Chapter 1: The Unique Association of Autism Spectrum Disorder with Sleep Problems

“Nightmare” denotes a word with different connotations for different people. For medical practitioners, psychologists, and sleep researchers, a childhood nightmare signifies a report of vivid and frightening dreams (American Academy of Sleep Medicine [AASM], 2014). For parents of individuals with autism spectrum disorder (ASD), the word “nightmare” may epitomize their nightly experience with their children’s sleep. Anecdotal reports from parents of individuals with ASD include cases of extremely stressful and sometimes dangerous sleep behaviors. Parents graphically describe their children (a) sleepwalking into the cold, night air into busy public streets; (b) waking screaming during the night and remaining awake for hours; (c) throwing furniture out of bedroom windows in the middle of the night; (d) hitting their heads against furniture seemingly in their deepest sleep; (e) screaming and hitting parents and siblings during the bedtime routine; and (f) sleeping in all environments but their own bed and then only on their terms. These parent observations of dangerous and disturbing sleep behavior can create a nightmare of locked and alarmed doors, of fear for their children’s safety, of sleepless nights from children’s screams or other disturbing behaviors, and of parents’ worry.