Sleep and Autism

Best Practice

We have identified a number of organisations that have published best practice guidance on sleep and autism.

NICE Guidance on Sleep in People on the Autism Spectrum

The National Institute for Health and Care Excellence (NICE) is a UK government body which supports healthcare professionals and others to make sure that the care they provide is of the best possible quality and offers the best value for money.

NICE has not made any recommendations on sleep problems in autistic adults.

NICE has made the following recommendations on sleep problems in autistic children and young people.

• The first step should be a full assessment of any sleep problem to determine its precise nature and any factors that might be contributing to it, such as the sleep environment, co morbidities (other conditions) and current medication
• Following the assessment, parents and carers should be supported to develop a sleep plan to encourage the child or young person to develop positive sleep habits, and use a diary to record sleeping patterns and bedtimes
• Medication should not be considered until it is clear behavioural interventions would be ineffective and the child or young person's negative sleep behaviours would persist and have a detrimental impact on them and their family or carers
• Medication should only be used following consultation with a specialist paediatrician or psychiatrist who has expertise in the management of autism or paediatric sleep medicine, and in conjunction with behavioural interventions
• Any medication to aid sleep should be regularly reviewed to ensure that that its benefits continue to outweigh the side effects and risks in children and young people with autism.
• Loud snoring, choking or witnessed apnoeas (the cessation of airflow during sleep preventing air from entering the lungs caused by an obstruction) should prompt referral to a sleep expert to exclude diagnosis of obstructive sleep apnoea.

Source: The management and support of children and young people on the autism spectrum. (2013). London: National Institute for Health and Clinical Excellence.

Further information: Please see NICE Clinical Guidance on Sleep in Children and Young People with Autism

Sleep Committee of the Autism Treatment Network

The Sleep Committee of the Autism Treatment Network is a US-based organisation which consists of pediatric sleep medicine specialists as well as developmental pediatricians, neurologists, and psychiatrists.

The ATN Sleep Committee has created a clinical practice pathway which is designed to assist primary care providers and others working directly with families affected by ASD in addressing the challenge of insomnia with regard to identification assessment, and management.

The pathway recommends that

(1) all children who have ASD should be screened for insomnia,
(2) screening should be done for potential contributing factors, including other medical problems,
(3) the need for therapeutic intervention should be determined,
(4) therapeutic interventions should begin with parent education in the use of behavioural approaches as a first-line approach,
(5) pharmacologic therapy [medication] may be indicated [used] in certain situations, and
(6) there should be follow-up after any intervention to evaluate effectiveness and tolerance of the therapy.

Source: Malow B.A. et al. (2012). A practice pathway for the identification, evaluation, and management of insomnia

Updated

16 Jun 2022

Last Review

01 May 2018

Next Review

01 May 2021