autism and sleep

2 Comments Posted on Autism, Patient Talk

Sleep disorders and children diagnosed with autism. Read some amazing information in our guest post from Dr. Sonya Doherty

Dr. Sonya Doherty

Dr. Sonya Doherty

Welcome to our latest guest post from Dr. Sonya Doherty. You can read the original post on her blog here. Dr. Sonya Doherty is a licensed and board certified Naturopathic Doctor who is an active member of the CAND. Sonya Doherty completed her undergraduate training at the University of Western Ontario in a Bachelor of Science Honors Kinesiology program.

You may be also interested in a recent discussion blog we ran which looked at this very subject!

If you have a child diagnosed with autism, or who you suspect is on the spectrum, chances are your child is having trouble getting to sleep or staying asleep.  Sleep is essential to support optimal development.  Research at the Arkansas Children’s Research Institute has identified that 90% of children diagnosed with autism havemethylation impairments . Methylation impairment can change the way children produce brain chemicals like serotonin, dopamine, GABA, glutamate and norepinephrine.  With respect to sleep, serotonin is a much need neurotransmitter.  90% of serotonin comes from the gastrointestinal tract.  Up to 85% of children with ASD have digestive problems including constipation, diarrhea, pain and gut flora imbalance.  Serotonin is converted to melatonin with the help of vitamin D.  Vitamin D deficiency is well documented in the autism focused medical research. 

Adequate magnesium levels are required for healthy sleep onset and maintenance.  Many children with autism and ADHD have magnesium levels that are lower than normal.  Magnesium deficiency is the 4th most common nutrient deficiency in North America.  Nutrient deficiencies, digestive problems and methylation impairment combine to negatively impact healthy sleep patterns in ASD.  Children who are experiencing developmental concerns are at a substantially higher risk of experiencing sleep disorders.  The children who need sleep the most are having trouble getting to sleep, staying asleep,  having restful sleep are early waking.

Addressing sleep issues in children with autism is multi-faceted.  Many parents have altered routines to accommodate their child’s imbalanced circadian rhythm.  Putting children to sleep much later than same age peers, results in an exhaustion cycle that exacerbates behaviours and sensory overload.  Your child’s body has two ways to get to sleep. One is at their age appropriate bed time which is supported by appropriate melatonin levels.  The melatonin signal is initiated by darkness and regulates the sleep-wake cycle by causing drowsiness.  Limiting TV, iPads and other screens in the evening is important for children with sleep onset insomnia.  Blackout blinds are also crucial to help support the repair of your child’s sleep cycle.  Melatonin production must be stimulated to increase documented low levels experienced by children with an autism diagnosis.  Use of melatonin is an important “band aid” treatment during this time as children’s methylation cycle is supported and repaired.  Other helpful sleep supports include magnesium glycinate, GABA, L-theanine and botanical medicines like valerian, skullcap, lemonbalm, zizyphus and passionflower.

The importance of melatonin in the management of sleep disorders and gastrointestinal problems in children diagnosed with autism spectrum disorder:

One of the most common questions that I am asked by parents is about melatonin safety.  “Is it safe to give my child melatonin?”

I think the below information will make it clear that it may be unsafe not to give your child with autism melatonin.

The International Child Development Resource Center performed a systematic review and meta-analysis on melatonin and autism.  Their findings show that most children diagnosed with autism have:

  • Abnormalities in their melatonin levels
  • Gene abnormalities that contribute to lower melatonin levels
  • Show positive changes with respect to sleep duration, onset and night time waking
  • Show improvement in autistic behaviours

Sleep problems in autism usually start at the same age as developmental regression, suggesting a higher vulnerability at this period of life. Healthy sleep patterns are essential to support neuroplasticity and development so it is important to address sleep disorders as soon as possible.  According to the Center of Pediatric Sleep Disorders, studies of melatonin use in children with ASD provide evidence for its effectiveness and safety in the long run.

Melatonin, however, has a larger role to play in development beyond its function as a synchronizer of the biological clock. Melatonin is a hormone that helps in the regulation of the gastrointestinal system.  The gut is 100% responsible for post-natal development.  In the gut, melatonin, governs intestinal reflexes, motility, the immune function, gut secretions, energy balance, pain regulation and protects against inflammation.  The gut contains at least 400 times more melatonin than the pineal gland  The GI tract produces its own melatonin which suggests it plays a large role in maintaining gut health; both in a healthy digestive tract and in gut disorders.  Children diagnosed with ASD have alterations in their gut flora in addition to higher prevalence of constipation, diarrhea, reflux and pain.  The balance of good bacteria is not the same as typically developing children.  Melatonin levels change gut flora and improve anti-microbial actions.  With the startling numbers of children experiencing both gut issues and sleep issues, this new research about melatonin’s role in gastrointestinal health could provide clues about treatment and repair of these biological systems.

Other interesting information about melatonin:

  • Melatonin is also synthesized by the bone marrow cells, white blood cells, mast cells and skin cells
  • It is a powerful antioxidant
  • Melatonin helps to protect mitochondria from oxidative stress which damages cells
  • Melatonin also helps to support glutathione production.  Glutathione is widely considered the most important antioxidant in the body.  In another study, The Arkansas Children’s Research Institute found that children diagnosed with autism have up to 80% of their glutathione depleted.  Glutathione depletion may be part of the central mechanism for developmental delay because the role it plays in protecting the brain from toxicity
  • There is research to support that melatonin helps to support healthy immune function by fighting infectious disease including viral and bacterial infections
  • Melatonin has shown some promise in modulating the immune function in autoimmune disease
18 Comments Posted on Autism, Patient Talk

Autism Life Hacks – Getting to sleep and staying asleep.

Autism and sleeping

Autism and sleeping

Actually this is also an issue shared by most parents/caregivers of children when they are first born.  One can tell parents of new born babies  as they walk down the road by the zombie-like expression on their faces and occasional habit of going to sleep mid-conversation.

Problem is that for parents of children with autism this can go on for a long, long time after other children are snuggled up in bed.

In AutismTalk (https://www.facebook.com/AutismTalk), our Facebook discussion page, people often write in asking questions about how best to get their children with autism a  good night‘s sleep.

Now, I should mention that our son John has over the years developed reasonably regular sleeping habits. Although he is a nightmare when jetlagged.  But then so am I……………..

These days he sleeps from around 10 o’clock in the evening to around 7 o’clock the next morning.  So we know we are doing pretty well considering.  That being said he likes to have a snack before going to sleep (in his case either an apple or a pear) and needs to be cuddled as he drops off.  Oh, and he will often re-appear in the middle of the night to check we are okay.

I can generally tell when this has happened by the kick which emanates from the middle of the bed where he has placed himself.  He has a bath generally after his supper a few hours earlier.

But I know that even though he goes to sleep much later than we would like we are much better off than many parents.  Indeed I’ve heard of some children and adults who hardly sleep. Sometimes just a few minutes at a time.

The aim of this blog post is to give you an opportunity to share your autism and sleeping story.  In particular what methods you have employed to improve the situation.  You might like to consider some of the following questions when giving your comments and sharing your experience:-

1) Can you describe your or your loved one’s sleep patterns and how they have developed/changed over the years?  For better or worse?

2) If you or your child has poor sleeping patterns what effect does this have on the people around your?

3) What techniques have you used to develope a more “normal” sleeping pattern?

4) How successful have they been?

Please feel free to share anything with our readers you think will be of value in the comments section below.

Finally, is it possible for it NOT to be a problem that somebody only sleeps for a shorter time than the eight hour norm?  I know a number of people who really only sleep for a few hours a day and do not suffer from sleep deprivation. Is this ever the case with a person with autism?

Thanks very much in advance.

 

Melatonin has been a life saver for my two boys with autism. If all else fails I give them half of a dissolving tablet and the drift off 20-30 minutes later. But if you give it every night they can develop a resistance to it and you have to keep upping it. That is why we use it as a last resort. Try a steady nightly schedule first. Hope this helps.
LauraAndruk Elizabeth Howell  A developmental pediatrician told me that autistic children do not produce enough melatonin in order to fall asleep, this is why he suggests it.
clairsims I have two one grandson with downs syndrome and autism, sleep has always been a problem, still is he is now 28yrs, My great grandson is 4yrs old just been diagnosed with autism, just read about melatonin and calms forte, going to call my granddaughter and have her check this out. Iwill also look in to it.
AimeeTrevelyan Our lb used to have to be cuddled to sleep evey night, would take hours laying in bed, and eventually he would drop off usually before midnight, but then would wake around 2 and stay awake for about 3 hours running around smiling. When he was a baby we couldn’t put him in his cot and do the whole cry to sleep thing he would just make himself sick. He was put on fenerghen and it made things worse. Then when he was diagnosed high functioning asd at the age of 3 they prescribed 3ml of melatonin nightly and now majority of the time he falls asleep by 9 and wakes at 7. So much better 🙂
Rebecca318 Elizabeth Howell Yea – I should have added we only do that during school days or on days when he cannot sleep in the next day.  While it can cause the body to stop producing on its own – he already does not produce enough to slow his brain down so the good far out weighs the possible bad.  He needs sleep and I would rather give him something his body would otherwise produce instead of a narcotic or other substance.
Elizabeth Howell There is a problem with giving your child melatonin. Our bodies naturally produce melatonin and when you feed it extra doses your body then stops producing it’s own melatonin which in turn leaves you dependent on the pill. It’s a nice temporary fix but not to give to your child on a nightly basis.
Rebecca318 Melatonin and Calms Forte has worked wonders for my 8 year old son.  The melatonin helps slow his brain down to fall asleep and the Calms Forte helps him stay asleep.  He went from waking 3-4 times a night to now 1 or 2 and sometimes sleeping all night!  Calms Forte is all natural.  I had never heard of it but his new child development specialist recommended it and said she had great results for the sleeping with her spectrum kids as well as ADHD – the Calms Forte has also helped him during the day when he gets really wound up or overwhelmed.  I give him 1/2 of one for the day.  Worth checking out!
nicolebicebey My son was diagnosed PDD/NOS at age 3. He is now 19. He never slept well after the age of 2, he was a perfect baby before that sleeping more than most. He wanted to stay up all hours and then only sleep for about 4hours at most when he did fall asleep. My husband was in the military and we were so tired I remember being so frustrated at my child for not going to sleep so I just laid in his bed with him and made him stay with me and held him tight so he could not leave the bed. He got upset and cried until he cried himself to sleep. That started to be a pattern for about a week until he started to go to sleep when I put him to bed but he never slept through the night. I finally stopped fighting it and found things for him to do during the night which were quiet. Oh we tried GF/Casein free which was good for skin problems but not much else, he was also non verbal. He is now verbal with a slight delay in speech and is “recovered” from the autism. Not really but that’s what I was told by the last person who did his testing. At age 5 when he all of the sudden decided he wanted to make anime cartoons and started drawing I found my quiet task to get him through the night and keep him occupied while we slept. I slept in his room while he drew and drew and drew. He draws wonderfully (thanks to that obsessive quality) and wants to become a special effects artist. He is not a natural artist. There are people who can just draw anything, his comes from working hard at it and he is never without his sketch book. I just took a weakness or problem-his lack of sleep- and turned it into a major strength. I don’t think his sleep pattern will ever be “normal” but he turned into an artist in a very employable field and can now support himself. That is all I ever wanted for him is to have a life where he can be productive and possibly have a family of his own and be happy. I also homeschooled so that helped with our crazy hours.
LisabethHutchison
jlrowan1973 My son, now almost 14, had a really rocky start with his sleep patterns.  I can’t remember exactly when it started, but probably around age 2.  We would put him to bed…then spend the next 3 hours taking turns putting him back into bed when he came out.  It was exhausting for all of us.  We were tired at work the next day and short with the kids, and Luke was trying to sleep in the daytime.  It didn’t matter what we did to keep him awake, he still was up at night for hours.  To be honest, the sleeping didn’t resolve until we put him on a gluten free/casein free diet.  I eliminated dairy first, which I do feel is a bigger problem for him, and the improvement was almost immediate.  Taking out gluten helped too, with the sleeping but with other behaviors as well.  Since then, Luke has not had any sleeping problems.  He goes to bed exactly on time and has an uncanny internal clock that wakes him up exactly when he needs to to get ready for school.

These days, we are more lax on the GFCF diet and give enzymes with dairy/gluten, but in the beginning, I think the strict diet was crucial for helping his sleep habits along with many other behaviors.  Dairy contributes to his stimming and general awareness of everything around him.  When we first eliminated dairy, I saw a cloud lift from his eyes almost immediately.  Gluten contributes to his emotional well-being.  If he gets a lot of gluten, even now, I notice more anxiety and a shorter temper.

I know the diet is still controversial, but that is how we solved a lot of problems.  Did it “cure” my son?  No, not by a long shot.  However, it was and still is a huge component of his success.  The diet was something I could control and I was adamant about not using medication with him and it worked out for us.