Sleep & disability: finding the right routine

For many parents of children with disability, bedtime can feel like a nightly struggle. Sensory sensitivities, anxiety, medical conditions, physical discomfort and irregular sleep cycles all play their part in making sleep harder to come by. Research from the Journal of Paediatric Psychology suggests that children with neurodevelopmental disorders, such as autism and ADHD, are two to three times more likely to experience sleep disturbances than their neurotypical peers. While there’s no single fix, one thing is clear: structured routines and tailored sleep environments can make a difference.

Take bedtime consistency, for example. Sleep studies consistently show that predictable sleep patterns help regulate the body’s internal clock, making it easier to fall asleep and stay asleep. A 2017 review in Sleep Medicine Reviews found that children with developmental disabilities benefited significantly from a structured bedtime routine. This doesn’t mean an overly strict schedule, it’s not all going to fall apart if you don’t get to bed right on 8pm everyday, just aim for a familiar sequence of calming activities that signal to the brain that sleep is coming. Something as simple as dimming the lights, reading a short book, or listening to soft music can create a predictable pattern that eases the transition to sleep.

Of course, not every child responds the same way to bedtime routines. Sensory sensitivities can make what works for one child completely ineffective for another. Some children need total darkness and silence to fall asleep, while others find comfort in soft lighting or white noise. Occupational therapists often recommend weighted blankets for children who seek deep pressure, as they can help create a sense of security and encourage relaxation.

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Anxiety around bedtime is another issue many parents encounter. Some children struggle with transitions, making the shift from daytime activity to sleep particularly difficult. Visual schedules, social stories, or verbal countdowns can help ease the shift by providing a sense of control and predictability. For some children, incorporating relaxation techniques – like deep breathing or progressive muscle relaxation – before bed can calm their minds and prepare their bodies for sleep. Research backs this up – mindfulness and relaxation techniques have been shown to improve sleep in children with anxiety disorders.

Sleep associations also play a major role in whether a child sleeps through the night. Many children rely on specific conditions to fall asleep, such as a parent sitting with them, which means they may wake up needing the same reassurance. One sleep study published in Behavioral Sleep Medicine described a child with ADHD who successfully transitioned from needing a parent in the room to sleeping independently by introducing a consistent bedtime cue—a lullaby that played each night. Over time, the song itself became the sleep trigger, helping the child settle on their own. Establishing positive, independent sleep associations—like a favourite stuffed animal, a calming sound machine, or a predictable bedtime phrase – can encourage self-soothing when nighttime awakenings occur.

Then there’s the issue of hidden sleep disruptors. Many parents don’t realise that diet, medication timing, and even physical activity can influence sleep. Stimulant medications for ADHD, for instance, can cause restlessness if taken too late in the day. Some children with autism naturally produce less melatonin, making it harder for them to regulate their sleep-wake cycle. A paediatrician may recommend melatonin supplements, which have been shown in studies to help children with autism fall asleep faster. However, timing and dosage are key – what works for one child may not work for another.

Beyond routine and environment, some children continue to struggle with sleep despite every effort. In these cases, a sleep study might be worth considering. Sleep studies – also known as polysomnography – can provide valuable insights into what’s happening during the night. They measure brain activity, breathing patterns, oxygen levels, and movement to detect issues like sleep apnea, restless leg syndrome, or abnormal sleep cycles. Some children with disability may have undiagnosed sleep apnea, which can significantly impact their rest. A sleep study can help pinpoint underlying medical reasons for persistent sleep struggles, leading to targeted treatment options.

While there’s no one-size-fits-all approach, small, thoughtful changes can make bedtime easier. Whether it’s adjusting the sleep environment, fine-tuning a routine, or seeking medical guidance, the goal is to create a space where sleep feels safe, predictable, and restful – for both the child and their caregivers. Sleep challenges may not disappear overnight, but with patience and persistence, better sleep is within reach.