Autism & Sleep, with Dr. Beth Malow | EDB 238

 

Vanderbilt University’s Dr. Beth Malow discusses sleep challenges on the autism spectrum.

(26 minutes) Dr. Malow is Professor of Neurology and Pediatrics, Director of the Vanderbilt Sleep Division, holds the Burry Endowed Chair in Cognitive Childhood Development, and serves as Vice Chair for Clinical Research in the Department of Neurology and incoming director of the Vanderbilt Kennedy Center Clinical Translational Core. Her research has emphasized the interface of sleep and epilepsy, autism, and related disorders of neurodevelopment. Dr. Malow is board certified in neurology and Sleep Medicine. She is Vice Chair of the governor-appointed Tennessee Autism Council. Dr. Malow serves as PI for the Vanderbilt site of the NeuroNEXT Network (NINDS Network of Excellence in Neuroscience Clinical Trials). She also serves as the principal investigator for Vanderbilt’s Autism Treatment Network, one of 12 regional autism centers across North America developing standards of medical care for children with autism.

For more info on Dr. Malow’s work: vumc.org/sleep-in-autism

For her book, “Solving Sleep Problems in Children with Autism Spectrum Disorders: A Guide for Frazzled Families” click here

 

 

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HACKIE REITMAN, MD (HR):

Hi, I’m Dr. Hackie Reitman. Welcome to another episode of Exploring Different Brains. I get to meet the most exciting people and today with us all the way from Nashville, Tennessee, where she sings in a chorus by the way, I’ll get to that later… we have one of the world’s authorities on sleep and autism, a tenured professor at Vanderbilt… none other than Professor Beth Malow. Beth, welcome.

 

BETH MALOW, MD (BM):

Thank you. I’m glad to be here.

 

HR:

Oh, thank you for taking the time to, to be with us. Because aside from everything else, one of the most underrated things in the world is sleep. And yet here we are, here we are in 2021 and people still don’t get the importance of sleep. How did you get into sleep?

 

BM:

That’s a great question. Well, we all sleep. And I’ve always been fascinated by it. But I was actually training as a neurologist and the National Institutes of Health in Bethesda, Maryland. And I was I was studying epilepsy seizures. And I was really fascinated by how when people with seizures went to sleep, their seizures went away. And certain parts of their sleep like they just completely didn’t have seizures. They didn’t have abnormal– we call them spikes on their brainwaves, their ages, they all just went away. And I was like, wow, this is pretty magical. And then I also worked with some seizure, patients who had sleep apnea, obstructive sleep apnea where they would stop breathing in their sleep. And when we gave them a CPAP machine, and and improve their sleep apnea, we noticed that they stopped having seizures. So I… those two things just fascinated me. And I said, I really need to know more about this. You know, what happens when we sleep and how we can make a difference in people’s lives.

 

HR:

How did you end up at Vanderbilt?

 

BM:

So I ended up at Vanderbilt? Well, I wasn’t I went from the National Institute of Health to University of Michigan, in Ann Arbor, Michigan, where I was junior faculty studying sleep and epilepsy. I did both I saw patients with sleep problems, patients with epilepsy. And then I wrote grants in the interface of the two. And what happened was the my mentor at University of Michigan, his name is Bob McDonald. He became the chair of neurology, at Vanderbilt in Nashville. And he said, Do you want to come down and start our or revamp our sleep program? We want to expand the sleep program. And of course, my impression of Nashville at the time was being from New York originally, right? was, Oh, isn’t that where Elvis is? Right? Turns out out, this is in Memphis. But it was a very unusual thing. I really didn’t ever think I would find myself in Tennessee. And here I am. 17 years later, and we’re still here.

 

HR:

And helping so many people with all the great research you’re doing. So you’re in Nashville. So naturally, you have to do something with music. Tell us what you’re doing in music.

 

BM:

Well, I want to say and I found a group called Sweet Adelines. It’s actually Metro Nashville Chorus. And were a chapter of Sweet Adelines International. So I sing barbershop acapella music with about 50 other women. And we compete, we go to different conferences, we we we’ve done really well. Like we want our region a few times. And we’ve gone on and then in the top 10 in an international competition. I also sing in a quartet of four of us, you know, there’s different parts similar to the men’s barbershop. I have to say it’s been really frustrating with COVID because right now we’re rehearsing on zoom, which is kind of interesting, because of the risks, you know, of transmitting COVID. But our hope is that, you know, as the vaccines come out, and more and more of us are vaccinated, we can go back to rehearsals soon,

 

HR:

What is the biggest single thing you can share with our audience that you’d like them to really know and remember about autism and sleep?

 

BM:

Wow, that’s that’s a great question. I think what I would say was, you really want to take a holistic approach. So when I started getting involved, I would read all these papers on that were kind of esoteric, really like, really, you know, there’s this problem with rapid eye movement, sleep, or there’s this neuro chemical that’s not quite right in the brain. But there’s so many different facets. So for example, kids with autism watch screens, just like any other kid, and in some way, some instances, they do even more work, you know, they do even more time with their video games, and they just love their video games. That is a problem with sleep, right? Because you get bright light from the video games, it can be very stimulated content. So as a result, you don’t sleep. So you could have the best neuro chemicals in the world in your brain, you could have medication on board to help you sleep. But if you don’t address that video game issue, and that screen time, you’re not going to get anywhere. So that’s something I always tell people is you have to look at the whole child, you have to look at whether they’re having gi issues, whether you know they’re having constipation, or whatever, and that’s keeping them awake, you have to look at whether they could be having sleep apnea, you have to be looking at whether they’re depressed, you have to be looking at what meds they’re taking right for their depression or their ADHD, which could also want to interrupt sleep. So you don’t want to just focus on one thing like a neurotransmitter and REM sleep or, you know, you really want to look at the whole child. And when you do that, you actually find there are a lot of opportunities to improve sleep, that you wouldn’t necessarily think about you don’t want to assume you know, the child has autism, they’re not going to sleep kids with autism don’t sleep. Instead, you want to say you know, what else could be going on with this kid that I can improve and help the parents with?

 

HR:

See at Different Brains, we’re focused on tools that help. And what we found — we find is… we’re not academics per se, but in general, the things that are good for you. For one, neurodiversity are good for you, and another neuro diversity. I consider insomnia, a neurodiversity. Because I think those of us who really have trouble sleeping, our brains are wired a little bit differently, okay, whatever we want to call it. And then, and so if you go to the standard things that are good for our hearts, and good for diabetes, and good for our brains, well, exercise, a good diet. You know, the most underrated thing, I think, is socialization, having strong social relationships and everything. And when you add all these, I’ll call them for lack of better term habits that really don’t cost much, but you have to, you have to put them in there. And then you add to with some of the things is, you know, so well, specific to sleep, like, you know, cut down on your screen time and so forth and get ready for sleep. Does the research bear that out? That that these things are all corollaries to each other?

 

BM:

Yeah, yeah. I mean, we’ve done, we’ve done research others as well have done research, showing that when you do these things, it matters, it makes a difference in improved sleep, we’ve even put actigraphy watches on kids, which is similar to like a Fitbit. But it’s more research reliable. And we’ve shown that it takes them a shorter amount of time to fall asleep. When you do these things, you know, these good habits, whether it’s minimizing caffeine during the day and getting involved in exercise, getting exposed to bright light, turning off the screens at night. All of that really matters. What I’ve found to be the challenge and I guess the next frontier in the work that I like to do, is getting families who are busy stressed, whatever to actually do those things like how do we get that information into the hands of families because they may not necessarily have a doctor who can do that for them or understands to do that for them. They may be in a rural area, right? So we’ve written books for parents on how to help their kids sleep. We’ve, through Autism Speaks, we’ve published all these toolkits, and they’re available free online, all of this with the intent of trying to get the material into the hands of the families. But it’s still challenging because they’ve got a lot on their plate. So, to me, that’s the next frontier, we know what we need to do. And it works. Now we just need to get the families to do it, and we can support them.

 

HR:

And part of part of that puzzle, if you will, is the changing technology and social media. Now, sometimes when I go have my friend Joe, his restaurant cafe Seville, this is always a bunch of college football coaches and professional NFL coaches there and stuff. They all he comes back, he’s going to talk about neurodiversity. Oh, no. And I say, Well, wait a minute. Let me ask you this. What were your team meetings like 2025 years ago? Well, I used to watch a whole game film, and it’s there and you discuss it maybe like three hours? What are they now? All we show is little like social media clips, length. From the games, we break every 15 minutes where everybody can text on their phone. And the whole meeting is an hour, 90 minutes at the outside. And then we make all these clips available for them to look on their phone and everything. And I said, Yeah, their brains are now wired differently. Okay, that’s what’s going on. And neurodiversity itself, I believe, anyway, is it’s increasing, whether it’s neurotoxic, its environmental. But look, if I was a, you know, a teenager or a college kid today, if I don’t rewire my brain to have some ADHD, I’m going to be a social outcast. Talking on the phone and texting and reading your papers and figuring things out and worried about how to calm down before I go to sleep. And it’s, it’s hard. What are you seeing in your world as regarding the incidence of people with neurodiversity problems and sleep problems? or sleep problems increasing?

 

BM:

Yeah, that’s a really good question. I, I don’t know for sure. You know, as a researcher, I really don’t want to say something that I haven’t seen proven, because I think neuro diversity and sleep is just beginning to come into its own. But I do feel that if you look at sleep problems in our general population, they are increasing, right? I look at two different things, I look at the stress that causes insomnia or the screens, as you mentioned, that makes it harder to fall asleep or stay asleep. That’s what insomnia is. And then I look at the obesity epidemic, which can contribute to sleep apnea, which is a blockage in your airway at night. And you have to overcome that by waking yourself up to breathe. Right. So those two things to me, in the general population, we know insomnia and apnea are increasing. Whether that’s happening in our neuro diversity population, I think it probably is just by inference, because they’re subject to the same stresses we know that weight issues are a problem in our, in our in the diversity population, their diversity population. So I would imagine they also are struggling with greater instances of sleep problems over time. I just don’t know that for sure. And I think it’s, it’s, it’s a really hard time right now. Because you want to be careful. And say, like the fact I made a few minutes ago that we don’t know for sure that people with who are neurodiverse are sleeping worse than they used to because we’d ever study their sleep 510 1520 years ago, so it’s all new. But I also think it’s important as researchers and scientists to get our points across in a way that help, right, that helped the field. So, you know, to be able to say, this is what we we don’t know, but this is what we do. Now we do know that people who are you know, have no diversity. There’s so many different stresses on them. And we know that stress affects the brain and affects our ability to sleep. And I think stressing what we do know to the public, and learning how to talk to the public in a way that people will listen, not just our patients but policymakers being compelling is so so important. And it’s it’s somewhat of a lost art, right in terms of what we teach our our medical students and our faculty, you know, we never have enough time. So we’re down there, and the in the trenches, and we really need to be out there talking to the public.

 

HR:

How can people find out more about your work?

 

BM:

the simplest thing is, is probably you can either go to your search engine, whether it be Google or Internet Explorer, or whatever, and just put in Beth Malow and see what comes up. Although you’re going to get other stuff, too, you’re going to get a whole lot of political stuff, but we won’t go there today. What, what you could also do is if you’ve heard of PUBMED, it’s P-U-B-M-E-D. It’s through the National Library medicine. And it’s free. And you can go to this site called PubMed and put my Mallow and my middle initial A, and that makes it a simpler search. Although I’ve been blessed not to have like, Smith is my last day, right. So most people can find my things. If you just put in mallow and then VA, you’ll, you’ll get a whole list of my publications. You’ll also then many of them are now free, you can just download them. I also wrote a book that’s available on Amazon- “Solving Sleep Problems in Children with Autism: A Guide for Frazzled Families”, I read that with my friend, Terry Katz in Colorado, and you can look at that as well, that’s on Amazon. We really wanted it to be self teaching. So we wanted a parent to be able to pick up the book with no prior knowledge of sleep, and with no one really there to coach them and do it themselves.

 

HR:

Is there anything we have not covered that you would like to emphasize today?

 

BM:

I think I would just I’d like to focus. I know you you work throughout the lifespan, right? So, you know, I think we’re all aware that individuals on the autism spectrum are growing up. And there’s a lot of adults now on the autism spectrum, or if they prefer to be called autistic, whatever, you know, we want to use. And I just think it’s super important if they’re going to meet if if that if they’re going to meet their goals, and so many of them have so much to contribute to our society, I mean, big time, whether it’s in financial or sports, or you know, whatever, they’re restricted interest temps today, it’s so important that they be sleeping and the rest of mental health, physical health, all of that needs to be optimized so that they can be the best that they can be and contribute in a positive way to our society. So I think that’s something that really resonates with me is making sure that we pay attention to that physical health and mental health of individuals with neurodiverse conditions.

 

HR:

Throughout the lifespan.

 

BM:

Throughout the lifespan. Exactly.

 

HR:

Which is why we feel — I feel anyway — that society has inadvertently discriminated against adults. Yeah, because it’s all about the cute little kids well the cute little kids grow up. And so we we start our internships and mentorships here at 18 and above, for all of our neurodiverse individuals.

 

BM:

I think that’s great. I so I’m an adult neurologist. But what happened is when my kids were born, and were diagnosed as being on the autism spectrum, I got more involved in pediatrics. And then also there’s very few people doing pediatric sleep. So that’s how I got involved in autism and sleep and kids. But now, it’s pretty exciting because my kids are college age, and there’s more and more adults, not just with autism, but with intellectual disabilities, whatever. And now I’m seeing that my adult neurology skills are coming back full circle, and I can, you know, I have that, that credibility and that experience. Oh, cool, I’m going to be able to give that back. I think the other point I was going to make before we go is sleep affects everything. Right? So not just individuals who are neuro diverse who have or have disabilities, but I mean, you and I know your audience knows how we feel when we don’t sleep, right? We are more apt to send that nasty tweet or post on Facebook and regret it or send that email and the brain. You know, getting back to research. There have been brain studies that show that the parts of the brain that keep our emotions in control, that there’s a weakened connection when we’re sleep deprived. So we’re not able to keep your emotions in check. It’s been proven scientifically. So if you can improve sleep, you can improve so many things mental health, depression, anxiety, ADHD, and then also your heart, your lungs, your brain, you know, all of these different organ systems are affected when we don’t sleep well. So it’s a huge opportunity to make a difference in somebody’s health as well as their well being when we’re sleeping better.

 

HR:

That’s a great soundbite. You just set it all there. Now for another one: would you care to rattle off off the top of your head put you on the spot, Professor Beth Malow’s Top 10 hits, for tools to get good sleep.

 

BM:

We’re going to start — I’m holistic, So we’re going to start at the beginning of the day, we’re not just going to limit it tonight time. So I would say the first thing is try to wake up the same time or within an hour, hour and a half of your you want the same starting time every day. So let’s say it’s 7am. On weekends, don’t sleep till noon, like maybe a day 30. But don’t sleep paths that you want to your body makes its own brain chemicals like melatonin and you want to teach it when it’s supposed to be awake and when it’s supposed to be asleep so that it doesn’t get confused. And that way you’ll you’ll get the most consistency. So my first tip is pick a bet pick a pick awake time. Tip number two is get exposed to bright light, open the windows get outside for a walk or exercise. Bright light in the morning synchronizes your biological clock, it’s huge. It’s really important in waking you up and actually helping you go to sleep at night on time. And then get lots of exercise during the day. Limit caffeine to the morning if you can, because caffeine can stain your system and interfere with sleep at night. You want to make sure that you’re your stress level is manageable during the day, you want to be involved and engaged, but not so stressed that you can’t fall asleep at night because you’re thinking about what you have to do the next day or what you just did during the day. And as you get closer to the evening, you want to dim the lights wind down a turn off those screens, or at least dim them, you want to have some soothing bedtime routine that interrupts the day from the night or I should say separates the day for the night. For me, it’s taking a warm bath. So I take a turn all the screens off, I do the warm bath. And then I’ll read but I won’t go back on any screens. And then make sure that you’re you’ve got you’ve got a cool or you know, whatever the temperature needs to be for you. You don’t want it to be too warm. I do things like rent out my nose at night with sinus rents. And I use these breathe right strips because I’ll get congested in the middle of the night. And that will wake me up. I’ll have a pen by my pen and not a pen light by my bed so that I if I think of something I don’t have to turn on the light and wake up I can just write it down. Otherwise I’m sitting in bed trying to remember stuff for the morning. Um, I think I hit 10 in there…

 

HR:

More than 10. That was one that was worth the price of admission right there. Right there.

 

BM:

You are so funny. Oh, well, I’m

 

HR:

telling you. You’re terrific. This is great. I’ve learned so much today. And I hope our audience had and this is going to be especially inspirational to so many of our terrific neuro distinct interns who are seeking career paths and things plus help them in their everyday life. It’s great. You’re helping so many people. I’m so glad I met you. And I’m so glad Dr. Steve Perlman my hero and Rick Rader have introduced us so it’s wonderful. What’s the biggest thing about sleep that most of us don’t realize?

 

BM:

So the biggest thing about sleep that people don’t realize is that it affects every part of your functioning. It affects your heart, it affects your lungs, it affects your brain. It affects how you feel, whether you’re going to be able to be calm and your interactions with others or whether you’re going to fly off the handle. When a you’re going to be able to get through the day. feel good about everything you’re doing. Sleep Affects everything we do our health and our well being.

 

HR:

Well, Professor Beth Malow, Vanderbilt, Nashville, Tennessee, the world’s expert on sleep, and autism. Thank you so much for being with us here at Exploring Different Brains.

 

BM:

Thank you. It’s just been an absolute pleasure.