Melatonin - The Sleep Master
An emerging role for this over-the-counter supplement in the treatment of autism.
One of the most common and most troubling times we experience is when we or our children cannot fall asleep effectively. Autistic children appear to be especially prone to this problem, and in has been estimated that more than half exhibit some disturbance in sleep patterns. This suggests some form of deficit in the brain systems that normally promote sleep. During the past decade there has been great progress in understanding the normal brain mechanisms which sustain restful sleep. Since a great number of sleep promoting substances exist in the brain and body, any of them might be deficient in neurological condition we call autism. Here we will focus on one of the major factors, melatonin, which is presently proving to be a remarkably effective natural sleeping aid not only for restless autistic children but also their often bedraggled parents.
As many parents have already discovered, this natural sleep molecule is presently available over-the-counter at many health food stores and distributors (although the ever present danger exists that special-interests will succeed in coaxing the FDA into taking this safe and effective aid off the shelves, as has already been done for several other important supplements, most notably tryptophan). Of course, as with any powerful and effective substance, there are certain guidelines that one should follow to maximize benefits and avoid problems. Although there are sound theoretical reasons for believing that autistic children may be manufacturing either too much melatonin (see Chamberlain & Herman, 1990) or too little, our own viewpoint has been that many kids do not secrete enough (see Panksepp, Lensing, Leboyer & Bouvard, 1991).
Unfortunately, there presently is simply not enough good data to decide which viewpoint is correct. However, the fact that melatonin can stabilize and promote normal sleep and daily bodily rhythms is presently certain. However, it is important to learn how to use this remarkably safe and powerful substance wisely. After briefly summarizing how melatonin works in the brain, we will share some important advice in the proper use of melatonin (including when it should be given, how much should be given, and what to do if melatonin stops working, as sometimes does happen). The first thing that is important to know is that our brains contain a wonderful clock-like mechanisms that normally keeps time with about a 24 Hr. period, but its accuracy is controlled by many factors such as light (i.e.,.., day-night cycles) and various brain chemicals, especially melatonin. This clock-like control center is situated in two small clusters of neurons at the base of the brain called the suprachiasmatic nuclei (SCN) which, as the name implies, are situated directly above the optic chiasm, the place where half the nerves from each of our eyes cross over to the opposite halves of our brains. The many output pathways from the SCN control practically all behavioral rhythms that have been studied, from feeding to sleep. When both nuclei are destroyed, animals scatter their behavior haphazardly throughout the day instead of maintaining a well-patterned routine of daily activities. Our own natural melatonin secretions, which normally occur during the early morning hours when we have our deepest sleep, coordinates the accuracy of the SCN clock. People who have lost their sight, and hence are unable to coordinate their bodily clock via the influence of natural day-night cycles, are able to stabilize their rhythms by taking small amounts of melatonin at exactly the same time each day. And that is really the secret to proper melatonin use--it should be given only once a day in small amounts, and the proper time is about half an hour before one's normal sleep-time.
Within our bodies, melatonin is naturally produced within the pineal gland, a glandular organ nestled between the cerebral hemispheres, that the great French philosopher Descartes once proposed to be the "seat of the soul." In that gland, melatonin is synthesized in two steps from the precursor neurotransmitter serotonin. Pineal stores of melatonin are typically released into the circulation when illumination diminishes, and may help explain why most of us sleep better when the lights are off. During those morning hours when melatonin levels begin to diminish, birds begin to sing and we also tend to wake up, restored, to start our daily activities. It is easy to understand why lack of sleep might increase behavioral and psychological problems during the day. In addition, melatonin does a remarkable number of beneficial tasks in the body: Not only is it a powerful inducer of sleep, but it also regulates a variety of other bodily processes ranging from brain maturation to the vigor of our immune responses. It has been found to retard the growth of some cancers, and quite independently of that beneficial effect, it can also alleviate certain forms of anxiety and depression. Most remarkably, given in the drinking water, it has increased life-span in various experimental animals by about 20%. It also helps control the onset of puberty during adolescence.
In short, melatonin exerts many beneficial effect on the brain and body, but parents are well advised to follow certain guidelines in its use as a sleep-promoting agent:
- WHEN? It should be given only once a day, about half an hour before the regular sleep-time. Supplementing with additional melatonin in the middle of the night may be effective, but it is not a smart policy, for that can shift the biological clock in chaotic and undesirable ways.
- HOW MUCH? Although melatonin is very safe (people have consumed grams each day for many day with no ill effects), very small amount can go a long way. Commercially available preparations usually come in 2.5 or 3 milligram (mg) tablets, and a young child should do well on a third of this amount. The higher amounts will produce deeper sleep, but the hormone may still be circulating at quite high levels in the morning, and there are reasons to believe that is undesirable.
- POTENCY CHANGE? Melatonin usually does not diminish in its effects even with prolong use, but for unknown reasons, this is not the case in all individuals. If a low dose of melatonin that has been effective for some time seems to be losing its effect (i.e., tolerance is setting in), one is wiser to stop giving the supplement for a while rather than increasing the dose. Some parents seek to restore the desired effects by increasing the doses, but that only seems to intensify the tolerance process. It is better to take a week to a month off, and then see whether sensitivity has returned. In our experience, sensitivity is usually restored in this way. Many autistic children that have been receiving melatonin on a regular schedule appear to exhibit benefits above and beyond the improvements in sleep. They are more "with it" during the day. These may be the side-benefits of the still mysterious restorative processes that sleep provides for all of us. Additional benefits may arise from the stabilization of body rhythms that may have been out of synch before the melatonin supplementation.
- Although we do know that melatonin and sleep have many bodily benefits, we do not have adequate evidence about the many "hows and whys." Our knowledge of such matters has not progressed much beyond Shakespeare's speculation that the function of sleep is "to knit up the raveled sleeve of care" even though modern thinkers are more likely to suggest that "sleep restores brain neurochemistries and other bodily resources that have been depleted by waking activities." Melatonin appears to be a prime guardian of such restorative processes, and without it, our lives become raveled indeed. It is likely that the for presently unknown reasons, the brains of some autistic children are deficient in this important chemistry. If so, early supplementation with this hormone may be essential for normalizing development. Unfortunately we know little about such matters, and only future research can give us the answers that we desperately need now.
Chamberlain, R.S., & Herman, B.H. (1990) A novel biochemical model linking dysfunction in the brain melatonin, proopiomelanocortin peptides, and serotonin in autism. Biological Psychiatry, 1990, 28, 773-793.
Panksepp, J., Lensing, P., Leboyer, M., & Bouvard, M.P. (1991) Naltrexone and other potential new pharmacological treatments of autism. Brain Dysfunction, 4, 281-300.
Permission was obtained to republish this article which first appeared
in Lost and Found: Perspectives on Brain, Emotions, and Culture.
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