Earplugs + eye mask

35 studies / 21 in meta-analysis (n=2,678). Eye mask and/or earplugs improved sleep quality: PSQI reduced ~5.02 points, RCSQ +11.46, plus polysomnography-confirmed increases in total sleep time, sleep efficiency and REM and fewer awakenings. Robust, but population is ICU/hospital patients, not ADHD/autism.

RCT of 64 ICU patients: those sleeping with earplugs + eye mask had significant improvements in depth of sleep, falling asleep, awakenings, re-falling asleep, and overall sleep quality vs control.

Pilot crossover, 21 children with ASD: Goal Attainment Scaling significantly higher with earmuffs vs baseline (Z=2.726, p=.006). Supports the device for daytime auditory hyper-reactivity, but this is not sleep and several children refused to wear them.

Observational: children with sensory sensitivity had higher rates of sleep anxiety, bedtime resistance and sleep-onset delay. Establishes the mechanism (sensory over-reactivity disrupts sleep in ADHD) but does not test earplugs/mask as a remedy.

Only one study addressing sensory environmental modifications met inclusion criteria — the authors note a lack of evidence specifically on environmental sensory modifications, confirming the direct evidence gap for this method in neurodivergent populations.