Autism Spectrum Disorder, or ASD, is a neurological and developmental disorder. This disorder has some distinctive characteristics, and notably, these characteristics fall along a spectrum. This means that some people will be further along this spectrum than others.
Often, we think about autism in terms of children as autism is generally diagnosed at a younger age, and the conversation around children and autism has become a more prominent topic in recent years. However, people of all ages can live on the autism spectrum, and no matter where they fall, there is some impact on daily life.
Sleep, for example, can have its own particular challenges for people with ASD. In this guide, we’ll talk about those issues and give you tips for better sleeping if you or your child have ASD.
What Is Autism and How Is It Diagnosed?
Autism Spectrum Disorder (ASD) is a neurodiverse developmental condition that influences both cognition and behavior, and the following are some characteristics uniquely common in autistic people:
atypical responses to sensory information
difficulty participating in social interaction
alternative ways of learning and processing
difficulty expressing and understanding language
repeated fidgeting or flapping
Diagnosis of autism is often difficult for physicians as there is currently no physical test to obtain results, like a urine or blood sample. Rather, doctors have to look at both behavior and development to reach a diagnosis. Many people are reliably diagnosed with ASD as young as two years old, but some people aren’t diagnosed until adolescence or even adulthood.
Autistic people are considered to be neurodiverse because their condition falls on the “spectrum”, with some needing more assistance than others. The challenges and strengths these individuals have will vary from person to person.
The causes of autism are not completely clear, though there are some common elements that most experts agree can factor into the causality, including biology, environmental factors, and genetics.
Sleep-Related Problems in the Autistic Community
“Sleep problems in ASD, are a prominent feature that have an impact on social interaction, day to day life, academic achievement, and have been correlated with increased maternal stress and parental sleep disruption.” – Preeti A. Devnani, M.D. & Anaita U. Hegde, M.D.
Over half of all children with autism, and potentially as many as four out of five, struggle with ongoing sleep problems. According to the National Autistic Society, numbers may be even higher for adults; about 70 percent of adults with ASD have chronic sleep issues that are usually associated with sensory issues or high anxiety at night.
Additionally, more nighttime awakenings, nightmares, sleep onset delays, shorter sleep duration, gut issues, and symptoms of PTSD have been reported among people with ASD.
Common Sleep Disorders Associated with Autism
Insomnia
Insomnia is a sleep disorder in which a person has trouble falling asleep or staying asleep, and it is quite common in people who are autistic.
“[Insomnia] affects up to 80 percent of autistic people across the lifespan.” - Professor Richdale, La Trobe University
Parasomnia
A parasosomnia is any type of sleep disorder in which someone exhibits disturbing or odd behavior, such as sleepwalking or talking while asleep. Parasomnias can happen either during REM or NREM sleep.
Parasomnias that occur during REM sleep include nightmares, sleep paralysis, talking, punching, laughing, swearing, or otherwise “acting out” and verbalizing during sleep. Parasomnias that happen during NREM sleep include sleep walking, sleep terrors, eating during sleep, and more.
Adults and children with ASD are more likely to experience these sorts of parasomnias compared to people without ASD.
Interestingly, people with ASD also tend to spend less of their sleep in REM sleep – about 15 percent of their total sleep is spent in REM, versus 25 percent for neurotypical people. Therefore, the parasomnias that happen during NREM may be more common for those on the spectrum.
Obstructive Sleep Apnea (OSA)
Obstructive Sleep Apnea (OSA) is a sleep disorder in which the sleeper starts and stops breathing throughout the night. This causes blood oxygen levels to drop, which leads to “mini-awakenings.”
Commonly, people with OSA feel less rested the next day but aren’t always aware they are waking up repeatedly at night.
OSA is particularly common among children who are on the autism spectrum but are higher functioning. Researchers believe that because these children are presenting with fewer ASD symptoms (and so are less likely to see a practitioner early on), their sleep apnea is also less likely to be detected until later in life.
What Causes the Correlation Between Sleep and ASD?
The reason for the correlation between sleep issues and ASD is not straightforward and the science is still ongoing. However, there is a theory that has shown up in multiple observations about sleep and autism.
Evidence suggests that there is a link between melatonin production and sleep disturbances in people with autism. According to a study published in the Journal of Pediatric Sciences, “any impairment in the production of these neurotransmitters (melatonin) may disrupt sleep… In melatonin synthesis, the final enzyme encoded by the N-acetylserotonin O-methyltransferase gene demonstrated less activity in (those with ASD); therefore, implying lower levels of melatonin.”
To put it simply, this study suggests that melatonin production may be irregular in ASD individuals due to genetic activity.
Sleep Medication for Autistic People
“Our finding that 46% of children aged 4 to 10 years with sleep diagnoses were taking at least 1 medication for sleep suggests that medication use for sleep is common in the ASD population.” - American Academy of Pediatrics
This study from the American Academy of Pediatrics (AAP) was unique to children, but seeking medical intervention for sleep issues is common among people with ASD of all ages. In fact, sleep medication seems to be the first line of defense among ASD adults who seek help for their sleep problems. In one study in the UK, of the participants who sought help with sleep issues, 72 percent were prescribed some sort of sleep aid, and 60 percent of those people were not satisfied with the results.
It may sound like a simple solution: If autistic individuals have a melatonin deficiency, why wouldn’t supplementing with melatonin at night lead to better sleep? The answer, however, is more complicated.
Some research shows that melatonin supplementation can help people with ASD fall asleep, achieve better sleep quality, and may even help ameliorate other ASD symptoms like anxiety, depression, pain, and gastrointestinal issues.
However, some research shows that children in particular who have taken a sleep aid exhibit worse daytime behavior than children not taking the medications.
Research conducted by the AAP mentions that some of the participants were taking melatonin but other prescription medications were involved as well, including benzodiazepines, anticonvulsants, antidepressants, and antipsychotics. The study doesn’t make a distinction between whether or not the daytime behavior was worsened by melatonin or one of these stronger drugs.
In the end, more research is needed for a conclusive understanding of the relationship between melatonin production and supplementation for ASD individuals, but there appear to be some promising findings.
We advise anyone seeking out medication for sleep with ASD to consult with their doctor first.
Good Sleep Hygiene for Autistic Sleepers
Practicing good sleep hygiene is helpful for sleeping better, regardless of whether or not you have ASD. Sleep hygiene refers to habits meant to improve sleep. These can include everything from daily practices to optimizing your bedroom for better sleep.
Create a Consistent Bedtime Routine
Studies have shown that all people benefit from creating a regular sleep routine– in fact, if you have trouble sleeping, one of the first recommendations experts make make is to make sure you are going to bed and waking up at the same time, every day.
Routine seems to be especially important for people with autism. According to the United Kingdom’s National Autistic Society, “routines can be a source of enjoyment for autistic people and a way of coping with everyday life.”
As far as sleeping goes, this means going to bed and waking up at the same time each day, even on weekends, but it extends beyond that.
It’s also important to find something that relaxes you before bed, like reading, meditating, taking a bath, sipping on some chamomile tea, or whatever works for you, and making that a nightly ritual. This will help your body relax, and it will also let your body and mind know, it’s almost time to go to sleep.
Watching something relaxing at night is okay, too, if that helps you wind down. However, be sure you’re putting away all your screens – phone, computer, T.V., etc. – at least one hour before bed. These devices all emit blue light, which can make it harder to fall asleep by suppressing melatonin production. This may be especially true for certain autistic people who are more sensitive to light.
Lastly, another helpful nightly routine could be that you read before bed each night.
Have an Appropriate Bedroom Environment
Having a bedroom that is conducive to sleep is just as important as creating a consistent bedtime routine, especially for people on the spectrum. This means, well before it’s time to go to sleep, you should make sure the bedroom is clean and free of distractions because clutter can be a big sensory overload for people with ASD.
The bedroom should also be dark, quiet, and cool (think “cave-like”). This can help all people get better sleep. However, it will be especially important for people with ASD who might be sensitive to lights, sounds, and temperature.
For those with sensory issues, make sure you’re investing in a quality mattress and bedding. Sheets, for example, should feel soft, breathable, and comfortable in order to avoid distraction.
Exercise Regularly
Exercise is an effective tool to help get energy out, especially before bedtime. Many people with autism also have ADHD and high amounts of energy, so this could be especially beneficial for those who have these corresponding conditions.
Daytime exercise would be ideal, but if you must work out at night, avoid doing vigorous exercise one hour before bed or it might keep you awake. Rather, practice yoga, pilates, or stretching.
“There has been more and more research in the last decade showing exercise can reduce insomnia.” - Kelly Glazer Baron, Ph.D
Avoid Caffeine and Alcohol
Interestingly, there is some evidence that caffeine may be helpful for people on the autism spectrum by helping them focus and even reducing hyperactivity. That said, stimulants like caffeine can impact sleep up to six hours before bedtime. That means, if you drink caffeine and want to go to bed by 10:00 p.m., your last cup should be before 4:00 p.m.
Additionally, alcohol can lead to more disturbed sleep. This is important to note as there is some evidence that people with ASD may be more susceptible to using substances like alcohol in order to cope with their ASD symptoms.
Nap Wisely
Generally, daytime naps are fine as long as they’re taken earlier in the afternoon and kept relatively short. More specifically, adults should ideally for about 20 minutes no later than 3:00 p.m.. This should ensure that napping doesn’t negatively affect your sleep later that night. Children, on the other hand, need more sleep than adults, so longer naps early in the day are okay.
Read more about how to get your autistic child to sleep.
Additional Tips for Better Sleep With Autism
Deep Pressure Simulation
Deep pressure stimulation is a range of firm to gentle squeezing that is done with the hands or a massaging tool. This treatment is meant to relax the nervous system and has been used as a method of helping calm ASD individuals before bed.
You can practice this technique on yourself, but it is most effective if done by somebody who you trust and feel safe with.
Weighted Blanket
A weighted blanket provides some of the same relief as deep pressure stimulation. Added weight can act as a comforting embrace. Weighted blankets are typically filled with sand, glass beads, or some other finite substance that can provide extra pressure.
The general rule of thumb is that a weighted blanket should be no more than 10 percent of your total body weight.
Comfort Object
We commonly think of comfort objects as “just for kids”– things like teddy bears, blankies, etc. However, people of any age can benefit from a comfort object, especially those with ASD.
Some adults still sleep with their favorite stuffed animal, while others replace this later with a soft blanket or a pillow between their arms while sleeping on their side. Not only does this provide a feeling of safety, but it can also help keep your shoulder from collapsing and keep your spine in alignment, while on your side.
White Noise Machine
White noise cancels out outside noises by blending a mix of all the sound waves, which can be helpful for sleepers who are sensitive to sounds. Some white noise machines include other calming sounds like rain and ocean waves.
Conclusion
In the United States, about 2.21 percent of the adult population and about 1 in 36 children are living with ASD. Mind you, these are just the people with a formal diagnosis; it’s expected that many more people are on the autism spectrum but undiagnosed.
Though autism can present challenges to sleep, there are ways to help. We hope that this guide has helped you better understand some of the problems associated with ASD and sleep, and has given you some tools for a better night’s rest. After all, with good sleep, everything else is more manageable as well.