Melatonin is our sleep hormone which is experienced naturally in the brain as a sleepiness signal. Melatonin is available in “exogenous” form, over-the-counter as a tool for supporting sleep. In clinic, there are two main times when we consider support of Melatonin: 1. Developmental delay, autism, or other medical/neurogenetic diagnoses are co-occurring with insomnia complaints: in such scenarios we still utilize evidence-based behavioral interventions but such patients may see benefit from adjunct Melatonin; 2. Delayed sleep phase: We may use a very low dose of Melatonin to gradually advance the sleep phase (e.g., 0.5mg taken 4 hours before the natural sleep onset time while the waketime is anchored). if there are severe difficulties with falling asleep and returning to sleep, causing severe impact on functioning, sometimes Melatonin is used even for kids without comorbidities. In such circumstances, we still use the evidence-based behavioral strategies and aim to decrease Melatonin once sleep starts to improve. For children who do not have developmental delay or significant comorbid diagnoses, and whose sleep problems are more mild or moderate, we rarely start with encouraging Melatonin. Evidence-based behavioral strategies are the first line treatment recommended to help with falling asleep and returning to sleep.
For those families that are currently using Melatonin, use of evidence-based behavioral strategies can be a great way to supplement and/or support tapering off when interested. For those families who are not interested in trying Melatonin, use of behavioral strategies are a great alternative.