Sleep Issues
What are Sleep Issues?
Approximately two-thirds of children with ASD have chronic insomnia, which is 2-3x greater than children without ASD. Children with ASD and with sleep disturbances had lower performance in daily living skills, social cognition, social communication and intellectual development than ASD children without sleep disturbances.
Sleep is an essential function for humans in order to allow the body and brain time to heal and repair, increase our immune system, and prevent many chronic diseases.
Sleep problems in individuals with ASD have also been associated with poor social interaction, increased stereotypy, problems in communication, and worsening daytime behavior, as well as increasing parental stress levels [2-5]
Both gastrointestinal issues and sleep issues are common in ASD, and there is likely a connection. [10]
It was discovered that the circadian rhythm plays a very important role in sleep!
The circadian rhythm is a natural, internal process that regulates the sleep-wake cycle and repeats roughly every 24 hours.
Nutrition + meal timing can also play into the regulation of the cycle and hormone regulation
Thought to be the cause of jetlag
Having a good morning and nighttime routine is a great way to regulate the circadian rhythm!
Abnormalities in the circadian rhythm are hypothesized to play a role in sleep issues with children with ASD [1]
Signs/Symptoms of Sleep Issues
Restless sleep
Tired during the day
Fatigued
Irritable
Poor focus
Mood changes
Worsening daytime behavior
Chronic sleep loss over time can cause other health issues. If your child exhibits the following symptoms, it may be worth considering if sleep is a contributing factor:
Weak immune system
Difficulty learning or focuses
Increased body weight
Increase risk for cardiovascular disease
Hormone dysregulation
Daily Sleep Needs:
1-2 years: 11-14 hours, including naps
3-5 years: 10-13 hours, including naps
6-12 years: 9-12 hours
13-18 years: 8-10 hours
18-60 years: 7 or more hours
Underlying Causes for Sleep Issues
Sleep issues can be caused by many other underlying nutritional issues such as: [1]
GI Pain
Respiratory disorders
Sleep-disordered breathing
Allergies & asthma
Neurological disorders
Epilepsy/seizures
Restless leg syndrome/abnormal movements
Skin and integumentary disorders
Sensitivity to textures/light/sound
Dental issues
Eczema/itching
Nutrition
Hunger
Nutrient deficiency
”Growing Pains”
Certain Medications
Talk with your doctor
Next Steps
Nutritional Considerations for Sleep Issues
Address any underlying gastrointestinal issues
Consider all underlying factors (see above section)
Dietary changes:
No caffeine intake after noon, or eliminate altogether
Evaluate how much sugar your child has before bed or at dinner each night
Aim for 3 consistent mealtimes each day
Avoid heavy meals or large snacks late at night
A light snack may help some children fall asleep more easily at night
Trial certain supplements
Certain supplements can help children wind down and/or promote neurotransmitter balance, such as:
Consider taking B vitamins in the morning to prevent any sleep disturbances
Be sure to supplement with iron, as iron deficiency is a common cause sleep issues If you ever believe a supplement is causing sleep issues, discontinue and add it back
Lifestyle Considerations for Sleep Issues
Possibly the most important factor is creating a consistent bedtime routine that you can stick to
First, choose a bedtime and a wake time and keep it as consistent as possible all days of the week
Even weekends!
Next, determine which events are calming and which are stimulating. Calming events should be used during bedtime, and stimulating events should be moved to an earlier time in the evening
For example, bathtime may be calming or stimulating. Depending on which it is for your child, timing it in the evening can be helpful for sleep
Create a bedtime routine that is done in the same order each night
Consider a visual schedule or “to-do list” to help remind them of each step
Bedtime routine ideas
Dim the lights and turn off all screens at least an hour before bed
Keep the bedroom quiet, dark, and cool.
Take a nightly Epsom salt bath
Trial essential oils (lavender, roman chamomile, valerian, and ylang ylang are all calming)
Give your child a sensory massage
Try a weighted blanket (should not be heavier than 10% of the child’s body weight + 1 lb)
For children that take naps, wake your child by 4pm from afternoon naps
Consider alternative therapies
Trial meditation (yes, kids can do this too!)
Cognitive behavioral therapy
This may help a child talk through patterns that are contributing to limited sleep
Yoga is a non-invasive and alternative therapy that brings change in both physiological and psychological level of an individual. [11]
Other ecological interventions:
Remove toys and TV from room
Cool, dark environment
Transition to own bedroom
Nightlight
Having a pillow wrapped with a familiar scent (such as mother's PJs) has helped some children
Source: Strategies to Improve Sleep in Children with Autism Spectrum Disorders: A Parent's Guide. Autism Speaks Autism Treatment Network.
The Bottom Line
Start with tips that work well with your family’s lifestyle
Try one small change, and then slowly incorporate other changes
Be patient. It can take upwards of 2 weeks of persistence to see a change.
Stay consistent!
Every child is different. Finding what works for yours is key!
DISCLAIMER: Before starting any supplement or medication, always consult with your healthcare provider to ensure it is a good fit for your child. Dosage can vary based on age, weight, gender, and current diet.
Sleep Issues & Autism in the Research
Prevalence of Sleep Issues in ASD
Approximately two-thirds of children with ASD have chronic insomnia, which is two to three times greater than children without ASD [1]
Children with ASD are extremely vulnerable to sleep problems due to underlying biological and behavioral rhythms that predispose them to extrinsic and intrinsic stressors affecting sleep. [1]
Sleep problems are common in autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) [2]
Symptoms Associated with Sleep Issues
Sleep problems in individuals with ASD have also been associated with poor social interaction, increased stereotypy, problems in communication, and worsening daytime behavior, as well as increasing parental stress levels [2-5]
Sleep disturbances were associated with extra nutrient supply during lactation and feeding, and child's picky eating. Autistic children with GI or/and sleep problems may represent clinically relevant subtypes of ASD, for which targeted treatments may be needed. [4]
Current evidence supports the existence of associations between ASD to circadian dysregulation, behavior problems, increased inflammatory levels of cytokines, sleep disorders, as well as reduced circadian neuroendocrine responses. Indeed, major effects may be related to a low melatonin rhythm. We propose that maintaining the proper rhythm of the circadian timing system may be helpful to improve the health and to cope with several behavioral changes observed in ASD subjects.” [6]
Sensory Processing Issues + Sleep
Touch hypersensitivity exhibits the strongest relationship with sleep disturbances in children with ASD, and in one study single-handedly explained 24% of the variance in total sleep disturbance scores. [7]
Atypical sensory behaviors are important to consider in relation to sleep deficits in children. [8]
Children with ASD who have anxiety and sensory over-responsivity may be particularly predisposed to sleep problems. These findings suggest that some children with ASD and sleep disturbance may have difficulties with hyperarousal. [9]
Gastrointestinal Issues and Sleep
Children with ASD and GI symptoms have been found to have a higher prevalence of sleep disturbances compared with typically developing peers who do not have GI symptoms. [10]
Circadian Rhythm and Melatonin Abnormalities
One hypothesis for sleep issues in ASD are circadian-relevant gene anomalies resulting in biological and behavioral rhythm disturbances [1]
A delayed melatonin rhythm and low melatonin amplitude has been hypothesized to be associated with a hard time falling asleep and night waking in children with ASD [1]
Multiple investigators have identified lower levels of melatonin or a major metabolite of melatonin in either the urine, serum, or plasma of individuals with ASD [1]
Keep in mind some children with ASD do not respond to melatonin and some families find that melatonin loses its effectiveness over time.
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[1] Souders MC, Zavodny S, Eriksen W, et al. Sleep in Children with Autism Spectrum Disorder. Curr Psychiatry Rep. 2017;19(6):34.
[2] Singh K, Zimmerman AW. Sleep in Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder. Semin Pediatr Neurol. 2015;22(2):113-25.
[3] Relia S, Ekambaram V. Pharmacological Approach to Sleep Disturbances in Autism Spectrum Disorders with Psychiatric Comorbidities: A Literature Review. Med Sci (Basel). 2018;6(4)
[4] Yang XL, Liang S, Zou MY, et al. Are gastrointestinal and sleep problems associated with behavioral symptoms of autism spectrum disorder?. Psychiatry Res. 2018;259:229-235. doi:10.1016/j.psychres.2017.10.040
[5] Devnani PA, Hegde AU. Autism and sleep disorders. J Pediatr Neurosci. 2015 Oct-Dec;10(4):304-7. doi: 10.4103/1817-1745.174438. PMID: 26962332; PMCID: PMC4770638.
[6] Pinato L, Galina spilla CS, Markus RP, Da silveira cruz-machado S. Dysregulation of Circadian Rhythms in Autism Spectrum Disorders. Curr Pharm Des. 2019;25(41):4379-4393.
[7] Tzischinsky O, Meiri G, Manelis L, et al. Sleep disturbances are associated with specific sensory sensitivities in children with autism. Mol Autism. 2018;9:22.
[8] Reynolds S, Lane SJ, Thacker L. Sensory Processing, Physiological Stress, and Sleep Behaviors in Children with and without Autism Spectrum Disorders. OTJR: Occupation, Participation and Health. 2012;32(1):246-257. doi:10.3928/15394492-20110513-02
[9] Mazurek MO, Petroski GF. Sleep problems in children with autism spectrum disorder: examining the contributions of sensory over-responsivity and anxiety. Sleep Med. 2015 Feb;16(2):270-9. doi: 10.1016/j.sleep.2014.11.006. Epub 2014 Nov 28. PMID: 25600781.
[10] Klukowski M, Wasilewska J, Lebensztejn D. Sleep and gastrointestinal disturbances in autism spectrum disorder in children. Dev Period Med. 2015 Apr-Jun;19(2):157-61. PMID: 26384115.
[11] Narasingharao K, Pradhan B, Navaneetham J. Sleep Disorder, Gastrointestinal Problems and Behaviour Problems Seen in Autism Spectrum Disorder Children and Yoga as Therapy: A Descriptive Review. J Clin Diagn Res. 2016 Nov;10(11):VE01-VE03. doi: 10.7860/JCDR/2016/24175.8922. Epub 2016 Nov 1. PMID: 28050484; PMCID: PMC5198437.
[12] Strategies to Improve Sleep in Children with Autism Spectrum Disorders: A Parent's Guide. Autism Speaks Autism Treatment Network. Downloaded 18 May 2020.
