As a child psychologist and carer for an autistic family member, I understand how important sleep is for your autistic teenager’s wellbeing. Adequate sleep is the cornerstone of mental health. Your autistic teenager not sleeping can directly lead to a range of physical health conditions and emotional and behavioral problems.
Unfortunately, sleep problems are common among teens with a diagnosis of autism spectrum disorder. Sensory processing issues, anxiety, and difficulty with transitions can all contribute to sleep issues. In this article, I’ll explore why autistic teenagers may struggle with sleep and the consequences of poor sleep. Most importantly, I’ll recommend effective strategies for improving their sleep habits.
Why Is Your Autistic Teenager Not Sleeping?
I’m going to run through some areas that autistic people commonly struggle with when it comes to sleep. Not all will apply to your child. As you read through, make a note of which areas could be contributing to sleep disturbances for your child. This will help you when it comes to deciding which strategies to try.
I also recommend keeping a sleep diary with your child, or using my free sleep tracker. When we’re dealing with all types of sleep problems, it’s really vital to pay attention to the tiny details and get them right so that we can build an individualised, healthy sleep routine.
Sensory Processing Issues
Does your child sleep through the night or do they wake frequently?
Sensory processing issues can impact your autistic teenager’s ability both to get to sleep and stay asleep throughout the night.
They may wake up frequently due to discomfort from the sensory input they receive while sleeping. This could include feeling the rough texture of their sheets or the temperature of the room being too warm or too cold. They may also struggle with the feeling of certain fabrics, tags, or seams on their clothing or bedding. In some cases, even the feeling of the mattress or pillow can cause a sensory issue that affects sleep quality.
If your teenager is woken by a sensory stimulus, such as a sudden noise, it may take them longer to calm down and return to a good night’s sleep. For example, a car honking outside could startle your teenager and put them on edge. Even a change in temperature or a sudden shift in the position of their body can be disruptive and prevent them from sleeping soundly. These sensory disruptions can interfere with healthy sleep cycles.
The smallest interruptions can have a significant impact on your teenager’s physical and mental health, including fatigue, daytime sleepiness, irritability, mood swings, and difficulty with focus and attention.
Of course, sensory sensitivities often prevent your child getting to sleep in the first place too. Autistic children often feel stressed when trying to drift off to sleep because their senses are heightened and something doesn’t “feel right”.
Case study: Dan
Fourteen-year-old Dan has been struggling to fall asleep and stay asleep at night. He has always had sensory issues and is extremely sensitive to noise and temperature changes. Dan’s parents noticed that he takes longer to fall asleep than others and wakes up several times during the night. This has led to chronic sleep deprivation and increased anxiety during the day.
He feels he needs complete silence to get to sleep and struggles with any background noise. He also often feels too hot in his bedroom and finds it difficult to get comfortable. These sensory issues are making it difficult for Dan to relax and fall asleep, leading to increased stress and exhaustion for him and his family.
To help Dan manage his sensory issues and improve his sleep quality, his parents consulted with a child psychologist who specializes in autism and sensory processing disorders. The psychologist recommended several strategies to help Dan feel more comfortable and relaxed in his sleep environment. They suggested using a white noise machine to block out any background sounds, as well as adjusting the temperature in his room by using a fan or air conditioning. Dan’s parents also invested in a cooling mattress topper to help regulate his body temperature and keep him comfortable.
With these strategies in place, Dan’s sleep has significantly improved. He now falls asleep faster and wakes up less frequently during the night, leading to better physical and mental health for him and his family. By identifying and addressing his sensory issues, Dan’s parents were able to help him create a calming sleep environment that promotes restful sleep and improved overall wellbeing.
Anxiety and Stress
Anxiety is common in autistic teens for several reasons. First, being autistic in a “neurotypical world” can cause significant stress and anxiety due to differences in social communication, sensory processing, and adapting to changes in routine. Autistic teenagers may feel overwhelmed by their environment, struggle to keep up with neurotypical social cues, or experience sensory overload, which can lead to anxiety and stress.
On top of this, many autistic teenagers may have difficulty identifying and managing their emotions. This can cause a build-up of stress which has a big influence on sleep. When your teenager is feeling stressed, their brain is in a state of hyperarousal, making it difficult to relax and fall asleep. They may also experience snowballing thoughts, worry, and physical symptoms such as a racing heart, sweating, and muscle tension that can further interfere with sleep.
Anxiety often involves a pattern of negative thinking and rumination, which can make it difficult for your teenager to turn off their thoughts and sleep. This can cause them to lie in bed for hours, unable to fall asleep, or to wake up frequently during the night with racing thoughts.
Autistic teenagers often have sensory processing differences, which means they may be more sensitive to sensory input, such as loud noises or bright lights. When they are overstimulated, their brains may be in a state of hyperarousal, making it difficult for them to get into that essential pre-sleep drowsy phase.
Overstimulation can also lead to physical symptoms such as headaches, fatigue, and muscle tension, which can further interfere with sleep. In addition, if your teenager experiences overstimulation in the evening, it can disrupt their natural circadian rhythm, so that natural sleep cues become dysregulated and the body can’t easily distinguish between sleep time and awake time.
Difficulty with Transitions
Transitions can be particularly challenging for autistic teenagers. They often have related difficulties with executive functioning and processing speed. This can make it difficult for them to move from one task or environment to another, and they may experience anxiety, frustration, or sensory overload during these transitions.
These challenges with transitions can also contribute to sleep difficulties. For example, if your teenager struggles with transitions, they may have difficulty winding down and transitioning into a bedtime routine. They may also experience anxiety about upcoming transitions which can keep them awake at night.
Case study: Alex
Alex is a sixteen-year-old girl who has always struggled with transitions. Her parents noticed that she has a difficult time moving from one activity to the next, and that she gets anxious and frustrated when her routine is disrupted. This challenge has also extended to her sleep routine, where she takes 2-3 hours to fall asleep each night. She feels scared of the transition between wakefulness and sleep. She finds it extremely difficult to move through a bedtime routine, such as brushing her teeth and putting her pyjamas on.
Alex’s parents have tried implementing a consistent bedtime routine to help her transition into sleep, but even with this routine, Alex still struggles to settle down at night. They have noticed that she becomes increasingly anxious and agitated as bedtime approaches, and that she often gets up and down from bed multiple times before finally falling asleep.
One possible explanation for Alex’s sleep difficulties is her challenges with transitions. Even though she has a consistent bedtime routine, the transition from being awake and engaged to settling down for sleep may still be difficult for her to manage. This can lead to anxiety and sensory overload, making it hard for her to relax and fall asleep.
To address Alex’s sleep difficulties, her parents are working with her therapist to develop strategies for managing transitions and reducing anxiety at bedtime. They are exploring sensory-based relaxation techniques, such as deep breathing and progressive muscle relaxation, to help her calm her mind before bed. They are also implementing a visual schedule that maps out the steps in her bedtime routine, so she knows what to expect and can prepare herself for the transition to sleep. With these strategies in place, Alex’s parents are hopeful that they can help her manage her sleep difficulties and get the rest she needs to thrive.
For some autistic young people, obsessive routines or repetitive behaviors need to happen before they go to sleep. For example, bedding may have to be carefully arranged in a certain way. Repetitive behaviors or routines can be an essential part of the process, helping your child to feel safe and secure. However, red flags to be aware of include the following:
- The routine or repetitive behaviour takes more than a few minutes to complete.
- The routine is becoming noticeably longer or more complex to complete.
- Your child is distressed while they are completing the routine or repetitive behaviour.
If the routines or repetitive behaviors start having a negative impact on your child’s wellbeing and/or sleep, consider whether OCD (obsessive-compulsive disorder) is a factor. If it is, speak to your doctor as your teen will need therapeutic support. Therapy for OCD can be offered by a range of healthcare providers such as clinical psychologists and CBT therapists. OCD can escalate quickly, so early intervention is important.
What are the Consequences of Poor Sleep for your Autistic Teenager?
Sleep is essential for regulating emotions, and its deprivation can be particularly problematic for autistic teenagers. When your teenager does not get enough sleep, their mood can become more volatile, leading to irritability, mood swings, and emotional outbursts.
Your teenager’s ability to regulate their emotions can also become compromised, leading to heightened levels of stress and anxiety. As a result, they may withdraw socially, experience difficulty communicating, and have a lower threshold for frustration.
The effects of chronic sleep deprivation on mental health can be particularly concerning. For instance, depression and anxiety can worsen if your teenager is not getting enough sleep. The inability to cope with everyday stressors is one factor that contributes to the cycle of poor sleep and worsening mental health symptoms.
Memory & Cognitive Functioning
Did you know that sleep deprivation can impair cognitive functioning, including memory, attention, and decision-making skills? This can lead to difficulty engaging with peers and of course succeeding in school.
Lack of sleep can lead to an increase in challenging behaviors that can negatively impact your teenager’s mental health. Autistic teenagers who do not get enough sleep may become more impulsive and reactive.
Sleep-deprived teens may also experience sensory overload more easily. In the long term, these behaviors can lead to social isolation and difficulties in forming and maintaining relationships.
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Tips for Improving Sleep in Your Autistic Teenager
Create a Calming Bedtime Routine
Many autistic teenagers require a lot more support with sleep routines than parents often think. One effective way to support your teenager is to establish a calming bedtime routine.
Here are five brief case studies with examples of calming bedtime routines:
Jack is a 13-year-old autistic boy who has difficulty falling asleep due to overstimulation. His calming bedtime routine includes dimming the lights, turning off electronic devices, listening to soft music, and engaging in deep breathing exercises.
Maya is a 15 and struggles with transitions. Her calming bedtime routine includes a visual schedule of the routine, support from mum and dad, a warm bath, head massage, and reading a book with a dimmed light.
Liam is a 16-year-old autistic boy who experiences anxiety that disrupts his sleep. His calming bedtime routine includes sipping on a warm cup of decaffeinated tea, writing in a journal to process thoughts, and listening to a guided meditation.
Sarah is a 14-year-old girl who has difficulty regulating her emotions. Her night time routine involves listening to calming music, doing a puzzle, and practicing yoga in her bedroom.
Noah is a 17-year-old who has trouble staying asleep throughout the night. He has a warm shower, uses a weighted blanket, and engages in mindful colouring for 30 minutes before bed.
Not every strategy will work for every teenager. Experiment with different calming techniques to find what works best for your child. You should involve your teenager in the process of establishing a bedtime routine to empower them and give them a sense of control.
Use Visual Supports
Visual supports can have a massive positive effect on your child’s ability to successfully make the transition between waking and sleeping. You can use a colourful poster or whiteboard to support your child with the steps they need to take before bed. For example:
- Go upstairs
- Put pyjamas
- Wash face
- Brush teeth
- Pull curtains
- Get into bed.
Following a visual timetable reduces demand on the brain, and means the routine will take less time to complete.
I love this simple video with a great idea for how to make a visual schedule.
Help Your Child With Transitions
You may think: “My child is a teenager now. They should be able to get to bed by themselves”. This is completely understandable but actually, teenagers’ brains are highly underdeveloped and they still need a lot of help with organisation, planning and sequencing. Autistic teens in particular are likely to need extra support moving from one task to another, relative to neurotypical people. I’m not suggesting that you stand over your child whilst they brush their teeth, put their pyjamas on and get into bed. But you may need to help them get started with each task.
Here’s an example.
Case Study: Eddie, age 15
Lynn is mum to fifteen year-old Eddie. He gets hyper-focused on his art work in the evenings. If Lynn didn’t support him, he would carry on with his art creations until the early hours of the morning.
Lynn and Eddie have agreed that he will stop at 9pm.
At 8.30pm Lynn reminds Eddie that he has 30 minutes to go. She then gives him a fifteen minute and five minute reminder. At 9pm she prompts him to move away from his desk and reminds him of the poster on the wall containing his bedtime routine list.
Eddie can see that the first item on the list is going upstairs and into the bathroom to brush his teeth. He needs help getting started with this.
Lynn goes with Eddie to the bathroom and puts the toothpaste and brush next to Eddie to help his brain manage the transition. He can then manage the rest of the task himself so Lynn can get on with a few of her own tasks. However, she returns to support him to get started with the other items on his poster (pyjamas on, curtains closed, dim the lights in my bedroom, get into bed with my book).
Once in bed with his book, Lynn can leave Eddie to read one chapter and then turn out his light.
Understand and Manage Your Teen’s Sensory Profile
To help your autistic teenager cope with sensory processing issues and improve their sleep quality, you can work with them to identify their specific sensory triggers and develop a plan to manage them. This may include using weighted blankets or compression vests to provide deep pressure input, incorporating sensory activities like yoga or deep breathing into their bedtime routine, or adjusting the lighting or temperature of their sleep environment.
Is your child under or over-sensitive to visual, auditory and tactile stimuli, tastes and smells? They be be under-reactive in one area and over-reactive in another. And don’t forget the three lesser-known senses: vestibular (balance), proprioception (awareness of your body’s position in space) and interoception (awareness of your body’s internal signals).
Addressing your teenager’s sensory needs is vital not just for their sleep but for your child’s overall mental health and quality of life.
Minimize Sensory Input Before Bed:
Reducing sensory input before bedtime can be beneficial for many autistic teens who struggle with overstimulation. Here are some tips to help you create a calming and sensory-friendly environment for your teen before bedtime:
Dim the lights: Bright lights can be overstimulating for some autistic teens. Consider using dimmer switches or investing in dimming lamps to create a more soothing environment. You can also try using blackout curtains to block out external light sources.
Reduce noise: Noise can also be a source of stress or overstimulation for some autistic teens. Consider using earplugs, white noise machines, or soothing music to reduce unwanted noise. You can also try using sound-absorbing materials like carpets, drapes, or acoustic panels.
Remove screens: Blue light emitted by electronic screens interferes with the production of the sleep hormone melatonin, making it harder for your teen to fall asleep. Remove screens from your teen’s bedroom or set up blue light filters on their devices. Encourage your teen to stop using screens at least an hour before bedtime.
Use sensory tools: Many autistic teens benefit from using sensory tools like weighted blankets, fidget toys, or chewable jewelry before bedtime to help them relax. Experiment with different sensory tools and see what works best for your teen.
Reduce Daytime Overstimulation
Reducing daytime overstimulation is a vital strategy in helping your autistic teenager sleep better at night. If they have been overstimulated their nervous system can become overwhelmed, producing more of the stress chemical cortisol, which is not conducive to sleep. It can make you feel “wired” rather than sleepy.
Here are some concrete strategies that parents can use:
Create a calm and structured environment: Establishing a predictable daytime routine and creating a calm and quiet environment can help reduce overstimulation for your teenager. What small tweaks could you make?
Use sensory tools: Sensory tools such as noise-cancelling headphones, weighted blankets, and fidget toys / stim toys can help reduce sensory overload during the day.
Identify triggers. Work with your teenager to identify potential triggers for overstimulation, such as specific noises, bright lights, or overwhelming social situations.
Plan activities strategically. Plan activities and outings strategically. For example, avoid overloading your teenager’s schedule with too many activities in a short period. If they have done something intense (like been to a party), they may need a whole day of rest the next day to decompress.
Encourage breaks. Encourage your teenager to take regular breaks throughout the day to rest and recharge.
Consider a sensory diet. A sensory diet is a personalized program of sensory activities that can help regulate your teenager’s nervous system and reduce overstimulation. This generally involves working with an occupational therapist who is a specialist in sensory processing.
Establish Consistent Sleep Patterns:
Setting up consistency in sleep patterns for autistic teens can be challenging. However, there are several practical strategies that parents can use to establish a consistent and regular bedtime routine:
Set a regular bedtime. It sounds obvious, but does your teen actually know what time you expect them to be in bed? Establish a consistent bedtime for your teenager and stick to it as closely as possible, even on weekends. This will help regulate their body clock and improve their overall sleep quality.
Create a relaxing bedtime routine. Work with your child on this. Spend time figuring out what they find relaxing. Adapt and tweak the routine until it feels just right, to help them wind down and prepare for sleep. This might include taking a warm bath, reading a book, or listening to calming music.
Limit electronic device use before bedtime. Electronic devices emit blue light, which interfere with sleep by suppressing melatonin production. Limit your teenager’s use of electronic devices in the hours leading up to bedtime, and consider implementing a “no screens in the bedroom” rule. I know how challenging this can feel (I have two teenagers). If your family has slipped into bad habits, it’s time to re-define your boundaries.
Keep the bedroom conducive to sleep: Make sure your teenager’s bedroom is cool, dark, and quiet. Use blackout curtains to block out light, and consider using a white noise machine to drown out any background noise. If possible, move desks and computers to another room.
Encourage physical activity during the day: Regular physical activity can lead to better sleep, so encourage your teenager to get plenty of exercise during the day. Be sure to avoid vigorous exercise close to bedtime though, as this can have the opposite effect.
Frequently asked questions (FAQs):
How much sleep do autistic teenagers need?
The recommended amount of sleep for autistic teenagers is similar to that of neurotypical teenagers, which is around 8 to 10 hours per night. However, it is important to note that some autistic teenagers may need more sleep than their neurotypical peers. This is because the sensory and emotional challenges associated with autism can cause increased fatigue and exhaustion.
Should you give your autistic teenager medication to help them sleep?
Sleep medication, such as melatonin, can be a helpful tool for managing sleep difficulties in autistic teenagers. However, it is also important to note that sleep medication should not be a substitute for addressing underlying causes of sleep difficulties, such as sensory processing issues or anxiety.
Melatonin is a hormone produced by the body that helps regulate the sleep-wake cycle. It can be taken in supplement form to help with falling asleep and staying asleep. However, it’s important that you understand the potential pros and cons of using melatonin supplements for your autistic teenager and to consult with a healthcare provider before making any decisions. In the UK, use of melatonin is through prescription only, whereas in many countries such as the united states, it can be purchased over the counter.
One of the potential benefits of using sleep medication is that it can help regulate sleep patterns and improve overall sleep quality. This can benefit physical and mental health, such as improved mood, attention, and academic performance. Improving sleep can positively impact problems related to sleep deprivation such as anxiety and irritability.
One thing to be aware of is that some professionals argue there is insufficient research on long-term impacts of melatonin supplementation on children, and its safety has not been conclusively proven.
Dr Lucy Russell is a UK clinical psychologist who works with children and families. Her work involves both therapeutic support and autism assessments. She is the Clinical Director of Everlief Child Psychology, and also worked in the National Health Service for many years. 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 is a mum to two teenage children. She lives in Buckinghamshire with her husband, children, rescue dog and three rescue cats. She enjoys caravanning and outdoor living, singing and musical theatre.
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