About sleep problems in autistic children and teenagers
All children can sometimes have problems getting to sleep and staying asleep. Autistic children can have particular sleep and settling difficulties, including:
- irregular sleeping and waking patterns – for example, lying awake until very late or waking very early in the morning
- sleeping much less than expected for their age, or being awake for more than an hour during the night
- getting up and playing their favourite activity or making noise for one or more hours during the night.
Causes of sleep problems in autistic children
Autistic children’s sleep problems are sometimes related to their:
- bedtime habits
- daytime habits.
Sleep problems for autistic children can also be caused by or related to things like:
- biological causes
- illnesses and health conditions
- night terrors and nightmares
- restless sleep
- social communication difficulties.
When you understand what’s causing your autistic child’s sleep problems, it can be easier to work out the most appropriate way to solve the problems.
If you’re having trouble working out why your child is having sleep problems, try keeping a sleep diary. By writing down your child’s sleep behaviour, you might start to see a pattern, or notice something in the environment that could be affecting your child’s sleep. This record of your child’s sleep behaviour will also be useful for any professionals working with you and your child.
Some sleep problems are related to what children are doing before bed and when they go to bed. What time they go to bed and where they go to sleep are also factors. For example:
- If your child has a lot of noise, activity and excitement before bed, it can be harder for them to feel calm and ready for sleep.
- If your child does things differently each night before bed, they might not get predictable cues that it’s time for bed and sleep.
- If your child is used to falling asleep somewhere other than their own bed – for example, in the family room – it can be hard for them to fall asleep in their own bed.
- If your child needs all their toy cars lined up on the bed before they’ll go to sleep, this can make it hard if one of the cars isn’t there. It can also make the bed uncomfortable.
- If your child’s sleep environment is too hot, cold, light or noisy, this can make it hard for them to get to sleep. This can be a particular issue for autistic children with sensory sensitivities.
Our article on helping autistic children settle and sleep better explains how you can work on these kinds of problems with positive bedtime routines, regular bedtimes, healthy sleep associations and comfortable sleep environments.
Some sleep problems are caused by things like unhealthy eating habits and lack of physical activity during the day. You might be able to sort out these problems by making some simple lifestyle changes. These include encouraging your child to:
- do more physical activity – aim for several hours of physical activity a day including at least an hour of energetic play, like running and jumping
- have their evening meal at a time that lets them go to bed feeling not too hungry but not too full
- avoid caffeine and excitement in the evening
- avoid long and late daytime naps for children aged over five years.
Sleep problems often start to get better after 2-3 nights of changing your child’s bedtime and daytime habits. But for some children it can take 2-4 weeks. If you don’t see any improvement, it’s best to see your GP in case there’s a medical or other problem. You might be referred to a paediatrician, psychologist or other health professional experienced in treating children’s sleep.
Autistic children who experience anxiety often have difficulty falling asleep. It’s best to avoid talking about things that might make your child worry at bedtime. Instead, try to talk with your child about their fears during the day.
Sleep relaxation strategies for children might also help.
Bedwetting and toileting
Late toilet training and difficulties with toilet training are common in autistic children. If your child isn’t dry at night, your child might wake because they’re wetting the bed. Or your child might wake to go to the toilet and then won’t go back to bed.
You might consider getting some help if toilet training and bedwetting are problems for your child. For example, you could start by talking with your child’s therapists. If there’s a persistent problem, you could also talk to your child’s GP.
For autistic children, sleep problems can also have biological causes. For example, sometimes the hormones in the brain that control sleep are released differently from the way they’re released in typically developing children. This can mean that some autistic children aren’t ‘tuned in’ to their own need for sleep. Speak to your child’s GP if you think this could be affecting your child’s sleep.
Illnesses and health conditions
Like all children, autistic children can suffer from illnesses – colds or ear infections – that make it hard for them to settle or sleep well. Also, when your child is sick, your child’s bedtime routine might change.
Once your child is better, gradually change the bedtime routine back to the usual one. Rewarding your child for making changes will help get the routine back on track.
Night terrors and nightmares
Some sleep behaviour can look like a problem but is actually typical for all children. This includes:
- night terrors, which is when children suddenly get very agitated while deeply asleep – these are normal in children aged 2-12 years
- nightmares, which are bad dreams that can wake children up and and make it hard for them to get back to sleep – these are normal for children of all ages.
Talk to your child’s GP if you’re concerned or your child’s behaviour seems severe.
Autistic children sometimes have more restless sleep than other children. In particular, they might be prone to body-rocking, head-rolling and head-banging. Although quite common, restless sleep can also be a sign of some less common sleep disorders. It’s best to consult your child’s GP if you’re concerned or your child doesn’t respond to settling strategies.
Some autistic children take medications that can have side effects that make it harder for them to settle to sleep. Speak with your child’s GP to check if this could be a problem for your child.
Social communication difficulties
Some sleep problems in autistic children can be caused by social communication difficulties. For example, your child might be kept awake by something they need but can’t ask for. It might help to work on your child’s communication skills.
Sometimes social communication difficulties might mean your child doesn’t notice that other people in your family are getting ready for bed. A regular and positive bedtime routine can help your child realise it’s bedtime.
Medication for autistic children with sleep problems
Before trying medication, it’s always best to try behaviour solutions like changing your child’s bedtime routine. But medication has been found to help some autistic children.
For example, melatonin supplements might help some autistic children fall asleep faster, sleep for longer and wake up fewer times in the night.
If you’re interested in melatonin for your child, you’ll need to get a prescription from your GP or paediatrician. These health professionals can prescribe the right dose and give you information about melatonin and any possible side effects or interactions with other medicines. They’ll also monitor your child while they’re taking the medication.