More than half of autistic individuals suffer from chronic sleep problems. So if your little terror dislikes bedtime, you’re not alone. The good news is, if you start today, you may be able to help your child practice good sleep habits for life.
Around 3.5 million Americans are on the autistic spectrum with one in 59 children diagnosed with Autism Spectrum Disorder (ASD). Boys are four times more at risk than girls; one in every 37 boys is diagnosed as on the spectrum compared to one in 151 girls.
Although there’s no cure yet, early detection and management have positive results. That’s why, as a parent, it’s important for you to educate yourself about Autism Spectrum Disorder, it’s early signs and what you can do about it.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person on the Autistic spectrum shows the following major signs:
These sleep disturbances affect their daytime behavior and may exacerbate ASD symptoms such as less social interaction, limited communication, and a restricted repertoire of behaviors, interests, and activities.
The University of Pennsylvania also had similar findings when conducting a study to assess the effect of poor sleep on children with autism. They noted significant behavioral issues and learning problems in kids with sleep issues. Those children also found it difficult to maintain peer relations and social skills.
Another study by Ben Simon and Walker also noted more social withdrawal and loneliness in autistic people compared to the rest of the participants.
Lack of sleep in people on the spectrum is also linked to attention deficit disorder (ADD), depression and obsessive-compulsive disorder (OCD).
Sleep problems also distress the parents and adversely affect the quality of family life. As the child grows, the sleep issues may reduce but never disappear completely. Still, their sleep quality remains less restorative than those suffering from insomnia and other sleep disorders.
People on the autistic spectrum can suffer from a wide array of sleep difficulties. These problems include delays in getting to sleep, staying asleep, waking up frequently at night and less sleep overall. The following are some of the sleep issues common in children and adults with autism.
Sleep apnea restricts oxygen reaching the brain repeatedly. It can delay brain development and worsen behavioral symptoms like irritability and excitability in people with autism.
Nevertheless, there are several theories about the many causes of sleep issues among people on the autistic spectrum.
If your child with autism has difficulty falling asleep, you should consult your pediatrician. They can refer you to an expert who will have the right treatments at their fingertips. To give you an idea, here are the treatment options usually advised for sleep problems in autistic people.
People suffering from ASD take prescription drugs such as clonidine, risperidone and donepezil to manage sleep disorders. Other types of drugs include melatonin supplements, antipsychotics, antidepressants and alpha-agnostics
Melatonin is one of the most effective drugs for treating insomnia in children with autism. It is also preferable due to its minimal side effects. The dosage starts at 0.3-0.5 mg and increases according to the child’s response to melatonin.
A 12-week study tested the effect of melatonin on 146 children with neurodevelopmental disorders. Two groups were made; one group took 0.5 mg of immediate-release melatonin 45 minutes prior to bedtime while the other group was given a placebo.
The kids who received melatonin slept faster and woke up earlier. Also, melatonin was most effective in kids who had the longest sleep latency.
SSRIs are the least effective and less tolerated among autistic children. Antipsychotic drugs are used for treating irritability while D-cycloserine is helpful against social skills impairment. However, much research is still required, so always consult your doctor before attempting to medicate your child.
For a comprehensive approach to improved sleep, behavioral intervention is one of the most effective, long-term treatment plans.
Before giving you a treatment plan, sleep experts conduct an informal assessment to identify the types of sleep problems and any contributing factors. They take account of your child’s bedtime routine and any inadvertent reinforcements such as giving snacks or electronics to control bedtime tantrums.
Parents of children with ASD can get counseling to prepare them for behavioral treatment. Keeping consistent routines and bedtime schedules are of utmost importance and require excessive parental participation.
The goal is to improve the child's ability to sleep independently and move to their own bedroom eventually.
You can use many different techniques along with your medications to make bedtime as smooth as possible for your child and yourself. These therapies have no side effects and can be used safely along other autism treatments.
Whether you medicate your child or not, for long-term success it’s imperative that you instill good sleep habits in your child. These lifestyle changes and general tips and tricks can make bedtime peaceful for you and your autistic child.
People with Autism Spectrum Disorder are extremely sensitive to their environment, especially loud noise and light. You can keep the room dark and soundless to ensure fewer disturbances.
Thick, blackout curtains can block out light and mask sounds. Sounds can be difficult to block but many parents use earplugs, white noise machines or calming music to block outside noises.
Remove toys and TV to make the room ecologically comfortable for your autistic child. Make the bedroom secure by adding a night lamp or light vanilla candles to calm the nerves. Some kids feel safe if their mother’s PJs with their unique perfume is in the room where they sleep.
When you choose your child’s mattress, sheets, pillows or blankets, visit a mattress showroom with your child to see which material agrees with them. Weighted blankets, worry dolls, or stuffed animals are quite effective in de-stressing autistic children.
Always set a list of activities for your autistic child that they must do prior to sleep time. The purpose of this bedtime routine is to help them unwind and calm the mind for some shut-eye.
These activities may include a warm bath, putting on PJs, brushing their teeth, taking their favorite toy to bed, reading a story, and shutting off the light. By repeating this chain of events daily will help develop a sleep onset time for your autistic child.
Gradually, it will train their body and mind and set a consistent rhythm for their sleep-wake cycle. Use visual aids, pictures, sleep charts or written cues to help your child understand what they need to do and why.
Revise this sleep regime often to see what works and what does not as your child’s sleep improves.
Be consistent with your sleep time. Make sure that your autistic child goes to bed and wakes up at the same time each night, even on weekends. It will help normalize the child’s circadian rhythm and the sleep-wake cycle.
Always make sure to give them a predictable transition from waking to sleeping and vice versa. Sudden changes can easily terrify children with ASD. You can alert them at least 15 minutes before time for their bedtime rituals.
You can also use visual cues or set auditory alarms to signal them about their approaching bedtime. This can also ease their transition to sleeping independently.
Avoid all caffeinated drinks or sugary foods at least four hours before bedtime. If your child suffers from constipation, avoid foods that can cause bloating or discomfort. A healthy gut improves sleep and other behavioral symptoms in children with autism spectrum.
Another thing to avoid is blue-light exposure prior to sleep. Turn off the TV and other gadgets with brightly-lit screens an hour before going to bed.
Don’t let them engage in intense activities and gently steer them to their sleep ritual. You can do a gentle massage or put pressure on their body to help them settle down.
Autistic children typically have high energy levels; they are mostly restless and hyperactive. Engage them in high-intensity activities and exercise during the day to run as much energy off as you can.
You can also cut down their daytime nap to build sleep pressure for the night. Even a short nap during the day can give them a second wind and delay sleep onset at night.
It’s a good idea to consult your child’s pediatrician regarding any sleep issues. Keep a sleep diary to identify your child’s sleep routine, which prevents them from falling asleep, and what helps. This way your child’s doctor will be in a better position to guide you.
If your child has sleep apnea, getting proper treatment can improve sleep significantly. The doctor can advise various therapies and early intervention services if required. They often have information about respite care for parents of children with ASD or other support groups.
According to Angela Maxwell-Horn, a pediatrician and professor at Vanderbilt University in Nashville, “better sleep can’t cure autism.” However, most of the research shows a direct relationship between the severity of sleep issues and behavioral ASD symptoms such as cognition, social skills, and irritability.
In a child who underwent surgery to treat sleep apnea improved her ability to socialize immensely. Her attention span increased and the repetitive behavior reduced. Similar improvements were observed among autistic individuals who took melatonin for poor sleep.
There is no single treatment to solve sleep problems in children with autism spectrum. But you can try different methods to find the one that best suits your child. This may require time, effort and patience but will ensure better sleep for your child.
Here are a few resources if you wish to know more about autism, its causes, treatments, and ways you can improve your quality of life.
Autistic children can be very intelligent with high IQ levels but low intellectual abilities. When in distress, they throw tantrums, make noises or show signs of irritability and anger. Along with medical care, they need attention, love, and acceptability from the people around them.
Sleep plays an important role in the well-being of children with ASD. Although much research is still needed, you still have a lot of options including medications, CBT, and various other techniques to help your autistic child develop healthy sleep habits.