ABSTRACT
INTRODUCTION Disordered sleep affects daytime health and behavioral functioning in a variety of neurologic and psychiatric conditions, and autism spectrum disorders (ASD) are no exception. Treatment of sleep disorders in this population may not only improve sleep, but daytime behavior and autism symptoms as well. Furthermore, treatment of sleep problems in children with developmental disabilities and challenging daytime behavior may reduce parental stress and heighten their sense of control and ability to cope with their child’s sleep. The causes of disrupted sleep in ASD are discussed in a separate chapter (chap. 24); this chapter will emphasize non-pharmacologic and pharmacologic treatment options to promote sleep. Two points should be emphasized. First, defining the cause of the sleep disturbance is critical to appropriate intervention. For example insomnia due to poor sleep hygiene may be responsive to behavioral interventions, insomnia due to impaired circadian control of sleep may be responsive to treatment with supplemental melatonin or light, daytime sleepiness due to obstructive sleep apnea should respond to treatment with adenotonsillectomy or continuous positive airway pressure (CPAP), and nocturnal events due to epileptic seizures should be treated with antiepileptic drugs. Second, pharmacologic and non-pharmacologic treatments often go hand-in-hand in the treatment of sleep disturbances in ASD. Whenever possible, behavioral treatments, which provide the foundation for proper sleep, should precede pharmacologic treatments to minimize adverse effects and maximize benefits achieved from pharmacologic treatments (Table 1).
