The Big Three.

Discussions regarding sleeping, eating and toileting are among the most common in the autism spectrum treatment community. It is no surprise as to why this occurs, as these three functions are imperative to survival and impact our daily lives in countless ways; for example, hunger, fatigue, and physical discomfort are unpleasant, hinder our ability to positively interact with the world, decrease our tolerance for stress, and when chronically present, can negatively impact overall quality-of-life.

If you are a parent of a child with an autism spectrum disorder, you have likely faced challenges in at least one of these three areas. Over the next three weeks, we will provide information regarding methods for tackling these highly-important, and at times exceedingly difficult, tasks. Today we will start with sleep.

Much Ado About Sleep.

Children’s brains depend on sleep (particularly deep sleep) to support proper and swift brain development. Persons diagnosed with autism spectrum disorders (ASD) often experience sleep difficulties, such as difficulty falling asleep, waking often during the night, waking early in the morning, irregular sleep patterns, and/or appearing to need less sleep overall. Either in isolation or in combination, these difficulties can lead to sleep deprivation which manifests as daytime fatigue, irritability (which leads to increased number of outbursts, aggression), hyperactivity, depressed mood, and/or diminished cognitive functioning (e.g., poor memory, slower processing speed, reduced capacity for learning).

Researchers have yet to pin-point the cause of sleep issues in children with ASD. However, common causes of sleep difficulties include medical conditions (such as sleep apnea, seizure activity, allergies, or gut disturbances), psychiatric conditions (such as anxiety or depression), or medication side effects.

If your child experiences persistent sleep disturbances, such as periods of abnormal breathing, excessive snoring, complaints of daytime fatigue on most days (despite obtaining an adequate amount of sleep), an excessive number of night awakenings, significantly diminished need for sleep, and/or significantly delayed sleep onset on most nights, or if you note symptoms of sleep disturbance (such as irritability, hyperactivity, outbursts, depressed mood, or diminished cognitive functioning) it will be important to first consult with your pediatrician. Your medical provider can assess for medical conditions, order tests for food/environmental allergies, gut issues, and/or seizure activity, assess whether medication side effects may be at play, and/or refer you to a specialist who can evaluate further.

Whether or not medical etiology of sleep disturbance is present, it is important for children (and adults for the matter) to engage in behaviors that promote healthy sleep patterns. For example, balanced diet, regular exercise, fresh air, reduction in sugar/caffeine, and reduction in overall screen time (e.g., television, video games, computer) work to support sleep fitness. Additionally, anxiety-reduction techniques (used throughout the day and upon getting into bed at night), such as deep breathing, progressive muscle relaxation, and visualization can work to decrease overall level of anxiety and promote sleep onset. Additionally, environmental modifications, such as dark curtains, reduced stimulation in the home environment (turning off T.V., radio, lowering voice level), proper room temperature, soothing textures (for bedding and pajamas), and/or ear plugs, headphones, or white noise (such as a fan or noise machine) can be helpful.

In addition to engaging in sleep hygiene behaviors during the day, it is important for children to engage in consistent sleep routines in the evening. A consistent bedtime is the foundation for such a program. (Note: Weekend bedtimes should be no more than 30-60 minutes later than they would be on the weekdays.) Sleep preparation tasks (e.g., bath, pajamas, brushing teeth,) should begin at the same time and in the same order each night. It can also be helpful to implement “wind down” time in the child’s bedroom (e.g., 20 minutes before “lights out”), wherein the child can engage in activities that are calming for them (e.g., reading a story, listening to music, saying prayers). (Note: Screen time is not considered a “wind down” activity, and should be avoided in the 60-90 minutes before bedtime.)

In sum, sleep issues are common for children with ASD and can cause sleep deprivation and any number of related symptoms (such as irritability, hyperactivity, mood disturbances, and sub-optimal cognitive functioning). If you notice symptoms of sleep deprivation in your child, it is important to have your pediatrician assess for medical etiology or refer you to someone who can evaluate further. Whether medical etiology exists or not, it is important to encourage pro-sleep behaviors, such as exercise, proper diet, reduced sugar/caffeine, and limited screen time. Parents are also encouraged to make environmental modifications (such as white noise, dark curtains) and to engage children in a consistent sleep schedule Monday through Sunday. Happy sleeping!