It's 2 a.m. and I'm replaying a conversation from four days ago. Not a big one. Somebody said something at the hardware store, I answered wrong, or I think I did, and now my brain wants to run the tape again. And again. With edits.
That was most of my nights for a long stretch.
So why can't people like me sleep? Short version: anxiety keeps your body in alarm mode, and alarm mode and sleep don't share a bed. If you're autistic, add a full day of sensory noise that never got processed, plus the mask you wore all day finally coming off at exactly the wrong moment. The brain picks bedtime to do its filing.
I'm not a doctor. This is what I've figured out, plus what the research I trust actually says.
Why does anxiety keep me awake at night?
Anxiety is a guard dog. Useful at 2 p.m. when something is actually wrong. Useless at 2 a.m. when the only threat is a dumb email you sent.
When you're anxious your body stays a little revved. Heart a bit fast, jaw a bit tight, thoughts jumping around. You lie down, the outside goes quiet, and the inside gets loud.
Then you start worrying about not sleeping. Now you have two problems. That second loop is the one that got me: look at the clock, do the math on how many hours are left before the alarm, feel the chest tighten, look at the clock again.
Why is sleep so hard for autistic adults?
I was diagnosed with Autism Spectrum Disorder (ASD) at 50, during a breakdown in the COVID years. A lot of my life made more sense after that. Sleep was one of the things that clicked.
Here's what I think is going on, for me anyway:
- Sensory stuff. A fridge humming two rooms away. A sliver of light from the hall. Things other people sleep right through.
- The replay. All day I'm reading faces and guessing what people meant. At night the brain goes back over the footage, frame by frame.
- The mask coming off. If you spend the day performing "normal" (that's masking, if the word is new to you), you end up exhausted and wired at the same time. Great combo.
- Hyperfocus. I start something at 9 p.m. "for ten minutes" and look up at 1:30.
A lot of autistic adults also have ADHD, and ADHD comes with its own sleep mess. I have ADHD too, so that's likely part of my nights as well. If it sounds like you, ask about it.
What actually helps me sleep?
This is where most websites tell you to drink chamomile and put your phone away. Fine. Do that. It won't fix a brain that's been on alert for fifty years.
The thing with real evidence behind it is CBT for insomnia, usually written CBT-I. Forget the tea. CBT-I is a structured program: you keep a sleep diary, lock in a wake-up time, stop lying in bed for hours fighting it, and learn to talk back to the 2 a.m. disaster voice. Some of it feels backwards. You might spend less time in bed at first, on purpose.
You can do it with a therapist, which is best. There's also a free app from the US Department of Veterans Affairs called Insomnia Coach, built on CBT-I. Don't let the "veterans" part put you off. The VA describes it as a stand-alone self-care tool, but says people with things like sleep apnea or bipolar disorder should talk to a provider before using it.
The rest of what helps me, roughly in order of how much:
Same wake-up time, every single day. Even after a garbage night. I hate this one. It works best.
A boring room. Dark and cool. I'm sensitive to sound, so a fan for steady noise helps on a lot of nights.
Morning light. I live in the woods in La Petite-Nation, and in winter the light here is thin. Getting outside early, even ten minutes by the lake with a coffee, sets my clock better than anything I could swallow. Winter is its own fight, so I wrote a separate post on winter depression in Québec.
Writing the loop down. When the replay starts, I get up, write the thing on paper, go back to bed. Solves nothing. It just tells my brain the file is saved and it can stop holding it.
A weighted blanket. I was skeptical, because this sounded like a gadget. Turns out it has a decent trial behind it. A Swedish randomised study gave 120 adults with depression, bipolar disorder, generalised anxiety or ADHD either a heavy chain blanket or a light one for four weeks. The heavy-blanket group's insomnia improved a lot more, and the benefit held over a year of follow-up. One study isn't gospel. It's still more than most sleep products can show.
Weighted blanket (about 10% of body weight)
My take. A 2020 trial found weighted blankets cut insomnia in people with depression, anxiety and ADHD. The pressure just calms the body down.
Good to know. Can be hot. Pick around 10% of your body weight.
They run hot. People usually pick one around 10% of their body weight. If you kick every blanket off by 3 a.m., try borrowing one before you buy.
What doesn't help (in my experience)
Trying harder. You can't push your way into sleep, and believe me I've tried, because pushing through is how I do everything.
Knocking yourself out with substances. I haven't touched cocaine or heroin in sixteen years, and I won't pretend I never used things to shut my head off. Works for a night, then it owns you. If you're using alcohol or anything else to get to sleep and the idea of stopping scares you, talk to a doctor before you stop. Withdrawal can be dangerous and it's not a do-it-yourself project.
Pills on your own schedule. Some people do need medication for sleep for a while. That's a conversation for your doctor or pharmacist, and I'm not naming anything here.
Reading "how to fix insomnia" articles in bed at 1 a.m. Yes, I see the irony.
When should I see a doctor about not sleeping?
If it's most nights for a few weeks or more. If you snore like a chainsaw or wake up gasping, because sleep apnea is common and treatable. If you're nodding off while driving. If the bad sleep comes with a low mood that won't lift.
In Québec you can call Info-Social 811 to talk it through and figure out where to go. Elsewhere, start with a family doctor or a walk-in clinic.
And if the 2 a.m. thoughts turn into "everyone would be better off without me," that's bigger than a sleep problem. Call or text 988 (US and Canada). In Québec, 1 866 APPELLE (1-866-277-3553), text 535353, or chat at suicide.ca. Numbers for other countries are on the Get help now page.