Sleep and Autism
Introduction
Many adolescents and adults on the autism spectrum can experience sleeping challenges, which can affect how they feel during the day. The importance of quality of sleep is especially vital to the well-being of individuals on the spectrum. The goal of this toolkit is to provide helpful information for parents to best support their children on the spectrum so they can live their best lives and accomplish their goals.
Sensory differences related to sleeping challenges
• Increased sensitivity to sensory stimuli contributes to difficulties in falling asleep and high tactile sensitivity to sleep difficulties (Figure 4) [8].
• Sleep disturbances in people on the autism spectrum include difficulties initiating and maintaining sleep, frequent and prolonged night awakenings, irregular sleep–wake patterns, short sleep duration, and early-morning waking.
• Hyperarousal, particularly pre-sleep arousal or anxiety, may strongly influence sleep in adults, which may explain the relationship among these variables for autistic adults [9].
• For toddlers on the spectrum, sensory over-responsivity predicted late sleep difficulties, but this relationship did not hold for 4-year-olds to 10-year-olds, indicating the complexity and developmental differences in sleep-behavior relationships in autism [10].
• Obstructive sleep apnea (OSA) is common in autism. Children with OSA can present with a range of symptoms, including loud snoring, excessive daytime sleepiness, and changes in cognitive function [11].
• Children on the spectrum have a greater variability in the circadian rhythm cycle, a natural clock that helps the body fall asleep and wake up [12].
Sensorimotor Traits
• Repetitive sensorimotor behaviors can cause poorer sleep in children on the spectrum [10]. Refer to Figure 6 for sleep hygiene tips to support your child.
• Problems sleeping happen more often if the child has restricted and repetitive behaviors, anxiety, or sensory problems and can lead to having trouble paying attention, and feeling restless [11].
• People on the spectrum spend 15 percent of their sleeping time in the rapid eye movement (REM) stage, which is critical for learning and retaining memories. Neurotypical people spend about 23 percent of their nightly rest in REM [10].
Figure 4. Sleep challenges for children on the spectrum
Mental Health Impact in Care Providers
• In a study of 107 children on the spectrum aged 2-18, 1 mg or 3 mg (of Melatonin) resulted in improvement of sleep onset. This treatment not only showed an improvement in the sleep pattern of the children, but also their ability and capacity to cope with stressors [14].
• In one study, families that were raising children on the spectrum who also had sleep problems also had caregiver mental health challenges (Figure 8). This indicates the importance of figuring out how to fix sleeping challenges in children on the spectrum, as this can relieve stress or tension in families [15].
Figure 5. Sleeping challenges can affect other family members.
Autism and sleep in people with trauma
• “Everyday experiences” that neurotypical individuals view as non-emergencies can appear as traumatic experiences to individuals on the spectrum [15].
• The most common adverse events for individuals on the autism spectrum were loss of work and bullying [12], [16].
• Sleeping disturbances are more common in adults with PTSD and range from insomnia and nightmares to occasional leg movements and disruptive night behaviors, which can negatively impact sleep in adults on the spectrum with PTSD [12].
• Ongoing trauma can lead to longer-term neurobiological effects on the brain, which can chronically increase cortisol levels, leaving adolescents constantly on edge or shut down in reaction to a real threat, disrupting natural sleep cycles. (Fig.
•Exposure to trauma can lead to sleep disturbances, which in turn, can increase the chance of developing anxiety condition or depression. Either could mimic PTSD symptoms [9], [17].
Figure 6. Developmental Effects of Complex Trauma [36].