Everybody needs a good night’s sleep, though for some children with Autism Spectrum Disorder falling asleep and staying asleep can be challenging. Compounding this is that some features of ASD like repetitive behaviors can make quality sleep even more difficult.
This type of disruptive feedback loop makes sleep problems increasingly prevalent in children with ASD and a priority concern for the families that support them grappling with autism. Yet it is also one of the least-studied aspects of autism.
Though a recent body of research has started to shed some light on the potential causes and methods for helping people with autism spectrum disorder to get a good night’s sleep.
Are Sleep Problems Common in Children with Autism Spectrum Disorder?
A series of recent studies starting in 2019 found that roughly 80% of autistic preschoolers had some type of disrupted sleep pattern. This makes sleep problems twice as common among children with autism spectrum disorder compared to typical children or children who had other developmental conditions.
Sleep Problems Associated With Autism Spectrum Disorder
Insomnia is relatively common in all age groups of people with autism. On average, it takes an autistic individual an average of 11 minutes longer to fall asleep than typical people. This is compounded by a higher frequency of waking up during the night. A lot of these individuals also have sleep apnea, which causes them to stop breathing several times during the night.
It’s also worth bearing in mind that individuals with autism spectrum disorder also tend to be less restorative than people in the general population. This translates into only 15% of their sleeping time is spent in the rapid eye movement (REM) stage. Of course, REM sleep is critical for learning and retaining memories. In comparison, most “Neurotypical people” spend around 23% of their sleep time in REM.
This makes it increasingly difficult for autistic individuals to process memories and easily retain recently learned skills. By improve overall sleep hygiene and sleep quality, it increases an autistic individual’s chances of reaching the best possible therapeutic outcomes.
What Are The Consequences Of Poor Sleep Quality?
A growing body of research points to the fact that too little sleep can easily worsen autism symptoms and impede the therapeutic process. This goes beyond simple mood and poor social skills.
A lot of children who fail to get enough sleep will start to display more severe repetitive behaviors as well as have a tougher time making friends than other people on the spectrum. These children also tend to score lower on tests of intelligence.
Several studies have found that children with autism spectrum disorder who have chronic sleep difficulties are more hyperactive and easily distracted than those who sleep well.
What Causes Difficulty Sleeping In Autistic Individuals?
A large percentage of people with autism spectrum disorders have other conditions, or co-morbidities such as gastrointestinal problems, attention deficit hyperactivity disorder, and anxiety issues. Any one of these can further disrupt sleep.
This could come in the form of cramps from constipation, the inability to lie still long enough to fall asleep, or even a sensitivity to light and sound. At the same time, some forms of ADHD and other co-morbid conditions also include taking prescription stimulants, which have a common side effect of causing insomnia.
Compounding this further is that a lot of people on the autism spectrum also have genetic mutations that make them prone to sleep problems. These individuals are even more likely than typical people to have mutations in genes that govern the sleep-wake cycle or those that have links to insomnia. Some studies suggest that people on the spectrum carry mutations that affect levels of melatonin, a natural hormone that controls sleep.
Identifying Sleep Quality Problems
The first step in helping an individual with ASD to get a better night’s sleep calls for diagnosing their sleep dysfunction. This allows therapists and parents to better target the sleep hygiene methods the child needs to improve.
Polysomnography is one of the more common and thorough types of sleep quality analysis. It effectively tracks the individual’s brain waves, as well as their eye movement, limb movement, and breathing patterns during sleep. However, it requires attaching multiple sensors, wires, and components, which means it needs to be done in a lab.
But this gold-standard method is not always practical for people with autism, many of whom require specific routines at bedtime. At least one research group has brought polysomnography equipment into the homes of people with autism to try to get around this problem.
Actigraphy is a less cumbersome technique for measuring sleep quality. It uses a sophisticated wristwatch-like device to record an individual’s movements throughout the night. It can be used at home to record the amount of time a person sleeps each night. This tends to give a more authentic understanding of sleep quality factors as opposed to a lab, which is an unfamiliar setting.
Treatment Options For Autism-Related Sleep Problems
Fortunately, there are some new therapeutic techniques and practices that can help improve sleep quality for individuals with an autism spectrum disorder.
This starts with simple things like establishing a recurring night routine that the child or adult sticks to. This might include things like an order of activities to get ready for bedtime. With constant reinforcement, can help them fall asleep. Sticking with regular bed and wake times can put the brain and body on a schedule that makes sleep more reliable.
There are also some prescription and OTC medications approved by the FDA to help treat insomnia. This might come in the form of melatonin supplements which can help children with autism fall asleep faster and get better-quality sleep. A stronger option might call for the common prescription medications like Ambien. However, a serious sleep hygiene problem such as sleep apnea might require the use of a nighttime breathing device, sleep guard, or (CPAP) machine.
While improving sleep quality likely won’t provide watershed moments in therapeutic outcomes. However, it will certainly increase your child’s ability to learn and process memories in the long term. Improving their quality of sleep through simple things like sticking to an established bedtime routine, improving sleep hygiene in their bedroom, and perhaps the use of FDA-approved OTC medications like melatonin can have a cumulative effect on their sleep quality.
If your child’s sleep problems are more severe, you should consult with their ABA therapist to discuss other options and diagnostics.