Sleep issues are common among children and adults with ASD.

• Difficulty with sleep onset, or falling asleep
• Difficulty with sleep maintenance, or staying asleep throughout the night
• Early morning waking
• Short-duration sleeping
• Sleep fragmentation, characterized by erratic sleep patterns throughout the night
• Hyperarousal, or heightened anxiety around bedtime
• Excessive daytime sleepiness

Persistent sleep problems in people with ASD may indicate a sleep disorder. Insomnia is the most commonly reported sleep disorder among adults and children with ASD. Insomnia is defined as difficulty falling and/or remaining asleep on a nightly or semi-nightly basis for a period of more than one month.

In addition, parasomnias such as frequent nightmares, night terrors, and enuresis (bedwetting) have been widely reported among children with ASD, particularly those once diagnosed with Asperger syndrome. The child’s inability to express their fears and discomforts upon waking — often due to ASD — can complicate the way parasomnias are addressed and treated. Additionally, children with ASD often wake up in the middle of the night and engage in ‘time-inappropriate’ activities like playing with toys or reading aloud

Cognitive behavioral therapy (CBT) has proven fairly effective in alleviating sleep disorder symptoms for young people with ASD. CBT is designed to improve sleep hygiene in patients by educating them about the science sleep and helping them find ways to improve their nightly habits.

a consistent bedtime schedule can be quite beneficial to them. A healthy bedtime schedule might consist of the following:

• Putting on pajamas
• Brushing teeth
• Using the toilet
• Washing hands
• Getting in bed
• Reading a book (or being read to)
• Shutting off the light

Sleep tool kit

• Create a ‘visual schedule checklist’ with pictures, objects and other visual aids that can help a child with ASD grasp the concepts more easily.
• Keep the bedtime routine concise, and limit it to roughly 30 minutes before bed. Otherwise, the child might become overwhelmed with too many commitments.
• Order the routine so that stimulating activities like television and video games come first, followed by reading and other relaxing activities.
• Physically guide the child to the schedule at first, and use verbal cues to remind them to check the schedule. Teach them how to cross things off on the checklist themselves.
• Provide positive reinforcement whenever the child follows the schedule correctly.
• If the routine must be changed, let the child know in advance so that they can mentally prepare for the disruption. Alter the checklist ahead of time to reflect these changes.