Only the parents of a child who sleeps little can understand. This form of sleep deprivation can become torture over time. However, you have to be very careful about the remedies you resort to. Even those advertised as natural which, if used inappropriately, can ultimately prove to be very dangerous. Among these is melatonin, the main supplement ingredient most commonly used to help children indulge in sleep.
Prescriptions got out of hand
Many times it is the pediatrician who recommends it, other times you follow what a friend is doing or even what you read on the web. Perhaps this is why pediatric melatonin intake seems to have gotten out of hand. She is convinced of it Judith Owensdirector of the Center for Pediatric Sleep Disorders at Boston Children’s Hospital and professor of neurology at Harvard Medical School, on the pages of the journal Jama.
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The increase
In fact, data from the US National Health Interview Survey found a 7-fold increase in the use of melatonin in children: it went from 0.1% in 2007 to 0.7% in 2012. But this surge in consumption it does not only concern minors, but also adults.
In the US, more recent data from the National Health and Nutrition Examination Survey (NHANES) show that melatonin use has increased 5-fold among adults, from 0.4% between 1999-2000 to 2.1% in 2017. -2018. Furthermore, research suggests a dangerous trend: Plenty of adults use doses above 5 mg, which raise serum melatonin levels well beyond typical nighttime peak concentrations, before decreasing after 4 to 8 hours.
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Prior to the 2005-2006 NHANES survey, no participant reported taking more than 5 mg per day, but in 2018, around 1 in 8 melatonin users did. Sales figures confirm an increase in the use of melatonin. Indeed, they suggest a dangerous acceleration: sales would more than double to $ 821 million in 2020 from $ 339 million in 2017. “It’s a crazy situation that got out of hand,” confirms Owens, who is also president of the International. Pediatric Sleep Association.
High doses and taken for a long time
The scientist and many of her colleagues fear the potential harm that taking melatonin can cause without a doctor’s supervision. Particularly in cases where higher doses are taken and for long periods of time. Poison Control Centers in the United States have reported a surprising increase over the past decade in calls from children who have ingested melatonin.
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“An alarming fact”
“It’s a little alarming; just because the product is over-the-counter doesn’t mean it’s totally harmless and doesn’t have major physiological effects,” says the senior author of the NHANES analysis. Naima Covassin della Mayo Clinic College of Medicine e Science a Rochester.
The sleep hormone
Melatonin is a hormone secreted by the pineal gland that helps synchronize the body’s daily circadian rhythms with the light-dark cycle. Melatonin levels slowly rise a few hours before bed, preparing the body to shift gears and prepare for rest and other physiological nocturnal activities.
“Melatonin can be very effective in resetting the clock and changing sleep times by anticipating or delaying it,” explains Covassin. “But it’s often misused to combat insomnia,” he adds.
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It works for shift workers
Studies show that melatonin is effective for improving sleep in people who work shifts or for relieving jet lag. A guide from the American Academy of Sleep Medicine (AASM) also suggests that melatonin may be helpful against rapid eye movement (REM) sleep disorder, a condition that particularly affects the elderly and causes some people to talk and move in the sleep.
Children with Adhd
Children with some neurodevelopmental conditions may also benefit. For example, children with attention deficit / hyperactivity disorder (ADHD) appear to release melatonin in a delayed manner, while other children with autism release melatonin at the wrong time of day. But for the rest of the population we still know little about the effects of melatonin. Most studies are small and short-lived and show very modest benefits, such as a 5 to 8 minute decrease in the time it takes to fall asleep.
A doctor’s advice for adults too
According to a recommendation by the AASM, melatonin should not be used without a doctor’s advice by adults with insomnia who have difficulty falling or staying asleep. “There are no drugs recommended for long-term use for insomnia in children or adults,” he points out Jennifer Martin, president of the AASM and professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles. “We always try non-drug approaches first and, for most people, it works,” he adds.
More and more sleepless
Certainly, insomnia rates have increased dramatically over the past 20 years with about a third of US adults suffering from insomnia. Likewise, a recent CDC report found that one-third of US children and teens do not get enough sleep. To worsen the quantity and quality of sleep are the work rhythms, but also the constant use of social media which can expose people to blue light at night, which in turn can inhibit the endogenous production of melatonin.
Looking for ‘natural’ therapies
This increase in sleep disorders has led more people to seek treatments and very often the choice falls on options considered ‘more natural’, such as melatonin. “It’s kind of self-medication,” he says Phyllis Zeedirector of the Center for Circadian and Sleep Medicine and professor of neurology at Northwestern University’s Feinberg School of Medicine.
Pay attention to the label
Some studies have raised concerns about the control and content of these products. For example, a study of over-the-counter melatonin supplements sold in Ontario, Canada found that, in some products, the melatonin content was up to 478% higher than indicated on the label and could fluctuate substantially between batches. Eight of the 31 products tested also contained serotonin, a breakdown product of melatonin, at clinically significant doses.
“It’s cheap, it’s available, and I think marketers have done a great job of making it look safe and not a big deal,” Owens says. Melatonin supplements are “generally safe and well tolerated, but they are not completely risk-free,” Covassin points out.
Adverse Effects
Adverse effects may include headache, fatigue, dizziness or daytime sleepiness. Small studies have also documented potentially more serious consequences, including impaired glucose tolerance and an increase in blood pressure and heart rate in patients taking melatonin and antihypertensive drugs simultaneously.
“We know very little about their long-term safety,” Covassin points out. For example, a recent analysis concluded that long-term studies are needed to evaluate the effects of melatonin on puberty.
Adverse Effects
High doses can increase the risk of adverse effects. Zee noted that the pineal gland releases melatonin in picograms and that the doses used to treat circadian change disorders are typically small, around half a milligram, which is much less than what is offered in many over-the-counter products. Yet we know that doses and timing of intake can influence the effect of this hormone.
The timetable
Owens explained that a dose of 3 to 5 mg taken half an hour before bedtime will induce sleepiness. A much lower dose of about 0.5 mg taken in the evening anticipates falling asleep. A high dose of melatonin taken in the middle of the night could lead to morning sleepiness, Zee noted. “If given at the wrong time, it can move the clock in the wrong direction,” says Zee.
As with prescription drugs, inappropriate use or neglect can have dire consequences. Between 2012 and 2021, US poison centers received 260,435 calls involving children who had ingested melatonin, a 530% increase over the period. Most of the children did not require medical intervention. But 4097 were hospitalized, 287 ended up in intensive care, 5 required mechanical ventilation, and 2 died.
Fruit flavored, like candy
Owens hopes the CDC report will make doctors and parents who use melatonin think. Many products are fruit-flavored or sold as gummy or chewable candies, and no child-resistant packaging is used. “It’s a drug,” Owens says. “Like any other drug, you don’t leave it on the kitchen counter at the risk of your child taking it,” he adds.
What to do against insomnia
Not abusing melatonin doesn’t mean we can’t do anything about insomnia. The AASM recommends cognitive behavioral therapy as a first-line treatment for adults and children with insomnia. Owens said he typically spends an hour with new patients trying to understand the underlying causes of their sleep difficulties. For example, a child with difficulty falling asleep might have an underlying circadian rhythm problem, restless legs syndrome, or bedtime might be wrong.
Melatonin? With guidelines only
According to Owens, medications or supplements, including melatonin, may be appropriate for children in some circumstances. He is therefore working with his colleagues at the International Pediatric Sleep Association to develop guidelines on the use of melatonin for primary care physicians. Sometimes, he noted, it is appropriate to use drugs or supplements such as melatonin in conjunction with behavioral interventions. But he adds a caveat: “Like any sleeping pill, melatonin is a patch and does not solve the underlying problems, which are typically behavioral.”