sLEEP dISORDERS (developed by Veronique Bure)

Sleep disorder in children with autism

Suggestions for sleep improvements

There is accumulating evidence that  persons with autism experience far more sleep disturbances than the general population. In order to establish that sleep disorders belong to the Autism Spectrum Disorder a study was conducted by  a team of Canadian researchers [1]. Subjective and objective data collected from that study confirmed the link between Autism Spectrum Disorder and sleep disturbances.

 It seems that persons with autism present a longer sleep latency, more frequent nocturnal awakenings and a lower sleep efficiency.  Poor sleep efficiency is related to:

·         An increase of the length of the sleep latency

·          A   decreased  length of REM sleep ( sleep with Rapid Eye Movements) as well as a lower number of eye movements during that sleep. Long term memory consolidation takes place during  REM sleep.  According to Dr Dinges [2] : “Without adequate REM sleep  some memories from the preceding day do not get consolidated”

·         A  decrease in Non REM sleep.  Non  REM sleep functions are poorly understood. It seems more likely that this phase of sleep has an important role in recovery. It is not fully known what is recovered.  Glycogen  seems to be restored during the Non REM sleep. There could be important  correlations between the function of recovery and those of emotional processing.  Many observations suggest that sleep and emotional balance are linked. ( sleep deprivation can trigger mania in certain person and relieve depression in others) Some molecules such as some hormones  turn  on during sleep, therefore sleep disturbances can alter many  physiological systems  i.e., the  immune system.

Epilepsy is more prevalent in persons with autism than in the general population. Epilepsy and sleep have reciprocal relationships : seizures are facilitated during sleep and sleep patterns are affected by seizures.  There is strong evidence that improving sleep disorder will have a   favorable effect on seizure control and on day time behaviors.

Those evidences have to be further investigated in a  children population.  Sleep problems appear to be very acute in childhood especially in between the age of 2 to 5 years old. Age at which temporary sleep difficulties are “expected”as part of a normal child development.

Severe sleep disturbances  experimented by a  child  impact drastically his/her parents ‘general health and stress level. The child’s sleep  disorder can rapidly turn to be a family sleep problem. Many parents of children with autism are severely sleep deprived, which can cause depression, eating disorder, poor and non productive  communication with spouses, (  blaming each other….).

For practical advice on sleeping improvement click here.

According to the Higasho Research Institute in Japan,  sleep disturbances improve drastically after the age of 5. (see abstract below from Musashino Higashi Education Research Institute, Japan).
    
"...Eighty-eight children with autism, 44 of whom were reported to experience sleep disorder before 3 years old,  were examined by questionnaire from 21 July to 31 August 2004. Experienced sleep disorders were observed in 56 children.  The average age when sleep disorders were seen to have stopped was 5 years old." 

Medical approach

 
When sleep disorder is linked to a disorder of the REM sleep it is treatable (See below abstract of Thirumalai SS, Shubin RA, Robinson R, Department of Neurology, Children's Hospital, Los Angeles, CA 90027, USA. sthirumalai@chla.usc.edu ). 

"...We performed nocturnal polysomnography on 11 children with autism who had symptoms of disrupted sleep and nocturnal awakenings. We identified rapid eye movement (REM) sleep behavior disorder in 5 of these 11 patients…….. Further, accurate diagnosis of REM sleep behavior disorder would enable specific treatment with clonazepam and help the family and the child consolidate sleep and improve daytime performance...."

Adverse side effects of drugs belonging to the  class of medications such as

Clonazepam should be weight carefully against the benefits of healthier sleep patterns., especially when administered to very young children.

Use of melatonin

Melatonin is secreted by the pineal gland in the brain in response to the light /dark cycle. (circadian cycle).  Melatonin regulates, among other functions,  the circadian cycle of sleep, hormones activities, and body temperature.  In the general population melatonin level rises at night and drops during early morning hours and throughout the day.  Both low and high level of melatonin have been associated with autism.

Nightly supplement of melatonin have improved sleep patterns in more than 50% of  the patients according to a Japanese study.  It is possible to assess the circadian secretion of melatonin using a comprehensive melatonin profile  with  analyses of samples of saliva three times over 24 hours.