Sleep Issues in Children with Autism

Key Points

Up to 80% of autistic children face sleep issues like difficulty falling asleep and irregular patterns.
Problems often stem from disrupted routines, sensory sensitivities, irregular melatonin levels, and anxiety.
Poor sleep can lead to behaviour problems, heightened anxiety, and poor cognitive performance.
Consult a paediatrician or specialist for persistent issues; keep a sleep diary to track patterns.
Varies by age, but establishing good sleep habits is crucial for overall health and family well-being.

Introduction

From a young age, children with autism often have trouble sleeping, more so than other children. Studies show that up to 80% of autistic children may face sleep issues at some point during their childhood, and for many, these problems can be long-term. Sleep issues usually start around 30 months of age.

The most significant sleep problems include:

Difficulty falling asleep.
Irregular sleep patterns. For example, staying awake late or waking up very early
Sleeping much less than usual for their age or being awake for over an hour during the night
Getting up to do their favourite activities or making noise during the night

These sleep troubles don’t just affect the children; they can also disrupt their parents’ sleep. All children can struggle with sleep, but autistic children may have specific challenges.

Potential Causes of Sleep Problems in Children with Autism

Researchers are not entirely sure why autistic children have a higher risk of poor sleep compared to typically developing children, but they have a few theories. Sleep problems for autistic children can be caused by or related to things like:

1. Bedtime patterns

Some sleep problems in autistic children are related to their bedtime routine and environment. Here are a few examples:

Noise and activity: If there’s a lot of noise and excitement before bed, it can be harder for your child to calm down and sleep.
Lack of routine: If your child’s bedtime routine changes every night, they might not get clear signals that it’s time to sleep.
Sleep location: If your child falls asleep somewhere other than their own bed, like the family room, they might struggle to sleep in their own bed.
Comfort items: If your child needs all their soft toys lined up on the bed to sleep, missing one can cause problems and can make the bed uncomfortable.
Sleep environment: If the room is too hot, cold, bright, or noisy, it can be hard for your child to sleep, especially if they have sensory sensitivities.

2. Daytime habits

Some sleep problems can be caused by unhealthy eating habits and lack of physical activity during the day. You can help by making simple lifestyle changes, such as encouraging your child to:

Be more active: Aim for several hours of physical activity each day, including at least an hour of energetic play like running and jumping.
Eat at the right time: Ensure they have their evening meal, so they go to bed neither too hungry nor too full. Serve the last meal at least 4 hours before bedtime.
Avoid caffeine and excitement: Children should not have caffeine and should avoid overly exciting activities after 3 pm.
Limit naps: Avoid long and late daytime naps for children over 5 years old.

TIP

Sleep problems often improve after 2 – 3 nights of changing your child’s bedtime and daytime habits. However, for some children, it can take 2 – 4 weeks. If there’s no improvement, see your doctor to check for any medical issues. You might be referred to a paediatrician, psychologist, or other health professional experienced in treating children’s sleep.

3. Social Communication Difficulties

Most people know when it’s time to sleep by following the natural light and dark cycles and their body’s internal clock. Social cues, like seeing others get ready for bed, also help signal that it’s time to sleep. However, children with autism, who often have communication difficulties, might not pick up on these cues correctly. In addition, they might be kept awake by something they need but can’t ask for.

4. Melatonin Levels

Melatonin, a hormone that regulates sleep-wake cycles, can be irregular in autistic children. The body needs tryptophan, an amino acid, to produce melatonin. Research indicates that tryptophan levels can vary in children with autism. Typically, melatonin levels rise at night and fall during the day. However, some autistic children release melatonin at the wrong times, with high levels during the day and low levels at night.

If your child persistently has sleep problems, discuss with your doctor whether melatonin could be beneficial.

5. Sensitivity to Stimuli

Autistic children might be more sensitive to things like touch or sound. While most children continue to sleep through minor disturbances, like their mother opening the bedroom door or tucking in the covers, autistic children might wake up easily.

6. Anxiety

Anxiety can also affect sleep. Children with autism often have higher levels of anxiety than other children, making it hard for them to fall asleep. To help, avoid discussing topics that might worry your child at bedtime. Instead, talk about their fears during the day.

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Sleep relaxation for children

Using sleep relaxation techniques can help an anxious child sleep better. Check out this link for visual resources on deep breathing for sleep relaxation, using pictures for sleep relaxation and sleep relaxation after a busy day. Also available in Chinese and Tamil.

7. Bedwetting and Toileting

Toileting, nappies, and bed wetting can cause night waking, especially in younger autistic children and those with intellectual disabilities, who are often hard to toilet train. These children might wake up because they wet the bed or need to go to the toilet and then struggle to fall back asleep. If toilet training and bedwetting are ongoing issues, consider seeking help from your child’s therapists or doctor.

8. Restless sleep

Autistic children sometimes have more restless sleep than other children and may engage in body-rocking, head-rolling, and head-banging. Although common, restless sleep can also indicate less common sleep disorders. If you’re concerned or if your child doesn’t respond to settling strategies, consult your child’s doctor.

Some autistic children take medicines that might have side effects affecting their sleep. Speak with your child’s doctor or a pharmacist to check if this could be an issue.

TIP

If you’re having trouble figuring out why your child has sleep problems, try keeping a sleep diary for a week. Track how much and when your child is sleeping, including any snoring, changes in breathing patterns, unusual movements, or difficulty breathing. Note observations about your child’s behaviour the next day as well. Sharing this diary with your child’s doctor and any specialists involved in their treatment can help identify patterns or environmental factors affecting their sleep.

What kind of effects do sleep problems have?

Children who don’t sleep well often experience more daytime behaviour problems, poorer attention, and higher anxiety. Good sleep is crucial for memory, learning, and better emotional management.

Lack of sleep can seriously affect a child’s life and health. In children with autism, poor sleep is linked to:

Aggression
Depression
Hyperactivity
More behavioural problems
Irritability
Poor learning and cognitive performance

In addition, children who don’t sleep well will disrupt their parents’ sleep, affecting the family’s well-being as well as their own.

If your child regularly has trouble falling asleep or wakes up repeatedly during the night, it might indicate a sleep problem. To know for sure, check with your child’s paediatrician. The doctor may refer you to a sleep specialist or an ear, nose, and throat doctor.

Read our article on

Better Sleep Strategies for Children with Autism

Reference

WHO (2019). Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age: Summary.