Melatonin: An Effective Sleep Aid?

We all have those nights.  The clock is ticking away, an early morning commitment is pressing, workday stressors are running through your mind and you just can't fall asleep.  Sure, you could take a Benadryl or prescription sleep aid if you have one handy but they often leave you feeling groggy and sluggish long past your allotted time to get some zzzz's.  Or, maybe you just don't like to take medications.  Is melatonin, a natural sleep aid effective for relief of insomnia?

How Does Melatonin Work?

Melatonin, a hormone naturally produced by the pineal gland, is released within the body around 9pm each day triggered by evolving darkness.  Melatonin levels continue to rise gradually inducing drowsiness and eventually sleep.  Levels of the hormone remain elevated for about 12 hours until they naturally decrease to a nearly undetectable level during the day.  

Melatonin supplements, sold over the counter, aim to simulate the naturally occurring melatonin hormone  signaling the brain to initiate sleep.  It works by telling your brain it is time for sleep but does not increase your drive or need for sleep.

Are Melatonin Supplements Effective?

Melatonin's efficacy depends on which type of sleep difficulty consumers are hoping to solve.  As a general sleep aid taken at night to induce sleep, melatonin is certainly not a miracle cure.  A review of 130 studies on the supplement showed that melatonin is mildly effective for insomnia and other sleep disorders.  On average, melatonin reduced time needed to fall asleep by 4 minutes and extended sleep time by 13 minutes.  Research remains unclear as to whether melatonin is effective long-term.  

Melatonin does appear to be effective for one group of individuals- shift workers.  Taking a melatonin supplement helped night shift workers attempting sleep during the day obtain much better sleep efficacy and increased length of sleep for about 30 minutes.  

A study last month also concluded that melatonin may help patients taking beta-blockers sleep better.  Beta-blocker therapy can impair sleep, however researchers found if simultaneously taking a melatonin supplement at night patients improved sleep quality and increased sleep time by 36 minutes.

Is Melatonin Supplementation Safe?

Melatonin is the only hormone available over the counter in the United States.  It is not categorized as a drug and is therefore not FDA regulated.  As with any supplement, the quality cannot be verified and must always be taken with caution.  There have not, however been any reports of toxicity or overdose in individuals taking melatonin supplements.

A dose of just 0.3mg of melatonin is needed for the supplement to be effective.  Taking the typical over the counter dose of 1mg to 3mg may elevate the body's melatonin levels to 1 to 20 times normal.  This can have side effects such as depression and fatigue.  Other reported side effects include nausea, headaches and vivid dreams or nightmares. 

Should You Recommend Melatonin Supplements to Your Patients?

Based on research indicating melatonin is only mildly effective for most individuals, your patients will largely not benefit from this supplement.  Patients on beta-blockers and individuals working odd hours requiring them to sleep during daylight however may benefit from melatonin supplementation.  With a relatively benign safety profile, it may prove a 'natural', inexpensive way to improve sleep in these patient populations.  

If you work night shift as a nurse practitioner, you may even want to give melatonin a try yourself!

Comments

Numerous studies showed that melatonin doesn't exactly have a "benign safety profile". For instance, it has been linked to the release of certain stress hormones, inflammation, the disruption of the metabolism, higher mortality, etc. (see http://www.supplements-and-health.com/tryptophan-side-effects.html ). Seems like it ought not be taken generally as a supplement, longterm.

Rolf Hefti