Insomnia, sleep medications common in children with mental health problems

Child psychiatrists say many of the children they treat suffer from insomnia in addition to their mental health disorders, according to a new study. The doctors use a wide variety of medications to help their young patients sleep, from over-the-counter antihistamines to antipsychotic medications, but there have not been definitive studies to show what works.

Dr. Judith Owens of Brown Medical School led a team that surveyed more than 6,000 members of the American Academy of Child and Adolescent Psychiatry. The nearly 1,300 who responded said almost a third of their patients had significant difficulty falling asleep or staying asleep, and they advised about a quarter of them to use drugs to help them sleep. Overall almost all of the psychiatrists said they recommended at least one sleep drug over the course of a month.

Behavioral or psychiatric disorders often cause sleep problems in children, whether they have developmental delays, attention-deficit/hyperactivity disorder, autism, or bipolar disorder. The medications some of these children take can also disrupt their sleep.

Sometimes child psychiatrists choose a psychiatric drug that also helps with sleep, such as a sedating antidepressant for a child with depression, the authors note in their paper, which is published in the journal Sleep Medicine.

No sleep medications have been approved for children by the US Food and Drug Administration, although doctors can prescribe them without specific approval. Behavioral therapies are commonly used in combination with medications.

"This is a very important clinical issue that is very stressful for families, and that clinicians are responding to by prescribing a variety of medications but without having a solid scientific basis to ensure that they are providing safe and effective medications for their patients,” Owens said in an interview in which she called for randomized clinical trials to find answers.

The study was funded by an unrestricted grant from Sanofi-Aventis, which makes the drug Ambien. The company had no role in the study’s design, conduct, or conclusions. It has sponsored a clinical trial of Ambien in children with ADHD. A 2009 paper published in the journal Pediatrics said the drug worked no better than placebo in children with ADHD.