when she eats an early dinner or eats specific foods? Does exercise help him to relax or rev him up before bedtime? Adjust your routine based on your findings.
• Consider certain products geared to people with sensory issues. Examples include a white noise machine, which makes a consistent, sound-blocking sound similar to that of a fan, or a weighted blanket which may help your child to calm himself.
• Low doses of melatonin supplements about 30 minutes before bedtime have been found to be helpful for some autistic people.

What if none of these simple, tried-and-true techniques works well (which is fairly likely if your autistic child has serious sleep issues)? In that case, you can take your search for help to the next level with several approaches:

• Sleep studies, which must be ordered by a physician, may help pinpoint issues related to your child's sleep cycle. Alternatively, they may uncover underlying sleep disorders such as sleep apnea, restless legs syndrome, or periodic limb movement disorder.
• A visit to a sleep program at your local clinic or hospital may be worthwhile. Specialists in the area of pediatric sleep issues may have tools and ideas at their fingertips that can help you better understand how to help your child sleep.

A Word From Verywell

While your child may have sleeping issues, it's critically important that you are able to get a good night's sleep. Waking up with your child whenever he opens his eyes can actually make it harder for your child to learn to self-calm and get back to sleep—and it can have serious implications for your own health.

If you are coping with an ongoing sleep deficit, you may need to find ways to enlist nighttime help from your partner or a friend. Alternatively, you may need to ensure your child's safety with a locked door, turn on a white noise machine, and allow your child to wake and sleep without your involvement, at least until you've put strategies in place that help get you through the night.