For many people, having quality sleep every night is not assured. Normally, this isn’t a big problem. Sleeplessness is just temporary and will disappear in a couple of hours or days.
However, for people with autism spectrum disorder (ASD), sleeping soundly is elusive. They have persistent trouble falling and staying asleep. As a result, their mental conditions such as repetitive behaviors, bad moods, and oversensitivity to stimuli worsen. The exacerbation of these behaviors makes sleeping even more difficult. Yet, even though sleep problems are among the most urgent concerns for ASD patients, their caretakers, and families, studies about ASD-related sleep problems and treatments such as behavioral therapy remain far and few.
Thankfully, there are ways to make sleeping better for ASD patients. Let us study what we can about ASD and how it is related to sleep.
Autism Spectrum Disorder Defined
First, we should understand what autism spectrum disorder is all about. Autism Spectrum Disorder (ASD) is not just one ailment. In actuality, it is a series of neuro-developmental mental disorders. The word “spectrum” refers to the severity and type of symptoms the patient experiences.
People, usually children, who are afflicted with ASD often find social communication and interaction challenging. Their speech, behavior, interests, and activities may seem restrictive yet repetitive. Some patients may experience mild, hardly noticeable, symptoms while others require specialized support as they go on their daily lives.
Mental ailments under ASD were initially considered separate disorders. However, in May 2013, the Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5) made a revision that ASD now encompasses Asperger syndrome, childhood disintegrative disorder, and autistic disorder. In other words, these disorders were no longer considered a separate criterion but are mainly diagnosed as ASD. DSM-5 recommended a framework that differentiates each individual patient by criteria such as severity, known genetic disorders, hereditary traces, and intellectual disability.
ASD affects around 62.2 million people all over the world or around 1% of the global population. In the US, approximately 1.5 million children, or 2% of the childhood population, are afflicted with ASD. Males seem to be more prone to this type of mental disorder than females.
Signs and Symptoms of Autism Spectrum Disorder
Difficulty in social communication and interaction as well as constrained and recurring behavioral patterns typify the symptoms of someone with Autism Spectrum Disorder. Such symptoms may manifest as early during childhood. As time goes by, the severity may increase, depending on certain factors, and thus impact daily functioning. Symptoms of ASD may include the following:
Lack or absence of sharing interests
People with ASD may not want to interact or play with other individuals of his or her age group.
Incapability of awareness, understanding, or understanding other people’s feelings or thoughts
ASD-afflicted individuals may physically get too close to friends and strangers. They may even be excessively inquisitive without knowing that their actions make others uneasy, uncomfortable, annoyed, or even hostile.
A persistent need for attention
A person with ASD may do things like throwing a tantrum, walking into someone’s field of sight, or doing actions just to gain attention prior to initiating a conversation.
Poor eye contact or none at all.
A patient may not respond with eye contact when someone calls him or her by name. He or she may also avert eye contact. Take note though that the lack of eye contact is not due to anxiety or shyness.
Inappropriate facial expressions
ASD-afflicted people may be unable to recognize or interpret the emotions of other people through their facial expressions. Inversely, they may not respond with the correct special expression given a certain stimulus.
For example, a person with ASD may express a stoic expression rather than laugh when someone says something funny.
Inappropriate facial expressions
ASD-afflicted people may be unable to recognize or interpret the emotions of other people through their facial expressions. Inversely, they may not respond with the correct special expression given a certain stimulus.
For example, a person with ASD may express a stoic expression rather than laugh when someone says something funny.
Odd speech patterns
An ASD patient may talk in a monotone voice devoid of emotion. Often, they may be unaware of the volume of their voice in several social settings. For instance, they may talk loudly in libraries, churches, or movie theaters when they’re supposed to be quiet.
Strange and repetitive behavior
People with ASD may display weird and cyclic behavior such as head banging, swaying their body, finger-snapping, and more. They may even repeat words, phrases, and sounds. Repetitive behavior may occur when a person gets upset, anxious, or stressed.
Unwilling to change
A person with ASD tends to have routines that he or she needs to absolutely follow. This includes a particular pattern when moving around the house, a set path in going to school each day, or a specific order in eating foodstuff. If there’s a disruption in the pattern or if the person is forced to disengage from his or her set pattern, he or she may throw a tantrum or have a complete meltdown.
Extreme sensitivity to stimuli
A lot of people with ASD are incredibly sensitive to various stimuli such as strong smells, bright lights, or physical contact.
Self-injury
An ASD-afflicted person may inflict self-injurious behavior such as slapping oneself, banging his or her head on the wall, or pulling his or her hair. Usually, certain environmental factors and stimuli trigger self-injurious behavior. Recent studies show that modifying or removing these environmental factors can help reduce self-injurious behavior.
Specific and restricted interest
An ASD-afflicted individual may exhibit hyperfocus autism, an excessive interest in a specific item, topic, or activity. In fact, he or she may dedicate all his or her time, effort, and attention to it. For instance, an autistic child may focus on a toy train that goes around the tracks and completely ignores everything or everyone else. Autistic adults may talk about a certain hobby or sport all the time. Or they may attempt to learn everything about a single topic only.
Prodigy-level skills in certain fields
There is a silver lining though. It is estimated that 1 in 10 people with ASD exhibit exemplary skills in mathematics, art, music, and other creative skills.
What Causes Autism Spectrum Disorder
Scientists have been unable to pinpoint the true causes of autism spectrum disorder. However, most researchers deem there are several factors that play key roles in the development of ASD.
Genetics
Individuals with a family history of autism is prone to developing ASD. The risk factor of family history is between 64% to 91%.
Brain defects
Recent imaging scans suggest that brains of individuals with ASD develop differently than normal people. The scans show defects in areas for communication.
Early life
Researchers have also reported that ASD may also be caused by various prenatal and post-natal complications. Women who are over 30, have gestational diabetes, are bleeding after the first trimester, or use prescription medication during pregnancy are prone to have ASD-afflicted children. Note that these factors are not yet conclusive, and further research is needed.
Vitamin D deficiency
Low vitamin D levels compromise the immune system. During early child development, an insufficient level of vitamin D is theorized as a risk factor for ASD.
MRR Vaccine (disproven)
In 1998, an ex-British physician named Andrew Wakefield suggested that taking the tri-vaccine for measles, mumps, and rubella (MMR) is risky as it causes autism. The study was later confirmed to be fraudulent, and researchers found no scientific evidence to support Wakefield’s claim. Then in 2014, 10 major studies regarding the link between vaccines and autism were done on 1.25 million children all over the globe. The conclusion was that no vaccine of any kind can lead to the development of ASD.
Treatment
Fortunately, there are several treatments to ease the symptoms of ASD. These include behavioral therapy, reinforcement of coping skills, and holistic methodologies. There are also certain medications to help alleviate the symptoms, but these should be taken under the advice of a professional.
The Link Between Autism Spectrum Disorder and Sleep
According to a 2009 study that was published by Sleep Medicine Review, parents complained that their children who have ASD suffered from autistic sleep disorders. These children experience these issues:
- difficulty in feeling sleepy
- waking up several times in the middle of the night
- waking up early in the morning even if the child slept late at night
- not completing the recommended 8 to 10-hour sleep duration
- increased anxiety or excitement during bedtime
- sleeping excessively during the day
In another research by UK-advocacy group Research Autism, researchers explain that autism sleep disorders have common causes that are directly or indirectly related to ASD. They include:
Existing mental health problems
Existing medical problems such as depression and anxiety can lead to insomnia among ASD patients. In addition, children with ASD also show indications of attention-deficit hyperactive disorder (ADHD). ADHD can result in hyperactivity during bedtime.
Medical problems
Researchers noted that epilepsy and autism can simultaneously be present in an ASD patient. Bouts of epileptic seizures can impact the quality of sleep. ASD-afflicted people also experience regular bouts of acid reflux, diarrhea, and constipation.
Sleep Aids and Techniques for ASD Patients
For a patient with ASD, failed attempts to sleep soundly can be extremely frustrating. If you’re taking care of someone with ASD, these tips can help you improve their quality of sleep.
- Don’t give them stimulants a few hours before going to bed. Stimulants such as caffeine, chocolate, alcohol, and sugar can impair sleep.
- Video games, televisions, smart-phones, and other gadgets or activities that stimulate mental activity must be turned off an hour prior to bedtime.
- Make it clear to everyone that bedrooms are only for sleeping and sex. Eating, playing, watching TV, and other non-bedroom activities must be relegated elsewhere.
- Create and follow a nighttime routine. For example, if the ASD patient is a child, give him a refreshing bath prior to bedtime. Then during bedtime, read him a nice story. It is important to put the patient on the bed at the same time every night to allow the circadian rhythm to establish a regular pattern.
- Make sure the environment is conducive to sleep. The mattress must be comfortable. Children and young adult comforters must be clean and sweet-smelling. Use soft and fluffy pillows. Adjust the temperature in the bedroom so it will be cool and relaxing. Take away items that cause distractions such as dolls (they look creepy in the dark), toys, and gadgets.
- ASD patients are overly sensitive to stimuli. Thus, it is important to considerably reduce sensory distractions in the bedroom. For example, apply oil on door hinges or replace them with new ones so the door doesn’t creak. Use heavy, dark-colored curtains to block out strong light. Install a thick carpet or rug to muffle out sounds.
- The patient can nap during the day, but it should not be over 30 minutes. No naps should be allowed 3 hours before bedtime.
- Certain foodstuffs are not only healthy, but they also help induce good-quality sleep. Include leafy greens, nuts, beans, and bananas in the patient’s diet. Aside from being rich in calcium and magnesium, these natural foods help the body relax. Fruits like grapes, pineapples, and sour cherries are all rich, natural sources of melatonin, a substance that regulates the circadian rhythm and stabilizes sleep patterns.
- Let the person with ASD exercise during the day. Physical exertion drains energy, helping him or her to get in a sleepy mood at night. However, don’t let him or her exercise a few hours before sleeping as physical activities too close to bedtime actually hinder sleep.
- Relaxation techniques are quite effective for people with ASD. Listening to soft music, meditation, reading, or just turning off the lights and lying in bed can help encourage sleep.
- If sleep disorders persist, consult a doctor for safe treatments. Standard treatment is melatonin, often used as a sleep aid for travelers to beat jet lag. Melatonin helps normalize sleep-wake cycles, and it has been proven to be safe and effective.
Frequently Asked Questions
There are several ways medical professionals assess sleep problems in autistic people. The most common one is polysomnography. Using sensors and computers, researchers can monitor a sleeping person’s eye movement, limb movement, breathing patterns, and brain waves. Another method, actigraphy, involves strapping a device on the patient. The device tracks and records data, specifically sleep duration, about the patient.
The typical effects of lack of sleep are bad enough. But it is worse for a person with ASD. That’s because inadequate sleep can aggravate the usual symptoms of ASD. In addition, people with ASD have the tendency to score lower in IQ tests, indicating that the lack of sleep affects mental function and capacity.
Conclusive studies are yet to be done on this topic. However, there are several types of research about ASD patients who underwent surgery to ease their breathing troubles when they snooze off. The studies indicate that these patients show improved communication with others. The patients also exhibited fewer repetitive behaviors. ASD-afflicted children who have regular sleeping schedules tend to be less irritable, learn better, and have fewer behavioral problems.
Conclusion
ASD can be an impediment to living normal lives. Mental disorders, in general, produce increased stress levels in the patient and his or her family.
However, there are existing ways to alleviate these problems and inconveniences. Having a good, relaxing, and restful sleep is a big step towards that relief. Biologically, when the body sleeps, it shuts down other systems so it can devote its energies to healing and refreshing itself.
For a person with ASD, having quality sleep is important as it helps regulate and stabilize their mental condition. Their hyperactivity, repetitive behaviors, excessive sensitivity, mood, and other symptoms are reduced, helping them live more normal lives. For his or her family, the stress of guardianship over the patient has reduced as the latter lives a life of normality.
