In 2013, the fifth edition of the Diagnostic and Statistical Manual (DSM-V) combined autism, Asperger’s syndrome, and pervasive developmental disorder into a single diagnosis of autism spectrum disorder. 1 Autism spectrum disorder has shown a steady increase in prevalence and was estimated to affect one in 54 children in the USA in 2016. 2 Autism spectrum disorder has multiple genetic and non-genetic causes and is made up of a group of clinically heterogeneous neurodevelopmental disorders sharing common features. 3 These features include impairments in social communication and the presence of restricted or repetitive behavioural patterns. 3 Sleep disturbance is a common co-occurring condition and is estimated to affect 40–80% of individuals with autism spectrum disorder. 4 Insomnia is ten times more frequent in children with autism spectrum disorder than in those without, and often persists into adolescence. 5 Treating insomnia in this population presents unique challenges to clinicians. The recent (2020) practice guideline from the American Academy of Neurology on the treatment of insomnia in children and adolescents with autism spectrum disorder provides much needed objective recommendations on pharmacological and non-pharmacological treatments. 6 The guidelines address four common presentations of insomnia in autism spectrum disorder and the daytime behavioural sequalae. Common presentations include bedtime resistance, prolonged sleep onset latency, fragmented sleep, and reduced total sleep time. Multiple treatment approaches are addressed, including complementary and alternative medicine, behavioural interventions, and nutraceutical treatment. All recommendations were level B, meaning that the benefit versus risk profile was favourable and clinicians should consider incorporating them into practice. The practice guidelines stress an individual approach. Each child with autism spectrum disorder is unique and there is not a one-size-fits-all approach. Thus, clinicians should review a child’s medications to check for ones that contribute to sleep disruption and assess cooccurring medical and psychiatric conditions that might lead to sleep disturbance. Medical problems (eg, reflux, epilepsy, and other undiagnosed sleep disorders) can cause insomnia. Also, some medications used to treat co-occurring conditions in autism spectrum disorder can lead to sleep disturbance (eg, activating selective serotonin reuptake inhibitors, antiepileptics). If the patient’s underlying medical condition is the cause of the sleep problem, it should be addressed; medications fizk es/iStock