People with autism may also suffer from disrupted sleep. Studies have found that more than 50% of the children with autism and possibly as many as four in five have one or more chronic sleep problems. (Cortesi 2010, Krakowiak 2008) Few commonly faced problems include difficulty falling asleep, prolonged wakening during the night and extremely early raising.
Sleep issues may have an effect during the day on the behavioural challenges for children with autism, which includes spikes in repetitive behaviour, difficulty in communication, hyperactivity, irritability, aggression and inattention – which have a huge impact on learning and a decrease in the overall quality of life. (Mazurek 2016)
It is well known that people with autism may have sleep issues and that goes hand in hand with day time behavioural challenges which might interfere in their learning and negative impact on the overall quality of life.
It was reported from many parents who are unable to sleep themselves for fear that their children will leave their rooms or even their homes in the night. Wandering from safety, or elopement is a common and life-threatening problem affecting nearly 50% of the children with autism above 4 years. (Anderson 2012) In 2006 a study found “significant” levels of chronic stress in 90% of parents of “problem sleepers” with autism compared to 65% of parents of non-problem sleepers with autism. (D00 2006)
Studies have shown that genes play an important role in regulating the body’s sleep-wake cycle (circadian rhythm), people with autism are twice as likely to have mutations in genes that regulate the circadian rhythm.
What causes autism-related sleep problems?
Research suggests that the cause of disrupted sleep in people with autism goes beyond poor sleep hygiene habits that disrupt sleep in the general population (Johnson 2008). Many potentially biological causes are identified from various studies, which likely vary and sometime overlap – in different people.
- Genetic studies have shown that people with autism are twice as likely as other people to have mutations in genes that regulate the body’s sleep-wake cycle (circadian rhythm). (Yang 2015)
- Seizures and sleep can worsen each other – undetected seizures during the night disrupts sleep patterns and lack of sleep or insufficient sleep worsens seizure control in people with autism who also have epilepsy. (Accardo 2015)
- Anxiety can affect sleep. It can interfere with the ability to fall asleep and stay asleep. Studies suggest that 11- 40% of children and teens with autism struggle with one or more anxiety disorders. (Vasa 2016, White 2009) It can also set up a worsening cycle with insufficient sleep worsening anxiety and depression.
- Rapid eye movement (REM) is associated with dreaming, and plays an important role in learning, memory and brain development. Studies suggest that children with autism spend relatively less time in REM stage of sleep than do other children. Children with autism spent around 15% of their sleep time in REM versus 23% of the other children. (Buckley 2010). The importance of REM has created a new interest for scientists to look more broadly at autism-related changes in the neuro-transmitter (brain-signalling molecules) that help control sleep.
- Melatoni so called the sleep hormone, produced by the brain, is found to be produced at lower levels in people with autism. (Nir 1995, Kulman 2000, Tordjman 2005, Melke 2008) A recent study found there is little difference in melatonin levels between children with and without autism. It concluded that autism-related sleep difficulties are not solely driven by biological differences. (Goldman 2017)
Fostering better sleep
Neurologist and sleep specialist Beth Malow, of Vanderbilt University Medical Center, has pioneered research-based clinical guidelines for evaluating and addressing sleep disturbances in children with autism, (Malow 2012) as well as programs designed to teach parents strategies for improving the sleep of children with autism. (Malow 2014)