Autism

No two people with autism are alike. It’s often said that “If you’ve met one individual with autism, you’ve met one individual with autism.” The breadth of strengths, challenges, unique interests, and behaviors is broad. Yet what unites many children and adults with autism is an underlying difficulty with sleep.

Individuals on the spectrum have difficulty falling asleep and staying asleep. Their sleep may be non-restorative as they spend less time in REM sleep than their neurotypical counterparts. Some kids with autism have sleep apnea, which causes them to stop breathing several times during the night. These sleep issues worsen behavioral challenges, hinder learning, impair social skills, and distress the child and caregivers.

Repetitive behaviors, anxiety, and sensory sensitivities to light, sound, and touch lead to inattention, restlessness, and irritability, worsening sleep problems. Co-existing conditions such as ADHD and anxiety and the medications used to treat them, such as stimulants for ADHD, can cause insomnia. Sleep problems may also indicate an underlying depression.

Optimizing sleep in children with autism engenders learning, calmness, and social interaction.

What we offer at Sleep and Brain

At Sleep and Brain, we conduct a detailed clinical history and specialized physical examination to evaluate if a sleep disorder is impacting you or your child’s behavior.. We prudently assess for sleep disorders as exampled below:

• Sleep-Disordered Breathing

  • The repetitive breathing interruptions cause arousals that heighten the sympathetic nervous system (i.e., fight-or-flight system) and dampen the parasympathetic nervous system (i.e., rest and digest system). Social communication, attention, and repetitive behaviors may improve following treatment for sleep-disordered breathing.

• Restless Legs Syndrome

  • Restless, tingly legs with an urgency to move can underlie insomnia and lead to bedtime resistance.

• Periodic Limb Movement Disorder

  • You or your child may unknowingly kick your legs intermittently during sleep. The limb movement can cause arousals and sleep fragmentation.

• Insomnia

  • Insomnia, defined as difficulty falling asleep, staying asleep, awakening too early, or non-restorative sleep, is commonly linked to autism.

Understanding the cause of you or your child's sleep problems is essential to customize a treatment regime for both the sleep disorder and autism. Treating sleep problems may improve autism because, as mentioned, disordered sleep symptoms can exacerbate autism symptoms. We direct treatment toward the sleep disorder as exampled below:

• Removing the tonsils, expanding the palate, and starting CPAP can help autism and disordered sleep symptoms.

• Iron and dopamine deficiencies can cause RLS and PLMD. We treat RLS with iron supplements, medication, and non-medication therapies.

• Identifying and eliminating the cause of awakenings from sleep

• Utilizing light therapy to advance or delay your sleep cycle

In addition to treating an underlying sleep disorder, we institute robust sleep hygiene interventions, as partly described below, to make going to bed a pleasant experience and reduce anxiety:

• Ensuring your bedroom environment is conducive to sleep

• Eliminating sources of sleep interruption like light and noise

• Optimizing your diet as food can promote and hinder sleep

• Assessing your nighttime habits and rituals

A state of hyperarousal, frequently marked by worry, is a critical factor of insomnia. CBT-I reduces negative thoughts about going to bed, a type of anticipatory anxiety that challenges healthy sleep schedules. Even after falling asleep, you may awaken with anxiety in the middle of the night. CBT-I reorients negative thinking and helps you return to sleep when your mind races with worry. We also utilize relaxation techniques as part of our CBT-I to reduce anxiety and make it easier to fall asleep quickly and peacefully. Guided imagery, deep breathing, and mindfulness meditation are just a few approaches to putting your mind at ease and improving your sleep.

Several medication classes treat autism and co-existing conditions, including anti-anxiety drugs, antidepressants, and stimulants. However, these medications mitigate symptoms rather than cure the underlying cause. Melatonin may be considered in some children with autism as endogenous melatonin may compromised. We judiciously use medications to treat an identified underlying cause.