Children with autism are far more likely to have sleep problems compared to typically developing children, including difficulty falling asleep, staying asleep, and waking up at night.

The reasons for autistic children’s sleep issues are unclear, so Lucia Peixoto, assistant professor of translational medicine and physiology at the Elson S. Floyd College of Medicine, studies the interplay between sleep and autism at a genetic level.

Profile of Lucia PeixotoLucia Peixoto (Photo Cori Kogan)

She says getting to the root of the difficulties could potentially help ease other autism symptoms, since sleep problems appear so early.

“We need to talk about sleep,” Peixoto says. “This is the first thing the parents bring to the pediatrician because it affects everybody in the household.”

At WSU’s Sleep and Performance Research Center, Peixoto examines sleep problems that may be linked to a mutation in SHANK3, a gene strongly linked to autism.

Peixoto and her colleagues first analyzed sleep data from patients with Phelan-McDermid syndrome (PMS), a genetic disorder often associated with autism known to be caused by a missing SHANK3 gene. Starting at age 5, most kids with PMS wake up multiple times, have trouble falling asleep, and often get less than six hours of sleep a night.

Peixoto’s lab then studied mice with a mutation in the SHANK3 gene similar to what is seen in some patients with autism. Those mice took twice as long to fall asleep, slept less, and the sleep was of lower quality. This could explain why some individuals with autism simply cannot fall asleep, even if they’re sleepy.

This finding is one of the earliest indications that sleep problems in autism may have a genetic origin.

The experiments with mice also showed decreased activity in a group of genes related to the body’s circadian clock. Sleep-deprived mice had twice as many sleep regulation genes that didn’t turn on correctly.

This suggests that people with SHANK3 mutations may experience worsening symptoms due to sleep deprivation, Peixoto says.

She collaborates on sleep research with Annette Estes, professor of speech and hearing sciences at the University of Washington, director of the UW Autism Center, and a specialist in early diagnosis of ASD. Peixoto says that the UW Autism Center received many comments from parents that they need to look at sleep. This prompted Estes to start her own research program on the connection between sleep, development, and autism, and forged the collaboration with WSU.

“We know baby siblings of individuals with autism are much more likely to be diagnosed,” Peixoto says. Sleep issues could be an early biomarker, and Estes showed that as early as 12 months, baby siblings who had trouble falling asleep were much more likely to later have a diagnosis.

Insomnia or poor sleep is not a side effect of your brain being different, though, Peixoto says. “It may be a core aspect of the disorder.”

Peixoto points out that ASD is a developmental disorder and not everything is known about how sleep loss affects development. The Peixoto lab is continuing its autism research in collaboration with Marcos Frank, a world-renowned expert of sleep and development at WSU.

Plus, “there is no drug for autism. It is behavioral,” she says.

Exploring the fundamental causes of sleep problems and ASD is more than academic to her.

“I wanted to work on something that was relevant to individuals and caregivers,” Peixoto says. “Perhaps sleep problems can be detected very early on. As some aspects of the sleep problems develop as the baby develops, it potentially creates opportunities for intervention.

“And there’s no debate that sleeping better will benefit everybody.”


Read more

Looking early for autism”  (in current issue)

Rising star: Lucia Peixoto, breaking down the interplay between sleep and autism”  (Spectrum, May 9, 2022)

Sleep problems in autism, explained”  (Spectrum, February 6, 2020)