Autism Spectrum Disorder (ASD) can mean any one of several conditions that affect the way a person communicates, interacts socially and behaves. Many people are affected y ASD, with a prevalence of around 1% of the population. It’s not known quite why some people have ASD, but experts believe that it is probably caused by a complex mix of the person’s environment and genes. ASD is more common in males than females.
ASD can affect individuals in a broad spectrum of ways, and no two people are affected in the same way. There’s a common misconception that everyone with ASD has the same traits. This can lead to unhelpful generalisations about the condition, for example the widespread belief that all people with ASD struggle to make and hold eye contact. It may not be immediately obvious that a person has autism, whereas others may have very noticeable learning and language difficulties.
However, the majority of individuals with ASD experience issues in understanding social cues. Some people will prefer to carry out the same activities and behaviours again and again and may adhere to very rigid routines and daily structures.
It often becomes clear that a child has ASD by the time they are 3 years old, and there may be noticeable symptoms before this. However, if a person’s communication difficulties aren’t as obvious to those around them, there’s a small chance they won’t be diagnosed until they reach adulthood.
Sleep issues are a commonly-reported symptom in people with ASD of all ages.For example, some people on the autistic spectrum may take a long time to fall asleep and wake up during the night. This means that they are more likely to experience a reduction in overall sleep quality and duration. This can in turn make issues arising from their condition more difficult to cope with than they might have otherwise been.
Poor sleep quality and quantity can affect a person with ASD in various ways. For example, it may make problems with hyperactivity or attention span more difficult to manage. Add to that the health concerns that affect anyone getting poor sleep, autistic or not, and it’s easy to see why parents of children with autism are looking for strategies to help them sleep longer and better. Luckily, there are all sorts of methods parents can employ to help children with ASD with a wide range of sleep issues.
How is Seep Influenced by ASD?
There are all sorts of ways that a person’s autism can influence how long and well they sleep. Generally, individuals on the autistic spectrum take longer overall to nod off to sleep and clock up less sleep hours overall than people without ASD. The condition also heightens the risk of getting one of several sleep disorders. The most likely sleep problems an adult or child with ASD may experience are:
- A reluctance to settle down to sleep
- Insomnia (trouble getting to sleep or staying asleep)
- Breathing difficulties while sleeping
- Trouble waking in the morning
- Excessive tiredness during the day
Which Sleep Disorders Affect People With ASD?
ASD can lead to a range of sleep disorders. This doesn’t mean that everyone living with one of these sleep disorders is autistic. Rather, ASD increases an individual’s likelihood of developing a sleep disorder. The most common are:
People with this condition have trouble falling asleep at the ‘normal’ time i.e. at bedtime. For many sufferers of the condition, this will only last for a short period of time or may come and go in episodes. On the other hand, some individuals will experience sleep-onset insomnia in the long-term, especially if they have ASD.
This condition affects the way a person breathes during the night. In can cause lapses in breathing for small amounts of time. It happens because the person’s airway collapses briefly, obstructing the airflow and causing their blood oxygen levels to dip. The result may be loud snoring or gasping for air. If a child has this condition as well as ASD, they are more likely to experience daytime fatigue and problems with their behaviour.
Sleep walking/night terrors
Sleepwalking refers to the phenomenon of adults or children walking around even though they are sleeping. Statistically, male children are more prone to sleepwalk than females. On the other hand, night terrors cause abrupt waking and come with a feeling of fright, confusion and other stressful feelings. If a child suffers from either disorder, this can worsen their sleep and cause them to develop fears about going to bed. This makes insomnia more likely to occur.
RMD stands for Rhythmic Movement Disorder. It causes a person to move their body parts repeatedly during the process of falling asleep. Most people with RMD experience this movements in their upper body, although they could occur anywhere. Children are more likely to develop this disorder than adults, and the risk is more increased if they also have ASD. However, it often goes away on its own without any medical intervention. By the time a child is 5 years old, it’s highly likely that their RMD symptoms will have settled down.
RLS is short for Restless Leg syndrome and is sometimes also called Willis-Ekbom disease. It causes unwanted and unpleasant creeping or itching feelings in a person’s legs during the night. This often causes them to feel the irresistible need to move their legs to attempt to get rid of the sensation. There are more females with the syndrome than males.
Bedwetting is sometimes called nocturnal enuresis. It is characterised by a person urinating without meaning to during sleep. Some bedwetting in early childhood is considered normal and is not a cause for concern. In neurotypical children, most will stop wetting the bed by around the age of 5.
However, nocturnal enuresis which continues to affect a child older than 7 may need medical intervention. ASD raises the overall likelihood of a child experiencing ongoing nocturnal enuresis. In certain cases, this may continue even once the person is an adult.
Hypersomnia causes excessive sleepiness at inappropriate times of day. It can also cause prolonged periods of sleep. If a person has hypersomnia, they may struggle to stay awake in the daytime and nod off at the wrong time. Many people with this condition experience issues with their behaviour and mood.
Anyone can get these sleep disorders whether they have ASD or not. However, people with autism are more likely to have worse symptoms. Recent scientific research has found that people with a greater level of social communication problems have proportionately greater issues with their sleep. These sleep issues increase the occurrence and intensity of behaviour and mental illness in people with ASD.
ASD is also associated with other illnesses and disorders such as epilepsy. These can also cause problems with falling and staying asleep and can make sleep quality worse.
Why are ASD and Sleep Linked?
Experts are unable to conclude the precise reason why people with ASD develop sleep issues and disorders. That being said, there is currently exciting research being carried out to explore several likely theories.
Some scientists have put forward the idea that sleep problems associated with autism are caused by abnormalities in an individual’s brain. There is some good evidence for this.
For example, children and young people with ASD produce lower levels of the amino acid tryptophan than unaffected individuals. This amino acid plays an important role in producing melatonin, a hormone responsible for promoting normal sleep. This means that autism has a direct impact on the way a person produces melatonin. Interestingly, individuals affected by ASD make a greater amount of melatonin in the daytime, which offers a potential answer to why people with the condition may feel tired in the day and struggle to nod off at bedtime.
A further possible explanation for the problems with sleep faced by autistic children is their problems comprehending social cues. Most neurotypical children gradually learn to recognise the signs that it’s time to go to sleep at night by watching how the adults and older children around them behave at this time. Children with ASD are less likely to recognize these behaviours and habits as they can be tricky for them to spot.
Also, autistic children are more likely to become overstimulated by the world around them than their peers. This means that they may find it hard to wind down in anticipation of bedtime. Outside stimuli are also more likely to interrupt their sleep and wake them up, whereas children without ASD become desensitised to small noises and other disturbances and learn to sleep through them.
Finally, small children change their sleeping patterns as they grow until they drop naps and consolidate all of their sleeping hours to night time. Having autism sometimes delays the development of these sleep patterns, so the child learns to sleep exclusively at night later than their same-age peers.
How Does a Child’s Sleep Change With Age?
Although ASD often causes problems with sleep, these often get better as the child grows up. Sometimes the sleep problems will be eradicated on their own without and specific intervention. For most children, sleepwalking, night terrors and RMD will resolve themselves entirely by the time the child is 7 years old.
Unfortunately, there is no known treatment to help get rid of these particular sleep disorders. So, parents and carers will need to find ways of helping their child cope until the problem goes away on its own.
There are several ideas that caregivers can employ to keep the child’s bedroom environment safe until they grow out of these sleep problems to prevent falls and other injuries occurring. It’s important to make sure all windows and external doors are securely locked to prevent the child from wandering or falling out. Some children may try to go outside the home while they are sleeping. You can also protect them from falling out of bed by installing guard rails and placing padded mats on the floor to break their fall should the worst happen.
As a rule, autistic adults have less problematic sleep than they did as children. However, some sleep disorders can last into adulthood or occur for the first time. Insomnia is a common example of this. Some of the illnesses that negatively affect sleep in children with ASD cause the same issues in adulthood.
Can Good Sleep Help Children With ASD?
As a rule of thumb, if a child with autism has a better sleep quality and duration, the impact of their issues with behaviour and social interaction is likely to be lessened. It can also help to reduce tiredness and problems with attention span in the daytime.
Therefore, keeping track of how well and long your child is sleeping is an important step in helping them cope with their ASD. Any ongoing problems should be discussed with their medical care providers in order to devise a successful treatment plan. Many common sleep problems in people with ASD can be well-managed with medical treatment and support.
It’s also important to understand that some sleep issues can cause serious health concerns or lead on to other problems. Sleep apnea is an example of a sleep disorder that poses a risk to health. Addressing these issues can help safeguard the overall health of a child with ASD.
When you take steps to improve the sleep of your child with ASD, you will also reap the rewards. It’s known that caregivers of autistic children are more likely to have problems with their own sleep. It may be that the stress and emotion of looking after a child with ASD, or the broken sleep caused by caring for them during the night, can affect the duration and quality of a caregiver’s sleep. Therefore, taking steps to resolve your child’s sleep problems will help you to sleep better too.
How Much Sleep Do Children Need?
Infants and children require a greater amount of sleep than adults. Gradually, the total amount required will diminish as they grow. While there are no hard-and-fast rules about how much sleep a child should get at each age (each child will have slightly differing requirements), there are some general guidelines you can follow:
- Babies: 14-16 hours per day/night
- 1-3 years old: 12-14 hours per day/night
- 3-6 years old: 10-12 hours per day/night
- 7-12 years old: 10-11 hours per night
- 12-18 years old: 8-9 hours per night
- Adults: 7-8 hours
You may notice that for babies and younger children, their total sleep is split across the day and night. This is because infants and toddlers will require at least one nap in the day. However, once the child is around 5 years old or starting school they probably won’t require or desire a nap in the day.
Several factors can affect the total amount of time a baby or child needs. As an example, a child that does a lot of sport or other physical activity may need a little more sleep to recover than the guidelines state.
ASD and Sleep Environment
One of the most effective ways of helping children to fall asleep is to promote a calm space in their bedroom, whether they have ASD or not. That being said, autistic children will benefit from these measures even more because it can help to exclude any outside stimuli that might stop them from sleeping. Hanging blackout curtains over the windows can help to stop potentially overstimulating light from entering their bedroom, especially in the months where it gets light early and dark late. Keeping the space free of stimulating toys or electronics can also help to prevent the temptation to play and help your child to wind down for sleep.
Bedtime Routines For Children With ASD
When it comes to establishing calming and healthy bedtime routines for children with ASD, it’s not so different to the ideas you may use for a neurotypical child. Research shows that a regular bedtime routine can help your child wind down and fall asleep more easily. Doing the same things each night can be particularly helpful in helping children with ASD understand those tricky-to-read bedtime cues.
First of all, it’s important to establish a set bedtime that you stick to as rigidly as possible. Allowing your child to vary their bedtime, even at the weekends, can make establishing a bedtime routine more difficult if your child has autism.
Familiar toys or objects can help to serve as powerful cues to signal to your child that bedtime is approaching. For example, you could use the same style of pyjamas or a favourite cuddly animal to help build sleep associations. To make this as effective as possible, these items should only be used at bedtime. It’s a good idea to make sure you keep duplicates of your child’s bedtime objects and rotate them so they become equally worn and familiar. Otherwise, this could scupper your whole bedtime routine if your only one gets lost.
Managing the transition from the last activity of the day to the bedtime routine can also be helpful, as this is often a sticky point for children with autism. This is because children with the condition can become upset or stressed when it’s time to end an activity, especially if it’s something they enjoy doing and they have anxiety around bedtime. Giving regular warnings that bedtime is approaching may help. You could try using an aid such as a countdown timer (the same every night) to make this easier.
If your child becomes overstimulated before bed, this can make falling asleep harder. Very exciting or physical activities, or using screens, right before bed can make this especially difficult. This doesn’t just apply to children with ASD, but to neurotypical children and even adults.
So, avoiding screens and sticking to quiet, soothing activities for roughly two hours before it’s time to go to bed can make it easier to relax ready for sleep. Keep this consistent every evening so that your child learns to understand that bedtime is around the corner.
Sleep, Lifestyle and ASD
When it comes to helping your child with ASD improve their sleep, there are certain changes you can make to their lifestyle to make it easier. Ask your child’s healthcare team whether altering their level of exercise and type of diet could help.
For example, ASD can cause digestive upset and discomfort. It may be worth taking the time to see whether certain foods trigger discomfort in your child and cutting them out to stop this interrupting their sleep. Removing too much caffeine or sugar from their diet can also promote sleep, just like it does in adults.
If your child is one of the many children with autism affected by bedwetting, this is a prime cause of night-time waking. Sleeping in wet pyjamas or on wet bedding is uncomfortable and likely to wake them up and cause them to become upset. While it’s important for your child to remain adequately hydrated, cutting down the amount they drink in the time before they go off to sleep can make bedwetting less frequent.
Encouraging your child to get active can also help them to nod off more easily at night. However, try to discourage them from too much exercise shortly before bedtime as this could actually make their sleep problems worse.
Helping Your Child to Sleep on Their Own
It’s perfectly normal for young children to want their caregiver to stay with them while they drift off to sleep, even if they don’t have ASD. That being said, falling asleep alone can be especially difficult for toddlers and children with autism. Many parents and caregivers find it easier in the short-term to stay with their child until they are asleep.
However, there may come a time when you decide it is necessary for your child to learn to fall asleep on their own. For example, you may find that If your child wakes up during the night, they need your presence to go to sleep again. This can be exhausting over time and cause you to burn out.
You could start the process by using photos or drawings to help your child get used to the idea of going to sleep on their own.
So, you could take a photo of them sleeping safely without you there and talk to them about it, explaining that it’s safe for them to do so. You could discuss where you will be while they are sleeping, for example watching television down the hall, so they realise that you will never be far away if they need you.
If you want your child to learn to fall asleep alone, you shouldn’t allow them to sleep anywhere other than their own bed. Otherwise, your child may start falling asleep in places you would rather they didn’t. It’s important to build up a strong association between their bed and sleep as young as possible.
It’s not uncommon for children with ASD to continue to struggle with falling asleep alone even if you employ all these tips. In this situation, you could try using the gradual retreat technique to ease them gently into this skill. Start by sitting by your child’s bed while they nod off.
Every few nights, increase the distance between you and them, allowing them plenty of time to adjust before you move further away. Rushing the process can be counterproductive, so patience is key. You may eventually graduate to sitting just outside their door, where they can’t see you but could call out to you to know that you are there. Hopefully, given time your child will be able to go to sleep independently.
Sleep Aids for Children With ASD
Fortunately, most of the tips and techniques to help a child with ASD to improve their sleep don’t cost a dime. However, you may want to invest in some of the many excellent products available to make the process easier. Some aim to optimise their sleeping environment, while others are designed with night-time safety in mind. Here are some of the products that may be particularly useful:
Waterproof Sheets and Mattress Protectors
Many children with ASD experience frequent bedwetting. Not only is this uncomfortable, but it can cause long waking periods if you need to change their bedding in the night. Protecting their bed with waterproof sheets and/or a mattress protector makes bedding changes much quicker and easier, so your child will be awake for as short a time as possible. It can also save you money, as you won’t have to shell out on replacing smelly and unsanitary bedding and mattresses.
If bedwetting is seriously affecting your child’s sleep, you might consider giving them children’s incontinence underwear or pull-ups to wear while they sleep. These are very absorbent and leave the layer next to your child’s skin feeling dry. So, it may help them sleep through even if they urinate during the night.
Children with RLS often find their leg movements keep them awake at night. A weighted blanket to put over their legs can help to control these movements and improve their sleep.
If your child sleepwalks or falls out of bed, a bed rail installed on the side can help prevent this from happening.
Sometimes, despite your best efforts your child may still fall from their bed, particularly if their ASD is accompanied by RMD. Placing thick, padded safety mats on the floor by their bed can help to prevent or minimize any injury.
White noise machine or app
You can buy white noise machines or download apps that play white noise on a tablet or smart phone. This type of noise can help children with ASD as they are often overstimulated or distressed by even small amounts of outside noise. White noise covers these irritating sounds and may stop them from waking up or struggling to fall asleep due to noise disturbance.
ASD is associated with health conditions that make snoring more likely. This can affect the quality of your child’s sleep. If this is causing a problem, you can purchase anti-snoring devices fitted by a dentist to help. If your child has a diagnosis of sleep apnea, their paediatrician may give them a positive air pressure device to control their breathing during the night. This can help them sleep better, but it’s also vital to safeguard them while they sleep. If you’re ever concerned that your child is snoring excessively, you should contact your doctor straight away as this can be a sign of an underlying health problem.
Can Sleep Supplements Help Children With ASD?
In some cases, giving supplements to children with ASD to help them sleep may be appropriate. It’s known that RLS is sometimes causes by low iron levels. If this is diagnosed by a doctor, they may suggest giving your child extra iron to improve their restless legs and help improve their sleep quality and quantity.
Some doctors prescribe melatonin supplements for children with ASD who struggle with their sleep. Research indicates that this can help improve the length of time it takes children with ASD to nod off at night. It can also lengthen their total sleep hours per night.
It’s not advised that you give any supplements to your child without first checking with their health care team. It’s important that the dose you give is safe for your child’s age and weight and won’t interact negatively with any of their other medications.
Traditional Sleep Remedies
You can buy some sleep medicines with their roots in traditional medicines in shops or pharmacies. These can often be purchased without a script from the doctor, but this doesn’t mean that they are always safe to give to your child. Many people assume that these ‘natural’ medicines aren’t very potent, but they can actually come with significant side effects. They could also be unsafe with any prescribed medicine your child is already taking to help manage their health condition.
Most of these traditional remedies come in dosages designed to be taken by adults. This could lead to an unintended overdose if you give them to a baby or child, even if they take the minimum amount. If you check the box, you may see that they shouldn’t be administered to children.
While this may sound like herbal supplements should never be given to children, this is not the case. In fact, some may be very helpful. If you ask their health care team, they will be able to tell you whether a medicine is safe and likely to benefit your child. They can also tell you how much to give and how often.
As you can see, your child’s autism can affect your child’s sleep quality and duration in many ways. However, there are all sorts of things you can do to improve the situation. Strategies such as set routines, healthy lifestyle and possibly medications can help them to get enough restorative sleep. This may help to make their condition easier to manage during the day.
Any concerns with your child’s sleep should be reviewed by their doctor in the first instance. Sometimes, it may indicate that there is a problem with their health while needs addressing such as sleep apnea.
It’s easy to forget your own needs when you’re caring for a child with ASD, and your own sleep can suffer as a result. It’s important to take care of yourself by making sure you get some time to yourself and support from those around you. You may benefit from speaking to a counsellor with relevant experience. Joining support groups and talking to parents in the same boat can also help.