Melatonin not a one-size-fits-all sleep solution, experts say

by Melissa Martin

It’s shortly after midnight and you’re at the ceiling. You’ve got to be up and out of the house by 7 a.m. to make an early meeting, so you reluctantly head to the medicine cabinet where a bottle of chewable melatonin tablets – purchased for nights just like this – is calling your name.

Approximately 30% of adults report experiencing brief periods of insomnia such as this, according to the American Academy of Sleep Medicine. Another 10%, the academy reports, experience chronic insomnia, defined as having difficulty sleeping at least three times a week for more than three months at a time.

Though melatonin, an over-the-counter, synthetic hormone, has a reputation for being a miracle cure for sleepless nights, sleep experts say users should be aware its effectiveness varies by user.

Cleveland Clinic Sleep Disorders Specialist Michelle Drerup said researchers are only beginning to understand how well melatonin works for different sleep ailments but added that it can be beneficial when taken in low doses for short periods of time.

The human body follows a circadian rhythm in which various physical, mental and behavioral processes are carried out depending on the time of day. Accordingly, the brain releases serotonin in response to natural daylight to regulate mood, appetite and memory. When the sun goes down, the body stops producing serotonin and releases melatonin to naturally calm the body and prepare if for sleep.

Alicia Roth, clinical health psychologist and behavioral sleep-medicine specialist at the Cleveland Clinic’s downtown campus, said this is the reason in places like Ohio, a person’s energy level may be lower during the winter months.

“We don’t have a lot of natural sunlight during the day so we’re not as energetic and we never quite get that burst of melatonin production at night,” she said.  

Using it right

Drerup says melatonin can be particularly helpful for those who have disrupted circadian rhythms, whether it be due to winter weather or from a case of jet lag, working the night shift or simply being a night owl. To be helpful, however, she advises her patients to tailor their dose to suit their needs and to be cognizant of the time of day they take the supplement.

“Taking it at the wrong time of day can actually make sleep disorders worse,” she said.

Melatonin tablets can be found on drug store shelves in tablets, capsules and gummies of 1-10 milligrams and higher. Both Roth and Drerup advise patients to use the lowest dosage possible to achieve the desired effect. The correct dosage should produce restful sleep without any daytime irritability or fatigue.

Drerup also noted that the correct dosage typically varies from person to person and higher doses do not necessarily result in better sleep.

Taking the supplement 30 minutes before bedtime is a good target, Roth said, noting that it takes most people 20-40 minutes on average to fall asleep.

“It’s not a sedative so it’s not going to knock you out,” she said. “It’s a little dose of nighttime that tells the [body’s] melatonin system to turn on.”

Alternative treatment

Some sleep disorders, including insomnia can gradually worsen for patients who take melatonin, Roth said, particularly if they take higher doses or take it too early or too late in the day.

“A person who has trouble falling asleep or staying asleep, no matter what time it is, won’t benefit much from melatonin,” she said.

Those who take too much melatonin or who take it too late in the evening also report feeling sluggish and drowsy in the morning and having delayed reaction times throughout the day. Other common side effects include irritability, bad or vivid dreams, nausea, mild anxiety, temporary feelings of depression, bedwetting and more.

If melatonin’s side effects become too much, however, there are alternatives. Allowing the body’s own melatonin to work best is a good place to start.

Create optimal conditions by keeping lights dim in the evening and avoiding the television, computer, smartphone or tablet before bed as bright light exposure can inhibit the release of melatonin. In addition, getting light exposure in the morning can help keep sleep-wake cycles on track.

If that’s not enough, common antihistamines, such as diphenhydramine and doxylamine, can have a sedating effect. Sleep experts recommend following the directions on the package and not mixing them with alcohol or other sedatives. Like melatonin, limiting dosage and not relying on them to fall asleep night after night works best.

Valerian root can be equally beneficial. The supplement works by slowing down the nervous system making users sleepy. Sold in capsule or tablet form, patients should use the lowest possible dose and avoid taking it with alcohol and other sedatives.

For those with long-term sleep issues or insomnia, Roth recommends contacting their physician for a consultation to determine the most effective solution. ∞