The Quest For Rest: Autism and Sleep
18th April 2019
Many people with Autism Spectrum Conditions (ASCs) are likely to suffer from sleep disturbances at some point in their lives. In fact, recent research suggests that up to 80% of young people with ASCs experience difficulties falling asleep or staying asleep, compared to 9%-50% of children without ASCs. Insomnia, defined as difficulty falling or remaining asleep on a semi-nightly basis for more than one month, is the most commonly reported sleep disorder among those with ASCs, with one study finding that 75% of sampled adults with (then diagnosed) Asperger’s syndrome suffered insomnia symptoms. However, elevated levels of night terrors, bedwetting and parasomnias have also been identified in people with ASCs.
A lack of sleep can cause a number of problems for most people. However, for autistic people extreme tiredness can be especially challenging, as it can aggravate some of the difficulties that they may already face. Increased hyperactivity or concentration difficulties can make it really difficult for some people with ASCs who have problems sleeping to perform at their best at work, in class or in exams. On top of this, autistic people may suffer significantly more stress and anxiety in their day to day life than neurotypical people, both of which can be greatly exacerbated by a lack of sleep.
It is not clear what the exact reason is for the link between ASCs and sleeping problems. However, a recent study has highlighted several underlying factors that could be related to difficulties sleeping for autistic people.
A circadian rhythm is the biological clock that regulates our sleep-wake cycle. Studies have identified an irregular circadian rhythm in many autistic people, and some studies have found that many autistic children produce irregular levels of melatonin, a hormone that helps to regulate this circadian rhythm. This could help to explain the common difficulty that some people with ASCs have with falling asleep and maintaining their sleep.
Additionally, it is very common for people with ASCs to also have comorbid mental health disorders such as anxiety. These conditions are often linked to troubles with sleeping, with studies showing that more than 50% of adults with anxiety disorders experience problems with sleeping. Furthermore, the use of medication in autistic people to address these potential co-morbid disorders or ASC symptoms themselves may interfere with sleep. For example, serotonin reuptake inhibitors (SSRIs) commonly used to address depression, also have been found to cause hyperactivity prior to bedtime in some individuals.
So, what can be done about this? There are a number of treatment options available for autistic people who are experiencing troubles sleeping. In the presence of a sleep disorder, cognitive behavioural therapy has been found to be very effective, especially for young people with ASCs. This aims to improve ‘sleep hygiene’ by educating people about ways to improve their nightly habits and inform them of the science of sleep. A study found that for many autistic people a consistent bedtime schedule can be beneficial in helping them sleep, so CBT aims to develop this routine for individuals to implement in their daily lives.
Pharmacological interventions, such as benzodiazepines or sleeping tablets, have also proven to be somewhat effective for adults with ASCs. However, medication alone is not usually encouraged; generally it is suggested that medication is used in concordance with CBT options in order to best target sleep disorders in autistic adults.
For some great tips for autistic people on getting into a healthy sleep routine, please have a look at this webpage: https://www.tuck.com/autism-spectrum-disorder-and-sleep/.
References:
https://www.autism.org.uk/about/health/sleep.aspx
https://www.tuck.com/autism-spectrum-disorder-and-sleep/
https://www.health.harvard.edu/newsletter_article/sleep-and-mental-health