Sometimes it’s hard for Tony Ugando to get his two daughters to bed on time. His teenager isn’t sleepy until almost midnight and his 6-year-old, who is autistic, suffers from insomnia.
So at the suggestion of a doctor, he started giving Alexandra and Shayla liquid melatonin — after he himself took the hormone first. It worked.
“Within 30 minutes you start feeling the effect,” said the computer programmer from Miramar.
His first experiment with melatonin was about two years ago and though he and his kids still use it, he hands it out only on rare occasions — when the 15-year-old has a big test the next day or when he has a full and hectic schedule at work.
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“I don’t like to abuse it,” he added. “It’s mostly to guarantee we get a good night’s sleep.”
Ugando is part of a growing trend of parents dispensing melatonin to children, particularly adolescents who don’t start feeling sleeping until well past 11. Though there are no figures on its use by teens and young adults, the sale of the supplement has risen steadily in the past five years, according to the Nutrition Business Journal. In 2007, sales came in at $90 million; by 2012 it was estimated to have tripled, to about $260 million.
Melatonin, known as the “hormone of darkness,” is manufactured by the pineal gland, a pea-sized structure located just above the middle of the brain. During daytime, there is very little melatonin in the body. At night, however, the pineal begins producing the hormone. The blood level of melatonin stays elevated for about 12 hours.
Much of melatonin’s popularity as a sleep aid is attributable to the fact that it can be bought over the counter. In fact, it is the only hormone available without a prescription. And it’s precisely this easy access that worries physicians, who point out that many other countries do require a script.
Doctors blame some of melatonin’s overuse on society’s ignorance about adolescents’ sleep cycle. Teenagers and college students, whose bodies tend to release melatonin much later than adults, often use it in pill or liquid form to reset their body clocks to conform to the demands of early-morning school hours.
“The way school hours work means that we’re asking teens to be functional at a time in the morning when their brains are not ready,” said Dr. Belen Esparis, medical director of Mount Sinai Medical Center’s Sleep Disorders Center and Laboratory and an advocate for later high school hours. Other doctors agree. In a policy statement published online last month, the American Academy of Pediatrics recommended middle and high schools delay the start of class to 8:30 a.m. or later.
Though it is considered relatively safe taken at the right dose for a short period of time, “few sleep doctors will recommend a melatonin supplement for teenagers as a first-line treatment,” said Tarig Ali-Dinar, assistant professor of pediatrics at the University of Miami Miller School of Medicine. He always suggests that parents and children look more closely at sleep habits before trying any kind of medication. The National Institutes of Health warn, however, that melatonin may impact kids’ development and people with immune disorders or taking immunosuppressants shouldn’t use the supplement.
Teenagers need an average of one or two hours more sleep than their younger siblings, or about 9 1/4 hours. Yet the average American teen gets a lot less. And it’s not just a delayed sleep cycle that keeps teens up into the wee hours.
“If the adolescent is involved in too many activities, have him or her choose the most important ones and choose a realistic schedule that allows time for enough rest,” Ali-Dinar admonishes parents.
Studies on melatonin’s effectiveness are inconclusive, he added, because of “possible difference in melatonin dosage, time of administration and variety of subjects.” Like other physicians, Ali-Dinar further worries that melatonin users may not know what, exactly, they’re taking. Because it is sold as a dietary supplement, just like vitamins and minerals, melatonin does not undergo the rigorous approval process of the Food and Drug Administration. Without this kind of regulation, the listed dosage may not be accurate.
What’s more, parents may be using melatonin incorrectly — giving it too close to bedtime or dispensing too high a dosage. “Most of the time it’s simply not used correctly,” said neurologist David Seiden, medical director of Baptist Sleep Center at Miami Lakes and Pembroke Pines. “Dosage should be much lower than what’s being sold out there and it should be taken in late afternoon or early evening, long before going to bed.”
He suggests no more than half a milligram, but the most common dosages are 1 to 3 milligrams. That typical dosage can elevate blood melatonin levels up to 20 times the normal level, which in turn can lead to drowsiness the following day.
Melatonin has proven effective in regulating sleep cycle of shift workers and of people suffering from jet lag or certain disorders, including autism. But even in such cases, melatonin is not a miracle drug. Common side effects include dizziness, headaches, nightmares and daytime sleepiness.
It also doesn’t work as quickly or consistently as some users would like. Maraya Rivera, 16, began taking it as a high school freshman, after her therapist suggested it when she couldn’t fall asleep before 1 a.m. The melatonin made her groggy but didn’t knock her out.
“It didn’t make that much of a difference,” she said. “And I was still really sleepy in the morning at school.”
Mount Sinai’s Espari explains that melatonin doesn’t work like Ambien. “It acts like a weak hypnotic,” she added, “and is not as strong a medication.”
As an alternative to melatonin, physicians suggest parents look more closely at what prevents their children from getting a good night sleep.
“Adolescents should be encouraged to keep a fixed sleep schedule during weekdays and allowing no more than one or two hours later than usual awakening time in the weekends,” Ali-Dinar said. “In the afternoon avoid caffeine and caffeinated beverages which can disrupt sleep.”
Maraya, now a junior in high school, still has trouble falling asleep at 10 p.m., the time her mother would like her to crawl into bed. But she made an effort to improve her sleep habits after she ditched the melatonin pills.
“I don’t take the naps I used to take when I get home from school,” she explained. She also runs, an exercise that tires her physically.
As for Ugando, he installed black-out shades in his daughters’ bedrooms. “That,” he added, “has helped tremendously.”
Doctors recommend practicing good sleep hygiene before trying any supplement or medication, including:
• Make sleep a priority.
• If you’re going to nap, don’t do if too long or too close to bedtime because it can interfere with your regular sleep cycle.
• Keep your bedroom quiet and dark. Get eyeshades or black-out curtains if you need them. Let in bright light in the morning to signal your body to wake up.
• Don’t consume caffeine close to bedtime. Nicotine and alcohol can also interfere with your sleep.
• Stick to a consistent bed-and-wake time. On weekends don’t sleep more than an hour past your regular wake time.
• Don’t eat, drink, or exercise within a few hours of your bedtime.
• Avoid the TV, computer and telephone in the hour before you go to bed. Reading or taking a warm shower or bath before bed may help get you sleep-ready.