How does melatonin affect restless legs syndrome symptoms. What does research reveal about the relationship between melatonin and RLS. Which management strategies can help alleviate RLS symptoms.

The Complex Relationship Between Melatonin and Restless Legs Syndrome

Restless legs syndrome (RLS) is a neurological disorder characterized by an irresistible urge to move the legs, often accompanied by uncomfortable sensations. Research has uncovered a fascinating connection between melatonin, the hormone that regulates our sleep-wake cycle, and RLS symptoms.

A study explored the effects of melatonin administration and bright light exposure on RLS symptoms. The findings revealed some surprising insights:

• Exogenous melatonin increased motor symptoms (leg movements) in RLS patients
• Bright light exposure slightly decreased sensory symptoms (leg discomfort)
• Suppressing endogenous melatonin with bright light did not affect leg movements

These results suggest a complex interplay between melatonin and RLS. While melatonin may exacerbate motor symptoms, manipulating light exposure could potentially offer some relief for sensory discomfort.

Understanding the Mechanisms Behind Melatonin’s Impact on RLS

Why might melatonin worsen RLS symptoms? Several theories have been proposed:

1. Circadian rhythm influence: Melatonin’s role in regulating the body’s internal clock may interact with the circadian pattern of RLS symptom intensity.
2. Dopamine interaction: Melatonin may affect dopamine levels or receptor activity, which are implicated in RLS pathophysiology.
3. Vascular effects: Melatonin’s impact on blood flow could potentially influence RLS symptoms.

Further research is needed to fully elucidate these mechanisms. Understanding the precise relationship between melatonin and RLS could lead to more targeted treatment approaches.

Bright Light Therapy: A Potential Avenue for RLS Symptom Management

The study’s finding that bright light exposure slightly improved sensory symptoms opens up intriguing possibilities for non-pharmacological RLS management. How might bright light therapy benefit RLS patients?

• Melatonin suppression: Bright light inhibits melatonin production, potentially mitigating its negative effects on RLS.
• Circadian rhythm regulation: Light therapy may help realign disrupted circadian rhythms associated with RLS.
• Mood and alertness: Improved mood and daytime alertness from light therapy could indirectly benefit RLS symptoms.

While more research is needed to confirm the efficacy of bright light therapy for RLS, it represents a promising area for future investigation and potential treatment options.

Navigating Melatonin Use for RLS Patients

Given the study’s findings, should RLS patients avoid melatonin supplements? The answer isn’t straightforward and may depend on individual factors:

• Symptom severity: Patients with mild RLS may still benefit from melatonin’s sleep-promoting effects.
• Timing: Taking melatonin earlier in the evening, before RLS symptoms typically worsen, might be more beneficial.
• Dosage: Lower doses of melatonin may have less impact on RLS symptoms while still aiding sleep.
• Individual response: Some RLS patients may not experience worsened symptoms with melatonin use.

RLS patients considering melatonin supplementation should consult with their healthcare provider to weigh the potential benefits and risks based on their specific situation.

Comprehensive Management Strategies for Restless Legs Syndrome

While the melatonin-RLS connection is intriguing, it’s essential to consider a holistic approach to managing this challenging condition. What other strategies can help alleviate RLS symptoms?

Lifestyle Modifications

• Regular exercise: Moderate physical activity may help reduce RLS symptoms.
• Sleep hygiene: Establishing a consistent sleep schedule and creating a relaxing bedtime routine.
• Avoiding triggers: Identifying and minimizing substances that exacerbate symptoms (e.g., caffeine, alcohol).
• Stress reduction: Practicing relaxation techniques like meditation or yoga.

Dietary Considerations

• Iron supplementation: Addressing iron deficiency, which is linked to RLS.
• Magnesium-rich foods: Some patients report symptom improvement with increased magnesium intake.
• Hydration: Maintaining proper hydration may help alleviate symptoms.

Medical Interventions

• Dopaminergic medications: Often used as first-line treatment for moderate to severe RLS.
• Alpha-2-delta ligands: Medications like gabapentin and pregabalin can be effective for some patients.
• Opioids: In carefully selected cases, opioids may be prescribed for severe RLS.

A personalized treatment plan, developed in consultation with a healthcare provider, often yields the best results for managing RLS symptoms.

The Role of Chronotherapy in RLS Management

The study’s findings highlight the potential importance of chronotherapy in managing RLS. Chronotherapy involves timing treatments and activities to align with the body’s natural circadian rhythms. How can chronotherapeutic principles be applied to RLS management?

• Medication timing: Administering RLS medications at optimal times based on symptom patterns.
• Light exposure: Strategically using bright light or avoiding light to influence melatonin levels and circadian rhythms.
• Sleep scheduling: Adjusting sleep and wake times to minimize symptom impact.

Incorporating chronotherapeutic strategies into RLS treatment plans may enhance overall symptom control and improve quality of life for patients.

Emerging Research and Future Directions in RLS Treatment

The field of RLS research is dynamic, with ongoing studies exploring new treatment avenues and deepening our understanding of the condition. What are some promising areas of investigation?

Genetic Studies

Identifying genetic markers associated with RLS could lead to more personalized treatment approaches and potentially new therapeutic targets.

Novel Pharmacological Approaches

Research into new drug classes, such as adenosine antagonists or glutamate modulators, may yield additional treatment options for RLS patients.

Non-Invasive Brain Stimulation

Techniques like transcranial magnetic stimulation (TMS) are being explored for their potential to alleviate RLS symptoms.

Gut Microbiome Connection

Emerging evidence suggests a possible link between gut health and RLS, opening up new avenues for dietary and probiotic interventions.

As research progresses, the management of RLS is likely to become increasingly sophisticated and tailored to individual patient needs.

The Importance of Patient Education and Support in RLS Management

Living with RLS can be challenging, and patient education plays a crucial role in effective management. How can healthcare providers and support networks empower RLS patients?

• Symptom tracking: Encouraging patients to keep detailed logs of their symptoms, triggers, and treatment responses.
• Treatment adherence: Educating patients on the importance of consistent medication use and potential side effects.
• Lifestyle coaching: Providing guidance on implementing beneficial lifestyle changes and coping strategies.
• Support groups: Connecting patients with peer support networks to share experiences and tips.

Empowering patients with knowledge and support can lead to better treatment outcomes and improved quality of life for those living with RLS.

The complex relationship between melatonin and RLS highlights the multifaceted nature of this condition. While exogenous melatonin may exacerbate motor symptoms in some patients, the potential benefits of chronotherapy and bright light exposure offer new avenues for symptom management. As research continues to unravel the intricacies of RLS, a comprehensive approach combining pharmacological treatments, lifestyle modifications, and emerging therapies holds promise for improving the lives of those affected by this challenging disorder.

RLS patients and healthcare providers must work together to develop personalized treatment plans that address individual symptom patterns and respond to the evolving landscape of RLS research. By staying informed about the latest findings, such as the melatonin-RLS connection, and remaining open to novel management strategies, patients can take an active role in optimizing their care and finding relief from the restless nights that characterize this condition.

Effects of melatonin and bright light administration on motor and sensory symptoms of RLS

Background:

A close temporal relationship was shown between the onset of melatonin secretion at night and the worsening of restless legs syndrome (RLS) symptoms, suggesting that melatonin may play a role in the genesis of this phenomenon. To test this hypothesis we studied the effects of the administration of exogenous melatonin and, conversely, the suppression of endogenous melatonin secretion by bright light exposure on the severity of RLS symptoms.

Methods:

Eight RLS subjects were studied in three conditions: at baseline, after administration of melatonin and during bright light exposure. The severity of RLS symptoms was assessed by the suggested immobilization test (SIT), which allows quantification of both sensory and motor manifestations (SIT-PLM) of RLS.

Results:

Analyses showed a significant increase of SIT-PLM index when subjects received exogenous melatonin compared to both baseline and bright light conditions, but bright light exposure had no effect on leg movements compared to the baseline condition. Analyses also revealed a small but significant decrease in sensory symptoms with bright light exposure compared to baseline.

Conclusion:

Exogenous melatonin may have a detrimental effect on motor symptoms, and bright light exposure produced small but significant improvement of leg discomfort. The study shows the interest of using the SIT to measure outcome of intervention in RLS. Further studies will be needed to assess the therapeutic value of bright light in RLS.

NightWalkers – Restless Legs Syndrome Foundation

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RLS Advocacy in Washington, New Guidelines for Iron Treatment, Attend the National RLS Symposium Sept. 29-30, Finding a Medical Provider, RLS Foundation Membership: Give the Gift!

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Suspected Agomelatine-induced restless legs syndrome: a case report | BMC Psychiatry

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Restless Leg Syndrome (RLS) – Symptoms, Types of RLS

Characterized by prickling, pulling, tingling, and itching in the legs, restless leg syndrome (RLS) creates an overwhelming urge to move the legs. Unless the patient moves his or her legs, he or she keeps feeling the symptoms.

And although moving the legs may provide temporary relief, the symptoms return as soon as the patient relaxes his or her legs.

Affecting 5-10 percent of adults in the United States, RLS can affect people of all ages: from children to old people.

Symptoms of Restless Legs Syndrome

Although different from the sensations that normal people feel, RLS symptoms are defined by patients as:

• Restlessness
• Twitching
• Bruning
• Creeping
• Crawling
• Ithing
• Tingling

These symptoms occur mostly when the person is rested or inactive. When the person with RLS moves his or her legs, the symptoms temporarily resolve.

Because of its onset during the resting phase, many people with RLS develop insomnia, as they lose the ability to fall asleep quickly.

In fact, a study concluded that 88 percent of individuals with RLS report at least one sleep related symptom. This can further lead to:

• Depression
• Irritability
• Mood swings
• Other physical and mental health issues.

If the RLS is caused because of a certain drug or substance, then stopping it will resolve the issue. However, if RLS is primary or idiopathic (has no known symptoms), then the symptoms may worsen over time.

Types of RLS

RLS may be primary/idiopathic or secondary. While primary RLS has no known symptoms, secondary RLS results from an underlying medical condition or medication.

Primary or idiopathic RLS

Idiopathic means that the pathology has no known cause. It can be especially difficult to treat because of the absence of an underlying medical condition.

Idiopathic RLS is quite common in people:

• Age 40 or above
• Who are genetically predisposed to the condition

Primary or idiopathic RLS generally lasts for the entire lifetime, but sometimes the symptoms disappear for a long time.

Secondary RLS

Secondary RLS may result from the following medical conditions:

Although the cause hasn’t been identified yet, experts hypothesise that neurotransmitters play an important role and that basal ganglia, a region in the brain that uses dopamine to control muscle activity, may be involved.

Excess dopamine in the brain damages nerve cells, leading to involuntary movements.

So when dopamine levels fall at the end of the day, the symptoms of RLS get worse. This is why people with RLS should avoid melatonin supplements, which lower the amount of dopamine in the brain.

There are a few triggers that can cause restless leg syndrome or exacerbate the symptoms. Here are the triggers for RLS:

• SSRI antidepressants (selective serotonin reuptake inhibitor)
• Antipsychotics
• Calcium channel blockers
• Antihistamines
• Lithium

Periodic Limb Movement Disorder

People with RLS generally have period limb movement disorder, which causes the limbs to jerk and twitch while the person is asleep.

As the movements occur during sleep, the person is mostly unaware of this symptom. However, these movements can sometimes be severe enough to wake up the person.

Diagnosis of RLS

Generally, your GP can diagnose RLS on the basis of test results, family history, medical history, and physical examination. Here are a few things that your doctor may look for:

• Overwhelming urge to move legs because of uncomfortable sensations
• Symptoms resolve on moving the legs
• Symptoms occur or get worse when inactive
• Symptoms get worse during the night

Assessment of RLS

It’s essential to look for patterns when it comes to RLS. You need to take note of:

• How often do the symptoms occur?
• What type of sensations do you feel?
• If your sleep is disrupted, then how often?
• How much distress do the symptoms cause?

Your doctor may advise you to keep a sleep diary, which maintains a record of:

• Daily sleep habits
• Time of sleep per day
• Number of times you wake up during the night
• Excessive daytime sleepiness

If your symptoms are severe, your doctor may prescribe you a few medicines to relieve the symptoms and to help you fall asleep faster.

Tests for RLS

Your doctor may conduct a few blood and sleep tests.

Blood tests may include tests for:

• Diabetes
• Kidney function problem
• Anemia

Blood tests can ascertain any underlying issues that may lead to secondary restless legs syndrome. Primarily, your doctor looks at the levels of iron in your body.

As RLS may disrupt sleep and cause insomnia, your doctor may recommend polysomnography (sleep tests), which measure your brain wave, oxygen levels, breathing rate, etc while you sleep.

Treatment for RLS

By making a few lifestyle changes, you can easily manage mild to moderate symptoms of restless legs syndrome.

Lifestyle changes that you can make include:

1. Sleeping at a specific time each day
2. Avoiding caffeine and alcohol
3. Quitting smoking
4. Regular exercise, but not close to bedtime
5. Following good sleep hygiene
6. Avoiding medications that exacerbate your symptoms

Apart from these changes, you can practice relaxation techniques that may calm your anxiety:

1. Take a hot bath before heading to bed
2. Massage your legs
3. Stretch out your muscles
4. Use the 4-7-8 breathing technique to calm your nerves
5. Practice mindfulness to learn not to judge your thoughts

Medication

For severe restless legs syndrome, your doctor may prescribe the following medicines:

Dopamine agonists

If you frequently experience symptoms of RLS, your doctor may prescribe dopamine agonists, which increase the levels of dopamine in the brain.

Since low levels of dopamine have been linked to increased symptoms of RLS, dopamine agonists may provide relief.

Painkillers

Opioids, such as codeine, may be prescribed to relieve chronic pain, which is sometimes accompanied by RLS.

Gabapentanoids, such as gabapentin and pregabalin, may be prescribed to provide relief from restlessness and tingling sensations. They work as painkillers as well.

Home remedies for RLS

People with RLS sometimes find relief from home remedies. Here are some of these remedies that you can try:

Magnesium supplements

Consuming magnesium may provide some relief from restless legs, as magnesium is a natural muscle relaxant. Further, our body requires magnesium to make melatonin, the sleep hormone.

Start off with small doses between 200-400mg of magnesium per day. Once your body gets used to this dose, you can increase the dosage to up to 1,000mg per day.

Avoid certain foods

You need to avoid certain foods that trigger and exacerbate the symptoms of restless legs syndrome.

Stimulants, such as alcohol, caffeine, and tobacco, must be avoided close to bedtime. Further, consuming processed foods high in simple carbohydrates and items containing sugar in large amounts may trigger your symptoms.

Use compresses

Hot and cold compresses are often used for relief from muscle injury. Anecdotal evidence exists that people with RLS may find it helpful to use hot and cold compresses, which may reduce the uncomfortable sensations triggered by RLS.

Conclusion

Restless legs syndrome causes irritability, anxiety, and depression. It can lead to sleep disorders, such as insomnia, which further exacerbate the problem. If you think you have this condition, then get a diagnosis from your doctor.

Periodic Limb Movement Disorder (PLMD)

Overview

What is periodic limb movement disorder (PLMD)?

Periodic limb movement disorder (PLMD) is a condition that was formerly called sleep myoclonus or nocturnal myoclonus. It is described as repetitive limb movements that occur during sleep and cause sleep disruption. The limb movements usually involve the lower extremities, consisting of extension of the big toe and flexion of the ankle, the knee, and the hip. In some patients, the limb movements can occur in the upper extremities as well.

The limb movements occur most frequently in light non-REM sleep. The repetitive movements are separated by fairly regular intervals of 5 to 90 seconds. There can be significant night-to-night variability to the frequency of limb movements.

Who gets periodic limb movement disorder (PLMD)?

Many individuals have periodic limb movements in sleep (PLMS). This is observed in about 80% of patients with restless legs syndrome (RLS). PLMS can occur in over 30% of people aged 65 and older and can be asymptomatic. PLMS are very common in patients with narcolepsy and REM behavior disorder, and may be seen in patients with obstructive sleep apnea and during PAP therapy initiation.

True PLMD – the diagnosis of which requires periodic limb movements in sleep that disrupt sleep and are not accounted for by another primary sleep disorder including RLS – is uncommon.

PLMD has been less extensively studied than RLS. The exact prevalence is unknown. It can occur at any age; however, the prevalence does increase with increasing age. Unlike RLS, PLMD does not appear to be related to gender.

As with RLS, some medical conditions are associated with PLMD. These include uremia, diabetes, iron deficiency, OSA, and spinal cord injury.

Symptoms and Causes

What causes

periodic limb movement disorder (PLMD)?

The exact cause of PLMD is unknown. However, several medications are known to make PLMD worse. These medications include some antidepressants, antihistamines, and some antipsychotics. PLMD may be related to a low iron level or problems with limb nerve conduction due to diabetes or kidney disease. Though not necessarily a cause, the following are all thought to “influence” or increase the risk of periodic limb movements in sleep:

What are some of the symptoms of

periodic limb movement disorder (PLMD)?

Most patients are actually not aware of the involuntary limb movements. The limb jerks are more often reported by bed partners. Patients experience frequent awakenings from sleep, non-restorative sleep, daytime fatigue, and/or daytime sleepiness.

Diagnosis and Tests

How do I know if I have

periodic limb movement disorder (PLMD)?

The diagnosis is based on the clinical history as well as an overnight polysomnogram (PSG). This is a test that records sleep and the bioelectrical signals coming from the body during sleep. A thorough neurological examination should be performed. Respiratory monitoring during the PSG allows one to rule out the presence of sleep disordered breathing as a cause for the disrupted sleep and excessive muscle activity. Occasionally, additional sleep laboratory testing is useful. Blood work may be ordered to check on iron, folic acid, vitamin B12, thyroid function, and magnesium levels.

Management and Treatment

How is

periodic limb movement disorder (PLMD) treated?

First, certain products and medications should be avoided. Caffeine often intensifies PLMD symptoms. Caffeine-containing products such as chocolate, coffee, tea, and soft drinks should be avoided. Also, many antidepressants can cause a worsening of PLMD in many patients and should be reviewed, discussed and replaced by your doctor.

Generally, there are several classes of drugs that are used to treat PLMD. These include dopamine agonist, anticonvulsant medications, benzodiazepines, and narcotics. Current treatment recommendations consider the dopamine agonist as a first line of defense. Medical treatment of PLMD often significantly reduces or eliminates the symptoms of these disorders. There is no cure for PLMD and medical treatment must be continued to provide relief.

What is the role of medications in the treatment of pediatric sleep disorders?

Author

Sufen Chiu, MD, PhD Assistant Clinical Professor (Volunteer Faculty), University of California, Davis, School of Medicine; Staff Physician, Mercy Medical Group

Sufen Chiu, MD, PhD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Psychiatric Association, California Medical Association, Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Dennis Anthony Nutter, Jr, MD President, Owner, and Director, North Georgia Neuropsychiatry, PC

Dennis Anthony Nutter, Jr, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Medical Association, American Psychiatric Association, Georgia Psychiatric Physicians Association, Physicians for a National Health Program

Disclosure: Nothing to disclose.

Guy K Palmes, MD Assistant Professor, Program Director, Department of Psychiatry, Section of Child and Adolescent Psychiatry, Wake Forest University School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Acknowledgements

Chet Johnson, MD Medical Director, Child Development Unit, Department of Pediatrics, Professor, University of Kansas Medical Center

Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Benyam Tegene, MD Fellow, Department of Psychiatry, Wake Forest University Baptist Medical Center

Benyam Tegene, MD is a member of the following medical societies: American Medical Association and American Psychiatric Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Melatonin | Susan G. Komen®

What is it?

Melatonin is a hormone found naturally in the body. Melatonin used as medicine is usually made synthetically in a laboratory. It is most commonly available in pill form, but melatonin is also available in forms that can be placed in the cheek or under the tongue. This allows the melatonin to be absorbed directly into the body.

Some people take melatonin by mouth to adjust the body’s internal clock. Melatonin is most commonly used for insomnia and improving sleep in different conditions. For example, it is used for jet lag, for adjusting sleep-wake cycles in people whose daily work schedule changes (shift-work disorder), and for helping people establish a day and night cycle.

Coronavirus disease 2019 (COVID-19): There is no good evidence to support using melatonin for COVID-19. Follow healthy lifestyle choices and proven prevention methods instead.

It is effective?

Natural Medicines rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

Probably Effective for …

• Trouble falling asleep at a conventional bedtime (delayed sleep phase syndrome). Taking melatonin by mouth appears to reduce the length of time needed to fall asleep in young adults and children who have trouble falling asleep. However, within one year of stopping treatment, this sleeping problem seems to return.
• Non-24-hour sleep wake disorder. Taking melatonin at bedtime seems to improve sleep in children and adults who are blind.

Possibly Effective for …

• Sleep disturbance caused by certain blood pressure medicine (beta blocker-induced insomnia). Beta-blocker drugs, such as atenolol and propranolol, are a class of drugs that seem to lower melatonin levels. This might cause problems sleeping. Research shows that taking a melatonin supplement might reduce problems sleeping in patients taking beta-blocker drugs.
• Cancer. High doses of melatonin, administered by a healthcare professional along with chemotherapy or other cancer treatments, might reduce tumor size and improve survival rates in some people with cancer.
• A painful uterine disorder (endometriosis). Taking melatonin daily for 8 weeks seems to reduce pain and painkiller use in women with endometriosis. It also reduces pain during menstruation, intercourse, and while going to the bathroom.
• High blood pressure. Taking the controlled-release form of melatonin before bedtime seems to lower blood pressure in people with high blood pressure. Immediate-release formulations do not seem to work.
• Insomnia. Taking melatonin short-term seems to shorten the amount of time it takes to fall asleep in people with insomnia, but only by about 7-12 minutes. Melatonin might also increase the amount of time that a person with insomnia spends sleeping. But results are conflicting, and any benefit is small at best. Some people say melatonin makes them sleep better, even though tests do not agree. There is some evidence that melatonin is more likely to help older people than younger people or children. This may be because older people have less melatonin in their bodies to start with. There is also interest using melatonin for people with insomnia and other conditions. Research shows that melatonin might improve sleeping trouble related to conditions such as depression, schizophrenia, epilepsy, autism, developmental disabilities, and intellectual disabilities. But it’s unclear if melatonin improves sleep problems in people with Alzheimer disease, dementia, Parkinson disease, traumatic brain injury, substance use disorders, or in people undergoing dialysis.
• Jet lag. Most research shows that melatonin can improve certain symptoms of jet lag such as alertness and movement coordination. Melatonin also seems to slightly improve other jet lag symptoms such as daytime sleepiness and tiredness. But, melatonin might not be effective for shortening the time it takes for people with jet lag to fall asleep.
• Migraine. Most evidence shows that taking melatonin before bed can prevent migraines in adults and children. When headaches do occur, they are milder and pass more quickly. It is not clear if melatonin helps to treat migraines.
• Anxiety before surgery. Melatonin used under the tongue or by mouth modestly reduces anxiety before surgery in adults. It also seems to have fewer side effects than some other medications used to reduce anxiety before surgery. It is unclear if melatonin is beneficial for reducing anxiety before surgery in children.
• Sunburn. Applying melatonin gel to the skin before sun exposure seems to prevent sunburn. Applying melatonin cream to the skin before sun exposure seems to help people that are very sensitive to sunlight. But melatonin cream might not prevent sunburn in people with less sensitive skin.
• A group of painful conditions that affect the jaw joint and muscle (temporomandibular disorders or TMD). Research suggests that taking melatonin at bedtime for 4 weeks reduces pain by 44% and increases tolerance to pain by 39% in women with jaw pain.
• Low levels of platelets in the blood (thrombocytopenia). Taking melatonin by mouth can improve low blood platelet counts associated with cancer, cancer treatment, and other disorders.

Possibly Ineffective for …

• Athletic performance. Taking melatonin shortly before resistance exercise or cycling doesn’t appear to improve performance.
• Involuntary weight loss in people who are very ill (cachexia or wasting syndrome). Research shows that taking melatonin each evening for 28 days does not improve appetite, body weight, or body composition in people with wasting syndrome from cancer.
• Diseases, such as Alzheimer disease, that interfere with thinking (dementia). Most research shows that taking melatonin does not improve behavior or affect symptoms in people with Alzheimer disease or other forms of memory loss. But taking melatonin might reduce confusion and restlessness when the sun goes down in people with these conditions.
• Inability to become pregnant within a year of trying to conceive (infertility). Taking melatonin does not appear to improve pregnancy rates in women undergoing fertility treatments.
• Sleep disorder due to rotating or night shifts (shift work disorder). Taking melatonin by mouth does not seem to improve sleeping problems in people who do shift work.

Probably Ineffective for …

• Withdrawal from drugs called benzodiazepines. Some people take benzodiazepines for sleep problems. Long-term use can lead to dependence. Taking melatonin at bedtime doesn’t help people stop taking these drugs.
• Depression. Although melatonin might improve sleeping problems in people with depression, it does not seem to improve depression itself. There is also some concern that melatonin might worsen symptoms in some people. It is not clear if taking melatonin can prevent depression.

Insufficient Evidence to Make a Determination for …

• An eye disease that leads to vision loss in older adults (age-related macular degeneration or AMD). Early research shows that taking melatonin might delay the loss of vision in people with age-related vision loss.
• Eczema (atopic dermatitis). Early research shows that melatonin can reduce the symptoms of eczema in children. However, although melatonin improves sleep quality it does not always can shorten the time it takes for these children to fall asleep.
• Attention deficit-hyperactivity disorder (ADHD). Limited research shows that melatonin might reduce insomnia in children with ADHD who are taking stimulants. But improved sleep doesn’t seem to decrease symptoms of ADHD.
• Autism. Early research shows that taking melatonin may improve aggression or impulsiveness in kids with autism. But taking melatonin doesn’t seem to improve other behaviors.
• Enlarged prostate (benign prostatic hyperplasia or BPH). Taking melatonin may reduce excessive urination at night in some men with enlarged prostate. But it’s not clear if this improvement is clinically meaningful.
• Bipolar disorder. Early research shows that taking melatonin at bedtime increases sleep duration and reduces manic symptoms in people with bipolar disorder who also have insomnia. But there are also concerns that taking melatonin might make symptoms worse in some people with bipolar disorder.
• Tiredness in people with cancer. Taking melatonin short-term doesn’t seem to improve tiredness or quality of life in people with cancer. It’s unclear if it would be beneficial if used for a longer time.
• Chronic fatigue syndrome (CFS). Some early research shows that taking melatonin in the evening might improve some symptoms of CFS, including fatigue, concentration, and motivation. However, other early research shows that taking melatonin by mouth does not improve CFS symptoms.
• A lung disease that makes it harder to breathe (chronic obstructive pulmonary disease or COPD). Some evidence shows that taking melatonin improves shortness of breath in people with COPD. However, it does not seem to improve lung function or exercise capacity.
• Cluster headache. Taking melatonin 10 mg by mouth every evening might reduce the frequency of cluster headaches. However, lower doses don’t seem to work.
• A mental state in which a person is confused and unable to think clearly. It is unclear if oral melatonin helps to prevent delirium in adults who are in the hospital.
• Diabetes. Although some research shows that melatonin might reduce levels of blood sugar, it isn’t known if this is helpful for patients with diabetes.
• Dry mouth. Taking melatonin by mouth and using melatonin as a mouth rinse doesn’t prevent dry mouth in people with head and neck cancer being treated with cancer drugs and radiation. But it might delay the start of symptoms.
• Indigestion (dyspepsia). Taking melatonin nightly might reduce indigestion in some people. But it doesn’t seem to work as well in people with prior H. pylori infection.
• Side effects in people with a breathing tube. Taking melatonin might reduce some side effects from having a breathing tube.
• Confusion and agitation after surgery. Early research in children shows that taking melatonin might help to reduce the amount of agitation caused by a certain type of anesthesia, called sevoflurane.
• Seizure disorder (epilepsy). There is some evidence that taking melatonin at bedtime may reduce seizures in children and adults with epilepsy. But higher quality research is needed to confirm.
• Fibromyalgia. Melatonin might decrease the severity of pain and stiffness in people with fibromyalgia.
• Persistent heartburn. Taking melatonin daily at bedtime might improve symptoms of acid reflux, including heartburn. However, taking conventional medication seems to be more effective.
• A digestive tract infection that can lead to ulcers (Helicobacter pylori or H. pylori). Evidence shows that taking melatonin together with the drug omeprazole improves healing in people with ulcers caused by H. pylori infection.
• A long-term disorder of the large intestines that causes stomach pain (irritable bowel syndrome or IBS). Early research shows that taking melatonin might improve some, but not all, symptoms of IBS. Some research shows that melatonin works better in people with IBS in which constipation is the main symptom.
• Kidney transplant. Early research shows that taking melatonin does not improve how well the kidney works after a kidney transplant.
• Symptoms of menopause. Limited research shows that melatonin does not relieve menopausal symptoms. However, taking melatonin in combination with soy isoflavones might help psychological symptoms associated with menopause.
• A grouping of symptoms that increase the risk of diabetes, heart disease, and stroke (metabolic syndrome). Early research shows that taking melatonin reduces blood pressure as well as low-density lipoprotein (LDL or “bad”) cholesterol in people with metabolic syndrome.
• Multiple sclerosis (MS). Early research shows that taking melatonin doesn’t improve MS symptoms such as fatigue and disability.
• Heart attack. Early research shows that melatonin injected directly into the vein within 2.5 hours after a heart attack, might decrease damage to the heart.
• Brain damage in infants caused by lack of oxygen. Early research shows that giving melatonin in addition to cooling-therapy might improve outcomes in infants with brain damage caused by a lack of oxygen. It is unclear if melatonin helps to prevent death in these infants.
• Injury to the brain, spine, or nerves (neurological trauma). Early research shows that taking melatonin does not improve symptoms in children that have had a concussion.
• Bed-wetting. Early research shows that taking melatonin before bed does not change how often children wet their beds at nighttime.
• Build up of fat in the liver in people who drink little or no alcohol (nonalcoholic fatty liver disease or NAFLD). Some evidence shows that taking melatonin improves markers of liver function in people with NAFLD. But not all research agrees.
• Swelling (inflammation) and build up of fat in the liver in people who drink little or no alcohol (nonalcoholic steatohepatitis or NASH). Some evidence shows that taking melatonin improves markers of liver function in the blood of people with nonalcoholic steatohepatitis.
• Swelling (inflammation) and sores inside the mouth (oral mucositis). Taking melatonin by mouth and using melatonin as a mouth rinse seems to delay mouth ulcers from forming in people getting cancer drugs and radiation. But it might not reduce the number of these people who get mouth ulcers.
• Low bone mass (osteopenia). Early research in women with low bone mass after menopause suggests that taking melatonin slightly increases bone thickness in the spine and shin but not in other areas.
• Chronic pain. Limited research suggests that taking melatonin might improve different types of chronic pain by a small amount.
• A hormonal disorder that causes enlarged ovaries with cysts (polycystic ovary syndrome or PCOS). Melatonin might improve irregular menstruation in women with PCOS. Taking melatonin seems to increase the number of menstrual cycles over 6 months from 2.5 to 4.
• Pain after surgery. Some research shows that taking melatonin for 2 days and continuing for up to 3 weeks when undergoing surgery might reduce pain and use of pain medication.
• Recovery after surgery. Some evidence shows that taking melatonin the night before and one hour before undergoing surgery might reduce pain and drug use after surgery.
• Changes in heart rate when you move from laying down to sitting up (postural tachycardia syndrome). Early research shows that taking a single dose of melatonin reduces heart rate when you change from sitting to standing. But melatonin does not seem to affect blood pressure or other symptoms.
• A pregnancy complication marked by high blood pressure and protein in the urine (pre-eclampsia). Taking melatonin with vitamin B6 might sometimes reduce the need for blood pressure medicines. But it doesn’t seem to improve pre-eclampsia overall.
• Prostate cancer. Taking melatonin by mouth together with conventional medications might reduce the growth of prostate cancer.
• Itching. Taking melatonin by mouth might reduce itching in people with kidney failure who are on dialysis.
• Skin damage caused by radiation therapy (radiation dermatitis). In women with breast cancer, applying a specific melatonin emulsion cream to the skin during radiation treatment seems to reduce radiation dermatitis.
• A sleep disorder in which people act out dreams while sleeping. Some evidence shows that taking melatonin before bed reduces muscle movement during sleep in people with a sleep disorder that involves acting out dreams.
• A disorder that causes leg discomfort and an irresistible urge to move the legs (restless legs syndrome or RLS). Early research shows that taking melatonin before bedtime might make symptoms worse in people with restless legs syndrome.
• A disease that causes swelling (inflammation) in body organs, usually the lungs or lymph nodes (sarcoidosis). Early evidence shows that taking melatonin daily for one year followed by a reduced dose for a second year improves lung function and skin problems in people with an inflammatory condition called sarcoidosis.
• Schizophrenia. There is conflicting evidence about the effects of melatonin on schizophrenia symptoms and side effects related to medications. Some research shows that taking melatonin by mouth for 8 weeks reduces weight gain associated with the use of the drug olanzapine and improves symptoms of schizophrenia. But other research shows that it might not have any benefits and might worsen the side effects of second-generation antipsychotic medications.
• Seasonal depression (seasonal affective disorder or SAD). Some early research shows that taking melatonin by mouth might reduce depression during the winter in people with SAD. But giving melatonin under the tongue does not seem to improve symptoms.
• Quitting smoking. Taking melatonin 3.5 hours after quitting smoking seems to reduce anxiety, restlessness, and cigarette cravings.
• Blood infection (sepsis). There is conflicting research about the effect of melatonin on sepsis in neonates. While some early research shows that giving melatonin in addition to antibiotics improves severity of blood infection, other research shows that melatonin has no effect.
• Stress. There is some evidence that taking melatonin might improve memory while under stress.
• A movement disorder often caused by antipsychotic drugs (tardive dyskinesia). Some evidence shows that taking melatonin by mouth decreases symptoms of a movement disorder called tardive dyskinesia. However, other evidence shows that taking melatonin daily does not reduce involuntary movements in these patients.
• Ringing in the ears (tinnitus). Some evidence shows that taking melatonin at night reduces ringing in the ears and improves sleep quality. However, other research shows that it does not reduce ear ringing.
• Tension headache. It is unclear if melatonin is beneficial for reducing tension headaches.
• A type of inflammatory bowel disease (ulcerative colitis). Taking melatonin daily in combination with conventional medication seems to help control a type of inflammatory bowel disease called ulcerative colitis.
• Aging.
• Birth control.
• Osteoporosis.
• Problems with mental function.
• Other conditions.

More evidence is needed to rate melatonin for these uses.

How does it work?

Melatonin’s main job in the body is to regulate night and day cycles or sleep-wake cycles. Darkness causes the body to produce more melatonin, which signals the body to prepare for sleep. Light decreases melatonin production and signals the body to prepare for being awake. Some people who have trouble sleeping have low levels of melatonin. It is thought that adding melatonin from supplements might help them sleep.

Is there concern for the safety of its use?

When taken by mouth: Melatonin is LIKELY SAFE for most adults when taken by mouth short-term.
Melatonin is POSSIBLY SAFE when taken by mouth appropriately, long-term. Melatonin has been used safely for up to 2 years in some people. However, it can cause some side effects including headache, short-term feelings of depression, daytime sleepiness, dizziness, stomach cramps, and irritability. Do not drive or use machinery for four to five hours after taking melatonin.

When applied to the skin: Melatonin is LIKELY SAFE for most adults when applied directly to the skin short-term.

When given by IV: Melatonin is POSSIBLY SAFE when injected directly into the body under the supervision of a health care professional.

Special Precautions & Warnings:

Pregnancy: Melatonin is POSSIBLY UNSAFE for women when taken by mouth or injected into the body frequently or in high doses when trying to become pregnant. Melatonin might have effects similar to birth control. This might make it more difficult to become pregnant. There’s not enough reliable information to know if melatonin is safe in lower doses when trying to become pregnant. Some evidence suggests that low doses (2-3 mg daily) might be safe, but additional research is needed to confirm. Not enough is known about the safety of melatonin when used during pregnancy. Until more is known, it’s best not to use melatonin while pregnant or trying to become pregnant.

Breast-feeding: Not enough is known about the safety of using melatonin when breast-feeding. It is best not to use it.

Children: Melatonin is POSSIBLY SAFE when taken by mouth, short-term. Melatonin is usually well tolerated when taken in doses up to 3 mg per day in children and 5 mg per day in adolescents. There is some concern that melatonin might interfere with development during adolescence. While this still needs to be confirmed, melatonin should be reserved for children with a medical need. There isn’t enough evidence to know if melatonin is safe in children when taken by mouth, long-term.

Bleeding disorders: Melatonin might make bleeding worse in people with bleeding disorders.

Depression: Melatonin can make symptoms of depression worse.

High blood pressure: Melatonin can raise blood pressure in people who are taking certain medications to control blood pressure. Avoid using it.

Seizure disorders: Using melatonin might increase the risk of having a seizure.

Transplant recipients: Melatonin can increase immune function and might interfere with immunosuppressive therapy used by people receiving transplants.

Are there any drug interactions?

Birth control pills (Contraceptive drugs)

Interaction Rating=Moderate Be cautious with this combination.

The body makes melatonin. Birth control pills seem to increase how much melatonin the body makes. Taking melatonin along with birth control pills might cause too much melatonin to be in the body.
Some birth control pills include ethinyl estradiol and levonorgestrel (Triphasil), ethinyl estradiol and norethindrone (Ortho-Novum 1/35, Ortho-Novum 7/7/7), and others.

Caffeine

Interaction Rating=Moderate Be cautious with this combination.

Caffeine might decrease melatonin levels in the body. Taking melatonin along with caffeine might decrease the effectiveness of melatonin supplements.

Flumazenil (Romazicon)

Interaction Rating=Minor Be watchful with this combination.

Flumazenil (Romazicon) might decrease the effects of melatonin. It is not yet clear why this interaction occurs yet. Taking flumazenil (Romazicon) along with melatonin might decrease the effectiveness of melatonin supplements.

Fluvoxamine (Luvox)

Interaction Rating=Moderate Be cautious with this combination.

Taking fluvoxamine (Luvox) can increase the amount of melatonin that the body absorbs. Taking melatonin along with fluvoxamine (Luvox) might increase the effects and side effects of melatonin.

Medications for diabetes (Antidiabetes drugs)

Interaction Rating=Moderate Be cautious with this combination.

Melatonin might increase blood sugar. Diabetes medications are used to lower blood sugar. By increasing blood sugar, melatonin might decrease the effectiveness of diabetes medications. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed.
Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.

Medications that decrease the immune system (Immunosuppressants)

Interaction Rating=Moderate Be cautious with this combination.

Melatonin might increase the immune system. Taking melatonin along with medications that decrease the immune system might decrease the effectiveness of medications that decrease the immune system.
Some medications that decrease the immune system include azathioprine (Imuran), basiliximab (Simulect), cyclosporine (Neoral, Sandimmune), daclizumab (Zenapax), muromonab-CD3 (OKT3, Orthoclone OKT3), mycophenolate (CellCept), tacrolimus (FK506, Prograf), sirolimus (Rapamune), prednisone (Deltasone, Orasone), corticosteroids (glucocorticoids), and others.

Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs)

Interaction Rating=Moderate Be cautious with this combination.

Melatonin might slow blood clotting. Taking melatonin along with medications that also slow clotting might increase the chances of bruising and bleeding.
Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), and others.

Nifedipine GITS (Procardia XL)

Interaction Rating=Moderate Be cautious with this combination.

Nifedipine GITS (Procardia XL) is used to lower blood pressure. Taking melatonin might decrease the effectiveness of nifedipine GITS for lowering blood pressure.

Sedative medications (Benzodiazepines)

Interaction Rating=Moderate Be cautious with this combination.

Melatonin might cause sleepiness and drowsiness. Drugs that cause sleepiness and drowsiness are called sedatives. Taking melatonin along with sedative medications might cause too much sleepiness.
Some of these sedative medications include clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan), and others.

Sedative medications (CNS depressants)

Interaction Rating=Major Do not take this combination.

Melatonin might cause sleepiness and drowsiness. Medications that cause sleepiness are called sedatives. Taking melatonin along with sedative medications might cause too much sleepiness.
Some sedative medications include clonazepam (Klonopin), lorazepam (Ativan), phenobarbital (Donnatal), zolpidem (Ambien), and others.

Verapamil (Calan, Covera, Isoptin, Verelan)

Interaction Rating=Moderate Be cautious with this combination.

The body breaks down melatonin to get rid of it. Verapamil (Calan, Covera, Isoptin, Verelan) can increase how quickly the body gets rid of melatonin. Taking melatonin along with verapamil (Calan, Covera, Isoptin, Verelan) might decrease the effectiveness of melatonin.

Are there any interactions with herbs and supplements?

Caffeine: Caffeine might increase or decrease melatonin levels in the body. When taken together with melatonin supplements, caffeine seems to increase melatonin levels.
Echinacea: Taking echinacea together with melatonin might have negative effects on immune function.
Herbs and supplements that might lower blood pressure: Melatonin might lower blood pressure. Using it along with other herbs and supplements that have this same effect might increase the risk of blood pressure dropping too low in some people. Some of these products include andrographis, casein peptides, cat’s claw, coenzyme Q-10, fish oil, L-arginine, lycium, stinging nettle, theanine, and others.
Herbs and supplements that might lower blood sugar: Melatonin might lower blood sugar in some people. Using it along with other herbs and supplements that have this same effect might increase the risk of hypoglycemia.
Herbs and supplements that might lower seizure threshold: Melatonin might increase the risk for seizures in some people, particularly in children. Taking supplements that also lower seizure threshold with melatonin might increase the risk even more. Some of these supplements include butanediol (BD), cedar leaf, Chinese club moss, EDTA, folic acid, gamma butyrolactone (GBL), gamma hydroxybutyrate (GHB), glutamine, huperzine A, hydrazine sulfate, hyssop oil, juniper, L-carnitine, rosemary, sage, wormwood, and others.
Herbs and supplements that might slow blood clotting: Melatonin might increase the effect of herbs that slow blood clotting and might increase the risk of bleeding in some people. These herbs include angelica, clove, danshen, garlic, ginger, ginkgo, Panax ginseng, red clover, willow, and others.
Herbs and supplements with sedative properties: Using melatonin along with herbs that have sedative properties might increase the effects and side effects of melatonin. Some of these supplements include 5-HTP, calamus, California poppy, catnip, hops, Jamaican dogwood, kava, St. John’s wort, skullcap, valerian, yerba mansa, and others.
Vitex agnus-castus: Taking vitex agnus-castus increases melatonin levels in the body. In theory, taking vitex agnus-castus with melatonin might increase both the effects and side effects of melatonin.

Are there any interactions with food?

There are no known interactions with foods.

What dose is used?

The following doses have been studied in scientific research:

ADULTS
BY MOUTH:

• For disorders that affect when a person sleeps and when they are awake: 0.5 mg to 5 mg of melatonin taken daily before bedtime for up to 6 years has been used in blind people. Also in blind people, high dose of 10 mg taken an hour before bedtime for up to 9 weeks has also been used. 2-12 mg of melatonin taken at bedtime for up to 4 weeks has been used.
• For trouble falling asleep at a conventional bedtime (delayed sleep phase syndrome): 0.3 to 5 mg of melatonin daily for up to 9 months has been used.
• For sleep disturbance caused by certain blood pressure medicine (beta blocker-induced insomnia): 2.5 mg of melatonin taken daily for up to 4 weeks has been used. Single doses of 5 mg of melatonin have also been used.
• For endometriosis: 10 mg of melatonin daily for 8 weeks has been used.
• For high blood pressure: 2-3 mg of controlled-release melatonin daily for 4 weeks has been used.
• For insomnia:
  • For insomnia: 2 mg to 3 mg of melatonin before bedtime for up to 29 weeks has been used in most research. Higher doses of up to 12 mg daily have also been used for shorter durations (up to 4 weeks).
  • For insomnia occurring together with other conditions: 2-12 mg for up to 4 weeks has been used. Lower doses have also been used for up to 24 weeks.
• For jet lag: 0.5-8 mg of melatonin at bedtime is commonly taken on the day of arrival at the destination, continuing for 2 to 5 days. Low doses of 0.5-3 mg are often used to avoid the side effects of the higher doses.
• For migraine: 3-4 mg of melatonin each evening for up to 6 months has been used.
• For reducing anxiety before surgery: 3-10 mg of melatonin taken 60-90 minutes before surgery has been used.
• For a group of painful conditions that affect the jaw joint and muscle (temporomandibular disorders or TMD): 5 mg of melatonin at bedtime for 4 weeks has been used.
• For low levels of platelets in the blood (thrombocytopenia) associated with cancer chemotherapy: 20-40 mg of melatonin daily beginning up to 7 days before chemotherapy and continuing throughout chemotherapy cycles has been used.

APPLIED TO THE SKIN:

• For sunburn: A gel containing 0.05% to 2.5% melatonin, applied either 15 minutes before or up to 4 hours after sun exposure, has been used. A cream containing 12.5% melatonin, applied to the skin before sun exposure, has been used.

UNDER THE TONGUE:

• For reducing anxiety before surgery: 5 mg or 0.05-0.2 mg/kg of body weight taken 90-100 minutes before anesthesia has been used.

CHILDREN
BY MOUTH:

• For disorders that affect when a person sleeps and when they are awake: 0.5-4 mg of melatonin daily for up to 6 years has been used in blind people. 0.5-12 mg of melatonin daily for up to 12 weeks has been used in children and adolescents 3 months to 18 years-old.
• For trouble falling asleep at a conventional bedtime (delayed sleep phase syndrome): 1-6 mg of melatonin before bedtime for up to one month has been used.
• For insomnia:
  • For insomnia: 5 mg or 0.05-0.15 mg/kg of body weight taken at bedtime for 4 weeks has been used in children 6-12 years-old with primary insomnia.
  • For insomnia occurring together with other conditions: 6-9 mg of melatonin taken before bedtime for 4 weeks, has been used in children with seizures 3-12 years-old.
• For reducing anxiety before surgery: 0.05-0.5 mg/kg of body weight has been taken before anesthesia in children 1-14 years-old.

By what other names is the product known?

5-Methoxy-N-Acetyltryptamine, MEL, Melatonina, Mélatonine, MLT, N-Acetyl-5-Methoxytryptamine, N-Acétyl-5-Méthoxytryptamine, Pineal Hormone.

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[Features of the organization of sleep in children with attention deficit hyperactivity disorder]

The article presents modern ideas about the clinical features of sleep in children with attention deficit hyperactivity disorder (ADHD), the macrostructure of sleep, its cyclic organization and possible common links in the pathogenesis of sleep disorders and behavioral problems in patients. The relationship between the structure of sleep and impaired executive functions, the level of social maladjustment in patients with ADHD has been proven.Typical of children with ADHD are difficulty in going to sleep and falling asleep for a long time (resistance to sleep time), increased motor activity associated with sleep, including the association of ADHD with Restless legs syndrome (RLS) and periodic leg movement syndrome ( PLMS), daytime sleepiness. The presence of circadian desynchrony in children with ADHD explains the relationship between chronotype, circadian typology, and clinical manifestations of the syndrome. Multidirectional data on the representation of REM sleep by nocturnal polysomnography in children with ADHD depend on age.However, the change in the proportion of REM sleep during the night is considered as a leading factor in the pathogenesis of ADHD manifestations. Various variants of metabolic disorders of melatonin, dopamine, serotonin, aggravated by social jet lag, are considered by the conjugatedcommon pathogenetic mechanisms of sleep disturbance and ADHD. As well as changes in the concentration of iron and ferritin in the blood, which may explain the frequency of RLS and PLMS in children with ADHD. The change in the number of sleep cycles during the night in patients has been demonstrated.Possible strategies for correcting sleep disorders in children with ADHD and their impact on the manifestation of ADHD are discussed.

The article reflects modern ideas about the clinical features of sleep in children with attention deficit hyperactivity disorder (ADHD), the macrostructure of sleep, its cyclic organization and possible common links in the pathogenesis of sleep disorders and regulatory functions, the level of social maladjustment of patients with ADHD.Typical for children with ADHD are difficulty in going to sleep and prolonged falling asleep (resistance to sleep time), increased motor activity associated with sleep, including the association of ADHD with Restless legs syndrome (RLS) and periodic leg movement syndrome during sleep (Periodic Leg Movement during Sleep —PLMS), daytime sleepiness. The presence of circadian desynchrony in children with ADHD explains the relationship between chronotype, circadian typology, and clinical manifestations of the syndrome.Multidirectional data on the representation of REM sleep – rapid eye movement sleep (REM) according to nocturnal polysomnography data in children with ADHD depend on age. However, the change in the proportion of REM sleep during the night is considered as a leading factor in the pathogenesis of ADHD manifestations. The general pathogenetic mechanisms for sleep disorders and ADHD are highlighted: various variants of metabolic disorders of melatonin, dopamine, serotonin, aggravated by “social jetlag”, as well as changes in the concentration of iron and ferritin in the blood, which may explain the frequency of RLS and PLMS in children with ADHD.This group of patients showed a change in the number of sleep cycles during the night. Possible strategies for correcting sleep disorders in children with ADHD and their impact on the manifestation of ADHD are discussed.

Keywords:

ADHD; REM sleep in children with ADHD; homeostres; polysomnography in children; preschool children; sleep disorders.

Instructions for use, radar, drug prescription for Medicines.mi

Instructions for use, contraindications, composition and photo

Trade name of the preparation: Melaxen

Active substance: Melatonin (Melatoninum)

Description:

Round, biconvex coated tablets from almost white to beige color, with a dividing line on one side of the tablet. Fracture view: homogeneous mass from white to almost white.

Pharmacotherapeutic group: normalizing biological rhythms, sedative, normalizing physiological sleep, adaptogenic.Regulates the sleep-wake cycle, daily changes in locomotor activity and body temperature.

Pharmacodynamics:

Normalizes circadian rhythms. Speeds up falling asleep, reduces the number of night awakenings, improves well-being after waking up in the morning (does not cause feelings of lethargy, weakness and fatigue upon awakening). Adapts the body to the rapid change of time zones, reduces stress reactions. Possesses immunostimulating and pronounced antioxidant properties.Inhibits the secretion of gonadotropins, to a lesser extent – other pituitary hormones (corticotropin, thyrotropin, growth hormone). It is not addictive and addictive.

Pharmacokinetics:

When taken orally, it is rapidly and completely adsorbed, easily passes histohematogenous barriers, including the BBB. Has a short T _1/2 .

Indications for the use of the drug Melaxen ^® :

Sleep disorders, normalization of biological rhythms.

Drug contraindications Melaxen ^® :

Hypersensitivity, severe renal dysfunction, leukemia, lymphoma, lymphogranulomatosis, myeloma, diabetes mellitus, chronic renal failure.

Melaxen ^® during pregnancy and breastfeeding:

Appointment during pregnancy and during breastfeeding – according to the strict prescription of a doctor.

Method of administration and dosage:

Inside, 30-40 minutes before bedtime. Adults, 0.5-1 tab. 1 per day. As an adaptogen when changing time zones – 1 day before the flight and in the next 2-5 days – 1 table. in a day. The maximum daily dose is up to 2 tablets. in a day.

Side effects of the drug Melaxen ^® :

When used in physiological doses, adverse reactions are rare.Allergic reactions, edema (in the first week of admission), headache, nausea, vomiting, diarrhea, morning sleepiness are described while taking melatonin.

Drug overdose Melaxen ^® :

Symptoms: in case of accidental overdose – increased severity of side effects.

Treatment: gastric lavage, symptomatic therapy.

Interaction with other medicinal products:

Strengthens the effect of drugs that depress the central nervous system, and beta-blockers.It is not recommended to take in conjunction with hormonal drugs, it is incompatible with MAO inhibitors.

Precautions:

Should not be used by vehicle drivers and people whose profession is associated with increased concentration of attention. It has a weak contraceptive effect (should be borne in mind by patients of reproductive age). Strong lighting should be avoided.

Storage conditions: Store in a dry, dark place at a temperature of 10-30 ° C.

Keep out of reach of children.

Shelf life: 4 years.

Melatonin Evalar instructions for use: indications, contraindications, side effects – description Melatonin Evalar Film-coated tablets (55525)

From the side of the hematopoietic system: rarely – leukopenia, thrombocytopenia.

From the immune system: frequency unknown – hypersensitivity reactions.

From the side of metabolism: rarely – hypertriglyceridemia, hypokalemia, hyponatremia.

On the part of the psyche: infrequently – irritability, nervousness, anxiety, insomnia, unusual dreams, nightmares, anxiety; rarely – mood swings, aggression, agitation, tearfulness, stress symptoms, disorientation, early morning awakening, increased libido, decreased mood, depression.

From the nervous system: infrequently – migraine, headache, lethargy, psychomotor hyperactivity, dizziness, drowsiness; rarely – fainting, memory impairment, impaired concentration, delirium, restless legs syndrome, poor sleep quality, paresthesia.

On the part of the organ of vision: rarely – decreased visual acuity, blurred vision, increased lacrimation.

On the part of the organ of hearing and labyrinth disorders: rarely – vertigo, positional vertigo.

From the side of the cardiovascular system: infrequently – increased blood pressure; rarely – “hot flashes” of blood to the face, angina pectoris, palpitations.

From the digestive system: infrequently – abdominal pain, pain in the upper abdomen, dyspepsia, ulcerative stomatitis, dry mouth, nausea: rarely – gastroesophageal disease, gastrointestinal disorders or disorders, bullous stomatitis, ulcerative glossitis, vomiting, increased peristalsis, bloating, hypersecretion of saliva, bad breath, abdominal discomfort, stomach dyskinesia, gastritis.

From the liver and biliary tract: infrequently – hyperbilirubinemia.

On the part of the skin and subcutaneous tissues: infrequently – dermatitis, increased sweating at night, pruritus and generalized itching, skin rash, dry skin; rarely – eczema, erythema, hand dermatitis, psoriasis, generalized rash, itchy rash, nail damage; the frequency is unknown – angioedema (angioedema), edema of the oral mucosa, edema of the tongue.

From the musculoskeletal system: infrequently – pain in the limbs; rarely – arthritis, muscle spasm, neck pain, night cramps.

From the urinary system: infrequently – glucosuria, proteinuria; rarely – polyuria, hematuria, nocturia.

From the reproductive system: infrequently – symptoms of menopause; rarely – priapism, prostatitis; frequency unknown – galactorrhea.

On the part of laboratory parameters: infrequently – deviation from the norm of laboratory parameters of liver function, increase in body weight; rarely – an increase in the activity of hepatic transaminases, a deviation from the norm in the content of electrolytes in the blood, a deviation from the norm in the results of laboratory tests.

Other: infrequently – asthenia, chest pain; rarely – herpes zoster, increased fatigue, thirst.

Anniversary conference “Extrapyramidal disorders: yesterday, today, tomorrow” dedicated to the 35th anniversary of the Center for Extrapyramidal Diseases was published on October 25, 2013 in the conference rooms of the GKB im.S.P. Botkin. The conference was attended by 450 doctors from Moscow, the Moscow region and 12 regions of the Russian Federation.

Academician of the Russian Academy of Sciences Yakhno Nikolai Nikolaevich also congratulated the staff of the Center for Extrapyramidal Diseases on their anniversary.

Professor Valentin Nakhmanovich Shtok devoted his speech to the history of the creation and development of the Center for Extrapyramidal Diseases.

Director of the Center, Professor Levin Oleg Semenovich, in his speech tried to answer the question: “Treatment of patients with extrapyramidal diseases: technology or art?”

Head of the Department of Nervous Diseases of the First Moscow State Medical University.THEM. Sechenov, professor Golubev Valery Leonidovich detailed the history of the study of extrapyramidal diseases in Russia.

Head of the Brain Research Department of the Federal State Budgetary Institution “NTSN” RAMS Professor S.N. Illarioshkin outlined the prospects for the treatment of Parkinson’s disease.

Professor Pille Taba from the University of Tartu (Estonia) gave a presentation on the topic “Experimental models of parkinsonism – in search of new treatments”.

A guest of the conference from Serbia, Professor Vladimir Kostic, spoke about the peculiarities of depression, concomitant Parkinson’s disease.

Professor from Prague Eugene Ruzicka shared his observations and experience in the report: “Freezing when walking in patients with parkinsonism”.

The second plenary session was opened by the speech of the head of the department of extrapyramidal pathology of the nervous system with the Center for Parkinsonism of the Institute of Gerontology of the Academy of Medical Sciences of Ukraine, President of the Ukrainian Association for the Fight against Parkinsonism, Professor Irina Nikolaevna Karaban. Irina Nikolaevna dwelled on the issues of extrapyramidal insufficiency in aging and parkinsonism.

Professor Alla Borisovna Gekht – Chief Physician of the Scientific and Practical Psychoneurological Center (formerly “Clinic of neuroses”) – made a presentation on the topic “Pharmacoeconomic aspects of Parkinson’s disease”.

Professor from Germany Inga Zerr in her speech gave a detailed description of Creutzfeldt-Jakob disease.

The research associate of the N.N. N.N.Burdenko Alexey Alekseevich Tomsky.

The conference guests warmly congratulated the staff of the Center for Extrapyramidal Diseases and the head of the Department of Neurology of the Russian Medical Academy of Postgraduate Education, Professor Oleg Semenovich Levin on the 35th anniversary of the Center for Extrapyramidal Diseases.

The first breakout session “Parkinson’s disease: motor and non-motor aspects” was opened by Professor Natalia Vladimirovna Fedorova with a report “Modern approaches to the diagnosis of fluctuations and dyskinesias”.

Litvinenko Igor Vyacheslavovich, Professor of the Department of Nervous Diseases of the Military Medical Academy named after S.M. Kirov (St. Petersburg), devoted his speech to the diagnosis and treatment of dementia in Parkinson’s disease.

Head of the neurological department of the Republican Scientific and Practical Center for Neurology and Neurosurgery (Minsk), chief freelance neurologist of the Ministry of Health of Belarus, Professor Sergey Alekseevich Likhachev focused on the characteristics of respiratory disorders in Parkinson’s disease.

Associate Professor of the Department of Nervous Diseases of the First Moscow State Medical University. THEM. Sechenova Nodel Marina Romanovna made a report “Sleep disorders in Parkinson’s disease”.

Chief specialist in neurology of the FMBA of Russia, deputy chief physician of the FSBI FMBC named after A.I. Burnazyan, Ph.D. Amosova Natalya Aleksandrovna spoke about the possibilities and problems of rehabilitation in Parkinson’s disease.

Professor of the Department of Nervous Diseases and Traditional Medicine, Krasnoyarsk State Medical University named after V.F. Voino-Yasenetsky Pokhabov Dmitry Vladimirovich shared the methods of step correction in parkinsonism.

The first to speak was Professor Valery Petrovich Zykov, Head of the Department of Pediatric Neurology, Russian Medical Academy of Postgraduate Education, with a report “Tics and Tourette’s Syndrome”.

Associate Professor of the Department of Neurology of the Russian Medical Academy of Postgraduate Education Dmitry Valerievich Artemyev read a report on muscular dystonia and the possibilities of botulinum therapy.

Professor of the Department of Nervous Diseases of the First Moscow State Medical University named after M.V. THEM. Sechenova Dyukova Galina Mikhailovna.

Leading researcher of the Scientific Center of Neurology of the Russian Academy of Medical Sciences, Ph.D. Klyushnikov Sergey Anatolyevich.

Professor Zalyalova Zuleikha Abdullazyanovna, Head of the Republican Clinical and Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy and the Consultative and Diagnostic Center for Extrapyramidal Pathology in Kazan, spoke about trembling hyperkinesis.

Movement Disorder Unit, National Hospital for Neurology and Neurosurgery, London, Ph.D. Selikhova Marianna Valerievna read a report on “Paroxysmal dyskinesias”.

During the breaks between the sessions it was possible to get acquainted with the exhibition of products of pharmaceutical companies and medical literature.The exhibition featured the stands of the pharmaceutical companies YUSIBI Pharma, Merz, GlaxSmithKline, Boehringer Ingelheim, Orion Pharma, Novartis, Servier, Roche, Unipharm, Medintorg, Lundbeck, as well as the stands of the information partners of the conference: a directory of medicines Radar, the all-Russian social network Physicians of the Russian Federation, publishing house “Media Medica”, “Medforum”, “Medizdat”, the journal “Modern therapy in psychiatry and neurology”, the magazines “Zemsky doctor”, “Attending physician”, “Polyclinic”.

At the end of the conference, the conference participants received certificates.

What we are treated with: Melaxen. The Dark Secrets of the Pineal Gland

Another Cochrane Review (this time in 2006), based on five studies, concludes that melatonin may be effective in behavioral disorders caused by dementia.

The authors of the 2016 article showed that delusions in the elderly over 70 years old can be prevented with the help of melatonin (although very few patients participated in the study – 36). But a Cochrane review from that year adamantly concludes: “There is no clear evidence that <…> melatonin reduces delusional episodes.”

The efficacy of melatonin has not been proven for menstrual cramps either – however, not a single food supplement has helped here at all. There is no proven benefit to melatonin in protecting the fetal brain from damage during pregnancy and childbirth.

12 small clinical studies found by the Cochrane Review authors support that melatonin can help adult patients manage anxiety before and after surgery.

Indicator.Ru recommends: the elderly from insomnia, the rest – from jetlag

Melatonin – the main active ingredient of Melaxen – has been studied a lot and in detail.But, although we know that circadian rhythms make us intimate even with plants, we still do not know how to control the internal clock at the snap of our fingers.

Therefore, the drug does not promise miracles: it can help you fall asleep early and reconfigure the regime for a different time zone or working days, but it can defeat lack of sleep without sleep – alas, no. Winter depression is also not in his power. Most likely, it will also not save you from menstrual pains, epileptic seizures, delirium, insomnia with dementia and many other troubles.

But it is effective as a sleeping pill for jetlag, insomnia in people over 55 and, possibly, in children with neuropsychiatric disorders.It is hoped that it will reduce anxiety during surgery in adults (not surgeons, but patients) and help you sleep longer during the day if you work the night shift.