Sleep Challenges in Children with Special Needs: Practical Tips for Parents

16/09/2025

https://www.deepranjani.com/storage/app/uploads/public/68d/f6e/f17/68df6ef17aa3a135151290.jpeg

Sleep issues in children are a common developmental concern and usually reflect normal stages of development or reactions to external pressures. For example, young children may challenge bedtimes as they struggle with separation anxiety, and preschoolers may experience night terrors or vivid dreams that interrupt their sleep. 

For older children, sleep problems are sometimes related to stress, anxiety or overstimulation that has accumulated through school, technology, or social interactions. These sleep issues are typically a common developmental aspect and often evolve with time; for example, regular bedtime schedules or routines, calm sleeping environments, and emotional reassurance can significantly assist in mitigating the issues. (Manti et. al., 2022)

In contrast, children with neurodevelopmental disorders frequently experience more consistent, complex sleep difficulties. Studies indicate that between 40–80% of children diagnosed with autism spectrum disorder (ASD) have persistent sleep difficulties (Azrieli 2024). 

These sleep problems may include difficulties initiating sleep, frequent awakenings, early awakenings, and overall reductions in sleep time. Sidhu, N.,et.al. (2024)Children with attention-deficit/hyperactivity disorder (ADHD) frequently experience problems with falling asleep, restlessness, and awakening without a refreshing sleep state. 

Sensory sensitivities are common to both ASD and sensory processing disorder. Sensory sensitivities can make what should be a pleasant sleep environment into a discomfort zone (Tzischinsky, et.al , 2018). Imagine for a moment that experiencing discomfort from sensory sensitivities is heightened: small things — like the feel of pajamas, or the sound of an appliance can limit or impede a person's ability to relax. 

There are multiple basic factors that can impact a person's ability to sleep. Biological differences can limit sleep abilities, like the abnormal production of melatonin that can dysregulate sleep-wake patterns in neurodiverse individuals. 

Co-morbid disabilities like anxiety, gastrointestinal issues, sleep apnea, or epilepsy can be potential factors as well. In addition, if they are put on medication for behavioral or emotional issues, there may even be potentially stimulating side effects that can limit sleep.

How Sleep Varies Between Kids and Adults

Sleep changes dramatically over time, and understanding these changes can help a parent develop more useful strategies for a particular age group. Children, especially those under 12 years of age, require greater amounts of sleep than adults typically need (about 9 to 12 hours each night on average, depending on their age).  

They also sleep differently as children have a higher percentage of REM (rapid eye movement) sleep, which is important for brain maturation, memory consolidation, and emotional regulation. 

Children are in contrast to adults, also not as adept at recognizing and responding to sleep deprivation. For example, a child might display hyperactivity or emotional dysregulation without appearing sleepy. 

Additionally, young children are in the process of developing their circadian rhythms and are more sensitive and responsive to environmental cues (e.g., light exposure, sleep habits) compared to adults, who may have difficulty with insomnia, sleep apnea, and/or sleep issues related to stress, but likely have more tools and experience with working through sleep difficulties. 

In addition, while adults can exhibit controlled chronic rates of sleep deprivation or unfaltering coping strategies such as using caffeine or napping, children (especially children with special needs) are more vulnerable to the adverse consequences associated with sleep deprivation. Sleep deprivation can affect attention at school, increase irritability, decrease tolerance for frustration, and even increase the symptoms of other pre-existing conditions such as ASD or ADHD.

Why Are Sleep Problems So Common in Children with Special Needs? 


Sleep challenges are markedly more common for children with special needs, and there are a number of factors for this. They include: 

Compounding Health concerns: 

Many children with special needs not only face those challenges but also have co-morbid health challenges such as epilepsy, cerebral palsy or severe gastroesophageal reflux. Some of these issues are intrusions into sleep because of pain, discomfort, or the potential side effects of medication.  Also, sleep-deprived children may have comorbidities such as asthma, diabetes or another medical issue that impacts their capacity for quality sleep. 

Differences in sensory processing: 

Individuals with ASD or related sensory processing difficulties, may have an increased or decreased sensitivity. They may be overly aware of normally inconsequential sensory stimuli and these stimuli may take them out of the sleep zone when they attempt to fall asleep or stay asleep. They may notice how their pajamas feel, a light's flicker, or even the sound the fan makes, and these curiosities may ultimately keep them awake through the night. 

Anxiety and Emotional Regulation: 

The world can pose itself as a serious distraction to children with special needs. Resistance to sleep, insomnia or waking during sleep can be symptoms of anxiety, issues with emotional regulation or general fear (e.g., fear of the dark or being alone).

Negative Aspects of Drugs

Drugs given for ADHD, anxiety or seizure disorders could affect common sleep. Stimulants often cause insomnia if taken late in the day. Other medications can affect a person's natural sleep-wake cycle.

Delay in Development

Children who have cognitive or developmental delay might have a difficult time understanding and following everyday bedtime routines. This also makes it hard to develop healthy sleep patterns.

Irregular Body Clocks

Some children (also children with neurological differences) sleep with irregular sleep-wake cycles. This makes it impossible for parents/guardians to set a regular bedtime and wake time for the child.

Barriers to Communication 

Children, who have impairments in language or speech, may not have the means to communicate discomfort, pain, or fears. Often their needs are missed and the result is multiple night awakenings or difficulties at bedtime.

Strategies for Improving Sleep in Neurodivergent Children

Sleep problems are common among neurodivergent children.  However, there are many evidence-based strategies that can improve sleep quality and health. It's also important to understand that every child is different, what works for one child may not work for a different child.  

Establishing a Consistent Bedtime Routine

Kids thrive on routine.  This is especially important for neurodivergent kids.

Bedtime routines can help lessen bedtime anxiety and prepare the body and mind for sleep.  Even though routines can look or feel different, routines will almost always have some similarities.  

A bedtime routine may consist of the following:

  • Begin a bedtime routine 30–60 minutes before bedtime. 

  • Carry out the same routine steps in the same order each night.

  • Include calming activities such as:  

    • Warm bath

    • Teeth brushing 

    • Reading a story together

    • A gentle massage

    • A quiet time (like meditation) or weighted blankets (if comfy and suitable)

Using Visuals

Many neurodivergent kids benefit from visuals. Consider using a bedtime schedule that includes pictures or drawings of the steps of bedtime. This may help the child transition and be more independent with the bedtime routine.

Create a sensory-friendly sleep environment

For many neurodivergent kids, sensory sensitivities and challenges may make going to sleep particularly difficult, so it is essential to make the most comfortable sleep space that you can.

Environmental Changes: 

  • Lighting: light blackout curtains or soft, natural dim lighting, avoid bright lights and flashing lights. 

  • Noise: white noise machine, fan (or calming sound) to muffle unexpected noises. 

  • Temperature: keep it cool, and ventilated (ideally, between 18 to 22°C, or 65-72°F).

  • Bedding: pajamas and sheets based on their comfort level.

  • Declutter: avoid visual distractions and noisy toys. 

  • Smell: Some kids respond well to lightly scented items (for example: lavender). Try a diffuser, do not put any oils on the skin without direction. 

If your child has intense and specific sensory preferences and needs for their sleep space, you may want to consider working with an occupational therapist (OT) to set-up a personalized, sensory-friendly sleep space for your child. 

Limit Screens and Stimulation Around Bedtime 

Blue light from screens: phones, TVs, and tablets can inhibit melatonin production, the hormone which regulates sleep. 

Practices:

  • Shut off screens 1-2 hours prior to bedtime. 

  • Use the time you would normally spend on screens, towards calming, non-stimulating activities. 

For example: 

  • drawing and/or coloring.

  • listening to an audiobook.

  • playing calm non-competitive games.

  • completing puzzles, or using calming toys. 

Use Social Stories and Bedtime Visuals

Social stories and visual aids can support neurodivergent children by helping them understand why sleep is important, as well as what to expect (or not expect).


  • Create your own or find pre-made social stories related to bedtime routines, including the importance of staying in bed.

  • Read books focusing on going to bed and staying asleep.

  • Use picture cards as visual aids to support the steps and rules around bedtime.

Track Sleep Patterns  

Keeping a sleep diary can help pinpoint triggers and patterns that lead to sleep issues.  

What to Record:

  • Bedtime and wake-up time  

  • How long it takes to fall asleep  

  • Number and duration of night wakings  

  • Behavior or mood the next day  

  • Food or medication intake  

  • Daily activities or any changes in routine  

Support Sensory Regulation Before Bed  

Many neurodivergent children find it hard to wind down due to sensory dysregulation.  

Techniques:  

  • Deep pressure input (like hugs, massage, or compression clothing)  

  • Calming sensory activities (such as rocking, bouncing, or using weighted blankets)  

  • A warm bath with soothing scents  

  • Slow, rhythmic movement or breathing exercises  

  • Listening to calm music or nature sounds  

An occupational therapist can help tailor sensory strategies to your child's specific needs.

Support Night Wakings with Calmness & Consistency

Night wakings are very common, and it is possible to support this with calmness and consistency. 

  • Quiet responses: Be quietly responsive to night wakings and keep it short, to try and prevent overstimulating your child, and allow for a smooth transition back to sleep.

  • Use reassurance: Reassure your child without having a conversation or developing a game, it can be difficult given the circumstances, but it is important to pay attention to approach.

  • Don't take them in your bed: If your goal is sleep independence, you should not allow your child to come into your bed.

  • Check basic needs and return them to bed: Immediate check in on their basic needs (thirst, bathroom, temperature) and support them to return to bed.

When Medication Turns into a final resort

When behavioral strategies have been thoroughly implemented but insomnia continues, medication options might assist but they serve as a last resort, not a primary approach. 

Melatonina 

Melatonin is the most researched sleep assistance for children with neurodevelopmental disorders. A meta-analysis involving children with autism found reduced sleep-onset latency, fewer nighttime awakenings, and increased total sleep duration (Xiong M, et.al., 2023). 

In a notable PubMed review, children using melatonin slept approximately 1.4 hours longer and fell asleep markedly quicker than those on placebo. Extended-release formulations have demonstrated safe utilization for up to two years without adverse impacts on growth or puberty (Petti, T., et.al.2024). 

Risks and Factors to Consider: 

  • OTC supplements are not regulated by the FDA; melatonin concentrations can vary significantly in tablets. 

  • Potential side effects: daytime sleepiness, migraines, lightheadedness, nocturnal enuresis. 

  • Data on long-term safety in children is scarce; optimal practice is administering consistent doses of pharmaceutical-grade products 

  • Standard pediatric dosages vary from 0.5 to 10 mg, administered 30 to 60 minutes prior to sleep, tailored to the child's requirements (Relia S & Ekambaram V.,2018)

Clinical Recommendations: 

  • Behavioral interventions must be prioritized. 

  • Melatonin is taken into account when those approaches do not succeed. 

  • Administer the minimal effective dosage, with continuous supervision from a pediatric healthcare professional. 

Alternative Medications (Administered Infrequently) 

  • Aside from melatonin, some medications are utilized off-label, although the evidence is scarce and poses greater risks: 

  • Clonidine, guanfacine: Used in children with ADHD and sleeping problems—but guanfacine could aggravate sleep in certain instances. (Relia & Ekambaram, 2018) 

  • Trazodone and mirtazapine: Occasionally help with sleep in complicated situations (such as coexisting mood disorders), but potential side effects are sedation in the morning and decreased blood pressure. 

  • Antipsychotics (e.g., risperidone, olanzapine): May assist with aggression or self-harm, not for regular insomnia. 

  • Hypnotics (such as zolpidem, eszopiclone, diphenhydramine): Typically ineffective and associated with greater risk factors. 

  • Since none of these are FDA-approved for treating insomnia in children, they should only be considered under the guidance of a specialist after all other alternatives have been tried. 

Caring for the Entire Family 

It’s essential to acknowledge that ongoing sleep problems impact more than solely the child. Parents of children with special needs frequently suffer from sleep deprivation, resulting in increased stress, burnout, and potentially even depression. It's vital for the family’s overall well-being that caregivers are provided with support, whether that comes in the form of therapy, parent support groups, respite care, or additional assistance from family or the community. 

Quality sleep involves the entire family, and when a child sleeps well, it positively impacts everyone. Better sleep can result in improved daytime conduct, enhanced learning, better emotional control, and a more peaceful home atmosphere. 

Conclusion

Sleep difficulties in children with special needs are difficult, yet they can be overcome. By comprehending the distinctive elements that lead to these challenges and acknowledging the variations in sleep requirements and habits between adults and children parents can make knowledgeable efforts toward enhancement. A mix of routine, changes in the environment, behavioral strategies, and professional help can result in major improvements in sleep quality and, consequently, overall quality of life.

Although there isn't a universal answer, each minor action can result in significant transformation. Through determination, empathy, and proper resources, improved sleep is attainable for children and their families.

Helpful Resources:

References

Armstrong, J., Batra, A., Buckley, A.,Bridgemohan, C.,  Hirtz, D., Maryam Oskoui, …Ashwal, S., (2020) Practice guideline: Treatment for insomnia and disrupted sleep behavior in children and adolescents with autism spectrum disorder, Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology PubMed+6American Academy of Neurology+6Wikipedia+6.

Manti, F., Giovannone, F., Aceti, F., Giacchetti, N., Fioriello, F., Maugeri, A., & Sogos, C. (2022). Unraveling the Relationship between Sleep Problems, Emotional Behavior Disorders, and Stressful Life Events in Preschool Children. Journal of Clinical Medicine, 11(18), 5419. https://doi.org/10.3390/jcm11185419 https://www.mdpi.com/2077-0383/11/18/5419

Petti, T., Gupta, M., Fradkin, Y., & Gupta, N. (2024). Management of sleep disorders in autism spectrum disorder with co-occurring attention-deficit hyperactivity disorder: update for clinicians. BJPsych Open, 10(1), e11. doi:10.1192/bjo.2023.589  The Guardian+15Cambridge University Press & Assessment+15NCCIH+15.

Relia, S., & Ekambaram, V. (2018). Pharmacological Approach to Sleep Disturbances in Autism Spectrum Disorders with Psychiatric Comorbidities: A Literature Review. Medical sciences (Basel, Switzerland), 6(4), 95. https://doi.org/10.3390/medsci6040095 The Guardian+15PMC+15SpringerLink+15.

Sidhu, N., Wong, Z., Bennett, A. E., & Souders, M. C. (2024). Sleep Problems in Autism Spectrum Disorder. Pediatric clinics of North America, 71(2), 253–268. https://doi.org/10.1016/j.pcl.2024.01.006,  https://pubmed.ncbi.nlm.nih.gov/38423719/

Tzischinsky, O., Meiri, G., Manelis, L., Bar-Sinai, A., Flusser, H., Michaelovski, A., Zivan, O., Ilan, M., Faroy, M., Menashe, I., & Dinstein, I. (2018). Sleep disturbances are associated with specific sensory sensitivities in children with autism. Molecular autism, 9, 22. https://doi.org/10.1186/s13229-018-0206-8 https://pubmed.ncbi.nlm.nih.gov/29610657/

Xiong, M., Li, F., Liu, Z., Xie, X., Shen, H., Li, W., Wei, L., & He, R. (2023). Efficacy of Melatonin for Insomnia in Children with Autism Spectrum Disorder: A Meta-analysis. Neuropediatrics, 54(3), 167–173. https://doi.org/10.1055/s-0043-1761437 The Guardian PubMed.

Is Melatonin Safe for Kids? By Emily Elveru Parents+1The Guardian+1.