Autism and Sleep: Empowering Children With ASD for Better Sleep

Coronavirus has had an enormous impact on all Americans’ sleep habits, but COVID-19 has been especially hard on children with autism who already deal with sleep-related issues.

It’s an especially critical issue because a new 2020 CDC report analyzing 2016 school data shows that autism is on the rise. The biennial update reports that one in 54 children is diagnosed with autism by age eight, up almost 10% from 2014.

“The world of autism has changed considerably since we were founded in 2005 when the estimated prevalence was 1 in 166,” says Autism Speaks President and Chief Executive Officer Angela Geiger.

Living with autism has its challenges, but life is made considerably more challenging when one isn’t armed with the sleep the body needs to function properly.

“Children with Autism Spectrum Disorder (ASD) are at an increased risk for sleep disturbances, and studies indicate that between 50% and 80% of children with ASD experience sleep problems,” says Dr. Rashmi Byakodi, a health and wellness writer and editor of Best for Nutrition. “It is also reported that sleep disturbances may increase behavioral problems in these kids.”

Children with autism have trouble with concentration, making it challenging to hold a conversation, make extended eye contact or keep still. They are easily distracted and prone to repetitive movements, making it hard to concentrate and focus. Children with autism are also prone to compulsive behaviors and may have delayed development when it comes to language or learning skills.

Autism can also have a significant impact on sleep patterns.

How Autism Affects Your Child’s Sleep

As a developmental disorder, autism attacks both a child’s behavior and the ability to communicate. Researchers aren’t sure exactly what causes autism, but several theories relate to environmental and genetic factors. Regardless, as a spectrum disorder, the effects of autism can be different from person to person.

New studies also show that sleep problems begin in infancy for children with autism, creating harmful sleep habits that carry on through later years. By preschool, nearly 80% of children with autism have sleep-related issues. Researchers identified higher growth within the brain’s hippocampus from six to 24 months of age, affecting its memory capabilities.

This can have a significant impact on a child’s ability to sleep. When the sun goes down and the house grows still, a child’s brain can sometimes be too hyperactive for sleep, making for a long and stressful night for both parent and child alike.

“Sleep issues in Autism are extremely common,” says Suman Chatterji, Founder and Editor of Ripples of Life. He is a special needs father and self-professed biohacker, mental health champion and researcher. “Being a father of a special need’s child, I live this on a daily basis. Autism is a very complex puzzle, and we all need to understand that there are some significant underlying biochemical imbalances associated with this diagnosis. Had there been no such imbalance, you would have had no Autism.”

Children can experience several different issues when it comes to their sleep.

• Difficulty falling asleep

Some studies blame the body’s circadian rhythm and an imbalance of melatonin, hypothesizing that the body’s biological clock actually works against itself, keeping the body awake even when it’s time to rest. While more research is required, it’s an exciting school of thought that can offer an immediate solution.

• Restlessness or poor sleep quality

Poor sleep has also been shown to increase when the child is prone to restricted and repetitive behaviors. This can include things like continually waving the hands, moving the feet, or lining up toys.

• Waking early and waking frequently

The inability to sleep through the night is a common and serious problem for children with autism. It can leave them feeling unbearably exhausted and unable to properly start the day when it comes time to wake up.

The consequences can range from moderate to severe. The effects of poor sleep on autism include:

• Anxiety
• Sensory problems
• Trouble paying attention
• Feeling restless
• Aggression and anger
• Hyperactivity
• Throwing tantrums

The added fatigue can also make children more tired during the day, interfering with their schooling and normal development. Studies already show that for children with autism, a lack of sleep can mean more problematic behavior than those who sleep better.

A licensed social worker, Sharon O’Connor specializes in neurodiversity and anxiety at Choosing Therapy. She explains: “When Autistic kiddos aren’t able to get the sleep they need, we might see more difficulty with self-regulation or sensory issues that seem more pronounced, because these elements become so much more difficult to manage when we’re sleep-deprived. We might also see a temporary loss of some skills – speaking or communicating might become more difficult, and a task previously done independently, like tying shoes, might now require support.”

For a child with autism, that inability can be enormously frustrating, but it’s more common than you might think.

How Common Are Sleep Disorders In Children With Autism

Autism Speaks reports that as many as 80% of children with autism experience sleep problems or sleep disorders. As many as four in five children suffer from one or multiple chronic sleep problems.

Studies suggest that a change in brain structure is what affects sleep problems associated with childhood autism.

While the average person spends about 23% of rest in the rapid eye movement (REM) stage, autistic children only spend about 15% in REM sleep in comparison. It means that sleep is far less restorative for an autistic child than it is for other children.

Many medications contain stimulants, which can keep children awake at night. Medications for ADHD are one typical example of insomnia-inducing sleep conditions.

Sleep issues in autistic children can have other repercussions, such as:

• Hyperactive behavior
• Gastrointestinal problems
• Attention deficit hyperactivity disorder (ADHD)
• Anxiety
• Sensory sensitivities to light, sound and touch
• Depression
• Epilepsy
• Restless legs syndrome

“From experience, the gut plays a significant role in sleep issues,” says Chatterji of Ripples of Life. “Most of the kids on the autism spectrum have an amount of gut dysbiosis, which results in various behavioral issues, including sleep. Conditions like SIBO, Leaky Gut or general inflammation of the gut can lead to pain, acid reflux, yeast overgrowth or growth of opportunistic and pathogenic organisms, which can cause havoc in a small body.”

That’s complicated enough, but about 95% of children with autism also have another co-occurring condition.

Autism-Related Behaviors

Even more concerning, at least 60% of children with autism live with two other related conditions, such as seizures, intellectual disabilities and gastrointestinal problems. Sleep issues are also widespread, but unlike the other conditions, they are easily treatable.

First, though, that requires a diagnosis, and that’s not always so easy to receive.

Issues with diagnosis

The CDC reports that screenings for autism are also increasing, with developmental screenings rising from 74% to 84% by the age of three. However, there’s an enormous disparity in the diagnosis between boys and girls, with boys four times as likely to be diagnosed with autism than girls. While one in 34 boys is identified with autism, only one in 144 girls was found to be affected.

There are other problems with the diagnosis of autism. Although autism can be detected as early as two years of age, most children are not diagnosed until after the age of four. There is also a lack of diagnosis amongst minority children, leaving them grossly underrepresented.

The earlier autism is detected, the sooner that medical professionals, parents and caregivers can begin to introduce sleep-forming habits that will reinforce better rest from a younger age.

How To Cope With Sleep Disorders In Children With ASD

COVID-19 has had a phenomenal impact on children with autism, disrupting already sensitive sleep schedules and further heightening the anxiety they feel daily.

“Anxiety is a common element of the autistic experience to begin with,” explains O’Connor. “Throw in a global pandemic and tons of upheaval and unpredictability, and it can increase that anxiety exponentially. Anxiety can adversely affect our ability to fall asleep, as well as our quality of sleep.”

She continues, “Times of major stress or change can lead to autistic burnout, when an autistic person may find themselves exhausted, with a temporary loss of certain skills. During these times, rest is so hugely important for recovery.”

Every child is unique and reacts to stress differently, so parents and caregivers should be patient and open to creativity in their sleep strategies.

Despite your child’s autism, there are still ways for your child to sleep longer and more soundly each night.

Optimize Your Child’s Sleep Setting

These are some tips that you can use in your home to help your child sleep better.

Check-in

Children may not always know how or why to express their trouble sleeping, so parents should take the initiative to regularly check-in and talk to their children about how they are sleeping.

Avoid upsetting material

In the hours before bed, make sure that your child avoids watching any TV, videos or games that may be disturbing.

Consider medical treatment

Sometimes, underlying issues are affecting a child’s medical or psychiatric well-being. Your child may be able to benefit from additional help through therapy or medication. This is especially recommended when a child experiences sleep apnea, sleepwalking, sleep terrors or restless legs syndrome. For children who are already being treated by medication, they could benefit from either an increase or change in medication or even behavioral therapy.

Adjust the thermostat

Science shows that cooler air is optimal for sleep, so watch the temperature in your child’s bedroom. Sleep experts recommend temperatures between 65° and 67° F in the bedroom. If your child tends to sleep without blankets or runs hot during sleep, adjust the temperature accordingly.

Restrict bedroom activities

It’s easy for games and toys to accumulate in your child’s bedroom, but that can be counter-effective when it comes to bedtime. Instead, keep all activities out of the bedroom, so it’s an area solely reserved for sleep. Your child’s brain will learn to associate the bedroom with sleep, automatically winding down instead of revving up for TV or games. If there are electronics or toys in the bedroom, keep them stored in a closed container so your child won’t be tempted to use them at the wrong time. Avoid screen time after 5 pm, so blue lights and LEDs do not keep your child up at night.

Chatterji, from Ripples of Life, explains that “stopping exposure to blue light or any iPad and television before bedtime helps in the production of melatonin.”

Use the S.L.E.P. method

This stands for Sleep, Learning, Eating and Play. Organize your room in such a way that there are designated areas for each time of the day. A desk in the learning corner and toys in another can help the brain reinforce the different parts of each day.

Consider a redesign

Children with autism live in a constant state of arousal, which can also have severe physical impacts on the body. To help eliminate this added stress and anxiety, reconsider their bedroom hygiene. Get rid of any overstimulating elements within the room and remove any blinking lights, humming machines or tangles of wires that can all prove visually distracting at bedtime. Instead, use colors, textures and furnishings that both calm and soothe. Skip the reds, oranges, yellows, and whites, and instead opt for colors that evoke relaxation, such as blues, greens, purples, browns and black. Invest in a new mattress that makes the bed a more comfortable place. Plants and essential oils can also help set the stage for sleep.

Chatterji adds that “essential oils like lavender helps with sleep. The compound linalool in lavender works as a mild sedative. Using Magnesium oil rubs and melatonin supplement 30 mins before bedtime helps as well.”

Daily Habits That Encourage Sleep

There are also some daily habits that you can use to encourage a better sleep quality each night.

Exercise

Exercise is one of the best natural ways to prepare the body for rest each night. Autism Speaks shares that children who exercise during the day tend to fall asleep faster and benefit from a more profound slumber. Keep in mind that exercising too close to bedtime could have the opposite effect, so try to schedule the physical activity for mornings or early afternoons.

Encourage independence

As much as children love to cuddle up to their parents, it’s also important that kids with autism learn the skill of independence. Your child needs to learn how to fall asleep alone, and creating a soothing bedroom atmosphere can make your child feel safe enough to fall – and stay – asleep.

Watch the naps

Naps can interfere with your child’s sleep at night. Though helpful for young preschool-aged children, naps should be kept at earlier times in the day and away from bedtime so your child won’t stay up all night.

Avoid caffeine

Caffeine is a popular stimulant that can keep your children awake all night. In addition to sodas and coffee, caffeine is also found in tea and chocolate. Caffeine can stay in the body anywhere from three to 12 hours after consumption.

Bedtime Routine

A bedtime routine is especially helpful for children with autism who have trouble sleeping at night. It helps to provide predictability and consistency in a world that feels largely out of their control.

Inconsistent sleep routines can also be a deterrent to healthy sleep. When a child does not have regular bedtimes and wake-up times, it can be hard for the body to know when to rest. For children with autism, bedtimes and wake-up times should be kept to the same times as possible to train the body to relax. Be sure to maintain this same wake-up and sleep times, even on the weekends and vacations.

“Having a fixed sleeping routine and time helps children. For example, having an Epsom salt foot bath, followed by lights off at 8 pm,” shares Chatterji.

It is also helpful to maintain the same routine throughout the day, with regular mealtimes and nap times, if necessary.

“I recommend doing a nighttime ritual before bed and sticking to a fixed sleeping schedule,” advises Stephen Light, a Certified Sleep Science Coach and co-owner of Nolah Mattress. “After the autistic child becomes accustomed to the routine, their body immediately knows to slowly transition to sleep mode when they do their nightly routine. In this scenario, sleeping time is easier since they associate a particular activity with bedtime.”

Sleep Toolkit

Much of our guide takes a proactive approach to your child’s sleep, but there are both active and reactive tools that you can employ to help your child adopt healthier sleep habits that last a lifetime.

Our Sleep Kit is designed to instill a sense of security, control, and peace within your child so sleep comes much easier each night. Children with autism can develop the proper routines and tools to empower them in their daily life, benefitting both child and parent alike.

Children living with ASD experience much higher stress levels than the average child, surrounded as they are by a world of constant stimulants. Having healthy ways to cope with this stress helps sleep and prepares children for a life with autism.

Creating A Visual Bedtime Routine

Children with autism can sometimes experience difficulty with verbal instructions, so employing the use of a visual bedtime routine can be an enormous help to your child’s daily routine.

A 2010 study argues that the “use of these visual artifacts has been shown to reduce the symptoms associated with cognitive, communication and social disabilities, particularly for individuals with autism spectrum disorder. These visual supports are used frequently to encourage communication and learning in children.”

Bedtime can be a fantastic opportunity to use a visual aid to reinforce your bedtime routine and help your child wind down for bed.

Our team understands that changes in routine can be difficult for anyone, especially for a child with autism. In an effort to make this resource accessible to all children, we’ve provided printable templates families can begin using tonight to co-create their child’s very own personalized bedtime routine. Creating a bedtime routine is a fun activity that can involve the whole family while arming your child with a renewed sense of independence and control during this adjustment period toward healthier sleep. Simply print the routine templates, below, and allow your child to begin creating their own routine with the tiles provided, or use the blank tiles for more personalized routine elements.

In preparation for this activity, we recommend parents use safety scissors to pre-cut the tiles for their child and work alongside them to place their routine elements (up to 10) into the visual bedtime routine template using non-toxic glue or tape.

Download these resources, here:

Visual Bedtime Routine Template

Visual Bedtime Routine Tiles (A)

Visual Bedtime Routine Tiles (B)

Implementing A Bedtime Pass

A bedtime pass can help reinforce bedtime for children who have autism. It is a photo card that uses a combination of photos and words that works as a cue card to help your child learn and repeat the bedtime routine each night. It also helps provide feelings of control and security when your child sees that the routine will be consistent and stay the same each night. As a parent, that means that if you are not home for bed one night, your child (and the temporary caregiver) can still take comfort in the visual cues provided on the card.

Autism Speaks also recommends its use for all ages. “A bedtime pass is a useful tool for older children,” the organization says. “This is a card (or another object) that your child can present to you if he/she wakes at night. Your child may use it to trade for something brief, such as a quick hug or a drink of water.”

To round out your child’s sleep toolkit, we have created this customizable bedtime pass that can be personalized for your child as well.

Considerations For Families

Research has shown that families with one autistic child have nearly a 20% chance of having another child or family member with ASD.

Explains Autism Now, “Families who have one child with an autism spectrum disorder face an increased risk of having other children who have cognitive impairments, psychiatric disorders, language delays, and social and communication difficulties.”

It’s always challenging to provide equal support when you have two children who are developing very differently. “I’m my children’s tour guide to the world,” explains one parent, “only I’m touring two different children in two different countries – one’s in France and one’s in Spain – at the same time.”

Regardless of how many family members have autism, parents of children with autism are known to have increased stress levels and are more likely to suffer from depression and anxiety. The entire family can also experience more significant stress, affecting family cohesion and rising tension within the family.

It doesn’t have to be that way, however. Several families have successfully adopted positive habits and methods that help the entire family adapt to life with autism.

Find a support group

Spend time with family and friends that serve as a supportive and positive outlet for you.

Incorporate the whole family

Find activities that the whole family can enjoy together. By finding a fun group activity, you reinforce positive interactions between family members that will last long after the activity is complete.

Create family rituals

Even the smallest ritual or tradition can reinforce those feelings of closeness and belonging that come with family.

Find time for relaxation

Life with autism can be incredibly stressful, so instead, incorporate relaxation exercises and meditation as a positive outlet for the whole family.

Stagger bedtimes

By separating bedtimes, you can spend one-on-one time with each of your children. It ensures that no child feels neglected or left behind.

Autism And Sleep Resources

There are plenty of organizations and resources that can help provide support and understanding for life with autism.

Bottom Line

Life with autism has its challenges, but healthy sleep habits can help arm children with the rest and strength they need to conquer each day.

“When autistic children don’t have enough sleep, they’re more unreasonable and difficult to understand,” says Light of Nolah Mattress. “Sleep is an essential part of growth and development, not just for kids with ASD, but for all children, in general.”

However, experts agree that children with autism have a significantly harder time sleeping at night.

“People with autism have incredibly high levels of adrenaline,” explains Dr. Michael E. Platt, author of Adrenaline Dominance. “Excess adrenaline is the number one cause of insomnia and anxiety.”

Chatterji agrees, thinking of his child. “The autistic brain works overtime 24/7,” he says. “It needs rest, and sleep is very important. Lack of sleep results in behavioral issues, attention deficit, and impaired learning and development.”

It may be more challenging for your child to sleep at night, but as a parent or caregiver, you can do much to create a more soothing environment that is more conducive to sleep.

Adjustments to medication can also be helpful, as well as other medical treatments and therapies. “A sleep study can be helpful to determine if there are any underlying issues like sleep apnea that might be impacting quantity or quality of sleep,” adds O’Connor of Choosing Therapy.

Life with autism doesn’t have to mean a lifetime sentence of sleepless nights. With some small adjustments to your child’s room and the added reinforcement of a routine, your child is likely to feel significantly more relaxed and secure when it comes time to count sheep. And as any parent knows, when your child sleeps, that means better sleep for the whole family, too.