About the Author: Dr. Yost Abrams received her PhD from the University of California, Berkeley and is a fellow with ZERO TO THREE. She is a parenting expert and early childhood researcher. Dr. Abrams specializes in parent-child attachment relationships, social-emotional development, and infant mental health.
Sleep problems, such as difficulty falling or staying asleep, are very common in all children–and even more so for children with developmental conditions such as autism and ADHD. You are not alone if you have ever felt frustrated or wanted to change something about your child’s sleep.
Sleep issues can profoundly affect children’s emotional, cognitive, behavioral, and physical health as well as the health and well-being of parents and overall family functioning. Here we explain some of the basics of sleep, steps for establishing a successful bedtime routine, and tips for addressing common autism sleep problems.
Sleep is a basic human drive, just like eating. In recent years, scientists have discovered that sleep is even more essential for our health and well-being than previously thought. Getting enough sleep restores our bodies and allows for critical brain functions to occur. Memories and learning from the day get consolidated when we sleep, helping us better focus our attention and retain the most relevant or important information. Sleep also helps our immune system, muscle growth, and emotional regulation.
You have probably heard of sleep stages. Essentially, sleep happens in two different phases during the night. One is called REM (rapid eye movement), during which we dream. Our eyes move back and forth, our heart rate increases, but our muscle tone drops so we cannot move around. The other phase is non-REM sleep, with 3 levels moving from light to heavy sleep.
Our circadian rhythm, or our body's “internal clock,” helps set when we feel tired and when we feel awake, and we produce a hormone called melatonin that helps keep that clock running.
Overall young children need around 10-13 hours of sleep a day (including naps). Typically, children with autism tend to need fewer hours of sleep than average. In fact, it is normal for children with autism to experience REM for 15% of their sleep cycle as opposed to the 23% required by children without autism.
Studies suggest this may be because children and people on the spectrum have a mutation in the genes that regulates the sleep-wake cycle and produces less melatonin. This phenomenon alone can require parents to adjust to autism sleeping habits and create a routine so their child can get as much restful sleep as possible.
Additionally, autism sleep issues can be caused by sensory sensitivities and difficulty blocking out certain sounds or sensations. Small irritants that people can typically sleep through, like pajamas made from a certain material or a muffled TV in the next room, can be disruptive to a person with ASD. That is why it is critically important to establish good sleeping habits at a young age.
Children and people with autism can experience a variety of sleep difficulties including insomnia, sleep apnea, and struggling to achieve a restful night’s sleep. In some cases, bruxism (teeth grinding) is another common problem autistic children experience during sleep. While insomnia tends to be the most common sleep issue, many children with autism can also wake up frequently in the middle of the night and even sleepwalk.
All this to say, there are ways to mitigate the symptoms of autism and sleep issues. Sleep is very important for all people within the neurological spectrum, and there is bound to be an effective solution for any child with autism who experiences sleep difficulties.
Knowing a little about the basics of sleep can help us set the right bedtime routine at the right time for our children. Children with autism are especially responsive to routines, but there may be some extra bumps or challenges along the way.
There are two essential parts to a successful bedtime routine. The first is timing—attempting to get your child to bed too early or too late will backfire. The second part involves the steps or activities within the routine. We want to help create a calming and relaxed atmosphere to fall asleep, not a never-ending series of power struggles and agitations.
For hitting that elusive sleep window where, just like Goldilocks, the timing is “just right,” pay attention to when your child naturally and easily falls asleep. Then start your bedtime routine about 30 to 45 minutes before that time and aim for a simple routine with calming activities. If things like bathing, brushing teeth, and getting into pj’s are challenges, consider moving them earlier in the evening.
Also, avoid snacks and screens within an hour of bedtime. Make a visual schedule of the steps and try to keep the order consistent each night.
Our bodies' energy levels naturally adjust throughout the day. It is important to make sure your child gets plenty of sunshine and physical activity during the day to promote better sleep at night.
When it is time to sleep, try lowering lights to help produce melatonin. If your child likes to be warm at night, try adding soft blankets to your child’s bed or placing a quiet fan in the room to lower the temperature. Creating a calming and comfortable environment is one of the most effective ways to mitigate symptoms of autism and sleep issues around bedtime.
Another way to improve autism sleeping habits is to incorporate your child’s sensory preferences into creating a calming and soothing environment. Consider the following:
Trouble falling asleep. It may feel counterintuitive but if your child is consistently taking longer than 20 minutes to fall asleep, you may need to move their bedtime later to catch their natural sleepiness. Try the calming activities mentioned above to wind down. Pay attention to the amount of light, physical activity, and possible caffeine in their diet during the day.
Waking in the middle of the night. Try to keep your child’s sleeping environment the same all night long. So, if they fall asleep listening to music or white noise, keep it playing throughout the night. Same goes for nightlights and fans. Also, do not have them fall asleep in one location and then move them somewhere else. Make a story about going to bed and what to do if you wake up in the middle of the night to read to your child during the daytime. Be prepared to respond calmly, with a simple “I love you, it’s time to go back to bed.” Keep lights low and voices soft, and gently escort them back to bed.
Waking too early. There can be a few possible causes of early waking. Some children simply are natural early risers, so a later bedtime and/or reducing daytime naps can help these children sleep a bit later. Make sure your child’s bedroom is at a cool
(but not too cold) temperature, and use black-out shades to block out early morning sunlight. Consider having a special bin of books and quiet toys that are just for playing with if your child wakes up before you are ready to start your day. If early waking is a sudden change, think about any recent differences in your child’s schedule or other family changes. Talk with your child about their feelings during the day to help process any changes. Sometimes simple exciting events like an upcoming birthday can temporarily disrupt a child’s sleep.