Sleep problems such as insomnia are more common in autistic people. Research suggests that behavioral features of autism, biology, and co-occurring conditions may cause sleep disturbances. Treatment can include developing sleep-promoting habits and medication.

Insomnia is a common co-occurring condition in autistic people.

This article explores the relationship between autism and insomnia. It also discusses other sleep difficulties autistic people may experience and tips for better sleep.

A person lying in bed with their head against the headboard while using their phone. People with autism are more likely to experience insomnia.Share on Pinterest
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Autistic people commonly experience delayed sleep onset, an inability to maintain sleep, early awakenings, and subsequent daytime sleepiness.

One study suggests that there may be a bidirectional relationship between autism and sleep disturbances, where worsening primary symptoms of autism aggravate sleep problems and vice versa.

The study further suggests that individuals with higher support needs experience more significant impairments in their functional ability and behavior. They may also have a higher predisposition to sleep disorders than their peers with lower support needs.

Autistic people with higher sensory hyper-reactivity and lower social skills were also associated with more severe insomnia.

Behavioral links

Core neurobehavioral features in autistic people may contribute to sleep disorders, including:

Biological mechanisms

Potential neurobiological mechanisms may also cause sleep problems in autistic people. These include:

  • delayed melatonin peak (which is associated with delayed sleep times)
  • reduced ferritin (a protein that stores and releases iron in a person’s blood)
  • increased periodic limb movements in sleep

Co-occurring conditions

Various medical and psychiatric conditions common in autism spectrum disorder (ASD) and their medications may disrupt sleep. These include:

Around 50–80% of children with ASD have disturbed sleep, compared to 11–37% in neurotypical children. Sleep problems in autistic people usually continue into adulthood.

Symptoms typically include:

  • difficulty initiating sleep
  • difficulty staying asleep
  • early awakening
  • subsequent daytime fatigue

Aside from insomnia, sleep disorders reported in children with ASD include:

Nonpharmacological therapy is the preferred first-line treatment for insomnia in autistic people before initiating medication.

Sleep education and behavior interventions

A 2017 meta-synthesis found that parent-based sleep education programs effectively manage sleep problems in children with ASD.

Behavior interventions based on the principles of learning and behavior may also help autistic people to develop positive sleep-related habits, relaxation, and self-soothing skills.

Therapy

A 2019 pilot study found that cognitive behavioral therapy for children with insomnia is an autism-friendly, helpful, and age-appropriate treatment that improves child and parent sleep, parent fatigue, and child behavior.

Medication

Typical over-the-counter medications or sleeping pills used to improve sleep in autistic individuals include:

Prescription medications that can aid with sleep include:

Other therapies

Other interventions that may help with sleep include:

The American Academy of Neurology recommends sleep hygiene as the first line of therapy for managing sleep disorders in children with neurodevelopmental disorders such as autism.

Sleep hygiene can also benefit autistic adults with insomnia. We explore sleep hygiene in further detail below and other tips for better sleep.

For autistic adults

Sleep hygiene practices include:

  • optimizing the sleep environment by adjusting the light, room temperature, and noise levels
  • maintaining a consistent sleep routine and schedule
  • following a calming and structured bedtime routine
  • managing nighttime hunger

Keeping a sleep diary may also help autistic people identify factors affecting their ability to sleep.

For autistic children

The recommendations are similar for children, but parents may need to help implement the sleeping strategies or assist in keeping a sleep diary.

The most common and evidence-based sleep practice recommendation for children is the ABCs of sleeping. It is a mnemonic, a pattern of letters used to help people remember steps. In this instance, it helps people remember recommendations for children with insomnia.

The mnemonic spells ABC sleeping and stands for:

  • age-appropriate bedtimes and wake times with consistency
  • schedules and routines
  • location
  • exercise and diet
  • no electronics in the bedroom or before bed
  • positivity
  • independence when falling asleep, and
  • needs of the child met during the day (such as hunger)
  • equal great sleep

Parents can help their children create a bedtime ritual to establish positive patterns. Providing reminders, creating a visual bedtime schedule, and maintaining consistency for the whole family may help an autistic child prepare for sleep.

An autistic person or a parent of an autistic child should talk with a healthcare professional if sleep problems affect well-being, work, school, or relationships or persist for more than 2 weeks.

Healthcare professionals can also help identify the cause of sleep problems and prescribe the best treatment.

Sleep problems are common in autistic individuals. Biology, disorder features, and co-occurring conditions result in autistic people being prone to insomnia or other sleep disorders.

Interventions such as sleep hygiene, lifestyle changes, and medication can help improve sleep for autistic individuals.

If sleep problems persist for more than 2 weeks or cause significant interference with day-to-day life, it is essential to speak with a healthcare professional for an evaluation and appropriate treatment.