A. -- Charlie is maintaining his curve on the height chart, but curve on weight chart is really flattening out.
Finally stumbled onto post from a while back. So, here's a snip and a link and another snip.
Quite a bit of traffic, different boards, about melatonin lately. Here's copy of something I posted to the List in 8/06:
We have been giving Charlie, turned 7 in July, approx. 1 1/2 mg melatonin about 30 min. before bedtime. It seems to work well and we haven't noticed any ill effects. At first we tried giving him melatonin on sort of an on demand basis, only gave it to him when he appeared to be having difficulty settling and getting to sleep. But couple of doctors told us melatonin doesn't really work that way, usually takes a couple of hours to kick in, at least the regular form, slow acting, long lasting. Nevertheless, often Charlie falls asleep within 20 to 30 min. of getting his bedtime snack.
I cut, as best I can, a 3 mg tablet into half--tablets not scored, often sort of saw off approximately half and leave the half that's left for next night--and mix in small serving, maybe tablespoon or two, of applesauce.
When I first asked his pediatrician about giving melatonin, in a quick phone consult he said he wouldn't recommend this in any kid with history of OSA. Later, face to face, discussing this further, and offered the choice of telling us it was okay to try melatonin or we'd expect him to come over and sit with Charlie the next time he awoke at 3 a.m. all ready to play, he said okay.
If your child's problem is staying asleep, you might do better to try the time-released version.
Here's an unauthorized snip, maybe he won't mind too much, of something Dr. Leshin posted about melatonin to the list in Jan. 2005:
<< A few comments about melatonin since my name is on this thread....
First, melatonin is not a regulated medication. It's been shown that the total mg of the tablet may not actually be what's on the label. Consumerlabs.com did a study on commonly sold melatonin and found that the following manufacturers were trustworthy: KAL, Twin Labs, Biochem, Duane Reade, Jarrow Formulas, MRM, Natrol, Nature's Bounty, Puritan's Pride, Schiff and Walgreens brand.
Melatonin is available in quick-release form regular tablets and capsules and special time-release forms extending its release over several hours (also referred to as extended-release, controlled-release, or time-release forms). Quick-release aids the ability to fall asleep, while time-release may be more helpful in staying asleep. Time-release versions cannot be crushed or chewed, but can be found as very small tablets.
There does seem to be some tendency to "get used to" the melatonin with less effectiveness over time. This varies from person to person, however.
Finally, melatonin's safety in young children has not been established.
Len Leshin, M.D., F.A.A.P.
Down Syndrome: Health Issues
www.ds-health.com >>
Also, some good info and advice in article found at
www.autism.org/melatonin.htmlCharlie has autism as well as Down syndrome. So, to my mind, all the more reason to try melatonin. I think he's getting more and better rest, and so are we. If the effect seems to lessen, I might go for whole 3 mg tablet. If that stopped working, I think I would just discontinue for at least 3 weeks. And, though melatonin is a dietary supplement, OTC, not a drug, believe I would treat like lots of medication with our kids, often best to start low and go slow--have heard that several places, just recently on the DS-autism list.
And, though it's not a drug and you don't need a script, can buy at drug store or vitamin shop, I would suggest you check with your child's doctor before trying any version of this. Who knows, maybe Emily's pediatrician would welcome the opportunity to come over in the wee hours and rock her to sleep.
Good luck,
Bob
Melatonin - The Sleep Master
An emerging role for this over-the-counter supplement in the treatment of autism.
Jaak Panksepp, Ph.D.
Bowling Green State University
Bowling Green, OH
One of the most common and most troubling times we experience is when we or our children cannot fall asleep effectively. Autistic children appear to be especially prone to this problem, and in has been estimated that more than half exhibit some disturbance in sleep patterns. This suggests some form of deficit in the brain systems that normally promote sleep. During the past decade there has been great progress in understanding the normal brain mechanisms which sustain restful sleep. Since a great number of sleep promoting substances exist in the brain and body, any of them might be deficient in neurological condition we call autism. Here we will focus on one of the major factors, melatonin, which is presently proving to be a remarkably effective natural sleeping aid not only for restless autistic children but also their often bedraggled parents.
As many parents have already discovered, this natural sleep molecule is presently available over-the-counter at many health food stores and distributors (although the ever present danger exists that special-interests will succeed in coaxing the FDA into taking this safe and effective aid off the shelves, as has already been done for several other important supplements, most notably tryptophan). Of course, as with any powerful and effective substance, there are certain guidelines that one should follow to maximize benefits and avoid problems. Although there are sound theoretical reasons for believing that autistic children may be manufacturing either too much melatonin (see Chamberlain & Herman, 1990) or too little, our own viewpoint has been that many kids do not secrete enough (see Panksepp, Lensing, Leboyer & Bouvard, 1991).
Unfortunately, there presently is simply not enough good data to decide which viewpoint is correct. However, the fact that melatonin can stabilize and promote normal sleep and daily bodily rhythms is presently certain. However, it is important to learn how to use this remarkably safe and powerful substance wisely. After briefly summarizing how melatonin works in the brain, we will share some important advice in the proper use of melatonin (including when it should be given, how much should be given, and what to do if melatonin stops working, as sometimes does happen). The first thing that is important to know is that our brains contain a wonderful clock-like mechanisms that normally keeps time with about a 24 Hr. period, but its accuracy is controlled by many factors such as light (i.e.,.., day-night cycles) and various brain chemicals, especially melatonin. This clock-like control center is situated in two small clusters of neurons at the base of the brain called the suprachiasmatic nuclei (SCN) which, as the name implies, are situated directly above the optic chiasm, the place where half the nerves from each of our eyes cross over to the opposite halves of our brains. The many output pathways from the SCN control practically all behavioral rhythms that have been studied, from feeding to sleep. When both nuclei are destroyed, animals scatter their behavior haphazardly throughout the day instead of maintaining a well-patterned routine of daily activities. Our own natural melatonin secretions, which normally occur during the early morning hours when we have our deepest sleep, coordinates the accuracy of the SCN clock. People who have lost their sight, and hence are unable to coordinate their bodily clock via the influence of natural day-night cycles, are able to stabilize their rhythms by taking small amounts of melatonin at exactly the same time each day. And that is really the secret to proper melatonin use--it should be given only once a day in small amounts, and the proper time is about half an hour before one's normal sleep-time.
Within our bodies, melatonin is naturally produced within the pineal gland, a glandular organ nestled between the cerebral hemispheres, that the great French philosopher Descartes once proposed to be the "seat of the soul." In that gland, melatonin is synthesized in two steps from the precursor neurotransmitter serotonin. Pineal stores of melatonin are typically released into the circulation when illumination diminishes, and may help explain why most of us sleep better when the lights are off. During those morning hours when melatonin levels begin to diminish, birds begin to sing and we also tend to wake up, restored, to start our daily activities. It is easy to understand why lack of sleep might increase behavioral and psychological problems during the day. In addition, melatonin does a remarkable number of beneficial tasks in the body: Not only is it a powerful inducer of sleep, but it also regulates a variety of other bodily processes ranging from brain maturation to the vigor of our immune responses. It has been found to retard the growth of some cancers, and quite independently of that beneficial effect, it can also alleviate certain forms of anxiety and depression. Most remarkably, given in the drinking water, it has increased life-span in various experimental animals by about 20%. It also helps control the onset of puberty during adolescence.
In short, melatonin exerts many beneficial effect on the brain and body, but parents are well advised to follow certain guidelines in its use as a sleep-promoting agent:
1. WHEN? It should be given only once a day, about half an hour before the regular sleep-time. Supplementing with additional melatonin in the middle of the night may be effective, but it is not a smart policy, for that can shift the biological clock in chaotic and undesirable ways.
1. HOW MUCH? Although melatonin is very safe (people have consumed grams each day for many day with no ill effects), very small amount can go a long way. Commercially available preparations usually come in 2.5 or 3 milligram (mg) tablets, and a young child should do well on a third of this amount. The higher amounts will produce deeper sleep, but the hormone may still be circulating at quite high levels in the morning, and there are reasons to believe that is undesirable.
1. POTENCY CHANGE? Melatonin usually does not diminish in its effects even with prolong use, but for unknown reasons, this is not the case in all individuals. If a low dose of melatonin that has been effective for some time seems to be losing its effect (i.e., tolerance is setting in), one is wiser to stop giving the supplement for a while rather than increasing the dose. Some parents seek to restore the desired effects by increasing the doses, but that only seems to intensify the tolerance process. It is better to take a week to a month off, and then see whether sensitivity has returned. In our experience, sensitivity is usually restored in this way. Many autistic children that have been receiving melatonin on a regular schedule appear to exhibit benefits above and beyond the improvements in sleep. They are more "with it" during the day. These may be the side-benefits of the still mysterious restorative processes that sleep provides for all of us. Additional benefits may arise from the stabilization of body rhythms that may have been out of synch before the melatonin supplementation.
1. Although we do know that melatonin and sleep have many bodily benefits, we do not have adequate evidence about the many "hows and whys." Our knowledge of such matters has not progressed much beyond Shakespeare's speculation that the function of sleep is "to knit up the raveled sleeve of care" even though modern thinkers are more likely to suggest that "sleep restores brain neurochemistries and other bodily resources that have been depleted by waking activities." Melatonin appears to be a prime guardian of such restorative processes, and without it, our lives become raveled indeed. It is likely that the for presently unknown reasons, the brains of some autistic children are deficient in this important chemistry. If so, early supplementation with this hormone may be essential for normalizing development. Unfortunately we know little about such matters, and only future research can give us the answers that we desperately need now.
Chamberlain, R.S., & Herman, B.H. (1990) A novel biochemical model linking dysfunction in the brain melatonin, proopiomelanocortin peptides, and serotonin in autism. Biological Psychiatry, 1990, 28, 773-793.
Panksepp, J., Lensing, P., Leboyer, M., & Bouvard, M.P. (1991) Naltrexone and other potential new pharmacological treatments of autism. Brain Dysfunction, 4, 281-300.
Permission was obtained to republish this article which first appeared in Lost and Found: Perspectives on Brain, Emotions, and Culture. Lost and Found is a quarterly newsletter and is distributed by the Memorial Foundation for Lost Children. For more information, write to:
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