This is the 2nd blog post from The Embodied Mind series by Dr Alice Siberry.
Rest is essential for everyone, but it can often look different from person to person. Most people associate the deepest form of rest with sleep, and on average, we spend one-third of our lives asleep (Stores, 2009)! For neurodivergent people, however, rest isn’t always as simple as “getting some sleep”, “going to bed on time” or “try waking up earlier”.
Research suggests that around 80% of neurodivergent people have diagnosable sleep disorders (Charrier, 2017; Papadopoulos, 2019; Hibberd, 2020), and while sleep quantity matters, the rhythm of sleep, when and how the body naturally wants to sleep, is equally critical.
Why sleep can be tricky
Sleep challenges in neurodivergence are multi-faceted. Some commonly reported issues include:
- Difficulty winding down or settling at night.
- Waking during the night or struggling to return to sleep.
- Heightened anxiety interfering with sleep.
- Difficulty recognising when it is time to sleep.
- Differences in melatonin secretion or circadian rhythm timing.
- Sensory sensitivities, for example from screens, noises, or textures.
- Digestive issues or reactions to stimulants like caffeine.
- Hypersomnia – the need to sleep too much, often due to cumulative stress of neurodivergent life.
These factors demonstrate that the fatigue and tiredness that is often reported by neurodivergent people isn’t simply just “laziness” or an inability to “rest”, there is a physiological explanation.
Picture this: A young adult who has recently been diagnosed with ADHD. They are currently going through titration of their ADHD medication. Though described as an “night owl”, now, they consistently find themselves unable to fall asleep until 3-4am, wide awake at night and struggling to wake in the morning. Despite their efforts, this misalignment leads to repeated lateness at work, and they are now facing a performance improvement plan.
This example highlights the importance of taking into account the whole person. This isn’t laziness or poor time management, it reflects circadian rhythm differences and the complex interaction of ADHD, medication and the body’s natural sleep-wake cycles. Practical support might include helping the individual review sleep hygiene strategies, monitor medication changes with a healthcare provider and, where possible, offer a flexible start time at work whilst they are adjusting to their medication. These adjustments can reduce stress, improve sleep and maintain performance whilst acknowledging the body’s natural rhythms.
Circadian rhythms and sleep cycles
Sleep is the state in which the brain and body engage in critical maintenance. It is the time to:
- Consolidate memories and learning
- Engage in emotional regulation
- Support immune systems
- Increase neuronal plasticity.
Our circadian rhythms, the internal 24-hour clocks regulated by the hypothalamus in the brain, governs the sleep-wake cycle (Dunlap, 2004). These rhythms are influenced by neurochemicals, environmental factors like light and temperature, and hormones, most notably melatonin, which is released in response to darkness and signals the body that it’s time to sleep.
The sleep-wake cycle is also determined by the drive to sleep and the ability to maintain wakefulness. In a typical sleep-wake cycle, the need for sleep accumulates across the day, peaking usually just before bedtime. The drive for sleep is subsequently reduced by adequate rest at night, and the circadian waking drive begins to increase, and the cycle starts again (usually in the morning).
Sleep itself occurs in cycles, which occur roughly every 90 minutes, moving through light sleep, deep sleep and Rapid Eye Movement (REM) sleep. However long you sleep, will determine how many times you pass through these stages. Each stage serves a different function for brain and body health.
Research suggests that, in neurodivergent people, circadian rhythms and melatonin production appears to be more frequently disrupted, making it harder to fall asleep or wake up at conventional times, and ultimately leading to:
- Delayed sleep onset
- Shorter sleep duration
- Nighttime waking.
For example, children with ADHD are up to 8 times more likely than non-ADHD children to have sleep disorders, often showing delayed sleep-wake patterns (Lok et al., 2025).
Circadian rhythm sleep-wake disorders are defined as ‘a chronic or recurrent pattern of sleep-wake rhythm disruption primarily caused by an alteration in the circadian timing system or misalignment between the circadian rhythm and the sleep-wake schedule desired or required causing sleep-wake disturbance’.
The impact of sleep loss
Sleep deprivation doesn’t just make us tired. In neurodivergent people, it can amplify:
- Executive functioning difficulties
- Attention and focus challenges
- Emotional dysregulation
It can also increase physical health risks. Getting less sleep than recommended is linked to psychiatric conditions, diabetes, cardiovascular disease, and stroke (Shanahan, Isaac, and Blackwell, 2020).
Understanding that fatigue and tiredness impact cognitive functioning is crucial in order to provide effective support, especially in workplace and in those who have shift-based roles.
Supporting sleep: Practical strategies
Sleep support is not about forcing neurodivergent people into a “typical” schedule. Instead, it is about aligning routines with the body’s natural rhythms. There are 2 types of intervention: non-pharmacological and pharmacological.
Non-pharmacological interventions
Lifestyle approaches can help manage insomnia and circadian rhythm sleep disorders:
- Sleep hygiene tailored to individual needs (Johnson, 2013). Keeping a sleep diary is recommended in the first instance.
- Stimulus control in the bedroom environment.
- Exercise and diet alignment with sleep patterns.
- Light therapy for autistic and ADHD adults, bright light during the day and dim red light before sleep can support circadian alignment.
Consider an autistic adult who is highly sensitive to sensory input. Even small noises, a dripping tap, the hum of an electrical socket, or changes in the light can wake them in the middle of the night. Over time, these frequent awakening prevent them from entering deep, restorative sleep, leaving them feeling tired, irritated and mentally drained during the day. Understanding theses sensitivities allows for practical support, such as attempting to reduce ambient noise, wearing earplugs, using blackout blinds or a sleep mask, or incorporating calming sensory input such as white noise to improve sleep quality and daytime functioning. These interventions go even further than just changes to the environment; they aim to reduce sympathetic “fight or flight” activity and aim to promote parasympathetic “rest and digest” states (see Week 1 and future blogs for more on this!)
Pharmacological interventions
It is important to recognise that some medications can help or hinder sleep:
- Stimulants for ADHD can reduce total sleep time (Stein, 2012), though some studies show they may improve sleep indirectly by reducing overstimulation in the brain.
- Melatonin supplementation has been shown to improve sleep potential, efficiency and duration in neurodivergent populations (Jenabi, 2019).
- Many also recommend magnesium glycinate supplementation, which has been found to assist in the regulation of nervous system functions and regulating GABA (a neurotransmitter commonly associated with anxiety).
It is important to have conversations about sleep interventions, particularly pharmacological interventions, under professional guidance, whilst recognising that many traditional sleep screening tools may not fully capture neurodivergent experiences.
Bringing it all together
Sleep in neurodivergent people is complex and still under-researched. What we do know is that neurodivergent sleep is shaped by multiple interacting factors, including:
- Biology, such as circadian rhythm differences and melatonin production
- Sensory processing differences
- Stress and autonomic nervous system activity
- Environmental factors and routines
When we understand the physiology of fatigue and sleep, we can move beyond judgement and towards practical, compassionate support. This is where neurodiversity-informed Workplace Needs Assessors, trained through our Level 4 Neurodiversity Workplace Needs Assessor programme, play a critical role in identifying how these factors impact functioning at work and translating that understanding into meaningful adjustments.
Line manager awareness is equally important, ensuring those responsible for day-to-day support understand how sleep disruption and fatigue affect regulation, wellbeing, and performance. Together, this creates space for informed conversations about how neurodivergent people rest, recover, and recharge in ways that allow them to thrive.
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References
Charrier, A., Olliac, B. and Roubertoux, P. et al. (2017) Clock genes and altered sleep-wake rhythms: their role in the development of psychiatric disorders. International Journal of Molecular Sciences, 18: 938. DOI: 10.3390/ijms18050938
Hibberd, C., Charman, T., Bhatoa, R. S. et al. (2020) Sleep difficulties in children with Tourette syndrome and chronic tic disorders: a systemic review of characteristics and associated factors. Sleep, 43 (6). DOI: 10.1093/sleep/zsz308
Jenabi, E., Ataei, S. and Bashirian, S. (2019) Evaluation of drug interventions for the treatment of sleep disorders in children with autism spectrum disorders: a systemic review. Korean Journal of Paediatrics, 62: 405-9. DOI: 10.3345/kjp.2019.00668
Johnson, C. R., Turner, K. S., Foldes, E. et al (2013) Behavioural parent training to address sleep disturbances in young children with autism spectrum disorder: a pilot trial. Sleep Medicine, 14: 995-1004. DOI: 10.1016/j.sleep.2013.05.013
Lok, R., Deshpande, N., Nair, S., Andrillon, T., Gatera, G. Hill, C. M. et al. (2025) The sleep-circadian connection: pathways to understanding and supporting autistic children and adolescents and those with attention-deficit hyperactivity disorder. The Lancet Child & Adolescent Health, 9 (12) 868-879
Papadopoulos, N., Sciberras, E., Hiscock, H. et al. (2019) The efficacy of a brief behavioural sleep intervention in school-aged children with ADHD and comorbid autism spectrum disorder. Journal of Attention Disorders, 23: 341-50. DOI: 10.1177/1087054714568565
Shanahan, P. J., Isaac, M. and Blackwell, J. E. (2020) Sleep disorders in attention-deficit hyperactivity disorder and autism spectrum disorder: a pragmatic approach to assessment and management. British Journal of Psychiatric Advances, 27 (5), 320-332. DOI: https://doi.org/10.1192/bja.2020.65
Stein, M. A., Weiss, M., and Hlavaty, L. (2012) ADHD treatments, sleep and sleep problems: complex associations. Neurotherapeutics, 9: 509-17. DOI: 10.1007/s13311-012-0130-0Stores, G. (2009) Aspects of parasomnias in childhood and adolescence. Archives of Disease in Childhood, 94: 63-9. DOI: 10.1136/adc.2007.131631