Good sleep for autistic children

Good sleep is about getting to sleep, staying asleep and getting enough good-quality sleep. All children, including autistic children, need enough good-quality sleep for growth, development and learning.

How long it takes children to get to sleep and settle back to sleep when they wake in the night can depend on things like:

• what they do before they go to bed
• when they go to bed
• what they need to get to sleep
• where they go to sleep
• what they do during the day.
• how they feel about being separated from you.

How to help autistic children sleep better: tips

The tips below help children develop healthy daytime and bedtime habits that promote sleep. They can help all children, including autistic children, sleep better.

If your autistic child has specific problems with falling asleep and waking in the night and the tips below don’t seem to be working after 2-4 weeks, it’s a good idea to seek help. Talk with your GP or another health professional about the best strategies for your child’s situation.

1. Set up a bedtime routine

A regular bedtime routine starting around the same time each night encourages good sleep patterns.

If your autistic child is younger, a bedtime routine of bath, story and bed can help them feel ready for sleep.

If your autistic child is older, a bedtime routine might include family time or a quiet chat with you about the day and then time alone relaxing before lights out.

How to help your autistic child get used to a bedtime routine

• Give your child clear and consistent cues when it’s nearly bedtime. For example, 30 minutes before bedtime, start some quiet activities like reading or drawing in the family room. Then 15 minutes before bedtime, get your child to clean their teeth and go to the toilet.
• Use a visual support with pictures showing your child’s bedtime routine, so your child understands the steps. For example, put on pyjamas, clean teeth, go to the toilet, get into bed, have a bedtime story, and turn out the light.
• Praise your child when they try to follow the steps in the routine. You can also put stickers or ticks on the visual support to show when your child completes a step.
• If your child gets upset or wakes during the night, quietly and calmly put your child back to bed. Settle them and remind them of the sleep routine using words or pictures. Also let them know you understand it can be difficult to sleep on their own or if they’re feeling anxious. You might need to do this many times.
• If your child is older, talk with them about what helps them feel relaxed and calm before bed and how they want to personalise their bedtime routine.

Once your child has a positive bedtime routine, you might find that your child settles well when they can follow that routine. But your child’s sleep problems might come back if the routine changes. You might be able to handle this issue by planning and preparing for changes to your child’s routine.

2. Set regular and appropriate bedtimes

Regular and appropriate bedtimes can help your autistic child get the sleep they need.

Step 1: work out the best time for your child to go to bed

You can do this by working out:

• when your child needs to get up
• how much sleep your child needs to be well and alert during the day.

For example, you might notice your child generally needs 11 hours of sleep. You also know you won’t make it to school on time unless your child is up by 7 am. This means that 8 pm is the ideal bedtime for your child. Your evening activities – dinner time, pre-bedtime and bedtime routines – should take this ideal bedtime into account.

Step 2: move your child’s sleepy time towards their ideal bedtime

To start with, put your child to bed when they’re sleepy. At first, this might mean that your child stays up later and starts their bedtime routine a bit later.

Once your child is falling asleep quickly, move the start time for the routine back by 15 minutes every 2 days. It might take a few weeks, but your child should start to feel sleepy earlier until they’re going to bed at the desired time.

Until your child is good at settling to sleep, try to keep the same bedtime at weekends and holidays.

It’s best to introduce new bedtimes, bedtime routines and sleep habits gradually. It’s also important to acknowledge that new routines can be tricky and to praise and encourage your child as you make the changes.

3. Set up healthy sleep associations

Sleep associations and habits are the things that children (and adults) need to settle for sleep. When children wake at night, they need the same things to go back to sleep.

For autistic children, sleep associations and habits can be very strong. They might include falling asleep while lying next to a parent, while watching TV or after using an electronic device.

If you’d prefer your child to fall asleep by themselves in their own bed, you might want to help your child develop some healthy sleep associations. Here are ideas:

• Use pictures of your child sleeping in their own bed as part of a visual support.
• Calmly and quietly return your child to their own bed if they get up after lights out.
• Praise and encourage your child as you make the change.

If your child falls asleep only when you’re next to them, you could try sitting on the edge of the bed or on a chair next to the bed. Gradually move away from your child each night as your child gets better at falling asleep alone.

4. Set up a safe and comfortable sleep environment

Some sleep environments can make it harder for children to get to sleep.

Start by checking that your child’s sleep space is quiet, dimly lit, and neither too hot nor too cold.

Also, gradually remove objects that might stop your child from sleeping comfortably. For example, a favourite soft toy in the bed might be OK. But if your child has a whole collection of toy cars in their bed, it might make it hard for your child to get comfortable in bed. You could encourage your child to put 1-2 cars per night into a box next to their bed.

5. Avoid caffeine, screens and excitement before bed

Caffeine is in energy drinks, coffee, tea, chocolate and cola. Make sure your child avoids these foods and drinks, especially after 3 pm.

Your child might be more likely to relax and settle for sleep if they also avoid excitement, TV and electronic devices in the hour before bed. If your child relies on using a device to help fall asleep – for example, by watching their favourite cartoon – use blue light filters or put the screen into night mode.

6. Eat the right amount at the right time during the day

What and when your child eats and drinks can affect their ability to settle down at night.

In the morning, a healthy breakfast helps to kick-start your child’s body clock at the right time. And in the evening, plan dinner so that your child is satisfied but not too full when they go to bed.

7. Get enough physical activity during the day

It’s a good idea to encourage your child to be more active during the day. For example, even a family walk before dinner can make a difference. And it’s great if your child can be active outside, because plenty of natural light during the day also helps with sleep.

Australian physical activity guidelines

• Preschoolers should be physically active for at least 3 hours a day, including at least an hour of energetic play, like running and jumping.
• School-age children should do several hours of light physical activity and at least one hour of moderate to vigorous physical activity each day.

8. Keep older children’s naps early and short

If your child over 5 years is still napping during the day, try to keep the nap to no longer than 20 minutes and no later than early afternoon. Longer and later naps can make it harder for children to get to sleep at night.