New Research on Autism and Circadian Rhythm Disorders

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Michelle Dawson has blogged about circadian rhythms in autistics here:

http://autismcrisis.blogspot.com/2010/0 ... rison.html .

I fall asleep at night listening to the radio.

It's past midnight here.

My circadian rhythm is very odd. I will usually not be sleepy early in the night, however, I get extremely sleepy around 9 in the morning, and 5 in the afternoon. It lasts for an hour, then I'm fine, though I'm much better if I nap during that hour.

Then the 'summer blues'. I have such a hard time with it dawning so early.

I use melatonin almost every night. I find that heavy exercise helps a lot (also helps my mitral valve prolapse). I've also had a lot of success doing relaxation tapes before sleeping.

Due to my work schedule, I regularly switch my schedule for diurnal to nocturnal twice a month. I'm a telescope operator, so I need to be awake all night, but I live in Hawaii and I want to enjoy the sunshine. I've worked night shift for 20 years now, so it obviously works for me.

I can easily stay up for extremely long periods of time, but it wracks my body, so I avoid it.

No it's not. I have a condition called "irregular sleep-wake pattern" that is exactly that. I have to take medication to make me sleepy at night and even that doesn't always work.

considering i was up with my 4 yr old last night until 1 am, i know at least one other aspie who has sleep troubles. he has been like that his whole life, hard for him to get to sleep, his mind doesnt seem to shut down and go quiet enough for him to get to sleep. once he does get to sleep, he will usually sleep a normal amount of time, so he would have slept today until noon if we let him, but that just makes bedtime tonight that much harder.

i believe most people have circadian rhythms that are naturally a bit longer than a 24 hour day. no surprise the amount of sleep issues people have.

ironically, i just came across a blog post a little bit ago that was about this topic. it was an interesting read, and talks about something i had never considered before: that the total lack of a circadian rhythm could be a GOOD thing. the blogger is an autistic with no natural rhythm. http://autismcrisis.blogspot.com/2010/0 ... rison.html

Whether it's a good thing or not depends on the person. For me, I can't do what she does -- I can't sleep any time I want to. I sleep when I have to. Sometimes that's two hour naps randomly scattered through the day, sometimes they cluster together, sometimes they don't, it's just totally random. And I am much, much healthier, with lower pain levels and stuff, now that I'm on medication that helps me sleep at night rather than randomly. (Although I still fall asleep in the middle of the day a lot.)

I don't mind at all that some people do well this way, it's just not how I experience it, at all.

I use to have a lot of trouble with sleep cycles.. never get tired, wake up every 30min or so, and then after about 8 hours of broken sleep I would finally fall into deep sleep and couldn't wake up. My doctors think I'm having partial seizures in my sleep which keeps it broken up and accounts for headaches, feeling sore, and feeling completely exhausted even after a full 8-10 hours of good sleep.

Ive been taking melatonin for about 2 months now and I sleep a lot better, however I still wake up with headaches and the feeling of exhaustion. Seeing my neurologist in a few weeks, they're probably going to do a sleep study and see whats really going on. Good times

I have sleep apnea and have a CPAP machine for it. If I don't use it I can't sleep.

Technically, yes, but it can get so disordered as to be a lack of circadian rhythm for all practical purposes.

The OP may want to read a checklist for bipolar disorder; being unable to sleep for long periods of time is a trait of a manic period, and these periods can last months. Bipolar disorder messes with your sleep cycle pretty badly.

But it is of course not the only possibility. Another is that the OP may be hyposensitive to the signals that tell you that you are tired; so that he is technically tired, but doesn't know it. (A more common problem has to do with hunger: Having to schedule meals because you don't get your body's "Hungry" signals until you're light-headed and haven't eaten all day.)

Then there's the laser-pointer attention issue. If you're not paying attention to anything but the thing you're focused on, tiredness can fall by the wayside just because you're so preoccupied.

Prescription sleeping pills are not the best way to handle it (though you may need them for now); have you had your doctor teach you about sleep hygiene and relaxation techniques?

Some prescriptions aren't as bad as actual sleeping pills, too. I was prescribed a nightly dose of amitriptyline (a tricyclic antidepressant that also works for a variety of non-depression-related conditions) as a migraine preventative. It didn't prevent my migraines, but I was sleeping regularly. I told my doctor and he told me that's an actual use for it (and better for you than most sleeping pills, although there's risks with any medication) and he'd be glad to keep me on it. It's a fairly low dose, too, to keep down side-effects.

I've been aware of sleep hygiene stuff since I was 19. Long story, but my neuropsychologist taught it to me thinking it would solve my sleeping issues. It... didn't. (He told me I had to become able to sleep regularly before he would concede that I was anything close to an adult, and that I had abrogated my right to adulthood (and any of its privileges) by being in the psych system. And that he might consider me a little bit closer to an adult if I could sleep regularly. I didn't know better so I believed him -- much easier to lie to a patient than to have to petition for guardianship and possibly lose. I knew another autistic patient of his and he was a jerk to her too in the end. Both of us had no idea what he could be like until we tried to get away from him.)

Here's what the international classification of sleep disorders says about it:

Irregular Sleep-Wake Pattern

ICSD: 307.45-3
ICD-10: G47.2 (Disorders of The Sleep-Wake Schedule)
DSM-IV: 307.45 (Circadian Rhythm Sleep Disorder)

Irregular sleep-wake pattern
consists of temporally disorganized and variable episodes of sleep and waking behavior.

Prevalence:
Apparently rare in the general population. The prevalence in patients with diffuse brain dysfunction is unknown, but the syndrome is probably not uncommon in severely impaired, institutionalized patients.

Keywords:
No circadian rhythm, disregard of Zeitgebers, grossly disturbed sleep-wake rhythm, low amplitude circadian rhythms.

So apparently it's thought of by some as "no circadian rhythm". (I've done some research and "irregular sleep-wake pattern" is common in autistic people. Also in people with Parkinson's. As a person with autism and an autism-related parkinsonlike condition (and a parent with a separate parkinsonlike condition and a great-aunt with Parkinson's, for that matter), maybe it's not surprising that I have this.)

Note also "disregard of Zeitgebers" -- Zeitgebers is another word for sleep hygiene. So if this is truly the problem, sleep hygiene will be likely of limited to no use. But it's worth trying if you haven't already. Just don't be shocked if it doesn't do anything. Sleep hygiene is better for people with different circadian rhythm disorders than this one.

I have always had trouble with sleep and my daily rhythms as well. I remember reading that people with ASD's are, on average, deficient in for . I have been taking melatonin and it has been working for me. However I have to take 9 mgs( 3 pills) a night for it to have any effect at all. I am afraid I may become to dependent on the pills.

I have the continually advancing sleep-time thing, though that's been better lately. I've been taking doxepin about 6 months, though the sedating effect seems to be lessening. I still get to bed late -- about 5am, but it's at least consistent from day-to-day.

I've tried Ambien, but got tolerant to highest does in 2 weeks, and the same with Xanax. Weirdly, alcohol gives me horrible insomnia (though it was different when I was younger; might be a CFS thing). The most sedating med I've ever been on is Remeron. It's normally used as an anti-depressant, so there may not be tolerance effects, as with Ambien or benzos. (I stopped it because it made me insanely hungry all the time, which is a known side-effect, though.)

And Adderal totally f-ed my (marginal) ability to sleep on a schedule. Ugh.

Before I went on antipsychotics I slept 4 hours a night for several years without ever getting tired. I loved it. I could get lots of stuff done at night. Now I am on two different antipsychotics and I sleep 8-9 hours a night very deeply and wake up in the morning feeling exhausted. Every time I attempt to stop my antipsychotics I relapse. So the "lesser of two evils" is to take them and be tired all day and sleep too much.

Sleep is annoying. I wish I could live without it completely.

The only thing that ever worked in helping me get to sleep at the same time every night was Cannabis. If you're lucky enough to live where you can get it legally give it a shot. I used to just take 5 or 6 puffs at 11pm and I'd sleep fine until 7am with maybe a bathroom break at some point. And if I couldn't get back to sleep then I would just take 2 or 3 more. Its far weaker, less addictive and less dangerous than alcohol or ANY of the prescriptions you are taking.

Not really. Many of the milder sleep aids are safer than marijuana, especially smoked (which enters your lungs and does the usual damage).

I mentioned sleep hygiene because it is always the first thing you should try--a lot of doctors seem to think that you can just throw pills at the patient and call it done, when there are non-medical approaches that often work just as well. And even when you do use chemical sleep aids, basic sleep hygiene is important (I use melatonin)--it helps minimize the dose needed and the strength of the medication you use.