Melatonin for the management of sleep disorders in children and adolescents

Question 1

What is the prevalence of difficulties in initiating and maintaining sleep?

Answer 1

15-25% of children and adolescents

Question 2

What is the definition of insomnia?

Answer 2

Loss of daytime function resulting from unsatisfactory sleep

Question 3

What are the symptoms of insomnia?

Answer 3

1. Fatigue
2. Inattention
3. Irritability
4. Lack of energy
5. Anxiety
6. Depression
7. Learning difficulties
8. Poor school performance

Question 4

What is the delayed sleep phase type of problem?

Answer 4

initiation of sleep significantly later than the desired bedtime. Sleep latency – the amount of time between lying down to sleep and onset of sleep – is increased to longer than the normal 30 mins. The shortened sleep time is often then associated with difficulty awakening in the morning

Question 5

What is behavioral insomnia - sleep onset type?

Answer 5

Special conditions are required of caregivers before the child goes, or returns, to sleep at night

Question 6

What is behavioral insomnia - limit setting type?

Answer 6

Child stalls or refuses to go to bed or to return to bed and the caregiver demonstrates unsuccessful limit-setting behaviours

Question 7

What medical issues can lead to insomnia?

Answer 7

1. Sleep apnea
2. Anxiety
3. Depression
4. Inappropriate use of media at bedtime

Question 8

What are recommendations re: sleep hygiene?

Answer 8

1. Consistent routine
2. Stable bedtime
3. Stable morning wake time
4. Age-appropriate number of hours in bed
5. A dark and quiet sleep space
6. Avoiding hunger (and eating) prior to bedtime
7. Relaxation via strict avoidance of screens and encourage reading prior to bedtime

Question 9

What is the dosing of melatonin?

Answer 9

Melationin 3-10mg PO 30-60min prior to bedtime

Question 10

Which types of sleep disorders have melatonin been helpful?

Answer 10

1. Delayed sleep phase type
2. Sleep-onset association type
3. ADHD
4. Austism
   Maybe helpful in:
5. Intractable epilepsy
6. Neurodevelopmental disabilities
7. Angelman syndrome