Sleep disruptions in children with autism studied
This week, a new study has been published in the Journal of Developmental Disorders 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 years old with a variety of 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.
Why children with autism struggle with sleep
This study used the 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 percent more likely to have trouble settling and falling asleep as well as 43 percent more likely to struggle to stay asleep and maintaining 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. Every group of neurodevelopmental disorder studied displayed higher instances of the 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.
These sleep disruptions might cause higher levels of difficult behavior in the child with ASD and increased irritability and fatigue for their caretakers. (Trickett, Heald, Oliver, & Richards, 2018)
What types of sleep problems are common in autism?
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 that children with autism experience are sleep apnea, night terrors and nightmares, bedwetting, and chronic sleep deprivation.
Autism and sleep apnea
According to the Autism Research Institute (ARI), 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.” (Murata, 2017) 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 a manageable occurrence. Night terrors, however, are disturbing not only for the child who experiences them but for his/her family as well.
There are two kinds of night terrors, 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 for 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, his/her 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 the time he/she has learned how to use the toilet during the daytime. A combination of 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 and It is crucial not to allow anyone to shame your child for something beyond his/her 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 his/her ability to function to his/her highest potential. Eating habits, mood, behavior, and academic performance can all be impacted by chronic sleep deprivation.
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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.
Tips on how to get a child with autism to sleep
Identifying strategies to improve sleep in people with autism can seem impossible to an exhausted caregiver, but practicing good sleep hygiene can be beneficial to 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 the following four components as crucial to good sleep hygiene: routine, schedule, environment, and the avoidance and treatment of sleep disruptors. (Kansagra, 2017)
When creating an effective sleep routine for your child try to 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.
This chart can help parents determine an appropriate sleep schedule for their child by age. 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 for your child can help. 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.
Finally, addressing underlying issues contributing to sleep disruption including reflux, constipation, excess caffeine consumption, sleep apnea, allergies, eczema, or restless leg syndrome is crucial to making sure your child can get a good night’s sleep. For children who continue to struggle with sleep, caregivers can discuss the best autism sleep medications with a pediatrician. Common medications include a low-dose of melatonin. (Magazine, 2018) If your child has persistent sleep disruptions, you can ask your child’s doctor for additional recommendations (clonidine, risperidone, and donepezil are sometimes used for more persistent cases of insomnia), explore medications, or request a referral to a sleep psychologist.
“Evaluation of behavioral change after adenotonsillectomy for obstructive sleep apnea in children with autism spectrum disorder,” E. Murata, I. Mohri, K. Kato-Nishimura, J. Iimura, M. Ogawa, M. Tachibana, Y. Ohno, and M. Taniike, Research in Developmental Disabilities, May 14, 2017, Vol. 65, 127-39.
Trickett, J., Heald, M., Oliver, C., & Richards, C. (2018, March 01). A cross-syndrome cohort comparison of sleep disturbance in children with Smith-Magenis syndrome, Angelman syndrome, autism spectrum disorder, and tuberous sclerosis complex. Retrieved February 2018, from https://jneurodevdisorders.biomedcentral.com/articles/10.1186/s11689-018-9226-0
Kansagra, M. S. (2017, November 21). Helping Your Child with Autism Sleep: An Overview of Sleep Hygiene and Behavioral Strategies. Retrieved February 2018, from https://www.autismparentingmagazine.com/helping-your-child-with-autism-sleep-an-overview-of-sleep-hygiene-and-behavioral-strategies/
Magazine, A. P. (2018, January 31). A Closer Look at Sleep Disorders with Autism. Retrieved February 2018, from https://www.autismparentingmagazine.com/sleep-disorders-autism/
Autism Parenting Magazine tries to deliver honest, unbiased reviews, resources, and advice, but please note that due to the variety of capabilities of people on the spectrum, information cannot be guaranteed by the magazine or its writers. Medical content, including but not limited to text, graphics, images, and other material contained within is never intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a physician with any questions you may have regarding a medical condition and never disregard professional medical advice or delay in seeking it because of something you have read within.