Sleep in Children with Autism

A new study examined sleep behaviors and sleep quality in children with autism spectrum disorder. The results were published Dec. 1 in the journal Sleep.

The study involved 59 children with ASD. They were between 4 and 10 years of age. They were compared with 40 typically developing children.

Parents completed the Children’s Sleep Habits Questionnaire. They also completed a sleep diary for their child each morning for 17 days.

Sleep was monitored for 10 nights by actigraphy. The actigraph was hidden in a pocket in the upper sleeve of a snug-fitting pajama top.

Results show that the average bedtime on weekdays was around 8:30 p.m. for children in both groups. But children with ASD had an average wake time of 6:27 a.m. This was 38 minutes earlier than the other children’s wake time.

About 58 percent of parents of a child with ASD had concerns about their child’s sleep. Less than 13 percent of other parents had similar concerns.

Thirty-seven percent of children with ASD were taking medication to aid sleep. Melatonin was the most common sleep aid. None of the other children were taking a medication for sleep.

Children with ASD had more parent-reported sleep anxiety. They were more often afraid of being in the dark, being alone and sleeping away from home.

A few sleep disorders also were reported more often by parents of children with ASD. These were sleep terrors, bedwetting and bruxism.

There was no difference between the groups in parent reports of bedtime resistance or sleep disordered breathing. Parents in both groups reported that their children are sleepy during the day.

Actigraphic data showed that sleep disturbances were common in both groups. An estimated 67 percent of children with ASD and 46 percent of other children had disturbed sleep.

It took children with ASD an average of 34 minutes to fall asleep; the other children fell asleep in about 22 minutes. Thirty percent of children with ASD had behavioral insomnia of childhood.

The authors concluded that all children should be screened for sleep problems during routine visits to the doctor. They also wrote that parents should be educated on strategies to promote strong sleep behaviors.

Earlier this year the Sleep Education Blog reported that melatonin supplements may be helpful for children with autism.

Sleep, Performance & Mental Practice

A new study examined how sleep enhances physical performance following mental practice. The results were published Dec. 1 in the journal Sleep.

The French study involved 32 healthy volunteers. They were between the ages of 20 and 35 years.

The volunteers were trained to perform a computerized finger-tapping task. First they memorized a sequence of eight finger movements.

Then they repeatedly tapped the sequence on a computer keyboard during 30-second periods. The goal was to be as fast and accurate as possible.

The authors reported that previous studies have used this task to show delayed gains in performance after a night of sleep. As a result some researchers recommend that physical practice should be followed by sleep to enhance a newly learned motor skill.

For this study some volunteers physically practiced the finger sequence. Others practiced it using motor imagery, a form of mental practice.

These participants only simulated the action in their mind. They perceived the sensations of how it feels to perform the action. But they didn’t practice the actual finger movements.

Performance was tested right after the 8 p.m. training session. It was retested at 8 a.m. after practice and an eight-hour night of sleep.

As a control, one group was tested after motor imagery practice and no sleep. They were trained at 8 a.m. and retested the same day at 8 p.m.

Results show “offline gains” in performance after a night of sleep for both practice groups. Their speed and accuracy improved. In contrast, the “no sleep” group was slower and made more errors during the retest session.

The results indicate that sleep contributes to the consolidation of motor learning acquired through motor imagery. They also support the principle of “functional equivalence” between mental practice and physical practice.

The authors suggest that motor imagery practice could be included during physical therapy and rehabilitation. For the maximum benefit this practice should be performed before a period of sleep.

Last month the Sleep Education Blog reported that sleep can improve skills that have been learned through observation. Learn more about sleep and memory.

Sleep, Pre-Teens & Puberty

A new study suggests that sleep changes in pre-teens may occur before the physical changes of puberty. The results were published Dec. 1 in the journal Sleep.

The Israeli study involved 94 healthy children from five schools. They were between the ages of 10 and 11 years when the study began.

The children completed sleep diaries to track their sleep-wake patterns. They also wore an actigraph on their wrist for one week as an objective measure of sleep. Assessments were repeated one and two years later.

Results show that changes in sleep-wake patterns predicted an increase in pubertal development over time. But pubertal change did not predict sleep changes.

Over the course of the study the time when children went to sleep was delayed by 50 minutes. Sleep time was reduced by an average of 37 minutes.

The authors noted that these changes are a typical part of the transition to adolescence. Children begin to go to sleep and wake up later. They get less sleep and compensate by sleeping longer on the weekends. They also develop greater tolerance to extended periods of wakefulness.

The Israeli children in the study only have one “weekend” night during the school week. They are off on Saturdays but go to school on Sundays.

On Friday nights they went to sleep later and slept longer. But their sleep quality was worse than on school nights.

Lead author Avi Sadeh said that parents and educators can play an important role in helping children prioritize sleep as they grow and mature.

“It is very important for parents to be aware of the importance of sleep to their developing teenager,” Sadeh told the AASM. “School health education should also provide children with compelling information on how insufficient sleep compromises their well-being.”

The NICHD reports that puberty tends to occur between the ages of 10 and 14 in girls. In boys puberty typically occurs between the ages of 12 and 16.

Learn more about sleep and children, and sleep and teens.

Sleepwalking, Sleep Terrors & Dreams

A new study shows that episodes of sleepwalking and sleep terrors may be related to short, unpleasant, dreamlike mental activity. The study suggests that people with these sleep disorders may be acting out dreamlike thoughts. The results were published yesterday in the journal Sleep.

The French study involved 43 people with severe sleepwalking or sleep terrors. Their age ranged from 11 years to 72 years. They were compared with 25 healthy controls. Sleep was monitored during an overnight sleep study.

Participants also were interviewed. They were asked, “What was going through your mind at the very moment of the episodes, whenever the night?”

Thirty-eight people were able to reliably answer questions about their mental content during the sleepwalking and sleep terrors episodes. These recollections covered a lifetime span.

Results show that 71 percent of people reported at least one incident of dreamlike mental content associated with an episode of sleepwalking or sleep terrors. The action in the dreamlike thoughts corresponded with the observed behavior.

A total of 106 reports of dreamlike mental activity were collected. The mental content was brief; 95 percent of the reports involved a single visual scene.

These dreamlike thoughts were frequently unpleasant. About 84 percent involved apprehension, fear or terror; and 54 percent involved misfortune. In 24 percent of the reports the dreamer was the victim of aggression.

People with sleepwalking and sleep terrors reported more severe daytime sleepiness. They also had four times as many arousals from slow-wave sleep.

The authors noted that dreaming typically is associated with the sleep stage of rapid eye movement sleep. REM sleep dreams tend to be long, complex and vivid.

Complex mental activity has been reported in non-REM sleep during slow-wave sleep. But are these dreamlike thoughts really dreams? The authors reported that this question is still debated.

So what does this dreamlike mental activity represent? The authors suggested that it could be the final part of a longer dream. The rest of the dream may be forgotten after waking up. Or it could be a short mental creation that is formed before or just at the time of arousal.

Learn more about parasomnias such as sleepwalking and sleep terrors. Get tips for preventing parasomnias on SleepEducation.com. Compare the common features of four parasomnias.

Image by Xava du

Acting Out Dreams: Fear and Laughing

A new study shows that healthy young adults are likely to report dream-enacting behaviors. The results were published today in the journal Sleep.

The Canadian study involved 1,140 first-year college students. About two-thirds of participants were women. They responded to different types of questions about dreaming.

One group answered questions that described specific types of dream-related behavior. Results show that 98 percent reported experiencing one of these behaviors at least “rarely” in the last year.

“Fear” was the most common behavior subtype. Ninety-three percent reported that they had felt signs of fear in their body after waking from a scary dream.

But not all dreams were frightening. Seventy-two percent reported smiling or laughing while waking from a happy dream.

Sexual arousal also was common. Seventy-eight percent reported that they had felt sexually aroused after waking from an erotic dream. This was more common in men than in women.

Each of the other behavior subtypes was reported by more than 50 percent of participants. They woke from a dream to find that they were talking, crying, punching or kicking, or making other motions such as waving or pointing.

Some of the behaviors were more common in women. They reported more fear, smiling and laughing, talking, and crying than men.

Lead author Tore Nielsen, PhD, noted that these were “normal” behaviors. They were unlike the extreme actions that occur when a person has REM sleep behavior disorder.

People with RBD act out vivid, action-packed dreams while remaining asleep. They may shout, punch, kick, run and even jump out a window. Injuries may occur to the dreamer or a bedpartner. Vigorous or violent episodes typically occur about once a week.

In contrast, the dream-related behaviors reported in the study were less intense. And they tended to be rare, occurring only once or twice a year.

“Normal episodes are usually extremely mild,” Nielsen told the AASM.

Read more blog posts about REM sleep behavior disorder. Learn more about dreaming.

Image by Krisztina Tordai