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Journal Article Review: Melatonin

Updated: 8 hours ago

WCF Clinical Team


What is Melatonin?

Melatonin is the hormone we produce to signal sleep. When there is no more blue light present in the environment- nighttime- the pineal gland converts serotonin into melatonin, which is secreted into our bloodstream and into our cells.


Melatonin facilitates both sleep and repair mechanisms which happens when our body is resting. This is associated with our circadian rhythm. We need these for memory consolidation and executive functioning.


However, Melatonin is naturally produced by our bodies in two ways. The pineal gland way is one, and this makes up to 5% of melatonin in the body.


The rest is through our mitochondria which is produced during the day. This melatonin cleans up natural damage that occurs with loss of electrons.


This process is enhanced by near infrared light- which is a wavelength that comes from the sun that is not visible. This light optimizes melatonin production.


Melatonin is also the bodies primary antioxidant system- i.e reducing oxidative stress and impacts the immune, reproductive, and metabolic systems


The light cycles explain why we get better sleep when we don’t use screens, as that artificial light disrupts our pineal glands signal to produce melatonin; and also, that being indoors more often or in places that doesn’t get much sun you may be more restless or even more tired- our circadian rhythm is out of whack.


This is also because cortisol is the hormone that facilitates waking up- when we have light it signals that the day has begun.


These reasons are also why taking melatonin before bed does not generally work.


Cortisol and melatonin work in opposition to each other. If we have high cortisol, we will have low melatonin and vice versa. Interestingly- (generally) children who have experiences of trauma may have higher levels of cortisol.


Serotonin also is also increased in response to light. Serotonin deficiency is related to lethargy and depression.


Within 1 hour of the ingestion of 1–5 mg, melatonin concentrations are 10–100 times higher than their physiological nocturnal peak, and return to basal levels 4–8 h. 


Melatonin Supplements for Children

Melatonin supplements are synthetic- they are made in a lab, melatonin outside of the body cannot be ‘natural’ despite advertising on supplements. They are usually homeopathic (alternative ‘medicine’ that involves highly diluted substances, to the point where there may be little to no active ingredient), making them potentially ineffective.


Products available online may not meet safety standards. A US study observed variances in the actual melatonin content ranging from 17% to 478% among melatonin products commonly sold in the United States. Some formulations were also found to be adulterated with serotonin, cannabidiol, and or herbal extracts in place of melatonin 


Supplements essentially boost the amount of available melatonin being produced- if used correctly. Exogenous (out of body) melatonin has time dependent effects, meaning incorrect administration relative to individual circadian rhythm (differs by age, gender, environment), can incorrectly phase-shift individuals and worsen sleep > problem occurs when caregivers continue to increase melatonin incorrectly


Melatonin supplements are generally recommended for people who have inconsistent sleep wake cycles like shift workers or those who travel a lot in different time zones.


Not a lot is know about the long-term effects of melatonin supplements or whether they can cause harm. There is evidence to suggest melatonin can suppress other hormones required in the onset of puberty, and long-term supplement use can lead to tolerance and dependence.


There are some minor effects such as headaches, nausea, and dizziness. There is evidence to suggest melatonin induces nightmares- again interesting given the high prevalence of both melatonin use and nightmares in children with trauma.


One major area of concern is that the gummies predominantly given to kids are severely under-studied and do not go through TGA (Therapeutic Goods Administration). They are often bought online from overseas and falsely advertised as natural. The second major concern is the lack of research on melatonin supplements in general, particularly long-term.


The Australian Government Department of Health for Melatonin Scheduling 2020 outlines: The Committee recommended the following Required Advisory Statements for Medicine Labels (RASML) statement to the Over the Counter Evaluations Section at the Over-the-Counter Medicines Evaluation Section at the TGA: Do not use in children and adolescent under 18 years of age.


Only over 55s can get melatonin without a prescription. The TGA has also approved prescription-only child melatonin for use in children between two and 18 with autism spectrum disorder.


Perspectives

An Australian study by Lee et al released this year exploring perspectives and experiences of caregivers and community pharmacists about pediatric melatonin use.


The findings showed melatonin is administered mainly by caregivers of neurodiverse adolescents for sleep disturbance.


The TGA closely regulates medicine in Australia leaving caregivers to resort to importing melatonin products online- which are not regulated.


Caregiver stress is also a predictor for child melatonin use


A US study of community perspectives melatonin also showed there was a lack of education around melatonin production and effects


So what do we need to do about giving our kids melatonin

Restrictive Practice wise:

  • The NDIS Rules define chemical restraint as ‘the use of medication or chemical substance for the primary purpose of influencing a person’s behaviour. It does not include the use of medication prescribed by a medical practitioner for the treatment of, or to enable the treatment of, a diagnosed mental disorder, a physical illness or a physical condition’.

  • If the medication is indicated for the treatment for insomnia, then it would not be considered chemical restraint. However, it is important to consider the reason for the sedative being prescribed. For example, if the person is engaging in behaviours of concern during the time you would expect them to be sleeping (or if a lack of sleep leads to increased behaviours of concern), then these behaviours should form part of the behaviour support plan.

  • However, insufficient sleep for children can lead to harmful outcomes such as cognitive and behavioural problems, and caregiver strain and sleep. Melatonin does significantly increase sleep times vs placebo or no treatment- this seems especially true for neurodiverse kids. Could be a genetic link between lower melatonin synthesis and ASD/ ADHD.


Chemical restraint:

  • Consider why the melatonin has been prescribed and what the person is doing during the time you would expect them to be sleeping. If the person is engaging in a behaviour of concern at night, which is consistent with definitions outlined in the Disability Act, or if a lack of sleep leads to increased behaviours of concern, then the use of melatonin would be considered chemical restraint.

  • If melatonin is used for insomnia or a diagnosed sleep disorder, then it would not be considered chemical restraint.

 

What Can We Do Instead?

  • Circadian rhythm training- sleep diaries (documenting sleep time, wake time, disturbances, nightmares, diet, caffeine, etc).

  • Black out curtains, no blue light (screens) an hour before bedtime

  • Sun!!! being outdoors is the main promoter of daytime production of melatonin

  • Education to the caregiver about melatonin, and also why sleep problems occur (hypervigilance and hyperarousal which prevents sleep even when in a stable home; safety seeking or learned behaviours) > what does the sleep disturbance look like? Can we find a cause?

  • Reassurance of safety and love and calm environment

  • Could be high cortisol? Stress-related; find cause of stress, potential ashwaganda (next review?)

  • Short-term melatonin use seems okay, most sources are vague but suggest approx 3 months. Trial strategies first. Dose should be consulted with by doctor and individualised. Probably best to get prescription only

  • High protein and vitamin diets to boost modulation of serotonin- B12 (beef, seafood, yeast), tryptophan (high protein, chicken, eggs).


References

Abdelgadir, I. S., Gordon, M. A., & Akobeng, A. K. (2018). Melatonin for the management of sleep problems in children with neurodevelopmental disorders: a systematic review and meta-analysis. Archives of Disease in Childhood, 103(12), 1155–1162. https://doi.org/10.1136/archdischild-2017-314181

Alfano, C. A., Valentine, M., Nogales, J. M., Kim, J., Kim, J. S., Rigos, P., McGlinchey, E. L., Ripple, C. H., & Wolfson, A. R. (2022). How Are the Sleep Problems of Children in the US Foster Care System Addressed? Journal of Developmental and Behavioral Pediatrics: JDBP, 43(8), e525–e532. https://doi.org/10.1097/DBP.0000000000001090

Australia, H. (2019, June 17). Melatonin. Www.healthdirect.gov.au. https://www.healthdirect.gov.au/melatonin

Comai, S., & Gobbi, G. (2024). Melatonin, Melatonin Receptors and Sleep: Moving Beyond Traditional Views. Journal of Pineal Research, 76(7). https://doi.org/10.1111/jpi.13011

Hartstein, L. E., Garrison, M. M., Lewin, D., Boergers, J., Hiraki, B. K., Harsh, J. R., & LeBourgeois, M. K. (2023). Factors contributing to U.S. parents’ decisions to administer melatonin to children. Sleep Medicine, 114, 49–54. https://doi.org/10.1016/j.sleep.2023.12.018

hub.health. (2024, February 7). Do You Need a Prescription for Melatonin in Australia? - hub.health. Hub.health. https://hub.health/blog/sleep/do-you-need-a-prescription-for-melatonin-in-australia/

Kunka, J. (2019, November 25). Melatonin and Cortisol. Thriven Functional Medicine Clinic. https://thrivenfunctionalmedicine.com/melatonin-and-cortisol/

McGlinchey, E. L., Rigos, P., Kim, J. S., Muñoz Nogales, J., Valentine, M., Kim, J., Ripple, C. H., Wolfson, A. R., & Alfano, C. A. (2023). Foster Caregivers’ Perceptions of Children’s Sleep Patterns, Problems, and Environments. Journal of Pediatric Psychology, 48(3), 254–266. https://doi.org/10.1093/jpepsy/jsac087

Melhuish Beaupre, L. M., Brown, G. M., Gonçalves, V. F., & Kennedy, J. L. (2021). Melatonin’s neuroprotective role in mitochondria and its potential as a biomarker in aging, cognition and psychiatric disorders. Translational Psychiatry, 11(1). https://doi.org/10.1038/s41398-021-01464-x

Nikolaeva, E. I., Dydenkova, E. A., Mayorova, L. A., & Portnova, G. V. (2024). The impact of daily affective touch on cortisol levels in institutionalized & fostered children. Physiology & Behavior, 277, 114479–114479. https://doi.org/10.1016/j.physbeh.2024.114479

Samantha, Kingston, Bin, Y. S., Smith, L., Edwin, Cairns, R., & Janet. (2024). Melatonin Use in School-Aged Children and Adolescents: An Exploration of Caregiver and Pharmacist Perspectives. Behavioral Sleep Medicine, 1–20. https://doi.org/10.1080/15402002.2024.2396838

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