How common are sleep problems in children with autism ?
A 2019 study, one of the largest to examine the prevalence of sleep problems in autism, found that nearly 80 percent of preschool children with autism experience disrupted sleep. Sleep problems are twice as common in children with autism as in children generally or with other developmental conditions.
What types of sleep problems are common in people with autism ?
People with autism are prone to insomnia: It takes them an average of 11 minutes longer to fall asleep than the average person, and many often wake up during the night. Some people with this disorder suffer from sleep apnea, a condition that causes them to stop breathing multiple times during the night.
People with autism may also have less restorative sleep than the average person. About 15% of their sleep time is in the rapid eye movement (REM) stage, which is critical for learning and retaining memories. By comparison, most neurotypical people spend 23% of their resting time each night in REM sleep.
Are there consequences to a lack of good sleep ?
There is growing evidence that too little sleep can exacerbate autistic traits, such as poor social skills. Children who are sleep-deprived tend to have more repetitive behaviors and have difficulty making friends than others on the autism spectrum. They also tend to score lower on intelligence tests. However, it is unclear whether these problems arise from poor sleep, lead to poor sleep, or both.
A 2009 study found that children with autism who had difficulty sleeping were more active and easily distracted than children who slept well.
Why do people with autism have trouble sleeping ?
Many people with autism also have other conditions, such as gastrointestinal problems, attention deficit hyperactivity disorder (ADHD), or anxiety disorders, that can disrupt sleep. For example, cramps caused by constipation may keep an autistic person awake at night. Sensory sensitivities to light, sound, or touch may cause difficulty sleeping. Sleep problems may also be an indicator of depression in people with autism, although whether it is a cause or a consequence of difficulty sleeping is unclear.
People with these other conditions may also take medications that affect their sleep. For example, many people with ADHD take stimulants, which can cause insomnia.
In some cases, people on this spectrum carry mutations that predispose them to sleep problems. Research shows that people with autism are more likely than the general population to have mutations in genes that control sleep-wake cycles or are associated with insomnia. Some studies suggest that people on the spectrum carry mutations that affect levels of melatonin, a natural hormone that controls sleep.
How do researchers assess sleep problems in people with autism ?
A polysomnogram is the most common and thorough type of sleep test. It tracks a person's brain waves, eye and body movements, and breathing patterns during sleep. Because it requires multiple sensors, wires, and computers, it's usually done in a laboratory.
But this gold-standard approach isn't always practical for people with autism, many of whom need a specific bedtime routine. At least one research team has brought polysomnography equipment into the homes of people with autism to try to solve this problem.
A less cumbersome sleep test is actigraphy, in which a watch-like device records a person's activities throughout the night. People can use the device at home to record how much sleep a person gets each night.
Researchers can also learn about sleep patterns by interviewing family members or asking them to keep sleep diaries. But these methods are prone to error because they rely on people's memories.
Are there treatments that can help people with autism sleep better ?
In some ways, the solution may be simple: establishing a routine, such as a sequence of activities before bed, often helps a person fall asleep; changing the temperature or lighting in the bedroom can, too. Sticking to a regular bedtime and wake-up time keeps your brain and body on track for more reliable sleep.
The U.S. Food and Drug Administration has approved insomnia drugs such as Ambien for use in adults with autism, but not for children. For more serious problems like sleep apnea, clinicians sometimes recommend a nighttime breathing device, such as a continuous positive airway pressure (CPAP) machine, or in rare cases, surgery.
But for many sleep problems, melatonin supplements may be a good option. Some studies show that supplements can help children with autism fall asleep faster and get better quality sleep.
Will better sleep improve quality of life for people with autism ?
perhaps. There are currently no large, definitive studies on this topic. But studies show that typical children and people with autism who undergo surgery to relieve breathing difficulties during sleep show better social communication and attention and fewer repetitive behaviors. In a small study of children with autism who took melatonin supplements, parents reported similar improvements.
Better sleep 'doesn't cure autism'. However, children with autism who return to normal sleep schedules appear to learn better, are less irritable and have fewer problem behaviors.