originally written for and published on Harkla.co
We all need sleep. Our bodies go through a period of rebooting when we sleep each night. Any given night, once we fall asleep, we alternate between the restorative Rapid Eye Movement (REM) stage and Non-REM stages of a sleep cycle every 90-110 minutes. It is during this normal sleep cycle that our bodies and brains process the events of the day and refresh for a new day!
If you’ve ever suffered through a sleepless night, you can testify to the irritability, daytime sleepiness, difficulty concentrating, poor planning, and disorganization that resulted. In fact, research has drawn correlations between learning issues and sleep disturbances. While the occasional poor night’s sleep will inevitably affect us all at some point or another, more frequent difficulties with sleep can be problematic and warrant professional help.
Sleep deprivation
The National Sleep Foundation recommends that preschool children receive 11-13 hours of sleep each night, school age children (10 -11 hours) and for teenagers (8 - 10 hours). Because the recommended sleep time decreases with age, the recommendation for adults is 7-9 hours of sleep per night.
If your child is not getting the recommended amount of sleep, the effects can compound and sleep deprivation can result.
Side effects of sleep deprivation can include:
Irritability, mood changes
Daytime drowsiness
Behavioral issues: hyperactivity, aggression, inattentiveness
Difficulties with organization, planning, judgement
Difficulties with new learning & retention of learned skills (memory)
Decreased safety awareness
Common Sleep disorders
The National Sleep Foundation reports that only 35% of American adults qualify their night’s sleep as “good.” When sleep issues manifest for a sustained period of time, a more clinically diagnosed sleep disorder may be to blame. While the most common sleep issues reported are related to falling and staying asleep, there are a number of ways to characterize a sleep problem:
Insomnias: difficulty falling asleep and/or difficulty staying asleep
Hypersomnia: excessive sleepiness
Sleep-Related Breathing Disorders: apnea, snoring, groaning
Circadian Rhythm Sleep-Wake Cycle Disorders
Parasomnia - excessive movement during sleep cycles
Unfortunately, for children with autism, these sleep problems occur more frequently are compounded by some of the stressors that are commonly associated with autism spectrum disorder.
Sleep Problems, Sleep Patterns, and Autism
Autism Speaks estimates that over 80% of children with autism have sleep problems. Researchers are working hard to uncover exactly why the incidence of sleep disorders is so high in autistic children: Does the neurological and genetic makeup of the autistic brain and body contribute to sleep issues? Or, are issues with sleep contributing to commonly observed symptoms, behaviors, and learning difficulties associated with autism?
In a study published in the Archives of Disease Control, it was reported that children with autism, aged 30 months to 11 years old, slept for 17-43 minutes less per day than their peers. The shortened sleep times were attributed to later bedtimes, earlier wake times, and night awakening (3+ times per night). As the age of the research participants increased, the problems with night awakening increased as well (11% of children with ASD versus .5% of children aged 6.75 years). Sleep deprivation is thought to exacerbate some of the social, behavioral, and cognitive skill issues associated with autism.
Research has also indicated that children with autism spend less time in the critically-important REM sleep cycle than other peers (15% compared with 23%). Since this is the restorative phase of sleep where the day’s information, experiences, and memories are consolidated, researchers are examining the role this lack of REM-sleep plays in the learning difficulties associated with autism.
Another common sleep problem with children with autism is difficulty falling asleep. Each of our bodies has a 24-hour sleep-wake pattern called a circadian rhythm. These circadian rhythms are controlled by the hypothalamus of your brain and are essential to falling asleep and waking in a regular timeframe. The hypothalamus controls the brain’s release of melatonin, which helps your body become tired. Research has found that people with autism have elevated melatonin levels during the day, and lower levels of melatonin at night - this is the opposite of what should be the case. This dysregulation of melatonin levels can contribute to a disruption of the body’s circadian rhythm, meaning parents have to work extra hard to make a non-drowsy child ready for bed!
Additionally, researchers are examining the role that genetics plays in the autism-sleep relationship. Recent research has found more than twice the genetic mutations of circadian genes in people with autism. Scientists continue to explore what mutations are indicators of sleep disorders and whether or not these specific mutations are unique to autism or found in other neurotypical sleep-disordered people.
If you haven’t realized by now, there is no easy answer for figuring out the origination and/or solutions for sleep disorders! To further complicate the issue, children with autism have additional considerations when looking at what could contribute to sleep disturbances:
Comorbid diagnoses like anxiety, restless leg syndrome, epilepsy
Side effects of medication(s)
Neurological diagnoses
Sensory dysregulation
Gastrointestinal problems
Behavioral rigidity associated with bedtime routine
Melatonin & Sleep
Some doctors and parents are combining behavioral approaches to sleep issues with over-the-counter melatonin. Melatonin is a hormone that is naturally produced by the pineal gland during the sleep cycle and it has been used as a supplement to treat sleep disturbances in kids with ADHD and autism. A study in the 2008 Journal of Child Neurology researched the effects of melatonin in the treatment of insomnia in children with autism and found that 60% of parents reported improved sleep. The 2006 Journal of Autism and Developmental Disorders reports that long-term melatonin treatment was effective overall and no safety concerns were found for continuing melatonin treatment.
As with all over-the-counter medications, you want to ensure the correct dosage for your child. Believe it or not, melatonin is not regulated by the Food and Drug Administration (FDA) so the dosages vary by manufacturers and medication form (pill, liquid, dissolvable lozenge). Because some children with autism are also on psychotropic medications, finding the right dose of melatonin can be a tricky task so it’s best to work with your pediatrician to consider all of the variables that are specific to your child.
Co Sleeping & Autism
The desperation of sleepless parents is a reality that forces many families to resort to co sleeping with their child in a last-ditch effort to get some shut-eye. If your child is known to climb out of his crib in the middle of the night or wander around the house while the rest of the family is fast asleep, co sleeping offers peace of mind and an element of safety. It’s an understandable and common adjustment that families often make out of resignation and frustration.
If you choose a family bed, keep in mind that your sleepless child with autism will soon become a teen... and then an adult! It will get more difficult to accommodate a larger body in bed with you, especially if behavioral issues associated with sleep disruptions escalate over time. Consider consulting with a behaviorist who can come into your home and work with your family to identify alternate solutions or a way to move from the family bed to another sleep setup. Sometimes recommendations are made for a cot, sleeping bag, or mattress placed adjacent to the parent’s bed to transition the child to a more independent sleeping arrangement in a gradual way.
Considering Sleep Strategies for Your Sleep “Tool-Kit”
Finding the right combination of tools, strategies, and routines will take some trial and error. As you trial sleep tools and make changes to routines and environments, be sure to keep a sleep log or sleep journal. Subtle changes can have drastic effects on your child’s behavior, so keep track of your observations by writing it down. Consider jotting down diet changes, bedtime adjustments, frequency of wake-ups, wake-up times, and behaviors completing the bedtime routine. Even small changes can add up to a big difference over time and it’s too easy to lose sight of your efforts without the written log. Here are some sleep solutions to consider:
1. Assess your existing bedtime routine - is it consistent? Establishing a consistent bedtime and bedtime routine can help your child begin to calm himself down. This routine is important for all children, but even more so for children with autism. A warm (not hot) aromatherapy bath, short story, and lotion massage can help offer calming sensory input, while providing visuals of the routine supports predictability and understanding.
2. Take a close look at what your child is eating - you may be surprised at the sugar content in common kids snacks! As adults, we’re mindful of limiting sugars and caffeine as we approach bedtime, but don’t forget to consider how your child’s diet may be impacting their sleep readiness. Also be mindful of the nutrients that are lacking in your child’s diet. Foods that contain tryptophan, magnesium, calcium, vitamin B6, and naturally-occurring melatonin may be helpful additions to your child’s dinnertime meal! For more information on foods that affect sleep, check out this resource here.
3. Natural and environmental lighting plays a role in our sleep-wake cycle and it’s not always a positive effect! Certain kinds of lighting affect one’s arousal level more so than others. For example, daylight and fluorescent lighting are stimulating. Limiting screen time 2 hours prior to bedtime and avoiding brightly lit rooms will help regulate your child’s circadian rhythm.
4. Consider your child’s bedroom environment - from the window coverings, to the colors on the walls, and the noises in between. Your child’s bedroom should be a calming retreat that offers sensory deprivation when it’s time to calm down.
Some parents find that a bedtime tent offers an additional light filter and cozy, contained space.
A white noise machine can help filter out some of the extraneous hallway or outdoor noises that may be disruptive to your child falling or staying asleep.
Black-out curtains or roller shades are effective ways to block excess light from peeking through the window to wake your child up earlier than needed!
Darker colors on walls will foster better sleep than lighter colors, so consider repainting in a darker hue that won’t reflect the light as much.
For more tips on designing a bedroom with sleep in mind, check out this article.
5. If you’re a parent of a child with autism, you already know the importance and neuroscience behind a sensory diet, vigorous activity, and getting plenty of exercise. All of these sensory activities promote regulation and the hormones released are also involved in sleep. So, encourage sensory activity throughout the day to support your child’s sleep patterns but be mindful of stopping alerting sensory activities one hour prior to bedtime.
6. If daytime lighting is alerting, what nighttime lighting is calming? Research has supported that red-hued bulbs do not affect the circadian rhythms, so if a nightlight is needed, consider swapping out the typical bulb for a red-hue.
7. Aromatherapy & essential oils like lavender, vanilla, chamomile can be used in bedtime sprays, lotions, and essential oil baths to promote calm. This aromatherapy article outlines some popular insomnia solutions.
8. Consider your child’s bedding: The textures of the sheets, pillows, and comforters should be sensory-preferred and snuggly soft. Some parents find that oversized pillows or stuffed animals offer additional sensory input for squeezing, hugging, and burrowing. Consider a heavy duvet/down comforter or a specifically-designed weighted blanket. Weighted blankets have been found to offer deep touch pressure which can positively impact sleep behaviors.
9. If your child has difficulty knowing when it’s officially “wake-up” time or oversleeping, try adding a sleep-smart alarm clock that specifically targets their needs:
OK to Wake Alarm Clock - Good for kids who wake up early and need to learn to wait in bed until a reasonable hour! This clock glows a green color when it’s wake up time (you set the time).
Wake Up Light - Good for kids who have trouble waking up. This alarm clock simulates a natural lightening when it’s time to wake. Another bonus is that it can act as a nightlight in any color hue (including red!)
10. Promote more regular circadian rhythms by increasing light-exposure during the day
Schedule 10 minutes of outdoor play in the early morning, noon, and at dusk.
Explore the use of a light box as a tool for light therapy. This is especially helpful in the winter months or if you live in an area that isn’t rich in sunshine year-round!
11. Talk to your child’s physician about whether or not Melatonin supplements would be appropriate to try with your child. For more information on Melatonin and Autism, be sure to read Harkla’s article here.
Autism Sleep Study
If you are interested in seeking more information about exactly what your child’s sleep patterns are, there are sleep centers that will conduct sleep studies. While these tend to be more invasive and a last-resort for families, they do offer helpful insight and possible additional solutions.
Takeaways
Sleep is a complex issue that doesn’t always have an easy one-sized-fits-all solution, especially when you’re a child on the autism spectrum. Fortunately, there are many sleep-specific resources and products available to help you create your own sleep tool-kit. Finding your just-right sleep solution might be a lot like picking out your new mattress though -- you may have to try a bunch before you find the right one! Let us know what sleep strategies work for you.
