Children with autism spectrum disorder (ASD) often experience problems with getting to sleep as well as sleep maintenance. The consequences of this poor sleep quality may include alterations in daytime behavior, memory, and learning. One of the possible reasons for the sleep issues is disturbance in the manufacture of melatonin. Several clinical studies have also shown that melatonin supplementation at dosages ranging from 0.75 mg to 6 mg prior to bedtime produces significant benefit in improving sleep quality in ASD.
Abnormally low levels of melatonin in ASD have been documented in several studies. Melatonin plays a critical role in influencing the onset and length of sleep. A genetic defect in proteins signaled by melatonin has also been noted in these patients.
The clinical studies that have been conducted with melatonin in ASD include three double blind studies which all showed a significantly shorter time to fall asleep and longer sleep duration with melatonin at dosages of 2-5 mg compared to placebo.
In an open trial, after initiation of melatonin, 86% parents of autistic children reported either complete elimination or significant improvement of sleep disturbance. Of the 107 children treated with melatonin only 3 children had mild side effects (morning sleepiness).
Twenty-four children with ASD, free of psychotropic medications, completed an open-label dose-escalation study to assess dose-response, tolerability, safety, and effect of melatonin supplementation during a 14-week study. At either 1 or 3 mg dosages melatonin improved sleep onset in most children. It was effective in week 1 of treatment, maintained effects over several months and was well tolerated and safe. In addition to showing improvement in sleep, melatonin also improved the behavior of the children leading to a significant reduction in the feelings of stress by the parents.
These findings contribute to the growing medical literature on supplemental melatonin for sleep quality and behavior in ASD.
Malow B, Adkins KW, McGrew SG, et al. Melatonin for sleep in children with autism: a controlled trial examining dose, tolerability, and outcomes. J Autism Dev Disord. 2012 Aug;42(8):1729-37