Posted tagged ‘insomnia’

Sleep aids for children

January 13, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

J-Mom wrote: “My 10 year old son often has trouble falling or staying asleep, mostly due to anxiety.  My son has not had any help from melatonin in the past.  We do several things to help him fall asleep, back scratch, singing softly, white noise machine, but some days are just impossible for him to sleep.  His doctor mentioned using a magnesium supplement as a natural sleep aid.  Do you have any experience with trying magnesium in kids?  Some cursory research I did suggests that it’s effective in cases of a Mg deficiency. Do some people use it even if no deficiency is found? Do you have to test them first? Any thoughts on this?  Thanks!”

The best ways to help a child relax and sleep are simple steps that J-Mom is probably already doing:

Have a set, relaxing bedtime routine.

Avoid screens for 1-2 hours before bedtime.

Set a consistent time for bed and waking.

Get plenty of exercise (though not in the few hours before bedtime)

Make the bedroom comfortable and happy.

Still, some kids even with great routines can still have trouble falling asleep or staying asleep. That can be especially so for children who are anxious—sometimes worries become magnified at night. Anxiety that causes significant day or night symptoms really should be discussed with a child’s pediatrician, and may need to be treated to help overcome its effect on sleep.

But to answer J-Mom’s question, what other kinds of sleep aids are there for children?

Melatonin is probably the most popular. What’s widely sold is a synthetic version of a natural human hormone that seems important in regulating sleep cycles and setting our “biologic clock” for the day. We know that children with damage to the part of the brain that makes melatonin have problems with sleep cycles, so why not give a little extra to help everyone sleep better?

In general, melatonin seems pretty safe for most people. It can have interactions with some medications, and there is some evidence that in at least some children it might increase the risk of seizures (though that is not seen commonly). There also isn’t great long-term data on daily melatonin use in kids. So I’d treat melatonin with respect, like any other medication: use it only if necessary, at a minimum dose, for a minimum amount of time.

J-Mom also asked about magnesium supplementation. Deficiencies of both magnesium and calcium have been linked to poor sleep in animal and observational studies, and magnesium supplementation in at least one study did seem to help elderly people sleep better. However, I couldn’t find any good evidence that magnesium supplements will help children sleep. An ordinary-dose magnesium supplement is unlikely to be harmful, so trying one isn’t unreasonable. Blood tests for magnesium levels can be deceptive—a one-time test may miss some people who are truly deficient, so testing children for blood magnesium levels is unlikely to be useful.

Chamomille and valerian are two herbs that have some evidence as sleep aids in adults, though again, studies in children are lacking. They’re both probably safe. One “natural product” that had once been touted as a sleep aid is Kava (sometimes called Kava-Kava), which has been linked to liver toxicity and many drug interactions, and should be avoided.

If a child is having significant sleep concerns, this ought to be discussed with a doctor. In addition to anxiety, medical things including asthma, allergies, sleep apnea, and restless leg syndrome can interfere with sleep. Though sedatives and sleep drugs are rarely used in pediatrics, there are often lifestyle changes and simple steps that can make a big difference. Though some natural sleep remedies are probably safe enough to try, they’re not the best way to help most children sleep better.

Trouble falling asleep? Turn off those screens!

April 4, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

Lots of people, kids and adults, seem to be having trouble falling asleep. Now, one solution would be to go to med school and do a residency—you’d be so exhausted, you could fall asleep while talking to your spouse (while you yourself were talking. Good trick.) But that would be impractical, and we’d end up with too many dermatologists. Instead, a recent study has found that there might be a simpler solution. Just turn off those screens!

The study, from New Zealand, looked at sleep habits of about 2000 children from age 5-18, correlating bedtime routines with what’s called sleep latency: how long it took them to fall asleep. The data and conclusions are simple: the kids who spent more of their presleep time watching TV took the longest to fall asleep; the kids who watched the least TV right before bed fell asleep the quickest.

It makes sense. For most of human history, our circadian rhythms were controlled by the sun. When there was light, it was day. Darkness means night. Now, we spend a tremendous amount of time not only under artificial light, but even worse, staring into light sources. Your TV, your phone, your iPad, computer monitors—all of them create light. When you stare at light, your brain thinks it’s daytime. No sleepy. Get it?

That doesn’t even include the stimulating effect of TV shows and crazy video game entertainment. I’m thinking that couldn’t help anyone sleep well, either.

The research was done on kids, but almost certainly applies to adults as well. Want to fall asleep better? Get more exercise (earlier in the day), stay off caffeine (that applies to everyone else but me, I have condition*). And turn off the TV and other video sources for a few hours before bedtime.

You can use that time to read one of your new medical textbooks!

*”I have condition” is an homage to my dad, who used this overall excuse for almost, well, anything. Try it sometimes, it works great!

Could Spongebob be keeping your child awake?

September 3, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

 

Don’t get me wrong: I like Spongebob. And Patrick. And even Mr Krabs. But a new study suggests that our favorite yellow porous invertebrate might be keeping your preschooler awake.

 

Researchers looked at about 600 families of children aged 3-5, and over a 12 month period had about half of the families participate in a program to encourage appropriate media use. The families were taught to avoid age-inappropriate television (no more Spongebob, which is rated TV-7). They were also given information about what shows were better to watch, and were told to watch TV together with their kids and to talk about the shows afterwards. Examples of shows suggested for these kids included Sesame Street (yay!) and Dora (which would give me nightmares). The other half of the families weren’t given any instructions to change their media habits. The families in the study were not encouraged to watch less TV, just to watch more-appropriate TV in a family setting.

 

The children in the no-Spongebob group not only slept better throughout the study period, but were reported to be easier to wake and less groggy in the morning.

 

That’s not the only bad news for Spongebob: previous research has shown that his likeness on packaging is being used to market unhealthy foods—which really isn’t his fault (I understand his agent very aggressively pursues licensing deals.) There was even one study—not a very good study, but who am I to say?—that supposedly showed that kids who watch he-who-lives-in-a-pineapple-under-the-sea become slower thinkers.

 

I’m not so sure that Spongebob is really the cause of all of our children’s ills, but this recent study is worth thinking about, especially if you’ve got a 3 to 5 year old (usually with an older sibling!) who’s having trouble sleeping. The fast-paced, crazy imagery of some cartoons really isn’t for younger children.

 

I’d stay away from Dora, too.