Melatonin Sleep Supplements for Children with ADHD Who Take Stimulant Medications

Children with ADHD often have a problem sleeping either because of the stimulant effect of medications they are taking or because of ADHD symptoms such as hyperactivity. This article discusses the safety and effectiveness of melatonin sleep supplements for children with ADHD who take stimulant medications and have a problem sleeping.

Melatonin Efficacy for Sleep in Children with ADHD Who are Taking Stimulant Medications

Evidence suggests that delay of onset of sleep in children with ADHD is due to delay in secretion of melatonin. Studies of stimulant-treated ADHD children, ages 6 to 14, showed improved sleep onset and total sleep time with doses of 3 to 6 mg of melatonin in the evening. It did not improve other ADHD symptoms.

Safety of Melatonin for Sleep in Children with ADHD

Side effects with melatonin sleep supplements are typically mild and of short duration. The most common side effects are daytime drowsiness, headache, and dizziness.

Since melatonin stimulates the immune system, it should be avoided in children with overactive immunity (disorders such as lupus, rheumatoid arthritis, etc.).

The safety of long-term melatonin sleep supplements has not been studied adequately.

Melatonin levels normally fall during puberty. It is not known whether melatonin supplements might delay onset of puberty because of this. Problems with puberty onset have not been reported, but this has not been studied in trials.

When Should Melatonin Sleep Supplements Be Used?

Because long-term effects are not known, it should not be the first choice for solving sleep problems in children with ADHD.

Before using melatonin sleep supplements, proper sleep hygiene should be instituted. Caffeine should be minimized, a regular sleep time set, and television viewing should be minimal before bedtime.

A doctor should be consulted to see if dosing of stimulant medications can be lowered, dosing times changed, or a switch made to a non-stimulant ADHD medication. Underlying conditions such as depression or sleep apnea may cause a problem sleeping and they should be evaluated and treated.

How Should Melatonin Be Used?

Melatonin can be considered when the above interventions fail.

Absorption of melatonin is best on an empty stomach. Melatonin requirements in children with ADHD who have a problem sleeping vary between 0.5 mg and 6 mg. The lowest effective dose should be used.

Melatonin should be stopped occasionally to see if the problem sleeping has resolved. Summer vacation is a good time to leave off melatonin sleep supplements for at least a week.

Monitor for problems such as worsening depression or increase in incidence of seizures and see a doctor if they occur.

Which Melatonin Is Best?

Melatonin from animal sources is sometimes contaminated with allergens or viruses. Synthetic melatonin is best. Short-acting melatonin has been studied the most in children with ADHD and it is preferred. Prescription melatonin agonist, Rozerem, has not been proven safe in children.

Summary

Poor sleep in children with ADHD can interfere with functioning in school and cause mood problems. A decrease in dose or an adjustment in timing of the dose of a stimulant medication may improve sleep in these children. Problems such as depression or sleep apnea should be eliminated as the cause of the problem sleeping. Good sleep hygiene is important. If poor sleep in children with ADHD continues after these issues have been addressed, melatonin sleep supplements can be tried. Use the lowest effective dose and the shortest duration possible. Breaks from melatonin during summer vacation may reveal that the problem with sleep has resolved.

Disclaimer: This article about use of melatonin sleep supplements in children with ADHD who take stimulant medications is provided for information only. This information is not a substitute for professional medical care by a qualified doctor or other health care professional. I am not responsible or liable, directly or indirectly, for any form of damages whatsoever resulting from the use (or misuse) of information contained in or implied by the information. This information is in no way intended as a recommendation of any drug therapy and is not intended as a diagnosis of any problem your child may have.

Sources:

Lisa M Bendz and Ann C Scates. Melatonin Treatment for Insomnia in Pediatric Patients with Attention-Deficit/Hyperactivity Disorder. The Annals of Pharmacotherapy.

Anna Little. Melatonin is Effective in Decreasing Sleep Latency in Children with ADHD on Stimulants. University of Michigan Department of Pediatrics.

No author given. Melatonin for Insomnia in Kids. Pharmacists Letter/Prescriber's Letter 2010;26(5):260508.

John P. Cunha. Insomnia Treatment: Sleep Aids and Stimulants. MedicineNet.