Autism, ADHD, and Sleep: An Expert Guide on Neurodivergent Sleep
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Autism, ADHD, and sleep trouble often go hand in hand. As a neurodivergent clinician who specializes in neurodiversity, I am both personally and professionally familiar with the struggle many Autists and ADHDers have around the topic of sleep. I suspect my interest in this arises from my lifelong sleep struggles.
Autism, ADHD, and Sleep: My Experience
As a child, I had terrible night terrors that would wake me up screaming, or I’d be out about the house, adventuring on one of my sleepwalking adventures. Insomnia has always been my companion during big life transitions. After the birth of my children, I experienced insomnia very often, and despite whatever I did, I could not “sleep when the baby slept.” My relationship with sleep and daytime sleepiness has been a lifelong struggle. Until I began studying the overlap between neurodivergence and sleep, it never occurred to me that my lifelong sleep struggles may be a sign of my neurotype. Turns out that with my late-in-life Autism-ADHD discovery, my sleep mysteries are solved. And while my sleep patterns are far from perfect, I have learned some powerful tools along the way to help me get back on track when I’m in the middle of an insomnia loop.
In this article, you will find lots of information about the overlap between both Autism and sleep issues as well as ADHD and sleep issues. Not only will you find information on sleep, but I also give you some information about practices you can begin to implement to help you get better sleep. These practices include sleep hygiene, sleep routine, sleep stimuli, sensory supports, cognitive behavioral therapy for insomnia (CBT-I), and relaxation exercises.
If you are looking for worksheets to help you understand and work on your sleep patterns, check out my Neurodivergent Sleep Guide. In the guide, you will find more detailed information about neurodiversity and sleep as well as loads of worksheets to help you understand your own sleep patterns and work on changing them. Buy the guide here:
Disclaimer: this article is not intended to diagnose medical conditions and is meant for educational purposes only! Sleep issues can be due to underlying medical conditions. If you are experiencing chronic sleep issues, such as chronic insomnia or snoring, then I recommend talking with a health care professional about ruling out these medical conditions.
Autism, ADHD, and Sleep: The Basics
It is not uncommon for people with Autism and ADHD to have sleep-related issues or even co-diagnoses. Research suggests that there is a huge overlap between Autism and ADHD and sleep trouble. For some neurodivergent people, we can experience sleep-disordered breathing (SDB) and sleep apnea; restless leg syndrome (RLS), limb movement disorders, and periodic limb movement disorder; insomnia, including difficulty falling asleep and/or staying asleep; circadian rhythm sleep disorders (CRSD); melatonin dysregulation; narcolepsy; and delayed sleep-waking and difficulty waking. As a result, our sleep is usually less restful, we often need more sleep to feel rested, and it’s more likely for us to be drowsy during the day.
Let’s get into the details of what these issues can look like:
Autism and Sleep
Although there is a lot of overlap between the sleep problems Autistic and ADHD people experience, there are some unique issues each group is likely to experience. For Autistic people, we tend to get less REM sleep (the phase of the sleep cycle responsible for dreaming) than allistic people. Autists spend roughly 15% of their time asleep in the REM phase, whereas allistics spend about 25%. This means we need more sleep than allistics to receive the full benefits of REM sleep (Buckley et al. 2010, Neumeyer et al. 2019).
Also, Autistic people are likely to experience insomnia—including difficulty falling asleep and staying asleep—and are more likely to have genetic mutations that affect melatonin regulation and the circadian rhythm (Furfaro 2020). Furthermore, Autistic children are nearly twice as likely to experience some kind of sleep issue as allistic kids (Reynolds et al. 2019).
For more information about Autism and Sleep, click here.
ADHD and Sleep
Like how Autistic people experience some unique sleep struggles, ADHDers do as well. For people with ADHD, experiences with sleep disturbances—including nonspecific sleep disruptions, parasomnias, hypersomnias, and limb movement disorders—are 83% more likely (Sobanski 2008). Anywhere from 25-50% of ADHDers will also struggle with insomnia, circadian rhythm disorders, narcolepsy, restless leg syndrome, and sleep-disordered breathing (Wajszilber 2018).
With children with ADHD, experiences with sleep issues is roughly 70% more common than with neurotypical kids, this includes issues with insomnia and nightmares (Sciberras 2020, Grünwald and Schlarb, 2017).
For more information about ADHD and Sleep, click here.
Causes of Autism and ADHD Sleep Struggles
There is a large variety of possible causes of neurodivergent sleep struggles, including genetic mutations, co-occurrences, and direct characteristics of the neurodivergence. Here’s a list of possible causes:
Co-occurring diagnoses that are common in neurodivergent people, including anxiety, depression, and gastrointestinal disorders
Sensory sensitivities that keep the body agitated and prevent relaxation
Generally poorer sleep quality as a characteristic of ADHD and Autism
Avoidance of sunlight during the day due to light sensitivity, leading to a disruption in the circadian rhythm
Iron deficiency and dopaminergic abnormalities, the presumed cause of restless leg syndrome (Konofal et al. 2010)
Co-occurring breathing-related sleep disorders
Genetic mutations impacting melatonin secretion and regulation as well as the circadian rhythm (Van der Heijden et al. 2007; Yan et al. 2020)
Consequences of Autism and ADHD Sleep Struggles
As you can imagine, the effects of sleep issues can really take a toll on the neurodivergent person. Because we tend to get less REM sleep than neurotypical people, we lose some of the benefits we need from REM. These include the consolidation of learning and memory that occurs during sleep (therefore we’re more likely to experience learning and memory difficulties as a result of poor sleep), the detoxification of the brain that happens during REM, boosts of serotonin and dopamine (therefore it’s more likely we struggle with our mood and mental health), and overall positive effects to neurotransmitters. And of course, when we get poor sleep, we are more likely to endanger ourselves (while driving, for instance), be more sensitive to stimulation, have a difficult time regulation our emotions, be less resilient to stress and change, and so on.
Being able to track my sleep patterns using a smart watch has been very useful to me. If you are interested in observing your unique sleep cycle, then I recommend considering an Apple watch or a Fitbit.
Although this information can seem dire, there are ways we can aid in a better sleep cycle. Let’s get into how:
Autism and ADHD Sleep Supports
Even though the statistics are not on our side when it comes to sleep, it is still possible for us to consistently get a good night’s rest! In order to understand how to get better sleep as an Autistic or ADHD person, it’s important to understand the role of these three things: Sleep cycles/sleep triggers, sleep resets, and neuroplasticity. Let’s dive in:
Sleep Cycles and Sleep Triggers
If you frequently have restless nights, it’s a good idea to have an understanding of your sleep patterns and what might be triggering this restlessness. To begin, it’s important to map these cycles. For many of us, we can get into ruts where one bad night’s rest causes the next bad night’s rest and so on until we’ve spiraled out of control. If we can identify when these cycles begin, we can eventually learn to stop them before they start. These triggers can include environmental triggers (sounds, smells, textures, etc.), situational triggers (disruption in routine, illness, work schedule, etc.), social triggers (social events, housemates, partners, etc.), emotional triggers (anxiety, sadness, stress, etc.), and others. Having an understanding of the things causing wakeful nights is an important first step to addressing them.
Sleep Resets
When we've gotten into a cycle of poor sleep, it’s helpful to understand how to reset our system. When you notice you’re in one of these ruts, what are some things that help you to get back to a healthy sleep cycle? These resets can look like pushing through the day without coffee or a nap so that you can get to sleep on time, using a sleep aid (like over-the-counter melatonin) to reset your circadian rhythm, exercising during the day so that you’re more tired at night, and so on. Identifying what practices reset your system is another important step to getting back on a healthy sleep schedule when you’re been thrown off.
Want to dive deeper into the connection between Autism, ADHD, and sleep? My Neurodivergent Sleep Guide will provide you with more information, as well as workbook pages to help you understand your sleep patterns better.
Neuroplasticity
What is neuroplasticity? Neuroplasticity refers to the brain’s ability to rewire itself to create new neuropathways. Imagine a trail in the woods. The more you walk that trail, the more defined it becomes. But one day, you decide the trail should go a different way in through the woods. You begin walking that trail and, although it’s not as easy to walk down at first, it progressively becomes more defined the more you walk the trail, and the old pass becomes increasingly less defined. This is essentially how your brain works, too. Although it can take some work, we can create new ways of thinking that are better than the old ones.
When it comes to sleep, we often get into ways of thinking that can be harmful to our sleep patterns. We can create harmful overcouplings and negative thought patterns. For example, if we lay in bed for hours without falling asleep, stressed about how tired we will be the next day, then our brain associates bed with restlessness and stress. However, if we understand how to work with our brain’s neuroplaciticy, we can learn to associate our beds with rest and learn how to quiet the mind at night.
I’m sure you’re wondering how to implement this information so that you can actually start sleeping well. Here are some places you can start:
Six Buckets of Sleep Supports
I’ve developed what I like to call the “six buckets of sleep supports.” These six buckets serve as six different starting places to begin your journey to getting consistently good sleep at night. These buckets include addressing your sleep hygiene, looking at your sleep routine, looking at sleep stimulus, adding sensory supports, introducing CBT-I, and practicing relaxation exercises.
Let’s get into more detail about each of these six buckets:
Sleep Hygiene
To put it simply, sleep hygiene encompasses everything you do to take care of your sleep and sleep cycles. All of your habits and routines that encourage regulation and sleepiness at the end of the day count towards your sleep hygiene.
Why is Sleep Hygiene Important?
Just like brushing your teeth or showering is important to keep your body healthy, sleep hygiene keeps your brain, hormones, and circadian rhythm healthy. When we have poor sleep hygiene, it can cause poor sleep, inflammation in the brain, disruptions in our hormone cycles, difficulty waking, and more. For Neurodivergent people, it is especially important to maintain healthy sleep hygiene because of our increased sensitivities, genetic vulnerabilities to sleep disorders, etc.
Examples of Good Sleep Hygiene:
Sleeping in a dark, cool, and quiet room
Putting away technology two hours before bed
Avoiding caffeine and naps after 2 pm
Moving the body regularly, avoiding rigorous exercise two hours before bed
Going to bed and waking up at the same time every day (see “sleep routine” next)
Avoiding alcohol and heavy meals two hours before bed
Get more information about sleep hygiene in this article.
Sleep Routine
Sleep routine is probably pretty self-explanatory. It refers to the rituals you perform every night before bed. Showering, brushing your teeth, and getting into comfy pjs may make up part of your sleep routine. What’s important is that these habits are things you do every night.
Why is Sleep Routine Important?
Sleep routines primes the brain and body for sleep. In the evening, when we begin our routines to get ready for bed, these actions signal to the brain that we’re about to sleep. That way, when we climb into bed, our brains and bodies are ready. Like Maslow’s dogs!
For Autistic people and ADHDers, we often have a delayed onset of melatonin. That means that, unlike neurotypicals, we often can’t fall asleep just because we get into bed because our brains need time to begin producing melatonin. Therefore, when we have a solid sleep routine, it can help offset this vulnerability.
Ideas to Include in Your Sleep Routine:
Taking a warm bath or shower right before bed
Having a self-care routine that feels good and grounding
Using essential oils as aromatherapy
Drinking herbal tea
Reading for thirty minutes
Doing some stretches or relaxation exercises (see “relaxation exercises” below)
Gratitude journaling or reflecting on the day
Listening to soothing music
Remember, too much change at the same time can be overwhelming for the body! If you are trying to introduce things into your sleep routine, start small and be gradual. The aim of building a new sleep routine is to be consistent and intend to soothe and regulate the body.
If you want more information on nighttime routines for ADHDers and Autists, check out this article on neurodivergent bedtime routines.
Sleep Stimulus Control
In this section, we are going to dive into how we can use neuroplasticity to associate bed with sleep. So what is sleep stimulus? Basically, sleep stimulus control is a protocol that helps break the cycle between the wakeful signals and the bed. Sleep stimulus control helps ensure that the bed is associated with sleepiness and falling asleep. Sleep routine is a big part of our sleep stimulus, but there’s a lot more than that to this bucket. Not only are we looking at what signals our brain to fall asleep when looking at our sleep stimulus, but we look at the things that are doing the opposite: the things that signal our brain to wake up and stay alert when we are trying to fall asleep. We call these sleep disturbances.
Why is Sleep Stimulus Important?
Like I said above, people with Autism and ADHD often have a delayed onset of melatonin. Therefore, priming our brains and bodies is really important if we are to fall asleep when we want to. However, lots of people with sleep problems have created the opposite effect in our bedrooms. Because of our sleep issues, we can easily learn to associate bed with stress and wakefulness, which, as you can imagine, does not prime the brain for a good night’s rest. When we look at our sleep stimulus, not only are we looking at the things that prime us for bed, but we look at the things that prime us to stay awake. Then, we do something about it. Here’s how:
Sleep Stimulus Control
“Sleep stimulus control” is a fancy way of saying creating a stronger association between bed and sleep, reducing interference. This means disrupting any associations between bed and wakefulness. For instance, many people have made the subconscious association that bed equals spending hours on TikTok and watching tv. Scrolling through social media and watching tv are wakeful activities; therefore, we want to break those associations.
Sleep Stimulus Control Guidelines
Don’t watch the clock—this is a wakeful activity! Try facing our clock away from the bed
Avoid using your phone while you’re in bed
Avoid sleeping in any other room (like the recliner in the living room)
Use your bed only for sleep and sex. And, if it’s possible, use your entire bedroom only for sleep and sex.
Only go to bed when you’re sleepy
Harmful Associations with Bed
Another thing to consider when analyzing your sleep stimulus is what harmful or distracting emotions are associated with bed. Due to insomnia, many people spend hours laying in bed feeling anxious and stressed. Over time, this causes the brain to associate bed with anxiety and stress. This association then perpetuates the insomnia cycle by priming the brain for anxiety and stress as it’s going to bed, making it that much harder to fall asleep. We want to break that association. One way to do this is by practicing the 15-Minute Rule. Let’s get into it:
15-Minute Rule Guidelines
Get into bed only when you’re sleepy. This will increase your chances of falling asleep.
After 15-25 minutes (estimate—don’t watch the clock!) if you are still awake, get out of bed and do something relaxing until you feel sleepy again. (This can be really hard, but it will help, I promise!)
In case you need to get up, have things prepared to do. For instance, have a book and your glasses in the living room by your chair. That way you can go right to your chair and read until you feel sleepy again. Other examples include folding laundry, doing a sudoku puzzle, or doing relaxation exercises.
When you feel sleepy, go back to bed. Repeat this process as many times as necessary.
If you become fixated on the clock or the exercise causes anxiety, drop it entirely. I invite you to consider the CBT-I and relaxation practices below instead.
If interoception is difficult for you and it’s hard for you to tell when you are tired, it could help to begin with some interoception exercises before trying this one.
Sensory Supports
For both neurodivergent and neurotypical people, sensory supports are any kind of tool or aid that helps eliminate sensory stimulation. Lots of people use black-out curtains and fans at night while they sleep. These count as examples of sensory supports.
Why Are Sensory Supports Important?
For Autists and ADHDers, it is especially important to use sleep sensory supports. It goes without saying that neurodivergent folks are more sensitive to sensory stimulation than neurotypicals; therefore, it makes sense that sensory stimulation is more likely to keep us awake at night. Sensitivities to light, sounds, discomfort, smells, and more can all affect our quality of sleep. Therefore, being mindful of these kinds of stimulation and using sensory aids can create a much more comfortable environment to fall asleep.
Examples of Sleep Sensory Supports:
Wearing a quality and comfortable eye mask to block out light
Using a sound machine or fan
Wearing earplugs
Purchasing memory foam mattress toppers and pillows for comfort
Sleeping with a weighted blanket
Sleeping by yourself
Installing black-out curtains
Cognitive Behavioral Therapy for Insomnia (CBT-I)
I don’t often recommend cognitive behavioral therapy (CBT) for Autists and ADHDers because it can easily feel disingenuous or like gaslighting. However, cognitive behavioral therapy for insomnia (CBT-I) is something that I’ve found to be very helpful for myself and for my clients.
CBT-I helps to interrupt thought patterns that are keeping you awake. The worse our sleep issues get, the worse our thoughts and beliefs around sleeping can be. Regardless of how rational these thoughts and beliefs may seem, they are always unhelpful and often make sleep issues worse.
Why is CBT-I Important?
The destructive thought patterns we get into around sleep perpetuate sleep issues and insomnia. They may not be the start of our sleep issues, but, as they develop, they can become a primary cause. Therefore, introducing techniques like the ones described below can make a profound difference in how effectively we can fall asleep.
Examples of CBT-I Techniques to Try
CONFRONTING STRESSFUL SLEEP THOUGHTS
When we catch ourselves getting caught up on stressful thoughts, it can help to reframe them to be less catastrophic. This is usually how it happens: First, we find ourselves laying in bed, not falling asleep. Then, the stress thoughts move in. “I’m never going to fall asleep,” “I’m going to be so tired tomorrow,” etc. When those stressful thoughts begin to occur, they signal the body’s trauma response which in turn makes it even harder to fall asleep. When this happens consistently enough, we begin to associate bed with stressful thoughts and wakefulness, making it harder and harder to fall asleep each night.
The good news is that, if we can identify the beginning of this cycle, we can interrupt the negative thoughts before they can activate the body’s trauma response. For instance, if we are having the thought, “I will never fall asleep,” then it could help to reframe the thought to say, “I’m not falling asleep right now, but I have to eventually”. Or maybe you’re having the thought, “I will be exhausted tomorrow,” which could be reframed to say, “I may be tired tomorrow, but I’ve gotten through tired days before, so I can do it again”.
DISTRACTION TECHNIQUES
Another way to break this cycle is to distract our brains from these stressful thoughts. There are a variety of techniques you can use to do this, but I recommend two: the calm visualization and cognitive shuffling.
To practice the calm visualization, imagine yourself in front of a whiteboard with your favorite colored marker in your hand. Visualize yourself writing the word CALM on the whiteboard, the number one below it, and then circle it. With your other hand, erase what you have just written. Repeat with the number two, then three, and so on, until you fall asleep.
Some neurodivergent people have difficulty with visualization, so, if that’s you, you can try cognitive shuffling. To do this, pick any word of any length (for instance, the word “garden”). Then, take the first letter (in our case, g) and think of every word you can that starts with that letter (grape, garbage, grandmother, etc). Keep going until you run out of words and then move to the next letter. Doing this helps to scramble the brain’s thoughts so they no longer have power at the moment.
APPS FOR SLEEP
If it would be helpful to have some help falling asleep, you can try using sleep apps. Here is a list of apps I really enjoy:
Relaxation Exercises
The mind isn’t the only player in the insomnia game. Even when we address the thoughts keeping us awake, our bodies can still be too wired to sleep. When our bodies are stuck awake like this, that means our sympathetic nervous system—or, the fight/flight/freeze/fawn response—is activated. These relaxation exercises help to get us out of the sympathetic nervous system trauma responses and into the rest and digest response, otherwise known as the parasympathetic state.
Why Are Relaxation Exercises Important?
Just like how harmful thoughts can keep us awake, so can emotions and energies in the body. So if CBT-I is for the mind, then relaxation exercises are for the body. It is impossible to sleep when our sympathetic nervous system is stuck on. Therefore, relaxation exercises can be necessary to get the body out of its fight/flight/freeze/fawn response so it can relax enough to fall asleep.
Examples of Relaxation Exercises:
DEEP BREATHING
A variety of breathing exercises would be able to help your body relax. Here’s one that works for me:
Take a deep breath in through your nose to a count of four
Hold for one or two seconds
Exhale through the mouth, slowly, to a count of six
Repeat for a couple of minutes or however long feels good to you
PROGRESSIVE MUSCLE RELAXATION (PMR)
PMR uses intentional muscle tension and release to activate the vagus nerve, the nerve responsible for our rest-and-digest state. Here’s how it goes:
Start with your feet. Clench your toes as much as feels comfortable and hold for five seconds.
Release and wait another five seconds, then repeat once more.
Once you’re done, move on to the next muscle group—feet and ankles in this case. And repeat.
Repeat moving up the body to the calves, thighs, glutes, pelvic floor, abs, and so on, until you’ve done this with each muscle group.
If you need help, you can listen to this recording from Dartmouth.
If you have trouble intentionally creating tension (as lots of neurodivergent people do), then skip the tension and just focus on relaxing these muscle groups.
GUIDED MEDITATIONS
Both UCLA and Dartmouth have some excellent guided meditations on their websites. Here are my suggestions:
UCLA:
Breathing Meditation (5 min)
Breath, Sound, Body Meditation (12 min)
Meditation for Working with Difficulties (7 min)
Loving Kindness Meditation (9 min)
Body and Sound Meditation (3 min)
Body Scan for Sleep (12 min)
Deep Breathing & Guided Relaxation Exercises (3 min)
Guided Imagery/Visualization Exercises (5 min)
Mindfulness & Meditation Exercises (3 min)
Progressive Muscle Relaxation
RELAXATION APPS
Breathe2Relax: This relaxation tool provides info on stress as well as some relaxation exercises to practice.
Calm: Calm is a well-known app and website with many practices that aid relaxation.
Mindshift CBT: This app uses CBT to teach you how to unwind. They also have some mindfulness meditations in the app’s “Chill Zone”.
Autism and ADHD Sleep: Conclusion
People with Autism and ADHD are known to have more difficulty sleeping. This can be due to genetic mutations, co-occurring diagnoses, sensory sensitivities, and much more. However, with the right knowledge and help, it is possible for us to get great sleep at night. The techniques discussed in this article all help you to understand your sleep cycles, your sleep triggers, and how neuroplasticity can be your friend. These techniques—or, as I call them, the six buckets of sleep supports—including sleep hygiene, sleep routines, sleep stimulus, sensory supports, CBT-I, and relaxation techniques.
Remember, take what sticks and leave the rest. And be sure to make changes progressively—too many changes at once can cause more damage. So listen to and trust yourself!
You deserve consistent, good sleep and you’ve got what it takes to get it. We can do this!
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