Does Autism Affect Sleep?
A good night’s rest isn’t guaranteed for anyone, but it is downright elusive for many people with autism. Individuals on the spectrum often have trouble falling and staying asleep. And that may worsen certain features of their condition, such as repetitive behaviors, which can, in turn, make sleeping even more difficult. Given this disruptive feedback loop, sleep problems are among the most urgent concerns for families grappling with autism. But so far, this also happens to be among the least-studied aspects of autism.
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Are Sleep Problems Common with Autism?
A 2019 study, one of the largest to investigate the prevalence of sleep problems in autism, suggested that between 40% and 80% of autistic preschoolers have disrupted sleep. Sleep problems are twice as common among children with ASD as they are among typical children or those with other developmental conditions.
The biggest sleep problems among these children include:
- Difficulty falling asleep
- Inconsistent bedtime routines
- Restlessness or poor sleep quality
- Waking early and waking frequently
What Sleep Problems Do Autistic Children Have?
People with autism tend to have insomnia: It takes them an average of 11 minutes longer than typical people to fall asleep, and many wake up frequently during the night. Some people with the condition have sleep apnea, a condition that causes them to stop breathing several times during the night.
Sleep in people with autism may also be less restorative than it is for people in the general population. They spend about 15 percent of their sleeping time in the rapid eye movement (REM) stage, which is critical for learning and retaining memories. Most neurotypical people, by contrast, spend about 23 percent of their nightly rest in REM.
When Do Sleep Problems Start in Autism?
Although there isn’t a set age, children on the autism spectrum often start showing signs of sleep problems at around the age of 2. That being said, these issues may linger throughout childhood and beyond. For several children, these sleep disturbances could be chronic.
Why Do People With Autism Have Difficulty Sleeping?
Researchers don’t know for sure why autistic children have problems with sleep, but they have several theories.
- Many people with autism have other conditions, such as gastrointestinal problems, attention deficit hyperactivity disorder (ADHD) or anxiety, and each of those is known to disrupt sleep.
- Cramps from constipation, for instance, may keep a person with autism up at night.
- Sensory sensitivities to light, sound or touch may contribute to difficulty sleeping.
- Sleep problems may also be an indicator of depression in autistic people, though whether it is a cause or a result of sleep difficulties is unclear.
- People with these other conditions may also take medications that affect sleep. For example, many people with ADHD take stimulants, which are known to cause insomnia.
- Studies suggest that individuals with autism are more likely than typical people to have mutations in genes that govern the sleep-wake cycle or those that have links to insomnia.
- Some studies suggest that people on the spectrum carry mutations that affect levels of melatonin, a natural hormone that controls sleep. To make melatonin, the body needs an amino acid called tryptophan, which research has found to be either higher or lower than normal in children with autism. Typically, melatonin levels rise in response to darkness (at night) and dip during the daylight hours. Studies have shown that some children with autism don’t release melatonin at the correct times of day. Instead, they have high levels of melatonin during the daytime and lower levels at night.
- Another reason children with autism may have trouble falling asleep or awaken in the middle of the night could be an increased sensitivity to outside stimuli, such as touch or sound. While most kids continue to sleep soundly while their mother opens the bedroom door or tucks in the covers, a child with ASD might wake up abruptly.
What Kind of Effects Do Sleep Problems Have?
Not getting a good night’s sleep can have a serious impact on a child’s life and overall health. Research has shown that, in children with autism, there is a connection between lack of sleep and the following characteristics:
- Increased behavioral problems
- Poor learning and cognitive performance
If your child isn’t sleeping, there’s a good chance you aren’t, either. One study showed that the parents of children with autism sleep less, have poorer sleep quality, and wake up earlier than parents of children without autism.
How Do I Know Whether My Child Has a Sleep Disorder?
Every child needs a slightly different amount of sleep. In general, these are the amounts of sleep children required by age:
- Ages 1-3: 12-14 hours of sleep per day (take into account whether your child naps)
- Ages 3-6: 10-12 hours of sleep per day
- Ages 7-12: 10-11 hours of sleep per day
If your child regularly has difficulty falling asleep or wakes up repeatedly throughout the night, it might be a sign of a sleep problem. To know for sure, make an appointment with your child’s pediatrician. The doctor may refer you to a sleep specialist or an ear, nose, and throat doctor.
Keep a sleep diary for a week to track how much and when your child is sleeping. You may include any snoring, changes in breathing patterns, unusual movements, or difficulty breathing. It may help to write down observations about your child’s behavior the following day. You can share this diary with your child’s doctor and any specialist involved in treatment.
How Can I Help My Child Sleep Better?
Sleep medications should only be used with children as a last resort. There are a number of lifestyle changes and natural sleep aids that can improve sleep time and quality for kids with autism spectrum disorder:
- Avoid giving your child stimulants such as caffeine and sugar before bed.
- Establish a nighttime routine: give your child a bath, read a story, and put them to bed at the same time every night.
- Help your child relax before bed by reading a book, giving a gentle back massage, or turning on soft music.
- Shut down television, video games, and other stimulating activities at least an hour before bedtime.
- To prevent sensory distractions during the night, put heavy curtains on your child’s windows to block out the light, install thick carpeting, and make sure the door doesn’t creak. You can also make sure that the temperature of the room and choice of bedding fit with your child’s sensory needs.
- Ask your pediatrician about giving your child melatonin supplements just before bedtime. Some research suggests that supplements help children with autism fall asleep faster and get better-quality sleep. It may help normalize sleep-wake cycles in autistic children who have sleeping issues, and research so far finds it safe and effective.
- Talk to a sleep psychologist about bright-light therapy. Exposing the child to periods of bright light in the morning may help regulate the body’s release of melatonin by helping them to feel more awake during the day.
Better sleep is “not going to cure autism,” says pediatrician Angela Maxwell-Horn, assistant professor of pediatrics at Vanderbilt University in Nashville, Tennessee. But, she says, children with autism who get back on a regular sleeping schedule seem to learn better, are less irritable and have fewer problem behaviors.