Are you considering melatonin to treat your insomnia? The truth is that most people turn to over-the-counter (OTC) sleep aids before seeking their doctor’s advice, and melatonin is one of the top aids that patients report taking for this purpose.
But is it safe? How effective is it? Here are 6 things you need to know about melatonin before considering initiation:
1- What Is Melatonin?
Melatonin is a natural hormone produced by the pineal gland located in our brain. It regulates our sleep “circadian rhythm,” or pattern. At nights, the levels rise 10-fold, commanding our brain to sleep. And in the daytime, the levels are suppressed once we are exposed to sunlight, forcing us into an awakening.
This is the reason we need to avoid exposure to light at nighttime. In addition to your bedroom’s light source, avoid exposure to light from televisions, tablets, computer screens, and smart phones. If you use your smart phone as an alarm, consider the use of an external alarm clock instead.
2- Lack of FDA Regulation
Melatonin is considered a “dietary supplement” — that means it is not regulated by the U.S. Food and Drug Administration (FDA) and that we cannot confirm its long-term or short-term effects. We are also unable to determine how effective it may be. Yet, it is available OTC, without a prescription.
3- Dosing
In order to mimic our normal physiologic process, the dose should be between 0.1 to 0.5 mg, taken 1 hour before bedtime. But it is often sold in doses up to 10mg OTC — this can elevate blood melatonin levels up to 60-fold its normal values. These supraphysiologic concentrations can be potentially unsafe, most especially in the elderly population who tend to metabolize drugs more slowly.
4- Duration of Use
Melatonin is not intended for chronic use — it is recommended for use up to 2 months only. If effective, it will have well-regulated your circadian rhythm by this time and the supplement should no longer be necessary.
5- Side Effects
Note that simply because something is “natural” or in a supplement form does not mean that it is safe. Most common side effects of melatonin that we are aware of include:
• Headaches
• Dizziness
• Mood changes
• Nausea
• Daytime sleepiness
• Hypothermia
• Increased blood glucose levels
• Increased bleeding risk in those taking coumadin (a blood thinner)
• Elevation of melatonin levels in those taking hormonal contraceptives
6- Efficacy
Is it effective? So far studies reveal that melatonin is most effective for two types of insomnia:
• Jet-lag insomnia for those who travel
• Shift-work insomnia for those who work nights and sleep during the day
This makes sense — these are instances in which the circadian rhythm may be disturbed. For the rest of us with other types of insomnia, it may not be as beneficial. Therefore, if your sleep hasn’t improved within a few weeks of intake, discontinuation should be a consideration.
And as always, you should discuss what may be best for you and your health with your doctor prior to initiating anything.
You may view the video version of this article at @MajdMD on YouTube.
Sanaz Majd, MD, is a board-certified family medicine physician who hosts a patient-education YouTube channel (@MajdMD), sharing home treatment tips for common medical conditions. You can also follow her on Facebook, Twitter, or Instagram: @SMajdMD.
