Chapter 2: Sleep in Autistic Adults

As has been demonstrated in the first chapter of this book, and a burgeoning research literature, poor sleep is common for children with autism spectrum disorder (ASD), both by parent-report and in older children, by self-report. This increase in problematic sleep generally is supported by sleep diaries, and objectively by actigraphy and polysomnography (PSG). Given that ASD is a lifelong condition, recent research has turned to the much neglected, adult population, with evidence to date indicating a continuance of sleeping difficulties. In 1993, Simblett and Wilson described three cases of young adults with Asperger’s syndrome where the referral for one case, a 27-year-old female, included “sleep disturbance with early morning waking.” In a survey of medical conditions in adult members of a health care delivery organisation, 17.6% (N = 1,507) of autistic members had a sleep disorder compared with 9.6% (N = 15,070) of controls (Croen et al., 2015), while in a longitudinal follow up of the Utah/UCLA sample (N = 92), 41.3% had disturbed sleep, 28.3% had insomnia and 25% had a sleep disorder (Jones et al., 2016). However, more detailed studies of sleep are few and generally limited by small sample size, wide age range, and the inclusion of adolescent participants. Nevertheless, they demonstrate that sleep disturbances persists into adulthood, with insomnia symptoms (increased sleep onset latency [SoL], wake after sleep onset [WASO], and poor sleep efficiency [SE]) consistently reported, while the presence of circadian rhythm sleep wake disorders (CRSWDs) is also common. This chapter reviews the current evidence for poor sleep in autistic adults, including the limited treatment research.