Does melatonin help insomnia?
Melatonin is one of the most commonly used supplements in the United States. One reason is because it is really effective for a number of conditions –not just insomnia. Did I surprise you there? Good! Keep reading.
Melatonin is a Hormone
Melatonin acts as a hormone or chemical messenger. Many hormones, like Vitamin D, are good for several things since the chemical messages they send. Most supplements contain synthetic melatonin, you can get animal hormone but there’s risk of transmission of viral illness so this is not recommended. Melatonin is a prescribed medication in most countries, surprisingly, the US is one of the few where this is an over the counter supplement.
What’s it Good For?
So what’s it good for? Melatonin is effective for a lot of things: from nicotine withdrawal to cluster and migraine headache management, thrombocytopenia, cancer prevention and treatment too. Actually there’s so much melatonin can be used for we’ll just discuss insomnia here. Melatonin does help insomnia!
The Research on Melatonin for Insomnia
A meta-analyses done in 2005, came to the conclusion that taking melatonin at bedtime does decrease the time required to fall asleep and increase total sleep duration ((Brzezinski et al., 2005). If your only problem is falling asleep try the immediate release formulation, if your problem is staying asleep try the controlled release version.
Dosing Melatonin
Figuring out the right dose or melatonin for each person is another story. Melatonin is a hormone and we all have some endogenous (produced by the body) melatonin that regulates our sleep wake cycle . Some people may have lower serum (blood) levels of melatonin which impacts their sleep. This would also cause them to need a different dose of melatonin. So, figuring out which dosage is right for you can be a process. Most of us don’t know if we have low levels of melatonin so if you are going to start on melatonin start on the lowest dose possible.
Often a dose of 0.3mg can be enough to provide restful sleep to a person who has low levels of melatonin. (Zhdanova et. Al 2001) . Try this for at least 2 weeks every night before slowly increasing your dosage every 2 weeks. Other people may need a dose as high as 3.0 mg or as suggested by Medscape up to 5mg nightly. Unfortunately, doses this high can have side effects. Hypothermia (abnormally cold body temperature), daytime sleepiness and morning grogginess are all side effects associated with taking a dose this high.
Dosage and Formulation
Medscape is a great medical reference, education and news site. Many healthcare providers rely on it. I like it because it provides information backed by solid research. It suggests treating insomnia with 3-5mg melatonin every night and for those who have difficulty falling asleep treating with 5mg melatonin 3-4 hours before sleep 3-4 weeks. For those who have trouble staying asleep, they should try a Controlled Release (CR) or Extended Release (ER) formulation.
So while most agree melatonin works for insomnia, resources suggest different starting dosages. Since we know some people need only 0.3mg to be effective, I always recommend the lowest starting dose possible to avoid side effects and medication interactions.
Common Side Effects
The expected drowsiness or morning hangover or grogginess, dizziness, bed-wetting, and as with all medications headache and nausea. It also may cause you to have slower reaction time while driving or operating machinery the next day.
Interactions
Melatonin is probably not a good choice for you if you are on other sedating drugs like opiates, benzodiazepines and muscle relaxers to name a few. In addition, melatonin may have serious interactions with warfarin and ALL anticoagulant therapies. By the way if you are on warfarin (Coumadin) there are better medications for almost every condition now!! Melatonin may also interact with medications like: nifedipine (Adalat) or fluvoxamine (Luvox). Of course, it interacts with caffeine too!
Melatonin Pearls
As crazy as this sounds, a difference on opinions and research findings is common in medicine and not always a bad thing. The lesson here is:
- As with all medications and supplements individualized therapy is key
- Start low and go slow! Stop or decrease the dose if you are having side effects.
- Remember this is not a FDA approved medication.
- If you have a seizure disorder or auto-immune disease, melatonin may be contraindicated. Talk to your healthcare provider!
- Talk to your favorite healthcare provider before starting melatonin to make sure this is a good fit for you.
Brzezinski, A., Vangel, M. G., Wurtman, R. J., Norrie, G., Zhdanova, I., Ben-Shushan, A., & Ford, I. (2005). Effects of exogenous melatonin on sleep: a meta-analysis. Sleep Medicine Reviews, 9(1), 41–50. doi: 10.1016/j.smrv.2004.06.004
Medscape Medical News, Medscape, Medscape Medical News, Medscape Medical News, Medscape Medical News, Medscape Business of Medicine, … Medscape. (n.d.). Melatonin dosing, interactions, adverse effects and more. Retrieved from https://www.medscape.com/ Zhdanova, I. V. (2001). Melatonin Treatment for Age-Related Insomnia. Journal of Clinical Endocrinology & Metabolism, 86(10), 4727–4730. doi: 10.1210/jc.86.10.4727
Is it safe for children?
Hi Jeff,
Thanks for your question! The answer is we don’t really know. It is being prescribed to children. But it is important to remember that 1. Melatonin is not approved by the FDA (though there is a time-released version in the pipelines). 2. It is a prescription only drug in may countries. 3. We don’t have any pediatric studies longer than 52 weeks so the long term effects in children are not known at this time.
There is an Australian pediatrician, Dr David Kennaway, who raises several questions as to the safety of melatonin in children. He writes about 5 main concerns regarding safety and melatonin: “(i) it is not registered for use in children anywhere in the world; (ii) it has not undergone the formal safety testing expected for a new drug, especially long‐term safety in children; (iii) it is known to have profound effects on the reproductive systems of rodents, sheep and primates, as well as effects on the cardiovascular, immune and metabolic systems; and (iv) there is the potential for important interactions with drugs sometimes prescribed for children.” Kennaway 2015. https://onlinelibrary.wiley.com/doi/abs/10.1111/jpc.12840
Another consideration was raised in a study on melatonin safety. This study observes that out of 30 over the counter melatonin products tested, 71% did not have the amount of melatonin in them listed not the package ingredients. The actual amount of melatonin ranged from ‘−83% to +478% of the labeled content’ (Erland 2017). This means that if you are purchasing 3mg melatonin products you may be getting anywhere from about 0.5mg to 14mg. A huge variability when you consider the body weight and not yet mature kidney function of a child. In addition, this study found that 26% of over the counter melatonin products also (unknowingly)contained serotonin -the chemical our body uses to help regulate sleep, appetite and mood.
To sum it up, all the choice to use melatonin in children is one that should be made with your own healthcare provider, carefully weighing out the individual risks and benefits. And of course, only the highest quality supplements, tested and verified by independent 3rd parties should be used.
Erland LA, Saxena PK. Melatonin natural health products and supplements: presence of serotonin and significant variability of melatonin content. J Clin Sleep Med. 2017;13(2):275–281.
Great jobs Kim!!!
Thanks so much Lynda!