Aspbergers Syndrome Sleep Disorders Linkages

A new study from University La Sapienza in Rome shows children with Aspberger Syndrome have more sleep problems than average children. Dr. Oliviero Bruni, who authored the paper, found that children with Asperger have a high incidence of certain sleep disorders and other problems involving sleep initiation and restlessness, as well as morning problems and daytime sleepiness.

The study, published in the journal SLEEP, November 1, 2007 issue, involved eight children with AS, 10 children with autism and 12 healthy control children. Parents of the children with AS filled out questionnaires, including the Pediatric Daytime Sleepiness Scale, which evaluates the relationship between daytime sleepiness and school-related outcomes, the Autism Diagnostic Observation Schedule, a standardized assessment of autism spectrum disorders, and a Child Behavior Checklist used to examine daytime behavior in children.

Sleep Study Results

According to the results, 50 percent of the children with AS were disinclined to go to bed. 75 percent had a need for a light or television in the bedroom, 87 percent had difficulty getting to sleep at night and 75 percent fell asleep sweating. Also, 50 percent felt unrefreshed when waking up in the morning, 87 percent had difficulty waking up in the morning and 87 percent felt sleepy during the day.

Another recent study of sleep disorders in children, 30%-40% of children had problems falling asleep, while a year later, about 30% to 40% of the same children did not describe any difficulties initiating sleep, and 60% did report continuing difficulties initiating sleep.

Non-REM Sleep

Sleep happens in stages occurring at different times of night. The two major types of sleep states are rapid eye movement (REM) sleep, and non-rapid eye movement (Non-REM) sleep. Non-REM sleep is divided into four different stages, stages 3 and 4 being referred to as deep sleep. REM sleep occurs approximately once every 90 minutes.

Many of the recuperative functions of sleep happen in non-REM sleep. For example, the release of hormones that aid the body in rebuilding from damage done during the day, which is why various phases of non-REM sleep are analyzed in such studies.

CAP EEG

CAP readings of the Asberger children, compared to healthy controls, showed a lower total CAP rate in the first two sleep stages, but not in slow wave sleep. In addition, they showed an increased percentage of synchronized EEG patterns and a decreased percentage of desynchronized EEG patterns. Duration of the A and B phases, and consequently the entire CAP cycle, was longer.

Compared to the children with autism, AS subjects showed an increased CAP rate in slow wave sleep and a decrease in the second sleep stage. The duration of the A phases was longer, as well as the CAP cycle duration.

“This study showed peculiar CAP modifications in children with AS and represented an attempt to correlate the quantification of sleep EEG oscillations with the degree of mental ability or disability,” said Dr. Bruni.

Not the First

This is not the first study to look at Asberger Syndrome sleep behaviour, contrary to claims in the press release accompanying the publishing of this report. See References below.

Most of these studies have similar conclusions; that Aspergers Syndrome children have a harder time falling asleep than non-Autism Spectrum Disorder children, and that these are symptoms that must be considered in treatment plans.

One paper ventured an intriguing explanation of the phenomenon. A 2004 study from Helsinki University (Neuropsychobiology. 2004;50(2):147-52) examined EEG readings of 20 young Asbergers Syndrome adults compared to their non-AS peers.

“It seems that nonorganic insomnia, due to anxiety inherent in AS, is responsible for the low sleep quality in these subjects,” the authors concluded.

Several other theories regarding the mechanism of sleep problems in people with Asbergers and other Autism disorders have been proposed. One is that some neuro-chemical difference in children with autism is to blame.

For instance, children with autism may be experiencing irregular patterns of melatonin secretion. Perhaps autism spectrum disorder children are unable to use social cues to time sleep/wake cycles, not understanding when it is time for bed or to get up?

This could be due to above average sensory sensitivity, and may be very sensitive to subtle changes in things in their environment, such as smells, barometric pressure or lighting conditions.

Along the same lines, allergies and food sensitivities have been brought up; are minute or not so minute amounts of sugar, caffeine or other additives keeping them awake? Or does lack of sleep actually produce autism-like symptoms, not the other way around?

Whatever the cause may be, and this is certainly an area of potential for neurological knowledge, it is clear that treatment of the sleeping difficulties linked to Asbergers can have a positive impact of the daytime life of these children.

References

Berthier ML et al (1992). Recurrent hypersomnia in two adolescent males with Aspergers syndrome. J Am Acad Child Adolesc Psychiatry, 31(4), pp. 735-738.

Hare DJ, Jones S, Evershed K. (2006). Objective investigation of the sleep-wake cycle in adults with intellectual disabilities and autistic spectrum disorders.J Intellect Disabil Res, (Pt 10), pp. 701-710. Abstract

Malow BA et al. (2006). Characterizing sleep in children with autism spectrum disorders: a multidimensional approach. Sleep, 29(12), pp. 1563-1571. Abstract

Oyane NM, Bjorvatn B. (2005). Sleep disturbances in adolescents and young adults with autism and Asperger syndrome.Autism, 9(1):83-94.

Patzold LM, Richdale AL, Tonge BJ. An investigation into sleep characteristics of children with autism and Aspergers Disorder.J Paediatr Child Health. 1998 Dec;34(6):528-33.

Polimeni M.A., Richdale A.L. and Francis A.J. (2005). A survey of sleep problems in autism, Aspergers disorder and typically developing children. J Intellect Disabil Res, 49(4), pp. 260-268. Abstract

Tani P et al. (2004). Sleep in young adults with Asperger syndrome. Neuropsychobiology, 50(2), pp.147-152.