Sleep is vitally important to everyone’s wellbeing, but especially children with autism. Poor quality rest can lead to challenging behaviors and have devastating repercussions for everyone involved in their care.
Sleep problems in people with autism are complex; this article explores some of their sources and provides solutions.
Insomnia
Insomnia is an ongoing challenge for people living with autism. On average, it takes them 11 minutes longer to fall asleep compared to neurotypicals and they’re also more likely to wake up during the night than their neurotypical peers – this disruption to sleep has serious ramifications on mood, behavior and learning – with scientists still studying what causes insomnia in autistic children – however they do know that poor rest worsens symptoms while making learning harder overall.
Researchers speculate that autism may contribute to sleeping problems by altering how our internal circadian clock functions, which regulates production and release of melatonin responsible for sleep-wake cycles. Autism mutations have been linked with disrupted circadian clocks that could cause insomnia or other sleeping disorders.
Researchers also suggest that autism may contribute to sleep problems due to its impact on sensory systems. For instance, sensory hyper-reactivity may cause someone to avoid bright lights altogether and have an impactful on circadian rhythm. Furthermore, social skills difficulties could interfere with scheduled social interactions that would normally help entrain it.
Autism often co-occurs with other health conditions that impede sleep, including digestive issues, anxiety and attention deficit hyperactivity disorder (ADHD). Medication prescribed to treat these disorders may also contribute to insomnia and restless nights.
Researchers are developing new medications that may improve sleep for those living with autism. Parents can help their child’s restfulness by creating and adhering to a consistent bedtime routine and maintaining as quiet and dark of an environment as possible in their bedroom environment. For additional support, consulting a sleep specialist might also prove invaluable.
If your child’s sleep is poor, consult with their physician or therapist immediately. If the issue continues, see a sleep specialist in order to identify what’s causing their insomnia and find effective solutions.
Sleep apnea
Sleep issues are an all too familiar part of autism. According to one 2019 study, 8 out of every 10 autistic preschoolers experience disrupted restful slumber. Sleep disturbances may worsen certain aspects of autism while creating an endless cycle of disruptive behaviors and inadequate rest.
Research indicates that those with autism are more likely to experience obstructive sleep apnea, which entails repeatedly stopping and restarting breathing during the night, leading to excessive daytime tiredness, poor concentration and irritability; further exacerbating sensory sensitivities and repetitive behaviors.
People with autism tend to be overweight, which increases their risk of obstructive sleep apnea as fat deposits around their throat can block off airways and block oxygen flow. Furthermore, thickening neck muscles or an increase in tonsil and adenoidal size may narrow their airway further leading to airway obstruction and reduced oxygen flow as well as decreased blood oxygen levels.
Researchers still aren’t certain why those with autism experience obstructive sleep apnea, but believe it could have to do with genetics and upper airway structure. Autism patients may possess mutations in genes responsible for controlling biological clocks and producing melatonin.
People with autism often struggle with increased appetites and digestive issues that interfere with falling asleep or staying asleep, waking them frequently throughout the night. Some also suffer from restless legs syndrome (RLS), a condition characterized by painful, disturbing tingling sensations in leg muscles that lead to an urgent desire to move them resulting in fragmented and non-restorative sleep patterns.
Understanding the relationship between autism and sleep is crucial so you can take steps to enhance your child’s restful slumber. A good night’s rest can reduce irritability, depression and anxiety brought on by poor rest; treating any medical conditions could also aid in bettering one’s ability to rest soundly and overall functioning.
Circadian rhythm issues
Circadian rhythm sleep disorders occur when our internal biological clock, also known as our “internal sleep-wake clock”, becomes compromised, leading to symptoms like insomnia, excessive daytime sleepiness and misalignments between internal clock cycles and environmental light/dark cycles. Circadian rhythm disorders may result from genetic conditions like delayed and advanced sleep phase syndrome or environmental influences like jet lag or shift work; or desynchronization may also occur due to blindness or reduced sunlight exposure.
Studies have correlated poor sleep with autism to numerous symptoms, such as irritability, behavioral problems and deficits in communication. Researchers believe these issues stem from abnormalities in the brain’s circadian system as well as lack of restorative REM sleep which helps consolidate experiences and memories over time.
Recent research found that children with autism who slept less than seven hours per night exhibited poorer cognitive and social abilities compared to those who got at least seven hours of restful slumber each night, as well as being more likely to have sleep disturbances like frequent night awakenings or early morning wake-ups.
Research has demonstrated that individuals with autism often exhibit lower parasympathetic activity during the daytime and tendencies toward hyper-sympathetic activity during sleep, leading to biological alterations of circadian systems and autonomic functions associated with autistic-like symptoms like sensory processing dysfunction, impaired gastrointestinal motility and behavioral regulation deficiencies.
Doctors frequently collaborate with behavioral therapists when treating sleep disorders in people with autism. Together they develop and implement a sleep routine and foster healthy sleeping habits for these individuals, such as setting consistent bedtime and wake times; refraining from caffeine consumption within several hours before bedtime; restricting screen time prior to sleeping and avoiding activities which might trigger anxiety, such as video games or flashing lights.
Caregivers of individuals with autism may be asked to keep a sleep diary to record disturbances and track behavior throughout the day and night. A noninvasive sleep study using wearable devices that track movement may also help diagnose certain types of sleep disorders.
Sensory issues
Children with sensory issues may have trouble sleeping through the night and may awaken frequently throughout the night, which can have negative repercussions for their health, mood and behavior as well as making it hard for parents to get adequate rest – creating stress and conflict among family members.
Sensory issues and disorders have many causes, from brain trauma and neurological conditions to environmental influences and toxic substances. They may be temporary or lifelong conditions affecting any of the eight senses; children with autism can experience hyper- or hyposensitivity of some senses as well as difficulty processing information and making sense of it all.
Many children with autism struggle to sleep due to sensory sensitivities. They may require being rocked, patted or having someone lie with them as they slumber. Furthermore, they can have difficulty understanding social cues like cycles of light and darkness as well as circadian rhythms which help establish sleep cycles.
Sensory issues and sensitivities can create issues in eating, learning, physical activity and social relationships as well as anxiety and depression. Children affected by sensory issues may find it hard to focus in school and may lack motivation to learn new things.
Sensory issues may manifest themselves through being sensitive to touch, smell, taste, vision, hearing, balance (vestibular), movement and internal body senses like proprioception and interoception. They may have strong reactions to loud noises, bright lights, cold temperatures or pressure stimuli and have difficulties engaging in activities requiring balance, like climbing on playground equipment or riding bikes.
Tzischinsky et al found that sensory over-responsivity was related to sleep difficulties among autistic children. Their authors used the Children’s Sleep Habits Questionnaire and Short Sensory Profile questionnaires with 69 children on autism surveyed using these instruments; their results differed significantly from those reported by Mazurek and Petroski’s survey of 1374 autistic children, surveying them all using these same instruments; possibly due to different sample size distribution; usage of different IQ tests as well as different sleep questionnaire, as well as surveying different age group.
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