Autism and Sleep: How to Help a Child with Autism Get a Good Night’s Sleep

Adults and children alike all over the world have problems going to sleep and staying asleep. It is estimated that 48% of children do not get adequate amounts of sleep, according to the American Academy of Pediatrics. It is recommended by sleep specialists that school-aged children get 9 to 11 hours of sleep a night and teenagers get 8 to 10 hours. A lack of sleep can greatly affect a child’s day, such as causing anxiety and mood-related problems, memory, attention, and learning difficulties, social issues, and these children are more at risk for health problems. 

Children with autism tend to have even more difficulty falling asleep and staying asleep than the average child. There is a wide range of research on sleep in children with autism along with resources for parents since it is such a prevalent issue and because sleep disorders are typical among children with autism. In fact, it’s estimated that over half of autistic children have one or more chronic sleep problems.

Autism Sleeping Problems Explained

Most experts agree that there is a link between autism and sleep issues. Sleep problems are almost twice as common in children with autism than among typical children or children with other developmental conditions.  The biggest sleep problems with autism include:

• difficulty falling asleep
• inconsistent sleep routines
• poor sleep quality
• waking early or frequently throughout the night

More specifically: “Children and adolescents with ASD suffer from sleep problems, particularly insomnia, at a higher rate than typically developing (TD) children, ranging from 40% to 80%,” (Cortesi, 2010). 

Some of the reasons why children with autism suffer from sleep disorders more often than other children are the following:

• Autistic children tend to have lower levels of the hormone melatonin, which helps to regulate sleep. Some with autism spectrum disorders have a mutation in the enzyme that produces melatonin.  A few have a syndrome that produces the hormone during the day instead of at night. 
• Children with autism tend to have a high rate of hyperactivity (over half of those with autism spectrum disorders) and need to be medicated for ADHD, which can affect sleep. While sometimes antipsychotic medications are still used to treat ASD symptoms in some children, ADHD medications are still often prescribed. 
• Children with autism spectrum disorder often take longer to enter the rapid eye movement (REM) stage of sleep. This can impact the child’s behavioral and emotional health the next day. 
• Autistic children tend to spend less time in REM sleep, which is the restorative sleep that everyone needs to make connections, engage the brain in problem-solving, remember things, and even regulate mood. 
• Autism sleep problems may be caused by mutations in the genes that govern the sleep-wake cycle. This can make a bedtime routine challenging.

Many parents struggle on a nightly basis to get their child to sleep and to help them to stay asleep. There are many tips from autism experts on how to achieve this. 

Tips for Helping Your Child with Autism Get Better Sleep

Start with a good and consistent routine. The experts at the Marcus Autism Center recommend the following to help autistic children establish good sleep hygiene. 

• Make sure your child is tired at bedtime. Allow your child to get ample amounts of physical exercise and time outside in the sunshine during the day.
• Make sure your child is full at bedtime. A healthy and filling dinner will eliminate the possibility of your child waking from hunger.
• Limit screens at least one hour before bedtime. Computers and other screens can be overstimulating and distracting for children.
• Have your child take a warm bath or shower. Warm water is relaxing, and being clean at bedtime can help your child fall asleep.
• Read or have a quiet conversation with your child in her bed. Reading books, singing a favorite song, or having a comforting conversation can help ease your child into relaxation.
• Use a sound machine or soft music to block disruptive sounds. Some children benefit from using a white noise machine or listening to lullabies to fall asleep and help drown out sounds that might wake them.

Considering the bedtime and bedroom environment(s) and keeping a regular bedtime routine are both very important. It is also wise to check on diet to see if there could be a GI reason for not sleeping and/or waking up.  It can also be helpful to keep a sleep diary for a week or so to help track your child’s sleep and note any sleep patterns or disturbances.

Making sure that the bedroom area is not stimulating for the child, but is calming, is imperative to getting him/her in the sleep zone. There are ways to create a sleepy ambiance including:

• blocking out light with blackout curtains
• having a starry sky projector light
• playing sleep sounds or calming music
• using a weighted blanket 

Getting rid of clutter, toys, or allowing the child to access anything stimulating in the middle of the night are also good ideas. 

Children with autism do well following schedules. Printing off a bedtime schedule and posting it in the bedroom or bathroom makes sense because individuals with ASD can be very visual and to-the-point. 

The National Autistic Society also recommends checking into diet and/or GI issues if sleep has become difficult. “If food sensitivity/stomach discomfort is a problem, visit your GP or a dietitian for advice. We also suggest that you visit a dietitian before introducing any major dietary changes to check that the person still has a balanced diet. Limit caffeine and other stimulants, especially near bedtime.”

Autism and Melatonin

Melatonin is a hormone that is naturally produced by the body.  It can help regulate sleep-wake cycles and has been used to treat sleep problems.  It has been used with some success to help individuals with autism spectrum disorder who have trouble falling asleep.

There is research to support the use of melatonin to combat sleep problems.  It can help improve sleep patterns by reducing the time it takes to fall asleep.  It can also increase total sleep time and improve sleep quality.  There is evidence that supports melatonin’s ability to help regulate circadian rhythms and improve daytime behavior.

While melatonin is believed to be safe, it should only be used under the guidance of a healthcare professional.  They can provide appropriate dosing recommendations and monitor for any adverse side effects like headache or stomach discomfort.  Each individual with autism spectrum disorder is unique and melatonin doesn’t work for everyone.  If you are considering using melatonin for yourself or your child to treat sleep issues, it is best to talk with a healthcare professional to get personalized advice.

The Benefits of a Sleep Study

In some cases, a doctor will order a sleep study, also known as polysomnography.  This important study is ordered for individuals having trouble sleeping.  It can help diagnose and identify sleep problems like restless legs syndrome and sleep apnea.  Sleep apnea, a condition characterized by pauses in breathing during sleep, can have a negative impact on overall health and development.  A sleep study can provide valuable information and insights to parents and caregivers.  This information can help you understand how to help you child sleep better.

Once a sleep disorder has been identified, a health professional can develop a targeted treatment plan.  This could include medication, behavioral interventions or a combination of approaches to help the child sleep better.  Addressing sleep disorders in an informed manner can help improve sleep quality which can lead to:

• better daytime functioning
• increased attention
• improved mood
• enhanced cognitive abilities

Lacking sleep is no fun. Sleep is important for several reasons no matter who you are, big or small; and because autistic children tend to have other comorbidities and challenges, it is even more imperative that they get a good night’s rest. Autism centers, doctors, and credible websites all have a plethora of resources out there for parents who have children on the spectrum who are experiencing sleep disturbances.