Autism and Sleep Problems: Understanding the Challenges and Solutions

Tuesday, October 29, 2024. This is for MH. If you get better sleep, you’ll be able to start your memoir.

Sleep can be elusive for many souls on the autism spectrum, with studies indicating that up to 80% of autistic kids experience sleep disturbances (Cortesi et al., 2012).

These challenges aren’t simply about being "bad sleepers." Instead, the nature of autism itself presents specific, often complex obstacles that make restful sleep hard to achieve.

1. Difficulty with Transitions and Sleep Routines

For autistic folks, transitioning from wakefulness to sleep can be a significant hurdle.

This difficulty with transitions relates to the way autistic minds are often wired to thrive on routines and predictability. Shifting from the day’s activities to the quiet of the night can disrupt their sense of stability and comfort.

Research shows that creating a structured sleep routine can help ease this transition.

For example, maintaining consistent bedtimes, using visual cues, and establishing a calming pre-sleep routine (such as reading the same book or listening to soothing music) can foster a greater sense of predictability, making sleep more accessible (Malow et al., 2006).

2. Autistic Inertia and Demand Avoidance

"Autistic inertia" is a term that captures how some autistic souls find it hard to start tasks or, conversely, to stop once they’re deeply involved.

When it comes to sleep, this inertia can mean that winding down for bed or deciding to get out of bed in the morning becomes a monumental task.

Paired with demand avoidance—resistance to demands perceived as overwhelming—these traits can contribute to a sleep pattern that resists regularity.

To address this, experts suggest breaking down the steps involved in preparing for bed into smaller, manageable parts.

A visual checklist can provide a straightforward roadmap, guiding the person through the steps of winding down and reducing the demands involved in transitioning to bed.

3. Co-Existing Conditions: Anxiety and ADHD

Sleep problems in autistic souls are often compounded by co-existing conditions, particularly anxiety and ADHD.

Both conditions are known to interfere with the ability to fall and stay asleep.

Anxiety, for example, can keep the mind alert and focused on potential threats or worries, while ADHD can disrupt the body's internal clock, making it harder to establish a consistent sleep-wake cycle (Taylor et al., 2016).

Behavioral therapies, such as Cognitive Behavioral Therapy for Insomnia (CBT-I), have shown promise in managing anxiety-related sleep disturbances.

For ADHD, melatonin supplements may help regulate sleep, though always consult a healthcare professional for personalized advice (Gringras et al., 2012).

4. Gastrointestinal Issues

Research has found that gastrointestinal (GI) problems are more prevalent in autistic individuals, with symptoms such as reflux, constipation, and abdominal pain being common (Coury et al., 2012).

These issues can significantly affect sleep, as pain or discomfort may prevent one from falling asleep or staying asleep through the night.

Dietary adjustments, as well as GI-friendly eating schedules, can alleviate some of these problems. For instance, reducing acidic or difficult-to-digest foods before bedtime may help reduce symptoms and improve sleep.

5. Sensory Overwhelm and Sleep Sensitivity

Autism often brings with it heightened sensory sensitivities. This heightened sensitivity means that certain textures, sounds, or lights can become intolerable.

For example, the sound of a fan or a flickering light outside the window might go unnoticed by some but become a substantial sleep disruptor for an autistic soul.

Creating a sensory-friendly sleep environment can be transformative.

Weighted blankets, which offer deep-pressure touch, may provide comfort for some, while blackout curtains or noise machines can eliminate sensory stimuli that might interfere with sleep. Testing different sleep aids can help identify what works best for each person’s unique sensory profile (Mazurek et al., 2013).

6. Challenges of Sleeping with Others

Sleeping with another person, whether a sibling, parent, or partner, can be challenging for autistic folks. The sounds, movements, and even the presence of another body in the room may lead to sensory overload, making it difficult to relax.

When sleeping solo isn’t feasible, establishing boundaries around shared sleeping space can help. For example, separate blankets, earplugs, or a body pillow between partners may help create a more comfortable arrangement that supports restful sleep.

7. Delayed Processing and the Challenge of “Turning Off” the Mind

Many autistic folks experience delayed processing, meaning that thoughts and sensations linger longer. This extended processing time can make it hard to “turn off” the mind when it’s time for bed. Racing thoughts or unresolved mental loops can lead to prolonged periods of wakefulness.

Engaging in a calming activity, such as reading or gentle stretching, can help ease the transition into sleep. Mindfulness exercises tailored for bedtime may also help by encouraging relaxation and gently redirecting the mind away from persistent thoughts (Reynolds et al., 2011).

8. Paradoxical Reactions to Medications and Sleep Aids? Yup.

Autistic souls sometimes experience paradoxical reactions to sleep aids or medications, meaning the effect can be opposite to what’s intended. Melatonin, for example, might work wonders for one person but lead to wakefulness or agitation in another.

It’s important to approach sleep aids with caution, starting with the lowest possible dose and carefully monitoring for unexpected effects.

Consulting with a healthcare provider knowledgeable in autism-specific needs is essential to ensure safe, effective use of any medication or supplement.

9. Effective Sleep Remedies for Autism

Managing sleep in autism may involve a multi-faceted approach. Here are a few proven strategies that can be helpful:

• Melatonin: Melatonin is commonly used to aid sleep in autistic souls and has been found effective in regulating sleep-wake cycles for many, though it may not work for everyone (Wright et al., 2011).

• Behavioral Sleep Interventions: Techniques such as gradually adjusting bedtime and using visual schedules can support consistent sleep patterns (Malow et al., 2006).

• Sensory Support: Weighted blankets, white noise machines, or blackout curtains may create a calming environment conducive to sleep.

• Routine and Consistency: Keeping sleep and wake times consistent, even on weekends, helps reinforce a stable circadian rhythm, benefiting sleep quality.

• Body Doubling. “Hey can you come get ready for bed with me?” Doubling, for some, increases motivation. Use your partner well. Ask them to get ready for bed with you.

• Bite Size Tasks. Break your bedtime routine into sequenced baby steps. Be curious. Notice how small preferences and gradual improvements arise.

• Consider Total Black Out Face Masks. There are new products coming with eye cups and weighted sleep masks. Your sleep quality deserves this sort of innovative tech. The neurodiverse live a life of the mind. Good sleep is essential for optimal brain function.

• Stay Hydrated. Hydration, for some, especially those with gastro-intestinal issues, is essential self care.

• Consider Yoga as a Bedtime Practice. This helps manny souls slow down their nervous systems.

• Intentionally Reduce Stimulus, and Move More Slowly as You Approach Bed Time. This actually helps with delayed processing of the events of the day.

Final thoughts

This is a very personal exploration for my clients on the spectrum.

Understanding sleep challenges in autism requires a compassionate and curious approach. A recognition of each person’s unique needs is utterly fundamental.

One size does not fit all.

By considering these specific factors and trying out individualized sleep solutions, we can support autistic individuals in achieving better, more restorative sleep.

Be Well, Stay Kind, and Godspeed.

REFERENCES:

Cortesi, F., Giannotti, F., Ivanenko, A., & Johnson, K. (2012). Sleep in children with autistic spectrum disorder. Sleep Medicine, 11(7), 659–664.

Coury, D. L., Ashwood, P., Fasano, A., Fuchs, G., Geraghty, M., Kaul, A., ... & Whitaker, A. H. (2012). Gastrointestinal conditions in children with autism spectrum disorder: developing a research agenda. Pediatrics, 130(Supplement 2), S160–S168.

Gringras, P., Gamble, C., Jones, A. P., Wiggs, L., Williamson, P. R., Sutcliffe, A., & Abdullah, A. (2012). Melatonin for sleep problems in children with neurodevelopmental disorders: randomized double-masked placebo-controlled trial. BMJ, 345, e6664.

Malow, B. A., Adkins, K. W., Reynolds, A., Weiss, S. K., Loh, A., Fawkes, D., ... & Clemons, T. (2006). Parent-based sleep education for children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 36(7), 841–852.

Mazurek, M. O., & Petroski, G. F. (2013). Sleep problems in children with autism spectrum disorder: Examining the contributions of sensory over-responsivity and anxiety. Sleep Medicine, 14(7), 668–675.

Reynolds, A. M., & Malow, B. A. (2011). Sleep and autism spectrum disorders. Pediatric Clinics, 58(3), 685–698.

Taylor, M. A., Schreck, K. A., & Mulick, J. A. (2016). Sleep problems in children with autism spectrum disorder: Prevalence, nature, & possible biopsychosocial etiologies. Research in Autism Spectrum Disorders, 24, 1–10.

Wright, B., Sims, D., Smart, S., Alwazeer, A., Alderson-Day, B., Allgar, V., & Whitton, C. (2011). Melatonin versus placebo in children with autism spectrum conditions and severe sleep problems not amenable to behavior management strategies: A randomized controlled crossover trial. Journal of Autism and Developmental Disorders, 41(2), 175–184.