COMPLEX CARE RESOURCE

Sleep and Autism: Understanding Common Sleep Challenges and Solutions

Sleep problems can affect people with Autism at any age—from childhood through adulthood. Poor sleep can impact learning, behavior, employment, mental health, relationships, and overall quality of life.

While sleep difficulties are common, they are not always simply part of Autism and are not always behavioral. Sensory differences, anxiety, sleep apnea, gastrointestinal issues, pain, seizures, medication side effects, and other medical conditions can all play a role.

The good news is that many sleep problems can be treated or improved. Understanding why sleep is difficult is often the first step toward finding solutions that work for the individual and their family.

Catatonia & Autism

THE MOST IMPORTANT QUESTION

Is this new or significantly
different for this person?

Look for change from the individual’s own baseline, rather than comparing them with someone else.

RECOGNIZING CHANGE

Why Are Sleep Problems So Common in People with Autism?

Sleep problems affect up to 80% of people with Autism and are one of the most common concerns reported by families. Sleep difficulties can affect children, teens, and adults and may impact mood, learning, attention, behavior, employment, relationships, and overall quality of life.

Because there are many possible causes, it is important not to assume a sleep problem is “part of Autism”

Sleep difficulties may be related to

Sensory differences

Anxiety

Body-awareness challenges

Sleep apnea

Pain or discomfort

Seizures

Gastrointestinal issues

Medication side effects

Changes in routine or environment

Large tonsils and adenoids

Understanding Sleep Challenges

Yes. Many people with Autism are highly sensitive to:

  • Light
  • Noise
  • Temperature
  • Clothing textures
  • Pajama seams
  • Blankets and bedding

Even small sensory discomforts can make it difficult to fall asleep or stay asleep.

Some individuals with Autism also experience differences in body awareness (proprioception). They may struggle to feel where their body is when lying down, making it difficult to relax and settle into sleep.

  • Some people find comfort from:
  • Body pillows
  • Weighted blankets (when appropriate)
  • Compression sheets
  • Firm mattresses
  • Specific sleeping positions
  • Tight-fitting sleepwear

What feels calming for one person may feel uncomfortable for another, so sleep support should always be individualized.

Sleep problems affect up to 80% of people with Autism and are one of the most common concerns reported by families. Sleep difficulties can affect children, teens, and adults and may impact mood, learning, attention, behavior, employment, relationships, and overall quality of life.

  • Sleep difficulties may be related to:
  • Sensory differences
  • Anxiety
  • Body-awareness challenges
  • Sleep apnea
  • Gastrointestinal issues
  • Seizures
  • Pain or discomfort
  • Medication side effects
  • Changes in routine or environment
  • Large tonsils and adenoids

Because there are many possible causes, it is important not to assume a sleep problem is “part of Autism.”

This is one of the biggest challenges many families face. Not everyone can say:

  • “My stomach hurts.”
  • “I have heartburn.”
  • “I can’t breathe well when I lie down.”
  • “I’m anxious.”

Some people with Autism may have difficulty localizing or communicating pain, discomfort, illness, anxiety, or other concerns. Instead, they may communicate through their behavior. You might notice:

  • Refusing to go to bed
  • Getting out of bed repeatedly
  • Frequent night waking
  • Crying or appearing distressed
  • Increased irritability
  • Aggression
  • Self-injury
  • Increased repetitive behaviors
  • Difficulty calming their body

Sometimes what looks like a behavior change may signal discomfort, pain, anxiety, illness, or another underlying medical condition. For example:

  • A child with acid reflux may resist lying down because it hurts. They may seem very tired but get up after a short time or move from their bed to sleep in a more upright position in a corner, on the floor, or in a chair.
  • A person with sleep apnea may wake repeatedly because they are struggling to breathe comfortably. A person with constipation may have difficulty settling because their stomach hurts. A teen or adult with anxiety may be exhausted but unable to fall asleep.

Before asking, “How do I stop this behavior?” it may be helpful first to ask, “What might this person be experiencing?”

It might be. Many people with Autism have difficulty “turning their brain off” at bedtime. Even when tired, they may still be thinking about their day, worrying about tomorrow, anticipating a change in routine, or feeling stressed about school, work, relationships, health concerns, or other life events.

You might notice:

  • Racing thoughts
  • Difficulty settling down
  • Repeated questions at bedtime
  • Frequent requests for reassurance
  • Difficulty transitioning from preferred activities
  • Difficulty relaxing
  • Waking during the night and being unable to return to sleep
  • Anxiety does not always look like worry.

For some individuals with Autism, anxiety may show up as:

  • Irritability
  • Restlessness
  • Increased repetitive behaviors
  • Resistance to bedtime routines
  • Emotional outbursts
  • Changes in sleep patterns

The good news is that predictable routines, sensory supports, counseling, relaxation strategies, and appropriate treatment for anxiety can often improve sleep.

Improving Sleep

Many families wonder whether they should call their doctor, a BCBA, a therapist, or a specialist. The answer depends on what may be contributing to the sleep difficulty. The good news is that you don’t have to figure it out on your own.

Start With Your Primary Care Provider or Pediatrician

If sleep problems are new, worsening, affecting daytime functioning, or causing stress at home, your primary care provider is often the best place to start.

They can help determine whether referrals to a sleep specialist, neurologist, gastroenterologist, psychiatrist, psychologist, BCBA, or other professional may be helpful.

A Sleep Specialist May Be Helpful If You Notice:

  • Loud snoring
  • Pauses in breathing
  • Gasping or choking during sleep
  • Excessive daytime fatigue
  • Frequent night waking
  • Difficulty tolerating CPAP

An Occupational Therapist or a BCBA May Be Helpful If the Challenge Involves:

  • Bedtime routines
  • Sleep schedules
  • Staying in bed
  • Bedtime resistance
  • Visual supports
  • Sleep-related anxiety
  • CPAP desensitization

Ask an occupational therapist or a BCBA if they have experience in building these types of healthy sleep habits and routines. However, these professionals cannot diagnose or treat medical conditions such as sleep apnea, acid reflux, constipation, seizures, or pain.

A Psychologist, Psychiatrist, or Mental Health Professional May Be Helpful If: 

  • Anxiety is interfering with sleep
  • Racing thoughts make it difficult to fall asleep
  • Depression, trauma, stress, or other mental health concerns are present

A Gastroenterologist (GI Doctor) May Be Helpful If There Is: 

  • Acid reflux (GERD)
  • Constipation
  • Stomach pain
  • Bloating
  • Discomfort that worsens when lying down

A Neurologist May Be Helpful If There Are: 

  • Seizures
  • Unusual nighttime movements
  • Frequent headaches
  • Sudden changes in sleep patterns

An Otolaryngologist May Be Helpful If: 

  • Large tonsils or adenoids visible when your loved one opens their mouth

 

What If I’m Still Not Sure?

Start with your primary care provider.

You don’t need to determine whether the problem is sensory, behavioral, emotional, or medical before asking for help. A healthcare provider can help you identify possible causes and connect you with the right support.

Remember: Sleep difficulties in people with Autism are often caused by more than one factor. The most effective approach is often a team effort involving the

Many families wonder whether they should call their doctor, a BCBA, a therapist, or a specialist. The answer depends on what may be contributing to the sleep difficulty. The good news is that you don’t have to figure it out on your own.

Start With Your Primary Care Provider or Pediatrician

If sleep problems are new, worsening, affecting daytime functioning, or causing stress at home, your primary care provider is often the best place to start. They can help determine whether referrals to a sleep specialist, neurologist, gastroenterologist, psychiatrist, psychologist, BCBA, or other professional may be helpful.

A Sleep Specialist May Be Helpful If You Notice:

  • Loud snoring
  • Pauses in breathing
  • Gasping or choking during sleep
  • Excessive daytime fatigue
  • Frequent night waking
  • Difficulty tolerating CPAP

 

An Occupational Therapist or a BCBA May Be Helpful If the Challenge Involves:

  • Bedtime routines
  • Sleep schedules
  • Staying in bed
  • Bedtime resistance
  • Visual supports
  • Sleep-related anxiety
  • CPAP desensitization

Ask an occupational therapist or a BCBA if they have experience in building these types of healthy sleep habits and routines. However, these professionals cannot diagnose or treat medical conditions such as sleep apnea, acid reflux, constipation, seizures, or pain.

A Psychologist, Psychiatrist, or Mental Health Professional May Be Helpful If:

  • Anxiety is interfering with sleep
  • Racing thoughts make it difficult to fall asleep
  • Depression, trauma, stress, or other mental health concerns are present
  • A Gastroenterologist (GI Doctor) May Be Helpful If There Is:
  • Acid reflux (GERD)
  • Constipation
  • Stomach pain
  • Bloating
  • Discomfort that worsens when lying down
  • A Neurologist May Be Helpful If There Are:
  • Seizures
  • Unusual nighttime movements
  • Frequent headaches
  • Sudden changes in sleep patterns

 

An Otolaryngologist May Be Helpful If:

  • Large tonsils or adenoids visible when your loved one opens their mouth

 

What If I’m Still Not Sure?

Start with your primary care provider.

You don’t need to determine whether the problem is sensory, behavioral, emotional, or medical before asking for help. A healthcare provider can help you identify possible causes and connect you with the right support.

Remember: Sleep difficulties in people with Autism are often caused by more than one factor. The most effective approach is often a team effort involving the individual, family, healthcare providers, behavioral professionals, and other specialists working together to improve sleep and overall quality of life.

While there is no one-size-fits-all solution, small changes can sometimes make a big difference. Remember that what works for one person with Autism may not work for another, so it may take time to find the right combination of supports.

Start with a Predictable Routine

Many people with Autism do better when they know what to expect.

Try to:

  • Go to bed at the same time each night
  • Wake up at the same time each morning
  • Keep bedtime routines consistent and predictable

A simple routine might include showering, putting on pajamas, reading, listening to calming music, and then going to bed.

Think About the Sleep Environment

Sometimes the bedroom itself may be contributing to sleep difficulties. Consider whether the person is sensitive to:

  • Light
  • Noise
  • Temperature
  • Clothing
  • Bedding textures
  • Busy decor or clutter
  • Families often find that small changes can help, such as:
  • Blackout curtains
  • White noise or nature sounds
  • Comfortable bedding
  • Sensory-friendly pajamas
  • A cooler room temperature
  • Reducing clutter and distractions
  • Be Mindful of Screens Before Bed

Phones, tablets, computers, and televisions can make it harder for the brain to recognize that it is time to sleep. If possible, consider winding down with quieter activities before bedtime, such as reading, listening to music, drawing, or another calming activity.

Use Visual Supports When Helpful

Some individuals feel more comfortable when they can see what comes next.

Supports may include:

  • Bedtime schedules
  • Checklists
  • Social stories
  • Visual timers

These tools can help reduce anxiety and make bedtime feel more predictable.

Explore Relaxation Strategies

Some people find relaxation techniques helpful as part of their bedtime routine.

Examples include:

  • Calming music
  • Nature sounds
  • Deep breathing exercises
  • Meditation
  • Gentle stretching
  • Aromatherapy
  • Weighted blankets (when appropriate)

These supports may help promote relaxation, but they should not replace medical evaluation or treatment if an underlying sleep disorder is present.

Be Patient with Yourself

Improving sleep can take time, especially when sensory differences, anxiety, medical conditions, or long-standing sleep habits are involved. If you’ve tried several strategies and sleep remains a challenge, don’t hesitate to reach out to your healthcare provider or sleep specialist for additional support.

Melatonin is a hormone that helps regulate the body’s natural sleep-wake cycle. Melatonin is one of the most used sleep supports among people with Autism, but it is not a substitute for identifying why sleep is difficult.

Some people with Autism may have differences in melatonin production, which can make it more difficult to fall asleep or maintain a consistent sleep schedule. Melatonin is one of the most used sleep supports for children, teens, and adults with Autism.

Some individuals find that melatonin helps them: 

  • Fall asleep more easily
  • Establish a more consistent sleep schedule
  • Improve sleep onset when combined with healthy sleep habits

However, melatonin is not the right solution for every sleep problem. Improper dosing of melatonin has caused vivid dreams and nightmares for some children.

Why Is It Important to Talk with Your Healthcare Provider? 

Many families start melatonin on their own because it is available over the counter. Even so, let your healthcare provider know if you or a family member is taking melatonin or any other sleep supplement.

Sleep problems can have many causes, including: 

  • Sensory differences
  • Anxiety
  • Sleep apnea
  • Acid reflux (GERD)/esophagitis
  • Constipation
  • Pain
  • Seizures
  • Medication side effects
  • Other medical conditions

Melatonin may help some individuals fall asleep, but it typically does not help sustain sleep or treat many of the underlying conditions that can affect sleep.

CPAP therapy can be challenging for some people with Autism who have been diagnosed with sleep apnea.

A CPAP may be uncomfortable because of:

  • Sensory sensitivities
  • Mask discomfort
  • Anxiety about the equipment
  • Sensitivity to airflow
  • Noise from the machine
  • Difficulty adjusting to a new bedtime routine

The good news is that many people become more comfortable with a CPAP over time when the right support is in place.

 

What Can Help?

Individuals, families, and caregivers have reported success with:

  • Introducing the mask gradually
  • Practicing when the person is calm and awake
  • Pairing practice with preferred activities
  • Using visual supports to explain each step
  • Creating a consistent bedtime routine
  • Exploring different mask styles for improved comfort
  • Celebrating small successes along the way

The goal is not to force CPAP use, but to help the individual become comfortable and successful at their own pace.

 

Can a BCBA Help?

In many cases, yes. A BCBA may help develop a gradual desensitization plan and identify behavioral strategies that increase comfort with CPAP use.

For example, a person might begin by:

  • Looking at the mask
  • Touching the mask
  • Holding the mask near their face
  • Wearing the mask briefly
  • Wearing the mask with airflow
  • Gradually increasing use over time

A BCBA may also help create visual support, reinforcement systems, and bedtime routines that support successful CPAP use.

 

Who Else Can Help?

Depending on the situation, support may also come from:

  • A sleep specialist
  • The prescribing healthcare provider
  • A respiratory therapist
  • Other professionals familiar with Autism and sensory needs, including Occupational Therapy

Remember: Sleep apnea is a medical condition. While behavioral strategies and sensory supports may help improve CPAP tolerance, they do not treat sleep apnea itself.

If a CPAP is uncomfortable or difficult to tolerate, talk with the prescribing healthcare provider before stopping treatment. Adjustments to the mask, settings, equipment, or treatment plan may make the CPAP more comfortable and effective.

Some individuals who cannot tolerate a CPAP may be candidates for alternative treatments, including Inspire® therapy (an implanted device used to treat certain types of obstructive sleep apnea). Talk with your healthcare provider to determine whether these options may be appropriate.

WHAT TO REMEMBER

What Is the Most Important Thing to Remember About Sleep and Autism?

You Can See Also

Sleep Problems Are Not Always a “Behavior Problem.” For people with Autism, sleep difficulties may be related to:

  • Sensory differences
  • Body awareness challenges
  • Anxiety
  • Sleep apnea
  • Acid reflux
  • Constipation
  • Seizures
  • Pain
  • Medication side effects
  • Other medical conditions

Before assuming a child, teen, or adult is simply refusing to sleep, consider whether they may be experiencing discomfort, anxiety, illness, sensory challenges, or an untreated sleep disorder.

The good news is that many sleep problems are treatable. Identifying and addressing the underlying cause can improve sleep, health, behavior, learning, independence, and quality of life for both the individual and their family.

Need Help Finding a Sleep Specialist?

Sleep problems can have many causes, including sleep apnea, anxiety, gastrointestinal issues, sensory differences, seizures, pain, or medication side effects. If you are concerned about sleep problems, a qualified healthcare provider can help determine the underlying cause and identify appropriate treatment options.

View Our Vetted Sleep Provider Directory

Find Sleep Specialists & Clinics

Medical Disclaimer

This Resource Guide was developed to provide families and professionals with an opportunity to find resources related to Autism in the Inland Empire in one place. All information provided or published by the Autism Society Inland Empire is for information purposes only. Specific treatment, therapy or services should be provided to an individual only at the direction of the individual’s doctor, caregiver, or other qualified professional. References to any treatment or therapy option, program, service, or treatment provider are not an endorsement by the Autism Society Inland Empire. References of treatments, therapies, programs, services, and/or providers are not intended to be comprehensive statements. You should investigate alternatives that may be more appropriate for a specific individual. The Autism Society Inland Empire assumes no responsibility for the use made of any information published or provided. The Autism Society Inland Empire provides information, but it does not constitute medical or legal information. Referrals provided are suggestions to organizations that might help, but do not constitute a recommendation. The Autism Society Inland Empire cannot be held responsible for consequences that arise from individual dealings with a professional or organization. The inclusion of any organization does not imply endorsement, and omission does not imply disapproval. The Autism Society Inland Empire may add or remove organizations from this list at its discretion.

Resources

You Can See Also