Autism & Sleep

In this post, I share with you the most critical issue any child with ASD faces and how to handle it as a good parent. You have been a top-notch mommy trying to care for your autistic child, yet you feel you are missing out on something. As a daddy you see your kid getting irritated and aggressive and wonder why it is so?–“Do I require to know something more about Autism?” Yes, you need to and it’s about Sleep.

Autism couldn’t stop Einstein, Newton or Mozart from achieving greater heights and so will it not be able to stop your child. Only if we realize that in each of our kids there could be another Newton or Einstein hidden we will strive to help them bring that to the forefronts.

A recent study by a UK-based advocacy group Research Autism has revealed that approximately 40% – 80% of children with ASD have some or the other sleeping disorder. This is on the higher side among adults with ASD. They face difficulty falling asleep, have inconsistent sleep routines/restlessness or poor sleep quality and often wake up early or wake frequently because of erratic sleep patterns throughout the night. They also experience hyperarousal or heightened anxiety around bedtime and because they aren’t sleeping well enough at night, they feel extremely sleepy at daytime. Are you one of those who is witnessing similar cases at home?

If yes, you know these affects both the child’s and the families daytime functioning and overall health. Due to lack of sleep, your child (or an Adult) with ASD exhibit all or some of these behaviors:

  • Aggression
  • Depression
  • Hyperactivity
  • Increased behavioral problems
  • Irritability
  • Poor learning and cognitive performance

Does my child have a sleeping disorder?

The amount of sleep varies as per every child’s need and age. Here’s a guide to the amount of sleep children require in general.

·         Ages 1-3: 12-14 hours / per day (take into account naps as well)

·         Ages 3-6: 10-12 hours / per day

·         Ages 7-12: 10-11 hours / per day

If your child is not getting the required amount of sleep regularly because of difficulty in the onset of sleep or any of the signs above mentioned for sleep problems, please take it into account and make an appointment with your child’s pediatrician.

The doctor may refer you to a sleep specialist if your child shows signs of sleep apnea, sleepwalking, sleep terrors, restless legs syndrome or may refer to an ear, nose and throat doctor. He might also ask for a change in your child’s medications. For children with persistent insomnia, further behavioral or pharmacological treatment is required to improve their sleep.

What causes sleep disorders in children with autism?

The exact cause for sleep disorder in autistic children are unknown, however, several theories have been proposed in an attempt to explain it. Some of these are:

 Irregular circadian rhythm and production of melatonin: Our bodies respond to the normal cycle of sleep-wake based on sunlight, temperature, and other environmental factors, regulated by a 24-hour biological clock called the circadian rhythm. It is processed in the brain; people with ASD exhibit irregular sleep-wake cycle due to irregular production of melatonin, a natural hormone that helps regulate circadian rhythm. For the production of melatonin, the body requires an amino acid called tryptophan, which is typically found to be either higher or lower than normal in children with autism. Melatonin level rises at night and dips at daytime hours in normal children, while it’s just the opposite in children with ASD.

Mental health disorders: Anxiety and depression co-morbid with ASD; these conditions are often a precursor to insomnia and other sleep disorders. Over, 66% of children with ASD reported being insomniac. Over 50% of all children with ASD exhibit symptoms of attention-deficit hyperactive disorder (ADHD), which can cause elevated moods around bedtime.

Medical problems and Medicine side effects: It is found that epilepsy is often concomitant with ASD. Thus sleep is greatly affected by seizures- these can be on a regular basis and severe. Other common medical issues that can cause sleep disorder include constipation, diarrhea, and acid reflux.

Medication can also have side effects that interfere with sleep. For instance, selective serotonin reuptake inhibitors (SSRIs), may cause agitation and hyperactivity before bedtime on the other hand antipsychotics like haloperidol and risperidone, may cause excessive drowsiness.

 In addition parasomnia (frequent nightmares/ terrors and bedwetting) and irregular breathing caused by the intracranial hypertension causing the child’s jaw to take on an irregular shape (in infants with ASD), disrupts sleep.

How to manage my child’s sleep better?

Here I recommend 3 common therapeutic approaches to improve your child’s sleep:

·         cognitive-behavioral therapy,

·         light therapy, and

·         sleep training.

Alongside you can also keep below mentioned tips/strategies in mind to establish and maintain a healthy night time routine and sleep hygiene in your children. Here I share, several lifestyle changes and natural sleep aid  that can improve both the quality and the quantity of your child’s  sleep:

  • Sleep environment: Create a relaxing, conducive to sleep, bedroom environment. Since children with ASD might be particularly sensitive to noises and/or have sensory issues, therefore the bedroom should be dark, quiet and cool for a comfortable sleep. Make sure that the temperature of the room and the choice of bedding fit with your child’s sensory needs.

·   Good food habits: Many foods are natural sleep inducers; you can include these in nightly meals and snacks to help your kids get better sleep. You can include foods like nuts, leafy greens, dairy products, and other products rich in calcium and magnesium. Tryptophan a type of amino acid is also found to induce sleepiness; this is found in turkey, chicken, bananas, and beans. Fruits like sour cherries, grapes, and pineapple that contain high levels of natural melatonin are good for children with lower melatonin level. Do consult your pediatrician about giving your child melatonin just before bedtime as a supplement. Caffeine, sugar, chocolate and some sodas (having caffeine) are a big no-no just before bed because they are stimulants.

·         Exercise: Encourage your children for daytime exercise, as it makes them feel more naturally tired at night. Physical exertion too close to bedtime should be avoided because it can hinder sleep.

·         Relaxation techniques: Relaxation techniques such as meditation, listening to soft music, reading, or laying in bed with the lights off can work wonders for children with ASD. You as a parent can associate in these activities to supervise and guide them to ensure the effectiveness of these techniques.

  • Shut down gadgets/devices: Electronic gadgets like television, video games, computer, smartphones, and other stimulating devices emit ‘blue light’ that can hinder melatonin production and increase sleep latency. Therefore, these should be avoided at least an hour before sleep.
  • Lights & Sound: Ensure the windows are heavily curtained to prevent sensory distractions due to light during the night. To ensure sound sleep, test the floor and door hinges for creaking sounds.

·         Bedtime schedule: Inculcate and develop a bedtime schedule for your children. Following and maintain a sleep diary can be of great help for children with ASD. Difference between the weekday and weekend schedule should be minimal. Check on their daily sleep routine, if unable to sleep reassure them—that all is fine and gently pat them on the head, rub their shoulders, or give them a high-five to help ease their worries. Consult a sleep psychologist about bright-light therapy. Short exposure periods to bright light in the morning may help regulate the body release melatonin thus helping children feel more awake during the day.

 ·    Teach your child to fall asleep alone:  Generally, children wake briefly during the night; initially, your child would need you to help him fall back asleep during the normal awakenings. But gradually, it is vital that your children learn the skill of falling asleep on their own. Instances when they wake up at night, they should be able to put themselves back to sleep without you.

  • Naps: It’s helpful for preschoolers but should be avoided late in the afternoon as they can be interference at bedtime.

I hope this somehow helps you. Please share with a parent or family that may need this information.

Sabrina Thomas

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