Herbie Murray
Sleep issues are common in autistic people, with as many as 50-80% experiencing some form of sleep difficulty compared to 25-30% of neurotypical people. Problems with sleep can affect both autistic adults and children, and can be disruptive to the parents of autistic children. Sleep issues can vary from difficulty falling asleep to needing very little sleep. There are many potential causes of sleep issues in autistic people, including difficulties with relaxing or winding down, irregular melatonin levels, hypersomnia, and underlying medical conditions.
| Characteristics | Values |
|---|---|
| Prevalence of sleep issues | 50-80% of autistic people experience sleep difficulties, compared to 25-30% of neurotypical people |
| Types of sleep issues | Difficulty falling asleep, needing very little sleep, insomnia, hypersomnia, night waking, sleep anxiety, poor sleep quality, sleep-disordered breathing |
| Causes of sleep issues | Irregular melatonin levels, difficulty relaxing, underlying medical conditions, environmental factors, psychological factors, medication, caffeine intake, screen time, gastrointestinal issues |
| Solutions | Lifestyle changes (e.g. increased exercise, reduced alcohol and caffeine intake, limited screen use), weighted blankets, addressing underlying medical conditions, relaxation techniques, establishing a bedtime routine, dietary changes, medication |
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What You'll Learn
Sleep disorders in autistic people
Sleep problems are common in autistic people, with up to 80% experiencing some kind of sleep difficulty compared to 25-30% of neurotypical people. These problems can affect both autistic adults and children, and can also be disruptive for the parents of autistic children, whose own sleep may be affected.
There are a range of reasons why autistic people may struggle with sleep. One reason could be irregular melatonin levels. Melatonin is a hormone that helps in maintaining and synchronizing the body's circadian rhythm, and autistic people may have lower levels of this hormone. Other reasons could be difficulties with relaxing or winding down, or coexisting medical conditions such as gastrointestinal problems, attention deficit hyperactivity disorder (ADHD), anxiety, or depression. Sensory sensitivities to light, sound, or touch may also contribute to difficulty sleeping.
The consequences of poor sleep in autistic people can include a worsening of certain autism features, such as repetitive behaviors, poor social skills, and increased irritability. Poor sleep can also lead to lower scores on tests of intelligence and more severe behavioral problems.
There are some strategies that may help improve sleep in autistic people. Establishing a bedtime routine and a consistent sleep schedule can be beneficial. Making changes to the sleep environment, such as adjusting the temperature or lighting, may also help. In some cases, medications or supplements, such as melatonin, may be recommended.
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The impact of autism on sleep patterns
Autistic people of all ages may need more support when it comes to looking after their health, including their sleep. Sleep problems are common in autistic people, with as many as 50-80% experiencing some kind of sleep difficulty compared to 25-30% of neurotypical people. Sleep issues can vary widely and include difficulty falling asleep, needing very little sleep, and hypersomnia (sleeping too much).
There are several potential causes of sleep problems in autistic people, including difficulties with relaxing or winding down, irregular melatonin levels, and underlying medical conditions. For example, hypersensitivity to touch, visual stimuli, or sound can make the process of falling asleep very difficult. In addition, gastrointestinal problems, which are common in people with autism, can cause discomfort during or after eating, disturbing sleep.
Sleep problems in autistic people can also be caused or exacerbated by psychological factors and emotional distress, such as anxiety, depression, stress, or trauma. Certain types of medications, such as stimulants, beta-blockers, and decongestants, can also affect sleep quality and duration. Environmental factors, such as seasonal allergies or changes in living arrangements, can play a role as well.
The impact of sleep problems in autistic individuals can be significant, affecting not only their own quality of life but also that of their family members. Sleep deprivation in autistic children can worsen behavioural disturbances and trigger disruptive or inflexible behaviour and anxiety. It can also have a significant impact on the parents of autistic children, disrupting their own sleep.
Addressing sleep problems in autistic individuals is crucial, and there are several strategies that can help. These include lifestyle changes such as increasing daily exercise, minimising alcohol and caffeine intake, and limiting screen time before bed. Establishing a consistent bedtime routine and creating a relaxing sleep environment can also be beneficial. In some cases, medical interventions or natural remedies may be considered, although these are typically seen as a last resort.
Overall, understanding and addressing sleep problems in autistic individuals is essential to improve their quality of life and the well-being of their families.
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Sleep interventions for autistic children
Sleep issues are common in autistic children, with prevalence ranging from 50 to 80%. These issues can be primary, or secondary to other factors such as anxiety, depression, or physical health issues. Sleep issues can also be exacerbated by medications, such as stimulants, beta-blockers, corticosteroids, and decongestants.
Non-pharmacological Interventions
Non-pharmacological interventions are the preferred first treatment option for sleep issues. These can include:
- Lifestyle changes, such as increased exercise, reduced caffeine and alcohol intake, and limited screen time before bed.
- Creating a predictable bedtime routine, including wind-down activities such as reading or listening to music.
- Reducing stimulation before bed by avoiding emotionally stimulating activities and limiting foods and beverages containing caffeine in the evening.
- Creating a good sleep environment by considering factors such as temperature, texture of bedding and sleep clothes, light levels, noise levels, and pressure on the body (e.g., using weighted blankets).
- Strategies to manage resistance to sleep, such as cueing, modelling, visual supports, sticker charts, and social stories.
- Strategies to manage anxiety issues, such as massage, which can reduce anxiety and physical discomfort.
- Strategies to manage night terrors, such as scheduled awakenings, where the child is woken before the usual episode of sleep terror.
- Strategies to wean co-sleeping, such as stimulus fading, which involves the gradual distancing of the parent from the child's bed until the child can fall asleep without them in the room.
Pharmacological Interventions
If non-pharmacological interventions are unsuccessful, pharmacological interventions may be considered. Melatonin is a commonly used supplement to treat sleep disorders in autistic individuals. It has been shown to improve sleep onset latency, total sleep time, and sleep efficiency. However, it may have side effects such as fatigue, mood swings, abdominal pain, restlessness, anxiety, constipation, diarrhea, and dizziness.
Other pharmacological agents that have been used clinically include antihistamines (e.g., diphenhydramine), alpha-adrenergic agonists (e.g., clonidine), antidepressants (e.g., trazodone), hypnotics (e.g., clonazepam), and atypical antipsychotics (e.g., olanzapine). However, these agents have not been specifically evaluated in the autism population, and some guidelines advise against their use as a first-line treatment for insomnia.
Complementary and Alternative Medicine
Some preliminary evidence suggests that certain complementary and alternative medicine approaches may improve sleep in autistic children. These include:
- Antioxidants such as L-carnosine and co-enzyme Q.
- Supplements such as L-5-Hydroxytryptophan (5-HTP) and gabadone, which have been shown to improve sleep in neurotypical individuals.
- The Sleepy Time Pillow, which contains soothing lavender to promote relaxation and naturally help with anxiety.
- The Rohm Portable White Noise Sound Machine, which creates a consistent sound environment to help children with sensory issues.
- The ZPod Autism Bed, which includes features such as lighting control, white noise generators, and air filters to control the sleep environment.
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Sleep deprivation in parents of autistic children
Sleep problems are common in autistic people, with 50-80% experiencing some kind of sleep difficulty compared to 25-30% of neurotypical people. These problems can also be disruptive for the parents of autistic children, who may find their own sleep affected.
Sleep disturbances can be caused by underlying medical conditions, environmental factors, changes in family or living arrangements, transitions to new day programs or employment, or environmental factors such as seasonal allergies or other air quality issues. Sleep problems can also be caused or exacerbated by psychological factors and emotional distress, including anxiety, depression, stress, or trauma.
Autistic children can have particular sleep and settling problems, including irregular sleeping and waking patterns, sleeping much less than expected for their age, or being awake for more than an hour during the night. They may also get up and do their favourite activity or make noise for one or more hours during the night.
Some sleep problems are related to what children are doing before bed and when they go to bed. For example, if a child has a lot of noise, activity and excitement before bed, it can be harder for them to feel calm and ready for sleep. If a child does things differently each night before bed, they might not get predictable cues that it’s time for bed and sleep.
For autistic children, sleep problems can also have biological causes. For example, sometimes the sleep hormones in the brain are released differently from the way they’re released in typically developing children, meaning some autistic children aren’t ‘tuned in’ to their own need for sleep.
These sleep difficulties commonly faced by children with ASD can produce a significant decrease in the quality of life of all family members as a consequence of sleep deprivation. Sleep deprivation in parents of children with ASD may lead to two consequences: firstly, their child's behaviour problems derived from their sleep issues and, secondly, the consequences of their own sleep deprivation.
Tips for improving sleep:
- Increase the amount of exercise during the day, such as walking and swimming
- Minimize alcohol and caffeine intake
- Limit screen use at night when possible
- If heartburn or acid reflux are suspected, prop up the head of the bed or use extra pillows to avoid laying completely flat on the bed
- Keep the bedroom cool and as dark as possible
- Consider a weighted blanket to help calm nerves and give calming sensory input
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Sleep issues in autistic adults
Sleep issues are common in autistic adults, with as many as 50-80% experiencing some kind of sleep difficulty compared to 25-30% of neurotypical people. Problems with sleep can be caused by a variety of factors, including difficulties with relaxing or winding down, irregular melatonin levels, and underlying medical conditions such as erupting wisdom teeth or restless leg syndrome. Sleep issues can also be caused or exacerbated by psychological factors such as anxiety, depression, stress, or trauma, as well as certain types of medications.
Autistic adults may face unique challenges when it comes to getting a good night's sleep. They may have difficulty falling asleep or staying asleep through the night, which can worsen behavioral challenges, interfere with learning, and decrease overall quality of life. Sleep issues in autistic adults can be disruptive not only for the individuals themselves but also for their families.
There are, however, strategies that can help improve sleep in autistic adults. Establishing a bedtime routine that includes relaxing activities and avoiding the use of electronics can be beneficial. Maintaining a regular sleep and wake schedule, even on weekends, is also important. Creating a comfortable sleep environment by making the bedroom dark, quiet, and cool can be helpful, especially for those with sensory issues.
In some cases, medical intervention may be necessary. Melatonin supplements, for example, have been found to help autistic individuals fall asleep faster and improve sleep quality. Other treatments, such as insomnia drugs or breathing devices for sleep apnea, may also be recommended by a healthcare professional.
Overall, addressing sleep issues in autistic adults is crucial not only for their well-being but also for improving their daily functioning and quality of life.
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