Use of melatonin for sleep disturbance in a large intellectual disability psychiatry service

Abstract Aims and methods: A retrospective case note analysis was undertaken to evaluate prescribing practices, tolerability and perceived effectiveness in patients treated with melatonin for sleep disturbance in a psychiatry service caring for people with intellectual disability in a city with a population of 1·1 million.Two authors scrutinized notes to extract information on to a previously agreed proforma on degree of intellectual disability, comorbid conditions and medication, type of sleep disturbance, dose of melatonin, response to treatment and side effects. Results: One hundred and nineteen patients of whom 103(86·5%) had Autism Spectrum Disorder or traits, had been prescribed melatonin; Eighty eight (73·9%) of these had documented improvements in their sleep pattern. There was variation in prescribing practice regarding doses used and titration regime. No serious adverse effects were associated with its use in the short term; those which did occur probably do not represent a rise above events that would be seen by chance in this population. Patients with autistic spectrum disorder (ASD) or autistic traits were more likely to show a positive response to melatonin than those with learning disability and no ASD/autistic traits (P = 0·0229.). Some subjects showed a loss of efficacy after initial response, some of who responded to a higher dose. Clinical implications: Melatonin appears to represent an effective treatment for sleep disorders in children and adults with intellectual disability (ID), patients with ASD are likely to be responders. It is associated with few serious side effects. There is a need for large-scale studies to further evaluate short and long-term side effects and to determine optimal dosing regimes.