I have been a doctor for over two decades and have devoted most of my time to sleep medicine. I have seen a huge increase in melatonin use by my patients and their families. Although melatonin has helped many of my patients, there are some concerns that I have that are worth sharing.
I am not sure if most of my patients took melatonin before my evaluation. The pineal glands in the brain produce melatonin. melatonin regulates sleep.
The brain responds to darkness by increasing melatonin levels in order to sleep. melatonin production shuts down when there is bright light and the brain knows it is daytime.
The melatonin and light properties make them the two key factors in the establishment of the internal sleep-wake clock.
When there is a mismatch between the internal clock and the socially accepted time to go to sleep or wake up, it's called a circadian disorder. Jet lag can occur when there is no travel. When you stay in an environment of bright lights until late hours of the night, you fool your brain into thinking that it is still daytime.
melatonin production does not occur and you don't feel sleepy until the late hours of the night or early hours of the morning.
Many teenagers come to my clinic because they can't sleep until 2 am or 3 am, but they are up watching videos on their electronic devices until late in the night.
I usually recommend that my patients turn the lights off at a reasonable time so that they don't wake up in the middle of the night. It takes time for the natural clock to adjust to a new schedule, and often my patients prefer to use a melatonin supplement.
With the increase in use of electronic devices, sleep disorders have become more common. melatonin is an attractive option for people who suffer from insomnia or sleep disruption because of its sleep-promoting properties.
melatonin can be bought without a prescription in the US. A lack of regulation can mean an increased risk of taking a different dose or ingredient than was reported.
A study of melatonin supplements found that the hormone's content ranged from -83 percent to +478 percent of the labelled content. Serotonin and valerian were not reported to be in the preparation.
melatonin is only available by prescription in the EU, the UK, Canada and Australia. This approach allows for better regulation, understanding and explanation of risks, benefits and alternatives to melatonin.
The most common side-effects of melatonin are headaches and dizziness. It can interact with other medicines.
The best evidence of safety for melatonin use is for short-term use only. melatonin's long-term effects are unknown.
Is melatonin recommended to my patients? Absolutely. I only recommend it for what I know is right. Insomnia can be a symptom of a sleep disorder such as restless legs syndrome, or it can be a symptom of another condition such as depression.
Treatment options can be explored when a sleep specialist identifies the correct diagnosis. When I need to prescribe melatonin, I usually recommend starting with the lowest dose possible, one to two hours before their current sleep time, and I recommend that the patient turn their lights off or dim them before taking melatonin. If you want to get a good night's sleep, you should avoid using electronic devices before bed, heavy exercise in the evening, and caffeinated products after 3 pm.
Lourdes M. DelRosso is a PhD Candidate in Sleep Disorders.
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