Autism
No two people with autism are alike. It’s often said that “If you’ve met one individual with autism, you’ve met one individual with autism.” The breadth of strengths, challenges, unique interests, and behaviors is broad. Yet what unites many children and adults with autism is an underlying difficulty with sleep.
Individuals on the spectrum have difficulty falling asleep and staying asleep. Their sleep may be non-restorative as they spend less time in REM sleep than their neurotypical counterparts. Some kids with autism have sleep apnea, which causes them to stop breathing several times during the night. These sleep issues worsen behavioral challenges, hinder learning, impair social skills, and distress the child and caregivers.
Repetitive behaviors, anxiety, and sensory sensitivities to light, sound, and touch lead to inattention, restlessness, and irritability, worsening sleep problems. Co-existing conditions such as ADHD and anxiety and the medications used to treat them, such as stimulants for ADHD, can cause insomnia. Sleep problems may also indicate an underlying depression.
Optimizing sleep in children with autism engenders learning, calmness, and social interaction.
What we offer at Sleep and Brain
At Sleep and Brain, we conduct a detailed clinical history and specialized physical examination to evaluate if a sleep disorder is impacting you or your child’s behavior.. We prudently assess for sleep disorders as exampled below:
Sleep-Disordered Breathing
The repetitive breathing interruptions cause arousals that heighten the sympathetic nervous system (i.e., fight-or-flight system) and dampen the parasympathetic nervous system (i.e., rest and digest system). Social communication, attention, and repetitive behaviors may improve following treatment for sleep-disordered breathing.
Restless Legs Syndrome
Restless, tingly legs with an urgency to move can underlie insomnia and lead to bedtime resistance.
Periodic Limb Movement Disorder
You or your child may unknowingly kick your legs intermittently during sleep. The limb movement can cause arousals and sleep fragmentation.
Insomnia
Insomnia, defined as difficulty falling asleep, staying asleep, awakening too early, or non-restorative sleep, is commonly linked to autism.
Detecting and treating sleep-disordered breathing is vital. We may recommend sensitive home sleep testing with peripheral arterial tonometry to quantify your sleep patterns and evaluate sleep-disordered breathing and sympathetic arousal frequency.
Laboratory sleep testing performed in your home may be necessary to evaluate for sleep disorders. Many individuals with autism require specific routines at bedtime and cannot perform a sleep test at the laboratory. We permit you or your child to sleep in natural comfort by bringing the polysomography equipment to the home.
Brain scans show different brain shape and structure, impaired connectivity, and altered activity in autism. We offer sophisticated testing to elucidate areas of brain imbalance. A brain map can additionally assess which networks between brain areas are improperly functioning. Together, the data allows us to determine if the brain imbalances support a diagnosis of autism versus something else.
Understanding the cause of you or your child's sleep problems is essential to customize a treatment regime for both the sleep disorder and autism. Treating sleep problems may improve autism because, as mentioned, disordered sleep symptoms can exacerbate autism symptoms. We direct treatment toward the sleep disorder as exampled below:
Removing the tonsils, expanding the palate, and starting CPAP can help autism and disordered sleep symptoms.
Iron and dopamine deficiencies can cause RLS and PLMD. We treat RLS with iron supplements, medication, and non-medication therapies.
Identifying and eliminating the cause of awakenings from sleep
Utilizing light therapy to advance or delay your sleep cycle
In addition to treating an underlying sleep disorder, we institute robust sleep hygiene interventions, as partly described below, to make going to bed a pleasant experience and reduce anxiety:
Ensuring your bedroom environment is conducive to sleep
Eliminating sources of sleep interruption like light and noise
Optimizing your diet as food can promote and hinder sleep
Assessing your nighttime habits and rituals
Our scientifically-based cognitive-behavioral therapy for insomnia therapy is a rigorous, 4-week program is vital to treat insomnia linked to autism.
A state of hyperarousal, frequently marked by worry, is a critical factor of insomnia. CBT-I reduces negative thoughts about going to bed, a type of anticipatory anxiety that challenges healthy sleep schedules. Even after falling asleep, you may awaken with anxiety in the middle of the night. CBT-I reorients negative thinking and helps you return to sleep when your mind races with worry. We also utilize relaxation techniques as part of our CBT-I to reduce anxiety and make it easier to fall asleep quickly and peacefully. Guided imagery, deep breathing, and mindfulness meditation are just a few approaches to putting your mind at ease and improving your sleep.
Brain TMS has advanced into treating autism and multiple disorders associated with autism, such as restless leg syndrome, anxiety, and insomnia. We personalize a TMS protocol based on your unique brain map.
Several medication classes treat autism and co-existing conditions, including anti-anxiety drugs, antidepressants, and stimulants. However, these medications mitigate symptoms rather than cure the underlying cause. Melatonin may be considered in some children with autism as endogenous melatonin may compromised. We judiciously use medications to treat an identified underlying cause.
