The brain is in charge of sleep rhythms! Sleep disturbance is not part of the specific autism spectrum diagnostic criteria, but it is a common associated characteristic. Although some in the spectrum sleep more than neurotypicals and some have no difficulty with sleep at all, many struggle with sleep patterns. There may be a history of night terrors, sleep walking, talking during sleep, or waking during the night.
The most common sleep disturbance that I see in my clinic is very late sleep onset (going to bed at 1-3 in the morning) and and related difficulty waking in the morning. Many autistic individuals have their days and nights reversed, particularly if there is no fixed daily schedule for work or school.
In my experience, many of the general sleep recommendations alone do not seem to do the trick as far as regulating the sleep pattern into a more restful rhythm. For example, the ASD individual may not sleep better when they are very tired, in fact he might actually sleep worse. If he hasn't slept one night, he may report being up two or three nights in a row rather than falling into a hard sleep the next night.
I don't find the question "Are you tired during the day" to be very effective as far as determining if the sleep issue is a problem. Many autistic individuals don't necessarily feel tired. The problem is often not sleepiness itself, but rather that lack of sleep makes everything else more challenging.
For example, the individual may feel her sensory issues are worse, social communication more effortful, and repetitive behaviors more intense. It is common for the sleepless ASD person to show less resilience toward unexpected changes or other daily demands.
It also seems true that lack of sleep may trigger some decompensation or psychotic features for some autistic individuals who otherwise would not experience these symptoms.
GENERAL SUGGESTIONS: (in addition to traditional sleep recommendations)
1. Make Improved Sleep a Goal
In general, I find that improving sleep patterns is a good goal because it is typically achievable (at least to some degree) and can make tackling other goals more successful. It also increases the chances that the individual will be able to interact with others during the day (e.g., doctor appointments, community programs, school).
2. Try Sensory Strategies
Proprioceptive inputs help center and balance the nervous system so that the person who is sleepy can become more alert and the person who is too alert can calm down/sleepy. These inputs include those that give pressure to the joints and/or muscles.
In order to help fall asleep, the autistic individual may try proprioceptive inputs before (e.g., nighttime yoga routine, warm bath, laying in a hammock) or during sleep (e.g., weighted blanket).
In order to wake up in the morning, proprioceptive inputs can help the nervous system alert. The individual may want to do a morning stretch routine, lift weights, or complete a yoga sequence to get going.
3. Medication or Supplements
Sleep is one of the major areas of struggle for which medication/supplements may be recommended for the autistic individual. You may wish to speak with your physician about recommendations for sleep supplements/medications as needed.
Help the autistic individual experience added resilience in daily life by tackling the goal of improved sleep!