Last Updated: June 26, 2003
Often, sleep disturbance can be a major problem that accompanies autism. This sleep disturbance can bring complete havoc to the entire family, especially to the parent who has to stay up late with the child who has the sleep problem only to have to get up early with another child who doesn't have a sleep problem. This is the problem I had: a 2 year-old child with autism who stayed up every night until 3:00 a.m., and a 3 year-old 'typical' child who had no sleep problems and awoke around 7:00 a.m. This was definitely a problem that I had to address to keep my health and sanity in tact.
Of course, family and friends who had neurologically typical children gave me all sorts of advice: Wake him up early every morning. Keep his naps short. Don't let him take a nap; keep him up till bedtime. Just MAKE him go to bed on time. Hmmm. As you might imagine, none of these worked with my son. I would just smile and say "you know, I'll try that," when all the while I'm thinking "You just don't get it; you just don't understand." There was no keeping him up with no nap or waking him up before he was ready to get up. And there most certainly was no "just make him go to bed on time." This just DID NOT WORK. Trust me, I tried it.
The truth with my son was that he was literally locked into a messed-up sleep schedule. Serotonin (a powerful neurotransmitter that helps regulate sleep, appetite, speech, body temperature, and sensory integration) regulates the release of melatonin, the body's natural hormone that helps regulate sleep. Serotonin imbalance often accompanies autism (many professionals in the field of autism would say that serotonin is what actually causes many of the symptoms of autism).
Hence, the serotonin imbalance and autism had caused a problem with my son's regulation and release of melatonin. His body was telling him to stay awake until very late; the key for me was to help that melatonin problem. Many of the suggestions below actually help to correct the serotonin imblance and the problem with melatonin regulation.
I will tell you what members of my therapy team suggested for my child, but please keep in mind that this was suggested for my child, and that you should consult with your pediatrician or neurologist before implementing any of the following for sleep disturbances.
Here's what my pediatric neurologist suggested for my child with autism, who is now 3 years-old:
1. Give him 3-4 mg of melatonin about 30 minutes before bed
2. If that doesn't work or if he awakens in the middle of the night, give him 1-2 teaspoons of Benadryl
3. Split up his SSRI dose from 2 cc's once a day to 1 cc twice a day (once in the morning, once in the evening)
My OT also suggested:
4. Bouncing him on the therapy ball
5. Giving him deep massages on his arms, legs, trunk, hands, and feet
6. Using a weighted blanket or applying deep pressure to his body (such as laying a pillow or couch cushion over his body then leaning into it for pressure)
7. Playing white noise or soothing music at a low volume while he falls asleep and while he is sleeping
Sensory Integration Therapy is a powerful tool in dealing with autism. It has helped dramatically with my son's 'meltdowns,' attending problems, auditory processing, speech, and, yes, sleep! My son craves propioceptive input (deep sensory input such as deep bear hugs, deep tickling, rough-housing). Before bed, it is often helpful to give him deep massages on his arms, legs, hands, feet, and body.
Sometimes it helps to bounce him on a therapy ball (or an exercise ball from the exercise section at WalMart). Rocking is also a form of sensory input that is calming.
Here are some ways I massage my son to help him calm down so he can fall asleep easier (but please keep in mind that I am not a physical or occupational therapist and that I have not been professionally trained in sensory integration therapy...I am a mom of a 3 yo child with autism, and I have found some techniques that are useful for him):
1. The standard massage of lightly squeezing muscles
2. The "sandwich" approach to massage (this is very effective for my son). I place one hand flat-palmed on the top of my son's forearm, and my other hand flat-palmed on the underside of his forearm muscle (making a "sandwich" of his muscle and my hands) then press firmly for one or two seconds, release, move down the arm an inch or two, apply my hands the same way, press firmly for a second or two, release, move down another inch or two, and repeat this all the way down to his wrist, hand, and fingers. I then proceed to the other arm, then to the legs and down to the feet.
3. I place a pillow over my son's trunk/arms/legs and lean in to it, applying light pressure. Believe it or not, this feels really good to propioceptive seekers like my son. HOWEVER, if your child is NOT a sensory seeker, s/he may not respond well to these types of massages.
You should speak with your OT or PT about the appropriate types of sensory integration that might help your child calm and sleep better.
Alternative Ideas for Sleep Difficulties in Children with Autism
Treatment Suggestions for Sleep Difficulties (for children with autism)
Calming Effects of Deep Touch Pressure in Patients with Autistic Disorder, College Students, and Animals, by
TEMPLE GRANDIN, Ph.D, from JOURNAL OF CHILD AND ADOLESCENT PSYCHOPHARMACOLOGY
RELAXATION TECHNIQUES Reducing and Managing Stress (for children with autism)
Sleep Problems, from Toddler Times
The Quiet Quilt: Special Weighted Quilts for Special Kids
Melatonin
Melatonin is a natural hormone in the body that regulates sleep. The release of melatonin is regulated by serotonin, a powerful neurotransmitter that sleep (via the melatonin) as well as appetite, mood, body temperature, and sensory integration. When serotonin levels are imbalanced, as is believed to be the case with autism, often times that imbalance creates problems with melatonin production and release. In other words, it creates problems in the sleep cycle.
My 3 yo son is locked into a cycle of staying awake until very very late at night. My pediatric neurologist suggested I use melatonin to aid in correcting his irregular sleep patterns. It has helped, particularly with the aid of Benadryl (also suggested by my pediatric neurologist). Please speak with your pediatrician or neurologist for proper dosing of melatonin and Benadryl before administering it to your child.
Sleep Disorders and Melatonin, from Great Smokies Diagnostic Laboratory
Melatonin: An emerging role for this over-the-counter supplement in the treatment of autism; The Center for the Study of Autism
Autism and Melatonin; Great Smokies Diagnostic Laboratory
MELATONIN HORMONE THERAPY OF AUTISM
Melatonin is effective and safe for sleep disturbance in children with cerebral palsy, autism and learning problems
Clonidine
Clonidine is actually a medication for hypertension (high blood pressure). However, it has the side effect of causing drowsiness. It is routinely prescribed for sleep problems with autistic children. I have not used prescription sleep aids for my son, so I do not know how of their safety, side effects, or successes. Please read the links below and speak to your pediatrician or neurologist for more information regarding the use of clonidine to aid in sleep disturbances.
AAP: Clonidine Provides Safe, Effective Sedation to Children with Autism/Pervasive Developmental Disorder
A Family Physician's Thoughts on Using Clonidine and Melatonin
ABSTRACT: A double-blind, placebo-controlled study of the efficacy of transdermal clonidine in autism, from J Clin Psychiatry. 1992 Mar;53(3):77-82
The Sleep Component and Strategies to Consider
ADHD medications (this talks about the use of Clonidine)
Antihistamines
Benadryl has been a life-saver for my son regarding sleep. His pediatric neurologist suggested I try using that as a 'back-up' when the melatonin wasn't enough to help him get to sleep at night. My main concern with it is that with regular usage, benadryl seems to cause congestion problems (stuffy nose and sinus drainage that leads to congestion and coughing). It is, however, highly effective for helping him fall asleep at night.
Children Remain Alert and Ready to Learn When Taking
Over-the-Counter Antihistamines That Make Adults Drowsy
Drugs Often Used for Insomnia in Kids, by webmd
Kirkman Labs
Drugstore.com (has liquid melatonin)
Local Pharmacies
Excerpt from "Sleep Better! A Guide to Improving Sleep for Children with Special Needs," by V. Mark Durand, Ph.D.
Autism and Sleep Problems
ABSTRACT: Parental report of sleep problems in children with autism, from J Autism Dev Disord. 2000 Apr;30(2):127-35.
Don't Combine Sleep-Inducing Drugs and Herbs
A Laboratory Study of Sleep in Asperger's Syndrome
ADHD and Sleep Problems
ABSTRACT: REM sleep effects as a biomarker for the effects of antidepressants in healthy volunteers, from Journal of Psychopharmacology Volume 17 Issue 02 - Publication Date: 1 June 2003
ABSTRACT: The effect of sleep loss on next day effort, from J Sleep Res. 2003 Jun;12(2):113-24.
ABSTRACT: Sleep patterns of children with pervasive developmental disorders, from J Autism Dev Disord. 2002 Dec;32(6):553-61
ABSTRACT: Instability of sleep patterns in children with attention-deficit/hyperactivity disorder, from J Am Acad Child Adolesc Psychiatry. 2000 Apr;39(4):495-501
ABSTRACT: An investigation into sleep characteristics of children with autism and Asperger's Disorder, from J Paediatr Child Health. 1998 Dec;34(6):528-33
ABSTRACT: Actigraphy and parental ratings of sleep in children with attention-deficit/hyperactivity disorder (ADHD), from Sleep. 2001 May 1;24(3):303-12
ABSTRACT: Circadian preference, sleep and daytime behaviour in adolescence, from J Sleep Res. 2002 Sep;11(3):191-9.
Sleep Difficulties in Children Resources
Sleep Research Sites
Sleep Research Group
TASK PAGES:
TASK Home Pages
TASK Home Page
TASK E-Mail List
Basic Information
For Those New to the Diagnosis of Autism: The First Things to Do and the Initial Visit to the Neurologist
What Is Autism, PDD, and Asperger's Syndrome?
Neurobiology: Neurotransmitters, Genetics, and Biomarkers
Resources
Tennessee Resources
National Resources
Northwest Tennessee Resources
Pediatric Neurologists in Tennessee
Funding
TEIS
Therapies and Treatments
Sensory Integration
Applied Behavioral Analysis
Auditory Integration Training
Medications
Diet and Nutrition
Selective Serotonin Reuptake Inhibitors (SSRIs) as a Treatment for Autism
A Parent's Decision to Use an SSRI for her Young Autistic Son
Misc. Info
Conferences, Workshops, Events, and Summer Camps
A Mother's Reflections on Life with an Autistic Child
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NOTE: The information contained on the pages of TASK are for informational purposes only. TASK does not endorse any particular therapy, organization, or professional, but is, rather, informing site visitors of the existence of such therapies, organizations, and professionals.
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