A recent paper released through the Journal of Paediatrics and Child Health is making waves through social media. University of Adelaide sleep researchers are concerned with the increased use of melatonin for children and the paper warns parents and doctors that giving their child melatonin isn’t a good idea, as the side effects for when children are older are unclear and the results could be serious. This is a topic that is near and dear to my heart, as I too am concerned with the increased use of this hormone in both adults and children when the first route, before any sleep aid drug is used, should be sleep behaviour and emotional modifications.
Melatonin has gained huge popularity as a non-prescription sleep aid, and to those of us who need sleep but want to avoid sleeping pills, or who are looking for something natural to help our children, melatonin sounds like a good thing. However, fresh ideas are saying that not all situations need melatonin. So what is melatonin, what does it do, and should I (or my child) use it?
Let’s look at some facts and myths around melatonin:
I know, melatonin is "the sleep hormone," and it’s made when it gets dark and helps you sleep. The key word there is "helps" – a melatonin supplement is not a sleeping pill since on its own it does not put you to sleep. It’s better to think of melatonin as a "sleep signaller" since what it does is signal the brain and body that it’s time for sleep as part of the system that helps your body figure out day and night and when it’s time to get some rest – the circadian rhythm. In your body melatonin is made in the Pineal (pin-KNEE-uhl) gland which is an area about the size of a grain of rice, tucked into the groove between the right and left hemispheres of the brain. The Pineal gland gets messages from other areas of the brain that sense how much light comes into your eyes. As it gets darker, melatonin is released and causes a cascade of effects that help us sleep. If you ignore those cues you may just become withdrawn, irritable and sometimes disoriented but you won’t go to sleep. So more important than getting more melatonin into your body is making sure that you get the melatonin you need at the right time of day.
Natural Melatonin boosting actions for adults: To make sure that your body releases enough melatonin to set off that ‘sleepiness cascade’ make sure that between the hours of 8 and 10 pm that you start to dim the lights, reduce or cut out screen time (the light from the screen will inhibit melatonin production) and maybe even try some melatonin boosting foods such as pineapple, banana, walnuts, ginger, or oats. Having a set bedtime and wake time (no matter how much sleep you get in the middle) will help too.
Natural Melatonin boosting actions for children: Make sure screens are turned off at least two hours before bedtime. Start to ‘put the house to sleep’ by drawing curtains, particularly in the summer, to help dim the surrounding light. Make sure that the bedroom is completely dark – studies have shown that you don’t need to see light to have it affect your sleep, just having it shine on your closed eyelids is enough! Stick to bedtime routines and bedtimes, even at weekends to reinforce the daily circadian rhythm.
It’s true, melatonin is a hormone made by the body that regulates your circadian rhythm – the one that makes you sleepy at night and awake and alert during the day. The melatonin in supplements is synthesized though chemically is not much different than the melatonin you produce in your body. What is different though is the amount of melatonin in the synthesized supplement compared to the natural amount you produce in your body. That amount can vary drastically between people and changes as you age, as seasons change – there are all kinds of factors. Because there is so much variance between people it is hard to pin down a number but it is thought that the average male makes about 150 micrograms, and the average female only 100 micrograms (a microgram is 1/100th of a milligram or mg so 1 microgram = 0.01mg).
If you look at melatonin supplements out there they vary in dose but in general there are brands offering 1mg, 3mg, 5mg and 10mg doses. Given that recommended doses (from a variety of sources) recommend anything from 0.2mg to 20mg you could be under or over-dosing easily. There’s also a huge difference in how different people absorb melatonin from the supplements. A small study looked at the levels of melatonin in the blood and urine after taking a standardized dose of melatonin and found that the amounts varied 25 fold between people. So the supplements out there may raise your levels of melatonin far beyond what is needed. Lastly how we naturally release melatonin is in a slow wave throughout the night. Over the counter supplements can be dispersed in short bursts and your body isn’t able to process these bursts how it needs to. I cannot stress how important it is to be educated on how much melatonin you take and when you take it. It needs to be expertly prescribed and timed yet today’s society is popping them like candy.
Melatonin is a hormone, not just a vitamin or mineral. Melatonin’s main role in your body is as part of that circadian system but that is not all that it does. It has a hand in regulating other hormones (including those involved in ovulation cycles) and you can’t tell the body that the melatonin you are taking is just for sleep and it shouldn’t affect those other things in the body. Research is being done into all kinds of things, good and bad, that might be influenced by melatonin including stunting growth and late onset puberty.
The perception is that melatonin is safe because it is sold over the counter as a dietary supplement. Companies are allowed to do this because melatonin naturally occurs in some foods but the classification of "dietary supplement" means that it does not need to be regulated or controlled by the Food and Drug Administration (FDA) as other drugs are. That means that dosages may vary within the product but also the places where they are made are not regulated. Some products on the market have been found to be contaminated with toxic metals or other drugs so if you are going to take melatonin for any reason it is important to purchase it from a reliable source. Melatonin has not been proven to be "unsafe" either, but there are few studies that track the long term effects of taking melatonin, and even fewer studies looking at the effects on humans (there’s lots of information on animals which makes sense – farmers for example are interesting in manipulating the circadian rhythm by introducing melatonin to fool an animals’ system into thinking it’s the right season to breed). More and more studies are being done on the long term effects of taking supplements but there are no conclusive studies yet.
Having just said that, sleep hygiene is most important overall for sustained, healthy sleep, but there are times for certain people where taking melatonin can help.
Your body is used to one circadian rhythm and you’ve upped and moved it to somewhere where the light cues are different. Taking melatonin can help that system shift to its new time zone more effectively but you can also help fight jet lag naturally.
Jet lag busters: You can start to shift your rhythm slowly before you leave – if traveling West go to bed an hour or two later for a few days before traveling and make sure to get bright light in the evening to delay that melatonin release. If you are traveling East try to go to bed a little earlier and get bright light in the morning to give that ‘morning time’ cue. Make sure that you avoid caffeinated beverages (and alcohol) while you travel, eat small meals at the appropriate time for your destination and drink plenty of water. Apps such as Jet Lag Rooster can help you put a plan in place – plug in where you are going and when and it will tell you when to seek/avoid light, when the optimal time for sleeping is and more handy hints.
Delayed Sleep Phase/Circadian Rhythm Disorder
Individuals with this disorder will experience falling asleep much later at night, typically after midnight and perhaps not until the morning. Because of this it can be very difficult to wake in the morning. Referred as the “social jet lag” melatonin may be necessary for someone with circadian rhythm disorder as it can help shift their sleep schedule earlier so that it is more in tune with societies natural sleep pattern.
Attention-Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD)
Often the disorder and/or the medication taken by children with ADHD can result in sleep-onset insomnia. The first step in combating this and improving overall sleep health is to practice proper sleep hygiene and for the most part that alone can help the child fall asleep easier and improve overall sleep time. At times a melatonin treatment may be included as well.
Sleep difficulties for children on the autism spectrum is quite common as is a recommended melatonin protocol. Following consistent routine and proper sleep hygiene is also encouraged as children with autism may have difficulty understanding the social cues of bedtime routine. Researchers have found that children on the spectrum may have lower amounts of tryptophan, an amino acid needed within the body to create melatonin. A melatonin treatment should be discussed with your doctor on the correct dose and timing for your child.
I understand the dread of the bedtime battles at night with your little ones – we’re all exhausted at night and we just want it to be over. I know it’s not fun to be the bad guy and have to set rules and limits in regards to your child’s sleep. I have 3 kids – I get it! But I want to see more parents fighting the fight at bedtime and implementing proper sleep strategies then turning to a Band-Aid solution like giving their child a supplemental hormone. Melatonin pills and my favourite "quick fix" – melatonin spray – yes folks - sprayable sleep - not to be confused with sprayable nutrition and sprayable exercise, may seem like an easy over-the-counter solution for your child’s or your own sleep issues but it’s not the right solution you should be taking. Practicing proper sleep hygiene consistently and re-establishing a positive relationship with sleep for your whole family should always be the first steps. We want to teach our kids that they are capable of doing it themselves. This will be a lesson they will keep for a lifetime.
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