- Sarah Breckon
Establishing a Bedtime Routine for Children with Autism Spectrum Disorder
Children with autism spectrum disorder (ASD) can face many challenges. Among them is getting into a calm state so they can sleep and enjoy the proper amount of rest each night. Finding the right way to help them unwind and keep an appropriate schedule may be difficult, but it is vital for the child’s overall health.
Here are some tips for parents and loved ones who want to help their children reduce frustrating experiences with sleep.
The Connection Between Autism and Sleep
Just how does autism relate to sleep? While we are still learning about the symptoms of ASD and the tools available to help kids, we know that up to 86% of kids with autism have difficulty getting good regular sleep.
In particular, REM sleep (the stage needed to recharge and repair the body) is shorter in kids with ASD, and it can take up to 11 minutes longer for these kids to fall asleep. This slight difference, added to the fact that they may wake up much earlier than their peers, creates a concerning connection between autism and sleep, which may make it hard for kids to learn and develop properly.
It doesn't just affect the child with ASD. Parents and caregivers who live in the home can worry about their children, find it hard to help them get good sleep, and even find themselves unable to sleep properly. Of all the challenges that ASD families face, sleep issues are especially stressful.
Preparing for nighttime starts during the day. Children with ASD tend to do better when there is structure to their lives. Establish a consistent daytime routine to wake up around the same time, keep predictable schedules, and avoid daytime activities so late in the day that they interfere with nighttime rest.
Setting Wake-Up Hours
When should children wake up? If they have a consistent bedtime, they should get up when they've had enough rest.
Children who need to get to school on time need enough space to wake fully, enjoy breakfast, and tend to do hygiene and care tasks (brushing teeth, dressing) without stress or rush. This may mean getting these children up earlier than the rest of the family, so they can go through their morning routine confidently.
Healthy And Consistent Diet
Nutrition plays a vital role in overall health, and children with ASD are no exception. Your physician may have more input into what specific food triggers may cause problems for your child. In general, avoid too much caffeine or sugary processed foods, as well as anything that a child may be sensitive to. In some cases, when children can enjoy special foods in moderation, and earlier in the day, eating treats won't interfere with bedtime.
Maintain An Active Lifestyle
While some children with ASD have physical challenges such as movement impairments, you can encourage them to stay healthy and active through games, play, and exercises. Going for a walk, using playground equipment, or even dancing to music are all things that kids of various ages enjoy and that also help them work their muscles and assist in healthy bone development.
Exercise also helps them regulate their energy, which is important when falling asleep at night. Not getting enough exercise can lead to kids feeling extra “wiggly.” You may try to avoid exercise too close to bedtime, however. This can get kids too exasperated and make it harder for them to fall asleep.
Keep Naps Short
Younger kids definitely need their naps, and if a doctor has advised your child to continue napping, don’t cut this much-needed rest time out of the day. You can move nap times a bit so that they aren’t too close to bedtime. Keeping them shorter may help you avoid the “wired” child who just isn’t sleepy yet.
If your child has outgrown naps or is well on their way to it, give them some downtime during the day, but don't let them sleep. If it's not possible to do this, keep naps under 20 minutes. It probably won't feel like much rest, and it can be hard not to let them keep sleeping. Too much sleep during the day can seriously affect sleep and keep everyone in the house up much later than usual.
Bedtime Routine for Children with ASD
Children with ASD benefit from all kinds of routines, and bedtime is no exception.
Build a visual guide
Setting the expectation for how bedtime will go can alleviate stress and keep everyone in the family on the same page. Children with ASD may benefit from a visual guide or a kind of nighttime “chore chart” that uses simple pictures to symbolize the different steps to take before bed.
This tool offers two benefits:
It reduces surprises and decreases the conflict of children not knowing how to behave before bed
It empowers children to take ownership of some tasks and gives them control over the bedtime process
Ideas for the visual guide include brushing teeth, dressing, getting a stuffed animal, singing a song, and saying goodnight. This same visual guide can be used as part of a reward system for kids who struggle with the steps. Completing a full night’s routine without conflict might earn them a sticker, special time the next day, or another valuable treat.
Set A Consistent Bedtime
Having a consistent bedtime at the same time every night supports their natural sleep rhythm and gives them a better expectation of what to expect each day and evening, which helps them with planning and reduces the anxiety of the unknown.
Whenever possible, have the child adhere to this bedtime, even on weekends or holidays. There may be some trial and error to figure out what time is the best time for your child since children with ASD sometimes need slightly less sleep than peers of the same age. The CDC recommends 8-10 hours of sleep for older children and teens, with as many as 13 or even 14 hours for preschoolers and young children. (This number includes naps.)
Consider when the rest of the family goes to bed and how easy it will be to put your child to bed during a certain time. Choose a bedtime that works for the child and is practical to implement in your household.
Set Up Healthy Sleep Associations
For a child who has difficulty falling asleep, the mere thought of bedtime can add stress to their day. Add in some of the common childhood bedtime fears (fear of the dark, fear of nightmares, separation anxiety, etc.), and it may be hard for a child to see falling asleep as a good thing.
Developing a healthy attitude towards sleep and sharing the benefits with the child can help them approach sleep better. You’ll also want any sleep associations (habits needed to fall asleep) to be practical and good for the child.
Sleeping alone or without the help of electronic devices are two healthy sleep associations that take time to develop. You may choose a reward system or ease into these gradually through step-based sleep training methods. Sitting in the child’s room until they fall asleep, then moving the next night to the hallway, etc., is one example of a gradual approach toward building positive sleep associations that don't cause undue stress for the rest of the family in the long term.
Avoid Electronics, Screens, And Stimulants
It’s tempting to let a child watch cartoons or play with their tablet until they grow tired, but this is an unhealthy sleep association and can make the child dependent on screens to transition peacefully to sleep. Not only is it a bad habit, but blue light has been shown to deter a restful state in adults and may make it harder for them to enter restful sleep stages. The effects on children may be similar.
In addition to screens, reconsider stimulants, such as caffeine or large amounts of sugar, before bed. How long before bedtime these ingredients affect kids varies, but start by keeping sugar, tea, energy drinks, and sodas out of a child’s diet anytime after lunch.
Wind-Down Before Bedtime
Play affects children in different ways, and some activities may cause them to get “wound up” or become overstimulated. Think carefully about letting kids roughhouse or listen to exciting or scary stories right before bed. Instead, try calming activities, such as reading or story time, having a warm bath, or listening to gentle music.
Having a “wind-down” routine is an important part of the sleep process. Whatever you decide on, be consistent about it every night. To make it easier for busy parents and caregivers to commit to a routine, make it short and easy. Brushing teeth, having a glass of water, using the bathroom, then a short story before lights out is an examples of a routine that sets the stage for sleep and also helps you connect with your child.
Use this as an opportunity to comfort your child and reduce stress, but try not to give in to extended or repeated requests outside of the routine. "One more drink of water" or "one more trip to the bathroom" can go on for hours if allowed. Having firm boundaries for what will happen every night lets the child know that bedtime won't be delayed and can help them get the right amount of sleep.
Consider The Room Temperature
A room that is too hot or cold can interfere with sleep. Put the thermostat to a comfortable temperature to help your child get some rest.
Assess Fabrics of Pajamas And Bed Sheets
Children with ASD often have sensory issues and may find the feel of certain fabrics to be annoying or even painful. Look for pajamas that have no seams, buttons, or tags. Bed sheets may also irritate, so consider how your child responds to bedding when planning for restful sleep.
Some children may benefit from special sleep tools made specifically for children with autism spectrum disorders, such as weighted blankets or sleep sacks. Just be sure kids are old enough to use these without the risk of suffocation. They should be able to take them off easily if needed without adult assistance. You can order weighted blankets in the size best for your child's age and weight, with heavier blankets most appropriate for older kids and adults.
Use Soothing Sensory Experiences
While music or lights before bed may help a child calm down, try to avoid having any of these going on while the child is sleeping. When they shut off, it can startle them from sleep. Instead, try out a white noise machine or a fan to help drown out the sound from other rooms and help the child relax throughout the entire night.
Reduce Light Exposure And House Noises
If your child with ASD goes to bed earlier than everyone else, make sure others in the home know to stay quiet and respect areas near the child’s bedroom. Noise from talking, TV, music, or general activity can distract them, since these children may be more sensitive to even the quietest noise.
Kids who fear the dark may need a small nightlight to help reassure them, but it shouldn't be too bright. Cover windows with curtains or blankets if the light outside comes in; moonlight, street lights, or even lights from passing cars make it harder for some kids to fall asleep and stay asleep.
More Resources On ASD And Sleep
Some of the best places to find out about sleep and ASD are from autism groups, such as other parents in your community who care for kids with ASD. They have experienced what you are experiencing and can share what’s worked for them. Look for these groups at your local school, church, or community center. Your child’s physician may also have ideas for where you can look for answers to your child’s sleep problems outside the medical literature they might offer.
In the meantime, consider the following website designed to support families: