Autism? ADHD? Focus on Sleep First!
Updated: Oct 31, 2020
“My life is a mess,” she said. “I hate my job. I feel sick just thinking about going to work. I still live with my parents and, with how little my job pays, there’s no way I’ll ever be able to afford to move out. When I’m not at work, I don’t really have anyone I spend time with. I’m anxious all the time, about everything. I don’t even know where to start to make it better.”
When people come to me feeling overwhelmed by problems, I recommend starting with one thing: sleep. My autistic clients often report that their sleep schedules are chaotic or flipped totally upside down (sleeping during the day and awake at night). Getting your sleep schedule on-track is the single most important thing you can do to improve your life.
Keep reading to learn why and how to get your sleep schedule on-track!
1. Fixing your sleep schedule makes other changes easier.
Sleep, good nutrition and exercise are three key components of physical and mental health. Focus on sleep before you tackle the other two. Getting a good night’s rest gives you the mental strength to make positive choices in the areas of nutrition and exercise. Adequate sleep will also help the part of your brain responsible for regulating emotions and achieving goals function better.
2. Go to sleep at the same time and get up at the same time every day.
If you sleep in on Sunday morning, you’ll have a harder time getting to sleep on Sunday night and will wake up on Monday morning feeling tired, groggy, and irritable. Not a great way to start your week.
3. Take a nap.
The best sleep pattern for your health is biphasic, which consists of 7-8 hours at night and a brief nap (20-40 minutes) before 3pm. When people move away from this pattern, their long-term health declines and mortality rates increase significantly.(3)
4. REM sleep is critical for moving from storing facts to creating knowledge. Autistic people need a full night’s sleep to get even close to enough REM sleep.
When you fall asleep, you cycle between NREM and REM sleep. During NREM sleep, your brain moves memories from short-term storage to long-term storage. During REM sleep, your brain integrates this new knowledge with what you already know.
When you first fall asleep, most of your sleep cycle consists of NREM sleep. With each progressive cycle, you begin to spend less time in NREM and more time in REM sleep. If you get only five or six hours of sleep, versus seven or eight, you lose a disproportionate amount of REM sleep. To make matters worse, autistic people get less REM sleep than their non-autistic peers, even when both groups get a full night’s sleep.(3)
Why is REM sleep so important? It is during REM sleep that we move from simply storing facts to “creating abstract overarching knowledge” (Walker, p. 228). We generate creative solutions. We generalize. We take a million tiny bits of information, see patterns, and make connections. We go to sleep with “disparate pieces of the jigsaw” puzzle, and wake up “with the puzzle complete” (Walker, p. 227).
It’s certainly a stereotype that many autistic people are storehouses of knowledge, but may have difficulties making connections that seem obvious to others. Difficulty generalizing is frequently listed as a symptom of autism. There is speculation that inadequate REM sleep, perhaps across one’s development, may be a causal factor in this. While a full night’s sleep might not give you as much REM sleep as a neurotypical person, it’s certainly worth your while to make sure get a full seven to eight hours of sleep each night.
5. It’s harder for autistic people to know when to sleep; a small dose of over the counter melatonin 1-2 hours before bed may help (but ask your doctor first).
Melatonin tells your body “it’s nighttime, go to sleep!” Autistic people’s melatonin cycle is “flatter” than those of non-autistic people. This means the signal for “go to bed” is not as strong for autistic people.3 According to John Hopkins Medicine, 1-3 mg of melatonin 1-2 hours before bed may help you sleep. Ask your doctor before taking melatonin as it is not good for people with certain health conditions or who are taking certain medications.(1)
6. Turn off screens.
Sorry, but there’s no easy way around this. Browsing the internet, watching YouTube, messing around on your phone – they all stimulate your brain, keeping you awake. Turn off all electronics 1-2 hours before bed (unless you’re using them only to access music, a meditation app, or an audio book as discussed later in this article). According to Harvard researchers, the blue light they emit also suppresses melatonin and can shift your body’s natural signal to go to sleep by three hours.(2)
How do you get your young person to get offline at night? Start with helping your child understand why sleep is so important. Ask them for their ideas about how to get more sleep, and keep reading for concrete suggestions on ways to relax before bed. Model making sleep a priority in your own life. Provide your child a lot of positive feedback for going to bed on time and staying offline.
Parents of younger children may want to consider providing external supports by either carefully monitoring electronic use, or by disconnecting the router and putting away cell phones after a certain time each night. Parents of teens and young adults will likely find disconnecting the router and putting away cell phones to be problematic for a variety of reasons. On a very practical level, if you engage in a battle of “who’s smarter technologically and can my teenager or young adult find a workaround to get online if they really want to” – your teenager or young adult will probably win. On a broader level, exerting this level of control over an older teenager or young adult may not be appropriate and may discourage them from making internally-motivated changes. You will need to rely on consistent reasoning, encouragement, and modeling.
7. But if I’m not browsing the internet, what do I do before bed?
I recommend the low-stimulation, non-electronic version of browsing online: have a stack of magazines on hand, and flip through one in bed. Other ways to relax before bed include coloring or drawing. Use a lamp near your bed for light, so that once you start feeling tired, you don’t have to get up to turn off the light.
You can also close your eyes and listen to calming music or a meditation. (Hint: Start the app, then put your phone out of reach so you’re not tempted to browse online.) Here are a few options that I use regularly:
The Insight Timer app has a great selection of bedtime listening to help you sleep. My favorite is Yoga Nidra for Sleep, by Jennifer Piercy. You can use the free version of the app, and have the option to donate to your favorite teachers to help support them. You can also upgrade to a paid version to access courses on improving your sleep.
The Calm app is more expensive, but does a particularly good job of providing before bed options including “sleep stories” that are soothing but not interesting enough to keep you awake. (Note that if you’re a Kaiser member, the Calm app is free this year.)
Spotify has some great albums and playlists for sleeping. My favorite is Wonderful Escape Rain and Piano, which combines sounds of rain with soft piano music. The family subscription allows everyone in your household to use it without ads.
Audio books are another option. Be sure and set the sleep timer so they won’t play all night. Also, avoid audio books that are too enthralling; you don’t want to get so engrossed that you’re still awake when the sleep timer goes off and you end up turning the audio book back on. Also, avoid distressing subject matter that may give you nightmares.
If you have an iPhone and an app doesn’t have a sleep timer option, click here for a quick and easy work around.
8. If you sleep too little one night, you have a “sleep debt” and will need to sleep more the next night.
The chemical adenosine builds up in your brain from the time you wake up until you go to sleep. Adenosine is referred to as “sleep pressure.”3 The longer you’re awake, the more adenosine builds up in your body, and the greater the pressure to go to sleep. When you go to sleep, the adenosine drains away. If you don’t get enough sleep, you’ll wake up with adenosine still in your system and will need even more sleep the next night to get rid of the accumulated adenosine.
9. Cut back or avoid caffeine.
Caffeine works by latching onto the adenosine receptors, temporarily blocking the adenosine from telling you that you’re tired. Adenosine is still being produced and building up, and as the caffeine wears off, you’ll get hit with a huge wave of adenosine.3 But your body doesn’t like you blocking its ability to tell you you’re sleepy, so if you consistently drink caffeine, it will just make more adenosine receptors! That means you’ll need even more caffeine to block out the feeling of being tired. In addition to disrupting your natural sleep cycles and creating a dependency cycle, caffeine is a stimulant which increases anxiety in many individuals. Caffeine is a lose-lose proposition for both sleep and anxiety management.
Melatonin for Sleep: Does It Work? (n.d.). Retrieved August 31, 2020, from https://www.hopkinsmedicine.org/health/wellness-and-prevention/melatonin-for-sleep-does-it-work
Blue light has a dark side. (n.d.) Retrieved August 31, 2020, from https://www.health.harvard.edu/staying-healthy/blue-light-has-a-dark-side
Walker, M. P. (2018). Why we sleep: Unlocking the power of sleep and dreams. New York, NY: Scribner, an imprint of Simon & Schuster.