What can parents do to promote better sleep in autistic children? Dr. Trock offers expert advice about sleep problems in children with autism spectrum disorders. His perspective gives insight as a neurologist specializing in sleep medicine.
About Dr. Trock
LoveToKnow (LTK): Please tell us a little about yourself.
Doctor Gary Trock (GT): I am a neurologist, with special interest in pediatric neurology, and sleep disorders of all ages. I am the Director of Pediatric Neurology and Co-Director of Sleep Evaluation Services at Beaumont Hospital and I am certified by:
- American Board of Pediatrics
- American Board of Neurology with added competence in Child Neurology
- American Board of Neurology with added certification in Neurophysiology
- American Board of Neurology with added certification in Sleep Medicine
I see a variety of children, adolescents and adults with sleep disorders.
Sleep Problems and Autism
LTK: Do you find that children with autism tend to have more sleep problems than typical children do?
GT: Yes. First is insomnia, difficulty falling asleep or staying asleep and poor quality of sleep. Children with autism often have difficulty initiating or maintaining sleep.
LTK: What can contribute to sleep problems?
GT: Anxiety contributes to insomnia. Children with autism may have anxiety about the room being dark and anxiety about falling asleep. They may feel anxious about the procedure necessary to help improve their sleep.
It helps to recognize that we have an internal clock in the brain, controlled by the suprachiasmatic nucleus. The circadian time clock in normal conditions automatically regulates the sleep-wake cycle.
Children with autism may have a condition known as delayed phase sleep syndrome, in which the clock does not follow a normal schedule. They may stay awake until three or four in the morning and sleep until noon, this is especially true in teenagers.
That's one internal clock disorder. Another one, even more difficult, is circadian rhythm disorder, irregular sleep-wake type, where they don't have a clock function at all. They may sleep two or three hours throughout the day but never develop a normal sleep cycle.
Hyperactive children may have difficulty settling down enough to fall asleep. Anxiety, circadian rhythm disorders and hyperactivity can interfere with sleep.
Promoting Better Sleep in Autistic Children
LTK: Is there a way parents can address anxiety related to sleep?
GT: There's no quick fix. Working with a behavioral specialist is the most effective way to deal with anxiety.
LTK: Do you have any suggestions about daily routines for promoting better sleep in autistic children?
GT: Yes, many autistic children tend to adhere to routines, which is good. Routines for better sleep are beneficial for people with insomnia in general.
- Reserve the bedroom specifically for sleep. Video games, books, television and other activities should take place in other areas of the home.
- If the child is wide awake and active, he shouldn't be put to bed. Wait until the child is tired.
- Have the same wake-up time every morning.
- Avoid stimulating activities like television and video games right before bed.
- Avoid giving the child caffeine, including chocolate, at least eight hours before bedtime. The general recommendation is two or three hours, but caffeine can stay in the system for up to 12 hours.
It also helps to have natural light exposure when they wake up and less light before bedtime. There's a treatment that helps set the circadian rhythm using bright light exposure in the morning and avoiding bright light exposure at night.
LTK: When should parents see a neurologist about sleep problems?
GT: Not all neurologists are sleep specialists. See a specialist when the sleep disorder is persistent, and interferes with the quality of life of the child or the parents. Begin by seeing a primary care physician who can recommend a sleep specialist.
Special thanks to Dr. Gary Trock for taking time to explain the possible sleep problems in autistic children and what parents can do about them.
See Ten Easy Tips for a Better Night's Sleep for other ideas for improving sleep.