Sleep problems in autism

What the guideline described about sleep problems

According to the guideline, besides problems falling and staying asleep, disorders of the day–night rhythm are common, as are parasomnias, nocturnal epilepsies and other sleep-related disorders such as reflux symptoms or obstructive sleep apnoea. The causes were varied. As possible consequences of lack of sleep or poor sleep quality, the guideline named in everyday life more stereotypies, attention problems, hyperactivity and aggressiveness. Persistent sleep problems could place considerable strain on the family. ^{[1, Ch. C.7.7]}

Step 1: Clarify physical causes

For a sleep disorder, according to the guideline, a possible organic cause should be ruled out first. This applied to children as well as to adolescents and adults. ^{[1, Rec. 94, 95]} Talk to the paediatric or GP practice about this.

Step 2: Sleep hygiene and sleep diary

If there is no organic cause, according to the guideline the individual sleep problem and its circumstances should be carefully recorded. After that, the following should be offered:

• Psychoeducation on sleep hygiene and on dealing with the various sleep problems: for the primary caregivers of children aged 2 to 12 years, and for adolescents and adults for those affected themselves. ^{[1, Rec. 94, 95]}
• A sleep diary over at least 14 days, recording bedtime, time falling asleep, number and length of waking periods at night and waking time in the morning. It serves as the basis for subsequent behaviour-therapy-oriented treatment. For children, parents keep it and, if the level of development allows, the child contributes. ^{[1, Rec. 94, 95]}

On behaviour-oriented measures, usually carried out by parents after guidance, only few studies were available, according to the guideline. ^{[1, Ch. C.7.7]}

Step 3: If that is not enough

If behaviour-oriented measures have no or insufficient effect and clinically relevant strain continues, the guideline recommended drug treatment with melatonin at the individually necessary dose. ^{[1, Rec. 94, 95]} The guideline stated that for many other medicines used for sleep problems there is no sufficient evidence; limited evidence existed only for melatonin. ^{[1, Ch. C.7.7]} Whether, when and how a medicine is used is decided by doctors together with you or the child. Do not change anything about medication on your own.

What else you should know

• Sleep problems are not a sign of wrong parenting. They are common and usually have several causes.
• Lack of sleep can show during the day, for example in concentration and mood. This applies to children and adults.
• Getting help makes sense if the nights permanently burden you or the family. Possible contact points are paediatricians, GPs and advice centres. Further relief: Relief for families.
• Co-occurring conditions can play a role: Common co-occurring conditions.

Sources and literature

1. DGKJP, DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 2: Therapie. S3-Leitlinie, AWMF-Reg.-Nr. 028-047, Stand Text 02.05.2021 (Kap. C.7.7; Empf. 94, 95). – Guideline (in German); expired on 23 March 2026 (see no. 2)
2. DGKJP. Aktuelle Leitlinien (Eintrag 028-047: „Gültig bis 23.03.2026“). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)