Many parents occasionally deal with children who have difficulty falling asleep or staying asleep. These sleep difficulties are normal and usually temporary.
Children with autism spectrum disorder (ASD) have much more sleep disturbances than typically developing children 1 . Autism spectrum disorder (ASD) is a developmental disorder characterized by problems of social communication, repetitive and stereotyped interests and behaviours 2 . Currently, one of the most burdensome complaints among parents of children with autism is disrupted sleep, which in many cases, lead to the decision to institutionalize the child 3 . More than 50–80% of autistic children experience sleep problems compared with 25–40% in typically developing children 4 .
Their sleep problems include difficulties falling asleep and mainly frequent awakenings throughout the night. Insufficient sleep or non-restorative sleep appears to impact daytime behavior, defect memory and learning and worsen repetitive behaviours, social and communication difficulties 4 as well as anxiety, self–injury, tantrums, and aggression 5 .Therefore, untreated sleep difficulties might cause significant stress for the child, the parents and the siblings.
It is known that autistic children have poorer overall memory consolidation (a processes by which memory traces become more stable and resistant to interference over a period of time), however, after sleep, these children show more stable memory consolidation than in wake conditions. Therefore, any actions that aim to help a child sleep better may not only improve their health and their family’s distress, but also relief the core and related symptoms of autism, while improving their overall cognitive functioning 6 .
The most common reasons for sleep difficulties in typically developing children are environmental influences and inappropriate sleep routine. Improving their sleep hygiene, a set of sleep-related behaviours which promote healthy sleep 7 , is the first line of treatment for sleep disorders. Simple measures such as having a consistent bedtime routine with the same sleep and wake-up times every day, limiting light exposure at least an hour before bedtime, reducing screen time (computer, TV), teaching the children to fall asleep on their own, avoiding naps and rewarding good night time to improve the family’s and child’s night’s sleep. In addition, as exposure to daytime light can help improve night-time sleep, parents need to make sure that the child is exposed to sunlight every day 8 .
However, good sleep hygiene alone may not be sufficient to treat sleep problems in children with ASD. In children with ASD, sleep problems may be related to low melatonin levels and impaired circadian rhythm 9 10 . Melatonin is an endogenous hormone that promotes sleep and regulates the sleep/wake cycle. Abnormalities in the amount and/or timing of melatonin release may be responsible for difficulties falling asleep, frequent nighttime and early morning awakenings 11 .
In addition, children with ASD have a high rate of comorbid medical conditions, such as mood and attention-deficit/hyperactivity disorders, that might interfere with sleep regulation 12 , resulting in complicated presentations of sleep disturbances 13 14 . Moreover, children with ASD are also more sensitive to sensory experiences such as light, touch or sound that may also contribute to their sleep disturbances.
Treating sleep problems in children with ASD, will not only improve their daytime functioning, but will also decrease the overall stress of their caregivers, parents and siblings.