ADHD & Sleep: Using Melatonin to Reset Circadian Rhythm (Part 3)

 Timothy Culbert, MD, IFMCP

[Read Part 1 of this series for more on melatonin and its relationship with ADHD.]

First: Is Melatonin Safe? 

I've found melatonin to be quite helpful for kids and teens with ADHD for both sleep onset and sleep maintenance issues. However, some concerns have popped up about kids and teens using melatonin for long periods of time (more than 6 months) or at high-doses. However, little has been substantiated through research studies. 

A recent systematic review of 13 RCTs assessed the safety and efficacy of melatonin for pediatric patients with ND disorders (e.g, ADHD and Autism). Studies included a total of 632 children who took either regular melatonin or controlled release melatonin. The review found that:

  • Kids who took the melatonin fell asleep faster and slept longer compared to those given a placebo pill (Abdelgadir).
  • No major side effect concerns were apparent in any of the studies.

Second: How Should You Use Melatonin?

Increase Dose Slowly

I start my kid and adult patients who are dealing with sleep onset problems on a low dose of immediate release melatonin (about 1-2 mg, preferably sublingual), taken about one hour before bedtime. I then very slowly increase the dose every 2-3 days until an effective dose is reached. If an individual is not getting any benefit from doses of melatonin around 5-6 mg, then I usually think about other options. A common indicator that I look for to gauge success is sleep onset in about 25 minutes or less. 

For those with sleep maintenance problems, I use a controlled release product. Usual dose for these products is 3-5 mg, also taken about one hour before bedtime. 

For those who have both sleep onset and sleep maintenance issues, I may try both forms (immediate and controlled release) together one hour before bedtime, starting slow as described above and not exceeding 5-6 mg.

Add Skills & Disconnect

At minimum, use of melatonin should be combined with two additional strategies to support sleep:

  1. Calming mind-body skills before bedtime. Try this Calming Breath Technique
  2. All electronic devices should be turned off at least 60 minutes prior to sleep onset, as exposure to the light spectrum emitted by computer screens and cell phones can suppress the normal release of melatonin. If you're a late-night scroller, be sure to read more about the impact of tech on sleep and mental health. 

Third: What if Melatonin Doesn't Work?

I often look to Relax Powder, Calm Nights, and Serene Sleep for folks who don't see a benefit from Melatonin. L-theanine or 5-HTP at 50-100 mg can also be considered. Be sure to speak with your doctor before starting any of these supplements.  

 


Further reading on sleep and ADHD:

https://thesleepdoctor.com/2018/04/24/a-new-theory-about-adhd-and-sleep/

https://www.additudemag.com/adhd-sleep-disturbances-symptoms/


Resources

Arns & Kenemans. (2014). Neurofeedback in ADHD and insomnia: Vigilance Stabilization through sleep spindles and circadian networks. 

Bijlenga et al. (2019). The role of the circadian system in the etiology and pathophysiology of ADHD: time to redefine ADHD?

Abdelgadir et al. (2018). Melatonin for the management of sleep problems in children with neurodevelopmental disorders: a systemic review and metanalysis. 

Cummings. (2012). Melatonin for the management of sleep disorders in children and adolescents.

Masi et al. (2019). Effects of melatonin in children with attention-deficit/hyperactivity disorder with sleep disorders after methylphenidate treatment.

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