Gina Johnson
Sleep issues are common among autistic people, with research suggesting that between 40% and 83% of autistic children experience sleep difficulties. These problems can also affect their parents and caregivers, who may find their own sleep is disrupted. There are several theories as to why autistic people may struggle with sleep, including genetic and neurological differences, difficulties with relaxing or winding down, irregular melatonin levels, and increased sensitivity to outside stimuli. However, there are strategies that can help autistic individuals sleep better, including establishing a bedtime routine, avoiding screens and stimulants before bed, creating a soothing sleep environment, and seeking professional advice if needed.
| Characteristics | Values |
|---|---|
| Prevalence of sleep difficulties in autistic children | 40-80% |
| Common sleep problems | Difficulty falling asleep, frequent wakings, early morning waking |
| Reasons for sleep difficulties | Sensory issues, anxiety, medications, sleep disorders, genetic factors, neurological differences, environmental factors |
| Strategies to improve sleep | Regular bedtime routine, avoid screens and excitement before bed, physical activity during the day, limit caffeine and sugar, melatonin supplements, cognitive behavioral therapy, bright light therapy |
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What You'll Learn
Establish a bedtime routine
Establishing a bedtime routine can be a great way to help autistic individuals sleep better. A sleep routine can offer familiarity and comfort, which are especially important for autistic people who often have difficulty communicating and understanding social cues. Here are some tips to establish an effective bedtime routine:
Keep it consistent
Consistency is key when it comes to bedtime routines. Try to stick to the same routine every night, and start the routine at the same time each day. This will help to regulate your body's internal clock and promote better sleep. If your bedtime routine starts at 8 pm, for example, ensure that you're following the same schedule every night. This means that on weekends and holidays, you should also stick to this bedtime. Consistency will help autistic individuals anticipate their sleep time and prepare their bodies and minds for rest.
Create a soothing environment
The environment plays a crucial role in establishing a restful sleep routine. Keep the bedroom cool, with temperatures ranging from 65° to 67° F, as this promotes better sleep. Ensure that the pajamas and bed linens are made of comfortable fabrics that don't cause irritation. Avoid seams, zippers, or buttons that might be uncomfortable. Minimize sensory disruptions by using dark window blinds, quiet carpets, and doors that don't creak. Reducing outside stimuli, such as touch or sound, can help prevent abrupt awakenings during sleep.
Develop a visual routine
Visual support can be incredibly helpful for autistic individuals, especially if they are non-verbal. Create a visual representation of the bedtime routine, using pictures or symbols that show each step. For example, put on pajamas, brush teeth, go to the toilet, get into bed, read a bedtime story, and then turn out the light. You can use stickers to indicate when each step is completed successfully, and provide praise or rewards for following the routine. This visual routine will help autistic individuals understand the sequence of activities and prepare for sleep.
Wind down with calming activities
Incorporate calming activities into the bedtime routine to promote relaxation. Reading a book, taking a warm bath, or listening to soft music can help to quiet the mind and prepare the body for sleep. Spending quiet time together before bed can also be a great opportunity for bonding. Avoid excitement, television, and electronic devices at least an hour before bedtime, as these can stimulate the mind and make it harder to fall asleep.
Adjust the routine gradually
If you're introducing a new bedtime or sleep routine, do so gradually. Making sudden changes can disrupt the progress you've made. Instead, make small adjustments over time. For example, if you want to move towards an earlier bedtime, start by putting your child to bed when they're already sleepy. Once they're falling asleep quickly, gradually move the bedtime routine earlier by 15 minutes every two days. This will help them adjust to the new sleep schedule without causing undue stress.
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Avoid screens and excitement before bed
It is important to avoid screens and excitement before bed to improve sleep quality for people with autism. This is because screen time can interfere with sleep, and excitement can make it harder for autistic individuals to feel calm and ready for sleep.
Firstly, removing screens from the bedtime routine is crucial. Screens can hinder the development of social skills and the ability to learn new skills, and they can also make it difficult for autistic individuals to fall asleep. Clinicians and parents should work together to manage screen time, especially before bedtime. A good practice is to replace screen time with calming activities such as reading a book, telling stories, or engaging in play, social, or physical activities. Gradually decreasing screen time can help prevent potential behavioural issues in autistic individuals.
Additionally, establishing a consistent and calming bedtime routine is essential. This routine should be free from excitement and stimulating activities. A positive bedtime routine can help autistic individuals realise it's bedtime, especially if they struggle with social communication. Keeping the same bedtime every night and sticking to a routine can provide predictable cues that it's time for sleep. It is also beneficial to ensure the sleep environment is comfortable and free from excessive noise, light, or temperature extremes.
Furthermore, it is important to address any underlying conditions that may contribute to sleep difficulties in autistic individuals. For example, anxiety is a common problem in autism and can lead to insomnia and other sleep issues. Managing anxiety through psychotherapy, cognitive-behavioural therapy (CBT), or mindfulness training can help improve sleep quality. Additionally, medical issues such as sleep apnea, epilepsy, or acid reflux are more prevalent in autistic individuals and can disrupt sleep. Seeking appropriate medical advice and treatment for these conditions can improve overall sleep quality.
Finally, it is worth noting that melatonin supplements, prescribed by a healthcare professional, can be beneficial for autistic individuals with sleep difficulties. Melatonin is a neurohormone that regulates the sleep-wake cycle, and autistic individuals often produce lower levels of it. By addressing melatonin levels and implementing the above strategies, autistic individuals and their families can improve their sleep quality and overall well-being.
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Manage anxiety and stress
Sleep is extremely important for children's development, and disrupted sleep is often part of autism. It is estimated that between 40% and 80% of children with ASD have difficulty sleeping. This can be due to various factors, including increased sensitivity to outside stimuli, such as touch or sound, and anxiety.
Anxiety can be particularly bothersome at night and can lead to insomnia and other sleep difficulties. It is estimated that 42% of autistic children meet the criteria for an anxiety disorder, compared with just 3% of non-autistic children. Autistic individuals might respond to anxiety in ways that are not readily recognized, such as withdrawing, meltdown, shutdown, repetitive speech or action, or obsessive thoughts.
- Psychotherapy: Cognitive Behavioral Therapy (CBT) is the most widely evidence-based approach for addressing problems with sleep in adults. It can be accessed via the NHS in the UK with a referral from a GP, or through self-referral services such as Improving Access to Psychological Therapies (IAPT). When seeking a private therapist, it is good to ask about their experience working with autistic people and adapting their approach to suit their needs and preferences.
- Mindfulness Training: Mindfulness can help individuals learn to refocus their attention on the present moment and be less bothered by worries or negative thoughts. Mindfulness exercises often involve focusing on breathing, sensations in the body, or a specific task.
- Relaxation Strategies: Relaxation techniques can help reduce high levels of general stress and anxiety during the day, as well as anxiety about sleep. These include having a bath, reading a book, listening to music, breathing exercises, and calm place imagery exercises.
- Nutrition and Hydration: Eating nutritious foods and staying hydrated can help support overall health and reduce anxiety. Protein-rich breakfasts, in particular, are known to help with anxiety levels.
- Journaling: The act of writing down feelings in a journal can be an excellent way to reduce distress and anxiety.
- Share Feelings: Talking about feelings with family, friends, or a therapist can be an effective way to reduce anxiety.
- Visual Graphs: Developing a visual graph to indicate events that lead to increased worry can be a helpful way to identify and manage anxiety triggers.
- Sleep Hygiene: This refers to a collection of healthy sleep habits that can help improve sleep quality. This includes reducing sensory disruptions, such as using dark window blinds or a quiet door, and establishing a nighttime routine with consistent bedtime.
- Limit Stimulants: Avoid giving your child stimulants such as caffeine and sugar before bed, as these can disrupt sleep.
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Optimise the bedroom environment
Optimising the bedroom environment is a crucial aspect of improving sleep quality for individuals with autism. Here are several strategies to create a soothing and conducive atmosphere:
Maintain a Cool Temperature
Sleep experts recommend keeping the bedroom cool to promote better sleep. The optimal temperature range for sleep is between 65°F and 67°F. If the individual with autism cannot tolerate bed clothes or covers, you can slightly increase the temperature, but it should not exceed 75°F.
Choose Comfortable Bedding and Pajamas
Select bedding and pajamas made from fabrics that are soothing and comfortable for the individual. Avoid fabrics, seams, zippers, or buttons that may cause irritation or discomfort. It is important to investigate and identify materials that are well-tolerated by the person with autism.
Minimise Sensory Disruptions
Reduce potential sources of sensory disruptions in the bedroom. For example, install dark window blinds to block out light, opt for quiet carpets that do not creak, and ensure doors do not make creaking noises. These measures can help create a calm and peaceful environment.
Establish a Visual Bedtime Routine
Create a visual support system that outlines the bedtime routine, such as putting on pajamas, brushing teeth, going to the toilet, getting into bed, and turning off the light. Use pictures or symbols that the individual with autism can easily understand. This routine provides structure and predictability, which can be comforting and help ease anxiety.
Encourage Relaxing Activities
In the hour before bedtime, minimise exposure to exciting activities, television, and electronic devices. Instead, engage in calming activities such as reading a book, listening to soft music, or taking a warm bath. These activities can help the individual with autism relax and prepare their body and mind for sleep.
Address Underlying Health Factors
If there are underlying health conditions or sleep disorders, such as sleep apnea, epilepsy, or acid reflux, it is crucial to address them with the help of a healthcare professional. Treating these conditions can significantly improve sleep quality and duration.
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Consider melatonin supplements
Melatonin is a neurohormone that regulates the sleep/wake cycle. Typically, melatonin levels rise in response to darkness at night and dip during daylight hours. However, autistic individuals may differ in how they produce melatonin. Some autistic people have lower melatonin levels, producing more during the day and less at night. This disruption in the melatonin system is associated with the progression of autism spectrum disorder (ASD).
Melatonin supplements have been shown to help autistic children fall asleep faster and sleep for longer. They can also reduce the number of times they wake up during the night. Melatonin supplements are available in the form of pills, or as sublingual tablets that are placed under the tongue or in the cheek.
If you are considering melatonin supplements for your child, it is important to first consult with your GP or paediatrician. They can recommend the appropriate dosage and timing. It is also important to monitor the effects of the supplement and ensure that it is taken daily at the specified time before bed.
While melatonin supplements can be beneficial, they may also have side effects such as nausea and headaches. High-quality research is needed to further understand the long-term effects, benefits, and risks associated with different types of melatonin.
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Frequently asked questions
There are several ways to help an autistic child sleep better. These include:
- Creating a nightly routine: A consistent bedtime routine can help autistic children feel more comfortable and relaxed at night. This can include activities such as taking a bath, reading a book, or listening to soft music.
- Reducing external stimuli: Autistic children may be more sensitive to external stimuli such as light and sound, so reducing these stimuli can help improve sleep. This can include using dark window blinds or a quiet carpet.
- Addressing anxiety: Anxiety is common in autistic children and can interfere with sleep. Psychotherapy, such as cognitive-behavioural therapy (CBT), can help regulate anxiety and improve sleep.
Here are some tips for creating a bedtime routine:
- Start with a sleep diary: Track your child's sleep patterns and behaviours for a week to identify any areas of concern and share this information with your child's doctor.
- Establish a consistent routine: Include calming activities such as a bath, reading a story, and putting your child to bed at the same time every night.
- Use visual support: Create a visual schedule with pictures that show your child's bedtime routine, so they understand the steps and feel more prepared for sleep.
- Encourage and praise: Encourage your child as they follow the routine and provide positive reinforcement when they complete steps correctly.
Some lifestyle changes that can improve sleep for autistic individuals include:
- Regulating melatonin: Melatonin is a hormone that regulates sleep-wake cycles, and autistic individuals may produce lower or irregular levels of it. A pediatrician can recommend melatonin supplements, and bright light therapy can help regulate its release.
- Reducing stimulants: Avoid giving your child stimulants such as caffeine and sugar before bed, as these can disrupt sleep.
- Encouraging physical activity: Increasing your child's physical activity during the day can help regulate their body clock and improve their sleep at night.
