For most people, the quiet hours of the night are reserved for sleep, peace, and rest. Yet, for the millions of individuals on the autism spectrum and their families, these nighttime hours can often bring unique challenges and sleepless struggles. One thing’s for sure – there’s no denying the connection between autism and sleep.
Join us as we explore the turbulent link between autism and sleep, shedding light on the common issues that arise and the solutions to help your child get some well-deserved rest.
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The Connection Between Autism and Sleep
In 2018, the Journal of Developmental Disorders published a study that examines why children with neurodevelopmental disorders experience higher levels of sleep disturbance. Researchers at the Universities of Leicester and Birmingham studied children ages 2-15 with various neurodevelopmental disorders, including autism spectrum disorder (ASD), Smith-Magenis Syndrome, tuberous sclerosis complex, and Angelman Syndrome. These children were studied opposite a group of 47 of their neurotypical peers. Thirty of the children with neurodevelopmental disorders had been previously diagnosed with ASD.
This study used Modified Simonds and Parraga’s sleep questionnaire to identify syndrome-specific profiles of sleep disturbance in various neurodevelopmental disorders and sought to “enable syndrome-sensitive treatment approaches.” The researchers found that children with autism were 30% more likely to have trouble settling and falling asleep and 43% more likely to struggle to stay asleep and maintain a healthy rhythm than their neurotypical peers.
Unlike children with other neurodevelopmental disorders, children with ASD were less likely to experience severe night walking and early morning waking but still more likely to do so than their typically developing peers. All neurodevelopmental disorders studied displayed higher instances of night walking, daytime sleepiness, nightmares, and night terrors. Additional symptoms, including gastro-oesophageal reflux, overactivity, and poor impulse control, created variations in the severity of sleep disruption experienced.
Why do Children with Autism Struggle with Sleep?
To effectively address sleep issues in children with autism, it’s essential to understand the underlying biological and neurological factors. 2021 research suggests several factors contribute to these sleep disturbances: melatonin dysfunction, sensory sensitivities, and anxiety.
Melatonin is a hormone produced by the pineal gland in the brain, and it plays a crucial role in regulating the sleep-wake cycle. It typically rises in the evening, signaling the body that it’s time to prepare for sleep, and decreases in the morning, allowing for wakefulness. However, children with autism often experience disruptions in their melatonin production and sleep patterns, which can significantly affect their overall well-being.
Sensory sensitivities and sleep difficulties are common features often associated with autism spectrum disorder. These two aspects can be interconnected and significantly impact the daily lives of individuals with autism.
Hypersensitivity to sensory stimuli can make relaxing and calming down difficult before bedtime. For example, a person with autism who is sensitive to sounds may be easily disturbed by background noises or sudden loud sounds, preventing them from falling asleep.
Anxiety disorders are relatively common among children with autism spectrum disorder. Research suggests that up to 40-70% of people with ASD also experience significant anxiety symptoms or disorders.
Anxiety can disrupt sleep patterns, making it difficult for children to fall, stay, or experience restorative sleep. Common anxiety-related sleep problems include insomnia, night sweats, nightmares, and frequent waking during the night.
This connection between anxiety and sleep is bidirectional. Poor sleep can also increase anxiety levels, creating a vicious cycle. Sleep deprivation can affect mood, cognitive functioning, and emotional regulation, contributing to anxiety.
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Common Issues with Autism and Sleep
Sleep disturbances exist on a spectrum and can vary from being a nuisance to a co-occurring diagnosis. Some of the most common sleep problems children with autism experience are sleep apnea, night terrors and nightmares, bedwetting, and chronic sleep deprivation.
Autism and Sleep Apnea
According to the research published by ScienceDirect, obstructive sleep apnea affects up to 10 percent of children with ASD and “causes symptoms including snoring and gasping during sleep, bedwetting, daytime sleepiness, and behavior problems.” Suggested treatments for autism and sleep apnea include weight loss, nasal steroids, and adenotonsillectomy.
Autism Night Terrors and Nightmares
For parents of children with autism, night terrors and nightmares can be a terrifying event to witness. Most people will experience occasional nightmares in their lifetime. Unpleasant or scary dreams can disrupt sleep and be bothersome the following day but are usually manageable. Night terrors, however, disturb the child who experiences them and their family.
Two kinds of night terrors exist: REM (rapid eye movement) and Non-REM. Children who experience night terrors might appear to be awake during the episode, cry, shake, scream, or flail, but are not reactive to stimuli or comfort from a caregiver. Night terrors usually occur 90 minutes after a child falls asleep and can last several minutes. Children do not usually remember the episode the following morning but are unlikely to feel unrested the following day due to the stressful disruption.
If your child experiences persistent nightmares or night terrors, their pediatrician might order a sleep study or suggest changes to your child’s bedtime routine to curb the episodes.
Other autism disorder sleep issues include bedwetting and chronic sleep deprivation. For children with autism, bedwetting instances might occur well past when they have learned how to use the toilet during the daytime. Heavy sleeping and poor nighttime bladder control make it hard for some children (especially those who take sedating medication) to feel the urge to go at night.
Bedwetting is a behavioral response, not bad behavior. It is crucial not to allow anyone to shame your child for something beyond their control. Anxiety and shame can damage a child’s self-esteem and contribute to an exacerbation of bedwetting.
Autism Sleep Deprivation
Finally, for children with autism, sleep deprivation can extend beyond morning crankiness to affect their ability to function to their highest potential. Eating habits, mood, behavior, and academic performance can all be impacted by chronic sleep deprivation.
Start a sleep routine about an hour before bed that includes relaxing activities and familiar transitions to help your child get the best night’s sleep possible.
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How to Help Your Child with Autism Sleep Better
Helping a child with autism sleep better can be challenging, but it’s essential for their overall well-being and development. Children with autism often experience sleep difficulties, such as insomnia or irregular sleep patterns. Let’s explore some strategies to improve your child’s sleep.
Practice Good Sleep Hygiene
Identifying strategies to improve sleep in people with autism can seem impossible for an exhausted caregiver, but practicing good sleep hygiene can benefit both the child and their caregiver. According to Sujay Kansagra, MD, sleep hygiene is “a combination of our behaviors and the things that can help or hurt our sleep.” Kansagra identifies four components as crucial to good sleep hygiene: routine, schedule, environment, and the avoidance and treatment of sleep disruptors.
Limit Screen Time
When creating an effective sleep routine for your child, keep it to about an hour. You might consider reducing screen time before bed, as the blue light can alter the brain’s ability to produce melatonin. Screen time can be substituted for calming activities, including yoga or reading a story.
Create a Sleep Routine
Establishing a consistent bedtime routine is crucial for all children, especially those with autism who often thrive on routines. A good idea is to create a visual chart to help your child understand and follow the routine steps. Keep activities calming, avoid bright screens, and aim for a 20-30 minute routine. Limit TV and electronic device use before bedtime, as it can disrupt the sleep-regulating hormone melatonin, which is particularly important for children with autism.
Create a Sleep Schedule
Children with autism often deviate from typical sleep patterns in duration and nap frequency. Despite this, they can often remain awake during the day without displaying signs of fatigue.
Establishing a sleep schedule for children with autism is vital. It provides structure and predictability, helping regulate their internal clocks and reducing anxiety. A consistent schedule improves sleep quality, enhances cognitive and behavioral functioning, and supports the child’s and their family’s well-being. It’s a critical tool in addressing sleep disorders and promoting overall health and growth in children with autism.
Focus on Creating a Comfortable Sleep Environment
When it is time for your child to go to bed, identifying the best room temperature and lighting to create a comfortable and familiar environment can help.
Maintaining an optimal sleep environment is crucial for a good night’s rest, and understanding the unique needs of children with autism is key. Typically, body temperature naturally drops during sleep, making a slightly cooler room more conducive to falling asleep.
Although dressing warmly may help, it’s important to recognize that children with autism may have specific sensory preferences. Some may feel more comfortable with extra blankets or particular types of clothing that soothe their senses. In such cases, it’s essential to prioritize their comfort, even if it means deviating from conventional recommendations for room temperature and clothing.
Use Sensory Tools
Using weighted blankets for sleep or other comfort items can help children relax and reduce anxiety around sleep, especially if sensory system issues affect sleep for your child. Additionally, it is important to be mindful of any fabric or texture sensitivities your child might have and purchase sheets and pajamas accordingly.
Sleep disturbances are a common challenge for children with autism and their families. Understanding the link between autism and sleep and implementing effective strategies can significantly improve the quality of life for those affected by this condition.
Q: Is there a cure for sleep problems in individuals with autism?
A: No, but various strategies and therapies can help manage and improve sleep patterns.
Q: Can medication treat sleep issues in individuals with autism?
A: Sometimes, healthcare professionals may prescribe medication, but it should be considered a last resort and closely monitored.
Q: How can I create a sensory-friendly bedroom for my child with autism?
A: Consult an occupational therapist for personalized recommendations on creating a sensory-friendly sleep environment.
A: Yes, sleep problems in autism can be related to co-occurring conditions such as anxiety, ADHD, or sensory processing disorder.