Sleep-Related Bruxism Response to Melatonin Treatment

To the Editor:

Parasomnias affect up to half of all children and may include sleep talking and bruxism (American Psychiatric Association 2013). Sleep-related bruxism involves activation of the chewing muscles and this results in teeth clenching, chattering, and grinding. Among the treatment choices for bruxism related to sleep are behavior modification, oral devices to protect the teeth, and pharmacotherapy (Guaita and Högl 2016). Sleep talking may occur with sleepwalking, sleep terrors, or rapid eye movement sleep behavior disorder. Sleep talking occurs in shortwave sleep during the first half of sleep.

Melatonin is synthesized within the pineal gland from the essential amino acid tryptophan (Axelrod et al. 1969). Melatonin is closely related to the initiation and maintenance of sleep in humans and is used for some circadian rhythm sleep disorders. Herein, we report a 7-year-old girl who presented with sleep-related bruxism and sleep talking, who responded to low-dose melatonin.

A previously healthy 7-year-old girl presented with nocturnal bruxism and sleep talking. She experienced sleep talking since the age of 2 years and symptoms occurred two to three times per night. She mostly talked about daytime events in her sleep, did not respond to family warnings, and continued sleeping without awakening. There were no motor movements and no shouting during the sleep. When she woke in the morning, she did not recall sleep talking. She had difficulty falling asleep at night. Teeth grinding had accompanied her symptoms for 2 years, which was a cause for concern of her parents. It happened almost every night and lasted nearly 30 seconds. She had symptoms of distraction and tiredness during the day. Her parents reported that she fall asleep late and had frequently woken at night since her infancy. She was described as a slightly hyperactive child by her parents, but there was no diagnosis of attention-deficit/hyperactivity disorder and no history of treatment. Otherwise, she had no significant past medical—psychiatric history and medication use. There was no pathological finding in the developmental history. Recommendations were given to improve the sleep pattern and sleep hygiene of the child. At the 1 month follow-up visit, the parents reported no improvement in her symptoms. Melatonin was started at 1.5 mg/day for medical management and the patient was followed every 6 months. Three days after starting melatonin, her symptoms improved significantly, sleep talking ceased, and the bruxism attacks and their duration reduced. In the second week of treatment, her symptoms completely resolved. Treatment was discontinued after 1 month and the symptoms did not re-emerge. In addition, no adverse effects were reported related to melatonin.