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Dysfunctional sleep is incredibly common in autistic people of all ages. What forms can this take, why does it happen, and can you do anything about it?

Many autistic people simply don't sleep that well — and that has a big impact on their quality of life during the day as well as at night. What sleep disorders are more common in people with autism spectrum disorder, why might that be, and is there anything you can do?

Sleep disorders and autistic children: What you need to know

Research based on parental reports has shown that an alarming 53 percent of autistic children between the ages of two and five had some kind of sleep problem. The majority of those who had at least one sleep problem dealt with it on a daily basis.

"Sleep problems" refers to a rather broad spectrum of possibilities, of course, so let's take a closer look at the kinds of dysfunctional sleep identified, and how prevalent they are:

  • Estimated to occur in 56 percent of autistic children who suffer from problematic sleep, insomnia is the most common form of disordered sleep. This can involve lying awake for hours — perhaps thinking about things that are simply more interesting than sleeping, perhaps plagued by anxiety, or perhaps for no apparent reason — but insomnia can also involve frequently waking up during the night and then finding it hard to get back to sleep, or consistently waking up much earlier than planned (like at four in the morning). 
  • Bedtime resistance is another very common problem, estimated to impact around 54 percent of autistic children with sleep problems. 
  • Parasomnias, which include sleep problems such as sleep walking, nightmares, and night terrors, affect around 53 percent of those autistic children who have disordered sleep. 
  • Around 25 percent of autistic children with disordered sleep have breathing problems while sleeping, which can be caused by disorders like obstructive sleep apnea or asthma. 
  • Forty-five percent will, meanwhile, have trouble getting up in the morning, and 31 percent will suffer from daytime sleepiness, a concept that pretty much speaks for itself. These two are clearly connected to the other problems. 

Are sleep disorders just as prevalent in autistic adolescents and adults?

Studies investigating sleep patterns and problems in autistic adolescents and adults tend to have smaller sample sizes, making it harder to come to definitive conclusions about how common these problems are. Nonetheless, existing research does point to similar problems in adults and teens on the spectrum. 

Even in the absence of physical issues that lead to problems sleeping (like sleep apnea) or parasomnias of any kind, one study of autistic teens and adults showed that it took this group of people longer to go to sleep, and that they woke up much more often during the night, too. 

It's known that anxiety and depression — which are both quite frequent among autistic people — cause disturbed sleep. One study of adults designated as having "high-functioning autism" who were neither clinically depressed nor suffering from an anxiety disorder still found that this group of adults slept less long than their neurotypical counterparts, feeling less refreshed when they woke up and often feeling sleepy during the day.

When we talk about sleep dysfunction in autistic people, the first thing that really comes to mind is the possibility that one of many possible comorbid disorders — like epilepsy, anxiety, and so on — is to blame. But these findings suggest that this is certainly not always the case. Could something about the autistic brain explain why autistic people of all ages are less likely to get the sleep they need?

What causes sleep problems in autistic people?

Studies have also found lower levels of night-time melatonin and higher levels of cortisol in the morning. They may also have abnormal levels of another neurotransmitter, GABA. All these chemicals play an essential role in establishing a normal sleep-wake pattern. Researchers currently believe that a combination of genetic, neurological, environmental, and other factors are responsible for causing irregular sleep in autistic people. 

Factors unrelated to autism as such, but that are more likely to strike autistic people — particularly depression and anxiety — would fall under "environmental factors", and certainly explain why anyone would have trouble getting to sleep or staying that way. 

More research into the causes of dysfunctional sleep in autistic people is certainly required. Not only does poor sleep quality negatively affect a person's overall quality of life, studies have also shown that it worsens the difficult symptoms of autism (including a person's ability to cope with social interaction). In the case of children, poor sleep also sends the stress levels of other family members through the roof as they attempt to deal with increased aggression and decreased concentration. 

Is there anything you can do to get a better night's sleep?

What can you do before further research sheds some hopefully very helpful lights on ways to fix all this? Some of the studies into the topic showed that autistic people of all ages already generally had good "sleep hygiene", or habits that promote healthy sleep. You'll likely have heard all this before and may already be doing most of it, too.

Just in case you haven't and aren't, though, here are some possible tips:

  • Consider melatonin supplements. Always discuss this with your doctor, as there can be side effects. 
  • Talk to your healthcare provider about ruling out physical problems that may be behind your poor sleep, like tonsilitis or gastrointestinal disorders, and mental health problems, like anxiety, depression, and obsessive compulsive disorder. 
  • Some studies showed that many autistic young people have an abnormally early bedtime, with the result that they're simply not sleepy when they head to bed. Consider a later bedtime. 
  • A comforting bedtime routine — one that's always the same — may help. Wind down your mind, or help your child wind theirs down, by taking a nice shower, playing a quiet game, reading or listening to a story, or whatever else helps in your individual case. 
  • Make sure the environment of your bedroom (or your child's) is comfortable. That generally means a few degrees cooler than room temperature, free from the kinds of textures or smells that trigger your sensory sensitivities, and consider a white noise machine and blackout curtains, as well as a weighted blanket. 

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