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News

Sleep problems in autism, explained

by  /  13 November 2017

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.

Here’s what researchers know so far about the causes and consequences of — and treatments for — sleep problems in autism.

How common are sleep problems in children with autism?

Between 44 and 86 percent of children with autism have a serious problem with sleep1. By comparison, between 10 and 16 percent of children in the general population have difficulty sleeping. This range among people with autism may be wide because studies use different measures to study sleep.

What types of sleep problems are common in autism?

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.

Does this lack of good sleep have consequences?

There is mounting evidence that too little sleep can exacerbate autism features, such as poor social skills. Children who do not get enough sleep often have more severe repetitive behaviors and a tougher time making friends than other people on the spectrum. They also tend to score lower on tests of intelligence. However, it is unclear whether these problems stem from poor sleep, contribute to it or both.

One 2009 study found that children with autism who have sleep difficulties are more hyperactive and easily distracted than those who sleep well1.

Why do people with autism have difficulty sleeping?

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.

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.

In some cases, people on the spectrum carry mutations that make them prone to sleep problems. A 2015 study suggests that individuals with autism are twice as likely as typical people to have mutations in genes that govern the sleep-wake cycle. Some studies suggest that people on the spectrum carry mutations that affect levels of melatonin, a natural hormone that controls sleep.

How can researchers assess sleep problems in people with autism?

Polysomnography is the most common and thorough type of sleep test. It tracks a person’s brain waves, eye and limb movement, and breathing patterns during sleep. Because it requires multiple sensors, wires and computers, it is typically done in a lab.

But this gold-standard method is not always practical for people with autism, many of whom require specific routines at bedtime. At least one research group has brought polysomnography equipment into the homes of people with autism to try to get around this problem.

A less cumbersome sleep test is actigraphy, in which a wristwatch-like device records a person’s movements throughout the night. People can use the device at home to record the amount of time a person sleeps each night.

Researchers can also learn about sleep patterns by interviewing families or asking them to maintain sleep diaries. But these methods are error-prone because they rely on people’s memories.

Are there treatments available to help people with autism sleep better?

In some ways, the fix can be straightforward: Establishing a routine, such as an order of activities at bedtime, can often help a person fall asleep; so can changing the temperature or lighting in a bedroom. Sticking with regular bed and wake times can put the brain and body on a schedule that makes sleep more reliable.

The U.S. Food and Drug administration has approved insomnia drugs, such as Ambien, for adults with autism but not for children. For more serious problems such as sleep apnea, clinicians sometimes recommend a nighttime breathing device such as a continuous positive airway pressure (CPAP) machine or, in rare cases, surgery.

But for many sleep issues, melatonin supplements may be a good option. Some research suggests the supplements help children with autism fall asleep faster and get better-quality sleep.

Would better sleep improve quality of life for people on the spectrum?

Maybe. No large, definitive study exists on this topic. But research has shown that typical children and those with autism who undergo surgery to alleviate breathing trouble during sleep show better social communication and attention as well as fewer repetitive behaviors. Parents reported similar improvements in a small study of children with autism who took melatonin supplements.

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.


References:
  1. Goldman S.E. et al. Dev. Neuropsychol. 34, 560-573 (2009) PubMed
  • Thank you for this detailed and informative article on a very difficult aspect in caring for a child with autism. In addition to the sleep hygiene recommendations (consistent bedtime routine and schedule), people may be interested to know that it is possible to increase sleep-enhancing behaviors via positive communication and encouragement. Please see this article on increasing pro-sleep behaviors such as Legs Down/Legs Still, Arms Down/Arms Still, Head On Pillow, Exhaling, Yawning. Parents who are interested in using positive communication to teach their child these behaviors can read more here: http://autismchaostocalm.com/got-autism-need-to-sleep-you-can-teach-your-child-to-stay-in-bed-and-sleep/

  • elsiep

    This is a good *description* of sleep problems experienced by children with autism, and some sound advice about how to improve sleep. But that’s not an explanation. Autism isn’t a primary medical condition. Autistic characteristics emerge from a whole bunch of different medical conditions. What we need is someone to look at the primary causes of the sleep disruption.

  • Han-Lin Yong

    Also, there could be alexithymia which most autistic people have. If a person with the condition has anxiety maybe from school or loneliness, they might not be addressed because the person didn’t know it other than bodily signs such as elevated HR and cold skin. The cortisol may make the person not feel tired. If it’s too high when the person should be sleeping, it might be confused with circadian rhythm disruptions or night owl. Gut discomfort can be caused by certain emotions too.

  • Joyce Strom

    I have 3 now young adult children with autism. None of us slept! Some one was always awake. My husband and I had to work opposite shifts to care for our kids as we were in rural Nevada and had none. I took special education, psychology, herbal medicine, occupational therapy and therapy animals to help with part of their treatments. Basically, what worked for one child didn’t really work for the other. Comfort was important. The change of clothes was a problem. Sensory issues made clothing noticeable. So what the liked to wrar in the day was often what type of clothes they wore at night. Their choice. But really, it made a difference. One needed good smells. Essential oils in the room & bright lights.( Extreme fear of the dark. ) Another, bed time stories for an hour. A pet in the bed. Redirected back to bed over and over per naseum. The other one, slept part time in a small bed by ours. The bouncer! Stem and bounce until they passed out! A trampoline during the day helped. Later noisy shows on the computer and headphones. They are adults. I just figure life can be during the day or night. Many jobs are at night. My only huge challenge is keeping peace with those with hardfast schedules! To this day, life is when it happens! I enbrace it! Melatonin helps a bit. We tried most of the cures and treatments. The happiest we have been is just embracing the insomnia and living doing stuff when awake and sleeping when tired. Back in time, people were allowed to do this thing called sleeping when tired. Try to go more with the flow. Enjoy the moments. That’s all we have anyways, right?

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