Autism
Sensory audits, routines, and the breathing referral that gets missed.
The short version
- The snoring and breathing referral sits in the same guidance. Make sure night-time breathing is covered in the assessment.
- Handed a plan without an assessment? Ask for the assessment. NICE says to build the plan with parents and record sleep for two weeks.
- Audit the bedroom sense by sense: block out light, reduce noise, remove distractions near the bed, and remove labels from bedding and night clothes.
- A visual timetable and social story help. Vary the order of the routine deliberately, so no single step becomes one your child cannot sleep without.
The rest of this page explains where this comes from. You do not have to read it tonight.
About 2 minutes to read
Autism
NICE guideline CG170 says to assess before doing anything else: what the sleep problem actually is, day and night patterns, whether bedtime is regular, the sleep environment, other conditions, daytime activity levels, "possible physical illness or discomfort (for example, reflux, ear or toothache, constipation or eczema)", medication effects, other individual factors, and the impact on you and the family. If you are handed a plan without that, ask for the assessment. NICE then says to build the plan with parents and record sleep over a two-week period. The snoring and breathing referral above is in the same section.
A sensory audit of the bedroom
The National Autistic Society goes sense by sense: block out light, reduce noise (thick carpet, closed doors, ear plugs), consider smells, "remove distractions, such as electronic devices near the bed and pictures on the wall", and "remove labels from bedding and night clothes". Blackout blinds cost money; a dark blanket over the curtain pole does the same job. Among the causes it names are irregular melatonin release, anxiety, epilepsy, and "social cueing problems", where a child does not make the connection between others going to bed and their own bedtime.
Social stories and visual timetables
A visual timetable of the evening and a social story about bedtime have the best support in UK sleep sources. Four or five drawn or photographed steps is enough, and the society suggests a routine "which can be followed anywhere", so it survives a night away from home.
Cerebra's caveat about the order of the routine
Some autistic children "may become very fixed in their routine and then not be able to sleep unless the full routine is completed". So build in variation deliberately: "consider allowing variation in the order of aspects of the routine to prevent the routines from becoming too rigid". Bath, story, teeth one night; teeth, bath, story the next. It protects you on the night when one step is impossible.
Where this comes from
- Cerebra, Sleep: A Guide for Parents (version 4, October 2025), the five-pathway model, assessment, sequencing, timescales, rewards rule and quotes.
- Cerebra, Sensory Processing: A Guide for Parents (2024), sensory prevalence, the UK diagnosis position, evidence limits and the avoidance point. Also Cerebra, Pain: A Guide for Parents.
- NICE CG170, autism in under 19s, the assessment list, the snoring and breathing referral, the two-week record and the conditions on medication.
- NICE NG62, cerebral palsy in under 25s, causes of sleep disturbance, pain assessment, the order of management and sleep positioning systems. Plain-English version: pain, discomfort, distress and disturbed sleep.
- NICE CG145, spasticity in under 19s, 24-hour postural management, overnight orthoses, and the equipment and training entitlements. NICE NG1 on reflux and neurodisability.
- The Paediatric Pain Profile, a free tool for assessing pain in a child who cannot describe it.
- National Autistic Society, sleep guidance for parents, the sensory audit, social stories, visual timetables and causes.
- Horwood et al. 2019, Sleep Health; Nadeem et al. 2025, Sleep Medicine; Newman, O'Regan and Hensey 2006, DMCN, prevalence in cerebral palsy and the visual impairment association.
- Scott et al. 2013 (ALSPAC), UK sleep data for children with ADHD. Review of sleep-disordered breathing in neurodisability, atypical presentation.
- Down's Syndrome Medical Interest Group sleep pages (updated November 2024) and the Down's Syndrome Association, for prevalence, mechanism, screening advice and the line about being taken seriously. Hill et al. 2016, Sleep Medicine, UK study of 188 children. British Thoracic Society 2023 guideline, on oximetry and questionnaires.
- Blake et al., Cochrane review of sleep positioning systems (2015).
- NHS Borders weighted blanket guidance and Oxford Health NHS Foundation Trust advice on weighted products, the two services that disagree. Lullaby Trust clear-cot advice for babies under 12 months.
- NHS, about melatonin; PrescQIPP bulletin 318; Medicines for Children, melatonin for sleep disorders. British National Formulary for Children, for ADHD medication side effects and rebound. NICE NG87 for ADHD review requirements.
- Scope, keeping a sleep diary. Contact, Disability Living Allowance, night-time care conditions and carer's assessment rights.
- Sheffield Children's Sleep Service and the Great Ormond Street respiratory sleep unit, for how tier 3 referrals work. Newlife equipment grants and Family Fund eligibility.
Last checked 1 August 2026. This page is general information, not medical advice. If you are worried about your child, speak to your health visitor or GP.