Saturday, February 23, 2013

Sleep Disorders in the Autistic Spectrum

This is not a picture of my son, but it so captures autism and sleep that I wanted to add it to the post.  You can see how the toys and shoes are carefully lined up on the bed.  I remember the first time my son lined up about 50 cars at a family gathering and had a melt down when my brother in law turned one car to face "the wrong" way. 

My son has also had a history of significant sleep disturbance.  It was only when he was 5 years old that I learned that autism and sleep disturbance are a common combination.  For my son, he was unable to maintain sleep even as an infant, napping perhaps 20 minutes twice a day and then waking perhaps 5 times a night.  We had to drive him in the car to calm him even as a toddler.  He also had night terrors, which are much less frequent now, but are a form of sleep disturbance just as sleep walking might be.  He would wake and scream "in terror" for about 20 minutes, eyes open, but not responsive to anyone's interactions.  Now at nearly 7 years old, he is sleeping through the night most nights.

According to the Vanderbuilt Sleep Center, sleep disturbance is reported in 44-83% of children in the autistic spectrum.  It occurs regardless of IQ of the child.  The most common problems reported are difficulty falling asleep and maintaining sleep.  Sleep studies have documented REM sleep abnormalities, REM sleep without atonia, and undifferentiated sleep in which non-REM and REM sleep were difficult to distinguish. 

According to Vanderbuilt, sleep and autistic symptoms share a related chemistry, although the exact connection between symptoms and sleep is difficult to tease out.  For one, usually about half of individuals in the spectrum report no problems sleeping.  In addition, it is difficult to know if sleep makes the autistic symptoms worse, or if worse autistic symptoms makes it harder to sleep.  Or perhaps the symptoms and sleep disturbance are each impacted by a third issue. 

Recommendations for sleep include sleep hygiene, predictability and routine (can use a visual schedule for sleep), and focus on comfort in the bed.  Some parents may have heard of the gluten-free, casein free (GFCF) diet to help with some autistic symptoms; my son actually experienced significantly improved sleep after starting this diet.  There seems to be great variability in how the diet impacts individuals within the spectrum, and consulting your pediatrician/physician is always recommended before starting something new. 

Sleep is also one of the 4 areas of autism that can be treated with medications (the 4 areas being outbursts/aggression, anxiety, attention, and sleep).  Melatonin is usually the first line of recommendation for sleep aide, although everyone should consult their own pediatrician/physician.  My son started using 3 mg of melatonin when he was 4 years old, and now is using 6 mg at age 6. 

Here is an example of a visual schedule: