Sleep Concerns in Autism and ADHD: Understanding Neurodivergent Sleep and How to Support It
Sleep is essential for overall well-being, yet many neurodivergent individuals struggle to get the rest they need. Research indicates that sleep disturbances are significantly more common in autistic and ADHD individuals than in the general population (Cortese et al., 2020). These challenges can persist into adulthood and often include difficulty falling asleep, frequent night awakenings, restless sleep, and early morning waking (Shelton & Malow, 2021).
This blog post will explore the sleep concerns that are common in autism and ADHD, explore how these disturbances manifest, and discuss strategies tailored for children and adults to improve sleep quality and overall well-being.
Common Sleep Challenges in Autism and ADHD
Neurodivergent individuals often experience a range of sleep difficulties, including:
Difficulty Falling Asleep: Sensory sensitivities, overactive thoughts, and difficulties with routine transitions can make it hard to wind down at night.
Frequent Night Wakings: Light sleep, nightmares, and heightened awareness of surroundings can lead to waking up multiple times throughout the night.
Early Morning Waking: Some neurodivergent individuals wake up unusually early, even if they haven’t had enough sleep.
Restless or Poor-Quality Sleep: Even when asleep, many autistic and ADHD individuals experience non-restorative sleep, leading to fatigue and difficulty functioning during the day.
Delayed Sleep Phase: Many ADHDers naturally fall asleep later than what is considered a "typical" bedtime due to differences in circadian rhythm regulation.
Hyperactive Brain at Bedtime: Racing thoughts, hyperfocus on interests, or difficulty winding down can make bedtime frustrating.
Restless Legs or Excessive Movement During Sleep: Some ADHDers experience Restless Leg Syndrome (RLS) or frequent movement during sleep, affecting sleep quality.
Difficulty Waking Up: Because neurodivergent individuals often struggle with restorative sleep, mornings can feel particularly exhausting.
Why Do Autism and ADHD Impact Sleep?
Autism and ADHD are neurodevelopmental conditions characterized by unique brain wiring, which influences everything from sensory processing to emotional regulation. These differences can make it more difficult for neurodivergent individuals to achieve restful sleep. Several key factors contribute to sleep challenges in autism and ADHD:
Irregular Melatonin Production: Both autistic and ADHD brains often experience dysregulation in melatonin cycles, the hormone responsible for regulating sleep. If melatonin is released at the wrong time or in insufficient amounts, falling asleep can become difficult.
Hyperarousal and Difficulty Relaxing: ADHD brains often remain in a hyperactive state, making it challenging to transition into restfulness before bed. Autistic individuals may experience heightened alertness due to sensory sensitivities or anxiety.
Sensory Sensitivities: Many autistic individuals are highly sensitive to light, sound, and touch, making sleep environments uncomfortable. ADHDers may also struggle with sensory processing differences that impact relaxation.
Inconsistent Sleep Patterns: Neurodivergent individuals frequently have a circadian rhythm that differs from the neurotypical norm, often leading to delayed sleep onset or a natural tendency to stay up late (a phenomenon known as delayed sleep phase syndrome).
Co-occurring Conditions: Anxiety, depression, gastrointestinal issues, and other co-occurring conditions common in autism and ADHD can further disrupt sleep quality and duration.
Sleep Strategies for Autistic and ADHD Individuals
Struggling with sleep is a common challenge for neurodivergent individuals, but small, thoughtful changes can make a significant difference. Whether for children or adults, establishing a sleep-friendly environment and consistent bedtime habits can help improve rest and overall well-being.
For autistic and ADHD children, predictable routines, sensory-friendly sleep spaces, and emotional regulation techniques can support smoother sleep transitions. Meanwhile, adults may benefit from sleep hygiene practices, stress management techniques, and adjustments to melatonin regulation.
The following sections provide practical, neurodivergent-friendly sleep strategies tailored to both children and adults, helping to promote more restful nights and energized days.
Sleep Strategies for Autistic and ADHD Children
1. Establish a Predictable Bedtime Routine
Creating a structured and calming bedtime routine can ease sleep transitions for children. This may include:
A warm bath
Reading a favorite book
Listening to soft music
Using a weighted blanket.
2. Optimize the Sleep Environment
Reduce Sensory Disruptions: Use blackout curtains, white noise machines, and soft bedding to minimize sensory overload.
Create a Comfortable Sleep Space: Ensure pajamas and bedding are comfortable for sensory-sensitive children.
3. Manage Anxiety and Emotional Regulation
Introduce relaxation techniques such as deep breathing, mindfulness exercises, and bedtime storytelling.
Use visual schedules to help children anticipate bedtime transitions.
4. Encourage Physical Activity
Regular outdoor play and movement during the day can help regulate energy levels and promote sleep.
Avoid high-energy activities right before bedtime.
5. Regulate Melatonin and Light Exposure
Ensure exposure to natural daylight in the morning.
Turn off screens at least 30 minutes before bed and remove screens from the bedroom.
Discuss the potential of melatonin supplements with your pediatrician.
Sleep Strategies for Autistic and ADHD Adults
1. Implement Consistent Sleep Hygiene Practices
Set a consistent sleep schedule, even on weekends.
Avoid naps that may disrupt nighttime sleep.
Use the bed only for sleep to reinforce its association with rest.
2. Manage Stress and Anxiety Before Bed
Practice mindfulness, meditation, or deep breathing exercises to reduce bedtime stress.
Engage in calming activities like journaling or listening to soft music.
3. Address Melatonin Regulation
Increase exposure to bright light in the morning.
Limit blue light exposure from screens at least 30 minutes before bedtime.
In some cases, use melatonin, or other sleep aid supplements under medical guidance.
4. Optimize the Sleep Environment
Use earplugs, blackout curtains, or white noise machines to block out disruptive sensory input.
Adjust bedding materials for maximum comfort and temperature regulation.
5. Limit Stimulants and Late-Night Activities
Reduce caffeine and stimulant intake in the afternoon and evening.
Avoid mentally stimulating activities, such as work or gaming, right before bed.
6. Engage in Physical Activity
Establish a routine for exercise, going for a walk, or other movement during the day.
Avoid high-energy activities right before bedtime.
Additional Sleep Interventions
Cognitive-Behavioral Therapy for Insomnia (CBT-I)
CBT-I is a structured, evidence-based therapy designed to help individuals with insomnia develop healthier sleep patterns. This approach can be particularly beneficial for those with anxiety-driven sleep issues. CBT-I helps patients identify negative thoughts about sleep and replace them with healthier attitudes and behaviors.
medications and supplements
When behavioral interventions are not enough, certain medications and supplements may be considered under the guidance of a medical professional.
Melatonin – This natural sleep hormone is commonly used to help regulate sleep cycles in both autistic individuals and those with ADHD. Research suggests that melatonin supplementation can improve sleep onset and duration.
Clonidine and Guanfacine – These medications, often used to treat ADHD, can also promote relaxation and improve sleep.
Sedative medications – In more severe cases, a doctor may prescribe sedative medications, though these are typically used as a last resort due to potential side effects and dependency risks.
Seeking Professional Support
If sleep difficulties persist despite implementing these strategies, seeking professional support may be necessary. A sleep specialist, behavioral therapist, or occupational therapist experienced in neurodivergent sleep issues can provide further guidance and tailored interventions.
How Sleep Problems Are Diagnosed
Sleep problems are diagnosed by sleep professionals through a detailed evaluation process that typically includes medical history, sleep pattern assessments, and diagnostic tests. A sleep specialist will first conduct an in-depth consultation, asking about symptoms such as difficulty falling asleep, staying asleep, excessive daytime sleepiness, snoring, or restless legs. Patients may also be asked to keep a sleep diary for a few weeks to track sleep patterns, bedtime routines, and any factors that may contribute to sleep disturbances.
In cases where a sleep disorder is suspected, the doctor may order additional tests to rule out medical conditions such as sleep apnea, restless legs syndrome, or narcolepsy. One of the most common diagnostic tools is a sleep study, also known as polysomnography.
What Is a Sleep Study?
A sleep study is a non-invasive test used to monitor and record physiological activity during sleep. It can be conducted in a specialized sleep lab or at home using a portable device, depending on the suspected sleep disorder.
Types of Sleep Studies
Polysomnography (PSG) – This comprehensive sleep study is performed in a lab setting and records brain waves, eye movement, heart rate, breathing patterns, oxygen levels, and muscle activity. It is commonly used to diagnose conditions such as sleep apnea, insomnia, narcolepsy, and parasomnias.
Home Sleep Apnea Test (HSAT) – This is a simplified version of a sleep study that can be done at home. It mainly monitors breathing patterns and oxygen levels to detect sleep apnea.
Multiple Sleep Latency Test (MSLT) – Often used to diagnose narcolepsy, this test measures how quickly a person falls asleep during the day in a controlled setting.
Actigraphy – This method involves wearing a small wristwatch-like device that tracks movement and sleep-wake cycles over several days or weeks to detect circadian rhythm disorders.
For individuals with autism or ADHD, a sleep study can help determine whether sleep problems stem from a primary sleep disorder or are linked to sensory processing differences, hyperactivity, or anxiety.
Conclusion
Sleep difficulties are a common and often challenging aspect of life for individuals with autism and ADHD. However, by understanding the root causes and implementing targeted interventions tailored to children and adults, it is possible to improve sleep quality and overall well-being. Whether through structured routines, environmental adjustments, anxiety management, or professional guidance, addressing sleep concerns can lead to better daily functioning and an improved quality of life.
If you or your loved one is struggling with sleep, consider seeking support from a healthcare provider to create a personalized sleep plan. Prioritizing sleep is essential for cognitive, emotional, and physical health, and with the right strategies, restful nights can become a reality.
References
Cortese, S., Brown, T. E., & Corkum, P. (2013). Sleep and ADHD: A review. Sleep Medicine,
14, 230-238.
Shelton, A. R., & Malow, B. (2021). Neurodevelopmental disorders commonly presenting
with sleep disturbances. Neurotherapeutics, 18, 156-169.
