Understanding Autism and Sleep: Navigating Sleep Patterns in Autistic Adults

Restorative sleep is essential for maintaining overall good health, influencing both mental and physical well-being. However, for many autistic adults, quality sleep feels out of reach.

Sleep challenges, such as trouble falling asleep or staying asleep, are some of the most common complaints among adults with autism spectrum disorder (ASD). Some autistic people may sleep too much or too little, have irregular sleep patterns or struggle with other diagnosable sleep disorders.

Read on to learn about sleep challenges associated with autism spectrum disorder, factors contributing to sleep struggles and how to get better sleep.

An estimated 50-80% of autistic children and adolescents experience some kind of sleep difficulty. In their neurotypical peers, that figure is closer to 25%. Though there is little research available to date on sleep in autistic adults, research on sleep differences among autistic children and adolescents and small initial studies with autistic adult populations suggest that these sleep issues persist into adulthood.The phrase “sleep challenges” can refer to any number of sleep-related problems. However, the most common difficulties reported by autistic individuals include: 

‍

• Insomnia
• Early waking times
• Short sleep windows

Further, research shows that autistic children and adolescents spend, on average, 15% of their sleep cycle in REM sleep, compared to the 23% experienced by neurotypicals. More REM sleep is associated with improved learning, mood regulation and brain development. 

‍

Additionally, autistic children are more prone to sleep apnea. This condition causes breathing to repeatedly start and stop throughout the night, preventing you from getting high-quality sleep. It can lead to daytime fatigue or cardiovascular problems. 

‍

The effect of sensory sensitivities on sleep

Sensory sensitivities––heightened reactions to sensory input, such as smells or sounds––are deeply embedded in the autistic experience. If an autistic person has an intense reaction to their sleep environment, they’ll likely experience sleep disruptions. 

‍
For an example of how this shows up in my life as an autistic adult, the feeling of wrinkled sheets prevents me from sleeping. I have to spend a lot of time in the morning meticulously making my bed, and sometimes, at night, I get out of bed to smooth out any wrinkles that have formed. My neurotypical friends can sleep in less-than-ideal situations, but my sensory issues make it hard or impossible for me to do the same. This is a common occurrence for people on the spectrum.

‍

Symptoms indicative of sleep disorders in autistic individuals

If you’re autistic and concerned about your sleep, there are things to look out for. If you share a bed with a partner, you may also ask them if they notice any unusual behavior while you’re sleeping. 

‍

Some signs that you may be experiencing disordered sleep include:

‍

• Sleeping too much or too little
• Appearing excessively tired during the day or talking about being tired during the day.
• Have a hard time “winding down” at bedtime
• Waking up often during the night, or being unable to go back to sleep after waking during the night
• Snoring, gasping for breath, or choking while sleeping
• Sleepwalking or sleep-eating
• Having very restless arms or legs when trying to sleep
• Grinding teeth while sleeping

‍

If you exhibit any of these signs, it’s important to seek medical attention. Your doctor can determine if there’s an underlying physical cause, such as sleep apnea, that needs to be treated.  

Not only does autism spectrum disorder itself impact sleep, but so do conditions that commonly occur alongside it. Several co-occurring conditions that are more common amongst autistic adults than their neurotypical peers are known to impact sleep. Some of those include: 

‍

• Attention-deficit/hyperactivity disorder (ADHD)
• Depression
• Obsessive-compulsive disorder (OCD)
• Anxiety

‍

How co-occurring conditions further impact sleep

Insomnia is the medical term for sleep difficulties that impede a person’s life. Though insomnia can occur on its own, co-occurring conditions put individuals at a higher risk of sleep troubles. For example:

‍

• About 44% of adults with ADHD struggle with insomnia. 
• People with obsessive-compulsive disorder are seven times more likely to receive an insomnia diagnosis. 
• Anxiety disorders and depression are also both linked to an increased risk of experiencing insomnia or other sleep disruptions. 

‍

How to manage co-occurring conditions to improve sleep

Because co-occurring conditions can impact sleep negatively, it’s important for autistic individuals to manage any other mental health conditions that they struggle with. Therapy and psychiatric medications can help autistic adults effectively manage co-occurring conditions, which may lead to better sleep. 

‍

Going through life on little sleep––or bad sleep––is rough. The long-term effects of inadequate sleep are daunting and may feel impossible to head off or avoid. However, improving your sleeping experience is possible, even for populations with notoriously bad sleep, like autistic adults.

‍

The importance of sleep hygiene

Sleep hygiene is a term used to describe good sleep habits or habits that are conducive to a good night’s sleep. Some examples of good sleep hygiene include:

‍

• Having a consistent bed and wake time: Try to go to bed and get up at the same time each day. This will help your brain and body establish a rhythm, and you’ll likely find that you’re naturally getting sleepy at bedtime and feeling more energized upon waking.
• Don’t stay in bed if you can’t sleep: If you’ve been in bed for over twenty minutes, get up. Getting up and doing something relaxing (or boring, even), like reading a nonfiction article or meditating, might help you feel sleepier and more relaxed. Just make sure to avoid anything too stimulating, like scrolling on social media.
• Limit caffeine intake: Avoid consuming caffeine about four to six hours before bed. Caffeine is a stimulant that will prevent you from feeling tired or disrupt sleep. 
• Avoid naps: If you struggle with falling asleep, avoid napping during the day. Being tired at bedtime is important for good sleep. 
• Establish a nighttime routine: Try developing a little ritual that will let your mind and body know that it’s time for sleep. This should be relaxing, like taking a hot bath, drinking a cup of decaffeinated tea or doing some gentle stretches.
• Optimize your space: Make sure your bedroom is comfortable and tailored to your needs. Comfort is subjective, and everyone has different preferences for their spaces. Your bedroom should be comfortable and soothing.

‍

Cognitive behavioral therapy for treating sleep issues

If good sleep hygiene on its own isn’t enough to combat your sleep difficulties, then cognitive behavioral therapy might be a logical next step. Cognitive behavioral therapy focuses on changing maladaptive or anxious thoughts into a more regulated and productive mindset. Research suggests that insomnia, or difficulty sleeping, may occur because of negative thoughts. For example, if an autistic adult frequently has trouble falling asleep, they may dread bedtime and think, “I don’t want to go to bed because I won’t be able to sleep. If I don’t sleep, I’ll feel terrible tomorrow!”

‍

‍A trained cognitive behavioral therapist can help autistic adults reframe their thoughts about sleep to eliminate some of the anxiety or negativity attached to it. A healthier thought could look like, “Even if it takes a little while to fall asleep, I’ll be okay. I can trust in my body’s ability to rest.”

‍

‍Further, a cognitive behavioral therapist will often help clients change their habits surrounding bedtime. For example, during treatment, a therapist may suggest that clients only use their beds for sleeping and get out of bed if they’re having trouble falling asleep. They may also be encouraged to avoid napping during the day and to get up at the same time each morning in order to establish a healthy sleep routine.

‍

Finally, a CBT practitioner can help teach clients different relaxation techniques, like deep breathing exercises or meditation. If an autistic individual is better able to relax at the end of the day, they may be able to fall asleep and stay asleep. 

Creating a comfortable sleeping environment is an important aspect of good sleep hygiene. Because autistic individuals tend to be especially sensitive to sensory input, they should modify their sleep space to accommodate their sensory preferences.

‍

How autistic individuals can create a sensory-friendly sleeping environment

When creating your sleeping environment, it’s important to think about your sensory preferences. Here are some ideas:

‍

• Use blankets or fans to maintain a comfortable temperature
• Use earplugs or a white noise machine to control the level of sound in the room
• Snuggle a comfort item
• Use a weighted blanket if you find deep pressure relaxing
• Use blackout curtains or sleep with an eye mask on

‍

I have found what works to help me sleep better, even though I have sensory sensitivities. For example, I’m very sensitive to heat, so my bedroom has a ceiling fan and a standing fan. I also use lightweight bedding to stay cool. As an added bonus, my fan's sound is very soothing and drowns out any unpleasant sounds that would keep me from sleeping well. Being in a chilly, quiet space helps prevent sensory overload, so I sleep better.

‍

Your sleep space is your own, so do what you can to make yourself comfortable.

Sometimes, even with environmental modifications, great sleep hygiene and therapeutic interventions, medication or other sleep aids are necessary. Sleep aids come in many forms, both pharmaceutical and natural. 

‍

Pharmaceutical options include over-the-counter supplements like melatonin. If over-the-counter options don’t do the trick, a doctor may prescribe a sedative or certain antidepressants if they are appropriate for a particular patient. Antidepressants (such as SSRIs) may also work to address underlying depression and anxiety. Doctors may opt to prescribe other sleep aids known as “Z-drugs” for insomnia––however, these are typically only used short-term. 

‍

Natural sleep aids include supplements like calcium, which helps the body naturally produce melatonin or vitamins. Vitamins will only improve sleep if there is an underlying vitamin deficiency. 

‍

You should always consult a doctor before trying any over-the-counter medication or supplement. Every medication is capable of causing side effects, and some may not be safe for people with certain medical conditions, so be sure to discuss any concerns with your doctor to make the best decision for your needs.

If you’re autistic and struggling with sleep, Prosper Health can help reduce your tossing and turning. 

‍

We offer neurodiversity-affirming online therapy covered by insurance. Our expert clinicians incorporate evidence-based therapies into our sessions, tailoring all care to the unique needs of autistic and neurodivergent adults. Plus, 80% of our clinicians identify as neurodivergent or have a close connection to a neurodivergent individual, so they truly understand the unique needs of neurodiverse people.

‍

Thanks to our fully online process and our network of providers, we can schedule intake appointments within days to get you feeling better faster. Therapy can help you learn to improve your sleep and overall well-being. Get started now and enjoy better sleep ASAP.