Written by Dr Lucy Russell DClinPsyc CPsychol AFBPsS

If your autistic teenager is not sleeping, you may feel completely exhausted.

Sleep affects mood, concentration, emotional regulation and everyday functioning. Sleep difficulties are also particularly common among autistic young people.

There is rarely one simple reason for poor sleep. Sensory differences, anxiety, routines, transitions and other health conditions can all contribute. Your teenager may also experience several of these factors at once.

The most helpful starting point is understanding what is keeping your teenager awake. Then you can build a sleep plan around their individual needs.

Why is your autistic teenager not sleeping?

Autistic teenagers can experience sleep difficulties for many different reasons. Rather than trying every sleep strategy, look for the patterns first.

A sleep diary can help you identify what happens before difficult nights. Record bedtime, sleep onset, night waking and morning waking for around two weeks. This gives you useful information about what might need changing.

Sensory differences

Sensory differences can make it difficult to feel comfortable enough to sleep.

Your teenager might be particularly sensitive to:

• Noise from outside or inside the house
• Light from windows, screens or electronic devices
• Temperature
• Bedding or clothing textures
• Pressure from the mattress or pillow
• Smells
• Physical sensations within their body

They might also wake because of sensory discomfort.

Think about what your teenager notices that you might not notice. For example, they may feel too hot while you feel comfortable. They may hear a noise that you barely register.

Ask your teenager what feels uncomfortable about their bedroom. Then make one change at a time. You might adjust the temperature, change bedding or reduce background noise. Earplugs, headphones or white noise may help some young people. There is no single sensory solution that works for every autistic teenager.

Anxiety and racing thoughts

Bedtime can give anxious thoughts plenty of space to grow. Your teenager might replay conversations from the day. They might worry about tomorrow or become preoccupied with something coming up.

Some autistic young people also find it difficult to switch off mentally or make the trasition from “awake” to “winding down for sleep”. This can leave them physically tired but mentally alert.

Try giving worries somewhere to go before bedtime.

For example, your teenager could write down:

• Something they are worried about
• Something they need to remember tomorrow
• One thing they can do about the worry

You can then agree when you will return to these concerns. The aim is not to eliminate every anxious thought. Instead, you are helping your teenager stop solving problems in bed. Bedtime journaling is an extension of this idea, helping your teenager to get thoughts down on paper rather than whirring around their heads.

Difficulty with transitions

For some autistic teenagers, bedtime itself is the problem. They may struggle to stop an absorbing activity and begin another task. Executive functioning differences can make planning and sequencing bedtime particularly difficult.

This is especially common when your teenager becomes intensely focused on something.

A teenager might genuinely intend to go to bed. However, getting from “I should go to bed” to actually being in bed can be difficult. Help them break bedtime into small, visible steps.

For example:

1. Stop gaming
2. Go upstairs
3. Put pyjamas on
4. Brush teeth
5. Close curtains
6. Get into bed
7. Read for 15 minutes
8. Lights out

You can use a visual schedule to make these steps predictable. Here is a useful video showing one way to create a visual schedule:

Repetitive routines

Some autistic young people have bedtime routines that help them feel safe. There is nothing inherently wrong with this. The routine becomes more concerning when it becomes lengthy, increasingly complicated or distressing.

Pay attention if your teenager:

• Takes a long time completing the routine
• Becomes increasingly distressed
• Needs to repeat actions again and again
• Cannot settle unless everything is exactly right

If these behaviours are significantly affecting sleep or wellbeing, discuss them with your GP. Sometimes anxiety or obsessive-compulsive disorder can contribute to these patterns.

How poor sleep affects autistic teenagers

Poor sleep can affect much more than tiredness the next day.

Mood changes

Sleep deprivation can make emotional regulation harder. You may notice more irritability, frustration, tearfulness or emotional outbursts. Your teenager may also have less capacity to cope with ordinary demands.

Anxiety and mental health difficulties

Poor sleep and anxiety can reinforce each other. An anxious teenager may struggle to sleep. Poor sleep then leaves them less able to manage anxiety the following day. This can create a difficult cycle.

Concentration and memory difficulties

Sleep supports attention, memory and learning. Your teenager may therefore struggle more with schoolwork after a poor night’s sleep. They may appear distracted or forgetful.

Increased sensory overload

Sleep deprivation can reduce your teenager’s capacity to cope with sensory input. Things they normally tolerate may suddenly feel overwhelming. This can contribute to distress and difficult behaviour. Remember this when behaviour changes suddenly. Sometimes the behaviour is communicating exhaustion rather than defiance.

How to help your autistic teenager sleep better

The most effective approach is usually individualised. NICE recommends developing a sleep plan based on the specific causes identified. It also recommends recording sleep and wakefulness over two weeks. Here are the areas I would consider first.

1. Create a predictable bedtime routine

A predictable routine reduces the number of decisions your teenager needs to make. Keep the sequence broadly the same each evening. The routine does not need to be elaborate.

It could simply involve:

Shower → pyjamas → teeth → bedroom → reading → lights out

Work with your teenager to decide what feels calming. The goal is to create a predictable transition towards sleep.

2. Use visual supports

A visual bedtime routine can be particularly helpful when transitions are difficult. Put the steps somewhere your teenager can easily see them. This means they do not need to remember every step themselves. It also reduces the amount of verbal prompting you need to give.

For older teenagers, a simple checklist may feel more appropriate than a colourful timetable.

3. Support transitions rather than expecting independence

Teenagers still need a lot of help with planning and organisation. Autistic teenagers may need even more support with transitions. This does not mean doing everything for them. Instead, provide the smallest amount of support needed to get started.

For example, you might say:

“It’s 9pm. Let’s get started with your bedtime routine.”

You could then walk upstairs with them. Once they begin brushing their teeth, you can step away. The aim is to support independence without expecting it prematurely.

4. Identify sensory triggers

Ask your teenager what makes their bedroom comfortable or uncomfortable.

Consider:

• Temperature
• Noise
• Light
• Bedding
• Clothing
• Smells
• Mattress and pillow
• Physical sensations

Make changes based on their actual sensory preferences. Do not assume that a bedroom needs to be completely silent or completely dark. Some teenagers sleep better with predictable background noise. Others need almost complete silence.

Your teenager’s sensory profile should guide your decisions.

5. Reduce evening overstimulation

Think about what happens during the hours before bed. Your teenager may arrive at bedtime already overwhelmed.

A busy school day, social demands, activities and sensory input can accumulate. Some teenagers need a period of what I call decompression time after school. This might mean quiet time, music, drawing, gaming or another preferred activity.

The key question is:

Does this activity help my teenager wind down?

Don’t remove something simply because it looks stimulating to you. Instead, look at what happens afterwards.

6. Look carefully at screen use

Screens can make sleep more difficult for some teenagers. The issue is not simply “blue light”. Screens can also provide intense stimulation and make stopping difficult. Gaming and social media can be particularly hard to transition away from.

If screens are affecting sleep, work with your teenager on a realistic boundary. For example, you might agree that gaming ends at a particular time. Give warnings before the stopping point. Then make the next activity clear.

A predictable transition is going to be more successful than suddenly demanding:

“Turn it off and go to bed.”

7. Keep sleep and wake times reasonably consistent

A consistent sleep pattern can help regulate your child’s body clock. Try to keep bedtime and waking time broadly similar each day. This includes weekends where possible.

However, avoid turning sleep into another source of conflict. If your teenager’s sleep pattern is significantly delayed, changing it gradually may be more realistic. Focus on consistency rather than perfection.

8. Encourage daytime movement and recovery

Regular physical activity can support healthy sleep. Your teenager does not need a formal exercise programme. Walking, cycling, swimming, sports or simply being outside can all count.

Also consider whether your teenager gets enough recovery time. Some autistic young people become exhausted by managing sensory and social demands throughout the day. A teenager who is overwhelmed may need decompression, not another activity.

9. Check for physical or medical causes

Do not assume every sleep problem is caused by autism. Pain, anxiety, medication, gastrointestinal problems and other health conditions can affect sleep.

NICE recommends assessing persistent sleep difficulties to identify what is causing them. This includes looking at sleep patterns, the bedroom environment, physical health, medication and daytime activity. NICE guidance on sleep problems in autistic children and young people

What about melatonin for autistic teenagers?

Melatonin can sometimes be used when sleep problems persist.

However, NICE recommends trying a sleep plan before considering medication. Medication should only be considered when sleep difficulties continue despite the sleep plan. They must also be having a negative impact on the young person or family.

If medication is needed, NICE says melatonin can be considered. It should only be started following specialist consultation. This should involve a specialist paediatrician or psychiatrist with relevant expertise.

The sleep plan should continue alongside any medication. The need for medication should also be reviewed regularly. In the UK, melatonin for children and teenagers requires a prescription. Do not start supplements without discussing them with an appropriate healthcare professional.

What should you do if your autistic teenager is not sleeping?

Start by becoming curious about the pattern.

For two weeks, record:

• When your teenager gets into bed
• When they appear to fall asleep
• Night waking
• When they wake in the morning
• Daytime naps
• Screen use
• Anxiety or stressful events
• Sensory difficulties
• Medication
• Anything else unusual

Then look for patterns. Perhaps difficult nights follow busy days. Perhaps screens make settling harder. Perhaps your teenager regularly wakes when the bedroom becomes too warm.

Those patterns give you something practical to work with.

Try my free children’s sleep tracker

I’ve created a free children’s sleep tracker to make this easier. It is suitable for children aged 5 to 17, including teenagers. The tracker records settling time, waking time, total sleep and night waking. It also includes space for notes and whether your child wakes feeling refreshed.

Get my free children’s sleep tracker

Once you have two weeks of information, look for patterns. Perhaps your teenager sleeps poorly after particularly demanding school days. Perhaps gaming makes the transition to bedtime difficult.

Use what you discover to decide what to change first. NICE specifically recommends using two weeks of sleep information to modify the sleep plan.

Want more help improving your teenager’s sleep?

If you’ve tried several sleep strategies without lasting success, you may need to look beyond bedtime routines.

Sleep for Success is my online course for helping children and teenagers develop healthier sleep habits. It is suitable for autistic and other neurodivergent young people too.

The course helps you understand what is getting in the way of your child’s sleep. You can then make targeted changes rather than endlessly trying different sleep tips.

You could see your child:

• Settle more easily at bedtime
• Spend less time awake at night
• Wake less frequently
• Develop a more predictable sleep pattern
• Feel more rested in the morning
• Have more energy during the day
• Cope better with everyday demands
• Feel less irritable and overwhelmed

You’ll learn how to tackle the factors that can interfere with sleep. These include routines, technology, daytime habits, the sleep environment, sensory needs and anxiety.

The course gives you a clear plan to follow, rather than leaving you wondering what to try next.

It is designed to help you make changes that fit your child’s individual needs and circumstances.

Find out more about Sleep for Success

Most importantly, avoid treating sleep as a battle your teenager should simply win.

Your teenager may desperately want to sleep but struggle with the process.

Your job is to identify the barriers and reduce them.

The goal is not a perfect bedtime routine.

The goal is better sleep and a more rested teenager.

Dr Lucy Russell is a UK clinical psychologist and Clinical Director of Everlief Child Psychology. She qualified as a clinical psychologist from Oxford University in 2005 and worked in the National Health Service for many years before moving fully into her leadership and writing roles.

In 2019 Lucy launched They Are The Future, a support website for parents of school-aged children. Through TATF Lucy is passionate about giving practical, manageable strategies to parents and children who may otherwise struggle to find the support they need.

Lucy lives with her family, rescue cats and dog, and also fosters cats through a local animal welfare charity. She loves singing in a vocal harmony group and spending time in nature.