Did you know that children with autism spectrum disorders (ASDs) have a 66% chance of having moderate sleep disturbances? April is Autism Awareness month, so let us take this opportunity to discuss the interplay between autism and sleep.
There is no proven explanation of why children with autism have trouble sleeping, but researchers have proposed several theories. Children with autism tend to have higher anxiety levels than normal children, and we know anxiety can make it difficult to fall asleep. They also have heightened sensitivity to noises and touch, which may also contribute to the problem.
Melatonin release is another contributing factor. Melatonin is the natural substance we secrete that helps us sleep normally. Children with autism may have irregular sleep-wake cycles because they tend to have higher levels of melatonin circulating during the day and lower levels at night.
Parents of children with ASD also have difficulty establishing a regular bedtime routine, so it may be helpful to reiterate the importance of practicing good sleep. Poor sleep is difficult for any child, but for those with ASD it can impede learning and daily functioning even more. Children with ASD who experience sleep trouble are more hyperactive, and experience more compulsive and ritualistic behaviors than those who sleep well.
One of the most common sleep disorders with ASD is insomnia, but it’s not common to t hear this complaint from the patient outright. This is why it is important to have general conversations with the family about their observations. Encourage parents to limit caffeine and sugar before bed. Suggest that they try doing a relaxing activity, such as reading to the child. Refrain from using electronics such as television, video games and computers an hour before bedtime.
Other sleep disorders that have been identified in children with ASD include REM sleep behavior disorder, obstructive sleep apnea, night terrors and periodic limb movements of sleep. Of course, if any of these or other sleep disorders are suspected, the patient should be referred to a sleep specialist for further evaluation.
Consider using melatonin to help promote sleep along with good sleep hygiene. Consult with the child’s pediatrician or sleep provider for dosing instructions. Use the lowest melatonin dose possible – studies show the 0.5 mg to 10 mg range to be effective.
Remember to encourage parents of children with ASD to take time for themselves. Often the parents are the ones who suffer the most. It is difficult enough to care for a child with ASD during the day, but when these children also have night time difficulty it may mean that the parent is not getting the rest they need either.
Encourage parents of children with autism to find others who might support them in getting the rest that they need. Local and national groups can be of assistance as well. Check out the National Autism Association at http://nationalautismassociation.org/ for further information and a list of support groups in your area that you can share with patients.
Sharon M. O’Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.