Way back in 2009 came published a study in Sleep Medicine Reviews that addressed experiential evidence of sleep problems for children with ASD. A whopping eighty percent of parents of children with ASD reported at least some distress at bedtime. Among youngsters not diagnosed with ASD, but nine percent of them had recurrent trouble falling asleep and staying so.
The problems followed an unsettling, unsettled pattern.
· Hyperarousal, heightened anxiety at bedtime
· Difficulty with sleep onset, or falling asleep
· Difficulty with sleep maintenance, or staying asleep throughout the night
· Fitful sleep of minimal duration
· Sleep fragmentation, characterized by erratic sleep patterns throughout the night
· Early morning waking
· Excessive daytime sleepiness
Meanwhile, the underlying causes for the above problems with sleep gather – both directly and indirectly — around the child’s diagnosis with ASD. In broad terms, the reasons cluster below.
· Irregular circadian rhythm: this splendid term (minus the “irregular”) refers to the twenty-four-hour biological clock that regulates our human, our daily cycle of time spent sleeping and waking. Based on sunlight, temperature, and other environmental factors, the circadian rhythm dances through the brain in a balanced and happy repetition of just what we need in terms of rest and activity, activity and rest. ASD intrudes on this wake-sleep cycle, inflicting irregularities of every sort. Throughout these pages, you’ll note that the Hughes Brothers discuss, over and over, the role of the hormone melatonin in good sleep, in the patterning of the circadian rhythm. In children with ASD, the production of melatonin is haphazard.
· Mental health disorders: The Hughes Brothers reel at the term “co-morbid,” but co-morbid is the case between ASD and such unhappy mental states as anxiety and depression. Such difficult conditions compound problems with insomnia and other sleep disorders. Further, recent studies suggest that many, if not most, children with ASD also exhibit the symptoms of attention-deficit hyperactive disorder (ADHD. Just leave it to ADHD to bring about elevated moods around bedtime.
· Other medical problems: Damn. Here comes that awful co-morbidity again, this time involving epileptic seizures accompanying ASD. The awful impact on sleep could not be more obvious. Further, gastrointestinal distress assaults children with ASD with relentless fervor – constipation, diarrhea, acid reflux, the whole ugly, painful ballgame.
· Side effects of medication: Doubly unfortunately, the medications prescribed for the symptoms of ASD can redound to significant interference with normal sleep patterns. Selective serotonin reuptake inhibitors (SSRIs), for example, may cause fretful agitation in the evening, harassing every attempt at a peaceful, productive bedtime. Any little child taking antipsychotics may anticpate excessive drowsiness during the day, a lethargy that drifts on down to sleep-onset and sleep-maintenance issues. (The Hughes Brothers will discuss in another article the ways and means of ASD medications. Please stand by.)
Little ones confronting ASD struggle day after day with the pressures confronting every child in a world built around stimuli, everywhere stimuli, electronic and otherwise. For children with ASD, the influx of stimulus leads to all the behaviors, the unavoidable behaviors implicit in the ASD diagnosis. Then, with a rough night just behind them, these poor youngsters must take on the following day with more distress, more anxiety, more frustration than is their usual distraught lot. “Vicious” does not begin to describe the cycle of sleepless night with painful, so very painful day.
And the struggles of the day, difficult for even the healthiest of children, impugn every attempt at education, at social interaction, at enjoyment of any kind.