Sleep and Health Benefits of Melatonin

As a treatment for chronic insomnia, melatonin supplements disappoint. Internal secretion of melatonin, the hormone of darkness, begins to rise some two hours before you fall asleep. Adding to it with a melatonin supplement is often redundant.

But there’s increasing evidence that melatonin supplementation is effective for some sleep problems and may also help to treat and/or avert serious health conditions. Here’s a summary of the benefits.

Melatonin ineffective for insomnia but effective for other sleep problemsAs a treatment for chronic insomnia, melatonin supplements disappoint. Internal secretion of melatonin, the hormone of darkness, begins to rise some two hours before you fall asleep. Adding to it with a melatonin supplement is often redundant.

But there’s increasing evidence that melatonin supplementation is effective for some sleep problems and may also help to treat and/or avert serious health conditions. Here’s a summary of the benefits.

Shifting the Timing of Sleep

Supplementary melatonin can be used as a chronobiotic—an agent that brings about a phase adjustment of the body clock. It can shift the timing (but not the duration) of your sleep. So it’s an effective therapeutic in at least two situations:

  1. As a jet lag remedy: Eastward travel across several time zones is difficult. Your body clock has to shift forward several hours until sleep syncs up with darkness in the new time zone. A melatonin tablet taken before a late afternoon or early evening departure (together with reduced light exposure) may help to initiate this phase advance and serve as a jet lag remedy. From day 1 you’ll fall asleep earlier and wake up earlier, starting out on the right foot.
  2. As a maintenance therapy for night owls: If you come alive in the evening and can’t get to sleep till 2 or 3 a.m., chances are your body clock runs late. Instead of completing a daily period every 24 hours, a daily period for you may be closer to 25 hours and even longer. The medical diagnosis for this problem is delayed sleep phase disorder, or DSPD. People with DSPD have a tough time getting up for early morning classes and work. The solution is twofold: bright light exposure in the morning and a daily melatonin supplement taken around dinnertime. (For details see this blog post on DSPD.) Recently, melatonin was found to be quite effective in helping adolescent night owls fall asleep earlier so they could rise ‘n’ shine in time for early morning classes.

Correcting a Melatonin Deficiency

Melatonin is secreted by the pineal gland. It helps to create the relatively strong biological rhythms that put you to sleep and keep you sleeping through the night. But melatonin rhythms can weaken with age. The following may be involved:

  • degeneration of neurons in the body clock
  • deterioration of neurons connected to the pineal gland
  • calcification of the pineal gland

All of these factors are associated with melatonin deficiency and will make it harder to fall and stay asleep.

How can you know if you’re deficient in melatonin? An easy way is to test for the main melatonin metabolite in a urine sample collected during the first void of the morning. Testing for melatonin in the saliva and the blood is more involved. Home test kits are available, but you’re more certain to get accurate results from tests ordered by a doctor.

Older adults deficient in melatonin may find their sleep improves when they take a daily melatonin supplement. Timed-release melatonin is now available over the counter in the United States. Particularly if your problem is sleep maintenance insomnia (you wake up several times at night), a timed-release supplement will probably be more effective than immediate-release tablets, which exit the system fairly quickly.

Other Benefits of Melatonin Supplementation

Melatonin may have other health-protective effects. It’s been found to act as a powerful antioxidant in laboratory tests. In a review paper published last year, Lionel H. Opie and Sandrine Lecour cite evidence that melatonin may be effective in helping:

  • lower hypertension
  • reduce damage to body tissue after a heart attack
  • protect against, and reduce cell death following, strokes
  • prevent the adverse health effects of obesity
  • treat type 2 diabetes

Weaker evidence suggests that melatonin may help combat some cancers, including prostate and breast cancer.

If you’re a garden-variety insomniac like me, you may not think much of melatonin. But don’t you have to love it a little bit for all the things it can do?

If you’ve tried melatonin for sleep or some other reason, how did it work?

Insomnia at the Pinnacle of Power

We don’t hear much about the sleep of presidents and prime ministers except for the hours they get: President Obama, 6; George W. Bush, 8: Margaret Thatcher, 4. Their personal habits matter little compared with the decisions they make and the work they do in office.

But Dr. Li Zhisui wrote about insomnia at length in his biography of Mao Zedong, The Private Life of Chairman Mao, suggesting that our leaders’ sleep (or sleeplessness) may affect their decisions and behavior more than we think.

Insomnia was a problem for Mao ZedongWe don’t hear much about the sleep of presidents and prime ministers except for the hours they get: President Obama, 6; George W. Bush, 8: Margaret Thatcher, 4. Their personal habits matter little compared with the decisions they make and the work they do in office.

But Dr. Li Zhisui wrote about insomnia at length in his biography of Mao Zedong, The Private Life of Chairman Mao, suggesting that our leaders’ sleep (or sleeplessness) may affect their decisions and behavior more than we think.

Mao’s Stress-Related Insomnia

As Mao’s personal physician, Li was expected to give up all other duties to see to the chairman’s health and wellbeing. So he worked and lived in the ruler’s compound, observing him at close range and eventually becoming Mao’s confidant.

Li noted right away that Mao’s sleep was erratic. Anticipatory anxiety would keep him awake on nights before public events where he was to address the masses.

“Often he would get no sleep at all the night before the festivities,” Li wrote. “He was exhilarated by the crowds and their adulation, and his energy always carried him through the event, but he often caught cold afterward. Sometimes the cold would become bronchitis, and he would be miserable for weeks.”

A Possible Circadian Rhythm Disorder

But Li observed that Mao’s erratic sleep patterns seemed to be driven by internal as well as external factors. Mao was a night owl who tended to be awake when most other people were sleeping.

“His body refused to be set to the 24-hour day,” Li wrote. “He stayed awake longer than others, and much of his activity took place at night. If he went to bed one day at midnight, the next night he might not sleep until 3 in the morning, and the day after that he would not sleep until 6. His waking hours grew longer and longer until he would stay awake for 24, or even 36 or 48, hours at a stretch. Then he could sleep 10 or 12 hours continuously, and no amount of noise or commotion would wake him.”

This erratic sleep pattern would probably be classified as a circadian rhythm disorder today. It might be delayed sleep phase disorder, a diagnosis often given to night owls who prefer to be up at night and sleep in late in the morning. It might also be non-24-hour sleep-wake disorder, a problem often seen in people who are blind, who cannot detect daylight and whose body clocks—as a result—are not set to the 24-hour day.

Whatever the diagnosis, the problem may have been amplified by Mao’s unusual lifestyle. He spent most of his time indoors—in his bedroom, according to Li, where thick dark curtains blocked out the sunlight. Without exposure to sunlight, his circadian rhythms may have become desynchronized, a situation that could easily give rise to insomnia.

But Li felt Mao’s problem was partly organic, and that he’d simply been born with a wayward body clock predisposed to run on its own time.

Insomnia Affected Mao’s Behavior

People with sleep problems like Mao’s don’t usually have easy lives. Perennial lateness and poor performance interfere with relationships and jobs.

But Mao rose to a leadership position despite his strange sleep habits and, as Chairman of the Communist Party, he called the shots. Without regard for the sleep needs of his associates, he would call impromptu staff meetings at 3 a.m. On the spur of the moment he would order his whole staff to get up early to prepare for a 4 a.m. departure by train.

As disruptive as his strange sleep habits were to others, they were a source of great anxiety to Mao himself, Li said. Mao tried swimming, dancing, and walking to wear himself out, and he took up to 4 times the recommended dosage of powerful sleeping pills. But often, Li said, nothing worked.

Could there be a relationship between the tight-fisted control Mao insisted on exerting over his country and the lack of control he seemingly had over his sleep? What do you think?

Q & A: Solutions for Sleepy Night Owls

A small business owner wrote to Ask The Savvy Insomniac to say that her problem was that she didn’t normally feel sleepy until around 3 a.m.

Here are a couple ways she could shift her biological rhythms so that she feels like going to sleep earlier.

owl-headphonesA small business owner wrote to Ask The Savvy Insomniac to say that her problem was that she didn’t normally feel sleepy until around 3 a.m.

“When I try to analyze my sleep problems,” she wrote, “I feel I’m possibly confusing being a nocturnal person with insomnia. I’ve always wanted to stay up late. I feel like I’m about 3 hours behind the rest of the world. No matter how tired I am in the evening, I still can’t go to sleep till early in the morning!

“Sometimes just  knowing that I have to get up earlier than usual for a meeting or having to catch an early flight makes me crazy and not able to sleep. Then I try to regain what I lost in sleep the following morning. On some days I don’t get in to my office until 1 p.m.!” Other than take sleeping pills, she wanted to know, what could she do that would help her get to sleep at a reasonable hour?

An Inherited Trait

It’s no fun being a night owl when you have to march to the beat of a corporate clock. Getting up at 7 a.m. may be easy for those who fall asleep by midnight, but it’s much harder if you can’t fall asleep till 3. You’re a zombie at early morning meetings, spilling coffee and forgetting papers and keys, and then slogging through the day with what feels like a whopping hangover.

This inclination to want to go to sleep and get up late is not a matter of choice; one in 10 people are genetically programmed to experience what doctors call Delayed Sleep Phase Disorder, or DSPD. The body clock simply runs on a later schedule in people with DSPD. Here are a couple ways to shift your biological rhythms so that you feel like going to sleep earlier.

Bright Light Therapy

One is to expose yourself to bright light for a few hours right after you wake up, every day. Sunlight works best—but taking a walk or sitting by a window may not be in the cards if you have to get yourself ready for work or get children off to school.

Another option is to use a light box. While sitting beside a light box for two hours straight may not fit into your early morning routine, time with the light box can be interspersed with taking showers, getting dressed, making breakfast, and other early morning activities. The idea is to spend as much time by the light box as possible in the first few hours after waking up.

Melatonin Supplements

The other way to shift your biological rhythms forward is to use melatonin supplements. But taking melatonin according to the instructions on the label—an hour before bedtime—is not going to help. To get a sizeable phase-shifting effect, you have to take it around dinnertime. Specifically, 3 mg of melatonin taken seven hours before the time you actually fall asleep will give you the biggest bang for the buck, according to Charmane Eastman, director of the Biological Rhythms Research Lab at Rush University Medical Center, whom I interviewed last year. As is true of bright light, melatonin has to be used daily to keep your body clock from shifting back to its natural cadence.

A combination of bright light and melatonin supplements works even better than either therapy alone. Not being a night owl myself, I can’t speak from personal experience here. But research shows these therapies to be effective for a majority of night owls wanting to sleep more “normal” hours.

If you’re a night owl, does your work allow you to sleep in late, or have you had to adjust your sleep schedule to start work early? How have you done it?