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Dr. Michael J. Breus

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Melatonin: Not a Magic Bullet for Sleep

Posted: 02/21/11 08:56 AM ET

Many of you have made a New Year's Resolution to get more and better sleep. I hope you are having great success! But I want to address a topic I am asked about repeatedly, and it may be something many of you have tried or considered in your quest for a better night's sleep: Is Melatonin good to take to help with my sleep?

So exactly what is melatonin?

Melatonin is a hormone. It is not an herb, a vitamin or a mineral. Hormones are naturally produced by your body as you need them. This means that it is very unlikely that someone has a melatonin deficiency. While melatonin could be considered natural, in most cases it doesn't come from the earth. There are exceptions -- foods that contain melatonin in them -- but this is a different type of melatonin than what is produced in your brain.

Your melatonin levels can be tested with a blood test, urine test or saliva test. If you are concerned that you may actually be melatonin deficient, ask your doctor about testing. Melatonin is produced by the pineal gland and sends a signal to regulate the sleep-wake cycle in the sleep center of the brain. Interestingly, melatonin is also produced in the retina, the skin and the GI tract, but this is not the melatonin what affects your biological sleep clock.

This is the really important thing you should understand about melatonin: Melatonin is a sleep and body clock regulator, not a sleep initiator. Melatonin works with your biological clock by telling your brain when it is time to sleep. Melatonin does not increase your sleep drive or need for sleep.

Melatonin is called the "Vampire Hormone" because it is produced primarily in darkness and inhibited by light. The levels of your melatonin increase in the middle of the night and gradually fall as the night turns to morning, so exposure to light before bed can push your biological clock in the wrong direction, making melatonin ineffective.

Melatonin treats Circadian Rhythm Disorders (where you sleep the right amount of minutes but your body clock is at the wrong time), Shift Work Sleep Disorders and early morning awakenings -- all things that deal with the timing of your need to sleep. Melatonin is not considered an effective treatment for insomnia.

Melatonin in pill form does not function like your body's naturally produced melatonin; it effects the brain in bursts and rapidly leaves the system, instead of the slow build-up and slow wash-out that your body's naturally produced melatonin experiences.

The correct dosage of melatonin can be a problem. According to research conducted at M.I.T., the correct dosage of melatonin for it to be effective is 0.3-1.0 mg. Many commercially available forms of melatonin are in three to 10 times the amount your body would need. In fact, there is some evidence that higher doses may be less effective. In Europe, melatonin at very high doses has been used as a contraceptive.

Melatonin can have side effects. Melatonin (two to three milligrams or higher) has reported side effects of:

  • Headaches
  • Nausea
  • Next-day grogginess
  • Hormone fluctuations
  • Vivid dreams and nightmares

Melatonin may also have some issues with safety. While melatonin is available over-the-counter, in the U.S. and Canada, melatonin is available only by prescription -- or not at all, in some countries. In the U.S., melatonin is sold as a dietary supplement, not a medication; so until recently, melatonin has not been subject to the same purity rules and standards as prescription medications. In June 2010, new F.D.A. rules went into effect that require all dietary supplements to comply with "good manufacturing practices," which include compliance in manufacturing standards and labeling.

So what does all this mean if you want to try melatonin as a supplement? Melatonin has been shown to be safe in healthy people when used for up to three months at the correct dosage.

Over The Counter Melatonin

  • When taken several hours before sleep, Melatonin can shift the biological clock earlier, making a better environment for falling asleep and waking up on time.
  • When taken in the correct dose (0.3-1 mg), it can be effective for shift workers and people with circadian rhythm disorders.
  • However, most Melatonin sold over the counter is packaged in doses ranging from one milligram to 10 milligrams, with most doses containing double or triple the amount that is needed to be effective for the population that will benefit from its use.

Other Possible Uses for Melatonin

  • As an anti-oxidant Melatonin acts upon free radicals. It may reduce damage caused by Parkinson's disease, and can have an anti-aging effect.
  • In the elderly, it has shown some promise in managing a type of insomnia called early morning awakenings ; but this area needs more study and does not take into account medications that may interact with melatonin.

Caution Should Be Taken When Using Melatonin

  • It should be used under the guidance of a doctor and sleep professional.
  • It should be used at the correct dosage.
  • It should be taken about 90 minutes before lights out.
  • It should be used for a short time (less than three months).
  • It should never be used in combination with other sleep inducing medications.
  • It should never be used with alcohol.
  • It should never be used with children younger than 18.
  • There are possible interaction effects that could change the effectiveness of your current medication regimen.

There are new and exciting experiments with patches for delivery of melatonin for use by shift workers and others who have work environments that put their regular circadian clocks to the test. Tart cherries contain a natural melatonin, and there is research to show that drinking tart cherry juice can help with insomnia. There are vitamins and minerals -- vitamin D, the B vitamins, folic acid and calcium -- that have been shown to help with both energy and relaxation.

At the end of the day (no pun intended), your first line of defense for sleep problems is good health and good sleep hygiene. Make it a habit to prepare your body and your mind at the end of every day to get the rest you need. Try that first before you start looking for something else. And when you do look, be careful.

Michael J. Breus, Ph.D.
The Sleep Doctorâ„¢

Everything you do, you do better with a good night's sleepâ„¢
www.thesleepdoctor.com
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Many of you have made a New Year's Resolution to get more and better sleep. I hope you are having great success! But I want to address a topic I am asked about repeatedly, and it may be something many...
Many of you have made a New Year's Resolution to get more and better sleep. I hope you are having great success! But I want to address a topic I am asked about repeatedly, and it may be something many...
 
 
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HUFFPOST SUPER USER
David4FreePress
I am a volunteer, Tong Ren distant energy healer.
09:57 AM on 03/01/2011
DSPS, thanks for answering.
With the sun coming up earlier each day, I think that a darker bedroom or blindfold would help people get a longer or full nights sleep. I know my sleep routines do not vary much, but the sun does and allows less darkness for a full nights rest.
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HUFFPOST SUPER USER
Ninotchka KS
I am woman; watch me vote.
04:46 PM on 02/27/2011
Since I was a child, I had difficulty falling asleep and staying asleep. Now in my 60s', I have found that the best aid to getting sleep is a comfortable eye mask, to keep any light out of my eyes. Don't bother with a cheap one, as they're useless. Adding this has made the biggest difference to a good night's sleep. I also take melatonin (1mg) about 2-3 times a week. More seems to guarantee a sleepless night. I alternately take 5HTP, Gaba (every night), valerian root, theanine and hops. Hope this helps other insomniacs out there.
HUFFPOST SUPER USER
onionboy
Blessed are the Cheese Makers
11:58 AM on 02/25/2011
Get a sleep study to make sure you don't have apnea that making your sleep restless or not restful by morning time. I got it done, got a CPAP and now sleep like a baby without having to ingest anything.
09:08 PM on 02/24/2011
I took advantage consulting with my son's psychiatrist regarding a sleep issue I had associated with a stressful period. My GP had tried me with Ambien (hated) and Lunesta (hated worse). He suggested coming off those and trying 3 mg Melatonin any 5 days out of seven in 30-90 minutes before bedtime. Allow 8 hours sleep. Do this in conjunction with all the other good sleep hygiene practices I was following.

This was the cure.

I must say - the presecription Ambien and Lunesta are truly awful drugs. It's like being hit with a sledgehammer - and I never felt better in the morning.

I don't need sleep help very often any more (maybe a couple of times a month - or when I fly). But when I do I reach for a Melatonin and know I'm gonna be OK.

Note: sometimes I may wake up in the middle of the night with Melatonin. But I don't feel any anxiety over it. It's nice to feel calm and rested and not worry about sleep. Sleep comes. Mornings are lovely after a Melatonin clock re-set.

Methinks the good doc author is a little too pessimistic about it.
This user has chosen to opt out of the Badges program
10:50 AM on 02/25/2011
I have sleeping problems maybe a half dozen times a year. It used to be much more common when I worked a long hour stressful job. The solution then and now was Melatonin. Take one pill, in 30-40 minutes fall asleep. I do sometimes have the vivid dreams, and usually do wake up in about 4-5 hours after a hard sleep, but then go right back to sleep.

My doctor had prescribed Ambien. Now that's some stout stuff for me. One pill for one night left me groggy and foggy headed for the next two days. I'll stay with the occasional Melatonin.
12:16 PM on 02/24/2011
I used to take Ambien, and tried just about every other sleeping pill and many store bought remedies but nothing works like a little marijuana. and wow, no side effects, the government doesn't want you using it because it hits them in the wallet when you don't buy your medicine from big pharma, who by the way spent $280,000,000.00 dollars lobbying the fools we sent to D.C. to represent us.
Please help end the prohibition of marijuana...
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David4FreePress
I am a volunteer, Tong Ren distant energy healer.
11:01 PM on 02/23/2011
Would it produce more melatonin to just sleep with a blindfold or darken the bedroom?
07:12 PM on 02/28/2011
Yes. In addition, don't turn on a light if you get up in the night. If you must, use just a tiny flashlight. Melatonin level starts rising a while before habitual bedtime. Dimmer lighting the last couple of hours helps, too. In the morning you want the remaining melatonin out of your system, so bright lighting is good then.
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SageSpencer
Angel brought Him the leaden heart & the dead bird
02:16 AM on 02/23/2011
I have tried both straight Melatonin and Dr. Weil's Sleep Support Formula in the past, not recently, and I had more success with the latter, for whatever reason.
07:13 PM on 02/22/2011
Good article. No such thing as a free lunch, or a free sleep. While insomnia is not a disease, it can certainly undermine one's resistance to disease, and make stresses much more difficult to defend against. My patients have told me they love this article on the Father Of Insomnia, none other than Thomas Edison;http://stressworksinc.com/Blog/post/Insomnia-Is-It-Worth-Losing-Sleep-Over.aspx
02:16 PM on 02/22/2011
Find it helps with jet lag when traveling. But also find it gives me headaches.
08:32 AM on 02/22/2011
I've always thought melatonin is sleep-regulating rather than sleep-inducing. At least, that's how it works for me. I just get a really good night's sleep when I take it & wake up feeling rested. I will say though, that if I do wake up during the night after taking melatonin, it's sometimes difficult to get back to sleep. I just lie there wide awake.

It's interesting to me, though, that my husband & I have both asked several different doctors (acutal MD's, not psychologists) about our use of melatonin & they all say it's perfectly safe. None have ever suggested taking it only for a short time. In fact, my daughter's pediatrician prescribed it when she started having sleep issues when she was around 3 years old.
07:05 AM on 02/22/2011
I have no problems with it.
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HUFFPOST SUPER USER
purenergy
03:46 AM on 02/22/2011
Melatonin is good for falling asleep, but not staying asleep. I get up in the middle of the night and can't get back to sleep for hours, melatonin doesn't help me.
07:15 PM on 02/28/2011
Don't turn on the light when you get up in the middle of the night. Use at most a tiny flashlight. Bright light banishes melatonin from your system very quickly.
10:04 PM on 02/21/2011
Melatonin works for me. And it definitely beats the hell out of taking benadryl as a local pharmacist suggested to me.
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Razzer
When the moon is in the 7th house, and Zyra collid
09:58 PM on 02/21/2011
For me personally: melatonin supplements do nothing. Sugar pills.

Valerian works consistently. Takes the edge off, helps me drift off sooner, seems to encourage vivid, memorable dreams. But for my brother, it does nothing. And for a buddy: an allergic response.
09:58 PM on 02/21/2011
I take it once or twice per week so I can get up to go in to work by 6:30 am (yuck). I need to break the pills down because the 3 mg are way too strong and I'm wide awake exactly 4 hours later.

Too bad they made it so difficult to get the right kind of tryptophan, after there was one contaminated batch imported. That was much more effective and gentle.