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Evidence Base

Evidence Base

Evidence Base

Sleep is probably one of the most important factors when discussing and investigating mental health and emotional well-being. There has been constant research looking at the link between mental health and sleep, with the scientific consensus being that sleep deprivation increases the likely hood of mental health and developmental issues (Freeman et al., 2017; Martin et al., 2019; Ravyts & Dzierzewski 2020). Importantly it’s not just the amount of sleep that one gets that is the deciding factor, it is the quality of sleep that a person gets which dictates any negative or positive influences on a person’s health. Sleep quality means reducing the number of times a person wakes up when sleeping while decreasing the time it takes for a person to fall asleep and fall back to sleep when woken up. It should take on average between 10 – 20 minutes for a person to fall asleep. Reduced sleep quality as mentioned has a lot of parallels to neurodevelopmental conditions, due to this it is important that you check if the person in question is getting appropriate sleep. If suitable interventions are made, then the possible neurodevelopmental issues that you notice may reduce, which would be evidence for the fact it was sleep issues causing the problems.

Factors which help improve the quality of sleep a person gets are;

  • Increasing light brightness during the day (i.e., exposure to natural light helps sleep) (Campbell, Dawson, & Anderson, 1993; Sanassi, 2014)
  • Decreasing blue light exposure during the night-time, which can be mainly found on smartphones and TVs (Higuchi et al., 2005),
  • Keeping a routine when the child/young person wakes up and goes to sleep, will help regulate their sleep cycle, this includes the weekends! (Van Dongen, & Dinges, 2003; Giannotti et al., 2002)
  • Keeping the room temperature in the 19-24°C range is optimal for sleeping. This does vary from person to person, but trial and error is the best way to find a person’s optimum sleeping environment (Caddick et al., 2018)
  • Not eating too late in the evening (Vander Wal, 2012)

If none of these tips work, and the young person/child is still having sleep difficulties, then as mentioned it may be secondary to their bring neurodivergent. It is something you may wish to speak to your GP about or health professional about. There are some extra resources and advice provided in the resource pack to help increase sleep quality. If you are greatly concerned about your child sleep, then keep a sleep diary which covers 2+ weeks to share with your lead professional or health professional. A good template for a sleep diary can be found on the first NHS link when you google “sleep diary”. The diary covers items like;

  • What time did you go to bed?
  • How long did it for you to get to sleep?
  • At what time did you finally wake up?
  • At what time did you get up?
  • After falling asleep, for how long were you awake during the night in total?
  • After falling asleep, about how many times did you wake up in the night?
  • How would you rate the quality of your sleep last night from 1 -5?

Some neurodevelopmental conditions, like ADHD and ASD come with sleep problems in themselves. Children who may have ADHD have an increase likelihood of sleep-disordered breathing, and restless legs syndrome when trying to sleep (Konofal, Lecendreux, 2010; Tsai, Hsu, & Huang, 2016). While those with ASD traits will have sleep problems related to a mixture of social and environmental factors, be they routines they must complete before bed, the sensory information they are getting from the environment or distress from anxious thoughts (Cohen et al., 2014; Cortesi et al., 2010). Therefore, it is important to know why a child may be suffering from low sleep quality. Nevertheless, the sleep techniques to help people sleep are quite universal across all ages and people, but some more specialized techniques may be suggested based on the profile of your child.

Research The Lancet July 2023

Use of melatonin for children and adolescents with chronic insomnia attributable to disorders beyond indication: a systematic review, meta-analysis and clinical recommendation: Henriette Edemann-Callesen et al. 

Evidence before this study: Melatonin has gained popularity as a sleep aid within the past decade, yet there are currently no recommendations available to guide clinicians on use of melatonin in children and adolescents with disorders beyond autism spectrum disorders and attention deficits hyperactive disorder (ADHD). We aimed to develop the first clinical, evidence-based recommendation for use of melatonin in disorders that are beyond indication, and thus currently not included in existing guidelines.

Added value of this study:  To the best of our knowledge, this is the first evidence-based clinical recommendation on this topic in children and adolescents with disorders other than autism spectrum disorders and ADHD. We searched multiple databases, with the latest search performed in March 2023. We found 13 studies reporting on the use of melatonin in children and adolescents (aged 1–26 years) with various disorders beyond indication. Evidence of low certainty collectively supports a moderate reduction of sleep latency by 15 min and a moderate increase in total sleep time by 19 min. These improvements in sleep continuity parameters did not have an impact on daily functioning or the quality of sleep. Evidence on adverse events was scarce. Our recommendations, outlined below, were constructed by a multidisciplinary guideline panel based on the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach.

Implications of all the available evidence:  Based on our findings, we recommend careful use of melatonin to treat insomnia attributable to disorders ranging beyond indications in children and adolescents. Such off-label treatment with melatonin should only be considered by a medical specialist with knowledge of the underlying disorder and in those cases where non-pharmacological interventions have proven to be inadequate. It remains to be investigated whether melatonin may provide a differential magnitude of effect and adverse event profile across different disorders.


We recommend that melatonin may be used in children and adolescents aged 2–20 years with chronic insomnia due to underlying disorders ranging beyond indication, granted that daytime functioning is affected and that sleep hygiene practices have been inadequate. We consider this to be one of the first evidence-based recommendations on the matter.

In all cases, chronic insomnia should initially be tried resolved by means of sleep hygiene practices and other non-pharmacological measures.


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