Sleep Problems and Mental Health in Middle-Aged and Older Autistic and Non-Autistic Adults

Sleep is a vital biological function, and impaired sleep can lead to a range of problems, including poor health and wellbeing. Poor sleep and higher rates of sleep-related problems and difficulties are often reported by autistic people of all ages, however, these experiences and problems have seldom been studied in diagnosed autistic populations in midlife and old age.

This study used data from the first wave of the AgeWellAutism cohort, from a sample of 265 autistic and 167 age- and gender-matched non-autistic adults aged 40-93 years (mean = ∼60 years; ∼50% female). Participants completed widely used and standardised measures of sleep quality and mental health symptoms.

The autistic group reported significantly greater sleep problems than the non-autistic group, with poorer overall sleep across all domains (all p < 0.001), with autistic women reporting greatest difficulties. The largest differences between groups were observed in sleep disturbances and daytime dysfunction (χ² = 101.8 and 95.1, respectively, both p < 0.001). These differences remained significant after controlling for age and symptoms of anxiety, depression and PTSD. Across both groups, poorer sleep was associated with older age and higher levels of anxiety, depression and PTSD symptoms, with a stronger association between sleep problems and anxiety symptoms in the autistic group.

Consistent with prior autism trait-based research in the general population, middle-aged and older autistic adults report more extensive sleep problems and worse sleep quality than non-autistic adults. Sleep problems were associated with older age and poorer mental health. Though the study is cross-sectional, the findings highlight the need to explore causal links through intervention. Addressing anxiety, and mental health problems more broadly, may improve sleep quality in ageing autistic populations.