Autism Spectrum Disorder (ASD) And Sleep

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Autism Spectrum Disorder (ASD) And Sleep
Tom Greenspan
December 21, 2022

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Getting a good night’s sleep consistently can be challenging for anyone, especially children suffering from autism spectrum disorder (ASD).

The problem of falling asleep and staying asleep can continue throughout their lives, resulting in many issues over time. But how does this condition affect sleep, and what are the best ways to ensure better quality sleep for these children? We’ll help you answer these questions in the following sections.

What Is The Autism Spectrum Disorder (ASD)?

ASD is a pervasive developmental disorder among infants that affects many brain functions, causing developmental disabilities and repetitive behaviors. However, the type and extent of these disabilities generally vary on a case-to-case basis. While some ASD sufferers may require extensive support throughout their lives, others may function with little to no external help.

It’s true that people with ASD have different ways of communicating, learning, and socializing than people with non-ASD, but not all of them are affected in the same way. For instance, some people suffering from ASD may develop many ‘normal’ skills (such as speaking), while others may remain non-verbal for the rest of their lives. 

This condition typically affects children below 3 years of age, but it can take considerable time before they exhibit any symptoms (we will tell you about these later). In fact, many autistic children may show symptoms during the first year of their lives, while for others, the symptoms may start after they attain 2 years of age.

On that note, here are some symptoms that can be indicative of autism spectrum disorders in children:

  • Repetitive behaviors like spinning, flapping hands, or rocking
  • Little to no response to name calling
  • Self-harming behaviors like biting or head banging
  • Reduced eye contact and difficulty in speech
  • Sensitivity to otherwise ‘usual’ lights, sounds, or physical touch   
  • Developing specific routines and getting upset at the slightest disturbance to them  

Some autistic children may develop normally, achieving all the ‘usual’ milestones (like walking and talking) until 18 or 24 months before they stop learning new skills or lose existing ones. Besides, many school-aged children with ASD may develop other issues such as anxiety, depression, attention deficit hyperactivity disorder (ADHD), and restless legs syndrome, among others. 

Likewise, as they become adolescents and adults, they may show improvement or experience severe difficulty in learning, communicating, and socializing.

How Does ASD Cause Sleep Disorder?

Although it’s not unusual to observe common sleep disorders and sleep disturbance in children, these problems are more prevalent in children with ASD than in typically developing children. And the correlation between ASD and sleep is largely dependent on how the disorder affects these children. For example, some children with ASD may have a specific gene mutation that makes them prone to developing sleep disorders, such as insomnia.

In hindsight, it may affect the amount of melatonin (sleep-inducing hormone) production in ADHD sufferers or the circadian rhythm (sleep-wake cycle of the body). And this may, in turn, make it difficult for them to fall asleep or stay asleep, which can eventually translate into insomnia. 

In fact, according to many studies, about 50 to 80% of children with autism can also experience sleep difficulties, resulting in low sleep duration due to disrupted sleep. Now, let us now take you through some of the reasons behind sleep problems in ASD sufferers in more detail.

1. Irregular Cardician Rhythm

The circadian rhythm of your body that governs the natural sleep-wake cycles depends on many external stimuli, like light, sound, and temperature. However, it’s the responsibility of your brain to ensure a proper circadian rhythm consistently.

Although the exact reason for developing ASD is still a subject of intensive research, it’s believed that issues with the part of the brain that deals with sensory input can cause ASD. This can, among other things, disrupt the body’s response to light and dark, which is a critical factor associated with the circadian rhythm. 

Hence, many children with ASD may also encounter sleep problems, like:

  • Difficulty falling asleep
  • Waking up frequently and inability to fall asleep again
  • Insomnia and sleep-disordered breathing problems like sleep apnea 

Generally, it has been observed that ASD sufferers dealing with sleep disturbances get low REM (rapid-eye movement) sleep. This can cause more behavioral issues and worsen the existing ones, but the same is also true for the overall poor quality of sleep they receive.

2. Associated Disorders And Symptoms

As we’ve stated above, children with ASD often experience other disorders like ADHD and restless leg syndrome, which can affect their sleep habits. ADHD, in particular, may cause increased daytime sleepiness with reduced nighttime sleep.

On the other hand, restless leg syndrome can cause discomfort in the legs, making it challenging to find the right sleeping position. As a result, the child may switch positions frequently through the night, leading to poor sleep.

Moreover, some children with ASD may have other issues, such as gastrointestinal problems like constipation. And constant cramps from constipation can keep them awake at night.

3. Erratic Sleep Patterns And Routines

Children with ASD, especially those suffering from sleep disorders like parasomnia, can develop an erratic sleep pattern. For example, some of them can exhibit abnormal sleep behavior and sudden movement, as well as suffer from frequent episodes of night terrors and bedwetting, all of which can disrupt sleep.

Aside from that, some children with ASD are known to engage in ‘time-inappropriate’ activities resulting in poor sleep quality. They may suddenly wake up at night and start playing with toys or walking around.

The lack of deep sleep during the night may also make them fall asleep during the day, which can, in turn, affect their nighttime sleep, causing a vicious circle. 

4. Use Of Certain Medications

Some medications required for managing and treating associated disorders like ADHD and depression in ASD sufferers may contain stimulants, which can cause problems with the child’s sleep onset. In extreme cases, the continuous administration of such medications can also lead to long-term insomnia.

What Are The Ill-Effects Of Reduced Sleep In ASD Sufferers?

Lack of sleep or poor quality sleep can severely affect the overall well-being of children with autism spectrum disorder, affecting their daytime functioning and making them lethargic and irritable. Besides, as we’ve already mentioned, sleep disorders can aggregate symptoms like repetitive behaviors, making it difficult to navigate the day.

Moreover, as surprising as it may sound, sleep problems in children with autism may contribute to poor socialization skills. As such, they may find it more challenging to make friends than those who are ‘well-rested.’ Not only that, but they may also score poorly on intelligence skills.

How To Help Diagnose Sleep Disorders In Children With Autistic Spectrum Disorder?

A sleep specialist can help confirm the presence of sleep disorders in children with ASD using the following procedures:

1. Polysomnography

Usually conducted in specialized sleep labs, polysomnography is an effective method for tracking different parameters like breathing patterns, eye and limb movements, and brain waves. The results can indicate specific sleep patterns and triggers of disruption during the REM and deep sleep stages, helping sleep specialists figure out circadian rhythms and any issue with chemical signals (neurotransmitters) in the brain.

Since new environments like a sleep lab can make children with ASD feel distressed, you can avail an in-home polysomnography test. However, the results may not be very accurate in this case.

2. Actigraphy

Actigraphy is a less stressful method of monitoring sleep problems in children with autism spectrum disorder, fetching more accurate results than in-home polysomnography tests. The individual being tested has to put on a wristband-like device, which helps track body movements in sleep to identify sleep and wakefulness patterns.

3. Sleep Diaries

Sleep specialists may also ask parents of children with ASD to maintain a sleep diary comprising sleep behaviors. However, this method is generally used with the others mentioned above due to the increased chances of human errors during observation.

How To Help Manage Disorders In Children With Autism Spectrum Disorder?

Thankfully, there are some effective treatments available to help establish healthy and consistent sleep schedules in these children, like:

1. Sleep Training

Since ASD sufferers often develop routines and stick to them, sleep specialists and therapists can use this opportunity to introduce them to positive bedtime routines. These routines typically consist of activities like brushing teeth, putting on pajamas, and shutting off the lights, contributing to better sleep hygiene. Besides, it can help them feel more connected to bedtime. 

Parents and caregivers can help children with ASD develop these routines through visual aids (like pictures and objects) that will aid the children in understanding the steps easily. Moreover, it’s generally advised to keep the routine limited to not more than 30 minutes; otherwise, children may feel overwhelmed and get agitated.

2. Cognitive Behavioral Therapy

Cognitive behavioral therapies employ customized treatment plans that take into account the existing bedtime routine, sleeping environment, and sleep behaviors. In other words, these plans educate parents and children about ways to improve the aspects that can help the latter sleep better.

Typically, cognitive sleeping therapy involves:

A. Sleep Restrictions

Sleep restrictions ensure that children get only the amount of healthy sleep required according to their age. This means that children will only be allowed ‘bedtime’ for the specified amount, whether or not they sleep through that period. 

This approach aims to help children associate bedtime with sleeping only so that they can ease into a definite sleep schedule.

B. Elimination Of Distractions

Distractions such as bright lights, particular colors, or objects like toys and mobile devices can cause difficulty sleeping, especially in autistic children with anxiety or ADHD. Or, they may prevent staying asleep. Hence, eliminating these distractions can aid in managing your child’s sleep problems to a certain extent.

C. Relaxation Therapies

Deep breathing, meditation, visualization exercises, and light muscle relaxation exercises can also be included to reinforce the effects of cognitive sleep therapy. We’d suggest gradually adding these activities to the child’s bedtime routine so that they find it easier to adapt to them.

2. Light Therapy

Also known as phototherapy, light therapy can be used in combination with cognitive behavioral therapies to ensure consistent quality sleep for ASD sufferers. It’s conducted using a light-transmitting box that can mimic natural sunlight minus the harmful UV rays of the sun.  

The child is exposed to this box for anywhere between 15 and 30 minutes during the morning or afternoon to boost melatonin production. Not only can this improve sleep quality and duration at night, but it can also keep them more aware during the day.

3. Consumption Of Dietary Supplements

Some children suffering from autistic spectrum disorders may also require dietary supplements in addition to sleep therapies. You will find many OTC (over-the-counter) melatonin supplements on the market that can stabilize low melatonin supplements. However, they may come with an increased risk of dependency as well as side effects like nausea, dizziness, and upset stomach.

Alternatively, you can opt for natural sleep supplements like kava, valerian root, iron, etc., that have a lower risk of dependency and side effects. But we’d strongly recommend consulting a medical professional beforehand.

Final Words

There’s no denying that addressing sleep problems in children with ASD can be challenging for their parents and caregivers. But we hope our suggestions can help ease the process. 

Apart from therapies and supplements, certain foods like leafy vegetables, nuts, chicken, and beans can help induce sleep naturally. Likewise, light exercises during the day or evening (but not too close to bedtime) can help wear out the children. 

But given the variation of sleep disorders and their extent, we’d advise getting in touch with a professional today to understand the best course of action. And most importantly, it’s important to remember that there’s nothing better than patience and assurance to help children with ASD overcome these issues.