Insomnia and Treatment Strategies: Improving Quality of Life in Children with Autism Spectrum Disorder
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LETTER TO THE EDITOR
Insomnia and Treatment Strategies: Improving Quality of Life in Children with Autism Spectrum Disorder Bárbara Virginia Vitti‑Ruela1 · Vinícius Dokkedal‑Silva2 · Priscila Kalil Morelhão2 · Sandra Doria Xavier2 · Sergio Tufik2 · Monica Levy Andersen2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Dear Editor, Autism spectrum disorder (ASD) is a complex developmental disorder that involves impairments in social communication and interaction, sensory abnormalities and restricted and repetitive behaviors (Vahia 2013). Insomnia is commonly observed in children with ASD, reaching a prevalence as high as 60–86%, two to three times greater when compared to typically developing (TD) children (Richdale and Schreck 2009; Posar and Visconti 2020). The main cause of sleep disorders include the interaction of several factors, such as poor sleep hygiene and abnormalities in the melatonin system (Mazurek and Sohl 2016; Gagnon and Godbout 2018). A systematic review assessing objective and subjective sleep studies in individuals with ASD found a significantly higher bedtime resistance, sleep onset delay, sleep anxiety, night awakenings, parasomnias, sleep-disordered breathing, daytime sleepiness, sleep onset latency (in min), restorative value of sleep and general sleep problems (Diaz-Roman et al. 2018; Mazurek and Sohl 2016). Moreover, sleep deprivation effects seem to be more intense in ASD children than in TD ones (Mazurek and Sohl 2016). As a consequence of these sleep problems there is a worsening of behavior, which may include aggression, irritability, inattention and hyperactivity (Mazurek and Sohl 2016; Posar and Visconti 2020). The neurological mechanisms underlying insomnia in ASD are not yet fully understood. However, it is known that sleep plays an important role in neurological development, since many of the processes involved occur at ages when * Monica Levy Andersen [email protected] 1
Faculdade de Medicina de Marília, Avenida Monte Carmelo, 800, Marília, Brazil
Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 925, Vila Clementino, São Paulo 04024‑002, Brazil
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sleep is the predominant brain state (Wintler et al. 2020). The balance between excitatory and inhibitory neurotransmission, especially with regard to the paradoxical mechanism of GABA, seem to influence the pathophysiology and be related to the dysfunction of the ASD network (Wintler et al. 2020). One possible mechanism involved in insomnia in ASD children could be sensorial dysregulation, which is very frequent. Reynolds et al. (2011) found a higher prevalence of atypical sensory behaviors and sleep disturbances in children with ASD aged between 6 and 12 years when compared to TD. As suggested by Souders et al. (2017), sleep difficulties may be connected to localized problems in different sensory areas and a higher sensory threshold (that is, a reduced sensibility to sensory stimuli) would be related to better sleep. In this sense, a focus must be
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