Autism and sleep

Sleep helps us to reset our bodies from the present day as well as preparing it for the following one. Many people suffer from sleep problems, which can also have an impact on their general health. For autistic people, and particularly children, sleep problems are more prevalent – estimates vary however, between 64 and 86% of autistic children have issues with sleep.¹ ² This could be anything from difficulty getting to sleep, night terrors or oversleeping.

At Tram House School we take sleep health very seriously and as such we are a Sleep Right recognised school. Below we’ll cover a few of the causes of sleep issues as well as some strategies and tips to help improve any sleep disturbances.

Causes of sleep problems

Autistic children having trouble sleeping can be caused by a range of factors.

• Children may find getting to sleep difficult if they have trouble winding down from the day. This inability to relax can be triggered by increased anxiety
• Conversely if additional stress leads to exhaustion, children may sleep for too long – a condition known as hypersomnia
• Any additional sensory needs that the child has can impact upon sleep. For example increased sensitivity to noises and smells in the bedroom
• Other medical conditions, whether neurological (e.g. epilepsy) or gastrointestinal (e.g. food allergies) can also impact upon a child’s sleep

If your child is having trouble sleeping, there are a number of things you can do to help improve their sleep pattern. If you suspect that it might be a medical problem or if sleep problems are causing your child difficulties throughout the day as well as at night, contact your GP in the first instance.

Autism and sleep support strategies

Sleep diary

Before looking at individual solutions it’s important to try and work out the cause of sleep issues. Sleep diaries are a great way of creating an overall picture of the situation. It is important to include the following when constructing a sleep diary:

• Time and length of any naps taken during the day
• When the bedtime routine was started and if there were any issues
• What time they went to bed and when they fell asleep
• How many times they woke up during the night, what time it was and how long they were awake for
• Time of wake up in the morning
• Total number of hours sleep

For more detail you can add in what activities they did shortly before bed, what their general mood was at bedtime and wake up, and anything else you think might be useful.

After a couple of weeks, patterns start to emerge that may point to where an issue lies. Perhaps they struggle sleeping at night when they’ve had a lengthy nap during the day, or they might have a disturbed night if they do a particular activity before bed.

• One hour before bedtime – no more electronics. Melatonin production, the hormone which controls the sleep cycle, is dramatically reduced by the blue light of electronic devices. If you can do the last hour before bed without electronics, this is a great help
• One hour before – playtime. Calm and quiet activities, maybe drawing or listening to calming music
• 45 minutes before – bedtime snack. Something light and not too sugary or caffeinated
• 30 minutes before – bath time. Only if this relaxes your child. If it would make them more alert, it’s best to wash in the morning
• 20 minutes before – brush teeth. If this causes anxiety, let your child do it themselves. You can do a more thorough job in the morning
• 15 minutes before – put pyjamas on and get into bed for a story. Try and leave pyjamas until later in the routine as this is a helpful cue for your child that it’s time for bed
• Bedtime – say goodnight and leave your child to settle into their sleep

This is just an example of the sort of thing you could include. Each timetable will look very different depending on the child.

Bedtime environment

When it comes to sleep, the environment is just as important as the routine. Many sleep problems can be improved by altering the environment. Here are some things you can do:

• Some children like a bit of light in the room but try to keep it as dark and quiet as possible. It should be a restful and peaceful place for your child
• Make sure the bed itself is comfortable. When were the mattresses/pillows last changed? Is the smell of the washing powder you’re using overwhelming for your child?
• Where possible, try to keep the temperature of the room between 16 and 18⁰ If it’s too warm, it can cause sleep disturbances
• No electronic screens from at least 1 hour before bedtime. The blue light created by screens makes the brain think it’s morning and makes it harder to fall asleep. If your child needs to have their device in their room, put it on night mode and add a screen filter to reduce the blue light
• Sometimes the easiest way for everyone to get a good night’s sleep is for parents to sleep alongside their children. However, co-sleeping is not recommended as it can be difficult to transition away from when the dependency is created
• Consider the sensory needs of your child. Would a weighted blanket help? Or a soft toy that smells of something soothing? Would some quiet white noise or rhythmic music help to relax them?

Where to go for help with sleep issues

If you are concerned about your child’s health or wellbeing in regard to their sleep, then you should contact your child’s doctor. They may choose to refer you to a hospital with a specialised sleep lab. If sleep problems are impacting on their learning, the school may also be able to support with sleep programmes. If your child has an EHCP, sleep can be included in the plan to receive additional support. Calming programmes or visual schedule support may be available from Occupational or Speech and Language Therapists.

Hunrosa also have a range of great online resources that you can access.

For more support for parents, head over to our resources page, or take a look at our free introduction to autism course.

1. K.B. van der Heijden et al (2018), Sleep, chronotype, and sleep hygiene in children with attention‑deficit/hyperactivity disorder, autism spectrum disorder, and controls, Journal of European Child & Adolescent Psychiatry, 27:99–111
2. Preeti Devnani and Anaita Hegde (2015), Autism and sleep disorders, Journal of Pediatric Neuroscience, 10(4):304-7