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Solutions for sleep in autism require a common approach

by  /  10 November 2017

The bidirectional relationship between sleep and behavior is well known. And clinicians, researchers and parents all recognize that sleep is essential to healthy development. Yet the complex interactions that govern sleep, along with the different frameworks used to talk about it, have combined to stall progress in understanding these essential relationships.

To overcome this impasse, I recommend a swift and decisive move toward convergence science.  In this model, experts from multiple disciplines not only share knowledge, but actually meld their fields to produce new disciplines that are greater than the sum of their parts.

There has been little consistency across disciplines regarding how we approach the metrics of sleep. Establishing a common approach to the acquisition of sleep data — including EEG and behavioral measures — will help us begin to accurately track the maturation of the sleeping brain. It will also enable us to identify patterns associated with typical and atypical trajectories. In order to do that, we must foster a multidisciplinary field covering both sleep and neurodevelopment.

Traditional clinical categories such as insomnia or circadian rhythm disorder allow us to determine the best treatments for a disrupted sleep-wake cycle. These categories do not, however, reflect the complex shifting of neurotransmitters and electrophysiological potentials that occur each night and over critical periods in development. These shifts underlie both typical sleep behavior and sleep disorders.

If we accept that sleep is a process — an active and essential participant in the building and maintenance of brain circuits — we can begin to ask how that process serves brain development.

In the first few years of life, the circuits that underlie language, memory, motor skills and emotional and sensory associations are all forming. It is for this period that we have the least amount of objective data. We need to know much more about the work the sleeping brain is doing during this time. We also need to understand how these newly built circuits function in children who develop typically, as well as in those diagnosed with neurodevelopmental conditions.

Using the sleep EEG to detect changes in brain rhythms over time allows us to measure and quantify how these circuits mature in relation to development and behavior. The electrical signals produced during sleep provide a unique and early window into circuit development long before the associated behaviors appear.

Sorting out which signals are biomarkers for sleep disorders as opposed to markers of aberrant neurodevelopment in general is a complex undertaking. This is where the sophisticated measurement of the sleep process becomes important, and team science becomes indispensable.

Earlier this year, the National Institute of Mental Health hosted a workshop dedicated to establishing a consortium on sleep and neurodevelopment research. The group includes neurologists, child psychiatrists, and sleep and pulmonary medicine specialists. It also includes geneticists, psychologists, neuroscientists, computational experts and bioengineers. It has become clear that no single discipline, working in isolation, can put the sleep and neurodevelopment pieces together.

This article was not written as part of Ashura Buckley’s official duties as a government employee. The views expressed in this editorial do not necessarily represent the views of the U.S. government.


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