Americans are tired, with nearly 40 million suffering from a chronic sleep disorder and 20 million to
30 million struggling with intermittent sleep-related problems. Yet, for children with autism, sleep issues are even more commonplace, with estimates suggesting between 40 percent and 80 percent of kids with autism have difficulty falling or staying asleep.
Everyone gets unfocused, snappish or snarly after a bad night of sleep, but for families touched by autism-related sleep issues, the next-day emotional fallout from poor slumber can be especially disruptive.
Dr. Beth Malow, in a 2008 study published in the Journal of Child Neurology, found the most common sleep concerns among parents who had children with autism were:
And, in her 2007 presentation, "Promoting Sleep in Children with Autism Spectrum Disorders," Dr. Malow outlined other sleep issues children with autism may experience such as: sleep disordered breathing, bruxism (grinding teeth), arousals from sleep with confusion or wandering, rhythmic movement disorder, leg movements and daytime sleepiness.
Sleep issues can become an around-the-clock challenge, disrupting the entire family's schedule at night and exacerbating existing behavioral issues in the child the next day. "Sometimes, children may take one to two hours to fall asleep, and often, they disrupt the household during this time," says Beth L. Goodlin-Jones of the M.I.N.D. Institute at the University of California Davis Health System in Sacramento.
Scientists aren't sure why children with autism tend to have sleep problems, although it could be partially due to poor awareness of social cues (e.g. noticing sibling getting ready for bed), sensitivity to sensory and external stimuli that keeps the child awake or anxiety -- a common issue in children with autism.
Another theory is a connection between the biochemistry of sleep and the brain imbalances associated with autism. People with autism, reports Dr. Malow, tend to have abnormalities with the neurotransmitters serotonin, GABA and the hormone melatonin, three chemicals involved in the sleep-wake cycle.
Melatonin, produced by the pineal gland in the brain, is a critical hormone involved in regulating sleep. Researchers Nir, 1995, Kulman, 2000 and Tordjman 2005 found that people with autism are often low in melatonin secretion and excretion that can lead to problems falling and staying asleep.
In a study reported in the Journal of Child Neurology, Dr. Malow and her colleagues reviewed the medical records of 107 children ages 2 to 18, with autism, with subjects trying varying doses of melatonin to treat insomnia. A quarter of the parents reported their children no longer had sleep concerns, 60 percent reported their child's sleep problems improved, 13 percent of the children still had major concerns and only 1 percent (one child) experienced worse symptoms.
Researchers in the April 2009 issue of the Journal of Clinical Sleep Medicine reported that melatonin decreased the length of time it took for children with autistic spectrum disorder (ASD), Fragile X Syndrome (FXS) or both to fall asleep at the beginning of the night.
On average, the children showed significant improvement in total night sleep duration, sleep latency (time period measured from "lights out," or bedtime, to the beginning of sleep) and sleep-onset (transition from wake to sleep). Average sleep duration was 21 minutes longer, sleep-onset latency was 28 minutes shorter and sleep-onset was 42 minutes earlier.
"Rather than treating them [the kids] with some other drug that would promote sleep, [we could] give them what they're missing," said Dr. Malow. She noted that melatonin is very appealing to parents because "it's something natural that's already in your child's body."
In her 2008 press release for Vanderbilt Medical Center, Malow stated, “Although prospective trials will be needed to determine if melatonin is an effective sleep aid in this population, this study does support that it may be a reasonable treatment option in these children when administered under the care of a physician and combined with behavioral therapies for sleep.”
Would you be more comfortable with the hormone melatonin to help your child with autism sleep better?
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