Sleep disorders
One of the most common comorbidities in children with ASD is sleep disorders. Their prevalence is 50-80%; for comparison, the prevalence of sleep disorders in neurotypically developing children is 20-30%.
According to the International Classification of Sleep Diseases, Version 3 (ICSD-3), we classify sleep disorders into seven main categories:
1. insomnia,
2. sleep-related breathing disorders,
3. hypersomnia of central origin,
4. circadian rhythm disorders,
5. parasomnia,
6. abnormal sleep-related movements,
7. other sleep disorders.
Insomnia is a late night’s sleep or frequent night-awakenings that reduce sleep efficiency.
Parasomnias include a variety of conditions that occur during sleep, such as drowsiness, teeth, grinding (bruxism), nightmares, and others.
It is these two types of sleep disorders that are most common in children with ASD.
Evaluation of sleep disorders
Subjective and objective methods are used to assess sleep disorders.
- Subjective methods include a sleep diary and sleep questionnaireswhere the parent records information about the child’s sleep, sleep time, length of sleep, night awakenings and other important facts related to sleep, or answers individual questions in the questionnaire, for example according to the frequency of occurrence of the given behavior.
- The objective methods are polysomnography and actigraphy.
Polysomnography is performed in a specialized workplace, in the sleep laboratory. It is an all-night monitoring examination which, using electroencephalography, electrocardiography, electromyography, and oximetry, records individual stages of sleep, detects limb movement and at the same time provides information about the respiratory and cardiovascular system.
Actigraphy can be performed in the home environment. It records the child’s physical activity throughout the day and night and thus analyzes the various phases of the sleep and wakeful cycle.
Treatment of sleep disorders
Behavioral methods are first used in the treatment of sleep disorders, and pharmacological therapy is considered when the aforementioned are ineffective. However, the primary intervention should be the establishment of healthy sleep hygiene, in regards to which it is possible to recommend:
- the room, in which the child is sleeping, should be quiet, dark, well ventilated, without television or other electronic devices,
- sleep and wake times should be approximately the same every day,
- avoid stronger emotional stimuli and physical activity 2-3 hours before going to bed,
- consume only easily digestible meals at dinner,
- have enough exercise in the fresh air during the day,
- introducing a ritual of activities before going to bed (e.g., changing clothes, brushing teeth, going to bed, fairy tale and good night).