I remember that as a child, I had occasional bad dreams that caused me to wake up. I would go down the hall to my parents' room (I cannot remember if I knocked or not), go to my mom's side of the bed, and say, "Mom, I had a bad dream." She would then move and let me get in the bed, between her and my father.I would immediately feel safe and fall back to sleep. (It never crossed my mind that I may not have been welcome.) In my case, this happened no more than once a year, between the ages of approximately 3 and 8.
Over the years, I have had a few patients who mentioned that their children had nightmares on a much more regular basis (three to six times per month). Until now, my only recommendations were the following: 1. Make an appointment with a pediatrician to rule out disease. 2. Determine if a specific incident was provocative, and if so, seek out psychotherapy. 3. Provide parental support and reassurance. 4. In the absence of disease, disorder, or an identified external cause, consult a sleep specialist.
Researchers from the University of Rome's Centre for Paediatric Sleep Disorders, Department of Developmental Neurology and Psychiatry, identified 45 children ages 3 to 10 who suffered from nightmares that caused them to wake up at least three times per month for at least three months.1 The children in this study were not taking any sleep medications, and rigorous examinations failed to uncover any disease processes. Thirty-one of the subjects received 2 mg/kg/bw of L-5-hydrotryptophan (5-HTP) at bedtime. Fourteen children acted as controls. In the control group, parents were told that the problem was benign, nothing to worry about, and would cease when their child reached adolescence.
5-HTP group at one month:
- 16/31 had total resolution of nightmares.
- 13/31 had at least 50 percent fewer nightmares.
- 2/31 had no response.
Control group at one month:
- 2/14 had total resolution of nightmares.
- 2/14 had at least 50 percent fewer nightmares.
- 10/14 had no change in the number of nightmares.
5-HTP group at six months:
- 24/31 had total resolution of nightmares.
- 2/31 had at least 50 percent fewer nightmares.
- 5/31 continued to have nightmares.
- 3/13 who had a 50 percent reduction after one month stopped responding.
Control group at six months:
- 0/14 had total resolution of nightmares.
- 5/14 had at least 50 percent fewer nightmares.
- 9/14 had no change in the number of nightmares per month.
It is known that 5-HTP is a serotonin precursor. In children suffering from nightmares, abnormalities in the serotoninergic system may be causal.2
The authors stated that due to the lack of side-effects and development of tolerance during long-term use, 5-HTP was selected as a possible interventional aid. The dosing was also low (2 mg/kg/bw), especially when compared to commonly used amounts of other amino acids.
There were limitations to the study, the most important of which was the association between tryptophan products and eosinophilia-myalgia syndrome (EMS). Although it is extremely rare in 5-HTP products, EMS has been reported.3 The authors of this study stated that improved purification and analysis methods have resulted in unadulterated pharmaceutical-grade preparations of 5-HTP that are safe. Other limitations of this study were the amount of subjects (45) and the fact that it was an open-label trial. I hope these findings provoke a double-blind, placebo-controlled trial with a larger sample size. Finally, anyone who takes 5-HTP should only purchase this product from major nutrition companies and/or companies that cater to health care professionals.
- Bruni, O., Ferri, R., Miano, S., Verrillo, E. L-5-hydroxytryptophan treatment of sleep terrors in children. European Journal of Pediatrics 2004;163:402-207.
- Adrien, J. The Serotoninergic System and Sleep-Wakefulness Regulation. In: Kales, A. (Ed) The Pharmacology of Sleep. New York: Springer, Berlin, and Heidelberg, 1995.
- Michelson, D., Page, S.W., Casey, R., et al. An eosinophilia-myalgia syndrome-related disorder associated with exposure to L-5-hydroxytryptophan. J Rheum 1994;21:2261-65.
G. Douglas Andersen, DC, DACBSP, CCN
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