Ideas for improving sleep in children with autism spectrum disorder

Many children with autism have difficulties sleeping, which may include not being able to fall asleep, waking up many times during the night, rising early, and having a reduced need for sleep. This is problematic as children who are not well rested have greater difficulties sustaining attention and participating in intervention. Children who do not sleep well may also have greater behavioural difficulties, including increased tantrums. To improve sleep:

• Set a consistent schedule with your child going to sleep and waking up at the same time every day (7 days a week). If your child has trouble falling asleep, or gets a “second wind” it may be helpful to put off bedtime for 30 minutes or so.
• Make sure your child has a dark sleep environment, which can be created using blackout curtains. This will ensure melatonin production, which contributes to better sleep. Your child can use a night-light if needed.
• Have a comfortable sleep environment, in terms of the temperature and bedding for example. This can be adjusted depending on your child’s sensory preferences.
• Remove electronics and highly preferred items from your child’s room. In particular do not have a TV, iPad, smart phone, or video game console in their bedroom.
• For some children with autism it is helpful to use a visual schedule with pictures, words, or both to remind them of what they need to do at bedtime. Using a visual schedule helps your child learn their bedtime routine and creates consistency from one night to another.
• Ideally, for 2 hours prior to bed, have your child participate in calming activities, such as reading a book together, having a light snack, taking a bath, having a massage, listening to music, and cuddle time. Avoid new activities, activities that are stimulating, or engaging with electronics during this time.
• Children can take melatonin before bed to help regulate their sleep-wake schedule.
• If your child continues to have difficulties falling asleep, consider other changes during the day that may help. For example, children who exercise regularly may fall asleep easier at night and have an improved sleep. It is also important to avoid caffeine for at least 3 hours before bedtime; this includes pop, chocolate, and tea/coffee. Also consider any noise in the environment that might impact your child’s sleep, even subtle noises can be quite noticeable for children with autism.
• Consult with a specialist such as your paediatrician, behaviour consultant, or psychologist to explore other options if these strategies don’t help improve the quality of your child’s sleep.

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