Melatonin

Melatonin is familiar to most people as an over-the-counter sleeping aid. It is important to remember that it is not an FDA approved medication for insomnia. However, the FDA approved its sale a “food additive/natural substance”. It is available in local drug stores.

How does melatonin works? Melatonin regulates the sleep-wake cycle. Darkness makes our brain produce melatonin, which sends a message to the body to prepare for sleep. Light, on the other hand, suppresses melatonin production and secretion, which prepares us to awaken. Melatonin is made in a tiny gland called the Pineal Gland.

Melatonin has a dual effect on sleep.

–      One is a sedative effect. So, when you take a melatonin pill, you feel sleepy, but this effect only works for a few weeks or less.

–      The other is what is known as a “phase shifting” effect. This means, it works on the biological clock or the timing of the sleep and wake cycle. This is how it works: if you take melatonin a few hours before your bedtime (let’s say evening), your sleep time is going to advance or move earlier, i.e. shifts earlier.

Since melatonin has not been formally tested as a sleeping medicine, we don’t really know the “right dose.” There are so many manufacturers that we don’t know what impurities are in pills. Nonetheless, I know that people have taken melatonin and I have not seen any reported harm. So, in small doses, it should be alright. If it is helping in small doses, then I don’t discourage it.

Sleep medicine physicians including me who are familiar with circadian physiology of sleep use melatonin to help a selected group of our patients adjust to more desirable timing of sleep and wake. Shift workers, blind individuals and those who are jet lagged (pilots for example) are in situations where their internal body clock is not in synch with the external environment. The body is in nighttime mode but the pilot is now overseas and it is daylight in France; a nighttime nurse is working at 3 am, but her body clock is sending messages that she should be asleep. Melatonin can help such individuals synchronize their clocks by taking it ahead of desired schedule.

Side effects on melatonin: Dizziness, headaches, rash and nausea are common. If you are pregnant, you should not take melatonin. It is best to talk to your doctor before you take melatonin especially if you have hypertension, diabetes or depression and/or are on medications to make sure there is no interaction. Long term use and overdosing can cause irritability, depression seizures or sleep walking. These side effects are rarely seen with short term use (2 weeks).

How to use Melatonin to shift your sleep rhythm earlier

  • Take a low dose of melatonin (let’s say 1 to 3 mg) in the evening about 4-6 hours before desired bedtime. let’s say desired bedtime is 11 pm. So you take melatonin around 6 pm. Take another pill about 1 hour before bedtime. This process helps you shift your rhythm earlier. So on subsequent nights, you can start getting sleepy earlier.
  • It is best to use melatonin on a short term basis. It is recommended by sleep experts to use it no more than 2 weeks, unless directed by your doctor to take it longer for special cases.
  • If you think you are suffering from a circadian rhythm disorder, consider the use of light therapy in the morning to help you regulate your rhythm. You can purchase light therapy (known as lux lamp) from various websites. You want to apply the light in the mornings. Light suppresses the secretion of morning melatonin, so it makes you less sleepy during the day; it also sends a signal to the brain to release the melatonin later, which is nighttime.