Could This Disorder You’ve Never Heard Of Be Causing Your Child’s Sleep Problems?A. Stout
It is well-known that many people on the autism spectrum experience sleep problems, more so than their neurotypical counterparts. Researchers aren’t entirely sure why this is, but there are several theories.
One theory you may have heard about involves issues with the body’s circadian rhythm, or internal clock. But perhaps you didn’t know that there are several different disorders that specifically affect the circadian rhythm. One of them is called non-24-hour sleep-wake rhythm disorder, or for short, non-24 or N24.
Previously called hypernychthemeral syndrome, non-24 is very common among those who are completely blind. But it can also happen among sighted people, and it is more prevalent in autistic people than in neurotypicals.
Like other circadian rhythm disorders, non-24 is a condition in which the body is not on the natural, 24-hour cycle. Instead, it might run on another schedule, like 25 hours, for example. That may not seem like much, but if your sleep time is gradually delayed minute by minute, hour by hour, day after day, that adds up, and eventually your schedule is totally out of whack. Others with non-24 may have a 24-hour sleep cycle, but their internal circadian rhythms, as reflected in hormonal and body temperature fluctuations, are off.
Both cases make it extremely hard to function on a traditional schedule. Many sufferers say it feels like they have really bad jet lag every single day.
Luckily, experts have a pretty good grasp of what causes non-24 (not too often you get to hear that said, eh?) Within each of our brains, there is a structure called the suprachiasmatic nucleus, or SPN. This is our body’s “master clock” that determines when it’s time to sleep or be awake—and directs the body to get moving or get sleepy, accordingly. But in order to keep up with a consistent, 24-hour schedule, it assesses the surrounding light; otherwise it gets screwed up (this is why non-24 is so common in those who are totally blind, and much rarer in those with sight). There may also be discrepancies between the body’s circadian rhythm and sleep schedule. Simply put: the body prepares for sleepytime, but actual sleep doesn’t happen in accordance with these bodily changes.
Since non-24 is pretty rare in sighted individuals, it can go undiagnosed. But if you think you or your child suffers from this unique disorder, definitely talk to the doctor. He or she may ask you to start keeping track of sleep schedules. If it is non-24, you’ll likely notice the data taking on a sort of stair-step pattern when charted, with sleep occurring at later and later periods until it goes around the clock. Kind of like in the picture below.
If you or your child has non-24, we’ve got good news and bad news. The good news: prescription medication for this condition exists! It’s called Hetlioz and is the only drug specifically for the disorder. The bad news: it may work on some, but not all, and it hasn’t been tested in children.
However, melatonin supplements—which you’ve probably already heard about if you’ve been parenting an autistic child for a while now—may also be effective in some patients.
Additionally, those with sight may benefit from a combination of medicine and what’s called light and dark therapy. Light therapy involves exposing oneself to bright light in the morning, a way of telling the body, “Hey, it’s time to wake up!” Dark therapy is pretty much the opposite: minimizing exposure to light at night so that the body’s hormonal and physiological bedtime routine can kick into gear.
All in all, non-24 is not about laziness. It is not about asserting willpower to be awake or asleep at the right times. It is a legitimate medical condition that deserves our respect and understanding. If you or a loved one is suffering from this debilitating condition, talk to your doctor. Consider joining an online or in-person support group, if you can find one. And above all else, remember that you are not alone.
See the next page to learn more about sleep issues in people with autism.