Many parents notice that sleep can be difficult for autistic children. Falling asleep, staying asleep, or feeling rested in the morning may be ongoing challenges. From an occupational therapy (OT) perspective, these sleep difficulties are often linked to sensory processing and nervous system regulation.

This article is intended to provide general educational information only and does not replace individual assessment or therapy. Every child is different, and support should always be tailored to individual needs.

Some autistic children appear very tired at the end of the day but have difficulty settling. This can occur when the nervous system remains in a heightened state after processing sensory input throughout the day.

OTs consider how sensory processing influences regulation and daily routines, including sleep.

Practical consideration:
Calming, low-arousal activities such as deep pressure input or slow movement may support relaxation for some children. These strategies should be used based on individual tolerance and preferences.

Evidence:
Research indicates that sleep difficulties are common in autistic children, with sensory factors contributing in many cases.

Environmental factors that may seem minor can be more noticeable for children with sensory sensitivities. Sounds, lighting, textures, and temperature can influence comfort and arousal levels at bedtime.

OTs may assess the sleep environment as part of a broader understanding of daily occupations.

Practical consideration:
Creating a calm, predictable sleep environment — such as reducing bright lights and considering comfortable clothing — may support sleep readiness for some children.

Evidence:
Studies have identified associations between sensory sensitivities and longer sleep onset in autistic children.

Consistent routines can help signal transitions and support regulation. For some autistic children, predictable bedtime routines may assist the body in preparing for rest.

OTs often explore routines as part of everyday functioning rather than focusing solely on sleep behaviours.

Practical consideration:
Using a simple, consistent bedtime sequence may support understanding and reduce uncertainty.

Evidence:
Research suggests that circadian rhythm differences and melatonin regulation may influence sleep patterns in autistic children.

Sleep patterns can be influenced by what happens during the day. Movement, rest periods, and daily structure may affect arousal levels later in the evening.

OTs take a whole-day approach when considering sleep-related challenges.

Practical consideration:
Balanced opportunities for movement and rest throughout the day may support regulation for some children.

Evidence:
Physical activity has been associated with improved sleep quality in children, including those on the autism spectrum.

Emotional responses, including worry or difficulty with transitions, can affect sleep. For some children, bedtime may be a time when emotional demands feel greater.

OTs consider emotional and sensory regulation as interconnected aspects of participation in daily routines.

Practical consideration:
Predictable comfort strategies, such as familiar routines or calming cues, may support emotional regulation at bedtime.

Evidence:
Anxiety has been shown to commonly co-occur with sleep difficulties in autistic children.

Occupational therapy does not aim to “fix” sleep or change a child’s identity. Instead, OTs work collaboratively with families to understand how sensory processing, routines, and environments influence daily occupations, including sleep.

Support is always individualised and based on professional assessment.

Practical consideration:
Consulting an occupational therapist with experience in sleep and sensory processing may help families explore supportive strategies appropriate to their child.

Evidence:
Individualised, occupation-focused interventions are consistent with OT practice frameworks.

Sleep challenges are common for autistic children and can be influenced by many factors, including sensory processing, routines, and emotional regulation. Understanding these influences may help families make informed decisions about support.

Occupational therapy offers a holistic, non-directive approach that respects individual differences and focuses on participation in everyday life.

Dream Sleep OT provides occupational therapy services focused on understanding sleep within the context of daily routines and sensory processing. Services are delivered in accordance with professional standards and do not guarantee specific outcomes.

🌙 To learn more or enquire about services, you’re welcome to get in touch to discuss whether OT support may be appropriate for your family.