Sleep issues for autistic children

Good sleep is essential for all children, as it helps them grow, develop and learn.

For many autistic children, sleep problems are common and can present in various ways with various causes. Challenges with sleep for autistic children will often affect the entire family and require specific strategies to address, sometimes delivered through professional support. Understand what can cause common sleep problems in autistic children and how sleep quality can be improved. 

Common sleep problems

Autistic children can experience a range of sleep problems, affecting their ability to fall asleep, stay asleep or wake up feeling rested and refreshed. Some common sleep problems include:

Difficulty settling and falling asleep

Many autistic children find it hard to wind down and go to sleep. This can be due to anxiety, difficulty relaxing, or simply not understanding the importance of sleep. Some children may lie awake until very late at night; others might wake up very early in the morning.

Autistic children might not pick up on social cues that signal it's time for bed. For example, they might not make the connection between other family members going to bed and their own need to sleep.

Waking in the night and having difficulty returning to sleep

Waking up during the night is another common issue. Some children might wake up to use the toilet and then struggle to go back to sleep. Others might wake up multiple times for no apparent reason. It is not uncommon for autistic children to wake up during the night and engage in their favourite activities or make noise, which can be disruptive to both themselves and others in the household.

Anxiety

Increased anxiety or an inability to relax can cause insomnia. Anxiety can be related to various factors, including social interactions, changes in routine, or sensory sensitivities.

Melatonin and circadian rhythms

Melatonin, the hormone that regulates sleep patterns, might be irregular in autistic children. This can lead to disrupted or unusual circadian rhythms, which make having regular sleep-wake cycles difficult.

Sensory differences

Autistic children often have sensory sensitivities that can interfere with sleep. For instance, they might be more sensitive to blue light from screens, certain sounds, or white noise, which can distract them and keep them awake.

Food and eating challenges

Gastrointestinal issues caused by food allergies or sensitivities to substances like caffeine can also affect sleep. If you suspect food-related sleep issues, it's important to monitor your child's diet and consult with a healthcare professional.

Hypersomnia

Some autistic children might experience hypersomnia, where they sleep too much. This can be seen in children who find their daily routines stressful or overwhelming, such as having to navigate many different social situations without time to rest and recover. 

Co-occurring conditions

Co-occurring conditions like ADHD and epilepsy can also disrupt sleep. Seizures or the fear of having a seizure, in particular, can cause sleep issues.

Reduced sleep

Some autistic children sleep much less than what is typical for their age, which can affect their daytime functioning as well as the sleep quality of other family members.

Causes of sleep problems

Sleep problems in children with autism can have a variety of causes, some of which can be difficult to identify straight away. Identifying the root cause of an autistic child’s sleeping problems is an essential first step in addressing the issue or seeking professional support. 

Sleep issues in autistic children usually fall under two main categories: daytime habits and bedtime habits. Daytime habits that can cause or worsen sleep problems include poor diet, lack of physical activity and irregular daily routines or unexpected events, which can cause anxiety and distress. Bedtime habits refer to behaviours that can be changed in both the short and long term, ranging from too many stimulating activities before bed (e.g., screen time) to anxiety, toileting issues, night terrors/nightmares and co-occurring conditions.

Strategies to address sleep problems

Every autistic child is different, and any approach to improving their sleep must be based on their current abilities, circumstances and support needs. However, there are several strategies that families can try with their children or adapt to suit their children’s needs.

The first step in addressing sleep issues in an autistic child is to keep a sleep diary. A sleep diary involves recording as many observations about your child’s sleep as possible, such as when they go to sleep or how often they wake up. These observations can help you identify your child's sleep patterns and what might be affecting their ability to sleep. A sleep diary is handy when discussing sleep issues with professionals, such as teachers, GPs, dieticians or social workers. For older children and teenagers on the autism spectrum, a sleep diary can help them understand their sleep patterns and work towards better sleep habits.

Children often have difficulty understanding why sleep is necessary, particularly children with autism. You could use visual supports, children’s books or a customised social story to explain the concept of sleep and reassure your child that they are safe when sleeping.

Once you have used the strategies above, families can try the following suggestions to address sleep issues:

Bedtimes

Establishing a regular bedtime that aligns with your child's sleep needs is very important. Finding your child’s optimal bedtime is based on two key factors: when your child needs to wake up and how much sleep they need to function. For example, if your child needs 11 hours of sleep and needs to wake up at 7:00am, an 8:00pm bedtime is ideal. 

Helping your child adjust to a new bedtime will be a gradual process. You will first need to put them to bed when they are sleepy, which will usually be much later than their goal bedtime. You can then begin moving their bedtime forward by 15 minutes until they can go to bed at their ideal bedtime. Avoid changing your child’s bedtime on weekends and holidays, as this can confuse them and cause regression in their progress. Any and all progress towards this ideal bedtime should be praised and encouraged, no matter how small. 

Bedtime routine

A consistent and calming bedtime routine can help autistic children feel calm before bed, increasing their chances of developing a healthy sleep schedule. Here are some tips for creating a successful bedtime routine:

• Reduce screen time at least one hour before bedtime
• Provide clear and consistent cues each night when it is time for bed
• Prioritise activities that help your child to relax, such as having a warm bath, reading a book or listening to music
• Use positive reinforcement each time your child completes part of their bedtime routine successfully. A reward chart can help your child visualise their progress. If your child wakes up during the night or does not follow the routine, redirect them as calmly as possible.

Using visual supports to explain your child’s bedtime routine to them can be very helpful in the early days. Examples could be pictures of the child completing routine steps with simple descriptions underneath. Having these supports somewhere your child can easily access (e.g., on the wall of their bedroom) can help ease their anxiety and increase their independence in completing this routine as they get older. 

Bedrooms

Having a safe, comfortable and calming bedroom will improve an autistic child’s sleep quality and help them understand what sleep is. When setting up or changing your child’s bedroom, it is important to consider their preferences, sensory sensitivities, support needs and any behaviours of concern. 

Here are some tips for creating a more comfortable sleeping environment:

• Block out light: Many children with autism are sensitive to light and may be woken up by sunlight more easily than other children. Use dark curtains or black-out blinds to create a dark sleeping space. 
• Reduce noise: Use thick carpets, close doors, turn off nearby appliances and move your child's bed away from noisy walls. Consider placing earplugs or headphones in your child’s room that they can use to block out noise or to listen to calming music or sounds before bed.
• Consider fabrics: Many autistic children have sensory sensitivities relating to touch, particularly the feeling of certain fabrics and clothes. Try to purchase bedding and pyjamas made from fabrics that your child is already comfortable with - allowing them to feel the fabrics before buying can help. Removing tags and labels from bedding and pyjamas can also prevent sensory overload.
• Reduce smells: Using unscented cleaning products in and around your child’s room can prevent sensory overload triggered by smells. Avoid using air fresheners or spraying perfume in or near your child’s room. Closing their bedroom door when you are cooking can also help. Some children might find scented oils like lavender relaxing before bed. However, it is important to try them in very small doses to build up your child’s tolerance if you plan to use them. 
• Remove distractions: Keep electronic devices out of the bedroom and remove any distracting items from the walls (e.g., bright posters, lots of toys). You may need to gradually remove toys from your child’s room, as removing most of their toys all at once will likely cause distress. If possible, avoid painting their bedroom walls brightly. 
• Consider temperature: A room that is too hot or cold will make it difficult for your child to sleep. Try to keep their bedroom temperature slightly cooler than the rest of the house so they are encouraged to stay in bed.
• Prioritise relaxation: Try to keep exciting and stimulating activities (e.g., playing with siblings, using an iPad) outside of the bedroom, particularly in the hours leading up to bedtime. Instead, use your child’s bedroom for relaxing activities, such as reading a book or listening to quiet music.

Independent sleep

Some autistic children develop very strong sleep associations, a common one being needing to sleep next to their parent or carer. These children can become very distressed if their parent or carer moves away from them, affecting sleep quality for the entire family.

Using visual supports (e.g., a child sleeping alone in their bed) and rewards can help children to stay in their own bed or remain safe and happy in their own room. If your child will only fall asleep with a parent or carer next to them, gradually move further away each night until they can sleep independently. 

Daytime habits

Prioritising healthy habits during the daytime can help autistic children feel tired and be more willing to go to sleep. A healthy diet limiting caffeinated foods and drinks (e.g., chocolate, fizzy drinks) after 3:00pm can help your child’s energy levels to wind down naturally. Consider adjusting the time your child eats dinner so they do not go to bed too full or too hungry.

Physical activity must also become a priority in your child’s daily routine, as this helps them to use their energy while keeping fit and healthy. Toddlers and preschool-aged children should exercise for at least three hours daily, including one hour of energetic play (e.g., running, jumping, playing tag or playing ball games).

Phasing out naps as your child ages can help them to sleep through the night. Most children will outgrow naps by age five, and any child who continues to nap at this age should be limited to 20-minute naps only. You can learn more about phasing out naps in children of different ages here.

Anxiety

Addressing anxiety and stress is essential for helping children to relax before bedtime and avoid sleep disruptions. Add calming and relaxing activities to your child’s daily routine, particularly in the hours before bedtime, can help. Encouraging your child to share or express their anxiety, either in conversation or through other activities like drawing, can also help children work through what is worrying them to avoid fixating on it as they try to fall asleep.  

Toileting

If bedwetting or toileting issues are disrupting your child’s sleep, consider seeking professional support. Our website has more information on toilet training for autistic children, and you can speak to health professionals for targeted support.  

Professional support

Many sleep problems experienced by autistic children require professional support. Speaking to your GP, paediatrician, or other health professionals supporting your child is important, as they can provide evidence-based and targeted strategies. This is particularly important for autistic children affected by biological factors, persistent illnesses and severe sleep disturbances.

Diets, medications and sleep

If you believe eating challenges or gastrointestinal issues are affecting your child’s sleep, it is important to seek medical advice from a GP, paediatrician, or dietitian. They can determine if this is the case and provide effective, evidence-based treatment. As mentioned above, limiting your child’s consumption of sugary foods and fizzy drinks, especially before bedtime, can help them relax in the evenings and fall asleep. You can also find more information on our website about addressing eating challenges and making mealtimes fun.

Some children and adults benefit from medications designed to help people fall asleep and stay asleep. It is best to try approaches that do not involve medication first and then consider medication if these solutions have not worked. Seek professional advice from a GP or paediatrician before trying new medications or stopping current medications, as doing this without medical clearance can cause other health problems. 

Melatonin is a hormone that our body produces naturally when it gets dark to help us fall asleep. Issues with melatonin production can make falling and staying asleep harder. By taking melatonin supplements, some children will fall asleep faster, sleep longer and wake up less during the night. These supplements are only available via prescription from a GP or paediatrician, who can assess your child’s sleep quality and advise if this medication is right for your child. They can also determine how sleep medications will interact with other medications your child takes and can give advice about managing side effects or reactions. 

There is plenty of discussion online about the impact of specific diets and medications on autistic children, and much of it is not supported by science. It is important to remember that any diet, medication or therapy that claims to ‘cure’ an autistic child’s sleep problems is probably too good to be true. Always seek guidance from a medical professional before changing your child’s diet or medications.

Sleep for parents and carers

When an autistic child struggles with sleep, their parents and carers will, too. Many parents and carers struggle to relax and sleep after spending hours helping their children go to bed or stay asleep. Others may develop anxiety around what will happen to their child when they are asleep, particularly if their child has self-injurious behaviours or tries to move around the house unsupervised at night. 

Making your child’s room safe and comfortable can help ease your anxiety about them harming themselves while you sleep. Families could put child-proof locks on cupboards or move heavy furniture or objects out of the room. You might also like to install monitors in your child’s room to help you check that they are safe without having to go to their room. 

When sharing your or your child’s sleep struggles with others, it is common to be met with plenty of advice based on the experiences of neurotypical children and their parents. Do not feel pressured to take this advice if you know it does not relate to you or your family. Remember, as long as you and your child are safe, you are doing your best. 

Supporting an autistic child with sleep problems, particularly when you are sleep-deprived yourself, can be incredibly challenging. Seeking external support for your child and yourself can reduce this pressure and improve your health and wellbeing. Asking other family members or paid carers to help look after your child during the night can help you get a good night's sleep, as can using respite services if you are eligible. Speaking to your GP, paediatrician, and other health professionals supporting your child can also help you discover new, evidence-based strategies to try.