Studies have consistently found that more than half of autistic children and possibly as many as 4 in 5 have at least one chronic sleep problem.
While sleep problems are common and chronic in children with ASD, some parents may not recognise a sleep problem and may not seek treatment. The biggest sleep problems among these children include:
- Difficulty falling asleep
- Inconsistent sleep routines
- Restlessness or poor sleep quality
- Waking early and waking frequently
We don’t know exactly why such a large percentage of autistic children have sleep problems, but through dealing with this issue we have seen some commonalities. Most of us know when it’s time to go to bed because our bodies are in rhythm due to the daily cycle of night and day and the body’s sleep and wake rhythm. Children with autism often miss these daily cycle cues as well as failing to recognise the routine and evening rituals of getting ready to go to bed.
Another theory has to do with the hormone melatonin, which normally helps regulate sleep-wake cycles. To make melatonin, the body needs an amino acid called tryptophan, which research has found to be either higher or lower than normal in children with autism. Typically, melatonin levels rise in response to darkness (at night) and dip during the daylight hours. Studies have shown that some children with autism don’t release melatonin at the correct times of day. Instead, they have high levels of melatonin during the daytime and lower levels at night.*
Some children with autism can develop some random irrational fears — the vacuum, thunder, monsters — but one fear that is universal is the dark.
Fear of the dark may begin as early as age 2 and continue through the preschool years to age 5.
Children fear what they don’t understand, they may hear stories about monsters under the bed, or it may come from nowhere. Don’t insist that they sleep in the dark. Be patient. Be responsive to their needs.
Ask questions, ‘What frightens you? What can we do about that?’
Tips for Improving Your Autistic Child’s Sleep**
Here are some of the most effective techniques, according to researchers:
Keep the bedroom as cool, dark, and quiet as possible to avoid sensory challenges that might make sleep difficult. If possible, use blackout curtains; do your best to keep outside sound to a minimum.
Establish a regular bedtime routine that starts at least an hour ahead of time. Turn off all electronics, and provide a clear, repetitive routine that includes putting on pj’s, brushing teeth, reading together, or whatever is most relaxing for your child (and you). Some children respond well to a warm bath and snack before bedtime. Many children with autism are attached to particular stuffed animals or other toys, and these can be incorporated into the routine. Stick with the routine even during vacations and weekends if at all possible.
Create a predictable transition from waking to sleeping hours. Give warnings fifteen, ten, and five minutes before it’s time to start the bedtime routine. Practice the process of (for example) turning off the TV and heading to the bathroom. You can use visual timers or auditory alarms if that seems to work better for your child.
Work with your child to help him fall asleep without you in the room. If this is an ongoing issue, you may have to take the process very slowly, starting with sitting at the other side of the room and slowly moving farther away until you’re actually outside the door.
In addition to these basic techniques, children with autism may also benefit from some special attention to sensory and physical issues. For example:
You may want to record your child’s bedtime response to specific foods and exercise. Does she have more trouble falling asleep when she eats an early dinner or eats specific foods? Does exercise help him to relax or rev him up before bedtime? Adjust your routine based on your findings.
Consider certain products geared to people with sensory issues. Examples include a white noise machine, which makes a consistent, sound-blocking sound similar to that of a fan, or a weighted blanket which may help your child to calm himself.
Low doses of melatonin supplements (1 to 3 mg) about thirty minutes before bedtime have been found to be helpful for some autistic people.
If none of these work, which is fairly likely if your autistic child has serious sleep issues, we can help, as several of our paediatricians can help with sleep issues. We understand how hard it as and know how much impact there is on the child and on the entire family (it is huge) and not to be ignored.
* https://www.webmd.com/brain/autism/helping-your-child-with-autism-get-a-good-nights-sleep#1
** https://www.verywellhealth.com/autism-and-sleep-issues-4165825
