What causes the sleep problems in SMS? Are there known treatments?
Efforts to understand sleep patterns and habits in SMS individuals have led to the confirmation of an unusual inverted circadian rhythm of melatonin. Research to determine the underlying cause for this disrupted sleep cycle has only just begun. Therapeutic management of the sleep disorder in SMS remains a challenge for physicians and parents. Reports of therapeutic benefit from melatonin suggest general improvement of sleep without major adverse reactions. However, melatonin dispensed over-the-counter is not regulated in the U.S. by the FDA; thus, dosages prepared by different companies may not be comparable. No formal melatonin treatment trials have been conducted. A parent monitored trial of four to six weeks on low-dose (1-3 mg) melatonin may be worth considering; continue with melatonin only if your notes indicate an improvement of sleep and/or behavior. It is important to note that high doses (>5 mg) of exogenous oral melatonin may remain in the body into the next morning, and may
