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Melatonin also may be used in specialist situations, such as in children or adolescents with neurodevelopmental disorders and sleep disturbances. Prescribers should be mindful that melatonin must be dosed at the correct time in order to be effective for assisting sleep. Due to a lack of studies on the potential adverse effects of the long-term use of melatonin, prescribing for prolonged periods should be approached with caution, particularly in children and adolescents. Melatonin 2 mg modified release is now fully subsidised with Special Authority approval for the treatment of persistent and distressing insomnia secondary to a neurodevelopmental disorder in patients aged 18 years or under, where behavioural and environmental approaches have been trialled or are inappropriate and the subsidised dose does not exceed 10 mg per day. Applications and renewals must be made by a psychiatrist, paediatrician, neurologist, respiratory specialist or on their recommendation. Melatonin is regarded as a hormone which regulates the circadian rhythm of sleep. It is synthesised from the amino acid tryptophan and then released from the pineal gland; the process is controlled by a biological clock in the suprachiasmatic nucleus located within the hypothalamus. The release of melatonin from the pineal gland is suppressed by ocular light at the retina. During a normal circadian cycle, melatonin reaches a peak concentration at approximately 2 — 3 am. People who work night-shifts have a delayed peak in melatonin secretion, the degree of which is influenced by their level of night-light exposure and number of nights worked.
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