In this article, we will cover the precise sleep difficulties frequently faced by people with ASD, some appropriate treatment options and longer-term coping advice to remove some of the due stress and make these issues more manageable.
It is estimated that around one percent of the population around the globe has autism spectrum disorder (ASD). As this incidence rate has increased over the last decade and more people are aware of ASD, interest has grown among specialists in further researching this disorder and exploring its links to other conditions, including mental health conditions and sleep-related problems and disorders. According to recent studies, of the people diagnosed with ASD, the majority, from 50% up to 80% of children and adults has some form of a sleep problem. It is due to many different factors either directly escalating from the disorder in point, medication for maintaining it, a combination of different medications or due to another present condition complicating things all the more. The most affected are those who are pinpointed on the low end of the spectrum, with regularly reported issues with either inducing sleep or maintaining it throughout the night. As a result of the inadequate amount of sleep, some depictive behavioral traits of ASD such as aggression, poor concentration, hyperactivity, and nervousness are aggravated and often magnified, leading to additional daytime struggle and decreased performance at school or work.
In this article, we will cover the precise sleep difficulties frequently faced by people with ASD, some appropriate treatment options and longer-term coping advice to remove some of the due stress and make these issues more manageable. But before all that, let’s get a bit more familiar with what ASD actually is.
Autism spectrum disorder is a lifelong condition that interferes with how people perceive life, form relationships and communicate with those around them. Despite many attempts at researching and identifying it, the exact cause of ASD is unknown; it is believed to occur resulting from a combination of complex genetic and environmental factors. People with ASD have specific needs depending on how debilitating their disorder is, and, albeit a cure doesn’t exist, with the appropriate amount of support, they are able to live long and fulfilling lives.
ASD is almost always diagnosed in the patient’s early childhood. Children under four years old already display symptoms that single them out from other children. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), one of the most renowned manuals on mental health disorder diagnosis and treatments worldwide, a patient can be diagnosed with ASD if fulfilling the following criteria:
The spectrum is a tool used to determine how debilitating the disorder is in an individual by evaluating how much support they need to navigate everyday situations. A person with a disorder classified as “high functioning” requires less help and is, with some difficulties, capable of handling day-to-day life, as opposed to a person whose disorder is classified as “low functioning” on the spectrum — this end groups people whose disorders are more extreme and can’t manage without very substantial support.
There are four categories of ASD that most people affected can be grouped in:
People with ASD frequently experience difficulties with sleep. Some of the common ones include:
The root of these problems is always linked or directly induced by the person’s specific disorder, with some common, overlapping causes such as the following:
People who live with ASD already have a harder time navigating their daily life than people who don’t have this disorder. Heightened stress in itself means they often require more sleep to be able to function to their best ability. Lack of sleep can further the struggle they go through, and over time issues with sleep can develop into disorders.
Insomnia, the difficulty falling and staying asleep is the leading sleep disorder reported among people with ASD, with the incidence rate for adults being up to 90%, and 66% in children. Among children, parasomnias (night terrors, nightmares and enuresis) are also very prevalent, with the added diagnostic difficulties of the child’s inability to explain these occurrences and their own distress or fear. Upon waking up from such an episode, many children will get up and play or do something else instead of going back to sleep.
The link between ASD and other sleep disorders is highly debated among mental health and sleep specialists.
Sleep medication is often prescribed to treat sleep onset and maintenance issues. Benzodiazepines, Z-drugs and other pills are all FDA approved for insomnia treatments, but the majority of them have some serious side-effects. The dependence potential, especially for children, is one strong reason for people with ASD to avoid sleeping pills altogether. Even for people without this disorder, sleep medication is not advised unless necessary, and under special circumstances; pregnant women, people with liver problems, high blood pressure and some other medical or neurological conditions, along with people who take other medication would all be ill-advised to take sleeping pills. Some people who have ASD might fall under this category as well, for two reasons:
These points should be carefully considered before opting for sleep pills.
Instead, the treatment will probably first involve cognitive behavioral therapy (CBT). Children with ASD are often very strict about their routines, so a well-planned sleep routine might be useful. This routine might include changing into PJs, brushing teeth, using the bathroom, laying in bed and switching off the lights. While attempting this with a child, it is important for the parent to be very clear with what is going to happen; using visual aids to help explain the process to the child, limiting the number of steps and positively reinforcing the child when a step is followed through can be very useful in establishing the routine.
Additionally, light therapy might help with sleep. Exposing the child to bright light when they wake up can help raise their alertness levels during the day.
If the child doesn’t respond well to the first two methods, pharmacological treatments can be considered. A doctor might prescribe:
Finally, if nothing stated above works, the parents of a child with ASD might consider prescription medication. Because of the smaller relative risks compared to common prescription medication, the only pills indicated for children are the following:
Treatment for adults with ASD, although also starting with CBT, might include some stronger medication as well. It is vital to discuss all options with a specialist before deciding on anything, and unless otherwise advised, don’t take over-the-counter pills.
Treating sleep disorders and issues is important, but staying free of them is impossible if proper sleep hygiene isn’t kept. Below are some ideas on how to make bedtime less of a struggle for people with ASD: