Current Treatment Recommendations
Treatment for insomnias and most parasomnias can begin within the clinical practice. Health promotion strategies that include education regarding healthy sleep habits within a “developmental framework” can improve sleep hygiene. Some parents benefit from a further understanding of sleep physiology and psychology, such as knowing about sleep stages and the environmental cues called “zeitgebers.” Monitoring daytime behaviors — including meals and other activities — can help regulate nighttime schedules. Appropriate treatment of co-existing conditions (i.e., ADHD, anxiety) will have positive secondary effects on sleep promotion.
Very few studies have investigated the effectiveness of sleep medication in children with Fragile X syndrome. However, multiple studies on the effectiveness of melatonin and Clonidine have been completed on other children, with and without neurodevelopmental disabilities.
The literature promotes the efficacy of melatonin for reducing sleep onset latency. Typically, melatonin is given one hour prior to expected bedtime. Typical dosing begins with the lowest dose (0.5 to 1 mg) with incremental increases up to 3 mg. The use of melatonin in children with special needs has been reported to range from 0.5 mg to 10 mg. Only one study showed an increase in seizure activity in a child with a significant neurologic condition and seizures. Melatonin also comes in an extended-release formulation and can help with sleep maintenance. Suggesting the purchase of pharmaceutical-grade melatonin is recommended since melatonin is not regulated by the FDA and may vary in strength and purity.
Although off-label, the alpha-agonist Clonidine is a widely used medication in pediatrics for insomnia. It is typically prescribed beginning at 0.025 mg to maximum dosing of 0.4mg/day. It has also been used to treat ADHD symptoms, especially in younger children. Frequently reported side effects include drowsiness, headache, insomnia, and hypotension. Several drug-to-drug interactions have been documented. It should not be used with a history of cardiovascular disease or depression. Rebound hypertension can occur upon abrupt discontinuation.