Autism and Sleep: How To Sleep Better As An Autistic Woman
If you are an autistic woman struggling to sleep, you’re not alone. Autistic people often experience trouble sleeping, which can include restless legs, sleep-walking, nightmares or sleep apnoea. In this article, I’ll be focussing on insomnia, including difficulties falling asleep and staying asleep in autistic adults.
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Disclaimer: this article is intended for educational purposes only and is not a substitute for medical advice. Sleep issues can indicate underlying medical conditions, so if you are concerned about your sleep I encourage you to seek support from a qualified health professional or contact your GP.
Sleep problems and autism
It has been suggested that up to 79% of autistic adults may experience sleep problems.
Despite this, there is very little research on sleep and autism.
I did find one study though, conducted by Halstead et al. (2021), which researched sleep problems in autistic adults. This involved surveying 288 adults living in the UK on their sleep quality, experiences & preferences for sleep treatment, and their experiences of self-management of their sleep problem.
They found that 90% of participants met the criteria for poor sleep quality, but only 42% had consulted with a healthcare professional about their sleep.
Of those who did speak with a professional, 72% were prescribed medication but 60% were not satisfied with the outcome.
A huge 80% of participants stated that self-management was not effective in addressing their sleep problems.
And finally, non-medication options were preferred by 41% of participants, such as education, advice or talking therapy.
This was quite a small study and much more research is needed into autism and sleep problems, but it still provides some interesting insights.
It’s clear that we need to shift how we treat sleep problems in autistic adults, ensuring that treatment actually reduces sleep problems and considers preferences.
Factors that may cause sleep difficulties in autistic adults
There are a variety of factors that may contribute to poor sleep in autistic adults.
More research is needed in this area, but some factors that may be involved in triggering or maintaining trouble sleeping include:
Co-occurring conditions, such as anxiety, depression or gastrointestinal issues
Stress from navigating a world that is designed for neurotypical people
Difficulty unwinding and relaxing at the end of the day
Change, such as changes to routine or life changes
Sensory sensitivities, for example to noise or light which may keep you awake
Some of these factors will be out of your control but you may be able to influence others and make improvements to your sleep.
It is also important to note that the factors that trigger your trouble sleeping may not be the same factors maintaining the problem.
Poor sleep and insomnia can continue even when the initial trigger has passed. This is due to perpetuating factors, such as:
🛌🏻 Unhelpful behaviours used to cope with poor sleep, for example napping or lying in on the weekend
🧠 Conditioned arousal – your brain has started to associate the bed with not sleeping well
💭 Sleep anxiety and unhelpful thoughts or beliefs about sleep
Fortunately, these factors are within your control. As a sleep therapist, I help my clients identify and address the factors maintaining their trouble sleeping so they can break the cycle of insomnia and start sleeping through the night again.
The impact of poor sleep on daily life
Poor sleep can have a big impact on your quality of life, as I’m sure you’re aware. Here are some examples of aspects of daily life that can be affected by trouble sleeping or insomnia:
Emotional regulation becomes more challenging – you might feel more anxious, on edge or irritable
Difficulty focussing or concentrating at work
Increased difficulty with executive functioning skills, such as memory, organisation, planning, prioritising tasks, setting and achieving goals, impulse control and flexibility. As an autistic person you may already struggle with executive functioning skills and lack of sleep may heighten this challenge
Increased tiredness and lack of energy
Finding it harder to mask in social situations
Increased hypersensitivity to noise
Tips for sleeping well as an autistic woman
Identify triggers
Are there any patterns to when you struggle with sleep? For example, is it always stress related? Do you have more trouble sleeping after social occasions? Maybe your sleep environment is important for you?
Take some time to reflect on this and consider whether there is there anything you can do to adapt to these triggers and set yourself up for a better night’s sleep.
As I mentioned above, we can’t always control or predict what will trigger a bad night’s sleep. There are many potential factors that could disrupt sleep. Unfortunately, we can’t control everything in life.
But you may find that you can make some changes or adjustments to prevent trouble sleeping or support yourself.
For example, a stressful day at work may be out of your control but when you get home you can choose to have an easy dinner and prioritise doing something relaxing to help you unwind before going to sleep.
Sleep supporting habits
Improving your sleep hygiene, or sleep habits, can be a good place to start if you are looking to sleep better.
Healthy sleep habits include lifestyle choices, such as:
Having a consistent wake time, which helps regulate your body clock
Avoiding caffeine in the afternoon
Avoiding alcohol in the evening as it disrupts sleep
You can read about more examples of sleep habits and why they are helpful here.
Don’t get too hung up on perfecting your sleep habits though. If you have chronic trouble sleeping or insomnia, improving your sleep habits alone is very unlikely to fix the problem.
As a sleep therapist, clients often come to me feeling like they have tried everything, yet they still can’t sleep. Instead of offering more sleep hygiene advice, it is vital to address the specific factors maintaining your trouble sleeping, such as unhelpful coping strategies or anxiety around sleep, and retrain a healthy sleep pattern.
Managing anxiety and stress
Many of my clients tell me that worry and stress keeps them awake at night. They find themselves awake at 3 am ruminating on the day, worrying about the future or overthinking decisions. This activates their ‘fight or flight’ response, putting their mind and body on alert and making it difficult to sleep.
One tip I share with clients to help with this is to journal or brain dump all your thoughts onto paper before you go to bed. This gets everything out your head, making it easier to sleep. You can come back to this the next day if needed and consider whether you need to address any of the worries or things you wrote down.
Practice relaxation
In order to sleep we need to feel relaxed and safe, so it’s important to allow time to unwind from the day before bed. This is especially important as an autistic woman, living in a world that may feel unpredictable, unsafe and exhausting.
Examples of relaxing activities include: yoga nidra, hypnotherapy, an adult colouring book, gentle stretching and reading.
But have a think about what you find relaxing. You might find it helpful to write a list to remind yourself of your favourite calming activities. Then you can pick something from it when you need a little help unwinding.
Further reading: Unlocking Relaxation: 5 Barriers to Effective Rest and How to Overcome Them
Address sleep anxiety
Anxiety about being unable to sleep is one of the most common factors involved in maintaining insomnia or chronic poor sleep.
Not being able to sleep is really frustrating and what often happens is people start to associate bedtime and their bed with wakefulness, being alert and feeling anxious or stressed.
There are various strategies and approaches we can use to manage sleep anxiety and rebuild the connection between the bed and sleep.
I’ve created a 15-minute masterclass exploring the signs you experience sleep anxiety, how it fuels insomnia and practical tips to help you sleep better tonight. Sign up below to watch now.
Create a comfortable sensory environment
How can you set up your bedroom to make sure your sensory needs are met and signal to the body that it is time to sleep? Below are some examples:
Noise
Earplugs, such as Loops, could be helpful if you are very sensitive to noise in the environment
Or you might actually find having some background noise helps you to sleep, for example listening to a relaxing sleep playlist or sleep story/meditation
Chronic poor sleep or insomnia can make hypersensitivity to noise worse, keeping you stuck in a cycle of poor sleep. Addressing insomnia and improving your quality of sleep can help improve this issue
Light
Switch to dim lighting in the evening to help you unwind and signal to your brain that it is bedtime
Use black out blinds to make sure the bedroom is dark enough for you to sleep well
If you can’t fully control the light, then an eye-mask may be useful
A Lumie wake-up light allows you to have a more gentle start to the day by waking you up more naturally with a gradually brightening light. They also have a variety of alarm sounds to choose from, such as birdsong, making it less jarring to wake up in the morning - my Lumie light has been a gamechanger for improving my mornings!
Smell
You could use aromatherapy or essential oils to help you relax and control the scent of the bedroom
Touch
Choose comfortable bedding and nightwear, such as cotton, and you may want to remove any labels
Some people like having a weighted blanket, but evidence suggests that they don’t actually improve sleep
Sleep therapy
Everyone will experience short-term, or transient, insomnia at some point in their life. This is totally normal and our body is adaptable, meaning sleep usually returns to normal after a few days or weeks. But if you’ve been struggling for over three months it might be time to think about getting some support.
At this point you may be unintentionally engaging in thinking or behaviour patterns that are maintaining insomnia, even if the initial trigger has passed.
In sleep therapy, we can get to the root cause of why you’re still struggling to sleep and work together to:
Rebuild the connection between the bed & sleep
Manage worry or stress
Address sleep anxiety
Regulate your body clock
And retrain a healthy sleep pattern
So that you can sleep through the night, feel calmer and have more energy for work and life.
References
Halstead, E., Sullivan, E., Zambelli, Z., Ellis, J. G., Dimitriou, D. (2021) The treatment of sleep problems in autistic adults in the United Kingdom.
Dr Megan Anna Neff. Autism, ADHD, and Sleep: An Expert Guide on Neurodivergent Sleep. https://neurodivergentinsights.com/autism-adhd-and-sleep/
National Autistic Society. Sleep and Autism. https://www.autism.org.uk/advice-and-guidance/topics/physical-health/sleep/autistic-adults