By Accardo, Jennifer
The Exceptional Parent , Vol. 43, No. 4
Sleep problems challenge children with autism and their families. Here's a primer on some of the testing, treatments, and resources that can help with sleep.
Sleep problems are common in human beings! Sleep problems affect many children, but children with autism spectrum disorders can have sleep problems that are more severe, and more persistent, than typically developing peers. Children's sleep problems can keep parents from sleeping, too. When a child's sleep problems affect daytime behaviors and learning, or disrupt family life, it may be time to seek help.
HOW CAN WE FIGURE IT OUT?
The most basic approach to figuring out what's wrong with a child's sleep is a clinic visit, involving a history and physical examination. A sleep-oriented history asks questions about sleep habits and schedules, snoring and breathing during sleep, restlessness, sleepwalking and night terrors, daytime sleepiness, conditions like epilepsy and anxiety, and family history of sleep disorders. Questions about electronics use may be especially important for children with autism in the age of the iPad, since illuminated screens can affect sleep.
There are a few more levels of sleep evaluations, though. Parents may be asked to complete questionnaires to point towards specific sleep symptoms or disorders. For instance, the commonly used Children's Sleep Habits Questionnaire screens for categories including sleep anxiety and daytime sleepiness. Families may be given sleep logs or diaries to complete. These record sleep over time, including bedtime, wake time, and naps, and are most helpful when filled out each day for at least a week. They can help families and professionals see patterns in sleep schedules.
Some children may stay up so late that parents don't know when they actually fall asleep. Alternately, parents may suspect that children are waking during the night (toys taken out, food wrappers in the bedroom), but are not sure how often or for how long. Actigraphy monitoring is another way to document children's sleep. Actigraphy watches look like sports watches and are usually worn on the wrist. They record movement, and that recording can be downloaded. The idea is that the more you're moving, the more likely that you're awake; the less you're moving, the more likely you're asleep. Because there are exceptions (child mesmerized by a favorite DVD sitting very still), parents are usually asked to keep a sleep diary along with actigraphy. Actigraphy is more likely to be available through a specialty sleep clinic.
Many families wonder about overnight sleep studies. An overnight sleep study for a child (also called a polysomnogram, or PSG) is a test done in a specialized laboratory. Your child, accompanied by a parent, comes in for an overnight test as an outpatient. A trained technician sets up monitoring to record different aspects of your child's sleep: breathing, oxygen levels, brainwaves, and leg and eye movements. Your child wears this monitoring throughout the night as information is recorded. Setup of this monitoring requires some cooperation and can be a sensory challenge for children with autism.
Recent guidelines published by the American Academy of Sleep Medicine show that pediatric sleep studies are indicated to look closely at sleep-related breathing disorders. They can be used to look for other sleep issues, such as leg movements, that suggest specific sleep disorders. With full EEG, they can also be used to distinguish sleep conditions such as sleepwalking or night terrors from seizures.
Some sleep laboratories, like the laboratory at the Kennedy Krieger Institute, are specifically pediatric; others primarily see adult patients and do occasional pediatric tests. If your child is scheduled for this test, it can help to tour the laboratory ahead of time. You may want to ask how often a laboratory tests children, or specifically children with developmental disabilities. …