The majority of children I see initially in my clinic are having tremendous difficulties with sleep. These sleep disturbances can manifest in many different ways:
• Not able to settle for sleep
• Not able to fall asleep until very late
• Goes to sleep well, but wakes up in the middle of the night and is up for the next 18 hour
• Cat naps, 20min at time
Some of the children I see did in fact develop normal sleep patterns and somewhere between 1 and 2 years of age these patterns fall apart. They can happen abruptly or over time. Usually the parents adapt and develop some very unusual ways of coping with it…just to get some sleep!
Sleep interruptions can manifest in different ways as well, with the child waking up:
• In a full panic
• Giddy and laughing
• Crying and sobbing
• Full out screaming
• With certain needs like the lights on, the TV on, requiring a parent to sleep near them
• Bowel movement
• Just plain happy to be up (usually much to the parents dismay)
• Some parents have to actually drive the child around in the car to sleep!
We certainly need to find out the cause or the causes of the sleep problems. I usually start with the gut.
Gut issues to address:
• Constipation: see my article Let’s Talk About…Constipation
• Diarrhea issues: see my article Let’s Talk About…Diarrhea
• Dietary changes: begin dairy free diet, followed by gluten free diet.
It has been published, in fact over 20 years ago, that there are a subgroup of children and adults who have autism and dysfunctions of brain melatonin. Melatonin is VERY important for initiating sleep. So, this is another area that we address in our clinic….we just add some melatonin each night!
For children who have issues of initiating sleep, we commonly start in our clinic:
• Melatonin: ½ mg to 3 mg before bedtime
• 5 Hydroxytryptophan (5HTP) 50 to 100mg. I have found this especially useful when taken with Vitamin B6 and magnesium
• Calcium and magnesium supplements
• Vitamin D3 given with dinner, usually about 1000IU
• GABA 125 mg with dinner
• Vitamin B6 50mg with Niacinaminde 500mg
• Inositol 100mg at bedtime (helps with REM sleep)
• Herbs such as valerian, and chamomile tea can be helpful, but most children won’t take these as they are not very tastey.
If these interventions are not successful, I can add in Benadryl and Ibuprofen at night time.
This helps with possible allergic sources as well as pain and inflammation.
Now, for the really tough kids, where none of the above interventions have proven helpful, prescriptive medications may be required. Your physician will have to be involved here.
• Naltrexone (low dose): either transdermal cream or oral, give 2-4 mg at bedtime
• Hydroxyzine: this is an allergy/anti anxiety medication that can be helpful
• Clonidine 0.1mg tabs, starting with ¼ tab each evening, but may have to go to a full tab
• Trazadone 0.75mg-1mg/2.2pounds of body weight at bedtime
• Risperidone 0.25mg-1mg at bedtime
• Buspirone 2.5mg -5mg divided twice daily
Anti-seizure medications: These can really help when abnormal brain wave patterns are seen on EEG. Lamictal and Depakote have really helped with sleep in children with possible seizure disorders.
Hyperbaric Oxygen Therapy Treatments: Many children sleep amazingly well with this intervention, in fact, it seems to be one of the earliest changes seen.
Again, I would like to stress the importance of getting the bowel function in order for helping with sleep issues.
And that is my approach to…Sleep.