Sleep and Autism

Persistent, altered sleep is a common finding among young children who have signs and symptoms consistent with a diagnosis of ASD. This is a key difference from neuro-typical peers.

And, like any person, changes in quantity and quality can result in further downstream behaviors; such as, inattention, poor focus, and easy distractibility. The situation can further deteriorate into tantrums, a ‘short fuse’, aggression and injurious actions (against self and/or others).

Sleepchart

Data from Ruffwarg, et.al. Science 1966

What is disturbed sleep?
Not only do young children sleep much longer, more time is spent dreaming, which is an important physiological necessity and developmental component. Since there is practically no muscle movement during REM periods, toddlers should be sleeping “like a log.” Many affected youngsters do not exhibit such activity.

Latency is prolonged. The time that it takes to fall into a slumber should be <~1/2 hour, even accounting for a great deal of individuality. Nighttime awakening is frequent in infancy, but the child should quickly drop off again. Because this process takes time, naps include less REM sleep.

For ASD affected individuals, problems can persist even into later years.

What causes disturbed sleep?
Sleep apnea is a possibility, especially for some premies, or when allergic asthma or rhinitis are frequent occurrences. More often, signs and symptoms represent GERD (reflux), of varying degrees and varied causes. Really bad heartburn, and no way to tell anyone.

Diarrhea, constipation and bowel inflammation may cause sleep alterations, as well. Since G-I conditions exist so frequently in ASD patients, this is a significant area for positive intervention and change.

Other medical issues include frequent ear infections causing fever and pain, seizures, altered melatonin metabolism, other metabolic disturbances, methyl B12 ‘shots’, and even the stimulant medications that many physicians prescribe.

A ‘workup’ is in order for any child who displays altered sleep, not a pill.

What interventions are useful?
A quiet environment at a regimented time helps everyone achieve faster, more sound sleep.

Sensory therapies can result in significant amelioration of sleep issues. Warm epsom salt baths, reading, and brushing are further examples of effective interventions, in selected patients.

After a suitable evaluation, youngsters who suffer GERD and other G-I discomfort may get a great deal of relief by proper positioning, appropriate feeding (time and volume), and occasional mild antacids. Medications that decrease acid production, such as Prilosec or Zantac, should be avoided, because of alterations in normal gut flora.

If food allergies are identified, avoidance of offending agents can calm the gut and help sleep to take hold. Unusual bacteria or fungal overgrowth should be addressed with strong probiotics, and anti-fungals when indicated.

Melatonin is a popular, safe and useful supplement. After a thorough patient evaluation, a doctor should suggest dosing. Providing this valuable antioxidant at exactly the same time each evening is central to producing predictable results. When the maximum dose is not effective in maintaining sleep, adding the natural amino acid, 5-hydroxy-tryptophan, may help.

With varying doses and results, supplements such as Valerian root, chamomile, passion flower, and kava have been recommended. GABA, an over-the-counter supplement, is a neurotransmitter that can either work quite well to assist sleep, or add to excitation in certain patients.

The most basic allopathic medication is Benadryl, an antihistamine that produces sleepiness. There are blood pressure lowering medications such as Clonidine®, Intuniv® and propranolol. These should be used short-term and the ordering physician should be alert to the cause(s) of the disturbance. Only rarely should strong CNS medications such as Depakote® be utilized. Sleeping pills that were meant for adults are just that – meant for adults.

Conclusions:
Unnatural quality and quantity of nocturnal activity often accompanies an autism diagnosis.

With such a plethora of downstream negative behaviors, interventions that reverse this situation are paramount to producing an effective autism treatment protocol.

Consulting with a knowledgeable, experienced clinician will yield the most valuable results.

Perhaps the most important improvement when affected children start to get an adequate night’s sleep is the positive effect on the whole family’s next day.

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