Casi dos tercios de los niños con autismo sufren insomnio crónico. Estos pacientes son especialmente vulnerables a los problemas del sueño –dificultad para conciliarlo, despertares nocturnos, etc.–, cuyos efectos negativos repercuten en su capacidad de atención, memoria, estado de ánimo y comportamiento.
La naturaleza del insomnio en estos casos acostumbra a ser multifactorial, por lo que cada vez es objeto de estudio por parte de más investigadores.
A partir del análisis de la bibliografía científica sobre el tema y con objeto de arrojar luz sobre las opciones de tratamiento e intervención, un estudio ha clasificado las posibles causas del insomnio en el niño autista, designando las de carácter genético, fisiológico o psicológico como intrínsecas y las de orden ambiental o externo como extrínsecas.
Así, entre las hipotéticas causas intrínsecas se barajan:
Diferencias en la madurez y la organización del sistema nervioso central: algunos estudios apuntan a que una anomalía en la madurez del sistema nervioso central afectaría a la calidad del sueño y reduciría su eficiencia, duración total y de la fase REM, dificultaría la conciliación y provocaría parasomnias.
Afectación de los genes del reloj circadiano: las anomalías en los genes que regulan los ritmos circadianos –el núcleo supraquiasmático del hipotálamo recibe de la retina información de los patrones diarios de luz y oscuridad y regula tales ritmos–pueden alterarlos, además de trastocar el ciclo de sueño-vigilia.
Hay indicios objetivos que vinculan las anomalías en los ‘genes reloj’ y en los genes de la homeostasis sináptica con el autismo y el ciclo de sueño-vigilia, pues una de las funciones del sueño podría ser la de mantener la adecuada homeostasis sináptica de las neuronas.
Producción anormal de melatonina: la melatonina se sintetiza en la glándula pineal del diencéfalo bajo la influencia del núcleo supraquiasmático y participa en multitud de procesos celulares, neuroendocrinos y neurofisiológicos, como el control del ciclo diario del sueño.
Así, niveles más bajos de lo habitual de esta hormona pueden provocar insomnio, despertares nocturnos y una mayor latencia del inicio del sueño.
El aporte complementario de entre 3 y 5 mg de melatonina ha demostrado mejorar la calidad del sueño en el niño autista cuando las intervenciones conductuales y ambientales resultan insuficientes.
Hiperactivación y alteraciones de la integración sensorial: el insomnio se podría definir como un estado de hiperactivación cognitiva y fisiológica.
De hecho, se ha observado que los insomnes presentan mayor actividad cognitiva y del sistema nervioso simpático, así como una frecuencia cardíaca más acelerada, mayor temperatura corporal y niveles más altos de noradrenalina.
Los trastornos como la angustia o el TDAH derivados de esta hiperactivación también pueden causar insomnio.
Entre las posibles causas extrínsecas del insomnio cabe destacar:
Estrés ambiental: los cambios en la rutina del sueño o en los estímulos sensitivos, o la necesidad de asociar algo (una persona, un objeto) al inicio del sueño favorecen el insomnio.
Estrés psicológico: provocado por situaciones de tensión mental o emocional: causa síntomas físicos como cambios prolongados en el estado de ánimo y el humor, angustia, depresión y, por supuesto, insomnio.
Estrés físico: la enfermedad como proceso estresante que es, empeora la calidad del sueño.
El niño con autismo es más vulnerable y proclive a ser afectado por todos esos factores extrínsecos e intrínsecos, por lo que a la hora de abordar su insomnio conviene recordar que varias de esas causas pueden concurrir de forma simultánea.
FUENTE: https://www.adsalutem.institute/posibles-causas-del-insomnio-en-los-ninos-autistas/
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