The finding

Systematic review of 20 studies (SMA News Today 2026-04-10, Sleep Medicine) shows SMA sleep disturbances are driven by a dual mechanism: respiratory muscle weakness AND central-brain sleep regulation defects. Source: SMA News Today 2026-04-10.

Why it matters

Sleep is one of the earliest-reported quality-of-life complaints in SMA types II/III and adult-onset disease. If half of the dysregulation is central brain rather than purely respiratory, then:

• Positive airway pressure (BiPAP) alone is insufficient
• Melatonin (Bowerman O39 at SMA Congress 2026) has a rational mechanistic basis beyond anecdotal reports
• Cerebellum and brainstem sleep-regulating nuclei may be additional pathology sites — consistent with Gerstner 2025 (cerebellar Purkinje death) and the autonomous-CNS theme

In-platform

Links to our cerebellum pathway node and to melatonin in /drugs. Suggests a new hypothesis card for "SMA central sleep dysregulation → melatonin as adjunct".