Sleeping without Prescription: Management of Sleep Disorders in Children with Autism with Non-Pharmacological Interventions and Over-the-Counter Treatments

Abstract

Autism Spectrum Disorders (ASD) are lifelong neurodevelopmental conditions characterized by abnormal social interaction, communication, and behavior. Sleep disturbances represent a common comorbidity in children and adolescents with ASD, with prevalence ranging from 50 to 80%. It has been proved that sleep disruption worsens the symptoms of autism and results in challenging behaviors. Improving sleep should therefore be a primary therapeutic goal. Treatment options range from lifestyle modifications to pharmacological therapy. Several reviews have been written on pharmacological treatments, but very few on the beneficial effects of non-pharmacological interventions, over-the-counter drugs, and nutritional supplements. This study consists of a narrative review of the literature, presenting the available evidence on the following treatments: sleep education, behavioral interventions, complementary and alternative medicine (special mattresses and blankets, massage, aromatherapy, yoga, physical activity), and commonly used over-the-counter medications and supplements (antihistamines, melatonin, tryptophan, carnosine, iron, vitamins, and herbal remedies). For some treatments—such as melatonin and behavioral interventions—effectiveness in ASD is well established in the literature, while other interventions appear of benefit in clinical practice, even if specific studies in children and adolescents with ASD are lacking. Conversely, other treatments only seem to show anecdotal evidence supporting their use.

Sleep Disorders in Autism Spectrum Disorder Pre-School Children: An Evaluation Using the Sleep Disturbance Scale for Children

“…Sleep disturbances are common in children with ASD [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 21 , 22 ], even if no consensus has been reached about the prevalence of this disorder, probably due to the different tools used as subjective (questionnaires, sleep diaries) or objective assessments (actigraphy, polysomnography) or due to the inclusion of children across wide age ranges. Very few studies have involved young children at pre-school age [ 2 , 5 , 23 , 24 ] or considered the associations between the severity of autism symptoms and sleep problems [ 23 ].…”

“…Among the medical conditions known to be associated with ASD, sleep disorders stand out as one of the most commonly reported; their prevalence in ASD children range from 45% up to 86% [ 2 , 3 , 4 , 5 , 6 , 7 , 8 ], and they have been shown to have a more chronic nature than those affecting typically developing children [ 6 , 7 ], thus having a significant impact on the health and quality of life of both patients and their caregivers. It has indeed been found that autistic chidren with sleep disorders experience increased daytime symptoms of anxiety, depression, aggressiveness, and attention deficit, as well as greater social impairment and poorer perfomances in cognitive and sensory–motor tasks, compared to autistic children who do not have sleep problems [ 9 , 10 , 11 ].…”

Effects of Supplementation With Antioxidant Agents on Sleep in Autism Spectrum Disorder: A Review

“…While the pharmacological treatment of sleep disorders in ASD children has been extensively reviewed, non-pharmacological interventions and nutritional supplements have been relatively under-examined ( 17 ). A separated discussion is required for melatonin, a hormone principally secreted by the pineal gland with an endogenous, circadian rhythm influenced by light/dark conditions.…”

The Sensory Abnormality Mediated Partially the Efficacy of Repetitive Transcranial Magnetic Stimulation on Treating Comorbid Sleep Disorder in Autism Spectrum Disorder Children

“…As mentioned in the “Introduction,” the high prevalence of sleep problems in children with ASD is more likely to be attributed to the pathogenesis of ASD, such as brain wave organizational and maturational differences, arousal and sensory dysregulation, circadian-relevant genes, and abnormal melatonin production ( 28 , 29 ). However, there is no intervention especially for the sleep problems of autistic individuals besides the conventional measures aimed at the behavioral insomnia of children caused by external factors, such as sleep education, sleep environment improvement, behavioral intervention, and drug treatment (such as exogenous melatonin) ( 28 , 30 ). Therefore, the intervention on the sleep problems in autistic individuals should consider the treatment of the core symptoms and sleep problems ( 31 ).…”