Autism and Sleep

Understanding the links between autism and sleep ›

Tips for improving sleep for children with autism

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Frequently asked questions ›

Tips for improving sleep for children with autism

Sleep difficulties in autistic children

Sleep difficulties occur in 50-80% of children with autism and are often accompanied by child and family distress.1

Disordered sleep may also worsen the core, and related, symptoms of autism including social interactions and repetitive behaviours. Therefore, interventions that target sleep may not only improve your child’s health, and reduce whole family distress, but may also improve the core, and related, symptoms of autism.2

A guide for parents and carers of children with autism experiencing difficulty sleeping. This leaflet describes why sleep is important for children with ASD and provides tips on what can be done to improve sleep behaviour and hygiene. 

Help your child to sleep better

Here are some strategies to help. You will need to adapt them to suit your child’s needs and their level of understanding. Many parents can help their children to develop better sleeping habits by putting into practice the various tips described on this site. When putting these tips into practice you may want to consider:

  • Choosing ideas that fit well into your family’s lifestyle
  • Only begin implementing the plan when you have the time and energy to assess whether it is
    working
  • Try one small change at a time, then slowly add more changes
  • Be patient. Sometimes you have to persist for 2 weeks or more to see a change

Here are some tips – good luck:

 

1. EXPLAIN SLEEP

Children can have difficulty understanding the need for sleep. A fictional story written by a consultant neurodevelopmental paediatrician, Dr Susan Ozer, explains the importance of sleep and is aimed at children with autism and/or ADHD aged 7-11 years.

A fictional story about the importance of sleep aimed at children with ASD and ADHD aged 7–11 years.

2. KEEP A SLEEP DIARY

A sleep diary, such as the SNappD®, sleep and nap diary app, can be very helpful to identify your child’s sleep pattern and any underlying problems. Record your child’s sleep and wakefulness throughout the day and night over the period of two weeks. This will enable a healthcare professional to develop a sleep plan to establish a regular night-time sleep pattern for your child.

If your child is young and still takes naps, maintain a regular schedule of the naps. If possible, the nap should take place in the child’s bedroom. Wake your child from their afternoon nap before 4p.m. or it will be difficult for them to fall asleep at night. If your child is older and no longer needs to nap, don’t let them nap unless they are unwell. Older children who sleep during the day will have more difficulty sleeping at night.

If you would like to capture sleep statistics for your child, the free Sleep Nap Diary App is available to download. 

SNAPPD – THE SLEEP NAP APP DIARY

SNappD is a simple-to-use sleep and nap diary app that allows sleep statistics, and the impact of poor sleep, to be recorded. Records demonstrating sleep behaviours can also be forwarded to a medical professional.

Find out more

3. CREATE A REASSURING BEDTIME ROUTINE

Establish a basic, short, ordered routine for the evening, which can be followed anywhere. A good routine will help your child learn how to relax and prepare for sleep. It should include calming activities and the predictability of the routine will calm your child each night.

Remember to start the bedtime routine at the same time, and in the same order, every night. As much as possible, your child should have the same bedtime and wake-up time 7 days a week.

Choose a bedtime that is appropriate for your child’s age. Bedtime should be tailored to your own evening schedule to help maintain a consistent routine each night. If your child’s schedule needs to change, due to new activities or family events, be aware of the impact this change has on their sleep. It may be necessary to develop a new schedule or return to the old one that worked well as soon as possible.

Bedtime will be later as your child gets older, but it should always be established to allow enough sleep each night.

Recommendations for how much sleep children need →

Autistic children may benefit from a visual schedule (e.g., pictures, words, or both) to help them remember each step. This will help your child understand that their bedtime routine will consist of the same events in the same order every night. A visual schedule will also help other family members, and caregivers, follow the order of the routine.

For children who are sensitive to images, objects can be used, and each stage of their bedtime routine can be represented by an object that is used during that stage.

BEDTIME CHECKLIST

A checklist of things to consider when developing your child’s personalised bedtime routine

Find out more

Determine which events calm your child and which events stimulate them. Events that calm your child should be part of the bedtime routine. Events that stimulate should be completed earlier in the evening. For example, if the bath has an exciting rather than relaxing effect on your child, move this to earlier in the evening.

To make a bedtime routine for your child, you can print, cut out and assemble the pictures. Pictures can either be coloured in, by you or your child, or already coloured.

Download bedtime checklist →

Download bedtime routine for colouring →

Download a coloured bedtime routine →

You may want to reward your child for following the schedule appropriately for example by giving them a hug or by simply saying, “Thank you for following your schedule”.

Families often wonder what impact changes in one child’s sleep patterns will have on their other children. The impact of a consistent bedtime ritual is often beneficial for everyone.

It may be helpful to think about how siblings can help each other to fall asleep. Allowing all children to use a visual schedule can help the child who has trouble sleeping to use this visual schedule. When everyone in the family is doing the same thing, sometimes it’s easier for your child to learn a new skill.

Some families find it easier to put their children to bed at slightly different times. This allows parents to give each child one-on-one time before bedtime. If your children go to bed at different times, consider the noise level for the child who is falling asleep.

4. Encourage and establish good sleep habits

Having both a bedroom environment and daily routines that promote consistent, uninterrupted sleep (often called sleep hygiene) can help, and specialists have created parent-guided programmes to help improve sleep in children with ASD.

In some cases, children with significant sleep disturbances may need to be evaluated by a sleep specialist.

During the day:

  • Exercising during the day helps your child to sleep better at night. Children and adults who exercise find they fall asleep easier at night and have deeper and better quality sleep. If your child doesn’t exercise regularly at school, try to schedule some at home. Ensure, however, that your child exercises earlier in the day because stimulating exercise near bedtime makes it harder to fall asleep. So, make sure that all difficult or strenuous activities end 2 or 3 hours before bedtime.
  • Another essential part of establishing a routine for your child is mealtimes. Your child should eat breakfast around the same time each morning, weekdays and weekends. At the end of the day, avoid offering your child overly large meals and hearty snacks late at night. A light snack or warm drink could, on the other hand, help your child to fall asleep more easily.
  • Good Morning Sun, Good Night Moon. Exposure to sunlight in the morning and darkness at night also helps to maintain a regular schedule. When your child wakes up in the morning, open the curtains and let natural light into the house. If your child goes to bed while it’s still light, make sure the spaces for the bedtime routine are dimly lit and the bedroom is dark.

Find out how light and darkness help to regulate our sleep-wake rhythms →

Before bedtime:

  • Avoid caffeinated drinks and foods which can stimulate your child’s brain and keep them awake. Some children sleep better when these products are completely eliminated from their diet. Most children manage to sleep by simply avoiding caffeinated foods and drinks several hours before bedtime.
  • As much as possible, limit your child’s screen time with gadgets (TV, tablet, games console, smart phone) 1 to 2 hours before bedtime. In addition, blue light from the screens can affect the secretion of a natural sleep hormone, melatonin, making it difficult for your child to sleep.

Understand more about how melatonin works →

  • Use relaxation techniques for example, gentle exercise, a warm bath, a massage, reading or listening to soft music.

5. Create a comfortable and consistent sleeping environment

It is important to create a calm sleeping environment for your child, where they feel safe. Wherever your child sleeps, they should have their own space to sleep at night. This can be a designated part of a shared bed, or their own bed, but it must be the same space each night.

The bedroom:

  • Ensure your child’s bedroom is comfortable, safe, and not too cold or too hot
  • Keep the bedroom free from toys and clutter which can be very distracting. Remove electrical devices such as television, games consoles and smart phones from the bedroom
  • Many children with autism have sensory problems:
        • Try to reduce noise levels for example, by shutting doors completely, moving your child’s bed away from walls where noise may travel and use earplugs if needed
        • Block out light using dark curtains or black out blinds
        • Ensure comfortable bedsheets and night clothes and cut off labels if your child finds them itchy
        • Reduce smells coming into the room by closing the door fully, or by using scented oils that your child finds relaxing

Teach your child to fall asleep alone

Why should children learn to fall asleep on their own?

Children and adults naturally wake up several times a night. Every time we wake up, we check our sleeping environment and then quickly fall back to sleep. These awakenings are so short that we often do not remember them in the morning.

If your child can’t fall asleep on their own at night, they’ll also have a hard time falling back to sleep without your help every time they wake up at night. If your child learns to fall asleep on their own, they can also learn to fall back to sleep when they wake up naturally at night and will wake up more rested in the morning.

How do you teach them to fall asleep on their own?

Just as your children learn over time to fall asleep with your help, you can teach them to fall asleep on their own. This should be done gradually, over several weeks. For example, if you usually go to bed with your child at night, you can change your habit by sitting on the bed a few nights in a row, then sitting in a chair next to the bed. Continue to sit in the chair but move it a little further away from the bed each night until you are out of the room and out of eye contact with your child. While implementing these changes, reduce the amount of attention you give your child, through speech, facial expressions or eye contact.

Once you are out of your child’s room, if they are restless and not sleeping, you can wait a few minutes and then go back into the room to check on them. When you enter the bedroom, stay there briefly (less than a minute) and limit physical and verbal contact by saying softly, but firmly: “It’s time to sleep now”, “Everything is fine. Good night.” You should then leave the room.

If you need to come back to the room, wait a little longer each time before going back in and make short visits each time. Once your child is able to fall asleep on their own, you can use the same techniques if they wake up at night or too early in the morning.

The “sleep card” – a tool for learning

The “sleep card” is a useful tool for older children. This is a card that your child can present to you if they wake up during the night. Your child can trade it for something brief, like a little hug or a glass of water.

You must teach your child that they can only use the card once per night and that when the card has been used, you keep it. You will return the card the following night so that they can use it again if needed.

Explain to your child that if they don’t use the card all night, they can exchange it for a gift in the morning. You can also set up a reward system. For example, each night that your child does not use the card, they receive a sticker or a “sleep point”. If your child collects a certain number of these points (five for example), they receive a special gift. Gifts can be small gifts or a special outing with you.

Download the sleep card →

What should I do if, despite my changes, my child’s sleep has not improved enough?

Sleep disorders can have significant consequences for your child and also for the whole family. It is therefore best to always talk to your child’s doctor so that they can assess your child’s sleep once the good sleep-wake habits are in place.

If sleep disorders are not sufficiently improved, your child’s doctor may find it useful to explore possible medical reasons why your child is not sleeping well and whether there are any medicines that could help them sleep better.

More information about seeking help from a healthcare professional for sleep disorders in children with ASD →

REFERENCES:
  1. Malow, B.A. 2021. ‘Sleep, Growth, and Puberty After 2 Years of Prolonged-Release Melatonin in Children With Autism Spectrum Disorder’, Journal of the American Academy of Child & Adolescent Psychiatry. 60(2), 252-261.
  2. https://www.autismspeaks.org/sites/default/files/2018-09/Sleep%20Quick%20Tips.pdf

UK/FLY/2023/2388 March 2023