Episode 12: Melatonin and Magnesium Oh My

Audio only Ep 12 Melatonin and magnesium, oh my
[00:00:00] Welcome to the Sleep Edit, a podcast devoted to helping tired kids and parents sleep better. We focus on actionable evidence-based sleep advice, so everyone in your home can sleep through the night. Now, a quick disclaimer, this podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice.
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[00:01:09] Craig Canapari MD: We’re recording. Well, welcome back to the sleep edit. I am Craig Canapari
[00:01:18] Arielle Greenleaf (2): and I’m Arielle Greenleaf.
[00:01:21] Craig Canapari MD: So today we’re gonna cover, the, two big Ms in sleep.
[00:01:27] Arielle Greenleaf (2): M and Ms .
[00:01:28] Craig Canapari MD: Yeah. So that would be Melatonin and Magnesium. Two of the supplements that are, a lot of parents are interested. For their kids’ sleep issues or themselves. A lot of people seem to be using, I can tell you it’s unusual for a parent to come to sleep clinic without having tried melatonin.
[00:01:48] A lot of pediatricians recommend it, but a lot of parents just try it as well. But in the last couple of years, I’ve seen more and more parents having tried magnesium or magnesium supplementation or are asking me about it as [00:02:00] well. so I guess we thought it’d be interesting to group these two things together.
[00:02:03] Arielle Greenleaf (2): Absolutely.
[00:02:05] Craig Canapari MD: Arielle. what are you hearing about this stuff?
[00:02:08] Arielle Greenleaf (2): I feel like the majority of my clients don’t share that they’ve tried these things. I.
[00:02:18] have to imagine, given being a member of many moms groups on Facebook and seeing what I see, I have to imagine that a lot of my clients or potential clients have tried whatever they can to help their, their child’s, their baby or child’s sleep. Hopefully we’re not looking giving
[00:02:39] melatonin to babies or magnesium to babies. Although I did see recently how do I get my, you know, under 1-year-old or something to sleep? Can I use something like melatonin or magnesium? And was, I was just blown away to see that. and I will say also that when parents are [00:03:00] asking for help in these groups, almost always the first response is melatonin. And lately it’s been magnesium and mostly I’m seeing magnesium in a lotion or cream that people are claiming works wonders.
[00:03:19] Craig Canapari MD: Oh yeah, we’re gonna get into that. as a provider, this is one of those things I just always ask now because people might feel weird about it, especially if their pediatrician didn’t ask them to do it. And yeah, you get some weird stuff, be like, hi, how do I get my four month old to chew this gummy, you know?
[00:03:35] it’s always best to ask in a nonjudgmental way, which I know that you do, but I know the providers listen to this and I think it’s valuable information. Like, I’ll say, what have you tried? What medications have you tried? What supplements have you tried?
[00:03:46] I’d say if you’re putting something in your kid’s body, think about it, like medication. I wouldn’t differentiate between a natural supplement, which is what a lot of people consider these things to be, and a prescription medication.
[00:03:58] there may actually be some more [00:04:00] issues with these types of things than with prescription medications.
[00:04:03] Arielle Greenleaf (2):
[00:04:04] Just because it’s natural and organic doesn’t mean that it’s necessarily A helpful or B, safe.
[00:04:11] Craig Canapari MD: I mean, I don’t know about you. My kids got an ear infection. That better be some free range penicillin they’re getting,
[00:04:15] Arielle Greenleaf (2): Yeah,
[00:04:16] Craig Canapari MD: Organic or a locally sourced, amoxicillin.
[00:04:20] Homemade.
[00:04:21] yeah, homemade. So let’s, let’s start with melatonin. ’cause I feel, I still feel like melatonin is like the 800 pound gorilla here.
[00:04:30] Yeah. So why don’t you tell us like, what exactly is melatonin? So melatonin is a hormone that is secreted in the pineal gland of your brain, which is the little tiny structure at the center of your brain. And some people call it the hormone of darkness. And the reason being is that. Your body starts to secrete melatonin about an hour before your usual sleep time.
[00:04:58] before then it’s undetectable in the [00:05:00] bloodstream. when you can detect that rise in melatonin, that’s called the dim light melatonin onset, that is the signal to your brain and the tissues in your body that it is time to wind down for the day. those melatonin secretions will stay relatively high in the bloodstream until about an hour after you wake up if you go to bed and wake up at the same time every day.
[00:05:21] one thing a lot of parents don’t know is melatonin is a hormone, right? So it’s kind of funny that you can just go down to the store and buy your kid a hormone for their insomnia. So, imagine if your kid was like having a hard time in little league and you’re like, I’m getting my kid these testosterone gummies and I’m gonna see how he does, right?
[00:05:40] That’s not the thing that we do.
[00:05:42] We’re not like, oh, you know, my 13-year-old hasn’t had our period. Why don’t I get some estrogen gummies and start giving them? But for reasons, we’re gonna talk about, melatonin is considered in the US at least to be a food supplement, and not a medication. it used to be sourced [00:06:00] actually from pig brains.
[00:06:01] now it is, synthesized in laboratories, which is better. So yeah, that’s maybe less organic, but, Probably better. so melatonin, if you take it, the, the technical term is exogenously. If you take it like a medication, first of all, the amount of melatonin in your bloodstream. Is much higher than your body naturally secretes.
[00:06:23] and there are really two notable effects when you take melatonin. The first is the hypnotic or sleep inducing effect. So this is what people are generally trying to do when they take melatonin ’cause they have insomnia or they’re giving it to their child for insomnia. They’re giving them a dose of melatonin.
[00:06:42] We’ll get into dosing later on, with the goal of helping to induce sleep. The important thing to note is that not everybody gets this hypnotic effect and the way this’ll manifest as I have parents coming in and they’re giving their kids these horrendous doses of melatonin, think like [00:07:00] 10, 20 milligrams and they’re like, it’s not working.
[00:07:03] And he is waking up more at night with nightmares and is sleepy during the day, which are all side effects if dose is too high. it just doesn’t work in everybody. The other effect which does occur in everybody, and this is gonna get a little bit more into the weeds of sleep physiology, is what’s called a chronobiotic effect.
[00:07:20] So if you have someone who’s circadian clock is out of sync with the schedule they want to have, in my world, that’s usually a teenager where their natural sleep schedule is much later than they would like giving a tiny dose of melatonin think 0.25 to 0.5 milligrams about five or six hours before they’re falling asleep, can start moving their sleep schedule earlier.
[00:07:47] This is not what most parents are trying to do, but honestly, this is one of the more common reasons we are using melatonin in sleep clinic, so the dosing for that is different and the timing is different as well.
[00:07:57] Arielle Greenleaf (2): Yeah. What does that, can you explain that timing?
[00:07:59] Craig Canapari MD: [00:08:00] So
[00:08:01] Arielle Greenleaf (2): about teenagers much in this podcast, but,
[00:08:04] it is interesting to understand the timing.
[00:08:07] Craig Canapari MD: So when we think about, and actually I’ll, I can link to a video that sort of demonstrates this graphically, but, um, in, when you wanna think about moving someone’s schedule, if you want to move their schedule, their sleep schedule earlier or later, melatonin will pull the sleep schedule towards it. So if you give melatonin in the evening, it’ll make someone over three or four weeks fall asleep earlier and light will push it away.
[00:08:33] So light will make them stay up later.
[00:08:35] and the opposite is true in the morning. So if you are trying to get someone to sleep later, which is generally not something I’m worried about a lot in sleep clinic, but in say, elderly who may have advancement of the circadian phase, meaning they’re falling asleep earlier than they would like falling asleep at six o’clock and getting up at three in the morning, a tiny dose of melatonin after they wake up can help move [00:09:00] it,
[00:09:00] We’ll pull it towards it so it’ll move the sleep schedule, and light in the morning. We’ll move the sleep schedule earlier. It’s pushing it away. and the magnitude of that effect, and again, we’re really getting in the weeds here, it’s what’s called a phase response. ’cause curb, if you give melatonin a bedtime, you’re not gonna get much of an effect on the body clock scheduling, which is actually not what we want in little kids.
[00:09:23] we’re not trying to move their schedule earlier or later too much. but in somebody else, you, if you wanna get the maximal effect of moving you body clock earlier, you want to do it five or six hours before they’re falling asleep.
[00:09:35] Arielle Greenleaf (2): Very interesting.
[00:09:39] Craig Canapari MD: circadian medicine is very cool, and kind of confusing for trainees. So we
[00:09:45] Arielle Greenleaf (2): Can you share a little bit about how, so a lot of times I see my child falls asleep easily, or I’m giving them melatonin because they don’t fall asleep easily and they [00:10:00] wake multiple times a night.
[00:10:01] Can you talk to me about the efficacy of night wakings and melatonin?
[00:10:08] Craig Canapari MD: sure. Well, most of the studies of melatonin are showing the primary effect is shortening what we call sleep onset latency. And that’s the time from when you turn off the lights. To when you actually fall asleep. Now in children with autism, there is some evidence that it might reduce night wakings. The problem is, and this is again, don’t think of melatonin as a a natural supplement, think of it as a medication.
[00:10:33] The problem with any medication for sleep is it’s pretty easy to help someone fall asleep. It’s harder to get them to stay asleep , to miss night awakenings. And the hardest thing of all is to get them sleep later in the morning, especially children. and the reason is, is just how your body processes medicine.
[00:10:51] If you take any medicine, typically you’re gonna get the highest amount of it in your bloodstream within an hour of taking it, and that’s gonna fall [00:11:00] off over time. We use a term called the half-life. a half life of a medication is the time when half of it is essentially gone from your body.
[00:11:09] If it’s gonna a longer half life, it’s gonna last longer in the body. If it’s got a short half life. It’s not gonna last as long, and melatonin has a relatively short half-life. So again, like any medication, it’s tricky to dose things, to try to get kids to stay asleep. And actually the dose is too high. You can make night Wakings worse.
[00:11:29] Arielle Greenleaf (2): I mean, I
[00:11:29] feel like it’s counterintuitive. you would think, oh, okay, we want this to have a longer effect. Let’s give more of it. But what I’ve heard is that in many cases, a smaller dosage is better, lower dosage. I’ve actually seen this reported in mom groups.
[00:11:47] It’s like, you know, it’s helped my child fall asleep. It is not helping them not wake in the middle of the night. They’re still waking in the middle of the night. What do I do? And then they’re like, do I give melatonin [00:12:00] again in the middle of the night? that’s a little scary too.
[00:12:04] Craig Canapari MD: Yeah, I mean, I think what we are seeing, and I know you know this, but for the audience is that like any of these, be it a prescription medication, a supplement, if you are having sleep problems, you really want to pair this with a behavioral intervention because these, these medicines, they’re not magic, they’re not anesthesia.
[00:12:25] It’s not like flipping a switch and you’re guaranteeing 10 hours of sleep for the majority of children, not all of them, but a lot of them who are having sleep problems. There’s at least a behavioral component to that. If you don’t change your behavior, if you don’t, if teach your your child to fall asleep independently, if you are letting them have screens in their room, if their schedule is different from what their body needs, no amount of medication is really gonna help.
[00:12:53] And you know, I think a lot of the times people are using these things [00:13:00] because they don’t want to, you know, it’s easy to give your child a gummy. It’s harder to make behavior change.
[00:13:04] Arielle Greenleaf (2): Absolutely.
[00:13:05] Craig Canapari MD: and really our goal for any of these tools, like supplements, medications, whatever, is to use them as long as you need them and to not use them anymore.
[00:13:15] Arielle Greenleaf (2): there are some of my patients who have me take melatonin for long term, and there are some that we are able to get them off it in the short to medium term because they, they’ve learned how to fall asleep independently.
[00:13:28] So the question then is,
[00:13:30] Craig Canapari MD: I.
[00:13:31] Arielle Greenleaf (2): you know, I see it so frequently used, or parents saying, oh, you have to try it. I feel like it’s like almost the first response these days. So when is it appropriate to use melatonin with a child? Are there age considerations, dosages, specific medical, conditions that it would be helpful for?
[00:13:55] Craig Canapari MD: So I wanna get into some of the conditions that are best studied for melatonin. But first of all, I’d say [00:14:00] recognizing that melatonin is a hormone that you’re giving your child to help them fall asleep, you should tell your child’s pediatrician to it. They don’t necessarily know a lot about melatonin, but they do know a lot about sleep and behavior in children. That’s where pediatricians are expert. So first of all, I’d say if you’re thinking about trying it, talk to your, your child’s pediatrician. I will say in most of the world, melatonin is prescription only.
[00:14:24] That’s true for much of the EU. In Taiwan, it’s classified as a, controlled substance actually. so it’s not marketed, appear or filling up the whole. I feel like there’s the purple aisle now in the pharmacy
[00:14:39] Arielle Greenleaf (2): a hundred percent
[00:14:40] Craig Canapari MD: It’s melatonin and sleep gummies and what have you. There’s clear evidence for, I’d say that most evidence is for kids with autism that it’s pretty effective for helping with falling asleep and staying asleep.
[00:14:52] And a recent study actually showed that it helps with daytime behaviors as well. there is some evidence for chronic insomnia in children, though most of that is in [00:15:00] older children. Not little kids, not like the, not like zero to three, it’s think more six to 15.
[00:15:06] ADHD, there’s evidence, the body clock disorder, we talked about.
[00:15:10] Delayed sleep face syndrome a circadian disorder. There’s evidence and actually there’s some studies and conditions like blindness, like eczema where it does seem to help as well. I would say that there’s less evidence for normally developing children. Who just need a little bit of help moving towards independent sleep.
[00:15:28] it doesn’t mean that, again, lack of evidence doesn’t mean it might not be helpful in an individual child, but that’s why it’s so important when you’re using something like this is to also be like, Hey, you know, say to your p say to your pediatrician, Hey, I’m struggling with my child’s sleep. I’m thinking of trying melatonin.
[00:15:47] Anything else I should try with this? Or could anything else be causing this? You know, like, I mentioned eczema because eczema causes terrible sleep disruption and the solution to it is not melatonin. The solution is treating the eczema.[00:16:00]
[00:16:00] So there are many childhood conditions which can cause disrupted sleep.
[00:16:04] Arielle Greenleaf (2): Seek out the root cause before you just go to the purple aisle. And they are, it is, it’s all purple. It’s, it is shocking to me because there is a whole section aimed at children, and I just think it’s, it’s wild that it’s just so accessible and
[00:16:31] it’s, a hormone, you know, like, like you said, it’s a hormone, it’s a synthetic hormone.
[00:16:35] And I, I mean, natural, like you said, is it really natural? Is it, I mean, it’s made in a lab. Is that what makes it organic?
[00:16:46] Like you said, free range, free range hormones.
[00:16:50] Craig Canapari MD: problem. Yeah. the, well, we can talk about, we talk about overdose and stuff like that.
[00:16:56] I would, I would say that, you know, when I would avoid melatonin is [00:17:00] I use it maybe sparingly in kids under three. I’m an expert. I wouldn’t recommend. Parents, do that, without guidance from a specialist.
[00:17:10] Jodi Mindell has this great quote that is, melatonin is like hormone replacement therapy for sleep. Right? Like, so, you know, if you’re, if you’re in menopause, you probably don’t just get a menopause gummy, right? You probably get hormonal therapy, replacement therapy. I, you know, I just wanna hammer this away because
[00:17:29] Arielle Greenleaf (2): Yeah.
[00:17:29] Craig Canapari MD: It’s just, you know, gone to the drug store.
[00:17:32] Arielle Greenleaf (2): Right.
[00:17:33] Craig Canapari MD: I got to the gas station.
[00:17:34] Arielle Greenleaf (2): next time I’m at the gas station.
[00:17:37] Craig Canapari MD: I’d say the other thing is if you’re not willing to make changes to behavior, again, any sleep medication, it’s not anesthesia, it’s not magic. At best, these things nudge things in the right direction.
[00:17:49] they’re not gonna cure the problem.
[00:17:52] Arielle Greenleaf (2): Would you recommend it for jet lag or like an overnight flight or something like that? For
[00:17:57] a child?
[00:17:58] Craig Canapari MD: there is some [00:18:00] evidence that melatonin, can help with jet lag, with sleep onset. It’s tricky though because it depends on when you dose, it depends on the time zone. the direction of travel, how far you’re traveling,
[00:18:13] There are even apps that’ll help you figure this out. I’m a little bit less worried about people who are using melatonin once in a while.
[00:18:20] Like I’m, I’m gonna be honest and full disclosure here. Uh, my older son, he’s 17. If he feels really revved up at night, he may have a melatonin.
[00:18:30] He has it maybe once a week. that doesn’t concern me, right? Like, you know, he’s a young adult who’s like, I know I’m gonna struggle to sleep tonight. ’cause I’m worried about school.
[00:18:41] He’s generally an excellent sleeper. I’m not that worried about that. And I’m not that worried about parents who after talking to their pediatrician, they use it once in a while, if they’re traveling or if there’s something stressful going on.
[00:18:54] so I think one of the themes will kind of close with is that using something once in a while is less worrisome than using it [00:19:00] all the time.
[00:19:00] Arielle Greenleaf (2): Right. When do you think it would be a problem like. Long-term use. I’m just thinking of parents that I see that are like, oh yeah, we’ve used it since Johnny was four and he’s 10. You know?
[00:19:12] Thoughts on, yeah.
[00:19:15] Thoughts on long-term use,
[00:19:17] in a neurotypical child?
[00:19:19] Craig Canapari MD: well there aren’t really a lot of long-term studies of neurotypical children. The longest studies we have at melatonin are mostly in kids with autism, and they’re the longest we’re looking at is two years. The biggest concern with, melatonin because. It’s a hormone is, could it have an effect on puberty
[00:19:40] could puberty happened early or late based on these two year studies? That does not seem to be the case.
[00:19:46] Arielle Greenleaf (2): yeah, I mean,
[00:19:47] can you become dependent on a gummy?
[00:19:50] Craig Canapari MD: so you don’t seem to get biologic dependence like you do with, like, say, I know people aren’t using opiates for this, but like you develop a [00:20:00] biological,
[00:20:00] Arielle Greenleaf (2): We hope not.
[00:20:01] Craig Canapari MD: It doesn’t seem to, if you take melatonin for a long time, it doesn’t seem to stop your body from making your own melatonin.
[00:20:06] But there is psychological dependence, right? Like I, I’ve had patients who are like, they’re just worried if, if they, if they miss their gummy, but they really don’t need it. And often we’ll kind of cut it in half. we’ve even had parents substitute in some regular gummies just like candy. and the, the kids seem to be fine.
[00:20:24] Not that I generally advocate deceiving kids, but like, I think in a, I was in like a special situation. there is a, there’s an obstetrician and a gynecologist named David Kennaway in Australia who’s very against this practicing kids. And he talks about, he has this, this quote, “parents shouldn’t be always be informed that one melatonin is not registered for use in children.
[00:20:45] [This is in Australia]. Two, no rigorous long-term safety studies have been conducted by children. And three, by the way, melatonin is also a registered veterinary drug used to alter the reproduction of sheep and goats”, which is true. you know, humans don’t, [00:21:00] they’re, we’re not, I’m, I’m blanking on the term, but we don’t go into heat once a season, which she goats do.
[00:21:08] So like, it’s a little bit of a, it’s not entirely fair comparison, but. You know, it makes you think right a little
[00:21:15] Arielle Greenleaf (2): Yeah, absolutely.
[00:21:16] Craig Canapari MD: so I do want to talk a little bit about the dosing of melatonin. ’cause there is, there are some guidelines about this. generally the max dose anyone should be using. and these are, this is from a European consensus statement, which is the best thing we have for kids under 40 kilos.
[00:21:33] That’s 88 pounds. The max dose should be three milligrams. So that’s a pretty big kid, right? That’s a 90 pound kid. above 90 pounds, five milligrams. In our clinic, we start at half a milligram and we go up by half a milligram to a milligram once a week. And we stop at either when the, the issue is better or when they hit the max dose.
[00:21:58] And there’s two reasons for that. First of [00:22:00] all, as you said, a lot of people actually do better with less melatonin than more. . the other thing is it gives a chance for the behavioral effects to take effect, right? Like if you start to make some behavioral changes, maybe, for our kids, a lot of the patients we’re seeing, they’re too young to have an ADHD or an autism diagnosis, but they may be headed that way.
[00:22:21] So a little bit of melatonin often can help the behavioral changes take root.
[00:22:27] Arielle Greenleaf (2): what age range are we looking at there?
[00:22:29] Craig Canapari MD: I’d say it’s, I still try for three and up sometimes younger though. But again, I’m an expert. I work with a sleep behaviorist in my clinic. we are screening kids for medical issues.
[00:22:40] I’d say for parents and pediatricians, generally less than three I’d, I’d really think twice.
[00:22:46] Again, no, me, you know, there’s not a lot written on this, but I just sort of feel like You have to be cautious, right? Little kids have a longer time to develop. We don’t know what the effect of adding hormones is to a developing brain.
[00:22:58] Arielle Greenleaf (2): [00:23:00] Right.
[00:23:00] Craig Canapari MD: the other thing is timing is that a lot of people give melatonin. A lot of kids actually do better, and the studies of chronic insomnia, melatonin, we’re looking at giving melatonin about an hour and a half or two hours before bedtime.
[00:23:12] Arielle Greenleaf (2): Interesting.
[00:23:13] Craig Canapari MD: So parents have to fiddle with this a little bit. Some will say it has to be 30 minutes before bedtime, or it doesn’t help, but others will say, oh, it works better. Got a seven 30 bedtime. It works better if I give it at like dinner,
[00:23:26] Arielle Greenleaf (2): Yeah.
[00:23:27] Craig Canapari MD: and then later on it, it kicks in. side effects, important to know about, with anything, nightmares are common or vivid dreams, especially if the dose is too high.
[00:23:37] Also, nighttime awakenings, that’s why we’ll see people coming in. They’re giving their three-year-old like 10 milligrams of melatonin. These kids are waking up in the middle of the night. They’re having horrible dreams. because the, the amount you’re getting in the bloodstream is so high, you can also get what we call
[00:23:52] you know, technical term is, is, uh, residual daytime sleepiness, or sleep inertia. Think of it like a hangover from the medication.[00:24:00]
[00:24:00] bedwetting can happen. and, there is a real overdose risk.
[00:24:04] Arielle Greenleaf (2): Natural.
[00:24:05] Craig Canapari MD: A couple of things. It is now the most common accidental ingestion in children, five and under. because it is regulated by the FDA as a food supplement, it is not required that, there be a childproof lid on your melatonin bottle. So, there’s this problem I think in medicine. I think of it, the “gummification” of medicine.
[00:24:27] Like no kid is dying to drink a bunch of amoxicillin
[00:24:31] something that is packaged as candy, looks like candy comes in a fun purple bottle. There’s a risk there of your child getting into it. a a, a study that came about from the CDC, in.
[00:24:44] I believe it was a 2022 show that there had been a 530% increase in calls to poison control centers over melatonin with a marked uptick during the pandemic when kids were sleeping poorly. and actually there were some ICU stays and even a few deaths reported on this. [00:25:00] Now because this is, we don’t, you know, we don’t really think of melatonin as something you can easily overdose on.
[00:25:06] So I don’t know anything about those other kids, those few kids that died. I know that they were young from this data. We don’t know if they had other medical conditions. We know what, don’t know what the magnitude of the overdose was, but it’s not zero, right? Like your kid
[00:25:19] could up in the emergency room or the hospital.
[00:25:21] the other group of kids that are overdosing, this are on teenagers who are making, suicidal attempts or gestures. they may take it with other medications. So again, like all medication, whether or not it’s a supplement, parents: have control of it. Keep it someplace safe. Do not let your kid have access to it.
[00:25:39] Arielle Greenleaf (2): Mm, mm-hmm. I did see that CDC study,
[00:25:43] a few years ago, and I was just blown away.
[00:25:47] Craig Canapari MD: couple other issues I wanna highlight with melatonin specifically in the United States, because this is regulated as a food supplement, it is not subject to the same level of scrutiny that, like, say a generic form [00:26:00] of ibuprofen would be. There was one study looking at over the counter melatonin prescriptions and found that compared with a dose on the label, the actual dose that was in the medication was between negative 83 to 478% of the label dose.
[00:26:17] Arielle Greenleaf (2): oh my Lord,
[00:26:18] So like if you were giving your kid a one milligram gummy, they might be getting a 0.25 milligram gummy. They might be getting a five milligram gummy this is another reason to start low. Go slowly and increasing your dose. ’cause we really, you know, it’s poor quality. in the UK they have some wonderful preparations that we know work.
[00:26:36] Craig Canapari MD: There’s some that come on quickly that are very, you know, it’s a pharmaceutical there. We have long-acting metaform that seem to work well in autism. The long-acting forms in the US really don’t seem to be that helpful because they’re not, we don’t know anything about the delivery system. It’s not tested like a pharmaceutical.
[00:26:55] Arielle Greenleaf (2): As a physician, our, are [00:27:00] there specific brands that you would recommend?
[00:27:04] Craig Canapari MD: I’m a little reluctant to get into that,
[00:27:06] Arielle Greenleaf (2): Yeah, I agree.
[00:27:07] Craig Canapari MD: anything. I mean, you can look for like NSP certification, that’s a third party certifying program. If there’s third party certification, it’s a little bit better. Your drugstore brands are actually usually pretty good.
[00:27:18] Another issue for parents to be aware of, and this is true, we’ll get into magnesium as well. Parents will come in the office, they have no idea how much melatonin they’re giving their kids.
[00:27:28] Because I’ll always ask if parents say, I tried melatonin. I don’t know why it didn’t work. My first question is, what was the dose and what time did you give it?
[00:27:37] And parents will say, oh, I gave them three milliliters. Or I gave them a gummy. Well, you could get a half a milligram gummy, you could get a 10 milligram gummy. three milliliters of what? So I’d say to parents, look on the label. Look at the number of milligrams. That’s the number that you need to know.
[00:27:54] Arielle Greenleaf (2): Yeah.
[00:27:55] Craig Canapari MD: companies that are responsible tend to have the melatonin gummies we get for my kid. Again, I’m not [00:28:00] gonna endorse anybody. Two gummies is like two milligrams, right? It’s one milligram per gummy. Honestly, I take a little melatonin at night. It helps me fall asleep. I take a half a milligram.
[00:28:09] It’s great. there are like 20 milligram gummies out there. it’s nuts.
[00:28:12] Arielle Greenleaf (2): 20
[00:28:13] Craig Canapari MD:
[00:28:13] Yeah, it’s great. It’s crazy. so those are the things I wanted to share about melatonin, but, what other questions do you have or other thoughts you have based on what you’ve seen?
[00:28:24] Arielle Greenleaf (2): I feel like anytime I see melatonin as the first course of action, it makes me cringe, it is so much easier. I. To say, give a gummy then to change habits and enforce habits, because children don’t like to do that. They like to take a piece of candy. but they don’t necessarily like the way you’re doing the bedtime routine or what time it’s going to happen or how you’re addressing any middle of the night wakings if you change that, if perhaps they are used to you coming into their room [00:29:00] and sleeping in their room or bringing them into bed,
[00:29:02] The family’s struggling here, take a whatever dose of melatonin. So that’s, those are my only thoughts. I don’t feel like people are, I think people are sometimes ashamed and so they aren’t forthright about saying, yeah, I’ve been using melatonin with my 4-year-old. sometimes they are, but in many cases I feel like they probably did try it, and it didn’t work well. so the more you can educate, the more we can talk about it, the better. Because I just want parents to be informed about what they’re putting in their child’s body, rather than just, you know, grabbing something off the shelf.
[00:29:37] Craig Canapari MD: Well, and I wouldn’t say to anyone listening to this, if you’re giving your kid melatonin, you don’t have to freak out, right? generally we have found that for people that are taking it as far as we can tell, seems to be reasonably safe. That being said, ask yourself, does your child really still need it?
[00:29:55] are there other changes you can make to make them less dependent on it? are there [00:30:00] issues that you might not be addressing that are, you’re addressing with this, like anxiety or something like that? so again, if you’re listening to this, don’t freak out, but maybe ask your pediatrician about, make sure that they know.
[00:30:15] and you know, even for our kids that we have taking melatonin long term, we often will do, you know, what’s called a drug holiday. So usually over like summer break or something like that. If they’re in school with the stakes are kind of low, let’s say stop it for a couple of days, see what happens.
[00:30:32] You know, like, and a lot of parents are pleasantly surprised that it doesn’t really matter once they, once they stop it, or if their kid was falling asleep at seven 30 on their melatonin and they take away their melatonin, they’re, they’re going to bed at one in the morning. And I have patients like this.
[00:30:50] You can feel pretty good about the fact that your child actually needs it. They’re deriving a real benefit from it, right? If you stop it and they’re like a little bit more [00:31:00] annoying and whining at bedtime, but then in a couple of days it’s back to what it was then, you know what? Save the money.
[00:31:06] This stuff isn’t cheap.
[00:31:07] Arielle Greenleaf (2): Right. I think maybe the answer is more, have a conversation with your pediatrician. It’s not necessarily, don’t freak out, don’t panic, but, you know, have a discussion with your pediatrician so that everyone’s on board dosage is being looked at, and things like that.
[00:31:24] Craig Canapari MD: Yeah, absolutely. Well, shall we move on to the new kid on the block? the new hotness magnesium?
[00:31:35] Arielle Greenleaf (2): magnesium.
[00:31:36] Craig Canapari MD: I always like to look in Google Trends and sort of see when things are. Popular,
[00:31:42] and this really started to uptick in early 2022,
[00:31:47] in terms of searches for magnesium, for sleep.
[00:31:50] I could not figure out what kicked this off it’s sort of like gradually increasing, compared to melatonin and theanine, which we’re not gonna get into today. [00:32:00] But another supplement is commonly marketed for sleep. magnesium in the last couple of years, there’s quite a bit of interest in it.
[00:32:07] I see that reflected in what people ask me about. I take a little magnesium glycinate for me. I sleep better. I’m gonna do an article in the supplements that I take for sleep and Oura ring data with and without it to show you the diligence that I’ve done.
[00:32:20] But, you know, I’m not sure what’s driving this other than the fact that people are stressed in it and not sleeping well.
[00:32:26] Arielle Greenleaf (2): I mean, I think you had a good point about, oh, the overdoses of, of, melatonin and that study coming out in 2022, which we were still sort of in the Covid era there. I think children did struggle a lot with sleep. Parents struggled with, everybody struggled with sleep over covid. and I think what I see sometimes too now is what can I, what supplements can I give my kids that aren’t melatonin to [00:33:00] help them sleep?
[00:33:01] I also feel as though marketers marketing. People who are creating new products picked up on the fact that parents were starting to feel a little uneasy about melatonin. As much as I still see it, I still am. I’m starting to see more of a trend of what else can I give my kid? and I would say in the past couple of years is when I’ve seen this uptick in magnesium. Now, like you said, for yourself, I actually discovered magnesium glycinate when Ashley was like 10 months old and my acupuncturist recommended it for, milk supply actually. ’cause she was getting older and I was working and I remember I took it and I had the best night of sleep I’d had since I’d had her. And I, I texted her in the morning, I said, is this supposed to help sleep too? And she said, yes. Did you sleep well? And I said yes. So I have taken it sporadically [00:34:00] over the last 10 years. It has worked. I feel like it’s worked well. Perhaps it’s, you know, in my head. But, I’m so interested in, you know, talking about what you’ve found out in your research.
[00:34:14] Craig Canapari MD: This is one of those things I meant to look at for a while. And then I started looking and it kept becoming more and more complicated. ’cause I don’t, you know, honestly, you know, it’s, it’s, most of the time the people think about magnesium or either endocrinologists or renal specialists, kidney specialists, in my world.
[00:34:34] So it’s, it’s, you know, magnesium, it, it is number 12 on the periodic table for the chemistry nerds and the audience. usually when you are taking it, you’re taking, essentially you’re getting the cation of it, sort of the positive ion for it. and magnesium is actually involved in 80% of the enzymatic functioning in the body.
[00:34:54] So this is. It’s a hugely important mineral for the way that we [00:35:00] function. Clearly, if someone waved their magic wand and hoovered all of the, magnesium out of your body, you would be dead. if someone took away all your, all your melatonin, you, you wouldn’t sleep that night. So like
[00:35:12] in the hierarchy of stuff Yeah, it’s, it’s kind of important, right?
[00:35:16] And it has a lot to do with the effects of muscle relaxation. there’s an interesting table that I put in my article on this that is sort of looking at the, the, re the overlap in symptoms between magnesium deficiency and the symptoms of stress. So top symptoms of magnesium deficiency, tiredness, irritability, anxiety, muscle weakness, top reported symptoms of stress, fatigue, irritability, feeling nervous, lack of energy.
[00:35:48] Arielle Greenleaf (2): Sounds like being a 43-year-old woman.
[00:35:50] Craig Canapari MD: Yeah, it sounds like being a citizen of America. specifically in the realm of sleep. it does a couple of things that are interesting. It stimulates [00:36:00] GABA receptors. GABA is a neurotransmitter that’s associated with relaxation and sleep.
[00:36:04] it is actually important in the production and release of melatonin from the pineal glands. So it may actually be a little bit upstream of melatonin release and it mediates the stress response. So if you have less magnesium than you need, you’re gonna feel more stressed. interesting stuff, right?
[00:36:19] Like in a lot of people with, anxiety or stress, struggle to sleep. So I thought that was actually a compelling relationship to look at, especially. We found that magnesium deficiency is actually thought to be incredibly common in the population at large. And, I was really surprised by this.
[00:36:39] let me jump ahead and say it’s actually very difficult to diagnose magnesium deficiency per se. And the reason is, is because it is so important in your body, your, the level of magnesium you have in your blood. If we do a blood test to measure your magnesium, it is almost always gonna be normal for two [00:37:00] reasons.
[00:37:00] First of all, the vast majority of your magnesium is in your bones, in your muscles, in your brain tissue. So that does, it’s not moving in and outta the bloodstream. And second of all, because it’s so important, the, it’s really closely regulated in the body.
[00:37:16] The way that they’ve looked at magnesium deficiency in the population is they look at intake of dietary studies of what, what are people are logging, what they’re eating. And a lot of people, like something like 70, 80% people are not getting enough magnesium in the diet. and there’s, there’s some two interesting reasons for this.
[00:37:33] I mean, first of all is that people don’t have particularly healthy diets. So processed food, has a lot less magnesium than, say eating a, you know, a bunch of spinach, right? Versus a Reese’s peanut butter cup. If you’re drinking soda, it reduces magnesium absorption.
[00:37:51] Arielle Greenleaf (2): Soda
[00:37:52] Craig Canapari MD: soda. I think soda specifically, what I saw. Maybe it’s all the seltzer you’re drinking, I don’t know. In the last hundred [00:38:00] years, the amount of magnesium, calcium, and phosphorus in produce has gone on down substantially because of the way that we farm. there’s a lot less magnesium in the food supply than there used to be,
[00:38:13] which is fascinating.
[00:38:15] and a little bit concerning too, right? Like,
[00:38:17] Arielle Greenleaf (2): Yeah.
[00:38:18] Craig Canapari MD: the, so, but I think we’re, so, we’re in a world where we have a lot of stress people, a lot of people in my world, they can’t sleep, their children can’t sleep, and a lot of reasons why people might not have as much magnesium in their bodies as they would for to function as well as they wanted, right?
[00:38:40] So, like, it seems like a setup for a good idea that taking magnesium might be a great idea. So. Here’s the problem. There are probably around 20 studies looking at magnesium supplementation for sleep. In adults, about seven or eight of these [00:39:00] studies were fairly compelling. They were in elderly people and they showed that magnesium helped with sleep onset latency, which is time to fall asleep, nighttime awakenings, and total time sleeping.
[00:39:12] There was one study from 2002 where they actually gave elderly adults magnesium and they had more slow wave sleep.
[00:39:19] Arielle Greenleaf (2): Hmm.
[00:39:20] Craig Canapari MD: ask me how many studies of magnesium kids have been performed.
[00:39:24] Arielle Greenleaf (2): How many studies of magnesium and kids have been performed?
[00:39:28] Craig Canapari MD: One that was in infants in the nicu and this was really giving them as part of their
[00:39:35] food, and it showed that they had more quiet sleep, which is the analogous thing to slow wave sleep, which is active sleep. It was like 15 infants. there have been studies that looked at this indirectly, specifically kids with ADHD or autism where magnesium has helped with daytime functioning, but those authors didn’t look at sleep.
[00:39:54] Arielle Greenleaf (2): Hmm.
[00:39:54] Craig Canapari MD: it’s hard to recommend magnesium in children where we don’t have any evidence that really [00:40:00] helps with sleep. So we have a situation which I would say has biological plausibility, right? A lot of people don’t have enough magnesium. That likely includes children as well. that low magnesium can be associated with sleep problems and having enough magnesium helps with sleep.
[00:40:19] But we haven’t made that final step to say giving magnesium seems to help with sleep. Whereas in melatonin, we actually have a lot of studies that it actually helps with sleep, right? So like, it’s not that it couldn’t help and it does potentially help in some kids. And we’ll talk about who might be more likely to benefit.
[00:40:38] It’s hard to recommend it when we don’t have any evidence.
[00:40:41] Arielle Greenleaf (2): it’s interesting that the studies that you found to be viable were all in elderly. because I feel like people my age and your age, you know, young people, talk about using magnesium glycinate and other things like that, to help them with [00:41:00] sleep. So. I’m wondering where the, you know, if it’s popular right now or becoming popular in the pediatric world and, and parents, of a certain age, why, why is, you know, is it just that they, you know, it’s not worth studying or, you know, where, what was the lack of, of
[00:41:24] scientific,
[00:41:25] Craig Canapari MD: here, here we get into the problem of. Pharmaceutical trials, first of all, in the world of pediatrics is very common for drugs to be tested in adults versus kids. The adult market’s a lot bigger. Most children don’t need any medications, right? Like they’re, most children are healthy or they take one medication.
[00:41:43] A lot of elderly adults are taking a ton of drugs, right? Like, so they have a lot more health problems. the other problem is how do you make money on it, right? Like, so a, a well powered pharmaceutical trial costs hundreds of millions of dollars [00:42:00] for something that is already available at low cost.
[00:42:05] Who’s gonna pay for that study?
[00:42:07] maybe I’d say before you know, January, January 20th. NIH don’t know. but like, you know, there’s not a lot of wood behind the arrow with this. Uh, but it’s very common for us to use. Because I’m a specialist, I deal with kids with complicated medical problems who don’t have easy solutions.
[00:42:28] We’re often using drugs where we call them being off-label. They don’t have pediatric evidence, but we need to do something.
[00:42:35] I think the main problem is the financial one.
[00:42:37] going back to melatonin, these wonderful preparations, and they have in the UK for, to help with autism, for that to get approved by the FDA as a pharmaceutical would literally require an act of Congress to say that melatonin is a pharmaceutical, it is no longer a supplement.
[00:42:56] And that it seems pretty unlikely right now.
[00:42:59] so it’s not gonna [00:43:00] be for sale here ’cause there’s no money in it.
[00:43:01] Yeah. That being said, there are some conditions in kids which are clearly associated with low magnesium. And if I saw a patient with these issues, I might actually be more likely to consider magnesium because I know that these kids are more likely to have low magnesium. Again, highlighting the fact that it’s actually difficult to measure magnesium without using like radiotracer studies where you’re measuring it in the muscle, in the bone.
[00:43:29] Blood tests aren’t particularly useful. those conditions are type one diabetes and celiac, Or kids on a gluten-free diet, first of all, parents, if your kid doesn’t have celiac, don’t put them on a gluten-free diet ’cause it has downstream effects. which is a thing that I see that happens actually obesity common, maybe associated with low magnesium and picky eaters.
[00:43:49] And I, when I think of picky eaters, I often think of my patients with autism who have very, restricted diets.
[00:43:57] Arielle Greenleaf (2): Sensory issue type diets, like they don’t [00:44:00] wanna eat specific things.
[00:44:02] Craig Canapari MD: I had, one young man I cared for who literally ate flurries and french fries for McDonald’s.
[00:44:08] Arielle Greenleaf (2): Sounds good.
[00:44:09] Craig Canapari MD: so yes, delicious, but like, you know, you don’t want to have the whole basis of your diet. and, you know, that was a real hardship for his family.
[00:44:17] I, and I think that I would definitely, if if someone with type one diabetes or a picky eater was having difficulty, I might consider a magnesium supplement in those patients.
[00:44:29] and I mean, here’s the thing about magnesium is if you take too much of it, you’re just gonna pee it out. You eliminate it through your kidneys. So as long as you, you don’t have kidney disease, it’s a little bit hard to overdose on. It could not find any poison control data about magnesium overdose like we have with melatonin.
[00:44:47] Doesn’t mean it’s not there, but. It doesn’t seem to be as big a problem. the other thing is that there’s, only one case report of a child that died from excess magnesium. [00:45:00] And this was a child with cerebral palsy. The parents were doing all these mega doses of vitamin,
[00:45:04] typical magnesium glycinate, like you might take, might have like 90 milligrams of magnesium. So like, you’d have to go out of your way to do that. that being said, for most parents, and most parents are like, oh, I would like my kid to have more magnesium. See if it helps with their issues. I would say make some dietary changes.
[00:45:22] I’ll actually post in the, show notes. The NIH has a wonderful, worksheet that, and also in a article I wrote on this, with high magnesium foods, I’d say beans, green leafy vegetables, and guess what the number one magnesium containing food is.
[00:45:37] Arielle Greenleaf (2): No idea.
[00:45:39] Craig Canapari MD: Pumpkin seeds,
[00:45:40] Arielle Greenleaf (2): of course.
[00:45:41] Craig Canapari MD: pumpkin seeds. So seed the nuts actually have a lot of these trace minerals. So if you could, again, in little kids, you don’t want to give them nuts ’cause there’s a choking
[00:45:53] Arielle Greenleaf (2): Yeah.
[00:45:53] Craig Canapari MD: You could try nut butters like almond butters, something like that. In older kids who are old enough to safely chew this stuff, [00:46:00] you know, pumpkin seeds are nuts, may be helpful.
[00:46:02] So I’d say for most parents, making dietary changes is gonna have some other downstream benefits. In terms of magnesium supplements, actually when I was writing this, the, again, the NIH came through because they have this wonderful sheet by age on what the dose max dose bias supplementation should be.
[00:46:21] Arielle Greenleaf (2): Awesome.
[00:46:22] Craig Canapari MD:
[00:46:23] so for parents, I would say that. First of all, I would try dietary changes first. Second of all, I’d say that this is not magic, right? We don’t know if this helps or not. Dietary changes, likely they have more benefits, but if you’re really struggling with this, you could try this. But I would ask that with any change that you make, again, also make behavioral changes and track your child’s sleep and see if it actually helps.
[00:46:51] Craig Canapari MD: Because the fact is, these things cost money and a lot of these supplements are quite expensive. And I sort of [00:47:00] feel like there’s a lot of chicanery out there. when I was looking at the number of magnesium and sleep gummies on Amazon, I was a little bit shocked, honestly, at how many products are market there.
[00:47:08] And they usually don’t just have, it’s not just magnesium. It’s like a, like a little chamomile, a little this, a little that, you know, like it’s all I.
[00:47:18] How do you know you have any of that stuff is even in there unless you have like a mass spectrometer in your house, you have no idea what’s actually in that stuff.
[00:47:25] Arielle Greenleaf (2): yeah.
[00:47:25] Craig Canapari MD:
[00:47:25] So, Arielle, let’s talk about your favorite topic, the thing you recommend to all your clients.
[00:47:31] Arielle Greenleaf (2): I sent it to them, didn’t, you know,
[00:47:34] as soon as they, as soon
[00:47:35] Craig Canapari MD: company, magnesium lotions and sprays.com.
[00:47:39]
[00:47:39] Arielle Greenleaf (2): well, I
[00:47:40] Craig Canapari MD: I don’t see this, so I wanna hear from you what you’re seeing out there
[00:47:43] Arielle Greenleaf (2): yeah.
[00:47:44] Craig Canapari MD: in the streets.
[00:47:45] Arielle Greenleaf (2): and out in the streets, you know, like I said, I feel like a lot of parents are saying, what can I do aside from melatonin? And so, what I’m seeing, and some people are, you know, they don’t wanna give a gummy or something like [00:48:00] that. So I see lots of people talking about lotions and creams, and I even saw someone who said she makes her own. magnesium lotion,
[00:48:17] I am trying to figure out how that is even a thing. And how do you make it, do you crush up the magnesium and put it in lotion? here’s someone we try to lo a roller recently.
[00:48:31]
[00:48:31] Craig Canapari MD: a roller, like a lint roller. Like
[00:48:34] Arielle Greenleaf (2): probably like a, you know, almost like a perfume roller or a, a,
[00:48:38] Craig Canapari MD: Oh yeah.
[00:48:38] Arielle Greenleaf (2): Yeah. Yeah. I used mag, so I’m looking at what I’ve, what I’ve seen. I used magnesium lotion and spray. I bought the magnesium spray from X and use it on my son’s feet every night.
[00:48:53] Craig Canapari MD: Stuff is wild.
[00:48:54] Arielle Greenleaf (2): yeah, there’s, there’s a whole, yeah. Someone swears by the lotion on the feet. [00:49:00] I find magnesium cream on my toddler’s feet really helps. So I’m really curious about, you know, how does it really help?
[00:49:11] Craig Canapari MD: I looked into this, there’s no studies, to support this practice. and again, like, I don’t want, I feel like I’m punching down a little bit here, but like, yeah, this is like obviously BS, right? so I think there’s three issues here. First of all, there’s little to no evidence that magnesium helps.
[00:49:31] Anyway. Again, we talked about the fact that it might help some people. This is not an evidence-based practice at this time. Second of all, the way you absorb magnesium is through the gut, not the skin. So like, imagine like if you’re like, oh, I need more sodium and chloride in my body, I’m gonna go for a swim.
[00:49:50] Does your body get filled up with salt when you go in the ocean? No, because your skin is impermeable to ions. Magnesium, [00:50:00] sodium chloride, it cannot pass through your skin. Your skin is a barrier, right? So there’s no way it’s actually getting into the body. Interestingly, when I, in my research, I did come across a trial looking at Epsom salt baths for which do increase magnesium.
[00:50:17] The way that they do that is probably being through, absorbed through the anus and rectum. So
[00:50:25] Arielle Greenleaf (2): Oh wow.
[00:50:26] Craig Canapari MD: a practice I would, I, I would recommend in a child for the simple reason. Is that like, how much dose are they getting? I don’t know. You know, or if you put like a cream or a lotion on your kid, how do you know that they’re not eating it right?
[00:50:38] Like, and then what’s the dose? Right? like my friend’s dog just had to have her leg cut off and they’re like, yeah, she has to wear the cone ’cause she’s got a fentanyl patch on. ’cause they don’t want her to eat it, right?
[00:50:48] if your child has a medication on that has a me what’s purportedly a medicine in it?
[00:50:53] They might eat it, right? I don’t know, I guess you put footy pajamas on, but guys save your money. Like this is just [00:51:00] like,
[00:51:00] Arielle Greenleaf (2): I,
[00:51:01] Craig Canapari MD: again, like the placebo effects does work, right? Sometimes doing something is better than doing nothing and it gives you a sense of power. But like, this stuff is not cheap.
[00:51:11] And this is the sort of thing that makes me angry.
[00:51:14] you know, when I look on Google and the top eight search results for magnesium, sleep of kids are like lotions. It’s bananas.
[00:51:21] Arielle Greenleaf (2):
[00:51:22] Marketing preying on tired parents, and they know that they’re going towards parents who want natural remedies and perhaps trying to stay away from melatonin or the market of children who are too young for melatonin. So let’s try this. it’s just, you know, there’s such a huge market out there for things that are going to help a normally developing child’s sleep when in actuality, they really don’t.
[00:51:55] Craig Canapari MD: I mean, let’s be real. The reason these things exist is ’cause this is a hard problem. [00:52:00] If your child won’t sleep, you’re stressed. life is difficult, right? Parents don’t have supports like they did a couple of generations ago. That being said. Parents, you’ve got a certain amount of money and a certain amount of time, spend it on things that actually have evidence for them.
[00:52:18] What pediatricians do know a lot about is kids and how to help kids. And I think that’s, you know, again, don’t think about these natural supplements or tools as having no side effects.
[00:52:31] Because the fact is there’s nothing that works, that has no side effects, right? Like, if you wanna think about it as being as powerful as a medicine, you have to think about it having side effects as well. You know, we see what, I don’t know, readers my age will remember Fen-fen, right? The, weight loss supplement that was very popular in the nineties.
[00:52:53] Everybody was taking it. They were losing their like weight. Like crazy was great, but then a lot of people were getting cardiomyopathy and dying, so that came off the market. not [00:53:00] that military and magnesium is gonna kill your kid, but like, you know, honestly, you gotta think about everything you’re doing just because it’s natural or a supplement subjected to the same amount of scrutiny that you would anything else.
[00:53:17] Arielle Greenleaf (2): Yeah, and just because it’s on the store shelves doesn’t mean it’s necessarily safe or effective.
[00:53:23] Craig Canapari MD: Or they have a beautiful website, or there’s a great Instagram account. again, we’re all, I bought stuff on Instagram. I’m not perfect. Marketing works right.
[00:53:32] Arielle Greenleaf (2): Yeah.
[00:53:33] Craig Canapari MD: So listen, I think we’re kind of at the end here, but there’s a couple of things I wanted to highlight, which is if you’re considering magnesium or melatonin, talk to your pediatrician.
[00:53:41] If you’re trying these things. start low and slowly increase the dose over time. Generally, and I’m talking kids three and up, for gummy medications specifically, keep them someplace safe. And gummies are a choking hazard, really for a gummy, I’d say like a five or 6-year-old at the youngest, right?
[00:53:59] they should take it under [00:54:00] supervision. Some nights are a little bit better than every night, right? Like in terms of reducing your perception that you need it. any supplements you use make some behavior changes to go with it.
[00:54:12] This is your opportunity. And with melatonin, remember the dose timing matters. you gotta fiddle around with it. Sometimes a little bit earlier even will be more helpful. We’ve got a lot of great stuff. We’re gonna put in the show notes on this. I think on YouTube for this too, I have a lot of graphics I can put up which might be helpful for people.
[00:54:29] And I’ll link to that video on how the timing of melatonin matters. so that’s what I’ve got. Arielle, what you got?
[00:54:37] Arielle Greenleaf (2): I am just really glad we dug into this, or I should say you dug into this. because, you know, again, there’s so much misinformation out there. So as long as we’re, sharing the truth and evidence and, educating people, I’m feeling really good about that. And hopefully we can at least reach a few people, so
[00:54:59] that they [00:55:00] don’t waste their money.
[00:55:01] Craig Canapari MD: Honestly, like, again, if you tried these things, parents, you haven’t harmed your kids, but like, you know, just be careful out there. there are a lot of evidence-based. treatments for sleep problems. it’s probably worth more, you know, worth thinking about. what’s our email again? ’cause I can never remember it.
[00:55:18] Arielle Greenleaf (2): The Sleep edit show@gmail.com.
[00:55:23] Craig Canapari MD: Are you sure?
[00:55:25] Arielle Greenleaf (2): Yes.
[00:55:26] Craig Canapari MD: Okay.
[00:55:27] Arielle Greenleaf (2): Now you’re making me second guess,
[00:55:29]
[00:55:30] Craig Canapari MD: that’s our email address forever. Okay guys, well, thanks for listening and, if you find this useful, share it with your friends.
[00:55:36] Arielle Greenleaf (2): Thanks so much.
[00:55:37] Craig Canapari MD: Bye-bye.
[00:55:39] ​
[00:55:44] Thanks so much for listening to the Sleep edit. You can find transcripts at the web address Sleeped show. You can also find video of the episodes at that address as well as in my YouTube channel. [00:56:00] You can find me at Dr. Craig canna perry.com and on all social media at D-R-C-A-N-A-P-A-R-I. You can find Ariel at Instagram at Ariel Greenleaf.
[00:56:14] That’s A-R-I-E-L-L-E-G-R-E-E-N-L-E-A. If you like the flavor of the advice here. Please check out my book. It’s Never Too Late to Sleep. Train the Low Stress Way to high Quality Sleep for babies, kids, and parents. It’s available wherever fine books are sold. If you found this useful, please subscribe at Spotify or Apple Podcast and share it with your friends.
[00:56:40] It really helps as we’re trying to get the show off the ground. Thanks.