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Top tips for sensory needs, activities and routines to help you sleep.Useful apps and products recommended by young people.

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If you have a child with additional needs and sleep issues, bedtime can be tricky.

Whether they struggle to communicate how they're feeling, have increased anxiety, sensory issues or social cueing problems, sleeping well may be difficult. For example research estimates that between 40-80% of children and young adults with autism have sleep problems. If your child regularly has difficulty falling asleep or staying asleep, it may be a sign of a sleep issue.

Lack of sleep can impact in the following ways:

Aggression

Depression

Hyperactivity

Increased behavioural problems

Irritability

Poor learning and cognitive performance

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If a child struggles to communicate how they're feeling, have increased anxiety, sensory issues or social cueing problems, sleeping well may be difficult.

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The bedroom environment plays an important role in getting a good night's sleep. There is a lot to consider including temperature, light and comfort. Here are some tips to help you to make sure that your child's bedroom supports a restful night's sleep:

1. Decorate in neutral colours, bright colours can be over stimulating.

2. If the room is too hot or too cold it can disturb sleep, around 18 degrees is ideal, you may find it helpful to invest in a room thermometer.

3. Make the bedroom a gadget free zone. If possible, keep TVs, gaming devices, tablets and phones out of the bedroom. Using them before may suppress the production of melatonin, the sleep hormone, and make it more difficult to nod off.

4. White noise can mask out background noise and may be useful.

5. For younger children put away toys or cover them with sheets at nighttime so that they don't provide a distraction. For older children try to discourage them from doing schoolwork on their bed and pack away school books at bedtime.

6. A dark environment can help with melatonin production making us feel drowsy at the start of the night. Blackout blinds can also help in the summer months to avoid early waking.

7. Some youngsters (and adults!) prefer a little light in the room at nighttime. If a dark room is distressing or disorientating, try using a soft glowing night light that can be safely left on all night. Those with visual/hearing impairments for example can find total darkness disorientating.

8. Consistent conditions throughout the night are important. Avoid using products that switch off during the night or turning landing lights off when you go to bed.

9. Comfort is important, we all have different needs when it comes to what we prefer and what suits our bodies. The firmness of the mattress and pillows, the texture of the bedding and nightclothes are all important considerations when planning our sleep environments, especially for those youngsters with sensory needs. For more information on mattresses for children visit NBF's Bed Advice UK.

10. Never use the bedroom or an early bedtime as a sanction for children, sleep should be promoted positively.

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The bedroom environment plays an important role in getting a good night's sleep. There is a lot to consider including temperature, light and comfort. Here are some tips to help you to make sure that your child's bedroom supports a restful night's sleep: Decorate in neutral colours, bright colours can be over stimulating.

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If your child is routinely waking in the night, it is important that they learn to self-settle rather than seeking a parent or joining a parent's bed. This can be difficult to enforce, and may be emotionally challenging, for both child and parent, but parents should remain firm and assertive.

If your child leaves their bed and seeks you out at night-time, try not to engage them in conversation, but lead them quietly and immediately back to bed. This may need to be repeated several times each night, but it is important that your child learns that they will receive the same response from you each time.

If your child is anxious, the use of a night light, cuddly toy or baby monitor may help them to feel safe and learn how to self-settle.

Praising your child in the morning for staying in bed at night can help reinforce good behaviour; this can be aided by the use of a reward chart or stickers, with a small token prize when a certain number of stickers/rewards have been won.

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Sleep hygiene in children and young people

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This information sheet from Great Ormond Street Hospital (GOSH) explains about sleep hygiene. The lead-up and routine around your child's bedtime is referred to as 'sleep hygiene'. Having good sleep hygiene can help your child both to settle to sleep and

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Our dedicated sleep service is here to help.

Alongside our Sleep Tips booklet and relevant guides, we also offer one-to-one support. This involves completing an application form for your child and two weeks' worth of sleep diaries which we'll send out to you as long as you come under our criteria for support.

If you need one-to-one support and are a parent/carer or a professional referring a family with their consent to having sleep support, please click the button below to contact the sleep service.

If you have a question or query about our services please email us at [email protected].

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Sleep tips Our Sleep Tips booklet introduces and explains different techniques for you to try that may improve your child's sleep. It covers ten main topics including bedtime routines, daytime napping, comfort objects and moving bedtime backwards or forwards. It gives lots of illustrated hints and tips for putting the...

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Teenagers often struggle to wake up easily in the morning. This is not actually due to laziness, but when children become teenagers their sleeping pattern changes to make them want to go to bed later and wake up later. This can make it very difficult to wake up early in the morning.

If you're struggling to wake up in the morning then it's very important you don't go to bed too late and that you set your alarm for reasonable time in the morning and get up at that time seven days per week. If you let yourself sleep in at the weekends, it can encourage your body to go to bed later and wake up later even when you have to go to school.

Some things that can help you get out of bed are:

putting your clock or mobile phone on the other side of the room, so you have to physically get out of bed to turn your alarm off

finding a small reason to get out of bed - like a tasty breakfast, exercise, meditation, writing a mood journal, or listening to your favourite podcast while you get ready.

It's also very important that you get bright light exposure early in the morning to help you feel more awake and alert. Ideally you should open your curtains as soon as you wake up to get some early bright sunshine exposure.

Once you start getting into a routine, you'll start to find that waking up each morning becomes slightly easier.

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Lots of people have problems sleeping sometimes. If you're struggling to get to sleep, check out our tips and advice.

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Pt3. THREE THINGS you can do if sleep is a problem

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Pt 3. Finally, we look at sleep stealers! Yup, these are the things that literally steal our ability to sleep and keep us WIDE awake when we should be resting. We hope you find some good ideas here to put into practice.

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Blue Light and Sleep - The Sleep Charity

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The blue light that emits from devices (including TVs) suppresses the natural production of melatonin – the hormone you need to feel sleepy

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Most games consoles have internet access, which means your child can go online and chat with other players or make in-game purchases. On many consoles there are parental controls which allow you to manage which features are available to your child. On some devices you can:

turn off chat functions to stop your child from talking to people they don't know

restrict games based on age

turn off in-game purchases, or set a limit.

Check the website for the console your child has for a parents section and details of features. Some games also allow you to change settings for that individual game.
PlayStation Family Management
On PlayStation consoles you can set up a Family Manager account which allows you to manage different accounts for different children/users. Within this you can manage a range of features, such as restricting communication with other players, restricting content, setting play time controls and set spending limits. See all the features available for PS4 and for PS5.

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If you're worried about what your child's searching for or seeing online, we can help you to set up parental controls and keep them safe.

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In the run up to bedtime, dim the lights and avoid screen time. Melatonin production is interfered with by screen activities for example watching television or playing on a computer. The light from the screens will stop the melatonin being produced as effectively therefore it is best to avoid these activities in the hour leading up to bedtime.

Even low amounts of ambient light will suppress the production of melatonin which will affect not only sleep but have other health consequences as well.

What about melatonin supplements?

Some people may take melatonin for jet lag or shift work and some sleep disorders like Delayed Sleep Phase Syndrome and REM Sleep Behaviour Disorder.

Some children, particularly those on the Autistic spectrum, are prescribed melatonin to help with their sleep issues. Good sleep hygiene should still be maintained as the melatonin will not work as effectively if your child is not comfortable, relaxed and in an appropriate bedroom environment.

Avoid buying melatonin supplements from the internet (they are only available on prescription in the UK). Taking them may disrupt your own natural melatonin production and potentially suppress your ability to produce this important hormone, ultimately making sleep problems worse. If you think you need help with melatonin production, speak to your GP.

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In the run up to bedtime, dim the lights and avoid screen time. Melatonin production is interfered with by screen activities for example watching television or playing on a computer. The light from the screens will stop the melatonin being produced as effectively therefore it is best to avoid these activities in the hour leading up to bedtime.

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The exercises in this series of videos are suitable for most people in good health with a reasonable level of fitness.

Unless stated otherwise, they are general exercises only and are not aimed at treating any specific cause of pain or condition. Video titles and descriptions can give more information on how difficult the exercises are and who they are for.

Get advice from a healthcare professional before trying them if:

you are not sure if the exercises are suitable for your current level of fitness

you have a health problem, an injury, any symptoms, are feeling unwell, or you have had a recent health event such as a heart attack or operation

you have any other concerns about your health

you are pregnant or have recently given birth

Stop the exercise immediately if you feel any pain or become unwell. If you are concerned about any symptoms, or they do not go away, get help from 111 online or call 111 for advice.

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Instructor Beth will take you through a sequence of mindfulness and meditation techniques in this home workout video from the NHS Fitness Studio, where you can find a range of workout routines to suit you, whether your aim is to lose weight, improve your overall fitness, or de-stress.

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How to Calm Your Worries and Sleep Better: A Scientist's Tips for Falling Asleep More Quickly

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3 Minutes Body Scan Meditation - Mindfulness For Kids And Adults

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Belly Breathing for Self-Care - Taking Deep Breaths to Relax

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The 5-4-3-2-1 Method: A Grounding Exercise to Manage Anxiety

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Night terrors and nightmares are often confused as the same thing but the two are completely different.

Nightmares are unpleasant dreams, occurring in dream sleep (REM), that are remembered upon waking. A night terror takes place during non-REM sleep and involves feelings of fear, screaming, thrashing around and sweating while still asleep, and won't be remembered the next day. More information on night terrors can be found here.

Nightmares are more common than terrors but neither cause any psychological harm to your child.

Here are our tips on telling them apart and how to handle them:

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Night Terrors and Nightmares - The Sleep Charity

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Night terrors and nightmares are often confused as the same thing but the two are completely different. Nightmares are more common than terrors.

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Feeling relaxed is important in the run up to bedtime for both parent and child. If your child is experiencing difficulties sleeping it can make you both feel anxious. Youngsters often pick up on stress levels so try to create a relaxing and calm environment as bedtime approaches.

Here is some advice that may help:

1. Turn off all screens an hour before bedtime, this includes television, laptops, tablets and mobile phones. Screen activities can be mentally stimulating and also may inhibit the production of melatonin, the sleep hormone that helps us to feel drowsy.

2. Set aside time earlier during the day to allow your child to share any worries with you. It can be helpful to share how their day has been and what is planned for the next day. Make sure to give them your full attention.

3. Dim the lights in the hour before bed to create a relaxing environment and aid the production of melatonin.

4. Fine motor skill activities such as craft activities, model making, jigsaws or colouring pictures can aid relaxation.

5. Massage can help some children to unwind.

6. Classical music can be very soothing and makes good relaxing music to play in the background during the bedtime routine.

7. Mindfulness is being increasingly used and there is evidence to suggest that it can be helpful to promote relaxation and sleep. There are a number of apps and products on the market that may be useful.

8. Encourage your child to concentrate on their breathing. Imagine breathing in a beautiful white light and blowing out any worries or troubles each time they exhale. Breathing exercises are also useful for parents to carry out and are a great exercise to enjoy together.

9. Teach your child to progressively relax the muscles in their body. They can begin my tensing their feet to the count of 5 and then letting them relax. Next tense the calf muscles and relax, moving up to the thighs and so on until they have relaxed each part of their body. This is another good activity to try together.

10. End the day on a positive note by sharing 5 great things that have happened during the day.

If you are concerned about your child's anxiety levels discuss with your GP or a healthcare professional, some children may require specialist support.

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Youngsters often pick up on stress levels so try to create a relaxing and calm environment as bedtime approaches.

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With the World Cup starting in November, it's a constant reminder of the positive benefits that exercise has on sleep. It isn't a myth that exercising regularly tends to help people sleep better. Did you know that athletes often focus on sleep as much as their diet and exercise routines?

Exercising often and effectively can tire your body out gently, resulting in a better sleep when it's done right! Releasing built-up tension through exercise has many benefits, including reducing stress before bedtime and dropping your body temperature, which promotes a better sleep.

The benefits include the obvious ones too with exercise not only good for sleep, but sleep is good for exercise. Exercising can create a positive cycle of sleep, building muscle tissue, and growth hormones.
When is the best time to exercise to help you sleep?
If possible, morning or afternoon exercising is the best. If you exercise too much or too close to bedtime, it could have a negative effect. When you go to bed, it's a time to relax and chill out, but exercising too much can cause you to feel too awake to wind down in time.

This being said, exercising in the evening is much better than none at all. It's a good idea to make sure you have enough time to wind down afterwards, though. You could always consider yoga or a gentle stroll to help you relax as part of your wind down routine.
How often should you exercise each day/week if you're struggling to sleep?
20 to 30 minute sessions, three times per week should do the job! This is providing you do aerobic exercise which boosts oxygen consumption, improves breathing, and strengthens your heart and circulation.
Can you exercise too much?
You can overdo it! If you exercise too much it can do the opposite and be counterproductive, leading to you feeling extra alert when trying to sleep. Although people believe that exercising a lot can tire you out and help you sleep, this can sometimes be incorrect, so sticking to a routine of 20-30 minutes is more beneficial.
What exercise will help?
Moderate to aerobic exercise like walking has been found to help people fall asleep faster. Swimming can help you to relax your mind and body, which can improve sleep. Aerobic exercise boosts oxygen consumption, improves breathing, and strengthens your heart and circulation. As mentioned, yoga is also known for its relaxation and sleep benefits. If you suffer with tension, gentle stretching before going to bed can also help.

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With the World Cup starting in November, it's a constant reminder of the positive benefits that exercise has on sleep. It isn't a myth that exercising regularly tends to help people sleep better. Did you know that athletes often focus on sleep as much as their diet and exercise routines?

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Autism and Sleep - Created by Spectrum Gaming and Reviewed by The Sleep Charity - Family Toolbox

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Spectrum Gaming is an autistic-led UK based charity that supports autistic young people. We aim to create a world…

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Teenagers often struggle to wake up easily in the morning. This is not actually due to laziness, but when children become teenagers their sleeping pattern changes to make them want to go to bed later and wake up later. This can make it very difficult to wake up early in the morning.

If you're struggling to wake up in the morning then it's very important you don't go to bed too late and that you set your alarm for reasonable time in the morning and get up at that time seven days per week. If you let yourself sleep in at the weekends, it can encourage your body to go to bed later and wake up later even when you have to go to school.

Some things that can help you get out of bed are:

putting your clock or mobile phone on the other side of the room, so you have to physically get out of bed to turn your alarm off

finding a small reason to get out of bed - like a tasty breakfast, exercise, meditation, writing a mood journal, or listening to your favourite podcast while you get ready.

It's also very important that you get bright light exposure early in the morning to help you feel more awake and alert. Ideally you should open your curtains as soon as you wake up to get some early bright sunshine exposure.

Once you start getting into a routine, you'll start to find that waking up each morning becomes slightly easier.

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Lots of people have problems sleeping sometimes. If you're struggling to get to sleep, check out our tips and advice.

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NELFT - North East London NHS Foundation Trust

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Top tips for helping children with autism to get a good night’s sleep

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Associations of sleep disturbance with ADHD: implications for treatment

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Attention-deficit/hyperactivity disorder (ADHD) is commonly associated with disordered or disturbed sleep. The relationships of ADHD with sleep problems, psychiatric comorbidities and medications are complex and multidirectional. Evidence from published…

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Associations of sleep disturbance with ADHD: implications for treatment

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Attention-deficit/hyperactivity disorder (ADHD) is commonly associated with disordered or disturbed sleep. The relationships of ADHD with sleep problems, psychiatric comorbidities and medications are complex and multidirectional. Evidence from published…

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The best way to get more deep sleep is to get enough total hours of sleep and to follow evidence-based tips for healthy sleep. Most deep sleep happens in the first hour or two of sleep. As a result, sleep habits that help people fall asleep faster may also help them to get more deep sleep naturally.

People can also cut out or limit things that make it harder for them to get deep sleep. In some cases, sleepers can make simple changes on their own. However, people should talk to their doctors if they think a medical condition or medication is interfering with their sleep.

Go to Bed On Time

Go to bed and wake up at the same time every day. While it may be tempting to stay up late or sleep in on weekends and other days off, research has shown that an inconsistent sleep-wake schedule affects people's circadian rhythms. Keeping a regular sleep schedule so they can get the deep sleep that they need.

Relax and Manage Stress

Stress and anxiety can make sleeping difficult. Researchers have found that people with a lot of stress not only have difficulty sleeping, but also . Calming activities that reduce stress may help people sleep more deeply.

Relaxation exercises, deep breathing, yoga, and meditation can naturally reduce anxiety and . Taking a bath, reading, or listening to quiet music before bedtime may also leave sleepers relaxed and ready for deep sleep. In addition to relaxing activities, sleepers should try to avoid discussing or thinking about stressful topics before getting into bed.

People should talk to their doctors if stress and anxiety do not improve with self-care or significantly interfere with their lives.

Avoid or Limit Caffeine and Alcohol

Caffeine and alcohol both reduce sleep quality and keep people from getting deep sleep. People who want to improve their sleep should avoid caffeine and alcohol in the evening. However, people who regularly drink large amounts of alcohol should talk to their doctors before quitting or markedly cutting down on alcohol, as alcohol withdrawal can be dangerous.

Keep a Comfortable Bedroom

People in pain or discomfort often have difficulty getting deep sleep. Loud noises and bright lights in or near the sleeping environment may also make it difficult to get deep sleep. To get the best possible sleep, sleepers should keep their bedroom dark, quiet, and cool with a comfortable bed and pillows. Ear plugs, sound machines, and blackout curtains may help people who live in noisy or bright locations.

Sleep is generally divided into rapid eye movement (REM) and non-rapid eye movement (NREM) sleep. As people fall asleep, they advance through three stages of NREM sleep, each progressively deeper, followed by a period of REM sleep. This cycle through each sleep stage is repeated four to six times each night.

Stage 1 NREM: This is the lightest stage of sleep and is the transition between wakefulness and sleep. Stage 1 usually lasts only a few minutes. People can be easily woken from stage 1 sleep and typically will not remember having been asleep.

Stage 2 NREM: This stage is deeper sleep than stage 1, but sleepers can still be woken by a stronger effort. People typically spend between 45% to 55% of the night in stage 2 sleep.

Stage 3 NREM: Stage 3 is the stage of sleep often referred to as deep sleep. It is very difficult to awaken people from deep sleep. If sleepers are awoken from deep sleep, they may feel groggy and confused for up to an hour after waking.

REM: REM sleep is when most dreaming occurs. Most of a sleeper's muscles are paralyzed during REM sleep, except for the muscles that move the eyes. In this stage, a sleeper's heart rate, breathing, and brain activity rise to levels similar to when they are awake.

Stage 3 sleep is deep, high quality rest that helps people feel refreshed when they awaken. Sleepers' heart rates, breathing, and brain waves are slowest during deep sleep, and their muscles are very relaxed. Most deep sleep happens in the first half of the night.

There are no guidelines for the amount of deep sleep a person needs, though most adults spend about 10% to 20% of each night in deep, stage 3 NREM sleep. Time spent in deep sleep also changes through the lifespan. Older adults usually get less deep sleep and REM sleep than middle-aged adults.

Various substances and medical conditions can also affect the amount of time spent in deep sleep. Conditions such as chronic pain, asthma, and heart disease reduce deep sleep. Researchers have also observed that people with and get less deep sleep than people without these conditions. Some anti-anxiety medicines can also reduce deep sleep, as can both caffeine and alcohol.

The body the amount of deep sleep a person gets each night. For example, people who are sleep deprived may get more deep sleep due to a phenomenon called . Rebound sleep involves having more REM and deep sleep after a period of sleep loss.

Although researchers are still uncovering the role and benefits of each stage of sleep, deep sleep may have important health benefits. Studies suggest that deep sleep helps people wake up refreshed, restores the body, and helps with learning and memory formation.

Hormone regulation: Deep sleep may help to regulate several hormones in the body, including growth hormone and prolactin. Growth hormone affects a variety of processes in the body, including growth and metabolism. Prolactin is an important hormone for pregnant people, contributing to breast growth and lactation.

Immunity: Deep sleep also strengthens the immune system by supporting the hormonal shifts needed for the body to respond to foreign or disease-carrying organisms.

Learning and memory: Researchers believe that NREM sleep stages promote learning and may play a role in memory formation. While deep sleep likely has an important role in the process of memory formation, exactly how deep sleep affects memory is still unclear.

Clearing waste products: Deep sleep may play a role in clearing out waste products from the cerebrospinal fluid that build up during the day. Deep sleep may be particularly important for removing waste products associated with the development of dementia.

Not getting enough deep sleep may affect the release of important hormones, interfere with learning and memory, and hamper the removal of waste products from the cerebrospinal fluid.

Sleep loss in general is associated with difficulties focusing and thinking clearly. Sleep deprivation can also cause a person to have mood changes or to feel so tired that it . Sleep loss also increases the risk of accidents and mistakes at work or school due to excessive sleepiness.

Over the long term, people who do not get enough sleep are at risk for several health conditions including heart conditions, high blood pressure, and stroke. Chronic sleep loss is also associated with an increased risk of obesity and type 2 diabetes.

People should talk to a doctor if they have sleep problems that do not improve after implementing healthy sleep tips or that significantly interfere with their daily life. People should also talk to a doctor if they suspect their sleeping problems may be caused by a health condition or medication.

Depending on a person's needs, a doctor may recommend tests or treatments for sleep problems. For example, a doctor may ask a patient to keep a detailed sleep diary to better help them understand their sleep patterns. If a doctor suspects a sleep disorder, then they may recommend a sleep study to help diagnose the condition. If the doctor suspects the sleep problems are caused by a medical condition, then they may do additional tests for that condition.

Learn more about our Editorial Team

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How to Get More Deep Sleep | Sleep Foundation

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Wondering whether you get enough deep sleep? Find tips to get more deep sleep, facts about deep sleep, and when to talk to a doctor about sleep problems.

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Feeling tired as the sun starts to set may be a sign of a synchronized circadian rhythm. Since circadian rhythms are closely related to environmental cues like light, they can affect how a person feels throughout the day.

Understanding circadian rhythms and how they work can be essential for maintaining a healthy sleep-wake cycle. We discuss what circadian rhythms are, how they are affected by different factors, and how to prevent related sleep issues.

Circadian rhythms are 24-hour cycles that are part of the body's internal clock, running in the background to carry out essential functions and processes. One of the most important and well-known circadian rhythms is the sleep-wake cycle.

Different systems of the body follow circadian rhythms that are synchronized with a biological clock in the brain. This internal clock is directly influenced by environmental cues, especially light, which is why circadian rhythms are tied to the cycle of day and night.

When properly aligned, a circadian rhythm can promote consistent and restorative sleep. But when this circadian rhythm is thrown off, it can create significant sleep problems, including insomnia. Research is also revealing that circadian rhythms play an integral role in diverse aspects of physical and mental health.

Circadian rhythms work by helping to make sure that the body's processes are optimized at various points . The term circadian comes from the Latin phrase "circa diem," which means "around a day."

Circadian rhythms exist in all types of organisms. For example, they help flowers open and close at the right time and keep nocturnal animals from during the daytime when they would be exposed to more predators.

In people, circadian rhythms throughout the body. The digestive system produces proteins to match the typical timing of meals, and the endocrine system regulates hormones to suit normal energy expenditure.

The circadian rhythms throughout the body are connected to an internal clock located in the brain. Specifically, it is found in the suprachiasmatic nucleus (SCN), which is in a part of the brain called the hypothalamus. At different times of the day, clock genes in the SCN send signals to regulate activity throughout the body.

The SCN is highly sensitive to light, which serves as a critical external cue that influences the signals sent by the SCN to coordinate circadian rhythms in the body. For this reason, circadian rhythms are closely connected to day and night. While other cues, like exercise, social activity, and temperature, can affect the internal clock, light is the most powerful influence on circadian rhythms.

Is a Circadian Rhythm the Same As a Biological Clock?

Biological clocks help regulate the timing of bodily processes, including circadian rhythms. A circadian rhythm is an effect of a biological clock, but not all biological clocks are circadian. For instance, plants adjust to changing seasons using a biological clock with timing that is distinct from a 24-hour cycle.

When people talk about circadian rhythm, it is most often in the context of sleep. The sleep-wake cycle is one of the most clear and critical examples of the importance of circadian rhythms.

During the day, light exposure causes the internal clock to send signals that generate alertness and help keep us awake and active. As night falls, the internal clock initiates the production of melatonin, a hormone that promotes sleep, and then keeps transmitting signals that help us stay asleep through the night.

In this way, circadian rhythms align sleep and wakefulness with day and night to create a stable cycle of restorative rest that enables increased daytime activity.

While the sleep-wake cycle is one of the most prominent circadian rhythms, these 24-hour cycles play a vital role in virtually all systems of the body.

Research continues to uncover details about circadian rhythms, but evidence has to metabolism and weight through the regulation of blood sugar and cholesterol. Circadian rhythms influence mental health as well, including the risk of psychiatric illnesses like depression and bipolar disorder as well as the potential for like dementia.

There are indications that circadian rhythms have an important influence on the immune system as well as processes of DNA repair that are involved in . Early-stage research indicates that circadian cycles can influence the and that new medications may be used more strategically.

When circadian rhythm is thrown off, the body's systems do not function optimally. A disturbed sleep-wake circadian rhythm can give rise to serious sleep problems. Without the proper signaling from the body's internal clock, a person can have difficulty falling asleep, wake up more often throughout the night, or be unable to sleep as long as they want into the morning. Their total sleep can be reduced, and a disrupted circadian rhythm can also mean shallower, fragmented, and lower-quality sleep.

In addition, studies have identified circadian rhythm disruptions as to obstructive sleep apnea (OSA), a sleep disorder marked by repeated lapses in breathing. OSA reduces the body's oxygen levels and causes numerous sleep interruptions through the night.

As a whole, a misaligned circadian rhythm can negatively affect sleep in many ways, increasing a person's risk of insomnia and excessive daytime sleepiness. Given the essential role of sleep for productivity and overall health, there are often significant consequences when a person's circadian rhythm is off.

Circadian Rhythms

Disruptions to circadian rhythm can occur over the short- or long-term. Experts have identified a number of types of circadian rhythm sleep-wake disorders (CRSWD) based on their characteristics and causes.

Jet lag disorder: This occurs when a person travels across multiple time zones in a short period of time. Until a person's circadian rhythm can acclimate to the day-night cycle of their new location, they are likely to suffer sleeping problems and fatigue from jet lag.

Shift work disorder: Work obligations can cause major disruptions in a person's circadian rhythm. Shift work, which requires having to work through the night and sleep during the day, puts a person's sleep schedule directly at odds with the local daylight hours.

Advanced sleep phase disorder: People with this rare type of disruption find that they get tired early in the evening and wake up very early in the morning. Even if they want to be up later at night or sleep later in the morning, people with an advanced sleep phase disorder usually cannot do so.

Delayed sleep-wake phase syndrome: This type of circadian rhythm disruption is associated with staying up late at night and sleeping in late in the morning. The exact cause is unknown, but delayed sleep-wake phase syndrome may be related to genetics, underlying physical conditions, and a person's behavior.

Non-24-hour sleep wake disorder: Non-24-hour sleep wake disorder occurs primarily in people who are blind and are not able to receive light-based cues for their circadian rhythm. Their body still follows a 24-hour cycle, but their sleeping hours constantly shift backward by minutes or hours at a time.

affect the brain National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. Irregular sleep-wake rhythm disorder: People with this rare disorder have no consistent pattern to their sleep and may have many naps or short sleeping periods throughout a 24-hour day. Irregular sleep-wake rhythm disorder is frequently connected to conditions that View Source , such as dementia or traumatic brain injury.

Some circadian disruptions are related to individual behavior, such as for travel or work, that makes sleep-wake schedules inconsistent with normal daylight hours. Other disorders stem from an underlying issue that causes an inability to receive or process environmental cues that regulate the body's biological clock. In certain situations, genetic causes may be involved, or the cause may be unknown.

How To Maintain a Healthy Circadian Rhythm

While it is not possible to have full control over circadian rhythms, there are healthy sleep tips that can be followed to better entrain these 24-hour sleep cycles.

Seek out sun: Exposure to natural light, especially early in the day, helps reinforce the strongest circadian cue.

Follow a consistent sleep schedule: Varying your bedtime or morning wake-up time can hinder your body's ability to adjust to a stable circadian rhythm.

Get daily exercise: Activity during the day can support your internal clock and help make it easier to fall asleep at night.

Avoid caffeine: Stimulants like caffeine can keep you awake and throw off the natural balance between sleep and wakefulness. Everyone is different, but if you are having trouble sleeping at night, you should avoid caffeine after noon.

Limit light before bed: Artificial light exposure at night can interfere with circadian rhythm. Experts advise dimming the lights and putting down electronic devices in the lead-up to bedtime.

Keep naps short and early in the afternoon: Late and long naps can push back your bedtime and throw your sleep schedule off-kilter.

Make the bedroom conducive to sleep: Your bedroom setting can influence your sleep habits and the quality of your sleep at night. Invest in a comfortable mattress, bedding, and sleep accessories.

These steps to improve sleep hygiene can be an important part of supporting a healthy circadian rhythm, but other steps may be necessary depending on the situation. If you have persistent or severe sleeping problems, daytime drowsiness, or a problematic sleep schedule, it is important to talk with a doctor who can best diagnose the cause and offer the most appropriate treatment.

Eric Suni has over a decade of experience as a science writer and was previously an information specialist for the National Cancer Institute.

Dr. Singh is the Medical Director of the Indiana Sleep Center. His research and clinical practice focuses on the entire myriad of sleep disorders.

Learn more about our Editorial Team

References

1. Brainard, J., Gobel, M., Scott, B., Koeppen, M., & Eckle, T. (2015). Health implications of disrupted circadian rhythms and the potential for daylight as therapy. Anesthesiology, 122(5), 1170-1175.
https://pubmed.ncbi.nlm.nih.gov/25635592/

2. Vitaterna, M. H., Takahashi, J. S., & Turek, F. W. (2001). Overview of circadian rhythms. Alcohol Research & Health, 25(2), 85-93.
https://pubmed.ncbi.nlm.nih.gov/11584554/

3. Sollars, P. J., & Pickard, G. E. (2015). The Neurobiology of Circadian Rhythms. The Psychiatric clinics of North America, 38(4), 645-665.
https://pubmed.ncbi.nlm.nih.gov/26600101/

4. Jagannath, A., Taylor, L., Wakaf, Z., Vasudevan, S. R., & Foster, R. G. (2017). The genetics of circadian rhythms, sleep and health. Human molecular genetics, 26(R2), R128-R138.
https://pubmed.ncbi.nlm.nih.gov/28977444/

5. MedlinePlus: National Library of Medicine (US). (2021. December 8). Degenerative nerve diseases., Retrieved February 16, 2023, from
https://medlineplus.gov/degenerativenervediseases.html

6. Sancar, A., Lindsey-Boltz, L. A., Gaddameedhi, S., Selby, C. P., Ye, R., Chiou, Y. Y., Kemp, M. G., Hu, J., Lee, J. H., & Ozturk, N. (2015). Circadian clock, cancer, and chemotherapy. Biochemistry, 54(2), 110-123.
https://pubmed.ncbi.nlm.nih.gov/25302769/

7. Sulli, G., Rommel, A., Wang, X., Kolar, M. J., Puca, F., Saghatelian, A., Plikus, M. V., Verma, I. M., & Panda, S. (2018). Pharmacological activation of REV-ERBs is lethal in cancer and oncogene-induced senescence. Nature, 553(7688), 351-355.
https://pubmed.ncbi.nlm.nih.gov/29320480/

8. Butler, M. P., Smales, C., Wu, H., Hussain, M. V., Mohamed, Y. A., Morimoto, M., & Shea, S. A. (2015). The Circadian System Contributes to Apnea Lengthening across the Night in Obstructive Sleep Apnea. Sleep, 38(11), 1793-1801.
https://pubmed.ncbi.nlm.nih.gov/26039970/

9. Zee, P. C., & Vitiello, M. V. (2009). Circadian rhythm sleep disorder: Irregular sleep wake rhythm type. Sleep Medicine Clinics, 4(2), 213-218.
https://pubmed.ncbi.nlm.nih.gov/20160950/

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What Is Circadian Rhythm? | Sleep Foundation

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Circadian rhythms promote quality sleep and overall health. Learn about the body's internal clock and how its 24-hour cycles affect sleep.

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Are All Sleep Cycles the Same?

Sleep cycles can vary from person to person and from night to night based on a wide range of factors such as age, recent sleep patterns, and alcohol consumption.

There are four sleep stages, including one for rapid eye movement (REM) sleep and three that form non-REM (NREM) sleep. These stages are determined based on an analysis of brain activity during sleep, which shows distinct patterns that characterize each stage.

The breakdown of a person's sleep into various cycles and stages is commonly referred to as sleep architecture. If someone undergoes a sleep study, their sleep architecture can be represented visually in a hypnogram, or graph.

NREM sleep is composed of three different stages. The higher the stage of NREM sleep, the harder it is to wake a person up.

Stage 1

Stage 1, also called N1, is essentially when a person first falls asleep. This stage normally lasts just one to seven minutes.

During N1 sleep, the body has not fully relaxed, though the body and brain activities start to slow with periods of brief movements. There are light changes in brain activity associated with falling asleep in this stage.

It is easy to wake someone up during this sleep stage, but if a person is not disturbed, they can move quickly into stage 2. As the night unfolds, an uninterrupted sleeper may not spend much more time in stage 1 as they move through further sleep cycles.

Stage 2

Stage 2 sleep can last for 10 to 25 minutes during the first sleep cycle, and each N2 stage can become longer during the night. Collectively, a person typically spends about half their sleep time in N2 sleep.

Stage 3

Stage 3 sleep is also known as N3 or deep sleep, and it is harder to wake someone up if they are in this phase. Muscle tone, pulse, and breathing rate decrease in N3 sleep as the body relaxes even further.

The brain activity during this period has an identifiable pattern of what are known as delta waves. For this reason, stage 3 may also be called delta sleep or slow-wave sleep (SWS).

Experts believe that this stage is critical to restorative sleep, allowing for bodily recovery and growth. It may also bolster the immune system and other key bodily processes. Even though brain activity is reduced, there is evidence that deep sleep contributes to , , and memory.

You spend the most time in deep sleep during the first half of the night. During the early sleep cycles, N3 stages commonly last for 20 to 40 minutes. As you continue sleeping, these stages get shorter, and more time gets spent in REM sleep instead.

During REM sleep, brain activity picks up, nearing levels seen when you are awake. At the same time, the body experiences atonia, which is a temporary paralysis of the muscles, with two exceptions: the eyes and the muscles that control breathing. Even though the eyes are closed, they can be seen moving quickly, which is how this stage gets its name.

REM sleep is believed to be essential to cognitive functions like , learning, and . REM sleep is known for the most vivid dreams, which is explained by the significant uptick in brain activity. Dreams can occur in any sleep stage, but they are less common and intense in the NREM periods.

Under normal circumstances, you do not enter a REM sleep stage until you have been asleep for about 90 minutes. As the night goes on, REM stages get longer, especially in the second half of the night. While the first REM stage may last only a few minutes, later stages can last for around an hour. In total, REM stages make up around 25% of sleep in adults.

Sleep stages are important because they allow the brain and body to recuperate and develop. Failure to obtain enough of both deep sleep and REM sleep may explain some of the profound consequences of insufficient sleep on , emotions, and physical health. Sleepers who are frequently awoken during earlier stages, such as people with sleep apnea, may struggle to properly cycle into these deeper sleep stages. People with insomnia may not get enough total sleep to accumulate the needed time in each stage.

Age: Time in each stage changes dramatically over a person's life. Newborns spend far more time in REM sleep and may enter a REM stage as soon as they fall asleep. As they get older, their sleep becomes similar to that of adults. Older adults tend to spend less time in REM sleep.

Recent sleep patterns: If a person gets irregular or insufficient sleep over a period of days or more, it can cause an abnormal sleep cycle.

Alcohol: Alcohol and some other drugs can alter sleep architecture. For example, alcohol decreases REM sleep early in the night, but as the alcohol wears off, there is a REM sleep rebound, with prolonged REM stages.

Sleep disorders: Sleep apnea, restless legs syndrome (RLS), and other conditions that cause multiple awakenings may interrupt a healthy sleep cycle.

While you do not have full control of your sleep cycle, you can take steps to improve your chances of having a healthy progression through each sleep stage.

A key step is to focus on improving your sleep hygiene, which refers to your sleep environment and sleep-related habits. Achieving a more consistent sleep schedule, getting natural daylight exposure, avoiding alcohol before bedtime, and eliminating noise and light disruptions can help you get uninterrupted sleep and promote proper alignment of your circadian rhythm. Your mattress, pillows, and sheets can also contribute to how comfortable your sleep environment is.

If you find that you have excessive daytime sleepiness or otherwise suspect that you might have a sleep disorder like sleep apnea, it is important to talk with a doctor who can most appropriately guide your care. Addressing underlying issues may pave the way for more complete and restorative sleep cycles.

Learn more about our Editorial Team

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Stages of Sleep: What Happens in a Sleep Cycle | Sleep Foundation

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Healthy sleep consists of distinct stages. We break down the defining traits of each stage and how they differ from one another.

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In the morning try to get as much light as you can, at least 30 minutes. Open the curtain and let the light in and kick-start your circadian 

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In the morning try to get as much light as you can, at least 30 minutes. Open the curtain and let the light in and kick-start your circadian 

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Melatonin is a sleep hormone which we all naturally produce and the body’s signal to release melatonin is being in the dark. When your child is anxious or stressed or even excited just before bedtime, it can be difficult or even impossible for them to fall asleep. Bright lights and screens or phone screens even a few hours before bedtime can delay the production of melatonin and therefore lead to sleep difficulties. rhythms.

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Melatonin is a sleep hormone which we all naturally produce and the body’s signal to release melatonin is being in the dark. When your child is anxious or stressed or even excited just before bedtime, it can be difficult or even impossible for them to fall asleep. Bright lights and screens or phone screens even a few hours before bedtime can delay the production of melatonin and therefore lead to sleep difficulties. rhythms.

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Melatonin is a sleep hormone which we all naturally produce and the body’s signal to release melatonin is being in the dark. When your child is anxious or stressed or even excited just before bedtime, it can be difficult or even impossible for them to fall asleep. Bright lights and screens or phone screens even a few hours before bedtime can delay the production of melatonin and therefore lead to sleep difficulties. In the morning try to get as much light as you can, at least 30 minutes. Open the curtain and let the light in and kick-start your circadian rhythms.

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In this guide we look at the reasons why autistic children can have difficulty sleeping and suggest what you as a parent can do to help.

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With children and teens heading back to school, it's a good time to prioritize sleep as we adjust to new schedules. Good sleep health can help improve mood, attention, academic performance, and reduce stress.

Establish a Sleep and Wake Schedule: Sleep and wake times may naturally drift during the summer months. Moving back to a regular sleep routine a week before school begins can help children and teens begin the school year well-rested. Shift bed and wake times by 10-15 minutes a day until you're back on the schedule you want.

Setting consistent times for sleep and wake will help children and teens stick to a regular sleep schedule. Keep in mind that children and teens have different sleep needs:

Children: Preschoolers (3-5 years) 10 to 13 hours

School-age kids (6-13 years) 9 to 11 hours

Teenagers: (14-17 years) 8 to 10 hours

Also, it's helpful to consider that children's biological sleep and wake time (sometimes called their chronotype) change with age. As children get older, their natural sleep/wake schedule will shift so they both get sleepy and wake up later. This normal shift to a later schedule is biological and reaches a peak in their early 20s.

Keeping these natural tendencies in mind can help to balance how long and when children need to sleep with their school start times. National Sleep Foundation recommends school not start for middle and high school students before 8:30 AM.

Model Good Habits: Help each of your family members be their Best Slept Self® by modeling good sleep habits during the day and night. It's important that children and teens understand the importance of sleep for their health.

During the day:

Spend time in natural light, especially in the morning. Whether outdoors or inside, bright daylight helps you feel alert.

Exercise regularly. Aim for 30 minutes a day to increase your drive to sleep at night as well as reduce stress and improve mood.

Eat meals at consistent times day after day.

At night:

Avoid heavy meals, nicotine, caffeine, and alcohol before bed.

Use a consistent routine with a relaxing wind down to help get the sleep you need.

Put the devices away an hour before bed and sleep in an environment that is dark, quiet, and cool.

Watch this National Institutes of Health (NIH) Q&A with National Sleep Foundation Past Chair Dr. Lauren Hale on the science of sleep and teens. Dr. Hale's presentation begins at 8:17.

Heading back to school can be an exciting time. As part of NSF's Bright Schools® initiative, NSF is committed to adolescent health and educating school-aged children and their families about the natural sleep/wake process and the importance of sleep for health.

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Back to School Sleep Tips - National Sleep Foundation

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With children and teens heading back to school, it's a good time to prioritize sleep. Get useful back to school sleep tips.

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Sleep problems in children with ADHD aren’t uncommon. Find out why and how to help.

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Sleep problems and solutions: children and teenagers

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Many children and teenagers have sleep problems like trouble getting to sleep or staying asleep. Simple lifestyle changes and better sleep habits can help. Article available in: Arabic, Dari, Dinka, Hakha Chin, Karen, Persian, Simplified Chinese, Swahili, Tamil, Vietnamese.

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ATN/AIR-P Strategies to Improve Sleep in Children with Autism | Autism Speaks

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Click here to download Autism Speaks Strategies to Improve Sleep in Children with Autism. This informational booklet is designed to provide parents with strategies to improve sleep in their child affected by autism.

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NELFT - North East London NHS Foundation Trust

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Top tips for helping children with autism to get a good night’s sleep

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Filmed June 2014 - edited into 18 parts; total 285 minutes

Many parents assume that nothing can be done about their nightly struggle to help their child with ASD go to sleep and stay asleep throughout the night. However, research is demonstrating that although common, poor sleep in children with ASD can be tackled effectively and that parent training is key to success. A good night's sleep is fundamental to all children being able to learn and for their parents to function. This event is relevant to both professionals and parents who are looking for practical steps that parents can take to reap the benefits of improved family health and quality of life. While developed specific to autism, many of the strategies that Dr. Malow will describe are relevant to children with a range of diverse needs.

Topics include:

Overview of Sleep Issues in Autism

Best Practices in Sleep Screening

Practical Sleep Screening

Working with your Health Care Provider

Behavioral Treatment - Strategies from Vanderbilt's Parent Sleep Education Program

Practical Behavioral Treatment

designing a program for a parent volunteer based on their child's sleep habits; constructing bedtime routine

inviting a parent volunteer to design a program for their child.

About the Presenter

Dr. Beth Ann Malow is the Burry Chair in Cognitive Childhood Development, Professor of Neurology and Pediatrics, and Director of Vanderbilt University's Sleep Division. Dr. Malow is the co-author of Solving Sleep Problems in Children with Autism Spectrum Disorders - a Guide for Frazzled Parents. A parent of two children with ASD, Dr. Malow has great compassion for parents and a deep understanding of the practical techniques that parents can use to improve attention and behavior and lessen anxiety through better sleep.

Part 1: Overview of Sleep Issues in ASD (25:51)

Part 2: Standards of Sleep Screening and Screening Tools (10:33)

Part 3: Q&A (22:24)

Part 4: Sleep Screening - Insomnia and Obstructive Sleep Apnea (17:50)

Part 5: Sleep Study - Sleep-Disordered Breathing and Restless Leg (9:14)

Part 6: EEG for Nocturnal Events and Safety Measures (16:09)

Key idea: cell phone videos can be useful aid in diagnosis.

Video examples in this section have been blurred for privacy.

Part 7: Monitoring Techniques at Home and Actigraphy (7:30)

Part 8: Guidelines for Medication Treatment (12:47)

Part 9: Q&A (29:14)

Key question: What is feasible for you as a family?

Part 10: Successful Sleep: Daytime Habits, Evening Habits and Sleep Environment (15:06)

Book: Goodnight iPad

Part 11: Sleep Needs and Timing (10:16)

Part 12: Bedtime Routine Visual Schedule, Worksheet and Q&A (12:02)

Part 13: Parent Volunteer Demo: Sleep Habit Questionnaire (17:15)

Part 14: Parent Volunteer Demo: FISH (19:44)

Part 15: Parent Volunteer Demo: Bedtime Routines Worksheet and Q&A (9:31)

Part 16: Sleep Resistance, Strategies For Night Waking and Q&A (16:51)

Part 17: Bedtime Pass and Other Strategies (12:34)

Part 18: Current Research and Final Q&A (19:51)

Want more? Online interview with Dr. Malow

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Solving Sleep Problems in Children with ASD - ACT - Autism Community Training

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Many parents assume that nothing can be done about their nightly struggle to help their child with ASD go to sleep and stay asleep throughout the night.

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NCMH (National Centre for Mental Health)

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Our Sleep booklet introduces and explains different techniques for tackling common sleep problems. It covers ten main topics including bedtime routines, daytime napping, comfort objects and and moving bedtime backwards or forwards. It gives lots of illustrated hints and tips for putting the techniques into practice.

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Our illustrated booklet introduces and explains different techniques for tackling common sleep problems.

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Childhood Sleep Problems - a video by Sussex Community NHS Foundation Trust.

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Strategies to address sleeping problems of children and their parents.

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Strategies to address sleeping problems of children and their parents.

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Sleep problems may be best considered a skill deficit, one that is common especially in children and youth with autism and developmental disabilities (63-80%, compared to 35-50% of typically developing young children). Sleep problems (difficulty falling asleep, staying asleep, or getting enough sleep) are associated with higher levels of severe problem behavior (meltdowns, aggression, self-injury), stereotypic self-stimulatory behavior, and noncompliance. Sleep problems also interfere with learning. Although there is a notion that children eventually grow out of the developmental phase characterized by sleep disturbance, these problems tend to persist and do not simply subside as children grow older. Persistent sleep problems in childhood are associated with childhood and adult obesity, adolescent behavioral and emotional problems, anxiety in adulthood, and sleep problems through adulthood. Children's sleep problems also negatively affect parents and are associated with marital discord and maternal malaise and depression. The good news is that all children can learn to be great, or at least better, sleepers, and so can their parents.

Click here for evidence-based strategies for promoting good sleep. For additional information, see the publications, tutorial, and implementation assistance pages on this site.

For an Italian translation of these evidence-based strategies relevant to children, click here. For an Italian translation of these evidence-based strategies relevant to adults, click here.

in sleep problems. Tags: insomnia, sleep problems

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Strategies to Address Sleep Problems of Children and Their Parents

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Sleep problems may be best considered a skill deficit, one that is common especially in children and youth with autism and developmental disabilities (63-80%, compared to 35-50% of typically developing young children). Sleep problems (difficulty falling asleep, staying asleep, or getting enough sleep) are associated with higher levels of severe problem behavior (meltdowns, aggression, self-injury), stereotypic self-stimulatory...

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Northamptonshire Healthcare NHS Foundation Trust (NHFT)

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Why is sleep important? - Wellbeing video

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Understanding and Coping with Poor Sleep (Part 1)

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Understanding and Coping with Poor Sleep (Part 2: What can parents do?)

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Sleep advice for parents with disabled children | Family Lives

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Advice on sleep issues for parents of disabled children

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Dr Georgia Pavlopoulou is an autism researcher and a teaching lecturer at UCL, IOE Department of Psychology and Human Development. Here Dr Pavlopoulou discusses research that explores young autistic people’s own sleep experiences.

Research has shown that most autistic people experience sleep problems throughout their life (Richdale and Schreck, 2009). The most common sleep problems include (Malow et al., 2006, Miano et al., 2007, Giannotti et al., 2008)

sleep onset delay

frequent night-time waking

shorter total sleep time.

Sleep is a strong predictor of quality of life (Deserno et al., 2019) and is related to cognitive and behavioural functioning. Despite the importance of sleep on many domains, it is still unclear from first-hand accounts what helps autistic people to sleep.

The purpose of this study was to explore, together with autistic adolescents, their sleep-related practices during the day and before bedtime that contributed to a good night’s sleep.

Paediatric sleep complaints are often problem-driven and developmentally focused, as they based on parental reports of their children’s sleep. However this study focussed on autistic adolescents own experiences of sleep and what constitutes a ’good night’ of sleep.

The first line of treatment for many autistic young people who struggle to fall asleep, or to stay asleep during the night, is introducing sleep hygiene rules. These are a set of sleep-related and lifestyle habits thought to aide better sleep, for example not viewing screens before bed and making sure a bedroom is dark. For some autistic people this might feel like one more pressure to comply with mainstream rules written by, and for, non-autistic people.

The study

I wanted to explore participants’ sleep experiences and what they perceive as helpful. This study adopts an experience sensitive approach that could, and should, complement other much-needed biomedical approaches to sleep research and practice.

I asked 54 autistic adolescents, aged 12 to 17 years, to generate their own photos and use objects and words to introduce subjects and ideas that are meaningful and important to them, around the following themes:

the place they sleep and its surroundings

activities or objects that are related to their sleep habits

activities, objects or people that show situations that are related to daytime and night-time activities that help them to fall or stay asleep

objects, people or drawings that show or are related to the bedtime thoughts and activities that help them to fall asleep

objects, drawings or actions that show how they feel or think about their sleep.

This qualitative approach meant the autistic adolescents were active participants across key stages of data collection and data analysis. This research shares interesting ideas for improving sleep routines that come directly from autistic teenagers.

What did the research tell us

The results identified four key factors that may play a role in the sleep experiences of autistic young people:

focused interests

physical activity

sensory autonomy during bedtime

having more control and choice in their daily lives.

Focused interests

Spending time on their focussed hobbies and interests before bedtime helps distract the teenagers from the stresses of the outside world, even in cases when traditional sleep hygiene rules were not followed (e.g., avoiding screen time or games before bed). Such activities feel familiar, comforting and predictable.

“It [drumming] helps me to release all energy, I am only allowed to have a short session before bed, like 15 min or so (…) It feels relaxing after”

“I am all smiley and happy, like some time ago when I constructed my own castle and a house for my dog in Minecraft (…) it is not real life, and that is the best thing about it”

Physical activity

Opportunities to exercise in their own time, doing activities they choose, was helpful and cultivated positive feelings.

"I love playing with my basketball … not in a team, alone, shooting. I am very good at shooting. I love my ball. (…) because I relax and when I relax I get tired and get to sleep faster.“

“Swimming (…) I think I sleep faster on days I had a swim”

Exercise has been shown to reduce and stabilize cortisol levels over time (McDonnell et al., 2015, pp. 311–322) which can have a positive effect on sleep.

Sensory autonomy during bedtime

This study highlights the importance of sensory issues in relation to sleep, such as touch, feel and smell of nightwear and bedding, for example. Autistic adolescents explained that they had personalised the sleep hygiene rules to fit their need to achieve the right level of sensory stimulation.

“I am sensitive during sleep time. Having a specific set of clothes helps me focus less on my skin sensations."

“If I hold this [pointing to the photo of her holding a soft bunny toy] then I know where my hand is (…) My body is more comfortable.”

Additionally, sharing intimate and predictable time with family members provides essential emotional warmth and safety which is valued by autistic young people as a facilitating factor when they try to have a good night’s sleep.

Sense of agency during day time

The research highlighted the importance of the daytime ‘feel good’ factor on quality of sleep. The feel good factor includes activities, interests, learning and social experiences, within and outside of school, that meet their needs. Being able to have more control and choice on how to spend time at school and home may cultivate positive feelings that promote better sleep.

“Happy thinking in bed (…) knowing that I will speak to people I like at school helps me fall asleep (…) it is all about happy thinking sometimes”.

It is important for sleep therapists to empower young people and their families, to evaluate the impact of daily activities and develop a balance between essential activities and those the young person chooses to do.

Conclusion

The study provides evidence that healthcare practitioners should go beyond providing mainstream sleep hygiene rules, and instead work with autistic adolescents to co-create a personalised set of sleep habits. These may include daytime activities that increase predictability, flexibility to achieve sensory comfort, and activities/relationships and objects that promote a sense of worth.

Further information

Pavlopoulou, G., (2020). A Good Night’s Sleep: Learning About Sleep From Autistic Adolescents’ Personal Accounts. Frontiers in Psychology, 22 December. Open access

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Research exploring the sleep experiences of autistic teenagers

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NELFT - North East London NHS Foundation Trust

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Top tips for helping children with autism to get a good night’s sleep

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Children's Sleep Hygiene (From an Occupational Therapist!)

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NHS medicines information on common questions about melatonin.

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If you’re tired of lying awake at night then the best place to start is your diet. Find out whether you should eat or avoid the following 15 foods.

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How much sleep do you really need? | Sleeping with Science, a TED series

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How sleep affects your emotions | Sleeping with Science, a TED series

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Hacking your memory -- with sleep | Sleeping with Science, a TED series

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How caffeine and alcohol affect your sleep | Sleeping with Science, a TED series

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A walk through the stages of sleep | Sleeping with Science, a TED series

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Looking for advice on how to sleep better? Tweak your routine and understand the science behind your sleep patterns.

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Northamptonshire Healthcare NHS Foundation Trust

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Huge thanks to our corporate partner, Furniture Village, who has helped us to launch a brand new National Sleep Helpline to ensure that everyone has access to high quality, evidence-based advice regardless of age, ethnicity, background or income.
"We've always believed that sleep is equally as important as diet and exercise yet we know the UK is really struggling to sleep, particularly with the ongoing effects of the pandemic" says Charlie Harrison, Furniture Village Commercial Director. "From my work as a doctor, I know how great the need for a National Sleep Helpline is. It will make a huge difference to so many people." Dr Ranj, Furniture Village Sleep and Wellness Advisor
Working together to improve the nation's sleep.

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National Sleep Helpline - The Sleep Charity

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Who do I talk to if I can't sleep? The National Sleep Helpline can help with your sleep problems, 7pm-9pm, Sunday to Thursday, 03303 530 541.

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A sleep diary can be helpful in establishing if there's any pattern with your children's sleep issue. For instance, it might identify if there's difficulty going to sleep on a Sunday night because of anxiety about school.

As a parent it can give you something proactive to do especially if you think your child has a sleep issue and there are no available appointments or support. It can be a good way of recording data and having information to hand should you need to present to a GP or health professional.

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Sleep Diary For Kids - The Sleep Charity

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A sleep diary can be helpful in establishing if there's any pattern with your children's sleep issue.

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Everyone needs different amounts of sleep, but the NHS recommends an average of:

7 to 9 hours for adults
9 to 13 hours for children
If you find that you always feel tired through the day, you are probably not getting enough sleep and should think about how you can improve your sleeping habits.

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What to Do When You Dread Your Bed By Dawn Huebner, PhD | Used & New | 9781433803185 | World of Books

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Buy What to Do When You Dread Your Bed: A Kid’s Guide to Overcoming Problems With Sleep By Dawn Huebner, PhD. New & used copies available with free delivery in the UK. ISBN: 9781433803185. ISBN-10: 1433803186

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In the bright buzzing room...it is time to power down. For parents and children alike, here is a modern bedtime story about bidding our gadgets goodnight. Don't worry, though. They'll be waiting for us, fully charged, in the morning.

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Goodnight iPad: a Parody for the next generation

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In the bright buzzing room...it is time to power down. For parents and children alike, here is a modern bedtime story about bidding our gadgets goodnight. Don't worry, though. They'll be waiting for us, fully charged, in the morning.

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Screen Time and Insomnia: What It Means for Teens

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Screen Time and Insomnia: What It Means for Teens

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Our Mental Health Space - Sussex Partnership NHS Foundation Trust

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Every teenager is different, though, and some teens need more than the recommended amount of sleep per night while others may require less.

Sleep is vital for people of any age. But especially in teens, profound mental, physical, social, and emotional development requires quality sleep.

Thinking and Academic Achievement

Given the importance of sleep for brain function, it is easy to see why teens who do not get enough sleep tend to suffer from excessive drowsiness and that can harm their academic performance.

Emotional Health

Most people have experienced how lack of sleep can affect mood, causing irritability and exaggerated emotional reactions. Over time, the consequences can be even greater for teens who are adapting to more independence, responsibility, and new social relationships.

Prolonged sleep loss may negatively affect , increasing risks for interpersonal conflict as well as more serious mental health problems.

Sleep-deprived teens are anxiety, depression, and suicidal thoughts and behaviors. Improving sleep in adolescents may play a role in preventing and managing these mental health conditions.

Physical Health and Development

Sleep contributes to the effective function of virtually every system of the body. It empowers the immune system, helps regulate hormones, and enables muscle and tissue recovery.

Substantial physical development happens during adolescence, which can be negatively affected by a lack of sleep. For example, researchers have found that adolescents who fail to get enough sleep have a troubling , evaluated through blood pressure, cholesterol levels, and other factors. These findings may put them at higher risk of diabetes and long-term cardiovascular problems.

Decision-Making and Risky Behavior

Sleep deprivation can affect the development of the frontal lobe, a part of the brain that is critical to control impulsive behavior. Not surprisingly, numerous studies have found that teens who do not get enough sleep are more likely to engage in like drunk driving, texting while driving, riding a bicycle without a helmet, and failing to use a seatbelt. Drug and alcohol use, smoking, risky sexual behavior, fighting, and carrying a weapon are also in teens who get too little sleep.

Behavioral problems can have widespread effects on a teenager's life, putting their safety in jeopardy, harming their academic performance, and sometimes damaging their relationships with family and friends.

Accidents and Injuries

Insufficient sleep in teens can make them prone to accidental injury and even death. Of particular concern is an elevated risk of accidents as a result of drowsy driving. Studies have found that sleep deprivation can reduce reaction times with an effect similar to that of significant alcohol consumption. In teens, the impact of drowsy driving can be amplified by a lack of driving experience and a higher rate of distracted driving.

By almost all accounts, many teenagers in America are not getting the recommended 8 to 10 hours of sleep per night. Around 6 out of 10 middle schoolers and 7 out of 10 high schoolers on school nights.

Insufficient sleep has been found to be higher among girls and people assigned female at birth. Older teens report getting less sleep than younger adolescents. Surveys have also found that teens who identify as Black, Asian, or multiracial have the highest rates of sleeping less than eight hours per night.

There is not one specific reason for sleep insufficiency among teens. Instead, several factors contribute to this problem, and these factors may vary from teenager to teenager.

Delayed Sleep Schedule and School Start Times

Adolescents develop a strong tendency toward being a "night owl," staying up later at night and sleeping longer into the morning. Experts believe this is a two-fold biological impulse affecting the circadian rhythm and sleep-wake cycle of teens.

First, teens have a sleep drive that builds more slowly, which means they do not start to feel tired until later in the evening. Second, the body starts producing melatonin later in the day, which is the hormone that helps promote sleep.

If allowed to sleep on their own schedule, many teens would get eight hours or more per night, sleeping from 11 p.m. or midnight until 8 a.m. or 9 a.m., but school start times in most school districts force teens to wake up much earlier in the morning. Because of the biological delay in their sleep-wake cycle, many teens simply are not able to fall asleep early enough to get eight or more hours of sleep and still arrive at school on time.

With reduced sleep on weekdays, teens may try to catch up by sleeping in on the weekend, but this can exacerbate their delayed sleep schedule and inconsistent nightly rest.

Time Demands

Many teenagers have a jam-packed weekly schedule. School assignments, work obligations, household chores, social life, community activities, and sports are just some of the things that can require their time and attention.

With so much to try to fit into each day, many teens do not allocate sufficient time for sleep. They may stay up late during the week to finish homework or during the weekend when hanging out with friends, both of which can reinforce their night owl schedule.

Additionally, pressure to succeed while managing these extensive commitments can be stressful, and stress has been known to contribute to sleeping problems and insomnia.

Use of Electronic Devices

Screen time late into the evening can contribute to sleeping problems. Using these devices can be stimulating, and incoming notifications can disrupt sleep. Evidence also points to suppressed melatonin production from exposure to the light from smartphones.

Sleep Disorders

Some teens have poor sleep because of an underlying sleep disorder. Adolescents can be affected by obstructive sleep apnea (OSA), which causes repeated pauses in breathing during sleep. OSA frequently causes fragmented sleep and excessive daytime sleepiness.

Though less common, teens can have sleep disorders like restless legs syndrome, which involves a strong urge to move the limbs when lying down, or narcolepsy, which is a disorder affecting the sleep-wake cycle.

Mental Health Conditions

Mental health conditions like anxiety and depression can be a challenge to quality sleep in teens as well as adults. Insufficient sleep can contribute to these conditions as well, creating a bidirectional relationship that can worsen both sleep and emotional wellness.

Neurodevelopmental Disorders

Teens who are having sleep problems should start by talking with their doctor about how much sleep they are getting and how it impacts their daily life. Their pediatrician can work to identify any underlying causes and craft the most appropriate and tailored treatment.

Depending on the cause of sleep problems, medications may be considered; however, in most cases, treatment with medications isn't necessary for teens to get better sleep.

A beneficial step is for teens to review and improve their sleep hygiene, which includes their sleep environment and habits. Some healthy sleep tips that can help in this process include:

Budgeting eight hours of sleep into your daily schedule and keeping that same schedule on both weekdays and weekends.

Creating a consistent pre-bed routine to help with relaxation and falling asleep fast.

Avoiding caffeine and energy drinks, especially in the afternoon and evening.

Putting away electronic devices for at least a half-hour before bed and keeping them on silent mode to avoid checking them during the night.

Setting up your bed with a supportive mattress that's the best mattress for you. And don't forget to bring your best pillow.

Keeping your bedroom cool, dark, and quiet.

Sleep hygiene modifications may be included in cognitive behavioral therapy for insomnia (CBT-I), a form of talk therapy for sleeping problems that has demonstrated effectiveness in adults and may be helpful to teens. CBT-I works by reshaping negative ideas and thoughts about sleep and implementing practical steps for better sleep routines.

How Can Parents Help Teens Get Better Sleep?

For many parents and caregivers, a first step is asking their teenage children about their sleep. Encourage teens to see a doctor while also working with them to make gradual sleep hygiene improvements. Some research has found that teens whose parents set a firm bedtime get more sleep and have .

Parents and caregivers can also work with their teens to avoid overscheduling and balance commitments that can generate stress with maintaining adequate time for sleep.

Learn more about our Editorial Team

References

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https://pubmed.ncbi.nlm.nih.gov/27707447/

2. Sio, U. N., Monaghan, P., & Ormerod, T. (2013). Sleep on it, but only if it is difficult: effects of sleep on problem solving. Memory & cognition, 41(2), 159-166.
http://link.springer.com/10.3758/s13421-012-0256-7

3. Perez-Lloret, S., Videla, A. J., Richaudeau, A., Vigo, D., Rossi, M., Cardinali, D. P., & Perez-Chada, D. (2013). A multi-step pathway connecting short sleep duration to daytime somnolence, reduced attention, and poor academic performance: An exploratory cross-sectional study in teenagers. Journal of Clinical Sleep Medicine, 9(5), 469-473.
https://pubmed.ncbi.nlm.nih.gov/23674938/

4. McMakin, D. L., Dahl, R. E., Buysse, D. J., Cousins, J. C., Forbes, E. E., Silk, J. S., Siegle, G. J., & Franzen, P. L. (2016). The impact of experimental sleep restriction on affective functioning in social and nonsocial contexts among adolescents. Journal of child psychology and psychiatry, and allied disciplines, 57(9), 1027-1037.
https://onlinelibrary.wiley.com/doi/10.1111/jcpp.12568

5. Roberts, R. E., & Duong, H. T. (2014). The prospective association between sleep deprivation and depression among adolescents. Sleep, 37(2), 239-244.
https://pubmed.ncbi.nlm.nih.gov/24497652/

6. Cespedes Feliciano, E. M., Quante, M., Rifas-Shiman, S. L., Redline, S., Oken, E., & Taveras, E. M. (2018). Objective Sleep Characteristics and Cardiometabolic Health in Young Adolescents. Pediatrics, 142(1), e20174085.
https://pubmed.ncbi.nlm.nih.gov/29907703/

7. Wheaton, A. G., Olsen, E. O., Miller, G. F., & Croft, J. B. (2016). Sleep duration and injury-related risk behaviors among high school students-United States, 2007-2013. Morbidity and Mortality Weekly Report, 65(13), 337-341.
https://www.cdc.gov/mmwr/volumes/65/wr/mm6513a1.htm

8. Meldrum, R. C., & Restivo, E. (2014). The behavioral and health consequences of sleep deprivation among U.S. high school students: relative deprivation matters. Preventive medicine, 63, 24-28.
https://linkinghub.elsevier.com/retrieve/pii/S0091743514000929

9. Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion. (2020, September 10). Sleep in middle and high school students. Centers for Disease Control and Prevention., Retrieved February 13, 2023, from
https://www.cdc.gov/healthyschools/features/students-sleep.htm

10. Carter, B., Rees, P., Hale, L., Bhattacharjee, D., & Paradkar, M. S. (2016). Association Between Portable Screen-Based Media Device Access or Use and Sleep Outcomes: A Systematic Review and Meta-analysis. JAMA pediatrics, 170(12), 1202-1208.
https://pubmed.ncbi.nlm.nih.gov/27802500/

11. Devnani, P. A., & Hegde, A. U. (2015). Autism and sleep disorders. Journal of pediatric neurosciences, 10(4), 304-307.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4770638/

12. Short, M. A., Gradisar, M., Wright, H., Lack, L. C., Dohnt, H., & Carskadon, M. A. (2011). Time for bed: parent-set bedtimes associated with improved sleep and daytime functioning in adolescents. Sleep, 34(6), 797-800.
https://pubmed.ncbi.nlm.nih.gov/21629368/

13. The Children, Youth, & Families Office of the American Psychological Association (2014). Later school start times promote adolescent well-being., Retrieved February 13, 2023, from
https://www.apa.org/pi/families/resources/school-start-times.pdf

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Too many teens get insufficient sleep. Learn about the importance of sleep for teens, challenges to getting the sleep they need, and steps to sleep better.

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Sleep Wise App | Download on the App Store & Google Play Now!

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Sleep Wise App. This app has been co-produced with Education and Health professionals. The Sleep wise app has been developed for anyone who is helping a young person resolve their sleep problem.

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Welcome to the World of Sleep eBook

Supported by Dunelm, The Sleep Charity has launched a brand-new Children's Sleep eBook as part of its 'Tired of Being Alone' campaign to support parents and carers who have a child or children that struggle to get good quality sleep. It's a helpful guide that shows how common sleep issues, that parents are not alone and that help and support is available.

When we have children, we expect there to be some disrupted nights. Unfortunately for some families the sleepless nights can continue for months and even years. Parents can feel isolated, lonely and often judged. We want to reassure those who are affected with children's sleep difficulties that there is help available, and that things can change.

Around 4 in 10 children will experience a sleep problem at some point and this rises to 8 out of 10 children where there is a diagnosis of Special Educational Need or Disability (SEND). These problems are typically persistent and do not resolve themselves without intervention.

While the eBook is aimed primarily at parents, we also want to educate health professionals, children's centres, primary schools - anyone who works with children and their parents. We want everyone to understand how important sleep is to good health, the impact of sleep deprivation and how we can help to prioritise sleep
We are here, we can help.

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Children's Sleep eBook - The Sleep Charity

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Supported by Dunelm, The Sleep Charity has launched a brand-new Children's Sleep eBook as part of its 'Tired of Being Alone' campaign to support parents and carers who have a child or children that struggle to get good quality sleep.

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NELFT - North East London NHS Foundation Trust

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Top tips for helping children with autism to get a good night’s sleep

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In these guides, we look at some reasons why some autistic people may struggle with sleep and some ways to address this.

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Families of children with brain conditions can often experience additional stress for different reasons. We know how important emotional and mental health is for the whole family.

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Families of children with brain conditions often need to take extra care with their emotional and mental health.

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Our Sleep booklet introduces and explains different techniques for tackling common sleep problems. It covers ten main topics including bedtime routines, daytime napping, comfort objects and and moving bedtime backwards or forwards. It gives lots of illustrated hints and tips for putting the techniques into practice.

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Our illustrated booklet introduces and explains different techniques for tackling common sleep problems.

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Sleep Strategies for Children | Sleep Foundation

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Wondering about sleep aids for kids? These proven sleep tips will help children learn to fall asleep quickly and stay asleep.

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By Dr Freya Spicer-White, Head of Neurodiversity Practice and Standards and Pankhuri Pilania, Assistant Psychologist

Many children and young people have sleep issues. But for those children who are Autistic, have ADHD or another form of Neurodivergence, sleeping well might be particularly difficult. In this issue we offer advice and guidance for parents and carers on how their children and young people can get a better nights' sleep.

Difficulties around bedtime and not getting enough sleep can result in children and young people being sleepy in the daytime, struggling to pay attention or experiencing emotional dysregulation. Those who get a good night's sleep are generally happier, alert and able to pay more attention during the daytime.

Amount of sleep for a child or young person needs varies and it needs to be monitored over a period as they grow and develop. As the child grows, its required to identify their effective pattern, amount, and timings of sleep.

Sleep becomes a problem when it has a negative impact on the child or young person's quality of life.

Research suggests that around 80% of neurodivergent young people will experience some difficulties with sleep.

There are different types of sleep difficulties, these can be:

Being unable to fall asleep

Struggling to stay asleep and waking during the night

Unusual or behaviours of concern at nighttime

What can impact a good night's sleep?

Diagnosed conditions - especially those that may feature hyperactivity; lots of young people with ADHD might be physically active before bedtime but they also may be mentally active. They might struggle to sleep because they can't switch their brains off.

Day time activity - children who sleep during the day or those who don't get enough day-time activity maybe not feel tired or need to sleep as many nighttime hours.

Environment -their bedroom might have too many distractions, bright lights, too much noise, or an overly warm temperature.

Food and drink - Caffeinated drinks such as tea, coffee or fizzy/energy drinks may disturb sleep. Some neurodivergent children also have gastrointestinal problems so they may experience discomfort after eating, which might also disturb their sleep.

High anxiety and arousal - If a child or a young person is anxious, which could be related to their neurodivergence, their arousal system may stay active longer and therefore it might take them longer to get to the 'rest and digest' state.

Lack of routine - All children and young people find reassuring routines to help them settle to sleep useful but an Autistic child might find a lack of a bedtime routine very upsetting and stressful.

Physical illness - Illness or discomfort including reflux, toothache or eczema can make settling for bedtime difficult. Neurodivergent children and young people have experience the physical sensations of illness more intensely causing more disruptions or they may have reduced sensation, for example not realising they have a fever but are still wrapped up tightly.

Sensory issues - Many neurodivergent children and young can be hypersensitive to sensory experiences e.g. sound, touch, smell, taste or vision. This can be both distracting and distressing and make the process of falling asleep very difficult. For example the feel of a blanket or the sound of people nearby could be distressing.

Transition - Some neurodivergent children and young people may struggle with transitions between a 'doing activity' and 'calming bedtime activity' and therefore need plenty of time and reassurance around bedtime to support the transition.

Here are some ideas and techniques to help your child get a better night's sleep.

This of activities of that you can do together that will be relaxing and that will encourage self-soothing and relaxation. Relaxation activities could be:

A warm bath

A gentle foot, hand or scalp massage

Quiet calm music

*As a parent or carer of a neurodivergent child or young person who is not sleeping, it is highly likely that you are also not sleeping.
When you make any plans, try to realistic with what you know you can achieve, even when you are exhausted, as consistency will be the key to success.

Lack of sleep can have a negative impact on your mental and physical health so also think about ways you can look after yourself and be kind to yourself. *

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Sleep Advice for Neurodivergent Children and Young People - Options Autism

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By Dr Freya Spicer-White, Head of Neurodiversity Practice and Standards and Pankhuri Pilania, Assistant Psychologist

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Autistic children and sleep: an interview with Chris Hoyle

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Chris Hoyle discusses sleep difficulties experienced by autistic children and young people

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Sleep deprivation causes increased hyperactivity and other behavioural problems, as well as damaging physical and mental development. Poor sleep habits from an early age can lead to long term sleep problems.

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Sleep deprivation causes increased hyperactivity and other behavioural problems, as well as damaging physical and mental development. Poor sleep habits from an early age can lead to long term sleep problems.

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ATN/AIR-P Strategies to Improve Sleep in Children with Autism | Autism Speaks

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Click here to download Autism Speaks Strategies to Improve Sleep in Children with Autism. This informational booklet is designed to provide parents with strategies to improve sleep in their child affected by autism.

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Sleep Services | Hunrosa | NHS Commissioned & Private Sleep Consultancy

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Sleep Services. We help young people of all ages: toddlers up to teenagers, with varying needs. Everyone who has followed our sleep advice has improved their sleep.