Sleep disturbances are a common yet under-explored challenge for autistic individual. Restful sleep is elusive for many on the spectrum, making it difficult for them to fall asleep, stay asleep, or achieve restorative rest. These sleep difficulties often exacerbate core features of autism, such as repetitive behaviours, social struggles, and hyperactivity, creating a vicious cycle in which poor sleep worsens the very symptoms that make sleep difficult. Despite the profound impact sleep issues have on autistic people and their families, research into this area remains relatively sparse. However, some important findings have emerged about the prevalence, causes, and potential treatments for sleep problems in autism.

Prevalence of Sleep Issues in Autism

A 2019 study, one of the largest of its kind, revealed that nearly 80 percent of autistic children experience disrupted sleep, a rate significantly higher than in neurotypical children or those with other developmental conditions. Sleep issues are twice as common in autistic children as in their peers, and this trend continues into adolescence and adulthood. These problems range from trouble falling asleep to frequent nighttime awakenings, which means autistic children often miss out on the full benefits of a good night's rest.

Common Sleep challenges in Autism

Insomnia is the most common sleep disorder affecting autistic people. On average, individuals on the spectrum take about 11 minutes longer to fall asleep than neurotypical people and are more likely to wake up frequently during the night. Sleep apnoea is another condition that affects some autistic people, causing pauses in breathing during sleep, which further disrupts their rest. Moreover, sleep in autistic individuals is often less restorative. For instance, research shows that autistic people spend only about 15 percent of their sleep time in the rapid eye movement (REM) stage—essential for learning and memory—compared to the 23 percent typically seen in neurotypical people.

Consequence of Poor Sleep

The impact of poor sleep on individuals with autism is profound. Lack of sleep can intensify core autism traits, such as repetitive behaviours, irritability, and social difficulties. Research has also found that sleep-deprived children on the spectrum tend to have more severe social challenges and lower scores on cognitive tests. Whether these issues are a cause or consequence of poor sleep remains unclear, but the correlation is strong. For instance, a 2009 study showed that autistic children who struggled with sleep were more hyperactive, easily distracted, and prone to behavioural issues compared to those who slept well.

Why do Autistic People Struggle with Sleep?

The reasons behind sleep difficulties in autism are varied and complex. Many people on the spectrum also have co-occurring conditions, such as anxiety, ADHD, or gastrointestinal issues, each of which can disrupt sleep. For example, discomfort from gastrointestinal problems like constipation or reflux can prevent restful sleep. Sensory sensitivities, such as heightened sensitivity to light, sound, or touch, may make it harder for someone with autism to fall or stay asleep. Additionally, sleep problems can be linked to depression or anxiety, although it’s often difficult to determine whether these conditions cause sleep disturbances or result from them.

Medications commonly used to manage symptoms of co-occurring conditions can also interfere with sleep. For example, stimulant medications for ADHD are known to cause insomnia. Beyond these factors, genetic predispositions may also play a role. Research has uncovered that individuals with autism are more likely to carry mutations in genes associated with regulating the sleep-wake cycle or those related to insomnia. Some autistic people also produce lower levels of melatonin, a hormone that regulates sleep, further contributing to their difficulties.

Assessing Sleep In Autistic People

Diagnosing sleep problems in autistic people can be challenging. Polysomnography, a comprehensive sleep test that monitors brain activity, breathing, and body movements, is considered the gold standard. However, this test requires an overnight stay in a lab, which can disrupt the routines of autistic people and lead to unreliable results. As a workaround, some researchers have begun using portable polysomnography equipment in the homes of autistic people.

A more convenient, though less detailed, approach is actigraphy, where a wrist-worn device tracks a person’s movements throughout the night. Families may also be asked to keep sleep diaries, though these self-reported methods can sometimes be inaccurate. Regardless of the approach, identifying and understanding sleep problems in autistic people is crucial for improving their quality of life.

Solutions for Better Sleep

Addressing sleep issues in autistic people often begins with lifestyle and environmental adjustments. Establishing a consistent bedtime routine, setting regular sleep and wake times, and adjusting room temperature or lighting can all promote better sleep. Reducing sensory stimuli and creating a calming bedtime environment are particularly helpful for those with sensory sensitivities.

Melatonin supplements have emerged as a popular option to help autistic children fall asleep faster and stay asleep longer. Some studies suggest that melatonin not only improves sleep quality but also helps individuals with autism become more alert and engaged during the day. Better sleep often translates into better learning, improved behaviour, and fewer mood swings.

For some individuals, behavioural interventions like cognitive behavioural therapy (CBT) for insomnia may be effective. This type of therapy helps to address the negative thoughts and habits that interfere with sleep, making it easier for someone to develop healthy sleep patterns over time. Medications may also be considered when other interventions prove ineffective, although these should be used with caution and under medical supervision.

Conclusion:

Sleep problems are a significant concern for individuals with autism and their families. While many factors contribute to these difficulties, from co-occurring medical conditions to sensory sensitivities and genetic predispositions, a variety of interventions can offer relief. A consistent sleep routine, environmental adjustments, melatonin supplements, and in some cases, behavioural therapies or medications, can all help individuals on the spectrum get the rest they need to thrive. As research in this area continues to grow, it will hopefully offer even more insights and solutions to help autistic people achieve better, more restorative sleep.