Fourth-grader Josh was diagnosed with ADD after a lengthy work-up and evaluation. He had been struggling in school and homework was a nightmare for both he and his parents. After the diagnosis was confirmed, I put him on a long acting stimulant medication, Concerta, which is a form of Ritalin. The results were dramatic. His mom said that after the first day on the medication, the teacher came out to the car and remarked, “What did you do today? Josh was so focused and his writing was so neat! This was the best day he has ever had.”
He continued to excel in school. A few weeks later a follow-up visit was made to be sure all was going well and to sort out any problems. His mom was ecstatic at his success, but did express concern about his sleep. “Josh always had trouble falling asleep. But since he’s been on the Concerts, now it takes him about an hour and a half. I’m worried that he’s not getting enough sleep,” she lamented. Then she added, “But you can’t stop the Concerta because he is doing so well in school!” She was assured that this was not an uncommon problem when one starts the stimulant medications. It should resolve on it’s own in a couple of weeks.
As it turned out, it did NOT resolve in Josh’s case. It was becoming a real concern for the mom. Academically he was doing great on the medication. It also helped his performance in baseball as he was more focused and into the game. But he still took up to two hours to fall asleep. That is when I suggested we might try Melatonin.
Melatonin is naturally produced by the pineal gland in the brain. It regulates the circadian rhythm of the body, which controls the sleep-wake cycle. In the presence of light its production is inhibited, and in the dark it is produced. Melatonin is also produced in small amounts by the retina and the gastro-intestinal tract. It is also available as an over-the-counter preparation and is considered a food supplement by the FDA. For years Melatonin has been studied as a sleep aid.
It is estimated that 15-to-25 percent of all children have some difficulty falling asleep. The normal time for a person to lie down and fall asleep reaching stage 1 is around 30 minutes. One study looked at pediatric patients, ages 6-to-12 years old, that had primary sleep disorders. These were patients who had no underlying medical conditions but took longer than the normal 30 minutes to fall asleep. One group was given 5 mg of Melatonin, and the other group was given a placebo over a four week period. Melatonin significantly improved falling asleep by 16.7 minutes and there were no adverse effects.
There have been many papers published that look at the use of Melatonin as a sleep aid in patients with secondary sleep disorders. These are sleep issues that occur along with medical or neurological problems. Again, Melatonin has proven to be a safe and effective aid in these situations. One study looked at 66 patients that had a variety of disorders such as developmental delay, Rett syndrome and tuberous sclerosis. This was a controlled study whereby Melatonin was given versus a placebo. The group that received the Melatonin fell asleep quicker by a average of 18.1 minutes.
Similar success has been reported in patients with autism. One study looked at 107 patients who fell into the autism spectrum. These patients were 2-to-18 years old and were followed for as long as 1.8 years. The dose of Melatonin depended on their age and was titrated up to a maximum of 6 mg. In this study, 60 percent of the parents reported improved sleep while on the Melatonin, whereas only 13 percent reported no significant change.
Next week we will look at the effect Melatonin has on ADD patients. Will this medication help Josh with his sleeping problem?