About sleep difficulties in children and adults with ASD

Hello, I am BCBA Minjeong Kwon.

Today, I'm going to talk about the sleep difficulties that children with ASD have, which many people come to me for advice.

Sleep has a major impact on children's development, but it also affects the daily lives of families. Sleep problems can occur during the process of falling asleep or when waking up during sleep.

The Sleep Foundation reports that approximately 50-80% of infants and toddlers on the autism spectrum experience sleep problems, and approximately 50% continue to experience sleep disorders as adolescents and adults.

Types of sleep disorders

There are various types of sleep problems, but the five major ones are as follows:

1) Insomnia : If you have trouble falling asleep or staying asleep. It may take your child a long time to fall asleep.

2) Irregular sleep-wake cycle : Often, irregular circadian rhythms make it difficult to maintain consistent sleep patterns.

3) Nocturnal awakenings : Waking up frequently during the night and having difficulty falling asleep

4) Restless legs syndrome (RLS) : causes an uncomfortable urge to move the legs, disrupting sleep

5) Sleep apnea : Breathing temporarily stops during sleep, affecting the quality of sleep.

Why Sleep Disorders Are More Common in People with ASD

So what exactly is the relationship between autism spectrum disorder and sleep problems? Sleep problems are caused by the following four main factors. For more detailed information, I recommend reading the Sleep Foundation ( link ) article.

1) Sensory sensitivity : Children with autism who are sensory sensitive are very sensitive to environmental stimuli such as noise, light, and temperature, making it difficult for them to relax and fall asleep.

2) Anxiety and arousal : Anxiety makes it difficult to relax, and excessive arousal makes it difficult to get a comfortable sleep.

3) Irregular melatonin secretion : Children with autism may have irregular secretion of melatonin, the sleep hormone, which may disrupt their sleep-wake cycle.

4) Communication and Routine Issues : Difficulties communicating or maintaining a proper bedtime routine can lead to sleep problems.

Tips to help your child with sleep problems!

1. Manage your sleep routine

It’s important to create a set bedtime routine and include consistent activities, like dimming the lights or brushing your teeth or reading a book. Sensory interventions, like weighted blankets or blackout curtains, can also help you relax and create a comfortable environment.

Checklist to improve sleep difficulties >> Free download in English and Korean

2. Melatonin supplements

<Reference article: USA Today>

The United States is the world's leading user of melatonin supplements, with one in five children under the age of 14 taking it.

We checked in with Dr. Judith Owens , co-director of the Sleep Center at Boston Children's Hospital, and Dr. Michael Toce in the Division of Emergency Medicine, who specializes in toxicology and was a co-investigator on the CDC study. Their answer is: Melatonin may be beneficial for some children who have difficulty falling asleep, when the supplement is accompanied by a behavioral program to address the sleep problems. It is probably safe when used appropriately, at the correct dose for age, and in consultation with a health care provider.

According to the article, melatonin supplements may be effective in treating sleep problems in children, but supplements should be used in conjunction with a behavioral intervention program and consultation with a healthcare professional will be needed to determine appropriate dosage and timing of use.

3. Behavioral Mediation

As mentioned above, melatonin supplements may help in the short term, but in the long term, it is better to manage it with behavioral interventions. You can make a plan to break down the bedtime routine into steps using task analysis or visual aids , and reinforce the behavior of staying in bed through positive reinforcement.

Schedule to improve sleep difficulties >> Free download in English and Korean

4. Anxiety Management

If your child's anxiety is too high, it may be a good idea to try using relaxation techniques such as cognitive behavioral therapy (CBT) or deep breathing to improve sleep quality.

Other Considerations

Adolescents and adults may have more complex sleep problems than children and may need different lifestyle changes than children.

• Exercise : Improve your sleep quality with regular physical activity
• Limit caffeine and alcohol : Are you old enough to drink caffeine and alcohol? It may help to limit your caffeine and alcohol intake late in the day.
• Reduce electronic device use : Be sure to reduce electronic device use before bedtime. If you find it difficult to do this on your own, we recommend setting your last electronic device use time at around 7-8 p.m. when creating a bedtime routine .
• Physical sleep problems : Symptoms such as restless leg syndrome or sleep apnea require further monitoring and it is recommended that you seek professional diagnosis.

Next Step?!

• Track your child's sleep patterns : Use a sleep diary to monitor changes in your child and find out what might be disrupting their sleep.
• Gradual changes : Introduce new routines one at a time, giving your child time to adjust.
• Modify the environment : First, create a sleep environment that meets your child’s sensory needs. Things like white noise, weighted blankets, and blackout curtains can help.
• Professional Consultation : If sleep problems persist, consider consulting with a medical professional, ABA therapist, or sleep specialist.

Sleep problems in children, adolescents, and adults with autism are very common, but can be managed sufficiently through behavioral interventions, environmental changes, and melatonin supplements. I hope you can find a method that works for your child and gradually improve their sleep difficulties.