Approaches to Improving Sleep in Autism across the Lifespan

Sleep problems are common in children with autism spectrum disorder and persist into adolescence and adulthood. Improving sleep can impact favorably on an individual's overall health, as well as daytime behavior and quality of life. Family quality of life may also improve when a child's sleep is improved. This presentation will discuss behavioral and pharmacological approaches to treating sleep problems in autism across the lifespan, with an emphasis on insomnia (defined as difficulty initiating or maintaining sleep).

For insomnia, supplemental melatonin is the most studied agent, and is effective in many individuals with autism with minimal adverse effects. Novel preparations of prolonged-release melatonin, which also improve night wakings, and melatonin agonists are becoming more available. However, the mechanisms whereby melatonin and melatonin agonists promote sleep are not clear, and in many individuals, insomnia may persist after treatment with melatonin. A wide variety of other medications are used to treat insomnia in autism, many with minimal evidence and significant potential for adverse effects. Behavioral sleep education and other non-pharmacological approaches have shown promise, although additional study is needed for how to effectively deliver these interventions, combine them with medications, and tailor treatments to individuals across the autism spectrum. The use of practice pathways to guide treatment, along with questionnaires and actigraphy to monitor treatment, will also be addressed.