1 Sheep 2 Sheep Getting to Sleep – S4E2

Jessica Stewart-Gonzalez: Welcome to The Parenting Brief. I’m your host, Jessica Stewart Gonzalez, an Arizona working mom and chief of the Office of Children’s Health at the Arizona Department of Health Services. No matter if you’re a first time parent or already have kiddos running around at home, we’re here to help you along your parenting journey with expert family advice.

Jessica Stewart-Gonzalez: Thank you for joining me for another episode of The Parenting Brief. Sleep plays a huge role in our child’s emotional, mental, and physical development. But falling asleep isn’t always easy for kids, and as parents, it falls on us to decide how to help them get the sleep they need. With so many options out there, it can be hard to decide what is best for your little one’s sleep routine.

Jessica Stewart-Gonzalez: A common recommendation seen on social media parent groups, heard from friends and relatives, or even a medical provider is melatonin. But what exactly is melatonin? Why and when should it be used? And what are the benefits and risks? Today we’re talking about melatonin with a specialist in sleep medicine to discuss these important questions.

Jessica Stewart-Gonzalez: With us today is Dr. Rupali Drewek. She is the medical director of the Sleep Disorders Program at Phoenix Children’s Hospital, where she specializes in pediatric pulmonology and sleep medicine. Dr. Drewek also holds board certifications in pediatrics, pediatric pulmonology, and pediatric sleep medicine through the American Academy of Pediatrics and the American Academy of Sleep Medicine.

Jessica Stewart-Gonzalez: Thank you so much for joining the show today. Let’s first start by learning about what melatonin is and what’s the primary reason parents might consider using it for their young children.

Dr. Rupali Drewek: Sure. So, melatonin is actually a hormone that is produced in our bodies. It’s produced by the pineal gland in the hypothalamus, which is in our brain, and basically melatonin helps control our circadian rhythm, and It goes up at night when it’s dark outside, and then it goes down when it’s light outside.

Dr. Rupali Drewek: So it’s basically regulated by light and dark. And when it goes up in quantity at night, it helps promote sleep. So it helps you fall asleep at night.

Jessica Stewart-Gonzalez: Does everybody produce the right amount, the appropriate amount every time?

Dr. Rupali Drewek: Yes. It is physiologic and it’s produced by all of us, but sometimes it can be altered.

Dr. Rupali Drewek: So like now in the modern world, we have a lot of artificial light and light can actually inhibit the production of melatonin. So nowadays we see a lot of, you know. iPads and phones and TVs and that bright light that comes out of those screens confuses the brain and makes the brain think that it’s light outside and so then it inhibits the production of melatonin and sometimes can prevent you from being able to sleep on time.

Jessica Stewart-Gonzalez: Is there a time period then in which we should have screens turned off and not have that exposure prior to going to bed that would help in that melatonin production naturally?

Dr. Rupali Drewek: Yes, definitely. We recommend, you know, staying off of screens approximately an hour before desired bedtime. And so that way. The body can get ready for bed, understand that it’s dark evening time, it helps you relax, just helps prevent that stimulation that can occur from screen time, gives the ability for that melatonin production to go up in your body and therefore makes you drowsy and then helps you sleep at night.

Jessica Stewart-Gonzalez: Are there any specific medical conditions or circumstances where the use of melatonin supplement might be particularly beneficial or contraindicated in young children?

Dr. Rupali Drewek: Yes, there have been several studies that have been done in children to see which children would be most benefited by melatonin. And they’ve shown that children who have medical conditions such as autism, ADHD or neurocognitive disorders or children who have some developmental delays are definitely benefited by the use of melatonin. I’ve seen in my practice certain children who have had surgery, you know, neurosurgery on the brain. And therefore, due to that surgical procedure, the melatonin production is affected.

Dr. Rupali Drewek: So in those medical circumstances, I think use of melatonin is extremely beneficial. And in terms of contraindications, there is no real contraindications. I think we’ve seen that melatonin is a very safe, effective medication in terms of reducing sleep latency or helping children fall asleep quickly, but it’s not really been studied extensively in children as a whole.

Jessica Stewart-Gonzalez: Is taking a melatonin supplement supposed to be something that is like short term and temporary or is it something that should be or could be long term, especially when we’re talking about some of those conditions or circumstances that you were just mentioning?

Dr. Rupali Drewek: That’s a great question. I think we don’t really know yet because melatonin is, you know, a relatively new medication. And when the American Academy of Pediatrics has weighed in on melatonin use, they really stress that this is a supplement. It’s not regulated by the FDA. So in terms of research on this, supplement. We’re not really in a place where we can say for sure that long term use is effective or really even give appropriate recommendations on the dose.

Dr. Rupali Drewek: I think that in certain medical conditions, long term use is indicated and we’ve not really seen any harm to it. In children who have normal development, I think that Ideally, you want to just stress on good sleep hygiene and try to avoid, you know, any kind of medical management for insomnia, but, you know, not sleeping has its own consequences.

Dr. Rupali Drewek: So I think you just need to weigh the risks and benefits. We’ve not really seen any long term harm from using melatonin in children.

Jessica Stewart-Gonzalez: Can you talk a little bit about what good sleep hygiene means?

Dr. Rupali Drewek: Yes. So sleep hygiene is just basically, you know, your sleep habits that you create and our body, you know, likes regularity.

Dr. Rupali Drewek: So good sleep hygiene means that you want to have a regular bedtime, a regular awake time. There is different recommended hours of sleep for each age. You want to sleep in a cool, dark room, as we had talked about, trying to avoid extensive screen time within an hour of bedtime. You want, like, a consistent, relaxing bedtime routine, such as maybe listening to light music or reading a book, I think is a great way to help.

Dr. Rupali Drewek: get you in the mood for sleep. In certain ages, naps are recommended, but after a certain age, taking a long nap during the afternoon would inhibit you from falling asleep. And then in older age groups, I think avoiding caffeine, avoiding rigorous exercise in the evening. So just basically having, you know, a consistent sleep wake cycle is very important in children.

Jessica Stewart-Gonzalez: Do you see in your practice Parents who are already using, like, melatonin as a supplement when they come and see you? And if so, do you see that they are, like, embarrassed by that or shamed by it or feel like they shouldn’t tell people that they’re using a supplement to help with their child’s sleep?

Dr. Rupali Drewek: Yes. I have seen all of that. I have seen patients who come in and they’re on melatonin and they’re worried about it or they’re considering starting it and they just want some reassurance. I don’t think that I’ve seen a lot of shame over it. I think it’s become very mainstream and a lot of people started on their own.

Dr. Rupali Drewek: But I think that there’s a lot of difference in opinions amongst physicians and parents and people who are in education about use of melatonin. My philosophy on sleep is that it’s extremely important. It’s very underrated and there’s a lot of benefit of sleep and particularly in children because lack of sleep can cause hyperactivity.

Dr. Rupali Drewek: It can cause issues with cognition. It can cause moodiness. It can cause parental fatigue. And so I think that if someone is not sleeping, despite doing a lot of sleep hygiene measures, then use of melatonin to help improve and consolidate sleep is a great thing.

Jessica Stewart-Gonzalez: Thank you to our listeners for tuning in. To learn more about melatonin, check out the resources in the show notes. And if you think this episode could help another parent struggling to get their child to sleep, please share it with them so we can learn as a community. Until next time, this is Jessica.

Jessica Stewart-Gonzalez: You’ve got this.