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Sleep Well

with Michael Breus, PhD, ABSM

Sleep disorders include a range of problems -- from insomnia to narcolepsy -- and affect millions of Americans. Dr. Michael Breus shares information and advice on sleep disorder and insomnia treatments and causes.

Friday, March 05, 2010

There's Hope for Children With Insomnia

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Is there anything worse than a child who can't get to sleep?

Okay, maybe a relentlessly crying kid who's having a temper tantrum in public. But for parents of children with attention deficit hyperactivity disorder (ADHD) who can't fall asleep easily, there could be a new solution: melatonin.

A new study published recently analyzed reams of data on the efficacy and safety of melatonin for treating insomnia in children with ADHD and indicated it can be a safe and helpful way to improve the falling-asleep process for these young insomniacs. Here is what the researchers found:
  • Melatonin is a hormone your body produces to help regulate your sleep-wake cycles. It usually starts pumping out of your pineal gland after it has become dark outside and your body prepares for bedtime. When melatonin levels in the blood rise, you begin to feel less alert and sleep becomes more inviting.

  • Children with ADHD usually have trouble falling asleep, which can have tremendous consequences to both their health and family life. Less sleep means a less-than-optimal refreshment of the brain and body during the night.

  • Giving 3 to 6 mg of melatonin within a few hours of bedtime has been shown to help kids with ADHD overcome some of their insomnia and improve their sleep. "Kids" in most cases reviewed in the study meant 6 to 14 years of age.

But hold on: There were several things about this study that would make me not just jump on the bandwagon to try melatonin in kids:
  • Melatonin is a hormone. Most kids produce plenty of Melatonin; it just might not be at the time of day when parents want them to go to sleep.

  • We have no idea what Melatonin will do to kids over the long term.

  • A dosage of 3-6 mg is between 3 and 6 times the dose that is needed in adults - could this be an overdosage?

While this research is very important in our understanding of ADHD and sleep, I would not consider placing a child on melatonin without working with both a sleep specialist and the child's pediatrician.

There's a lot to be said for instilling good sleep hygiene habits in your kids early on. They should be adhering to a pretty strict routine every night that includes:
  • Performing the same bedtime routine every night (winding down, getting ready for bed, brushing teeth, being read to or reading on their own, etc.).

  • Going to bed at the same time 7 days a week.

  • Avoiding stimulants within (at least!) an hour of bedtime. This includes electronics and digital media like the TV, computer and cell phone.

If your kids don't currently keep a regular bedtime routine, start there. The best prescription for a good night's sleep could be in your children's habits - regardless of any other condition like ADHD. Besides, who wants their children to have trouble sleeping before they even reach the throes of those oft sleep-deprived teen years? They need all the sleep they can get.

Sweet Dreams,

Michael J. Breus, PhD
The Sleep Doctorâ„¢
www.thesleepdoctor.com

Comment on this post and talk with others about ADHD and sleep problems on the ADD/ADHD Exchange.

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Posted by: Dr. Breus at 5:00 AM

Monday, August 24, 2009

Something New in Melatonin?

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You don't have to be a shift worker or jet setter to have awkward or non-existent sleeping habits, but both groups suffer quite a bit. Melatonin, one of the more popular over-the-counter supplements, may be headed toward a new delivery system, a patch placed on the body with small pulses of the hormone administered throughout the evening (or day), through your skin!

I've written about this sleep aid frequently because I get so many questions on it. Many supplement companies and health food stores will claim that melatonin is a natural sleeping aid or nightcap because it "naturally" helps regulate sleep-wake cycles. Given its wide spread availability today, you'd presume it's safe and effective.

Is it?

Well, that depends. Melatonin has been shown to help regulate sleep cycles in certain populations and really help out quite a few people, but like anything there are pros and cons:

  • The precise mechanism of melatonin secretion in the body is not well understood. We do know, however, that melatonin isn't just about sleep-wake cycles. It's been shown to help regulate the female reproductive cycle and may also affect the onset of puberty. Children who take melatonin can suffer a delay in sexual development. (So never ever give a child a melatonin supplement.)

  • This new patch study showed that men and women had different levels of melatonin in their system with the same dosage patch! So a gender difference may apply.

  • Studies have pointed to melatonin's role in regulating blood flow, specifically in constricting coronary arteries.

  • And it's been suggested that melatonin can increase depression in people prone to the illness.

For the record, melatonin is a hormone, and it's not a regulated drug under the FDA. No other hormone is available in the United States without a prescription. In some parts of Europe, melatonin is available by prescription only.

If this experimental patch version of melatonin reaches the market, it could have a much bigger effect on the body than just popping a pill. The half-life of a melatonin pill is short and it doesn't last long; a patch, on the other hand, can deliver small doses throughout its use to keep the levels in the body consistent for a longer, stronger effect. This might be great for shift workers who sleep during the day, when the body does not like to produce melatonin.

The patch has been tested on people who sleep during daylight hours and work at night.. For this reason, I can see why a melatonin patch could be helpful to those who maintain schedules opposite to the usual solar day (where the body prefers to be functional). And I have great respect for those who manage to live this life for the sake of their careers and my safety (e.g., emergency care, pilots, etc.). But, even though the patch would be sold as a prescription, it wouldn't surprise me to see people getting their hands on it without trying other sleep hygiene tactics first, which can be far more effective and healthier overall for the body, particularly for those of us that can really get our shut-eye at night.

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctorâ„¢

This article on sleep and melatonin is also available at Dr. Breus' official blog, The Insomnia Blog.

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Posted by: Dr. Breus at 8:48 AM

Monday, April 20, 2009

Melatonin: Miracle or Mistake?

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In this day and age, when sleep rhythms can go haywire at the drop of bad news, questions about sleep aids are a hot topic. They are no longer confined to those who are presumed to have oddball sleep cycles, such as jet setters and shift workers.

I get a lot of questions about melatonin in particular, since many supplement companies and health food stores will tout that melatonin is a "natural" sleeping aid. Given the availability of this supplement today, you'd presume it's safe and effective. But is it really?

What's better, taking a melatonin supplement to help you go to sleep on a crazed Monday night or going for a "PM" version of a pain reliever? Melatonin is a hormone your body produces to help it regulate your sleep-wake cycles, but taking additional melatonin in the form of a supplement isn't as good of an idea as you might think.
  • And it's not a regulated drug under the FDA.

  • No other hormone is available in the United States without a prescription.

  • In Europe, melatonin is only available by prescription.


So here's the 411 on how natural melatonin-the kind produced by your body-works. When the sun sets and darkness sweeps over, a pea-sized structure located deep between the hemispheres of your brain called the pineal gland begins to secrete this hormone-preparing you for bed.

Pineal-gland


As melatonin levels in the blood rise, you begin to feel less alert and sleep becomes more inviting. Melatonin levels stay elevated for about 12 hours, falling back to low daytime levels by about 9 a.m. Daytime levels of melatonin are barely detectable.

The precise mechanism of melatonin secretion is not well-known. We do know, however, that melatonin isn't just about sleep-wake cycles. It's been shown to:
  • Help regulate the female reproductive cycle and may also control the onset of puberty.

  • Children who take melatonin can suffer a delay in sexual development. (So never ever give a child a melatonin supplement.)

  • Studies have pointed to melatonin's role in regulating blood flow, specifically in constricting coronary arteries.

  • It's been suggested that it can increase depression in people prone to the illness.

A hormone with all of these possible effects - even though it's "natural" - isn't something you should be taking without the specific recommendation of your doctor.

Most commercial products are offered at dosages that cause melatonin levels in the blood to rise to much higher levels than are naturally produced in the body. So taking a typical dose (1 to 3 mg) may elevate your blood melatonin levels to 1 to 20 times its normal state. If you take it at the wrong time of day, you may reset your biological clock in an undesirable direction.

How much to take, when to take it, and melatonin's effectiveness, if any, for particular sleep disorders is only beginning to be understood. Remember melatonin is a sleep regulator not a sleep inducer, so it really should not be used as a sleeping pill. In the future, we may find several useful applications of melatonin.

You're better off regulating your own sleep-wake cycles in a genuinely natural way by:
  • exposing yourself to light during the day (preferably sunlight),

  • engaging in physical activity regularly,

  • practicing good sleep hygiene.

Remember: Your body will reset its own internal clock with the proper exposure to light at the right time. (And you shouldn't need a PM formula, either, unless you truly do need an occasional fix for quelling muscle aches or other pains that can prevent you from going to sleep easily. Just don't make this a habit every night.)

Bottom line: better sleep hygiene, better time going to sleep. And better moods the next day. Melatonin, on its own, is not a sleeping pill.

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctor

This sleep article is also available at Dr. Breus's official blog, The Insomnia Blog.

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Posted by: Dr. Breus at 10:00 PM

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