Melatonin - The Magic Pill to better bedtimes?

I have seen a recent rise in the discussions around supplementing children with melatonin to help improve their overall sleep presentation. Parents who struggle to achieve an easy and desired bedtime for their child, or are faced with frequent night wakes, often turn to melatonin supplements to help navigate these sleep issues. But I do wonder if parents know what melatonin is, and what negative consequences or positive improvements they can expect when supplementing their child.

There has been an increase of children given melatonin to help improve their sleep

What is Melatonin?

Let’s get right down to basics. In simple terms, melatonin is our sleeping neurotransmitter. It is responsible for supporting the process of falling asleep and staying asleep. It plays an important part in sleep, by helping regulate the circadian rhythm and the cycles of sleep and wakefulness. Melatonin is converted from serotonin in the pineal gland of the body, and once released in to the blood stream, it travels to all parts of our body.

Melatonin levels vary in 24 hour cycles; they drop to their lowest point during the day to encourage wakefulness and alertness, and typically start to rise about 2 hours before you go to sleep, preparing the body and mind for sleep, by making us feel relaxed and calm. The levels then rise in the evening reaching its highest point in the late evening, supporting sleep for the duration of the night sleep window. The melatonin levels start to then ease off in the early hours of the morning, in preparation for waking, ready to start the day.

The production of melatonin is completely dependent on darkness, meaning that it is only produced in the dark at night time, and its production is reduced by certain levels and hues of light. Exposure to wave lengths of 460-480nm (predominantly blue light) suppresses melatonin production and this can lead to issues with falling asleep and staying asleep.

Bedtime can be a battle for many children

Melatonin in Babies and Children

Babies begin to receive melatonin in utero from the transfer of maternal melatonin through the placenta during pregnancy, and continue to retain levels of melatonin once born. They continue to receive melatonin through breastmilk and do rely on this to induce sleep at night. Melatonin is produced in the body for the first time around 8 weeks of age, and this is what triggers the circadian rhythm to function for the first time.

Since melatonin is a natural production and secretion in the body, it is believed that most of the population do in fact produce their own melatonin. Reduced melatonin levels are usually observed in various diseases, such as types of dementia, some mood disorders, or cancer.

Melatonin Supplements

An increasing number of parents are turning to melatonin supplements to help with their child’s ability to settle to sleep at bedtime, reducing the possibility of delayed sleep onset, hoping it’s the magic pill to better bedtimes. But why would we need to supplement with melatonin if the body is producing its own? It is believed that long-term misuse of melatonin supplements can lead to the body naturally relying on the supplements, and as a result, no longer producing melatonin naturally. More research needs to be done on this as there is no evidence around artificial melatonin suppressing the body’s own production of melatonin.

A lack of melatonin secretion is often blamed as the reason for a child’s difficulties with falling asleep at bedtime. Many doctors are prescribing melatonin supplements as it’s a quick and easy fix to these challenging bedtimes. But, to be honest, it’s just a band-aid solution. Ideally, we need to take a step backwards and explore WHY a child is having difficulties with falling asleep. Not just that they are having challenges, and treating it with a form of medication. If the body is not processing these natural biological processes, it certainly needs to be explored more. This is where we can get to the bottom of the real issue, resolve it once and for all and move away from the need to medicate our children.

“It’s {melatonin supplements} so widely used, it is astonishing to me. Pediatricians have kind of glommed on to this as being the answer to children’s sleep problems.” - Dr. Judith Owens, M.D., M.P.H., the director of the Center for Pediatric Sleep Disorders at Boston Children’s Hospital.

Melatonin supplements appear to be safe for most children for short-term use, but did you know there is little information on the long-term effects of melatonin use in children? Melatonin use isn’t well studied, and there is also a lack in understanding of how much should be taken, or for how long. This certainly raises some concerns.

The benefits of melatonin aid in a child falling asleep easier and quicker at bedtime which certainly helps family dynamics and any bedtime battles. However, there are possible side effects reported in children and these include:

• Drowsiness

• Increased bedwetting or urination in the evening

• Headaches

• Dizziness

• Agitation
  

Additionally, melatonin supplements really only help with the onset of sleep, rather than the sleep quality and actually staying asleep.

In my opinion, melatonin supplements should always be a last resort. Before applying the use of melatonin supplements, you should address the sleep hygiene and rule out any underlying issues around problematic sleep.

Blue lights and screen time can affect your child's melatonin production

What Now?

So, what do you do if you want to improve bedtimes but don’t want to use supplements? Well, there’s a few areas you can address to have the best outcome and reach your goals.

You can:

• Support Melatonin Production with some simple changes

• Improve Bedtime Settles without focusing on melatonin being the main issue

• Explore the WHY behind your child’s sleep challenges

Supporting Melatonin Production

Since melatonin is only produced in the dark at night time, it is important that your child has a well established sleep environment to support the sleeping process. Lights which are blue, white or green in tone will negatively impact the body’s ability to secrete melatonin, whilst red lights at night or in the evenings can assist the body in transitioning into the sleep cycle more naturally.

• Avoid screens at least 2 hours before bedtime to limit blue light exposure

• Turn off any lights in your child’s room which omit a blue, white or green tone

• Ensure your child’s sleep environment is dark

• Use a dim red light, if you need to use a night light

Improve Bedtime WITHOUT Melatonin Supplements

• Ensure your child has the right sleep balance to support falling asleep at bedtime.

• Balancing their day naps age appropriately is super important for an easier bedtime

• Aim for a consistent bedtime so your child’s body clock is naturally set for that time and sleep becomes easier to achieve

• Expose your child to sunlight in the morning and throughout the day. Sunlight will boost serotonin production which supports the conversion to melatonin

• Provide your child enough physical activity during the day so they are prepared for sleep

• Avoid over tiredness by providing your child with enough day sleep, age appropriate. When children are overtired, they have a rise in cortisol which triggers adrenaline to be released into their system. A child who is over tired and full of adrenalin will have a lot of energy to burn, and no where to burn it at bedtime.

• Establish a healthy sleep environment; a dark, low stimulating room is important

• Build a nice and relaxing wind-down routine so your child is mentally prepared for bed.

Explore the Why

Don’t be fooled when you are told that bedtime challenges are most commonly environmental or behavioural issues. In my several years of experience as a sleep consultant, this is certainly not the case. There are MANY reasons why bedtime is difficult for a child, and in my opinion, behaviour is the least likely cause!

The possible causes of challenging bedtimes are:

• Underlying issues (ie medical, nutritional, physiological concerns)

• Under tiredness or over tiredness

• Inadequately balanced day sleep

• Overstimulation

• Anxiety

• Autism

• Unsupportive sleep environment

If we can determine WHY your child has difficulties with bedtime, then we have the key! With that information, we can use the right approach to address and adequately manage the bedtime issues you’re having, without the use of melatonin supplements.

Start your journey towards identifying the cause of your child's sleep resistance with my Underlying Issues Check List:

Underlying Issues Check List

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Melatonin supplements are not an overall good substitute for healthy sleep hygiene. I have worked with many families where I have identified the cause of difficult sleep and we have been able to move away from supplements easily, or avoid using them altogether.

If you’d like to know more, please book in for a 15 minute free chat:

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Forever bringing sleep to families,

Shereen x

I'm Shereen Nielsen, a certified Sleep Consultant specialising in infants and children from birth to 15 years old. With over seven years of experience, I've assisted over 4000 families in achieving better sleep. Additionally, I serve as a lecturer and mentor, guiding aspiring sleep consultants on their path to certification through my internationally recognised online Sleep Consultant Course.

Phone: +61419820474

Email: hello@shereennielsen.com

Website: www.shereennielsen.com

Facebook: @shereennielsen.sleepconsultant

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Neurotransmitters are the body’s chemical messengers. They are the molecules used by the nervous system to transmit messages between neurons, or from neurons to muscles. The important neurotransmitters related to sleep are serotonin and melatonin. The serotonergic system is one of the longest understood transmitter systems in the brain and it is responsible for transmitting serotonin and melatonin in the brain.

Serotonin is one of the most important chemical neurotransmitters for regulating the sleep/wake cycle, is our happy, awake hormone and is synthesised by tryptophan. Serotonin is created by the pineal gland (a small organ located near the centre of the brain) and plays a supportive role in many function, the most relevant and important, being sleep cycles. High levels of serotonin are associated with wakefulness and lower levels with sleep. When serotonin levels are not normal (low), sleep disruptions and disorders can occur. Serotonin is created by the pineal gland and is converted to Melatonin when its dark.