Why are they Waking up at 2 AM?

What Counts as a Night Waking, and Why They Cluster Around 2 A.M.

Night wakings (waking up after already falling asleep) have no single agreed definition. Galleon in 2023 reviewed many studies and built a working one. A waking counts if the child is awake 30 minutes or more after sleep onset (the moment sleep begins). It also counts if shorter wakings happen more than once a night and disrupt the child or the family.

The problem is common. Up to 80% of children with autism have some sleep problem at some point. About 50% have occasional or frequent night wakings. That is roughly double the rate in the neurotypical child population (kids without a developmental diagnosis). So a large share of any caseload is affected.

The 2 a.m. timing is not random. In the second half of the night, light sleep stretches out and deep sleep shrinks. In between sleep phases, everyone surfaces briefly. Depending on age, about 21 to 42 short awakenings a night can be completely normal. A child who stirs, rolls over, and drifts back off is doing exactly what a sleeping brain does. The trouble starts when something has changed in the room since the child fell asleep.

So sometimes just letting parents know to expect some of these wakings can be really helpful for their child and then also for their own sleep as well.

From the talk — Lindsay Anderson

How Night Wakings Slow Progress in ABA

Poor sleep shows up in three realms. Physically, kids tire faster, and their risk of accidents and injuries rises. Obesity risk goes up. Their immune system takes a hit, so they get sick more often and recover more slowly. Emotionally, poor sleepers are more irritable. They have big reactions to small events and little ability to calm back down.

Behaviorally, a poorly slept child cooperates less and follows fewer directions. Aggression is more likely. School performance drops, and memory suffers with it. A 2016 study by Maserac looked at 81 children with ASD. Sleep problems were tied to physical aggression, irritability, inattention, and hyperactivity. Night wakings stood out from every other sleep problem, even after controlling for age and sex.

In session, this looks familiar. Morning cancellations because the child was up all night. A learner who does show up but dozes through the hour. Attention so low that the team cannot get instructional control (the learner reliably following your lead). REM sleep (the dream stage that stores memories) got cut short. Yesterday's solid gains do not show up today.

Lindsay framed this as an ethics issue, not a nice-to-have. Code section 2.19 asks behavior analysts to find and address conditions that interfere with service delivery. We remove them, change the intervention, or bring in another professional. Chronic sleep loss fits that description well.

But that of all the different sleep problems, it was night wakings that had that most consistently strong association with daytime problem behaviors.

From the talk — Lindsay Anderson

Screen With BEARS, Then Rule Out the Medical Causes

Step one is to screen for sleep at every intake. The BEARS tool is free online and validated for primary care settings. B is bedtime problems, such as trouble settling or falling asleep. E is excessive daytime sleepiness, like being hard to wake or oddly tired all day. A is awakenings during the night, including sleepwalking and nightmares. R is regularity and duration of sleep, meaning a steady bedtime and wake time. S is sleep disordered breathing (trouble breathing during sleep).

That last letter is the urgent one. Loud snoring or gasping calls for an immediate referral to a health care provider. It can signal obstructive sleep apnea (throat muscles block breathing in sleep). The brain panics each time breathing stops and wakes the person up, which wrecks sleep quality. Lindsay noted that apnea in preschoolers has more than doubled in the last ten years. It went from about 9% to about 20%.

Other medical issues deserve a mention to families too. Constipation and acid reflux cause overnight discomfort. Restless leg syndrome (an urge to move the legs) can come from low iron. Asthma and allergies make breathing harder and feed into apnea. Eczema and other skin conditions itch a child awake. This list is not exhaustive, and none of it is our call to diagnose. We name the pattern and point to the doctor.

So the first really important point, if parents do mention any of that possible sleep disordered breathing, like loud snoring or gasping on that BEARS screening tool, then the first thing we want to do is give an immediate referral to a health care professional.

From the talk — Lindsay Anderson

Three Foundational Changes to Try Before Any Sleep Plan

Parent education is not a weak first move here. A 2013 study by Reed found that parent education improved sleep measures in children with ASD. It worked even for kids with low receptive language and for kids on medication. Parents also reported better sleep habits, less hyperactivity, and fewer restricted behaviors. Satisfaction with the workshops was high. That is real social validity (the people involved value the results).

First recommendation: the same wake-up time every day, weekends included. This keeps the circadian rhythm (the body's daily sleep and wake clock) steady. Timing matters as much as total hours, maybe more. A big weekend shift creates social jet lag (mismatched sleep timing between weekdays and weekends). It acts like the jet lag from crossing time zones. Expect fatigue, mood swings, and long-term health costs. Parents want to let a tired kid sleep in. Tell them kindly that it makes the problem worse.

Second: a calm bedtime routine in the same order every night. An hour is typical, but even 20 minutes of quiet activities starts winding the body down. If a child has few leisure skills, a longer bath works fine, as long as it is not overstimulating.

Third: check the sleep schedule for sleep pressure (the drive to sleep that builds while awake). Younger kids build it fast. Older kids build it slowly. A late nap can reset that pressure and shove bedtime hours later. Watch for small sleep stealers too, like a doze on the bus or in the car home. A special toy saved only for car rides can keep a child awake for the drive.

The key here is really keeping those same activities in the same order each night so that it starts to serve as that consistent signal to the brain of knowing when to predict sleep.

From the talk — Lindsay Anderson

What a Simple Parent Sleep Log Tells You

Give two weeks to the foundations. If the picture is still murky, collect data. Keep the sheet short. Track the morning wake time, the nap time if any, and the bedtime. Note the time the child actually fell asleep, plus any wakings and how long they lasted. Record whether the child fell asleep alone or with help. Some families are too stressed or too sleep deprived to track anything. That is a real limit, and it is okay.

The log answers three questions. First, what is the sleep latency (how long falling asleep takes)? Subtract lights-out from actual sleep time. People with insomnia spend long stretches awake in bed. That builds an association between the bed and lying awake, the opposite of what we want. The fix feels backwards to parents. Put the child to bed at the same time they currently fall asleep, or slightly later.

Reassure parents that the late bedtime is temporary. Aim for the child falling asleep within about 15 to 20 minutes. Then move bedtime up 15 minutes after each successful night until you reach the goal time. Second question: are the wakings normal or disruptive? Judge by how often they happen and how long they last. Third: did the child need caregiver support to fall asleep, either at bedtime or overnight?

Two free assessments go deeper. The Children's Sleep Habits Questionnaire is 23 items and parents can fill it out on their own before a visit. Dr. Hanley's Sleep Assessment and Treatment Tool is far more comprehensive. It covers the schedule, the contingencies maintaining the problem, parent goals, and treatment recommendations.

So the idea here is that we want the child to be really tired when they get into bed and fall asleep quickly.

From the talk — Lindsay Anderson

Sleep Dependencies: Sustainable Versus Unsustainable

A sleep dependency is something that must be present for the child to fall asleep. Common ones include a bottle or breastfeeding, a bright light, and the TV or a tablet. Others are falling asleep in the parent's bed, or a parent lying down and sneaking out. Sedating medication can act the same way. The pattern is always the same. The thing is there at bedtime and gone at 2 a.m. A normal light-sleep waking then turns into a full search mission.

Sort each dependency with the family into sustainable or unsustainable. An unsustainable one cannot hold all night by itself. A sustainable one is portable and stays constant all night. It does not require a caregiver who does not want to be there. Co-sleeping is a perfectly acceptable choice if the parent will stay in the room all night. Family culture and current capacity decide this, not us.

Fade objects before people. Swap a bright light for a nightlight that stays on. Swap the TV for a white noise machine. Swap a bottle for pacifiers the child can find alone. With caregiver dependencies, tread carefully. Bedtime is often the only moment a child slows down enough to snuggle. Nothing about that is wrong. We only move those connected moments a little earlier in the routine.

Screens are the hardest. Do not ask families to strip them away cold. Consider bringing the device into ABA as a reinforcer (something that makes a behavior more likely). That way relinquishing it gets practiced all day, not only at night. Shaping (breaking a skill into small, easy steps) helps too. A tablet on a stand a few feet away beats a tablet in the hands. Older work blamed blue light. Research as recent as 2024 points more at content features. A calm show with a clear beginning and end hurts sleep less than endless scrolling or autoplay.

On medication, stay in our lane. We never advise on drugs or doses. We can encourage a conversation with the doctor about timing. A sedative given closer to natural sleep onset lets the environment take over. Melatonin is a hormone that regulates the sleep and wake cycle, also sold over the counter. Immediate release has not been shown to help night wakings because it wears off. Extended release might, but the research is thin. One study found actual doses ranging from 0% to 347% of what the label advertised. A prescription gives families a known amount.

So basically, if the child didn't know how to put themselves to sleep independently at bedtime, there's really no way they're going to be able to put themselves back to sleep in the middle of the night.

From the talk — Lindsay Anderson

Night Terrors, Nightmares, and Nighttime Fears Are Not the Same Thing

These three look alike from the hallway and need opposite responses. Night terrors happen in the first half of the night during deep sleep. The child is not conscious of it. They may sit up, open their eyes, and scream, but they are usually not actually afraid. Waking them tends to make it worse. Keep them safe, guide them back down, and expect more of them when a child is overtired. Dropping a nap is a common trigger.

Nightmares land in the second half of the night during REM sleep. A scary dream wakes the child up. Here the child looks afraid because they are afraid, so comfort works. Everyone has nightmares now and then. If they are frequent and run for several weeks, consider a referral to a psychologist.

Then there are plain nighttime fears: the dark, monsters, being alone. These pull caregivers into the room and build new sleep dependencies. Spend happy, connected playtime in the bedroom during the day so the space feels safe. Lindsay described a 2012 study by Kushner and Sadeh with a clever twist. Young children with nighttime fears got a stuffed puppy. Some were told to take care of the puppy, others that the puppy would protect them. Both groups had fewer fears and better sleep, and the effects held up to six months.

So for night terrors, we just want to keep them safe and guide them back to laying down or maybe back into bed if it did progress into sleepwalking.

From the talk — Lindsay Anderson

Teaching Independent Sleep: Extinction, Time-Based Visiting, and Camping Out

Practice any method during the day first. We would never ask a child to try a coping skill for the first time when a favorite toy breaks. Yet we ask kids to use brand new sleep skills alone in the dark. Emily Varon at Ready, Set, Sleep calls one daytime protocol "I'll be right back." While the child is happy and playing, the parent says the phrase and returns fast. Start at three to five seconds. Peek-a-boo counts. Run it in the kitchen first, then the bedroom. The goal is for the child to stay alone there for one to two minutes.

Check the prerequisites before sleep training. Same wake time daily? Falling asleep fairly quickly, even with help? Sleeping in their own sleep space, even with help? Able to be alone in bed for a minute or two during the day without behavior? A consistent calming routine? Any no means go back and build that piece first.

Extinction (no longer giving the response that used to work) is not evil. Every shaping plan includes some partial extinction. But pure extinction without teaching the skill often produces a child who stops protesting and still does not sleep better. It is unsafe to recommend when aggression or self-injury is in the picture. It is also brutal for exhausted parents. That breeds intermittent reinforcement (giving in some of the time) and kills the plan.

Time-based visiting moves the daytime protocol to bedtime. Drop back to a few seconds even though the child reached two minutes during the day, because night is harder. Say the phrase, leave, return, give the child a quick pat, and leave again. Keep intervals short enough to stay under problem behavior. If it flares, settle the child and restart shorter. Camping out suits parents who need sleep tonight. A mattress goes on the floor for the whole night, then moves toward the door over several nights. A chair works too. In either case, warn parents that wakings will persist for a while. They stop once the child falls asleep with the parent already out of the room.

Funders rarely approve "falls asleep independently" as a goal. They approve the parts. Tolerating a caregiver leaving the room for two minutes with an alternative activity. Pairing the sleep space with reinforcement. Relinquishing electronics and switching to another preferred item. Do that work and the payoff spreads. Expect better attention, better mood, better retention of what you taught, and fewer lost sessions.

The wakings are not going to stop until the intervals become long enough that the child is actually falling asleep while the parent is out of the room.

From the talk — Lindsay Anderson