Is Melatonin Safe and Effective for Kids with ADHD?
For many children with ADHD, bedtime can be a long, drawn-out process. Putting pajamas on, brushing teeth, and reading bedtime books can easily turn into an hour or more, as kids with ADHD naturally have difficulty winding down, transitioning, and reducing stimulation, all of which are necessary for a successful (and stress-free) bedtime. And that is not to mention the amount of time it often takes kids with ADHD to fall asleep once the lights are out.
When kids and their parents have tried everything, including proper sleep hygiene, it may be time to consider alternative sleep support.
One such support that has gained a lot of recognition, both positive and negative, is melatonin. But is the use of melatonin actually safe and effective for kids with ADHD?
Before we look closer, please note that any information presented in this post is for informational purposes only. You should always consult your child’s pediatrician before considering any medications or supplements, including melatonin.
What is melatonin, and what does it actually do?
Melatonin is a naturally occurring hormone that your brain releases in the evening to help signal that it is nighttime. Melatonin can be thought of as a circadian rhythm cue. Simply put, it helps shift the body towards “sleep mode.” Melatonin is not a sedative that knocks someone out.
Many kids with ADHD have a late internal clock that can cause later sleep onset. Melatonin can help move the sleep signal to an earlier time and, by extension, allow them to fall asleep earlier.
How common are sleep problems in ADHD?
Sleep concerns are very common in ADHD, including:
Longer time to fall asleep
Restless sleep or frequent awakenings
Variable sleep schedules, especially on weekend or holidays
A recent review of sleep in children with ADHD “demonstrated that ADHD children exhibited impaired sleep continuity (reduced total sleep time, increased stage shifts), severe sleep interruption (prolonged wake after sleep onset, elevated awakening index), and abnormal sleep process effectiveness (decreased sleep efficiency, extended sleep latency) compared to non-ADHD children.
Does melatonin work for kids with ADHD who struggle falling asleep?
Much research exists investigating the problem of sleep-onset insomnia in children with ADHD.
Generally, it is found that melatonin tends to reduce time to fall asleep and may modestly increase total sleep time, especially when sleep onset insomnia is the primary issue.
One study involving children with rigorously diagnosed ADHD and chronic sleep-onset insomnia found melatonin improved sleep onset and sleep duration. A significant amount of children with ADHD fell asleep more than 30 minutes earlier when they took melatonin.
In another study, low-dose melatonin use was found improve total sleep time for kids with ADHD. And more importantly, minimal side effects were reported. However, it was also noted in the research that melatonin use was most effective for falling asleep; inconsistent daytime benefits were found, although better sleep may lead to better symptoms management during the day.
What does the research say about safety of melatonin?
Short-term safety
In many studies, short-term melatonin use is generally considered safe, particularly at low doses. Mild side effects may include morning sleepiness, headaches, dizziness, or nausea. Serious adverse events in controlled trials are uncommon.
Longer-term safety
Due to its relatively new popularity, studies are very limited on the safety of long-term melatonin use. That said, one study that involved long-term melatonin use for kids with ADHD found “no serious adverse events or treatment related co-morbidities,” even after several years of consistent use. Additionally, the majority of kids experienced improved behavior and mood during the day. However, it was also reported that “discontinuation of melatonin treatment usually leads to a relapse of sleep onset insomnia.”
How to Use Melatonin Safely
Start with the lowest effective dose. Many kids respond well to low doses, even as low as 0.5 milligrams.
Find the ideal time of night. For sleep-onset insomnia, melatonin is usually taken before bedtime, often 30–60 minutes prior.
Use melatonin as an aid, not a crutch. Regular and consistent bedtime hygiene is still an important part of the sleep process. Limit stimulation, including screen time, provide a bedtime snack, and encourage books to help your child wind down and prepare for sleep.
Reassess regularly. If you do not see meaningful improvement after a short trial, it may not be the right tool, or the dose may be too low. Consult your child’s pediatrician to consider alternative approaches to bedtime, including possible changes to the dose.
What else should you rule out before relying on melatonin?
When a child with ADHD has difficulty falling asleep, there may be other underlying conditions at play. These may include:
Stimulant medication for ADHD during the day can impact the child’s ability to fall asleep. You may need to adjust the timing of his or her stimulant medication.
Anxiety at bedtime can cause sleep difficulties.
Restless legs or low iron stores: can cause an uncomfortable feeling that makes settling down hard.
Sleep apnea or snoring can cause fragmented sleep, making nights and mornings harder.
Screen or light exposure at night can delay the sleep signal.
If your child is diagnosed with ADHD and has a difficult time falling asleep, you may consider the use of melatonin to help. However, while melatonin is widely viewed as a safe supplement, you should consult your child’s pediatrician to determine if it is the best choice for your child.