Background: Children with developmental and neurological disabilities are prone to develop serious sleep-wake cycle disorders that may be difficult to treat.
Material and methods: Case history.
Results: A 5-year old blind boy with multiple disabilities developed a chronic sleep-wake cycle disorder as his main clinical problem. Treatment included introduction of strict sleep habits and strengthening of environmental "zeitgebers". After five months melatonin 3 mg was administered at night for 4 weeks. The observation period also included 3 weeks without melatonin. Sleep was registered prospectively by a sleep diary. Strict sleep habits combined with strengthening of "zeitgebers" partially improved the sleep problems, but did not establish a normal sleep pattern. When melatonin was added, he normalized his sleep pattern in a few days. His sleep problems returned during the weeks in which he did not receive melatonin. No side effects were observed.
Interpretation: Melatonin is a promising treatment alternative for serious sleep problems in blind children.