Use melatonin to cut down on insomnia and middle-of-the-night awakenings? A reader, following last Friday’s blog, posted this question on Ask The Savvy Insomniac:
“I don’t have any problems falling asleep. I go to bed around 10 and I’m out cold. But then I wake up at 1 a.m. and can’t fall back to sleep. I’ve talked to my doctor about it, and he recommended taking melatonin at bedtime. So I started with 3 mg but I kept needing more. Now I’m up to 15 mg, but I’m still waking up. My doctor says it’s OK to take more. What do you think?”
Hmmm. There are two issues here: safety and efficacy.
Supplements of melatonin—a sleep-promoting hormone produced by the pineal gland—are known to be safe in doses up to 20 mg. Melatonin doesn’t usually cause morning grogginess nor, under experimental conditions, have subjects developed tolerance to it. Higher dosages of melatonin have yet to be tested for safety.
It’s the efficacy issue that has me scratching my head. Taken several hours before bedtime, melatonin can help people fall asleep sooner than they normally would. It’s often recommended for night owls wishing to fall asleep at an earlier hour, or for jet lag. But the man writing above is asleep by 10 p.m.; his problem is insomnia in the middle of the night.
Would a 15 mg dose of melatonin taken at bedtime help him sleep through the night? It depends. Many melatonin supplements sold over-the-counter in the United States have a very short half-life: 20 to 45 minutes. (Half-life refers to the time it takes for a dose of a drug in the blood plasma to decrease by half.) Melatonin supplements lose strength too quickly to help users sleep through the night, reviewer Rüdiger Hardeland says. Higher doses of melatonin—50 or 100 mg—have been proposed as a therapy for people who have trouble sleeping through the night, but they have yet to be tested. (For more information, see my blog on Melatonin Replacement Therapy.)
A Controlled Release Version?
A controlled release version of melatonin is sold in Europe and many other countries outside the United States. It’s called Circadin and is approved for insomnia patients 55 and older (and obtainable by prescription only). Some studies—but not all—have shown it improves the sleep quality of older people with insomnia, whose natural melatonin secretion may have declined due to a weakening of the circadian system or to calcification of the pineal gland. This drug might have more to offer older insomnia sufferers whose problem is waking up in the middle of the night.
I wrote this blog post over 3 years ago and, since then, timed-release melatonin supplements have become available in the United States. They’re made by several different companies and sold over the counter. If you’re using melatonin supplements for middle-of-the-night insomnia, try a controlled-release formulation.
Has taking melatonin improved your sleep? How?