Sleep

Over half of children with autism – and possibly as many as four in five – have one or more chronic sleep problems.

Many adults on the spectrum likewise have difficulty falling asleep and staying asleep through the night. These sleep issues tend to worsen behavioral challenges, interfere with learning and decrease overall quality of life.

Autism Treatment Network Research on Sleep

Researchers with the Autism Speaks ATN have extensively researched sleep and its influence on health, behavior and other areas of life. Many kids and teenagers with autism have problems sleeping which can be hard on the child and caregivers. Some have trouble falling and staying asleep, or wake up too early and have a hard time getting back to sleep.

Problems sleeping happen more often if the child has restricted and repetitive behaviors (lining up toys, rocking, hand-flapping), anxiety, or sensory problems and can lead to having trouble paying attention, feeling restless, getting angry, and throwing tantrums.

Watching TV, videos, or playing on the computer, especially if the shows or games are scary or violent, can lead to kids with autism having more trouble sleeping. All kids and teenagers with autism should be checked for trouble sleeping, by asking specific questions about bedtime, waketime, daytime and nighttime habits and bedtime routines. Then the parents can learn ways to help their child sleep better, for instance by cutting back on computer or video game time. Teaching parents about sleep habits, and sometimes using the right medicine can help kids with autism sleep better.

For the full reference list and more Frequently Asked Questions addressed by ATN research on sleep, visit asatn.org.

*Disclaimer: This summary is based on research conducted by Autism Treatment Network (ATN) members. It is not a summary of the entire body of research literature available on this subject

Sleep Resources

Researchers with the Autism Speaks ATN have developed and tested autism-specific strategies for improving sleep. These can be found in three ATN/AIR-P guidebooks:

ATN/AIR-P Strategies to Improve Sleep in Children with Autism Parent Booklet and Quick Tips
This informational booklet is designed to provide parents with strategies to improve sleep in their child affected by autism spectrum disorders (ASD). The suggestions in this tool kit are based on both research and clinical experience of sleep experts.

ATN/AIR-P Sleep Strategies for Teens with Autism
Many teens with autism have difficulty with sleep, which can affect their daytime functioning, as well as that of their families. This tool kit is designed to provide parents with strategies to improve sleep in their teens affected by autism. It helps tackle the problems of falling asleep and staying asleep through the night. 

ATN/AIR-P Melatonin and Sleep Problems: A Guide for Parents
Melatonin is a common medicine your doctor or healthcare provider may suggest to help improve sleep. This tool kit is designed to provide you with information about melatonin and help you decide if trying melatonin is right for you child.

Download our one-page overview on sleep for quick tips you can use at home.

Establishing Good Sleep Hygiene

by Carin Lamm, MD
Associate Clinical Professor of Pediatrics Diplomate American Academy of Sleep Medicine
Director Pediatric Sleep Disorders Center Columbia University Medical Center

Sleep problems are very common, reportedly as high as 80% in children with ASD. In typically developing children sleep problems and insufficient sleep can result in daytime sleepiness, learning problems and behavioral issues such as hyperactivity, inattentiveness and aggression. Recent research in children with ASD demonstrates that poor sleepers exhibit more problematic behavior than good sleepers.

Fortunately, there are several ways parents can improve a child’s sleep. 

Establishing good sleep hygiene by addressing the following domains is a good first step.

1. Sleep environment: the bedroom should be dark, quiet and cool. As children with ASD might be particularly sensitive to noises and/or have sensory issues, the environment should be adapted to make sure your child is as comfortable as possible.
2. Bedtime routine: the routine should be predictable, relatively short (20 – 30 minutes) and include relaxing activities such as reading or listening to quiet music. Avoid the use of electronics close to bedtime such as TV, computer, video games etc. that can be stimulating making it difficult for your child to fall asleep.
3. Sleep\wake schedule: the schedule should be regular with not much of a difference between the weekday and weekend schedule.
4. Teach your child to fall asleep alone: It is important that your child learn the skill of falling asleep without a parent present. All children and adults wake briefly during the night but quickly put themselves back to sleep by reestablishing associations used at bedtime. So if your child needs a parent present to fall asleep at bedtime, he might need a parent to help him fall back asleep during the normal awakenings.
5. Exercise: Daytime exercise can make it easier to fall asleep and children who exercise tend to have deeper sleep. Avoid allowing your child to exercise too close to bedtime as it can make it difficult for him to fall asleep.
6. Avoid caffeine particularly close to bedtime, which can be alerting making it difficult for your child to fall asleep. Caffeine is found not only in coffee, but also in tea, chocolate and some sodas.
7. Naps are helpful for preschool children, but should not be taken late in the afternoon as they can interfere with bedtime.

It is important to address medical or psychiatric issues that potentially interfere with sleep. Your child’s medications might need adjustment if they affect his sleep. If your child suffers from a sleep disorder such as sleep apnea, sleep walking, sleep terrors, restless legs syndrome, he may need a referral to a sleep specialist. Some children with persistent insomnia will need further behavioral or pharmacological treatment to improve their sleep.

In summary, although sleep problems are common in children with ASD they often can be helped. Better sleep for these children can potentially improve their daytime functioning as well as the sleep of family members.