Melatonin: How to Use it for ADHD Related Sleep Disorders

Physicians have recommended melatonin for years to help with sleep problems related to ADHD.  However, because melatonin is available over the counter, it isn't always clear how, or when to use melatonin.  A recent article published in the European Journal of Paediatric Neurology  clarifies some of these questions.  Here is a summary.

Is it ok for children to use melatonin for sleep?

Yes.  Although early reports cautioned that melatonin might cause seizures in children with certain medical problems, newer data suggest that melatonin may actually decrease the probability of seizures.  If your child has neurological problems such as autism or seizures, it is a good idea to consult your neurologist before giving melatonin.   

It should be noted that while there have been no reports of significant side effects from melatonin, long term studies have not been done.

Does melatonin work for all sleep disorders related to ADHD?

No.  Melatonin works only for those with difficulty falling asleep--either those who never get to sleep, or those who will only get to sleep much later than they should.  It does not help those who cannot stay asleep.  It works best if given 3 to 5 hours before the time when melatonin is normally released (midnight to 8AM).  That is, the best time to give it is about 7PM-9PM.

Is extended release melatonin better?

So far, research has not shown that extended release melatonin is more helpful.   Extended release melatonin is primarily useful for elderly patients who have melatonin deficiency due to diseases such as diabetes or Alzheimer's disease.  Patients with ADHD generally have a higher level of melatonin than average, so extended release melatonin is not expected to be more helpful.

Will a higher dose of melatonin help a person who cannot sleep on a standard dose of melatonin?

Not always.  Because the body senses melatonin by a change in concentration in the blood, and not by the amount, some people who metabolize melatonin slowly actually need to take LESS melatonin for the body to sense a change and become sleepy.

Does melatonin interact with any other substances or medications?

Some people metabolize melatonin slowly due to medication.  Medications that may have this effect include verapamil (used to control blood pressure and heart rhythm) ciprofloxacin (an antibiotic), and fluvoxamine (used mainly for obsessive compulsive disorder).  Lowering the dose of melatonin can help it retain its effectiveness for sleep.

Reference:

Bruni, O., D. Alonso-Alconada, F. Besag, V. Biran, W. Braam, S. Cortese, R. Moavero, P. Parisi, M. Smits, K. Van Der Heijden, and P. Curatolo. "Current Role of Melatonin in Pediatric Neurology: Clinical Recommendations." European Journal of Paediatric Neurology (2014): n. pag. Web. 9 Jan. 2015.

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