Developmental/behavioral pediatrician Gail Williams, M.D., discusses sleep disturbances related to autism spectrum disorder. She outlines physical and behavioral issues related to poor sleep patterns and considers their relationship to the neurobiology of individuals with autism. 

Williams also lists common sleep issues and highlights known diagnosis and treatment options while emphasizing the treatment of underlying conditions. The presentation includes her thoughts on behavioral therapies and melatonin and closes with Q&A, where she addresses advocacy issues and the importance of diagnosis and appropriate medical care. 

In this presentation: 

5:30 – Sleep patterns
7:10 – Sleep deprivation & prevalence
12:45 – Neurobiology & learning during sleep
17:35 – Impact of sleep problems in ASD
19:00 – Case study
20:40 – Sleep issues in ASD
28:50 – Diagnosing sleep disorders
36:25 – Treatment options
54:34 – Other resources
56:40 – Q&A session

Summary: 

Children generally spend 50% of their sleep cycles in rapid eye movement (REM). However, children with autism have significantly decreased REM time during sleep (5:30). Studies show 50 to 80% of children with autism experience sleep problems or disturbances (10:00, slide@12:00). Common sleep disturbances include nighttime wakings, sleep apnea, sleepwalking, etc. (9:30). Over time, and without proper treatment, these disturbances can lead to sleep deprivation, affecting the entire body and parent wellness (7:10). The impacts of sleep deprivation can include aggression, trouble concentrating, high blood pressure, increased appetite, memory issues, lower stress threshold, increased risk for heart problems, and a decrease in optimism and sociability (8:05). 

The presenter walks through the neurobiology of sleep disturbances specific to ASD and highlights the critical role of sleep in learning and behavioral regulation (12:45 – 17:15). Due to the neurobiological nature of autism, sleep problems can have particular impacts on stimming, behavioral issues, hyperactivity, self-care, and aggression (17:35). Common types of sleep issues in ASD include (20:40):

  • Insomnia (22:02): difficulty falling and staying asleep and waking up too early; this is the most common sleep issue for individuals with autism.
  • Obstructive sleep apnea (OSA) (23:55): obstructed airway leads to disordered breathing (i.e., loud snoring due to enlarged tonsils, etc.). 
  • Parasomnia (25:30): non-REM arousal and disorders. These can include night terrors (25:58), sleepwalking (26:35), and confusional arousals (26:20). 
  • Movement disorders (27:28): such as restless leg syndrome (RLS) or periodic limb movements. Iron supplements may help.

Williams outlines the standard practices for diagnosing sleep disorders (28:50, slide@31:18) and comments on the current push to automatically screen children diagnosed with ASD for sleep disorders. Diagnosis of sleep disorders generally involves a detailed sleep history (31:19), questionnaires (31:25), sleep diaries (33:35), actigraphy (34:15), and polysomnography (35:15, slide@36:17). Polysomnography is the “gold standard” for detecting OSA and many other disorders. It can be difficult for children as it is an overnight test using electrodes to measure brain waves (EEG), oxygen levels, heart rate, breathing, and eye and leg movements. 

The presenter outlines established options for treating sleep issues in individuals with autism (36:25, slide@37:49). She stresses the importance of treating underlying conditions such as anxiety, depression, GI issues, epilepsy, etc., as they often cause these disruptions. She also provides advice for implementing healthy sleep practices (40:15) via dietary changes, exercise, etc. Behavioral interventions, such as cognitive behavior therapy, visual schedules (44:30), and social stories (45:25), can assist with sleep disturbances and subsequent behavioral issues as well (44:30, slide@46:18). Williams discusses the use of melatonin (50:20, slide@53:38) as a safe and effective treatment for some sleep disturbances, noting the lack of long-term studies. She provides a list of more resources (54:34, slide@55:22) and closes with a question and answer session.

Handouts are online at:
https://www.ariconference.com/webinars/williams.pdf

Certificates of participation will be available after the webinar upon successful completion of a knowledge quiz at: https://www.classmarker.com/online-test/start/?quiz=eb6542ade492a5d7

ARI’s free sleep disturbance questionnaire helps identify potential care strategies for sleep issues commonly associated with autism.

Published 10/01/2014

Gail Williams, M.D. is a Professor for the University of Louisville Department of Pediatrics. She is a board certified developmental/behavioral pediatrician and works in a multidisciplinary setting seeing children of all ages with such concerns as autism, learning disabilities, attention deficit hyperactivity disorder, Tourette syndrome, and intellectual disability. Dr. Williams also conducts a biomedical clinic at the University of Louisville Autism Center one day weekly. While her primary responsibilities are clinical, she also engages in clinical research and has authored several articles on autism and other developmental topics.