People with autism frequently struggle with sleep. This could be caused by sensory stimuli, anxiety or depression; or co-occurring conditions like gastrointestinal disorders or Attention Deficit Hyperactivity Disorder (ADHD).
Autistic individuals frequently have irregular circadian rhythms; their bodies may secrete melatonin at inappropriate times of the day or night.
Sleep Routines
Autism spectrum individuals frequently experience sleep issues. This includes difficulty with falling asleep quickly and frequent awakenings throughout the night. Furthermore, these people typically spend less time in the REM stage of sleep that’s essential for learning and memory retention.
Multiple factors contribute to this condition. People with autism are more likely to carry genetic mutations that interfere with melatonin regulation and the circadian rhythm, and are also likely to exhibit sensory problems (sensitivity to noise or light) or anxiety symptoms.
There are ways to help those with autism sleep more soundly. One approach is establishing a consistent sleep routine and sticking with it over weekends and holidays, creating a comfortable sleeping environment, and limiting screen time prior to bedtime.
Many individuals with autism develop strong sleep associations and habits, such as sleeping next to a parent or using certain electronic devices. Breaking these patterns may not always be easy, but it is worth trying. Reducing stimulation before sleep by limiting electronics usage or engaging in relaxing activities such as listening to soothing music or practicing deep breathing exercises may also help.
Rewarding healthy sleep habits is another effective strategy for encouraging children’s safe sleeping practices and giving them control of their environment. Doing this may teach your children that sleeping alone in their bed is okay and gives them a sense of control over their environment.
Talking with a health care provider about sleep issues is also wise, since medical conditions such as reflux or sleep apnea may prevent adequate restful slumber for your child. A physician may even suggest medication that will aid their sleeping more soundly.
Sleep can make an incredible difference for autistic children and adults, helping them concentrate and focus in essential therapies such as Applied Behavior Analysis or occupational and speech therapy. Below are some general suggestions, but for personalized advice consult a medical provider directly.
Environment
Environment factors that impair sleep in typically developing children may also have detrimental effects on autistic sleep, including exposure to light which interferes with circadian rhythms and melatonin production, as well as certain sounds being off-putting or unpleasant. Furthermore, digestive issues like constipation or diarrhea may require multiple toilet trips at night which is both frustrating for both the individual and caregiver alike. Finally, repetitive behaviors like body-rocking or head-rolling may disturb rest and increase anxiety levels significantly.
Autistic individuals may find it harder to sleep for various reasons, including digestive disorders, seizures and depression. Studies have linked depression with poor sleeping patterns among autistic individuals; additionally, certain medications commonly prescribed to people with autism — including stimulants — can prevent restful slumber.
Research to date has focused largely on high-functioning autism, so it remains unknown which sleep problems are unique to low-functioning autistic individuals. A 2015 study noted, however, that lower-functioning individuals may exhibit more severe behavioral symptoms and disruptions compared to their higher-functioning peers.
Researchers conducting one study conducted data analyses on individuals with low-functioning autism and found they were more likely to experience sleep disruptions and disorders symptoms compared to their typical peers. They speculated this might be caused by sensory and motor challenges as well as overreacting to stimuli.
Though the study was relatively small, its findings suggested it is vitally important to assess sleep issues among low-functioning autistic individuals. To do this, an extensive history must be collected on their sleeping patterns – their schedule, quality and environment must all be factored into consideration. Evaluation should also take into account whether their sleep issues may be due to challenging behavior and/or medical and psychological conditions. Other evaluation techniques include keeping a sleep diary, polysomnography (a laboratory-based objective technique that records brain activity during sleep) and actigraphy (an noninvasive way of tracking movement). The authors of the study suggest limiting exposure to blue light from electronic devices like televisions and computers before bedtime by showering before going to sleep as well as purchasing blackout curtains for their bedroom.
Medication
Sleep problems are no small challenge for individuals living with autism. Sleep issues can exacerbate certain characteristics associated with their disorder, including irritability and self-injury – creating an unfavorable cycle that makes it hard to attain enough rest to remain functional during daily activities.
Researchers still are unsure exactly why autism patients experience sleep disorders, but one possible factor could be problems with the circadian rhythms that regulate both sleeping and wakefulness. Melatonin production regulates these cycles during darkness and decreases during daylight hours; those with autism may have trouble establishing strong circadian rhythms due to hypersensitivity to sensory stimuli that interferes with sleeping patterns, making falling asleep difficult or impossible altogether.
Mental health medications such as antidepressants, anxiety medicines and certain antipsychotics could potentially produce side effects that disrupt sleep.
Behavior interventions have proven successful at helping children with autism sleep more soundly, but they must be tailored specifically to each person’s functioning level and individual circumstances. ABA or parent-delivered strategies should always be tried first before turning to medication; the latter should only be considered if nonpharmacological approaches do not offer relief.
Autism patients suffering from sleep disorders may benefit from taking sedative hypnotics. A low dose should initially be given and gradually increased over time as symptoms improve. Individuals taking such drugs must be closely monitored so as not to become addicted or develop tolerance to them.
Some children with autism experience restless sleep, which may be triggered by environmental stimuli or nightmares. They may exhibit behaviors like body-rocking, head-rolling or head-banging which disrupt the quality of restful slumber for themselves and family members alike. If these symptoms become an issue for your family it’s essential to contact their GP immediately as this could indicate other sleep disorders or medical concerns that require treatment.
As part of your efforts to assist a loved one overcome sleep issues, it’s crucial that you collaborate with their GP in identifying the source. Address the factors contributing to sleep disruption.
Therapy
Sleep can have an immense impact on overall health and well-being, yet many individuals with autism struggle with sleeping issues such as difficulty falling asleep, staying asleep through the night, waking too early in the morning or nightmares. Other contributing factors to autism-related sleep issues may include digestive issues, seizures, co-occurring mental health conditions and medications that disrupt restful slumber.
Therapists are often effective in helping those with autism sleep disturbances. They can instruct individuals and caregivers alike on the importance of using bedtime routines, creating a calming environment and limiting exposure to stimuli that interfere with restful restful slumber. Furthermore, therapists can teach how to self-soothe as well as work towards solutions for anxiety that prevent sleep; certain therapies such as cognitive behavioral therapy (CBT) can even help manage intrusive thoughts that contribute to insomnia in autism patients.
Autism-related sleep disturbances may also be exacerbated by other issues, including gastrointestinal disorders, seizures, and an increased risk for iron deficiency anemia. Furthermore, some medications prescribed to treat mental conditions have side effects which interfere with restful slumber.
Most doctors, particularly with children, prefer non-drug approaches for treating sleep disturbances. Melatonin supplements taken before bedtime or bright light therapy (which regulates melatonin release and helps regularize sleep-wake cycles) might also prove useful; other remedies like chamomile tea and valerian root extract might also prove effective.
Sleep disturbances in autism are an unfortunate reality that can have lasting repercussions for behavior, mood, learning and physical functioning. With proper treatment however, they can be overcome to create an enjoyable lifestyle conducive to quality restful slumber.
This article draws upon research conducted at the Center for Sleep in Autism, one of 10 Autism Centers of Excellence funded by the National Institutes of Health. This piece was written by staff member at this Center and reviewed by Beth A. Malow MD – a nationally-recognized expert on both autism and sleep.
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As both an adult and parent, it’s crucial that we get adequate restful sleep each night. Do your best to follow a regular sleep schedule and limit stimulation or excitement in the evening as well as eliminate distractions such as screens before sleeping.
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