Now, a new brain imaging study published online in September 2020 in the Journal of Neurotrauma offers fresh evidence that melatonin may help improve brain function related to sleep quality in kids who have sustained concussions. Researchers studied the effects of melatonin on 62 children ranging in age from 8 to 18 years old. Starting four to six weeks after the children sustained concussions, the researchers randomly assigned the participants to receive one month of treatment with melatonin in either 3 milligram (mg) or 10 mg doses or to get a placebo. Researchers did magnetic resonance imaging (MRI) scans and assessments for sleep problems at the start of the study and again after 28 days of treatment. Compared with children who got a placebo, those taking melatonin had better sleep and fewer periods of nighttime wakefulness after treatment. The MRIs also showed that children who took melatonin had more improvement in brain regions thought to regulate sleep and cognitive function, therefore aiding recovery, says lead study author Kartik Iyer, PhD, of the Child Health Research Centre at the University of Queensland in Australia. The specific section of the brain that the researchers focused on is known as the default mode network, an area that is active during periods of relaxation and rest. “Our results indicated that the default mode network had increased functions in concussed children taking melatonin,” Dr. Iyer says. “This result suggests that when concussed children are taking melatonin, it facilitates some direct compensation of default mode network functions that may have been lost due to injury.”
Limitations of the Melatonin Study
Beyond its small size, another limitation of the study is that roughly one-third of participants didn’t return for follow-up MRIs after treatment. And even though melatonin was associated with sleep improvements, this treatment failed to achieve the main goal being tested in the study — to reduce overall post-concussion symptoms. “It is important to note that melatonin is not a treatment for concussion per se,” says Anthony Kontos, PhD, research director of the sports medicine concussion program at the University of Pittsburgh Medical Center. Instead, melatonin should be considered as one potential treatment to use for improving sleep in children who have sleep problems after sustaining a concussion, Dr. Kontos says, adding that by helping these kids sleep better, melatonin may indirectly aid concussion recovery over time. Concussion specialists routinely recommend melatonin as one of several interventions to help improve sleep in children who have sleep problems after a concussion, Kontos adds, and the current study results are unlikely to change this practice. More research is needed, however, to determine if melatonin might aid concussion recovery in children who don’t appear to have sleep difficulties.
Earlier Research on Melatonin and Concussion Recovery
In a previous study, the same research team examined brain scans of kids recovering from concussions and found that difficulty staying and falling asleep, exhaustion, and attention deficits in first few weeks after the injury were associated with reduced gray matter and decreased brain function. This study, published in December 2019 in the Annals of Clinical and Translational Neurology, found that children with persistent symptoms four to six weeks after their injury had worse sleep and a lower volume of total brain tissue, gray matter, and white matter than kids who had recovered from their concussions. More recently, a study published online in September 2020 in the Journal of Neurotrauma examined the impact of two doses of melatonin, 3 mg and 10 mg, on improving sleep-related concussion symptoms as well as objective measures of sleep based on actigraphs (devices worn at night to see how easily people fall and remain asleep as well as how much rest they get). Children saw more improvements in sleep-related problems with the higher dose than the lower dose, although both doses were more effective than a placebo.
How to Help Kids Sleep Better After a Concussion
Sleep problems, along with feeling fatigued or groggy, are common in children who sustain concussions, according to the Children’s Hospital of Philadelphia (CHOP). Kids may have trouble falling asleep and staying asleep, experience insomnia, or feel fatigued and sleepy during the day. CHOP recommends the following strategies to help kids sleep better:
Follow a regular sleep schedule. Have kids go to bed and wake up at the same time each day, and keep this schedule the same on school days and on weekends.Have a consistent nighttime routine. Do relaxing things like having them take a bath or read a book before bed, and avoid all screens and electronics, which can interfere with sleep.Make the bedroom dark. Consider blackout shades, and make sure the temperature is cool and the room is quiet.Don’t consume caffeine. Kids and teens shouldn’t have caffeine anyway, but this is especially crucial after a concussion.Avoid naps. Sleeping during the day can contribute to insomnia. If kids must nap, make sure it’s less than 30 minutes, and try not to allow naps after 3 p.m.Go to bed sleepy. If kids aren’t tired, let them read, listen to music, or relax in other ways that don’t require screen time or video games. If they can’t sleep after 20 minutes, let them get out of bed to do something to relax, then return to bed when they feel tired.Keep a regular daytime schedule. Having times for meals, homework, chores, exercise, and other activities can help make the body clock run better and improve sleep.
What’s the Right Role for Melatonin
Most children who have sleep problems after a concussion should be able to safely take melatonin, Iyer says. But he advises that parents should still consult a concussion specialist before giving melatonin to kids after a brain injury. The most common side effects of melatonin are headache, dizziness, nausea, and drowsiness, according to the Mayo Clinic. “Melatonin is only part of the answer in helping children with concussion potentially sleep better, but not the cure for all concussion symptoms such as memory problems, anxiety, and depression,” Iyer concludes.
