During the first few months of life, babies ease into a normal cycle of sleep and wakefulness. They gradually reduce the number of daytime naps they need and start sleeping for longer periods of time at night. But some children continue to have difficulty falling asleep or sleeping through the night, and the problem can persist long after children start school.
Sleep disorders may be even more common in children with autism spectrum disorders. Researchers estimate that between 40% and 80% of children with ASD have difficulty sleeping. The biggest sleep problems among these children include:
- Difficulty falling asleep
- Inconsistent sleep routines
- Restlessness or poor sleep quality
- Waking early and waking frequently
A lack of a good night's sleep can affect not only the child but everyone in their family. If you're bleary-eyed from night after night of waking up with your child, there are a number of lifestyle interventions and sleep aids that can help.
What causes sleep disorders in children with autism?
Researchers don't know for sure why autistic children have problems with sleep, but they have several theories. The first has to do with social cues. People know when it's time to go to sleep at night, thanks to the normal cycles of light and dark and the body's circadian rhythms. But they also use social cues. For example, children may see their siblings getting ready for bed. Children with autism, who often have difficulty communicating, may misinterpret or fail to understand these cues.
Another theory has to do with the hormone melatonin, which normally helps regulate sleep-wake cycles. To make melatonin, the body needs an amino acid called tryptophan, which research has found to be either higher or lower than normal in children with autism. Typically, melatonin levels rise in response to darkness (at night) and dip during the daylight hours. Studies have shown that some children with autism don't release melatonin at the correct times of day. Instead, they have high levels of melatonin during the daytime and lower levels at night.
Another reason children with autism may have trouble falling asleep or awaken in the middle of the night could be an increased sensitivity to outside stimuli, such as touch or sound. While most kids continue to sleep soundly while their mother opens the bedroom door or tucks in the covers, a child with ASD might wake up abruptly.
Anxiety is another possible condition that could adversely affect sleep. Children with autism tend to test higher than other children for anxiety.
What kind of effects do sleep problems have?
Not getting a good night's sleep can have a serious impact on a child's life and overall health. Research has shown that, in children with autism, there is a connection between lack of sleep and the following characteristics:
- Aggression
- Depression
- Hyperactivity
- Increased behavioral problems
- Irritability
- Poor learning and cognitive performance
If your child isn't sleeping, there's a good chance you aren't, either. One study showed that the parents of children with autism sleep less, have poorer sleep quality, and wake up earlier than parents of children without autism.
How do I know whether my child has a sleep disorder?
Every child needs a slightly different amount of sleep. In general, these are the amounts of sleep children require, by age:
- Ages 1-3: 12-14 hours of sleep per day (take into account whether your child naps)
- Ages 3-6: 10-12 hours of sleep per day
- Ages 7-12: 10-11 hours of sleep per day
If your child regularly has difficulty falling asleep or wakes up repeatedly throughout the night, it might be a sign of a sleep problem. To know for sure, make an appointment with your child's pediatrician. The doctor may refer you to a sleep specialist or an ear, nose and throat doctor.
It can help to keep a sleep diary for a week to track how much and when your child is sleeping. You may include any snoring, changes in breathing patterns, unusual movements, or difficulty breathing. It may help to write down observations about your child's behavior the following day. You can share this diary with your child's doctor and any specialist involved in treatment.
How can I help my child sleep better?
Sleep medications should only be used with children as a last resort . There are a number of lifestyle changes and natural sleep aids that can improve sleep time and quality for kids with autism spectrum disorder:
- Avoid giving your child stimulants such as caffeine and sugar before bed.
- Establish a nighttime routine: give your child a bath, read a story, and put them to bed at the same time every night.
- Help your child relax before bed by reading a book, giving a gentle back massage, or turning on soft music.
- Shut down television, electronic devices like phones, video games, and other stimulating activities at least an hour before bedtime.
- To prevent sensory distractions during the night, put heavy curtains on your child's windows to block out the light, install thick carpeting, and make sure the door doesn't creak. You can also make sure that the temperature of the room and choice of bedding fit with your child’s sensory needs.
- Ask your pediatrician about giving your child melatonin just before bedtime. This dietary supplement is often used as a sleep aid to help people get over jet lag. It may help normalize sleep-wake cycles in autistic children who have sleeping issues, and research done so far finds that it's safe and effective.
- Talk to a sleep psychologist about bright-light therapy. Exposing the child to periods of bright light in the morning may help regulate the body's release of melatonin by helping them to feel more awake during the day.