Sleep problems in autism remain ill-defined and overlooked
Individuals with autism tend to have poorer sleep quality and more insomnia throughout their lives than do people in the general population. Taking a long time to go to sleep, waking up early in the morning and staying awake for a long time at night are some of the common problems among people with autism.
We do not understand what causes these often severe and intractable sleep difficulties in autism, and they may not respond to our treatments. We also don’t fully understand the associations between sleep and daytime behavior, anxiety, attention, core autism features and gastrointestinal issues.
There are several reasons for this lack of information. First, clinicians often don’t ask families about their child’s sleep quality, so these problems may not even come up. Even when they do, it is often hard to define them. It is typically up to parents to describe them, and what one family considers problematic, another may tolerate. What’s more, research shows that parents’ knowledge about sleep and sleep problems across childhood is generally poor. And clinicians do not typically address sleep when prescribing treatments for autism.
At the same time, experts debate the definitions of common sleep-quality indicators, such as sleep duration and sleep continuity. These indicators change with age and can differ from one individual to the next. And among people with autism, there may be subgroups of sleep problems. Subjective sleep quality may also differ from objective sleep measurement. In 2015 and 2017, the National Sleep Foundation published guidelines for sleep duration and draft guidelines for sleep-quality indicators across the lifespan.
Understanding sleep problems in autism also has not been a priority area for research or research funders, and does not feature highly at either autism or sleep research meetings. As a result, we lack studies of individuals at different ages and over time, as well as research on therapies.
Autism researchers should recognize the potential importance of sleep for other conditions associated with autism. Insomnia, for example, may underlie a range of mental health conditions, including anxiety and depression, which are also common in individuals on the spectrum.
Changing scientists’ attitudes toward and approach to sleep problems in autism is a critical step toward a better understanding of the condition’s core features and comorbid conditions.