Sleep in children with autism

Sleep disorders in children with autism spectrum disorder (ASD) are very common and a source of concern for families. Òscar Ramon Sans , clinical neurophysiologist and Head of the Sleep Disorders Unit at Sant Joan de Déu Hospital Barcelona , and Aritz Aranbarri , child clinical neuropsychologist at the ASD Unit of the Mental Health Area of the same hospital and co-principal investigator of the iCase study, shared their knowledge on the subject in a talk for families organized by the Catalan Autism Federation and Sant Joan de Déu Hospital Barcelona.

There is strong evidence of the benefits of sleeping well , that is, getting an adequate amount and quality of sleep. Some of these benefits are:

• Reduction in heart problems.
• It helps the immune system.
• Reduced anxiety when eating.
• It helps with weight loss.
• It helps with memory.
• It reduces stress and depressive symptoms.

Sleep is essential at all stages of life, but in childhood it has implications for synaptic development and brain maturation. Growth hormone is also synthesized during sleep. Insufficient sleep is directly linked to cardiovascular problems, diabetes, overweight, obesity, stress, accidents, and immune dysfunction. It also leads to emotional, behavioral, and cognitive problems.

Children with neurodevelopmental problems have a high prevalence of sleep problems, between 50-80% compared to 25-30% of neurotypical children .

This poor sleep quality is also linked to a worsening of these children's clinical condition during the day. Dr. Sans explains that families often don't share this sleep problem because it's sometimes accepted as normal, as the family is more concerned with other issues. This is why the problem usually comes to the doctor's attention somewhat late.

"With improved sleep, we will also see an improvement in the main daytime symptoms that children with autism have," notes Dr. Sans.

Emphasis is placed on the importance of systematically assessing sleep problems in children and adolescents with autism spectrum disorder.

According to the data presented in this webinar, it is around 30 months of age that children with autism begin to show signs of sleeping less than neurotypical children and experiencing more frequent nighttime awakenings . In this regard, it is important to pay attention because the shorter their sleep, the greater their communication difficulties will be. The reasons for this are multifactorial: biological, medical (for example, the presence of epileptic seizures, gastroesophageal reflux, apnea, restless leg movements, etc.), and behavioral. The most frequent disorder is insomnia, but sleep apnea-hypopnea syndrome (SAHS), restless legs syndrome (RLS), periodic limb movements during sleep (PLMS), or rhythmic movement disorders (RMD) may also occur.

What are the effects of sleep deprivation on children with autism?

Sleep routines should be viewed as a 24-hour process: sleeping well means having a better day, and vice versa, having a better day leads to better sleep. When children with ASD experience poor sleep quality, key symptoms such as aggression, mood swings, sensory hyperresponsiveness, impaired performance and memory, compulsive behavior and rituals, stereotypies, and especially socialization and communication, increase.

It is also important to understand the impact that the lack of sleep in these children has on their families and caregivers, since they too will sleep poorly and, therefore, it will affect their rest and functionality during the day.

Guidelines for improving sleep quality

Sleep habits and routines are essential:

Maintain regular schedules:

• Time to go to sleep
• Time to wake up
• Feeding times
• If you use electronic devices late in the afternoon, activate sleep mode (white/blue light blockers).

Maintain a nighttime ambient light: orange spectrum

Time to turn off

Once these routines are established, they can be enhanced with additional routines that help prepare the child for sleep before bedtime. This involves doing things outside the child's room that promote relaxation beforehand, lowering cortisol levels and body temperature. This preparatory phase reduces anxiety because the child already knows it's time to get ready for bed.

Most children with autism need to take melatonin , a medication not covered by the public health system, to improve sleep onset and maintenance. In some cases, extended-release melatonin is prescribed. Dr. Sans cautions, however, that medical treatment for a sleep disorder should never be the sole solution; good sleep routines and habits must be established first.