Autism and Sleep Disorders

Sleep is a major issue for many adults and children who have been diagnosed with autism spectrum disorder (ASD). Recent studies suggest that up to 80% of young people with ASD also have difficulty falling and/or staying asleep at night. The incidence rate of sleep problems and disorders is also high among adults with ASD, particularly those who are classified as ‘low-functioning’. Lack of sleep can exacerbate some of the behavioral characteristics of ASD, such as hyperactivity, aggression, and lack of concentration. As a result, people with ASD who have a hard time sleeping may struggle at work or in their classroom.

We’ll look at some of the most common sleep issues among adults and children with ASD, as well as some suitable treatment options and tips for managing ASD and sleep on a regular basis.

How Does ASD Affect Sleep?

In a recent study titled ‘Sleep Problems and Autism’, UK-based advocacy group Research Autism noted that the following sleep issues are common among children and adults with ASD.

– Difficulty with sleep onset, or falling asleep
– Difficulty with sleep maintenance, or staying asleep throughout the night
– Early morning waking
– Short-duration sleeping
– Sleep fragmentation, characterized by erratic sleep patterns throughout the night
– Hyperarousal, or heightened anxiety around bedtime
– Excessive daytime sleepiness

The study also pinpointed several underlying causes for these sleep problems that are directly or indirectly related to the individual’s ASD diagnosis. These include:

Irregular circadian rhythm: The circadian rhythm is the 24-hour biological clock that regulates the sleep-wake cycle in humans based on sunlight, temperature, and other environmental factors. The circadian rhythm is processed in the brain, and many people with ASD also exhibit irregularities with their sleep-wake cycle. Additionally, some studies have noted a link between children with ASD and irregular production of melatonin, a natural hormone that helps regulate circadian rhythm.

Mental health disorders: Conditions like anxiety and depression are often co-morbid with ASD; these conditions often lead to insomnia and other sleep disorders. Studies have also suggested that as many as half of all children with ASD also exhibit symptoms of attention-deficit hyperactive disorder (ADHD), which can cause elevated moods around bedtime.

Medical problems: Epilepsy is often co-morbid with ASD, and seizures can greatly impact sleep — even on a regular basis, in severe cases. Other common medical issues among people with ASD include constipation, diarrhea, and acid reflux.

Medication side effects: People with ASD who take medication may experience side effects that interfere with sleep. Selective serotonin reuptake inhibitors (SSRIs), for instance, may cause agitation and hyperactivity prior to bedtime. Antipsychotics like haloperidol and risperidone, on the other hand, may cause excessive drowsiness during the day that leads to sleep onset and sleep maintenance problems.

People with ASD often struggle with daily pressures and interactions more than individuals who do not live with the disorder. Lack of sleep can greatly exacerbate the feelings of distress and anxiety that they experience on a frequent basis. As a result, may people with ASD who have trouble sleeping may struggle greatly with employment, education, and social interaction — all of which can impact their outlook on life.

Establishing a consistent bedtime schedule can be quite beneficial to them. A healthy bedtime schedule might consist of the following:

– Putting on pyjamas
– Brushing teeth
– Using the toilet
– Washing hands
– Getting in bed
– Reading a book (or being read to)
– Shutting off the light

Tips for Parents

Additional behavioral interventions may help children with ASD improve their difficulties with sleep. According to a ‘Sleep Tool Kit‘ published by the Autism Treatment Network, these interventions include the following:

– Create a ‘visual schedule checklist with pictures, objects and other visual aids that can help a child with ASD grasp the concepts more easily.
Keep the bedtime routine concise, and limit it to roughly 30 minutes before bed. Otherwise the child might become overwhelmed with too many commitments.

– Order the routine so that stimulating activities like television and video games come first, followed by reading and other relaxing activities.
Physically guide the child to the schedule at first, and use verbal cues to remind them to check the schedule. Teach them how to cross things off on the checklist themselves.

– Provide positive reinforcement whenever the child follows the schedule correctly.

– Daytime exercise can help children feel more naturally tired at night, while physical exertion too close to bedtime can actually hinder sleep. Encourage children with ASD to get exercise during the day, but try to curtail these activities in the hours leading up to bed.

– Relaxation techniques which include meditation, listening to soft music, reading, or simply laying in bed with the lights off. Parents can also participate in these activities to guide the child along and make sure the techniques are working effectively.

Sensory distractions are a major issue for children with ASD at all times of the day, particularly at night. To help them sleep better, test the floor and door hinges for creaking sounds. Other sensory considerations include outside light, room temperature, and bed size.

If the child follows an established bedtime schedule, be sure to check on them during the early stages to ensure they are actually asleep when they are supposed to be. If they are awake and seem distressed or upset about not being able to fall asleep, take a minute to reassure them that everything is all right.