Autism spectrum disorder, or ASD, encompasses a variety of conditions and affects a diverse population. One common issue plaguing many people with ASD is insomnia. Adults with ASD, as well as 40% to 80% of children with ASD, experience sleep disturbances including prolonged time to fall asleep, reduced sleep efficiency, shorter sleep time and continuity, and nighttime awakenings. [3, 11]
Unconventional and complementary treatments are commonly used for sleep issues and other concerns, with 74% of children using off-label or alternative therapies. Although common, healthcare practitioners are often unaware of their patients’ adjunctive treatments.  When considering implementing an alternative or complementary treatment for ASD or another condition, it is essential that the healthcare practitioner is informed, so that they can offer guidance and ensure that the treatment may be safe and effective for the individual. One therapy for insomnia growing in popularity is melatonin supplementation. New research supports this intervention for treating sleep disorders for people with ASD.
Melatonin is a hormone produced by the pineal gland, a small endocrine gland in the brain, and is the final product of the serotonin pathway. Colloquially known as “the sleep hormone,” melatonin is released in cycles, and plays an important role in circadian rhythms, affecting cognition and behavior along with sleep. [7, 10] Research has found that melatonin and/or melatonin metabolite levels are lower in people with ASD. [4, 7, 10]
While the exact mechanisms behind this abnormality remain unknown, recent research indicated that low melatonin may be due to low activity of acetylserotonin O-methyltransferase (ASMT). ASMT is an enzyme in the serotonin synthesis pathway[RR1] that catalyzes the last reaction to create melatonin. Irregular activity of this enzyme may be due to a genetic variation. [4, 7, 9, 10] Furthermore, there may be a positive correlation between abnormal circadian rhythm and below-average melatonin levels, and the presence of autistic behaviors. 
Effective, Sustainable, Safe
Supplementation with melatonin has been shown to be safe and effective for people with ASD. Research has demonstrated improvements in sleep onset latency (how long it takes to get to sleep), longer sleep duration, and number of nighttime awakenings. [2, 6, 8, 10, 12] Melatonin supplementation may also improve daytime behavior and help lessen parenting stress associated with parents of children with ASD. [6, 9]
These positive effects have been shown to be sustainable, maintained for several months during supplementation in research trials. [2, 6] Supplemental melatonin is well-tolerated and safe for adults and children, with research reporting minimal to no side effects. [1, 2, 6, 9, 10]
People with ASD should be screened for insomnia, as well as for potential contributing factors to their concerns, including other medical problems. Although melatonin is safe, well-tolerated, and effective, people with ASD/guardians of children with ASD should always consult with their primary healthcare practitioner to ensure a comprehensive and well-informed approach. The protocol should be tailored to the individual, complete with a follow-up after any intervention to evaluate effectiveness and tolerance of the therapy, as people may respond differently. [2, 5, 8]
To summarize, many people with ASD struggle with insomnia and sleep issues that affect daytime functioning and behavior, and are associated with the dysregulated melatonin levels and serotonin pathway found in ASD. Out of a sea of complementary treatments for ASD issues, melatonin supplementation is rising as an effective, evidence-based approach. Current research supports the efficiency and safety of supplemental melatonin in regulating circadian rhythms and improving sleep issues, providing a potentially life-changing intervention for people with ASD.
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