Sweet Dreams – Autism and Sleep

Autistic individuals often have difficulty falling or staying asleep.  It is estimated that 40 to 83% of autistic individuals have some form of sleep disturbance. Autistic children are twice as likely to have sleep issues as typical children or children with other developmental conditions. Disordered sleep is also one of the first concerns reported by parents.

As diverse as autism symptoms are, so are sleeping issues. Some may experience insomnia, characterized by waking up frequently throughout the night or staying awake for one of more hours during the night, sleep paralysis (waking but not being able to move), night terrors/sleep terrors, or sleep apnea.

Getting a good night’s sleep is important for a number of reasons. A lack of sleep can affect daytime functioning and lead to behaviors of concern such as sleepiness, depression, anxiety, lack of concentration, hyperactivity, increased distractibility, irritability, an increase in repetitive behavior, and poor learning abilities. Sleep disturbances reduce quality of life for both the individual and the family. This problem concerns everyone who supports an autistic person at school, during community activities, in the workplace and at home because a lack of sleep impacts a person’s well-being.

I remember how difficult life was because of the sleep issues my two autistic children had when they were younger. It took my son hours to fall asleep even with me lying beside him. My daughter got up at 2 am for the day and never napped. She had to wear a baseball cap all night long and it it fell off, she woke up immediately and couldn’t go back to sleep.

Between the two of them, I only had 4 hours of a sleep a night for 10 years and those 4 hours were never back to back. Sleep deprivation affected my mood, decision making, ability to problem solve, energy levels and changed my cortisol patterns. I had to go to work everyday as a teacher and my performance on the job was greatly reduced. I felt tired and desperate all the time. I could fall asleep anywhere – with my back pressed against a wall. on the floor, or sitting up. It took time and great patience to help both children achieve better sleep habits. Both sleep quite well as adults and have excellent bedtime/sleep routines.

What causes insomnia in autism spectrum disorders (ASD)?

Various biological, environmental, and psychological factors cause sleep disturbances in ASDs. Here are a few of them:

1. Co-existing medical conditions – Anxiety, gastrointestinal problems (constipation, diarrhea, and gastroesophageal reflux disease), ADHD, tic disorder, and OCD are just a few of the medical conditions that are associated with ASD and are known to disrupt the sleep cycle.
2. Imbalance in melatonin levels and other neurotransmitter action – Autistic people have abnormal levels and action of melatonin and certain neurotransmitters like GABA and serotonin. GABA is an inhibitory neurotransmitter that is also involved in the sleep cycle and acts on regions of the brain that promotes sleep. Low levels of melatonin in autistic people is attributed to the deficiency of a serotonin-based enzyme, ASMT (acetylserotonin methyltransferase), which is essential for the synthesis of melatonin. Melatonin is the major hormone that controls sleep.
3. Sensory issues – Autistic people experience a wide range of sensory issues and can be both hyper and hypo sensitive. Being hypersensitive to light, sound, smell, and touch can affect sleep. Minor sounds, light seeping in from underneath a door, outdoor noises like a dog barking can disrupt sleep. My daughter is very auditory sensitive and sleeps with noise cancelling headphones on.
4. Circadian rhythms and social cues – Our circadian rhythm is monitored by the absence or presence of sunlight. Circadian rhythm is also stimulated by social cues such as watching others get ready for bed, turning out lights etc. These social cues may not be understood as time to sleep signals.
5. Adjusting to changes – Any change in routine or environment can cause sleep disturbances such as switching to Daylight Saving Time, sleeping over at another person’s house, or travelling.

What is the recommended amount of sleep?

The National Sleep Foundation recommends the following sleep guidelines:

Age                                            Recommended Sleep Duration            Not Recommended

Toddlers (1-2 years)            11 to 14 hours                                                  Less than 9 hours; More than 16 hours

Preschoolers (3-5 years)    10 to 13 hours                                                  Less than 8 hours; More than 14 hours

School-aged children          9 to 11 hours                                                    Less than 7 hours; More than 12 hours
(6-13 years)

Teenagers                                 8 to 10 hours                                                    Less than 7 hours; More than 11 hours
(14-17 years)

Young adults                            7 to 9 hours                                                      Less than 6 hours; More than 11 hours
(18-25 years)

How can we help an autistic person get a better night’s sleep?

Here are 10 ideas that may help support a good night’s sleep.

1. Eliminate or reduce noise – Try to eliminate noises around the house such as the TV, music, the dishwasher, etc. Carpets reduce noise. Make sure the wall that the bed is against doesn’t have a lot of activity on the other side of it.

2. Make the bedroom more comfortable – Keeping the bedroom dark will help limit visual stimulation and encourage the production of melatonin, a neurohormone that promotes sleep. Limit distractions in the bedroom.

3. Limit tech devices before bed and in the bedroom – Tech devices emit blue light. Exposure to blue light in the hours leading up to bedtime can hinder sleep. Blue light suppresses the body’s release of melatonin, the hormone that makes you feel drowsy.

4. Keep the bedroom temperature cool – Optimal temperature for the bedroom is 18 to 20 degrees C.

5. Have a relaxing routine before bedtime – This could be a warm bath, massage, quiet time, listening to soft music or gentle exercise such as yoga.

6. Exercise during the day – Daily physical activity helps promote better sleep.

7. Food and drink – Light snacks are okay, but avoid larger meals two hours before bedtime. Also avoid caffeine which is found in chocolate, coffee, tea, cola, and energy drinks.

8. Sleep timing and bedtime routines – Keep a consistent bedtime and wake up time. A visual schedule of the bedtime routine can help autistic children know the steps that lead up to bedtime and lessen anxiety by creating predictability.

9. Avoid long naps – Try not to take long naps, especially late in the afternoon.

10. Speak to your doctor about using over the counter melatonin – There are studies that show melatonin can help with sleep difficulties. Speak to your doctor about correct usage and dosage.

References

Babich, A. Autism and Sleep. Ten possible strategies. Living Autism

Furfaro, H. (February 2020) Sleep problems in autism, explained. Spectrum News

Neff, M. Autism and Sleep. Neurodivergent Insights
https://neurodivergentinsights.com/autism-infographics/autism-and-sleep

Rudy, L. (August 2023) The Link Between Autism and Sleep Issues. Very Well Health
https://www.verywellhealth.com/autism-and-sleep-issues-4165825

Sleep Problems and Autism Spectrum Disorders. Autism Ontario
https://www.autismontario.com/sites/default/files/2020-05/Sleep%20Problems%20and%20ASD%20Eng.pdf