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A number of the children with autism experience unusual patterns of sleep. Problems with sleep are common in children and adolescents with autism at all levels of cognitive functioning. Children with autism take longer to fall asleep, go to bed later, wake more often in the night, awaken earlier in the morning, and get less sleep overall than typically developing children. Some children with autism display a non-24-hour sleep-wake pattern. These features are an additional challenge for caretakers. Sleep difficulties is linked to family distress and may have significant results on daytime functioning and quality of life for an autistic child.
In some cases, parents report that sleep problems are a continuous, rather than random, problem. Sleep problems usually begin in the first or second year of life and continue. Parents describe problems such as bedtime resistance, bedtime anxiety, delayed sleep onset, nighttime awakenings, nightmares, night terrors, sleepwalking, snoring, bed-wetting, early morning awakenings, and excessive daytime sleepiness. Initial and middle insomnia each occurs in some children with autism who suffer from sleep disturbances, whereas terminal insomnia is not present in children who are language impaired.
Melatonin as a Sleep Aid
There is some evidence of a flaw in melatonin production in autistic children. Melatonin has been successful in aiding sleep onset in children with autism as well as children with other developmental disabilities and otherwise healthy children with sleep/wake disorders. A recent study suggested that controlled-release melatonin improved sleep in a group of 25 children with autism and that treatment achievements were maintained at 1- and 2-year follow-up visits. A child and a young adult with autism with extreme insomnia were reported to have responded well, with no apparent adverse reactions, to melatonin treatment which is sometimes used to relieve pediatric insomnia.
Researchers are still examining the results of melatonin on insomnia in children with autism spectrum disorders. Studies have found that children with autism do not create the necessary internal melatonin. Although melatonin is a hormone, it is available over the counter in different dosages as a dietary supplement. Some parents of autistic children give their child a melatonin supplement to encourage sleep and to treat autism related irritability. Sleep improves in many of the children. Especially if parents also receive education on behavioral approaches to encourage sleep, improvements in sleep cannot be effective with melatonin alone. Melatonin was viewed as being a safe and well-tolerated treatment for insomnia in children studies, researchers reported it in the Journal of Child Neurology.
Treatment for Sleep
Little information is available regarding prescription medication for sleep problems in children with autism or other developmental disabilities. Parents can help by establishing bedtimes and wake times, follow predictable bedtime routines, and use other behavioral techniques. Educational workshops for parents, along with aids such as step-by-step picture schedules and checklists, develop natural and purposeful sleep and daytime behavior restrictions for autistic children.
In some cases, there may be a precise cause such as obstructive sleep apnea (a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep) or gastroesophageal reflux (when a muscle at the end of your esophagus does not close properly allowing stomach contents to rise into the esophagus and irritate it); assessment and treatment are advised by history and physical examination. When there is not a certain medical cause, behavioral interventions including sleep-hygiene measures, restriction of daytime sleep, positive bedtime routines and reinforcement methods are often successful.
Sleep disorders may imitate or worsen psychiatric disorders. Irritability, indifference and other symptoms suggesting a mood disorder in an adolescent, for example, may imitate chronic sleep deprivation associated with early school start times. What appears to be attention deficit/hyperactivity disorder or learning difficulty in an elementary school child may result from a sleep-related breathing disorder. Successful treatment of the sleep disorder may relieve or end psychiatric symptoms. In some cases, other conditions or symptoms, such as epilepsy, depression, anxiety, or aggressive outbursts, call for pharmacologic treatment that may help with sleep.
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