Sleep in Autistic Adolescents and Adults
Figure 9. Common Sleeping Challenges for Autistic Adolescents and Adults
Figure 10. Senses and Sleep in Adolescents and Adults on the Autism Spectrum. Repetitive sensorimotor behaviors that occur in autistic adolescents and adults, such as body rocking, hand flapping, and twirling, can impact an autistic individual’s night of sleep. In addition, it is known that autistic individuals spend less time of their sleeping time in the rapid eye movement (REM) category compared to neurotypical individuals. REM is a part of the sleep cycle in which body and brain development occur during this stage. As a result of less time spent in REM, autistic individuals struggle with more fatigue and other symptoms during the day.
Figure 11. Sleep Hygiene. In 50–80% children with autism, sleep challenges occur, such as reduced sleep duration and efficiency, bedtime resistance and drowsiness symptoms during the day (6). Improving your sleep hygiene can help you achieve better sleep as an autistic individual or neurotypical individual. For autistic adolescents or adults, it is especially important to maintain a sleep routine, manage nutrition before bed, exercise during the day and create an ideal sleep environment. With the tips in this figure, you can accomplish better sleep hygiene to improve sleep quality. In addition, studies found that insomnia in ASD can be caused by nutritional deficiencies, which could occur from food preferences related to a restricted diet, food phobias, and atypical mealtime rituals (7).
Figure 12: For autistic adolescents and adults, bedtime routines are important for them to understand the schedule of the day. Insomnia and reduced sleep duration from anxiety are more common in autistic adults compared with neurotypical adults, which can contribute to significant social, psychological, and health burdens. This can help them fall asleep better in the evening (15, 18). A daily routine can lessen the anxiety of understanding what is expected at bedtime. Having a schedule can help autistic individuals prepare for falling asleep and plan out their evening so they can best structure their night to meet their sleeping needs. For example, a relaxing activity, such as taking a warm shower, can help someone relax as their body's core temperature decreases, which is a circadian rhythm signal for sleep. For more information on creating a personalized bedtime routine with a template, use the following.
Figure 13. How to Make a Bedtime Routine. A sample bedtime routine for autistic individuals is shown below (Sarah’s Bedtime Routine). It can also be helpful to make your own bedtime routine suitable to your needs. Feel free to use the editable template below to create your own bedtime routine. As a guide for planning your own bedtime routine, it may be helpful to include more stimulating activities such as talking with loved ones and eating dinner earlier in the night and relaxing techniques such as reading a book right before you go to bed.
Figure 14. Autism and Sleep in People with Traumatic Experience(s). Autistic individuals can be more likely to experience post traumatic stress disorder (PTSD) compared to neurotypical individuals. For those who do have PTSD, this can impact quality of sleep and result in insomnia and disruptive sleep, highlighting the importance of identifying and providing solutions to help autistic individuals with PTSD improve their quality of sleep. In addition, it is common to experience typical day events such as driving home in traffiic or waiting at a doctor’s office as stressful events, if you are not getting enough sleep. When you don’t get enough sleep, this can impact your daily activities and even make it harder to focus on work, indicating the importance of learning how to improve your sleep.
Figure 16: Obstructive Sleep Apnea (OSA) is a common sleeping challenge in autistic individuals that can prevent them from obtaining restorative sleep, resulting in significant effects on physical health, mental health, and overall well-being. OSA occurs because sometimes during sleep, the upper throat muscles relax, which blocks the airway, resulting in a temporary pause in breathing. Since OSA can significantly imact the quality of life of autistic individuals, it is important they receive care and/or treatment for this condition (20, 21).