Young Insomniacs Often Drugged to Sleep, Medication comes before doctors find underlying problem

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Young Insomniacs Often Drugged to Sleep

Study: Medication comes before doctors find underlying problem

By Jennifer Thomas

HealthScoutNews Reporter

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

prescription and over-the-counter sleep aids 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 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. Stephen 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.

 

SOURCES: Judith Owens, M.D., M.P.H., associate professor, pediatrics, Brown

Medical School, Providence, R.I.; Stephen Sheldon, D.O., medical director, Sleep

Medicine Center, Children's Memorial Hospital, Chicago; May 2003 Pediatrics

2003 ScoutNews, LLC. All rights reserved.

 

 

 

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