Sleep and Autism: Overcoming Common Sleep Disturbances

Overview: This article discusses the value of sleep, the ways that autistic individuals commonly struggle with sleep, and the impact of those sleep disturbances. For more on sleep, see the article on Sleep Care, and the Sleep Tool Kit in the ALL Library.

Sleep is a necessary and confounding element of human life. It is essential for good physical and mental health and yet so frequently elusive. Further confounding is that we have thus far not found a cure for sleeplessness that does not lead to or exacerbate other health problems. Sleeplessness is indiscriminate, impacting all people, but it is an unfortunate statistic that it appears to plague almost all autistics throughout their lives. The first step to achieve a healthy sleep pattern is to understand sleep.

Importance of Sleep

Sleep is an essential part of our physiological and psychological functioning. Even one 24-hour cycle without sleep will result in some degree of emotional and cognitive impact, from irritability, blurry or confusing thoughts, and feelings of sickness. The more prolonged the deprivation the more intense the impact. A lack of sleep can lead to illness, confusion and fugue-like states. Why is sleep so important?

When we sleep our bodies and minds reenergize, repair and process our experiences. Sleep allows our immune system to function, keeps our metabolism in check, and fosters continued cardiovascular health. Sleep also helps with the regulation of hormone levels and stress within our body. While an occasional bad night of sleep might feel more like an unfortunate inconvenience rather than a problem, a pattern of persistent sleep disturbances can lead to significant physical health issues.

Like the body, the brain also requires sleep. Sleep allows the brain to consolidate memories, discard useless information, and develop better understandings of the world. Children who do not get enough sleep show significant changes in brain development that can lead to processing deficits and struggles with cognitive efficiency (Chen et al., 2006). Sleep also has a significant impact on our emotional experience. Sleep disturbances can negatively affect emotion regulation, mood, and attention levels. Given that these are issues which autistics often encounter, it is even more critical that they are able to develop and enjoy healthy sleep patterns.

Autism and Sleep

Sleep disturbances are a common co-occurring problem with autism. The issue frequently presents early in life and, if unchecked, can worsen and compound throughout the person’s lifespan. Some research has shown that up to 80% of autistic children suffer from sleep problems (Cortesi et al., 2010; Krakowiak, et al., 2008). Sleep disturbances often start as bedtime resistance but can grow into insomnia and daytime sleepiness later in life. Common sleep issues experienced by autistic people vary significantly, but many report the following:

• Difficulty falling asleep

• Frequent awakening during sleep time

• Insomnia

• Early morning awakening

• Bed wetting

• Sleepwalking

• Night terrors

• Daytime sleepiness

Impacts of Poor Sleep and Autism

If a night or two of poor sleep can cause mood and attentional issues, it follows that a lifetime of poor sleep will be even more devastating. The unfortunate reality for many autistic individuals is extended periods of emotion dysregulation, cognitive impairment, physical difficulties, and social struggles piled onto the already present deficits in these areas.

A common way poor sleep escalates autism symptoms is through poor emotional and behavioral regulation. Sleep disturbances often lead to increased irritability, hyperactivity, and impulsivity (Esposito et al., 2020), as well as impairment of emotional regulation, increased likelihood of mood swings, and difficulty coping with everyday stressors. Sleep issues have also been correlated with behavioral disturbances such as aggression and non-compliance for autistic individuals (Cuomo et al., 2017).

Sleep disturbances in autistics also increase challenges with social interactions, familial stress, and sensory sensitivity. Poor sleep has been shown to have deteriorating effects on communication skills and social desires. This too often leads to further social isolation among people who are already prone to loneliness. Social isolation can have a negative impact on home life as individuals self-isolate in their rooms or households adding stress on family systems. Additionally, sleep deprivation often causes a person to be more sensitive to sensory inputs which also negatively affects socialization. This may lead to stricter adherence to unhealthy patterns and non-functional routines (Cuomo et al., 2017).

Sleep issues are challenging for everyone, but even more so for autistic individuals who struggle in ways that are unique and demanding. The understanding and implementation of good sleep practices should be an essential step in a healthy and happy life strategy.


Sleep Care

There are an abundance of sleep tools or aids available, and what works for one person may not work for others. An ALL coach can help develop the strategy that works best for you, understanding that there are many strategies and hybrids thereof, including the following: 


Follow a consistent sleep routine

• Implement pre-bed relaxation exercises, such as stretching, breathing, and guided meditations

• Environmental and sensory supports – weighted blanket, sound machine, blackout curtains, eye mask, ear plugs, etc.

• Over-the-counter medications and supplements – melatonin, herbal supplements, vitamins, etc.

• Pharmacological interventions

• For more information, check out the article on Sleep Care and the Sleep Tool Kit. Sleep well and happy dreams to all!

Resources

Cortesi, F., Giannotti, F., Ivanenko, A., & Johnson, K. (2010). Sleep in children with autistic spectrum disorder. Sleep medicine, 11(7), 659-664.

Chen, F., Lemonnier, E., Lazartigues, A., & Planche, P. (2006). Sleep problems and information processing, a disconnection effect in autism?. Medical hypotheses, 66(6), 1245-1246.

Cohen, S., Conduit, R., Lockley, S. W., Rajaratnam, S. M., & Cornish, K. M. (2014). The relationship between sleep and behavior in autism spectrum disorder (ASD): a review. Journal of neurodevelopmental disorders, 6, 1-10.

Cuomo, B. M., Vaz, S., Lee, E. A. L., Thompson, C., Rogerson, J. M., & Falkmer, T. (2017). Effectiveness of sleep‐based interventions for children with autism spectrum disorder: a meta‐synthesis. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 37(5), 555-578.

Esposito, D., Belli, A., Ferri, R., & Bruni, O. (2020). Sleeping without prescription: Management of sleep disorders in children with autism with non-pharmacological interventions and over-the-counter treatments. Brain sciences, 10(7), 441.

Krakowiak, P., Goodlin‐Jones, B. E. T. H., Hertz‐Picciotto, I. R. V. A., Croen, L. A., & Hansen, R. L. (2008). Sleep problems in children with autism spectrum disorders, developmental delays, and typical development: A population‐based study. Journal of sleep research, 17(2), 197-206.

Park, S., Cho, S. C., Cho, I. H., Kim, B. N., Kim, J. W., Shin, M. S., ... & Yoo, H. J. (2012). Sleep problems and their correlates and comorbid psychopathology of children with autism spectrum disorders. Research in Autism Spectrum Disorders, 6(3), 1068-1072.