Sleep Difficulties and Autism Spectrum Disorders

A Guide for Parents and Professionals

Kenneth Aitken

• Publisher: Jessica Kingsley Publishers
• Year: 2012
• Print ISBN: 9781849052597
• eBook ISBN: 9780857005502
• Topic: Psychology
• Subtopic: Autism Spectrum Disorders
• Index: Psychology

Problems with sleeping are common and make life difficult for the individual who is affected and for those around them. Sleep difficulties are particularly prevalent amongst people with Autism Spectrum Disorders (ASD) and often cause or worsen other difficulties.

This comprehensive guide to the management of sleep problems, introduces all the proven remedies and focuses on the problems commonly found in ASDs and related conditions. The author discusses sleep in depth, including how we currently define and understand it. The full spectrum of sleep disorders is explained alongside the range of possible treatment approaches. The book also examines why some sleep problems are more common among people with an ASD than others, how sleep problems evolve over time, what can be done to treat them and the likely benefits from different treatments.

This book is a complete resource for professionals, families and carers working with those suffering from sleep problems of any kind. It will be of great interest to anyone wanting to gain a thorough understanding of sleep in relation to ASDs.

APPENDIX 1

MEDICATIONS USED IN SLEEP DISORDERS

This appendix provides information on the medications that are most commonly reported as being or having been prescribed in the management of sleep disorders. Recommendations on the use of medication can change over time and vary from country to country.

Appropriate advice on prescription medication should always be sought from a suitably qualified medical practitioner.

Medications have been extensively used in the management of sleep problems at least since the reported use of juniper berries, cyprus and beer to treat bedwetting by physicians in the Akkadian Empire over 4000 years ago. This early practice was noted in the Ebers papyrus around 1550 BC. Opium was reportedly used to aid sleep in Egypt around 1300 BC.

In more recent times a wide range of medications has been used in the management of sleep disturbances (Table App 1.1) (for general reviews, see Pagel and Parnes 2001; Reed and Findling 2002; Siriwardena et al. 2008; for ASD, see Attarian 2010; Johnson and Malow 2008c). The British Association of Psychopharmacology recently released a consensus statement on evidence-based treatment for sleep problems (Wilson et al. 2010).

TABLE APP 1.1 SUMMARY TABLE OF APPROACHES TO SPECFIC SLEEP DISORDERS
SLEEP DISORDER	Treatments of choice	Key evidence	Reported success rate for treatment	Possible issues
Difficulty settling to sleep and frequent night waking	Behavioural	Multiple studies, see: Moore, Meltzer and Mindell 2008; Ivanenko and Patwari 2009	70%	None
Insomnia	Behavioural and cognitive – behavioural and medication	Espie and Kyle 2009	70%+	None
Short night-time sleep	Behavioural	O’Reilly 1995; Piazza and Fisher 1991	Evidence base too small to compute	None
Excessive night- time sleep	Modafinil	Ali et al. 2009	88% (one study only)	Recent restrictions on use
Excessive daytime sleepiness/tiredness	Modafinil	Ivanenko 2003	Modest benefits in all (one small study)	Exacerbation of seizures and psychotic symptoms Recent restrictions on use
Nightmares	Imagery rehearsal; desensitization; relaxation and prazosin	Krakow et al. (2001a,b); Lancee et al. 2008a	Most studies with traumatic onset nightmares	Lack of maintained improvement with prazosin alone
Night terrors	Night waking and resettling; benzodiazepines; melatonin	Lask 1988; Popoviciu and Corfariu 1983; Jan et al. 2004	High spontaneous resolution rate; no RCTs	Uncertain due to limited evidence base
Night-time eating disorders	Sertraline; topiramate	O’Reardon et al. 2006; Stunkard et al. 2006	71%	Topiramate most effective but with a high rate of side effects
Nocturnal seizures	Medication – type dependent on diagnosis	Bazil 2003	No reliable data	Dependent on medication of choice
Sleep-related rhythmic movement disorder		Picchietti and Picchietti 2008	Self-remitting in most cases	No relevant safety data on ropinirole
Sleep bruxism	Orodental; behavioural; clonidine	Huynh et al. 2006; Huynh et al. 2007	Unclear	MADs can cause physical discomfort; clonidine can cause REM suppression and low morning BP
Obstructive sleep apnoea	Weight reduction; improved fitness; CPAP	Capdevila et al. 2008; Halbower 2008	80%+	Discomfort from CPAP and prostheses; general risks from surgery
Narcolepsy	Improved sleep hygiene coupled with medication (modafinil, sodium oxybate, venlafaxine or psychostimulants)	Kothare and Kaleyis 2008; Aran et al. 2010	70%	SSRIs have significant side- effects but are not first choice for management
Nocturnal enuresis	DDAVP; enuresis alarm; behavioural	Evans 2001a, 2001b; Wright 2008; Lyon and Schnall 2010	79%	Results with DDAVP do not generalize
REM sleep behaviour diso...

Table of contents

• Cover
• Of Related Interest
• Title Page
• Copyright
• Dedication
• Contents
• Acknowledgments
• Introduction
• Section A: Sleep and What we know About It
• Section B: Sleep Problems in General
• Section C: Sleep Problems in Asd
• Section D: Reasons Sleep Patterns May Happen or Can be Made Worse
• Section E: What Can You Do?
• Resources
• Appendix 1: Medications used in Sleep Disorders
• Appendix 2: Complementary and Alternative Treatment Approaches
• Appendix 3: Herbal Treatments
• Appendix 4: Assessment tools for Sleep Problems
• Further Reading
• Glossary
• References
• Index