Sleep and Autism

The beneficial effects of a good night sleep for both physical and mental well-being are well-known. We know, for example, that sleep is the body’s natural restorative, where much physical and mental healing occurs during the sleep process. For example, anxiety and stress are processed during sleep, particularly between the hours of 1:00 AM and 4:00 AM. Waking well-rested allows the body to cope with the various stresses and strains that occur on a daily basis.

However, research indicates approximately 75% of autistic people experience sleep problems, and these problems contribute to high levels of stress, anxiety and depression. If you or a loved one experiences sleep problems, I encourage you to complete the following four activities to help you further understand what may be contributing to your sleep problems, and to create a plan to improve your sleep.

Activity 1: Complete the Questionnaire

Please take a few moments now to complete the following sleep questionnaire.

How well do you sleep?

On average how many hours of sleep do you get per night?

How many hours of sleep do you need per night to function well?

Do you have difficulty falling to sleep?

If Yes, do you have difficulty falling to sleep when you initially go to bed at night (a condition called initial insomnia)? 

Or, do you have trouble staying asleep at night, waking up in the middle of the night and finding it difficult to get back to sleep (a condition called middle insomnia)?

Or, do you wake up too early in the morning, and generally not fall back to sleep (a condition called terminal insomnia)?

When you wake up in the morning, do you feel rested from your sleep?

What have you tried in the past to help you sleep?

What was the most helpful strategy?

What was the least helpful strategy?

Activity 2: Identifying any particular barriers for good sleep

There are many possible problems that can get in the way of a good sleep. This list below was compiled from research findings of some of the known barriers for being able to sleep at night. Please tick the ones that you believe apply to you.

Potential Barriers to Sleeping Well

• Sensory issues, for example, sounds are too loud, the bed is uncomfortable, problems with temperature regulation.
• Motor/muscular problems, for example restless leg syndrome, difficulties relaxing the body to allow sleep.
• Busy mind, for example, too many thoughts in the mind, or racing thoughts, no particular focus.
• Anxiety, where it is difficult to get to sleep because of a particular focus of anxiety, for example money worries, anxiety for the future, health anxiety, relationship problems, being able to get to sleep, worried about the next day, etc.
• Excessive alcohol consumption, where 2 to 3 standard drinks are consumed regularly per evening, leading to early-morning awakening and increased anxiety.
• Excessive caffeine consumption, where consumption of tea, coffee and/or caffeinated soft drinks is leading to wakefulness through the night.
• Inactivity, where daily life contains little to no physical exercise and the body is not tired for sleep.
• Over tiredness, where sleep has been delayed or missed too often, and the mind feels “wired” and unable to “switch off.”
• Fear, where sleep has been associated with trauma, and therefore it does not feel safe to go to sleep.
• Vitamin D deficiency, either as a result of lack of sunshine, or a difficulty with the body processing vitamin D.
• Unhelpful thinking patterns, for example, “I am just a hopeless sleeper,” “I can never change.”
• Any other reason, please specify.

Activity 3: Problem-solving activity

A problem well-defined is a problem half solved. Defining what a problem is, points the way to potential solutions. Using the questionnaire that you have just completed, tick the potential solutions that may assist you to enjoy a better night’s sleep.

Potential Solutions Allowing Better Sleep

• Addressing sensory issues, for example, exploring and discovering solutions for auditory and tactile sensitivities, and/or temperature dysregulation.
• Addressing motor/muscular problems by learning physical relaxation strategies to allow the body to let go of tension and rest.
• Addressing ‘busy mind’ problems by learning effective strategies to manage a busy mind at night time.
• Addressing anxiety problems by learning effective strategies to manage anxiety.
• Modifying alcohol or other drug consumption by addressing any problems with addiction.
• Modifying caffeine consumption, addressing any problems with addiction.
• Increasing physical exercise to where the body out, allowing deeper sleep.
• Easing the mind activities to counteract the problems of over tiredness and a mind that feels “wired.”
• Therapy to address resolved trauma that is affecting sleep.
• Addressing vitamin D deficiency via medical consultation and either/or increasing time in the sun, or taking regular vitamin D supplements.
• Addressing low melatonin levels via medical consultation and increasing time looking at the sun as it rises and sets, and/or taking pharmaceutical grade melatonin on prescription from your GP.
• Cognitive restructuring to recognise and challenge unhelpful thinking patterns.
• Any other reason, please specify.

Activity 4: Psychoeducation about Sleep

Next, read this paragraph about addressing sleep problems.

Some of us, genetically, have sleep problems. Others inadvertently learn how to have sleep problems. Fortunately, whether you have acquired sleep problems genetically, or by learning, or by a mixture of both, sleep problems can be overcome. Some important ideas about establishing and maintaining a good sleep pattern include:

• Go to bed at the same time each day (always before midnight, and ideally around 10 PM), and get  up at approximately the same time each day (around 6 AM if you went to bed at 10 PM).
• Ensure that you get enough sunlight. Whenever possible, watch the sun going down and coming up. The activities of getting enough sun and watching the sun go down increase melatonin, the sleep chemical in your brain, to assist your body to go to sleep.
• Start a ‘going to bed” routine that includes switching off all screens (including television, PC, smart phones and tablets) approximately one hour before bed, having a relaxing bath or shower, drinking a glass of warm milk or chamomile tea, engaging in a relaxing activity, for example reading a book that is not too exciting, having soft lighting, not engaging in anything too exciting or stimulating, including conversation in the last hour before bed.
• Once in bed tell yourself that you are going to have a good relaxing night’s sleep. Tell your body that it is time to switch off and rest.  Remind yourself that there is nothing more that you need to do. Tell yourself that it is okay to not sleep, just resting and relaxing will help your body to rejuvenate in the way that it needs to. Think of relaxation as skill that you can master with practice. Be kind and compassionate to yourself in the learning process. Read a book, listen to relaxing music, or to a relaxation or Yoga Nidra audio recording.
• If you find that you are still awake after 30 minutes, get out of bed, move into another room, sit in a comfortable armchair and  read  a relaxing book or magazine. Once you feel sleepy, go back to bed.
• It is important not to spend long periods of time lying in bed trying to go to sleep and not succeeding. This ties together the feeling of failure and stress with the experience of  lying in bed, making it even more difficult to go to sleep. It is important to teach the body to pair the experience of getting into bed with relaxation, ease, and sleep.

Activity 5: Your Plan for Sleep

Please complete this plan due to put into place your strategies.

I plan for a good night sleep. To allow this plan I am willing to make room for the uncomfortable sensations associated with change, learning new skills and trying again. I am willing to release old one comfortable thinking patterns. I plan to...

When are you going to put this plan into place? Be specific about dates and times. Use the weekly planner. Who will you ask to help you?

If you have tried these methods over the period of one month or more with no success, I encourage you to visit your GP for a referral to a sleep clinic. Many autistic people have undiagnosed sleep disorders, for example sleep apnoea, and sleep issues will not resolve unless these are assessed and treated.