Sleep Issues in ASD – Live Q&A with Kenneth Sassower, MD

Kenneth Sassower, M.D., answers questions about sleep issues experienced in autism. He discusses sudden changes in sleep cycles, considers interventions for epilepsy, and provides context on the use of melatonin, GABA, and other medications. The speaker highlights the importance of sleep hygiene and emphasizes behavioral strategies for improving sleep for children, families, and caretakers. Parental sleep deprivation is of critical importance in this segment of the population. 

In this webinar:

1:55 – Background and expertise
3:00 – Sudden changes in sleep cycles
12:15 – Epilepsy in autism
16:40 – Melatonin
24:25 – Extended-release
29:00 – GABA and magnesium
36:16 – Tryptophan with 5-HTP
37:45 – Sleep environments
41:00 – Causes of sleep issues
47:15 – Sleep hygiene
53:30 – Parental sleep deprivation

Question 1: Sudden changes in sleep cycles

Sassower explains how communication challenges can often hinder the detection and understanding of sleep issues in autistic individuals (3:00). Restless leg syndrome, diet, and bedtime routine all contribute to sleep onset and duration (5:25). The speaker emphasizes the need to rule out medical conditions such as chronic pain and sleep apnea, noting that in-lab monitoring is sometimes needed (7:30). Pulse oximetry, which measures oxygen desaturation throughout sleep, can be used to screen for sleep apnea (9:15). 

Question 2: Epilepsy in autism

As of 2016, researchers are still trying to understand specific details about why seizures occur and what role they play in sleep functioning (12:15). The speaker notes that children who experience seizures may find it harder to wake up in the morning and need more rest during the day (14:50). He outlines potential sleep interventions that support daytime function reiterating the connection between sleep and behavior (16:29).  

Question 3: Melatonin

Melatonin is produced in the brain’s pineal gland, which is sensitive to the dark-light cycle. Melatonin supplements/medications are proven to support sleep onset and, therefore, can help treat circadian rhythm (sleep clock) issues (16:40). Sassower notes that melatonin doesn’t help people stay asleep and so is not very effective for treating night wakings or epilepsy (18:25). Extended-release melatonin has seen some success in autistic patients, but the speaker avoids using it. He explains that melatonin isn’t meant to regulate sleep cycles, so he generally looks for another driver in cases of night wakings (21:30). If melatonin doesn’t affect sleep latency, it is best to halt its use and search for another option (24:44). 

The primary drivers of sleep issues are biological, medical, and behavioral factors (26:20). Therefore, treating medical conditions like sleep apnea, anxiety, or epilepsy can improve behavioral and social functioning during the day (27:40). 

Question 4: GABA and magnesium

Gamma-aminobutyric acid (GABA) is a neurotransmitter known to promote sleep depth, and GABA medications have seen safe success in inducing and maintaining sleep (29:00). GABA could be a promising intervention for major sleep issues like sleep apnea and epilepsy (31:00).

Magnesium is commonly used for headaches and restless leg syndrome. However, the speaker asserts that individuals should only supplement magnesium in their diet if their serum magnesium levels are below normal (33:45). Assessing calcium levels and other nutritional values is also helpful for sleep interventions. The speaker discusses the historical use of Tryptophan with 5-HTP, why it left the market, and its potential use compared to other available medications (35:16). 

Question 5: Sleep environments 

The presenter explains how screen time and other environmental factors impact sleep onset and efficacy (37:45). He notes that some people can only sleep with the light on and explains how this could be tied to anxiety, behavioral routines, fear, or several other medical and biological factors (39:00). Sassower explains that some people simply need more sleep than others. However, after a sudden shift in sleep patterns, it is essential to look for any critical changes that occurred around the same time (41:00). This includes new medications (over-the-counter), changes to diet, bedtime routines, daytime habits, etc. (44:30). The speaker touches on neural feedback as a behavioral treatment that helps with falling back to sleep (45:00). 

Question 6: Sleep hygiene

Sleep hygiene includes all daytime and nighttime routines that impact sleep efficacy (47:15). Sassower emphasizes behavioral management for sleep issues, including things as simple as brushing your teeth, changing clothes, and creating an environment conducive to sleep (51:15). Good sleep hygiene, he continues, means that you have tools and techniques to help support good, rejuvenating sleep.

Question 7: Parental sleep deprivation

Parental sleep deprivation is a critical aspect of sleep issue interventions in autism (53:30). In many cases if one person is awake at night, the whole family is awake, which can lead to stressors in relationships and daily functions for everyone (55:15). The speaker asserts the need for further investigation and focus on this subject because a significant segment of the autistic community is suffering from sleep deprivation (57:00).