According to an article published by Scientific American magazine,“at least half of children with autism struggle to fall or stay asleep , and parent surveys suggest the figure may exceed 80%. For typical children, the figures range from 1 to 16%”.
These days, it is known that sleep depends on a complex mechanism that involves several brain structures and neurotransmitters. It is also important to remember that sleep deprivation (that is, poor sleep or sleeping less than necessary) has severe consequences on brain function, hormones and human behavior.
People with an autistic spectrum disorder (ASD) have a much higher risk of developing sleep-related issues. Common complaints include “difficulty initiating sleep”, “restless sleep”, and “recurring night awakenings”. Symptoms such as snoring, shortness of breath during sleep and/or bedwetting may require a more detailed diagnosis and a treatment conducted by a sleep specialist.
Relationship Between the Severity of Autism and the Severity of Sleep Disorders
There is also a direct relationship between the severity of autism and the severity of sleep disorders. In other words, the more serious the ASD, the greater the intensity and frequency of sleep disorders. Furthermore, whenever a child with ASD presents other neuropsychiatric comorbidities, such as attention deficit hyperactivity disorder, impulsive behavior, anxiety disorder, conduct disorder, or oppositional defiant disorder, the risk of developing sleep disorders increases.
The reason why this occurs is not yet fully understood. Nevertheless, these children with ASD are unable to adequately perform a “social reading” of the discriminatory stimuli which indicate that bedtime is approaching. Although the body’s circadian rhythms and the light/dark cycle are preserved in ASD, there is difficulty in perceiving certain environmental characteristics that suggest the time to go to bed. This probably makes it difficult for the brain to trigger the natural processes for inducing sleep. Another important aspect is the fact that children with ASD are more sensitive to environmental stimuli such as sounds, smells, and visual stimuli. This may be the reason why the brain stays in a permanent state of excitability, hindering the process of initiating and maintaining sleep. Some children with ASD are incredibly sensitive to touch, so even mere contact with a bedsheet or a blanket could interfere with sleep.
There is another aspect related to the melatonin hormone, which normally helps regulate the sleep-wake rhythm. Melatonin is produced in several parts of the body, such as the retina, the lacrimal glands, lymphocytes, and the intestine. Yet there is no doubt that the pineal gland, located in the brain, is the greatest producer of melatonin. Besides sleep maintenance, melatonin reduces body temperature, heart rate and blood pressure during the night. Therefore, it is common to indicate an oral treatment of melatonin for several cases.
Tips to Improve the Sleep Quality of a Child With Autism
Here are some suggestions that may help improve the sleep quality of a child with autism:
- Physical activity: Engaging in exercise, preferably during the morning or early afternoon, is a good way to expend energy.
- Room conditions: Keep the room cool, dark, and quiet to avoid sensory stimuli that might hinder sleep. If possible, use blackout curtains and minimize external noise.
- Routine: Establish a routine to follow an hour before bedtime, even on weekends and holidays. Turn off all electronic devices and provide a simple, repetitive routine that includes putting on pajamas, brushing teeth, reading together, or any activity that is relaxing for your child (and for you). Some children respond very well to a warm bath and a meal before bedtime. Many children with autism have an attachment to certain toys that can also be incorporated into the routine.
- Falling asleep process: Help the child fall asleep alone in their room. If this is not a usual practice, the process should be gradual. Start by sitting on the other side of the room, and then gradually move further away until you leave the room completely.
- Relaxing and stimulating activities: Determine which situations relax and which stimulate your child. Relaxing activities should be part of the pre-bedtime habits, while stimulating activities should be done earlier in the day. For example, if a bath is stimulating rather than relaxing, have it earlier.
- Room temperature: Ensure a comfortable room temperature, as places that are too hot or too cold can interfere with the brain processes that trigger and maintain nighttime sleep.
If none of the aforementioned suggestions works, the physician can request a sleep study to help identify any problems related to the sleep state of the child. In this manner, sleep disorders can be detected, like sleep apnea, restless legs syndrome, or periodic limb movement disorder.
A poor night of sleep does not only affect the child, but also every family member. A good night of sleep will enhance the quality of life of a child with ASD.