Experiences of and treatment preferences for insomnia in autistic adults: An Interpretative Phenomenological Analysis

The study led by Dr. Gardani explored the experiences and treatment preferences for insomnia among autistic* adults, employing qualitative methodology to get an in-depth view of their perspectives. Autistic adults experience a high prevalence of insomnia, which often begins in childhood and persists into adulthood and impacts various aspects of daily life. Insomnia in autism presents unique challenges due to underlying sensory, social, and emotional characteristics, and typical treatment options, such as Cognitive Behavioural Therapy for Insomnia (CBT-I), have not been tailored specifically for autistic adults. 

The study involved 12 autistic adults aged 21-48 years who were recruited from social media and charities. Interviews were conducted in various formats (e.g., face-to-face, online, phone) to accommodate participant preferences and communication styles. 

Two primary themes emerged from the findings: 

1. “The Night is Friendlier”: Participants expressed finding a sense of relief and comfort at night, viewing it as a time free from the social demands of the day. Many participants noted that they found the night to be a more peaceful time for self-reflection and unwinding, despite often feeling restless. This theme also revealed a general acceptance of sleeplessness, which was normalized due to their longstanding experience with insomnia. 

1. “It Doesn’t Really Work for Me”: Participants reported that standard sleep interventions often feel ineffective, reporting that conventional advice or CBT-I may lack relevance to autistic needs. Many described trying various sleep aids or routines but found them difficult to integrate or sustain. For example, some interventions like mindfulness apps were helpful for some, yet overstimulating for others. The lack of personalised, autism-specific support often led participants to feel dismissed by healthcare professionals, who sometimes attributed sleep issues solely to autism without offering any further investigation. 

The study advocates the involvement of autistic individuals in designing sleep interventions to ensure they are relevant and effective. Future research and clinical practices should consider these perspectives, as well as the role of social masking and sensory sensitivities, in designing more supportive, tailored treatments for insomnia in autistic adults. 

*Throughout our paper we use identity-first language or neutral terms (‘autistic people’ or ‘people on the autism spectrum’) rather than person-first language as a result of the article by Kenny et al (2016) highlighting the preference for identity-first language by the majority of autistic people and their families in the UK, where the study was conducted. It is also the preferred language of the autistic researchers in this paper.