Melatonin Myths and its role in regulating sleep

Divya Rakesh, MD
Kedar Angirus, MD
April 19, 2022

Melatonin - The sleep hormone

Melatonin is a naturally occurring hormone produced in the brain and is commonly referred to as the sleep hormone as it regulates the sleep cycle. It is secreted in response to variations in the circadian cycle, the internal sleep-wake cycle.  The hormone secretion increases after the onset of darkness, peaks in the middle of the night and gradually falls during the second half of the night. 

Melatonin, as a sleep aid, has been researched over the last couple of decades for jet lag and for treating of sleep disorders in adults and children.

It is well known that many living with chronic pain also struggle to sleep or have a good quality sleep. It is important to recognize that depending on sleep-aids when you live with Chronic Pain should be the last resort.

Jet lag

Melatonin pills probably reduces symptoms associated with jet lag syndrome, a temporary sleep problem noted in people who travel multiple time zones quickly, where the body is still synchronised to the original time zone.  Melatonin may help adaptation to new sleep timing in frequent travellers repeatedly affected by jet lag, night shift workers and pilots.  Melatonin appears to be probably safe when used for occasional short-term sleep difficulties.  Further research is necessary to establish optimal dose, duration of use and possible side effects of this medication for use on treating jet lag.

Sleep disorders

A 2013 meta-analysis by Ferracioli-Oda, et al inferred that Melatonin pills can improve sleep parameters in people with sleeping-related issues.  It decreased sleep onset latency, i.e., the duration of time from turning the light off to falling asleep.  It also slightly increased the total sleeping time. Melatonin’s effect on overall sleep quality was observed to be varied in different studies - from improved to no significant effect.  Melatonin was slightly less effective than other sleep medications; however, it showed limited evidence of dependency, fewer side effects and lasting effects on sleep quality that were not dose or duration dependent. It is however worthwhile to note that there isn’t enough research examining efficacy and safety of Melatonin use in children with sleep disorders.

Conditions causing sleep difficulties

The production of Melatonin decreases with age and this could be partially responsible for sleeping difficulties in the elderly.  Changes in Melatonin secretion is also noted in neuropsychiatric conditions such as anxiety, depression, bipolar disorder and schizophrenia. Hence sleep difficulty is common in psychiatric disorders.  Prolonged release Melatonin might be useful in treatment of sleep difficulties due to some neuropsychiatric conditions such as mood disorders, schizophrenia and autism while immediate release Melatonin at lower doses, < 1 mg, might be helpful in treating neuropsychiatric-related circadian sleep disturbances.  Another study showed significant effects of Melatonin supplementation on sleep quality in subjects with sleep disorders, but not in subjects with psychiatric disorders or neurodegenerative diseases and migraine.  Hence, more studies are needed to address concerns of chronic Melatonin use in large doses and interaction with other medications in these conditions and elderly population. 

Is use of Melatonin safe?

There aren’t that many studies that speak about the safety of Melatonin in humans, especially in the long run.  Most studies are of short duration and based on them, Melatonin appears to be safe with mild to moderate side effects.  More large, structured, high quality studies are necessary to investigate the safety of Melatonin when used for an extended period of time in adults and children.  It is true that the side effect profile of Melatonin is benign in comparison with commonly prescribed sleep promoting drugs. However, the safety of long-term use has not been very well established. Most commonly reported side effects of Melatonin are dizziness, daytime sleepiness, irritability, headaches and also in some cases, nightmares and vivid dreams. Also, as is true with any other medication, please check if you are allergic to Melatonin before using it as a sleep aid.

Interactions:  Melatonin can have some interactions with the medications that you are taking for other medical conditions such as blood thinner, diabetes, hypertension, seizures, immune-suppressing medications among others.  Hence, it is advisable to discuss with your doctor before starting the Melatonin. 

Melatonin Myths vs Facts

Now, let’s clarify a few common myths. Continue reading to know more.

Myth #1: Taking Melatonin can make me fall asleep faster

Research has shown that Melatonin pills can modestly decrease sleep onset latency, the duration of time from turning the light off to falling asleep by a few minutes.  Studies evaluating efficiency of Melatonin have small benefits.  A meta analysis by Ferracioli-Oda showed that subjects on Melatonin fell asleep faster by an average of 7 minutes, stayed asleep longer for about 8 minutes and reported improved sleep quality than subjects receiving a placebo.

Myth #2: Melatonin can cause dependence or addiction

Studies on Melatonin use show no addictive tendency unlike some commonly prescribed sleep medications.  Melatonin was not associated with habit-forming behaviour and produced no hangover.   Higher Melatonin doses and longer duration trials were related to significant greater effect on sleep latency and total sleep time. These findings suggest minimal dependence potential with Melatonin use.

Myth #3: Higher doses of Melatonin will help me sleep better

Melatonin strength used in sleep disorder studies we researched ranged from 0.1 to 10 mg.  Melatonin’s effects on sleep quality was same for any duration or dose. Doses below 1mg has shown to be equally effective as higher doses. In fact, a Melatonin-placebo clinical trial involving participants aged over 50 yrs a dose of 0.3 mg produced the best results in terms efficiency than higher doses (the highest dose used here was only 3 mg). Please discuss with your healthcare provider about strength that maybe right for you and also for a prescription in case this is not available over the counter in your country.

Myth #4 Melatonin is naturally present in certain foods

Melatonin is naturally available in a number of foods. It is higher in eggs, fish, poultry, nuts, milk, sour cherries, mushrooms, some cereals and germinated legumes or seeds. A point to note is that some foods such as milk and meat contain high levels of the amino acid, Tryptophan that can be converted to Melatonin by the body.

The food and supplement industries have several Melatonin-containing products that claim to help in sleep difficulties. However, there are limited studies on effects of these foods on sleep quality.  Future studies are necessary to test the content of Melatonin in these foods, its efficiency and safety in treating sleep disorders.

Myth #5: The FDA has approved Melatonin for over the counter (OTC) use, so it must be safe

Over-the counter Melatonin is not regulated by the government in several countries.  Melatonin supplements may be available at the local drug store or health food store.  In the United States, there isn’t much regulation by the FDA and as a result, purity and strength of Melatonin can vary from brand to brand and from one batch to another.  One study demonstrated a surprisingly high variability of the labelled concentration of Melatonin content in Melatonin supplements that ranged from −83% to +478%! This means that you could end up taking too little or too high a dose of Melatonin than necessary.  Additionally, purity was also noted to be compromised in 8 of the 30 Melatonin supplements tested.  So do you fact checks before picking up that bottle of Melatonin from the aisle. It is true that the side effect profile of Melatonin is benign in comparison with commonly prescribed sleep promoting drugs. However, the safety of long-term use has not been very well established. Most commonly reported side effects of Melatonin are dizziness, daytime sleepiness, irritability, headaches and also in some cases, nightmares and vivid dreams. Also, as is true with any other medication, please check if you are allergic to Melatonin before using it as a sleep aid.

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