Adults may be suffering from “coronasomnia” — increased levels of sleeplessness, nightmares, and other sleep troubles — during the pandemic, but are children experiencing the same problems? Maybe not, according to a presenter at the American Academy of Pediatrics (AAP) virtual meeting.
Pandemic-related sleep studies in children have not shown a clear trend of insomnia, noted David Ingram, MD, of Children’s Mercy Hospital in Kansas City, Missouri, during his talk entitled, “Barriers to Sleep in 2021.”
He pointed out that a Canadian study had 40% of children reporting worse pandemic sleep, but 46% reported no change in sleep, and 14% actually reported better sleep.
For some kids, the increased flexibility that came with virtual school helped boost sleep quality, explained Ingram. Better sleep overall, including getting more sleep and sleeping later, have been reported in studies done in various pediatric age-groups from China, Israel, and the U.S., he added.
And adolescents experienced less “social jet lag” — weekday-weekend differences in their sleep schedules — during the pandemic.
Nonetheless, melatonin purchases rose by 46% in 2020 versus 2019, with more than $800 million in purchases in the U.S., Ingram stated.
While total calls to U.S. poison control centers dropped by 6.3% from March to December 2020, calls for melatonin ingestion by children increased by 70% during the same period. In fact, melatonin surpassed painkillers as the most frequently ingested substance by children in 2020, according to a July 2021 Pediatrics study.
Ingram urged healthcare providers to use caution when giving melatonin to children. While the agent is considered a dietary supplement by the FDA, and faces significantly looser regulations versus over-the-counter medications, melatonin products may not live up to their hype — one study showed that 71% of melatonin products did not contain the amount of advertised melatonin, Ingram noted.
“Even if you are confident in the amount of melatonin you’re going to recommend to a particular patient, you can’t necessarily be confident in the preparation that they pick up off the shelf,” he said.
In addition, Ingram noted in his presentation the “theoretical concern” that discontinuing melatonin could suppress the hypothalamic-pituitary-adrenal axis and trigger precocious puberty. Although “to date, human studies have not demonstrated any effects on puberty/hormone production,” with the agent, he said.
He also warned against another popular sleep remedy — blue light glasses or blockers, which saw a doubling of Google searches during the pandemic — as research has shown blue light can negatively impact circadian rhythms and sleep.
“I don’t think [blue light blockers] really [fix] the problem,” he said. “Even though you’re using [a blue light blocker], your brain is still engaged with the device and is still alert and awake,” Ingram said. “I kind of view it as putting a filter on a cigarette.”
He suggested healthcare providers take the following steps when deciding whether to prescribe insomnia medications to their young patients:
- Evaluate for underlying sleep disorders
- Look for other medical contributors to the sleep disorders
- Consider behavioral interventions
- Educate families that medications are not a panacea for sleep disorders
- Have an exit strategy
Behavioral sleep interventions are key for pediatric sleep disorders: “Our number one intervention for a child who has insomnia is a behavioral intervention — talking [to them] about healthy sleep habits, and other behavioral approaches to help them fall asleep and stay asleep independently,” Ingram said.
Ingram disclosed no relationships with industry.