Why it's harder for autistic children
Sleep problems affect 50 to 80% of autistic children, compared with around 25% of non-autistic children. The underlying biology is a stack of contributors, not a single cause:
- Delayed melatonin onset. Several studies show autistic children release melatonin later and in smaller pulses than typical children. The sleep drive arrives late, so falling asleep at a “normal” bedtime is genuinely harder.
- Sensory hypersensitivity. Sounds, textures (sheets, pyjamas), light leak around blinds, even the temperature of the duvet can keep the nervous system on alert.
- Anxiety and rumination. Many autistic children process the day's social demands at bedtime when external stimulation drops.
- Co-occurring ADHD (common in autistic children) typically delays sleep onset further.
- Routine disruption. Even small changes in evening routine can dysregulate sleep for several nights.
The wind-down toolkit
Start with environment and routine before reaching for medication. The combinations that help most autistic children:
- Blackout: blackout curtains or a blackout blind. Any leak of street light reduces melatonin release.
- Sound regulation: white noise or brown noise (a fan or a dedicated white-noise machine), or headphones with audiobooks for children who prefer spoken sound.
- Deep pressure: a weighted blanket (around 10% of body weight) for children whose proprioceptive system finds heavy pressure regulating. Not for children under 7 or under professional guidance.
- Sensory bedding: review whether sheets, pyjamas, and labels are tolerable. Many autistic children sleep better naked or in specific fabrics.
- Cool room: 16–18°C. Most autistic children sleep better cooler than warmer.
- Predictable routine: same sequence every night, ideally a visual schedule. Same lights, same drink, same book or audiobook.
- Screens off 60 minutes before bed (blue light suppresses what little melatonin is being released).
When to ask your GP about melatonin
If environment and routine aren't enough, prescription melatonin is the standard next step. In the UK, melatonin is prescription-only for children and is prescribed by a GP, paediatrician, or CAMHS clinician (BNF guidance, NICE evidence summary). Slenyto is the licensed slow-release preparation for children with autism aged 2–18 and is the usual first prescription.
Over-the-counter melatonin sold abroad or online is not regulated in the same way, has variable dosage, and shouldn't be your first move. Ask your GP.
When to escalate further
- Your child is regularly getting under 6 hours of sleep, for more than 4 weeks, despite environment and routine changes.
- Sleep problems are causing school refusal, daytime dysregulation severe enough to affect attendance, or significant family stress.
- You suspect a co-occurring physical cause (sleep apnoea, restless legs, reflux). Ask the GP about a sleep clinic referral.
Where the law comes from
Related
This page is general information, not clinical or legal advice.