2/4 Treatment Options for ASD-related Sleep Problems

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Since the mid-20th century, prescription medications have been widely used to treat insomnia and other sleep disorders. The general consensus among today’s physicians is that sedative-hypnotic z-drugs, or nonbenzodiazepines, are the most effective pharmacological option for treating sleep disorders. The three most common Z-drugs — zolpidem (Ambien), zopiclone (Lunesta), and zaleplon (Sonata) — induce sleepiness without disrupting sleep architecture, unlike benzodiazepines like alprazolam (Xanax) and diazepam (Valium), which can actually worsen sleep disorder symptoms in some patients.

However, Z-drugs and other prescription medications may be problematic for people with ASD. These drugs carry high dependency risks, and may cause side effects that exacerbate ASD-related physical problems like acid reflux and constipation. Additionally, sleep-inducing drugs may interact with other medications designed to help people with ASD feel more alert and focused throughout the day. The bottom line: people with ASD should consult their physician to discuss their current medication schedule before taking any sort of sleep medication.

Children with ASD are particularly susceptible to the dependency risks and negative side effects of sleep pills, so prescription drugs should be considered a last resort for them. If parents suspect their child with ASD has a sleep disorder, then a preliminary assessment should be their first course of action. These assessments may consist of actigraphy, where the child wears a sleep monitor on their wrist that tracks sleep-wake cycles, or polysomnography (PSG), which monitors neurological and cardiovascular activities during sleep. During this assessment, parents can help physicians rule out other factors that may be affecting their child’s sleep. These factors include medical issues like tonsillitis, swollen adenoids, epilepsy, and food allergies, as well as any medications they may be taking for ASD or ADHD.

Side Effects of Common ASD Medications

It’s important to consider that many medications used to relieve ASD symptoms may be negatively impacting the sleep of those who take them. The table below lists some of the most commonly prescribed drugs used to alleviate repetitive behaviors, hyperactivity, inattention, and other symptoms of ASD, along with their sleep and non-sleep-related side effects.

Medication

Trade Name

What It Treats

Can It Cause Insomnia or Disturb Sleep?

Other Side Effects

Risperidone

Risperdal

Irritability and aggression, aberrant social behavior

Yes

Weight gain, constipation, diarrhea, nausea

Aripiprazole

Abilify

Irritability and aggression

Yes

Weight gain, nausea, upper respiratory tract infection

Clozapine

Clozaril

Irritability and aggression

Yes

Weight gain, tachycardia, constipation, enuresis, frequent nightmares

Haloperidol

Haldol

Irritability and aggression, aberrant social behavior

Yes, but rarely

Hypotension, constipation, dry mouth, muscle rigidity

Sertraline

Zoloft

Irritability and aggression

Yes

Elevated energy levels, poor concentration, diarrhea

Oxytocin

Pitocin

Aberrant social behavior

No

Elevated blood pressure, nausea, vomiting

Methylphenidate

Ritalin

Hyperactivity and inattention

Yes

Appetite suppression, dry mouth, anxiety, nausea, weight loss

Venlafaxine

Effexor

Hyperactivity and inattention

Yes

Headache, nausea, dizziness, dry mouth

Fluoxetine

Prozac

Repetitive behaviors

Yes

Headache, dry mouth

Citalopram

Celexa

Repetitive behaviors

Yes

Elevated energy levels, hyperactivity, diarrhea, dry skin

Sleep Therapy Options

If the preliminary assessment indicates the presence of a sleep disorder in a child with ASD, then treatment will likely be the next step. Cognitive behavioral therapy (CBT) has proven fairly effective in alleviating sleep disorder symptoms for young people with ASD. CBT is designed to improve sleep hygiene in patients by educating them about the science of sleep and helping them find ways to improve their nightly habits. A study published in the Journal of Pediatric Neuroscience noted that children with ASD are often set in their routines, so establishing a consistent bedtime schedule can be quite beneficial to them. A healthy bedtime schedule might consist of the following:

  • Putting on pajamas
  • Brushing teeth
  • Using the toilet
  • Washing hands
  • Getting in bed
  • Reading a book (or being read to)
  • Shutting off the light

Additional behavioral interventions may help children with ASD improve their difficulties with sleep. According to a ‘Sleep Tool Kit‘ published by the Autism Treatment Network, these interventions include the following:

  • Create a ‘visual schedule checklist’ with pictures, objects and other visual aids that can help a child with ASD grasp the concepts more easily.
  • Keep the bedtime routine concise, and limit it to roughly 30 minutes before bed. Otherwise the child might become overwhelmed with too many commitments.
  • Order the routine so that stimulating activities like television and video games come first, followed by reading and other relaxing activities.
  • Physically guide the child to the schedule at first, and use verbal cues to remind them to check the schedule. Teach them how to cross things off on the checklist themselves.
  • Provide positive reinforcement whenever the child follows the schedule correctly.
  • If the routine must be changed, let the child know in advance so that they can mentally prepare for the disruption. Alter the checklist ahead of time to reflect these changes.

In addition to CBT, light therapy (also known as phototherapy) may also help children with ASD sleep better. This form of therapy is usually conducted using a light-transmitting box kept near the child’s bed. By exposing the child to bright light early in the morning, this therapy can help adjust melatonin production and make children feel more alert throughout the day. 

Pharmacological Treatments

Therapy interventions are often effective, but some children may not respond as well to them. If this is the case, then parents may want to consider some sort of pharmacological treatment. In lieu of prescription pills, the two options below are considered the most suitable route for children with ASD — though parents should not give either of these to their child before consulting a physician:

  • Melatonin: Children with ASD often experience circadian rhythm disruption that can lead to low melatonin levels. Melatonin supplements are widely available over-the-counter, and can help boost deficient melatonin levels. They also carry a low dependency risk and few adverse side effects, though nausea, diarrhea, and dizziness may occur.
  • Dietary supplements: In addition to melatonin, other natural supplements can help induce sleepiness and improve sleep maintenance in children with ASD. These include iron, kava, valerian root, and 5-Hydroxytryptophan (5-HTP). Multivitamins may also help, as well. These supplements carry no dependency risk, and adverse side effects are minimal.

The Center for Autism and Related Disorders notes that parents should avoid giving certain over-the-counter medications to children with ASD, including sleep-inducing antihistamines like Benadryl that are often erroneously used as sleep aids.

Finally, if none of these sleep improvement strategies work, then parents may want to consider prescription medication. Rather than turning to z-drugs or benzodiazepines — which are primarily intended for adult consumption — children with ASD may respond well to these two prescription drugs.

  • Clonidine: Clonidine is an anti-hypertensive medication used to treat a wide range of conditions, including tic disorders and ADHD, both of which are commonly found in children with ASD. Clonidine also induces sleepiness, so it may be used as a sleep aid — though the drug carries a dependency risk. A 2008 study noted that Clonidine reduced sleep latency and nighttime awakening episodes in children with ASD.
  • Mirtazapine: Designed to reduce ASD-related anxiety, Mirtazapine has also been shown to alleviate insomnia symptoms in children and young adults between 4 and 24 years of age. However, antidepressants like Mirtazapine have also been linked to suicidal thoughts and behaviors in young people (adolescents in particular), so this medication may not be suitable for certain patients.

Treating Sleep Problems in Adults with ASD

Z-drugs, benzodiazepines, and other stronger prescription sleep pills may be suitable for some adults with ASD who are experiencing insomnia and other sleep disorder symptoms. However, adults are also encouraged to seek out cognitive behavioral therapy options and over-the-counter supplements like melatonin before resorting to prescription drugs. Adults with ASD should meet with their physician to discuss which treatment pathway is best for them.

For more information about sleep therapy, please visit our guides to CBT and light therapy. We also offer a comprehensive guide to z-drugs, benzodiazepines, and other commonly prescribed sleep medications for adults.