Melatonin is an
important hormone concerned with the sleep-wake cycle in human beings. And,
children with neuro-developmental ailments show higher prevalence of sleep
disturbances as compared to their peers without these problems.
Paul Gringras and his
colleagues conducted a randomized placebo controlled trial to examine the
efficacy of melatonin in treating sleep disorders in kids with
neuro-developmental problems. The study was published in BMJ 2012.
enrolled 146 children from 19 hospitals across Wales and England, ranging in
age from 3 years to 15 years 8 months, and having neurological and
developmental problems. The children also had deranged sleep patterns.
Sleep problem was
defined in the study as 'the child not falling asleep within one hour of lights
out or having less than six hours of continuous sleep'.
Just 45 minutes before
retiring to bed, the children were given immediate-release melatonin or
matching placebo capsules for 12 weeks. The dose was started with 0.5mg and was
subsequently increase to 2mg, 6mg and 12mg depending upon the response. The
parents were asked to maintain a record of their children's sleep. The child's
sleep pattern was reviewed at four weekly intervals and the dose was increased
to the next dose increment if the child -
fulfilled the sleep
disorder eligibility criteria;
had received at
least 5 of the possible 7 doses in the preceding week; and
had no serious
observed the factors such as sleep onset latency, family functioning, adverse
effects and assessment of child behavior. Nature and duration of sleep was
assessed from parent's record diaries and actigraphy. Actigraphy is a
'non-invasive method of monitoring human rest / activity cycles'.
It was found that
melatonin increased total sleep time and decreased sleep onset latency.
Melatonin was very effective in children with long sleep latency.
observed that melatonin induced little extra sleep in children. They fell
asleep faster and woke up earlier. However the family functioning outcomes and
child behavior did not show significant improvement. The scientists were of the
opinion that further comparisons with melatonin analogues or slow-release
melatonin were needed.
Anant Dave, child
psychiatrist from West Midlands, while commending the study however feels that
frequency with which Melatonin is prescribed is quite high when one considers
its modest effect on sleep as described in this study'. He suggested that the
care-givers of children with neuro-developmental disorders should be given
better support as well as 'more specific non-pharmacological approaches towards
sleep problems, using a range of therapeutic modalities'.
Melatonin for sleep problems in children with
neurodevelopmental disorders: randomised double masked placebo controlled
trial; Gringras et al; BMJ 2012