Sleep Issues in Autism
Studies show that 53% percent of children with autism have at least one frequent sleep problem. Unfortunately, typical treatments are often short-lived as they don’t always deal with the underlying cause of the sleep issue. This article will provide some tips to improve your child’s sleep and discuss common medical causes of sleep issues in autism.
Sleep issues not only impact your child’s behavior and health, but are also associated with cognitive, verbal, and attention impairments. So, as you can see, ensuring that your child obtains an adequate amount of sleep can enhance their quality of life.
Tips to Help Alleviate Sleep Issues
Before discussing the medical causes of sleep issues in autism, let's talk about some simple things you can do at home to help your child sleep. Below is a list of tried-and-true tips that can help the whole family get more Zzz's.
Epsom Salt Baths
½ cup to 1 cup of Epsom salt in a warm bathtub can be calming for many children. You may even want to try adding a drop or two of lavender essential oil to their bath (lots of parents swear by it).
Eliminate Electronic Use One Hour Before Bedtime
Studies show a significant relationship between increased screen time and sleep disturbances. Children who use electronics before bedtime are more likely to have difficulty falling asleep, have trouble staying asleep, and get less overall sleep than children who do not watch TV or use electronic devices before bed.
A Set Routine
Routine can be very important for kids, but especially kids with autism. A calming bedtime routine including quiet music or a metronome, weighted blankets, a darkened room, massages, Epsom salts baths, and avoiding TV or stimulating toys/music can set the stage for a good night’s sleep. Consider using a visual schedule and set nighttime expectations to lessen bedtime anxiety.
Limit EMF Exposure
Just like light, exposure to electromagnetic fields (EMFs) can also interfere with the body’s melatonin levels. Limit your child’s EMF exposure by turning off your Wi-Fi router, unplugging cordless phones, and powering down all computers, tablets, and smartphones each night before bed. Learn more about EMFs and what you can do to limit your child's exposure to them here.
Make sure your child is getting some form of exercise each day. The bulk of the research indicates that exercise can help boost sleep duration and sleep quality (regardless of the mode and intensity of activity). Pick a fun activity to do together or go for a walk, and don’t forget to add an extra glass or two of water throughout the day to ensure your child is adequately hydrated.
Medical Causes of Sleep Issues in Autism
If you have tried all of the above and your child is still having trouble with sleep, please consider asking your child's doctor to evaluate if an underlying medical issue is causing your child's sleep issues.
If your child has trouble staying asleep, they could be low in potassium. Read more about low potassium and its relationship to sleep disturbances here.
A full iron panel plus ferritin can check for low iron. Vitamin C can help the body absorb iron. Please note that high iron levels can be toxic in children, so you should only supplement iron under the direction of your child’s physician. Studies showing a relationship between low iron and sleep issues in autism can be found here and here.
The pain of constipation alone is enough to wake the child during the night. Look for posturing, lack of appetite, loose stools (which can indicate a blockage), not eliminating completely, and more. To determine if your child is suffering from constipation, their doctor may order an abdominal x-ray called a KUB.
Cerebral Folate Deficiency
Cerebral Folate Deficiency (CFD) is a relatively newly identified disorder in which there is low 5-MTHF (5-methyltetrahydrofolate) in the cerebrospinal fluid but normal or even elevated 5-MTHF in the blood. Symptoms of CFD may begin as early as four to six months of age with irritability and sleep problems (insomnia). Treatment options for CFD include folinic acid and a dairy-free diet because mammal’s milk blocks folate receptors.
Learn more about Cerebral Folate Deficiency in Autism here.
Have you ever noticed your child cannot sleep during pollen season? This happens because histamine levels, which rise at night, can cause sleep problems. If you suspect allergies affect your child's ability to sleep, look into mold, pet dander, pollen, dust, and other environmental triggers. Likewise, look into food allergies. Over 90% of food allergies in kids are caused by these eight foods: dairy, egg, soy, wheat, tree nuts, peanuts, shellfish, and fish.
Unlike food allergies, food sensitivities cause a delayed reaction. These delayed reactions come in many different forms, night-waking being one of them. The biggest offenders tend to be dairy, gluten, soy, egg, and corn. An elimination diet can help pinpoint the foods that are causing a problem.
Phenols and Salicylates
Phenols and salicylates are chemical compounds found in fruit, vegetables, nuts, and some medications. These compounds are excellent antioxidants, so we typically think of them as very healthy. However, phenols/salicylates can be problematic for some people, causing them to experience various adverse reactions, including night-wakings.
Learn more about Phenols, Salicylates, and Additives here.
Research shows there's a relationship between low magnesium and sleep issues (see here and here). Doctors rarely test for this, but it is critical. If you suspect low magnesium is contributing to your child's sleep issues, talk to your functional medicine doctor about trialing a magnesium supplement.
Vitamin D Deficiency
Here is a study that demonstrates the link between vitamin D and sleep. A blood test can determine whether or not your child has low levels of Vitamin D.
Enlarged Adenoids and Tonsils
Enlarged adenoids and tonsils can interfere with both feeding and sleeping. Therefore, consider seeing a pediatric ENT if your child has any of the symptoms listed in this link (snoring, bad breath, cracked lips, episodes of not breathing during sleep, etc.).
The body needs methyl donors to make serotonin. Melatonin is a sleep hormone that depends on serotonin for proper function. Serotonin converts into melatonin in the pineal gland of the brain. Vitamins needed for melatonin production are 5MTHF (methylfolate), methyl B12, betaine, and other methyl donors.
Find more information about methyl donors and their relationship to sleep here.
Cortisol is a hormone produced by your adrenal glands that can affect sleep in a couple of different ways.
First, cortisol impacts sleep through its oppositional relationship with melatonin, the hormone that helps you sleep. In healthy people, cortisol levels are highest in the morning, helping them feel awake and alert, while melatonin levels are at their lowest. Throughout the day, cortisol slowly drops as melatonin rises. When it's time for bed, melatonin levels are at their highest, and they gradually decrease throughout the night, while cortisol increases again. In short, when cortisol is high, melatonin is low and vice versa. However, adrenal fatigue can compromise this pattern in some people.
Another way cortisol impacts sleep occurs in the liver. Here, cortisol is responsible for breaking down glycogen and converting it into glucose, which gives you energy in the morning. However, if your liver is taxed, you'll have a hard time completing this conversion. For this reason, liver supports can help with sleep, especially for people who have trouble staying asleep. Examples of supplements that help support the liver include milk thistle, inositol, molybdenum, artichoke, and more.
Low Blood Sugar
One of the liver's responsibilities is to provide energy, in the form of glucose (blood sugar), to the body when it needs it. However, if cortisol doesn't convert glycogen into glucose, the liver won't have enough glucose to release to the body, and blood sugar levels will drop.
Many kids that struggle with low blood sugar wake up screaming in the morning or after a nap. They only seem to settle once they have eaten. Trying a high-protein, high-fat snack before bed like a roll of turkey or a slice of avocado may help.
Interestingly, sometimes a cornstarch slurry can help a child sleep though the night. Corn starch is a resistant starch. It takes a long time to break down, thus keeping your child fuller, longer. It must be eaten raw (not cooked) before bed. Usually 2-3 tbsp mixed with water or applesauce is sufficient. Please use organic corn starch because regular corn is a highly genetically modified crop. If your child cannot tolerate corn, then potato or tapioca starch will work, though not quite as well.
Also, problems with low blood sugar can be a sign that your child may have Mitochondrial Dysfunction.
Parasites tend to be active at night. Pinworms, in particular, come out while sleeping. To learn about how to determine if your child has pinworms, click here.
Candida (Fungal) Overgrowth in the GI Tract
While it's healthy to have some fungus in your GI tract, a yeast overgrowth can cause many issues, including sleep disturbances. One example of a fungus that can get overgrown and out of balance in the gut is Candida Albicans (yeast).
Besides sleep issues, symptoms of Candida overgrowth include inappropriate laughter, rash or cracking between the toes, white patches in the mouth (thrush), high-pitched squealing, episodes of unexplained/intermittent crying, sugar cravings, and more.
To learn more, please read Yeast Overgrowth in Autism.
GABA - Glutamate Imbalance
The anti-anxiety neurotransmitter in the brain is GABA. Glutamate is an excitatory neurotransmitter that is supposed to convert into GABA, as needed, for calming.
Unfortunately, the GABA shunt can go two ways. It can convert glutamate into GABA, or it can continue to make glutamate. If it continues to make glutamate, it will impact sleep. Because of this, a diet completely free of glutamate may help improve sleep for some people.
To learn more about sleep issues associated with a GABA-Glutamate imbalance, click here and here. In addition, please read TACA's article that addresses glutamate and autism.
Seizures are relatively common in individuals with ASD. Some develop seizures in childhood, some at puberty, and some in adulthood. Although the prevalence of seizures by age is not well studied, recent studies suggest the risk remains high into adulthood.
Seizure activity can interrupt sleep. In fact, many seizures occur at night when we cannot see them. For this reason, we strongly recommend that all children with autism have a 24-48 hour EEG, especially if they have sleep issues.
You can find more information about seizures here.
GERD (acid reflux) occurs when stomach acid backs up into the esophagus. GERD is painful and can cause your child to wake up in the middle of the night.
Side Effects from Medication
Prescribed medications commonly given to people with autism can significantly impact sleep. For example, medications such as Risperidone, Abilify, and some prescriptions used to treat ADD/ADHD have side effects that include problems with falling asleep and staying asleep.
In summary, sleep issues are common to autism. While simple changes to home routines can resolve some sleep issues, those caused by underlying medical problems require proper medical care. Treating these issues will help improve your child's health and ability to fall asleep and stay asleep.
- Treating Behaviors and Sleep Issues with Evidence Based Medicine (video of a TACA Conference presentation given by Lanier Rossignol, BSN, MSN, FNP-C)
- Introduction to Medical Interventions for Autism
- Underlying Medical Issues in Autism
- Finding a Doctor
*All content in this article is for informational purposes only, including links to products and/or websites mentioned. To clarify, TACA does not receive any compensation or commission for providing them.
Furthermore, the information on this page is not a substitute for professional advice, diagnosis, or treatment. For this reason, always seek the advice of your physician, therapist, or other qualified health provider with any questions or concerns you may have.