For many autistic children, getting a good night’s rest can be a real challenge. Sleep difficulties can include taking hours to get to sleep, frequent nighttime wake ups, inability to stay asleep, very early mornings, and more. When your child is not sleeping well, you can see that they struggle to stay focused and may get upset more easily. They can also be more prone to tantrums and cannot regulate emotions as well.
In short, poor sleep can impact quality of life. This is because sleep deprivation greatly affects the areas of the brain that control important functions such as sensory integration, language, cognition, balance, and more. When your child with autism spectrum disorder (ASD) is struggling day and night, you want to do everything possible to help them rest well and thrive.
This article is designed to help you understand not only why sleep can be a struggle for your child with autism, but to give you the information needed to make the best decision when it comes to treatment for your child’s sleep.
Are sleep disorders common with autism?
It is estimated that anywhere between 50-80% of children with autism spectrum disorders have some sort of sleep difficulty. For some children, they may have been diagnosed with insomnia.
As a sleep consultant for kids with special needs, I find that many children with autism struggle to sleep well because they have not yet developed their own way to get to sleep. We all have our own way of doing this, and if your child is reliant on you in any way to fall asleep each night they will continue to look for that help each and every time they wake up.
In addition, when a child is not getting the right balance of activities during the day it will affect overall quality of sleep. The circadian rhythm will continually be interrupted either because the brain is already too tired and cannot continue a regular rhythm, or because it is seeking more stimulation. When there’s the right balance of sensory activities, physical activity, therapy, etc. sleep patterns will be more regular.
Sleep problems in children are too often overlooked. When parents reach out to their doctors to help their child rest better, they often find they don’t get the help they need. In my experience, in the majority of cases, parents are told to give their child melatonin and ultimately medication to help their child with falling asleep.
What medications are available to help children with autism sleep?
There are several different medications that are recommended by doctors to help resolve sleep problems. The most commonly prescribed to people with autism are Clonidine or Guanfacine, to help a child initiate sleep and get them on a more consistent schedule. This is often used as an option to help with daytime behaviors as well.
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Many doctors might recommend Benadryl (Diphenhydramine) to induce drowsiness in addition to another prescription medication. Less commonly prescribed drugs are Risperdone, or anti-seizure medication such as Clonazepam. These latter drugs are more commonly given to older children or teenagers with autism when the previous medications mentioned have not worked.
Is it safe to give a child sleep medication?
Before giving your child with autism any medication, I strongly urge you to do research. This is simply because all medications work differently, and may come with a wide range of side effects. Some children have no side effects when starting a medication, but others do. This is the case for any medicine.
Interestingly, sleep medications can throw off the natural balance between all the stages of sleep that we so desperately need. For example, certain prescription meds like Clonazepam reduce the amount of non-REM and REM sleep that you get each night. These stages of sleep are crucial for a child’s brain growth and development, as it is the brain’s time to process and organize new information. Some medications extend these stages of sleep, but reduce lighter stage sleep. Lighter stage sleep is important for motor development.
If you’re considering medication for your child’s sleep, make sure you discuss it with your doctor first and get all of your questions answered.
Is melatonin a good alternative to medication?
If you have not tried melatonin with your child with autism, this would absolutely be preferred over medication. It does not create dependency, and it is a much more natural supplement to give your child.
That being said, melatonin should not be used on a long-term basis, either. Although studies have yet to show this, the theory is that overuse of melatonin can affect the function of the glands that produce this hormone. It should really only be used temporarily to reset your child’s sleep/wake schedule.
Supplementing with melatonin is important to help your child start sleeping, but it will not help your child stay asleep. Very often, parents will tell me that their child will sleep very deeply with melatonin until the 1-3am hour, and then they’re up, energized, and ready to start their day. Parents will try to give their child another dose, but to no avail.
If your child can fall asleep well without melatonin but has trouble staying asleep, melatonin will not be effective.
If you’ve tried melatonin with your child and it has stopped working, or never worked, you can also try supplementing with magnesium citrate and some calcium, either with food or vitamins. Magnesium can help the body to relax, and calcium is necessary to help the body make melatonin.
Make sure you consult your child’s doctor or a nutritionist to get the correct dose of melatonin for your child, or to discuss other natural remedies.
What are other sleep solutions to consider?
Many parents I speak with want to do everything they can to avoid medication, and some parents may feel guilty because they have to resort to sleep medicine in the end. Remember, when your autistic child is suffering night after night for months, it is completely understandable—resorting to medicine is something that no parent should feel guilt over.
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Parents will often bring their concerns to their doctors and therapists, and be told that the only solution is melatonin or medication for their child. This is because most specialists do not know about, or will not consider, sleep training or behavioral interventions for a child on the autism spectrum. It is assumed that it is too hard, it will not work, or that your child is incapable of learning the crucial skill of sleeping well.
I urge you to note, prescription medication and melatonin are often a bandaid for deeper issues of sleep hygiene and dysregulation. One family I worked with had tried five different sleep medications with their little girl. In the end, when they were able to get her on a good schedule and sleeping independently through sleep training; years of sleep deprivation had been reversed.
Sleep training can be incredibly effective if your child has a plan that is unique to them and their needs. There is no one size fits all approach, and no strict schedule for children with autism. They need to have the space to understand, process, and succeed with each and every step of a sleep training program before moving on to the next one.
Although this route is challenging, the end result is absolutely worth it! You are able to give your child an important tool that will help them get good sleep for years to come.
How do I know if medication is the right way to go?
If you’re concerned about giving medication, then working with a consultant or therapist to help your child sleep better, or starting with melatonin are great options to consider. However, if you feel you’ve exhausted these and your child needs relief, then medication could be the next best option for tackling insomnia. Consulting a medical professional is vital before considering any medication.
When there are many different options and opinions, it can feel overwhelming to know what is the right step to take. But, you are the world’s leading expert in your kid. You have to make the decision that you feel is best for your child.
And chances are, whatever you decide, it is going to be the right choice for your child with autism spectrum disorder, because you only have their best interests at heart.
Roehrs and Roth, Drug-related Sleep Stage Changes: Functional Significance and Clinical Relevance: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041980/
Ekambaram and Relia, Pharmacological Approach to Sleep Disturbances in Autism Spectrum Disorders with Psychiatric Comorbidities: A Literature Review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313590/
Malow et al: Sleep Difficulties and Medications in Children With Autism Spectrum Disorders: A Registry Study: https://pediatrics.aappublications.org/content/137/Supplement_2/S98