The Link Between Autism and Sleep Issues

If your autistic child has trouble falling or staying asleep, you're not alone. In fact, studies suggest that well over half of all autistic people, adults as well as children, have significant sleep issues.

These sleep issues can be serious and lead to challenges both for autistic people and their caregivers. Fortunately, there are some tools to help with sleep problems in autistic people, although their use is not always successful and you may want to consult sleep specialists.

This article explains the link between autism and sleep disorders, and offers tips on how you can help an autistic person to improve sleep habits and sleep quality.

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 autistic children result in significantly more intense behavioral and learning problems during the day. Children who slept fewer hours had more intense 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, as well as:

• Attention deficit disorder
• Depression
• Obsessive-compulsive disorder

And, according to another 2016 study, sleep disturbance is associated with behavioral dysregulation among autistic kids. 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, autistic adults 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 autism traits, 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 autistic people to fall asleep, stay asleep, and awake refreshed.
• Sensory issues: Most autistic people 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 autistic people produce less melatonin at night (a sleep-related hormone) than do neurotypical people.
• Physical or mental illness: In addition to sleep-related challenges, many autistic people 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.

Autistic people 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 autistic children 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 five 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 them 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, autistic children 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. Do they have more trouble falling asleep after an early dinner or when eating specific foods? Does exercise help them to relax or rev them 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 self-calm.
• 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.

Summary

It's common for autistic people to also experience problems with sleep. The causes aren't always clear, but sleep disruptions in autistic kids are associated with patterns of learning and behavioral difficulty.

There are steps you can take to improve sleep hygiene, both by changing the sleep environment and ensuring the child follows a bedtime routine. You may want to consult sleep specialists if your child's sleep does not improve.

It's important that you are able to get a good night's sleep, too. 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.