Young Insomniacs Often Drugged to Sleep

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Young Insomniacs Often Drugged to Sleep

Wed May 7, 7:02 PM ET

By

HealthScoutNews Reporter

WEDNESDAY, May 7 (HealthScoutNews) -- Pediatricians frequently recommend

various prescription and over-the-counter sleep aids (news - web sites) to

young insomniacs, a new survey has found.

 

But researchers who conducted the survey question the practice of looking to

pharmaceuticals before doing a thorough examination to determine the cause

of the sleep problem. Far more should be known, they say, about the safety

and effectiveness of the medications and herbal remedies.

" There is no medication approved by the FDA (news - web sites) for use in

children with sleep problems, " says Dr. Judith Owens, lead author of the

study and an associate professor of pediatrics at Brown Medical School in

Providence, R.I. " None of these drugs have been properly tested for this

particular use and none of them have gone through the rigorous testing

process for efficacy and safety. "

The study appears in the May issue of Pediatrics.

Owens and her colleagues surveyed 671 primary-care pediatricians in six U.S.

cities. Pediatricians were asked when, what and why they prescribed or

recommended prescription or over-the-counter sleep aids. They were also

asked about their attitudes toward medicating children with sleep problems.

More than half of the pediatricians surveyed had prescribed sleeping pills

to children at least once in the last six months. Seventy-five percent had

recommended a nonprescription sleep aid, such as the antihistamine Benadryl.

Nearly 25 percent recommended melatonin or other herbal remedy, such as

chamomile teas and valerian root.

About 55 percent of physicians said they prescribed medicine to treat sleep

problems in children to " provide the family with needed respite. " About 52

percent said they used the medications in " special needs " children, and 50

percent said they prescribed the medicines " in combination with behavioral

treatments. "

" We found pediatricians are uneasy about using the medications because

there's so little information about them, but they do perceive a need for

them, " says Owens, who runs the Pediatric Sleep Disorders Clinic at Hasbro

Children's Hospital, also in Providence.

Sleep difficulties at all stages of childhood are common, Owens says. About

25 percent of children at some point have a sleep problem their parents

think is significant, she says.

Though definitions can vary, a child with pediatric insomnia can't fall

asleep for 30 minutes or more, or has difficulty staying asleep through the

night, at least three times a week, Owens says.

According to their survey, the use of medication to treat pediatric insomnia

fell into two broad categories. The first was short-term use of

over-the-counter medications for specific situations, such as travel, acute

pain or stress. The second was longer-term, prescribed medicines for

children with special needs, including mental retardation, autism and

attention-deficit hyperactivity disorder (ADHD).

The most commonly used over-the-counter medicines were antihistamines. The

active ingredient is diphenhydramine, which is the same active ingredient in

other over-the-counter sleep aids such as Tylenol PM.

" If parents don't know it, they could get into a situation where they are

overdosing a kid, " she says.

The most commonly prescribed sleeping pills were alpha-agonists. One brand

name is Calapres, a hypertension drug for adults that has sedating

properties. Another is Tenex, used as a sedative in kids with ADHD, Owen

says.

That's not to say drugs are never called for. In her practice, Owens says

she sometimes resorts to medications, but not before doing a full assessment

of the cause of the wakefulness.

In many cases, it's poor " sleep hygiene " -- bedtime practices that encourage

a restful night's sleep. Good sleep hygiene includes avoiding caffeine and

heavy foods before bed, and having a regular bedtime and waking time.

" Insomnia is a symptom, not a diagnosis, " she says. " There are many

different causes for insomnia, and it's certainly inappropriate for a parent

or a pediatrician to prescribe medication without conducting a thorough

search for underlying causes. "

Dr. Sheldon, medical director of the Sleep Medicine Center at

Children's Memorial Hospital in Chicago, agrees with the findings.

" This study brought to the surface significant areas of need in pediatric

sleep, " Sheldon says. " We don't know a lot about the pharmacology of

treating sleep-related problems in children. "

Sometimes medication is necessary, he says. But first, doctors need to take

the time to determine the cause of the sleeplessness. For example, if a

child comes in with a stomachache, a doctor should first try to determine

the cause before prescribing medicine to treat it.

" In childhood sleep problems, the key is making the diagnosis, just as in

any other medical situation, " he says.

More information

Check out the Sleep Foundation or the Riley Hospital for Children for more

in sleep hygiene.