Sleep problems may occur in up to 88% of visually impaired children with developmental disabilities. This can be due, in large part, to the significant role of visual cues, particularly of light/dark cycles, in the establishment of normal sleep patterns. Melatonin is a hormone secreted by the pineal gland in the brain. Its secretion is stimulated by darkness, and suppressed by light. The use of oral melatonin has recently been used for the management of sleep difficulties in both children with and without developmental disabilities. Promising results have occurred once an accurate diagnosis had been established after thorough history, examination, and (when indicated) a sleep study. The use of sustained-release melatonin may reduce nighttime awakenings and increase total sleep times in patients suffering from circadian rhythm sleep disorders. Therapy may improve cognition, socialization skills, and functioning of the patient's entire family unit.
SLEEP DISORDERS ARE common in young children, including those with developmental disabilities. Sleep is a major part of the young child's life. By the second year they will have slept around 14 months, and by 5 years about 50% of their lives will have been spent sleeping.1 As such, it is not surprising that up to 30% of all children seeking health-care services report sleep-related concerns.1 Among children with developmental disabilities, the prevalence of sleep problems can be as high as 88%.2,3 Management of sleep disorders in disabled children has included strict sleep-wake schedules, controlled sleeping environments, and the use of hypnotics such as chloral hydrate. Recently, melatonin, a sleep-promoting hormone, has been used in an attempt to treat a variety of sleep problems.4
This review will address a general background on sleep, and associated disorders, in children with, and without, developmental disabilities. Melatonin, its discovery and isolation, and effects will be discussed, followed by a review of published reports concerning its use in children with disabilities. Finally, assessment strategies for children with sleep problems and treatment options, including melatonin, will be presented.