Sleep Disturbances


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Sleep Disturbances: Trazodone

Sleep problems are common in young children with FXS (chap. 1). A variety of medications have been used to treat the sleeping difficulties, including clonidine, described previously, and trazodone, an antidepressant (fig. 8.2). Trazodone selectively blocks reuptake of serotonin, but it is also a potent antagonist of the 5-HT₂ receptor (Preskorn 1993). Trazodone has strong sedative effects, and it is often utilized at bedtime to counteract sleep disturbance. No published information is available concerning its efficacy in FXS. Carbamazepine or valproic acid may also improve sleep disturbances, particularly if spike-wave discharges or seizures are interfering with sleep.

Sleep Disturbances: Melatonin

Melatonin is a sleep hormone that is produced in the pineal gland from metabolism of serotonin. Melatonin's production is stimulated by darkness, and it is important for the induction and maintenance of sleep (Jan et al. 1994). Melatonin has been synthesized and is available in an oral form through health food stores in the United States. It has been shown to be effective for the treatment of chronic insomnia (MacFarlane et al. 1991), sleep problems related to jet lag (Arendt 1987), and delayed sleep phase syndrome (Dahlitz et al. 1991). Jan and O'Donnell (1996) and Jan et al. (1994) showed that melatonin given at bedtime, usually at a dose of 1 to 3 mg, can improve sleep disturbances in 82% of more than 100 children with developmental disabilities and sleep problems. No significant side effects were reported, even after continuous use for more than four years (Jan and O'Donnell 1996). Melatonin was nontoxic and without significant side effects, but it improved the mood and disposition of individuals who had improved sleep. Sadeh et al. (1995) suggested that melatonin might also improve aggressive behavior, as seen in their case study of a blind boy with severe mental retardation. Further studies are warranted in FXS concerning possible melatonin deficiency and the efficacy of melatonin for sleep disturbances.

This article is not intended to give medical advice for individual cases. Any change in medical treatment should be done in consultation with appropriate medical personnel. This article is written for medical professionals. Some of the terms will be unfamiliar to those who are not trained in medical fields.

*This article is from the chapter on treatment in the 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research edited by Randi Jenssen Hagerman, M.D. and Paul Hagerman, M.D., Ph.D., to be published May 2002. It is included with permission from The Johns Hopkins University Press. References to other chapters refer to chapters in the book which are not included as part of this website.

The complete 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research can be ordered from the National Fragile X Foundation by calling 1-800-688-8765 or from The Johns Hopkins University Press at 1-800-537-5487.

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