ARI Publication 40 – 2013 Version

Melatonin

Rationale: Many children and adults with autism have sleep problems, including falling asleep,
nighttime waking, and early waking. These sleep problems have a strong correlation with gut
problems, and healing the gut seems to reduce many of those sleep problems.
However, if sleep problems continue, supplementation with melatonin can help. Melatonin is the
hormone the body naturally produces at nighttime to regulate sleep. It is formed from the
neurotransmitter serotonin, so low serotonin levels can cause low melatonin levels.

Testing: The best test for melatonin is simply a trial of it, if a person has continuing sleep
problems not due to other causes (see below).

Treatment: Melatonin production is reduced by light, and even a simple nightlight can greatly
decrease melatonin production. So, first try eliminating all sources of light.

For problems falling asleep, first try a behavioral approach, including a regular nighttime routine (at
a fixed time, begin bath/shower, brush teeth, story, etc.). Also, be sure to eliminate caffeine and
reduce sugar intake at nighttime.
If sleep problems persist, start with 1 mg of melatonin (0.5 mg for children), and increase up to 2-5
mg if necessary (1-5 mg for children). If waking occurs during the night, then try a time-release
form rather than increasing the dose. 2 mg time-release can be better than 5 mg all at once.
However, in general it is not effective for night time waking, so other treatments may be necessary
if time-release melatonin is not effective.

Safety: Melatonin seems to be exceptionally safe; high dosages in animals produce no toxicity,
and a study of 1400 women taking 75 mg/day for up to 4 years with no adverse effects. Children
with autism have been documented taking up to 25mg at bedtime without adverse effects. In fact,
animal studies suggest that long-term use of melatonin can increase lifespan 20%, presumably due
to its strong antioxidant effect.

One study of children with ADHD and insomnia who were followed for approximately 4 years
revealed no serious adverse effects associated with long-term use of melatonin; after 4 years, 65%
still used it regularly, 12% occasionally, and 9% no longer needed it.

Hoebert M, et al “Long-term follow-up ofmelatonin treatment in children with ADHD and chronic sleep
onset insomnia’~ J. Pineal Res. 47 (1): 1-7. 2009

Research
Melatonin problems have been extensively studied in children with autism, and there are nine
studies that found abnormalities in melatonin levels and/or melatonin cycle in children with autism.
Five randomized, double-blind, placebo-controlled trials have been conducted, and Rossignol and
Frye conducted a meta-analysis of those five studies. They found that melatonin improved falling
asleep and sleep duration (30 minutes more than placebo), but not night-time awakening. The side
effects of melatonin were reported to be minimal or none.

ARI Survey of Parent Ratings of Treatment Efficacy:

Overall, melatonin seems like a safe and effective therapy for sleep problems for many children with
autism.

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