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?

Last-Minute Gifts for the Sleepless

Oops! Here it is just a few days before Christmas and Hanukkah and I’ve forgotten to write my annual gifts-for-the-sleepless blog.

Well I’ll just post this gift blog now and include items available from online sellers promising 2- and 3-day shipping. (Apologies to readers expecting a post about an insomnia treatment that increases sleep efficiency! I’ll publish that one next week.)

An essential oils diffuser may make a good gift for a person with insomnia
Photo courtesy of Your Best Digs

Oops! Here it is just a few days before Christmas and Hanukkah and I’ve forgotten to write my annual gifts-for-the-sleepless blog.

I’ll just post this gift blog now and include items available from online sellers promising 2- and 3-day shipping. (Apologies to readers expecting a post about an insomnia treatment that increases sleep efficiency! I’ll publish that one next week.)

Essential Oil Diffuser

The National Sleep Foundation says there’s evidence that certain scents are relaxing and may be conducive to sleep: lavender, jasmine, vanilla, rose, and “any scent you love.” Essential oils—natural oils that smell like the plant or other source from which they come—are popular now and, for those who like essential oils, a diffuser is a must. Some diffusers contain an atomizer that produces fine, airborne particles of oil and blows them into the air. Others blend the oil with water and release a cool mist. Diffusers are attractive and reasonably priced, and they make good gifts. Available at Amazon and many big box stores.

Satin-Lined Cap

It doesn’t have to be long and pointy, and it doesn’t have to look like the mop cap worn by Betsy Ross. These days satin-lined beanies are being sold as fashion accessories that can double as nightwear to protect fancy hairdos as well as warm the head on chilly nights. Check out these stylish options and these cute caps: an affordable gift sure to provide your loved one with comfort at night.

Wake-Up Light

In last year’s post I suggested night owls might find it easier to get up if they used a wake-up light. My night owl nephew tried one and was surprised to discover how much easier it was to get out of bed. But his light—made by Philips—begins to brighten 30 minutes before the alarm rings. A light that began to brighten 60 minutes before wake-up time would be even more helpful, he said. A 30- or 40-minute brightening cycle may be fine for the night owl in your life. But late, late night people may do better with the Lumie Bodyclock, which has a longer, more flexible light cycle.

Cashmere Socks

Wearing soft, warm socks to bed may be just the ticket for an insomniac who has trouble falling asleep, especially if during the colder months that person has cold feet. Icy extremities are never sleep friendly. And research shows that warming the feet can sometimes help people fall asleep. It dilates the blood vessels, helping lower core body temperature and hastening sleep. Some wool socks are scratchy, but not cashmere, which is warm and soft. Many choices for men and women online.

No-Drawstring Pajamas

Whoever had the idea of creating pajamas with a drawstring at the waist? Certainly not someone whose sleep is disrupted by bathroom calls at night! Especially if your mate or sweetheart makes several trips to the bathroom, do him or her the favor of getting pajamas with an elasticized waist. Warning’s fair: you may have to hunt a while for this gift and purchase tops and bottoms separately (drawstring pajamas are “in” and elasticized bottoms, apparently “out”). Yet for the persistent shopper they are available from Amazon and other online sellers.

Humidifier

I know: a humidifier is a pretty pedestrian holiday gift! Yet it can be oh so useful for the sleep-challenged in the wintertime. When it’s cold outside, we endure months of forced-air heating and the coughing that results, keeping us awake or waking us up. It actually took me years to realize that humidifiers weren’t only for use when someone was sick. Now we use ours nightly and our nights are quieter—and our sleep, more peaceful—as a result. Available online as well as at all the big box stores and very reasonably priced.

The Savvy Insomniac

Last but not least: Give your friend or family member this A-to-Z guide to improving sleep and stamina. There’s no more comprehensive book about insomnia on the market today. Print and Kindle versions available from Amazon. Epub format available through other online booksellers, including Barnes & Noble, Kobo, and iBookstore.

Can’t find the right gift here? Check out last year’s holiday gift blog or the ones from 2013 and 2014.

Insomniacs, Let There Be Light

If you’re prone to insomnia when it’s chilly outside, the problem may have to do with too little exposure to daylight in the colder months of the year. Working in well-lit conditions and using a light box may help to relieve your insomnia symptoms.

Use a light box early in the morning or in the evening, depending on your insomnia symptomsEvery November I hear increasing numbers of complaints about insomnia. Some people say they feel sleepier in the evening, go to bed early, and wake up at 3 a.m., unable to get back to sleep. Others toss and turn for hours before falling asleep only to oversleep their alarm clocks.

If you’re prone to insomnia when it’s chilly outside, the problem may have to do with too little exposure to daylight in the colder months of the year. Working in well-lit conditions and using a light box may help to relieve your insomnia symptoms.

A new meta-analysis suggests that bright light may be an effective form of therapy for insomnia all year round. But the effectiveness will depend on several things, including the timing of the light exposure and the intensity of the light. Here’s more about it.

A Gold Standard for Night Owls and Early Birds

The use of bright light therapy to treat circadian rhythm disorders—situations involving a mismatch between a person’s preferred sleep time and the alternation of daylight and darkness—is now standard practice. Results of the meta-analysis back these practices up:

  • Night owls tend to fall asleep and wake up quite late, missing morning activities. Their body clocks run slow, completing a daily cycle every 25 to 26 hours. Treatment calls for use of a light box immediately on waking up. Early exposure to bright light shifts their sleep cycle to an earlier hour and helps synchronize their circadian rhythms to the 24-hour day.
  • Early birds are usually struggling to keep their eyes open after 8 p.m. Their body clocks run fast, completing a cycle every 23 to 23.5 hours. The usual advice to early birds is to use the light box in the evening to postpone sleep and tune their internal rhythms to the 24-hour day.

Circadian Rhythm Factors in Insomnia

Surprisingly, the meta-analysis offers even more support for the idea that bright light therapy can improve the sleep of insomniacs. This may be due in part to the design of the studies reviewed. But it also suggests there may be a circadian component in insomnia, an idea that has been around a while. “Circadian rhythm factors may be involved in insomnia in several ways,” sleep investigators Leon Lack and Richard Bootzin have written in textbook on treating sleep disorders.*

People with sleep onset insomnia—trouble falling asleep at the beginning of the night—may have a mild version of the night owl problem. Our body clocks may run a little bit slow, completing a cycle once every 24.5 hours (rather than every 24 or every 24.2 hours, which in humans is the estimated norm). In certain situations—reduced exposure to light; sleeping in on weekends; working evening shifts—our internal sleep–wake rhythm may move farther and farther away from the daily alteration of daylight and darkness, exacerbating our trouble falling asleep.

Likewise, older adults who are increasingly prone to nod off after dinner may wake up feeling wired at their usual bedtime and have a tough time returning to sleep. Or if they do succeed in sleeping through the night, like early birds, they may not be able to sleep past 3 in the morning.

Light Exposure: Time It Right

Light can have a phase-shifting effect on the circadian system and blocks secretion of melatonin, a hormone associated with the night. So bright light may be used to shift sleep to a slightly earlier hour (which may help sleep onset insomniacs) or to prolong wakefulness in the evening. But the light exposure has to come at the right time of day.

Sleep onset insomniacs (whose goal is to get to sleep more easily) will—like night owls—want to expose themselves to bright light immediately upon waking up in the morning. The human body is most sensitive to light when it’s least expected. So half an hour’s exposure to bright light emitted from a light box as you’re getting dressed, eating breakfast, and reading the paper will be much more helpful than a longer exposure to light delivered later in the morning.

Older insomnia sufferers prone to drifting off too early in the evening may be able to remain up and alert until later if—while they relax after dinner with a book or in front of the TV—they do so in a room flooded with light (or better yet, seated next to a light box, which emits a lot more light than standard lighting fixtures). Delaying bedtime may also help to consolidate sleep at night and possibly extend sleep a little later in the morning.

Higher Intensity Light for Better Results

Authors of the meta-analysis found that in the insomnia studies they analyzed, the higher the light intensity, the greater was the effect. So if you’re shopping for light boxes, pay attention to the intensity of light different products emit. A light box that delivers light at the intensity of sunlight (10,000 lux) will give you the biggest bang for your buck.

If you’ve used a light box, what effect (if any) has it had on your sleep?

* Leon Lack and Richard Bootzin, “Circadian Rhythm Factors in Insomnia and Their Treatment,” in Treating Sleep Disorders: Principles and Practice of Behavioral Sleep Medicine, ed. Michael Perlis and Kenneth Lichstein (Hoboken: Wiley, 2003), 305-34.

Insomnia or Delayed Sleep Phase Disorder?

Sometimes I hear from people whose sleep problem sounds more like a circadian rhythm disorder than insomnia. Laurel wrote that she’d always been a night owl. So she was taking sleeping pills to get to sleep at night.

But if her problem is due to a delayed or sluggish body clock—if what she has is delayed sleep phase disorder (DSPD)—she’d be better off with other types of treatment. Here’s more:

Night owls are better off with bright light therapy than sleeping pillsSometimes I hear from people whose trouble sleeping sounds more like a circadian rhythm disorder than insomnia. Here’s what Laurel wrote:

 

 

 

 

I have trouble sleeping virtually every night—it is not intermittent—and I always have. I was a poor sleeper as a child, staying up until very late (3 a.m. to 5 a.m.), then being exhausted during the next school day and napping in the afternoon . . . continuing the vicious cycle. This pattern has pretty much stayed the same throughout my adult life. It seems to run in the family, as my mother had awful insomnia, as does my sister.

Laurel was taking sleeping pills to get to sleep at night. But if her problem has mainly to do with her body clock—if what she has is delayed sleep phase disorder (DSPD)—she’d be better off with other types of treatment.

Symptoms of DSPD

DSPD symptoms are similar to the symptoms of people with sleep onset insomnia:

  • Trouble falling asleep at bedtime
  • Catastrophic thinking at night (related to how their inability to fall asleep will affect their performance or interpersonal functioning the next day)
  • Poor cognitive functioning in the daytime and irritable mood

But in one fundamental way, the symptoms associated with the two disorders are different. Sleep onset insomniacs are inclined to poor sleep regardless of sleep opportunity. People with DSPD, in contrast, can generally get a good night’s sleep when allowed to sleep during the hours of their choosing (as, for example, when they’re on vacation). Their sleep problem has mainly to do with timing. School and work obligations fit poorly with their internal circadian rhythms. The result is sleep loss, poor performance, and, over time, reduced life prospects.

How DSPD Develops

It begins in adolescence. Then, for unknown reasons, children experience a biological delay in their sleep pattern. This delay causes them to want to go to bed and get up later (which is why later school start times for middle and high school students makes so much sense).

Then, as people reach the age of 20 or so, most of us start shifting backward again to earlier preferred bed and wake times. But a small number of people don’t shift back. They become night owls, and their preference to stay up till 3 and in bed till 11 can persist into middle age and beyond.

Delayed Circadian Rhythms

What keeps people like Laurel running late? Two phase markers determine when we feel like sleeping and when we’re ready to wake up. Onset of melatonin secretion is one. Melatonin secretion is negligible during the daytime but high at night, starting about 1 to 2 hours before normal bedtime. Research has shown that melatonin secretion begins about 4 hours later in people with DSPD than in normal sleepers.

The second phase marker is core body temperature. We’re physiologically alert at times when our core body temperature is high and sleepy when it’s low. Normal sleepers’ body temperature is highest—and physiological alertness, greatest—in the evening from about 6 to 9 p.m. In people with DSPD, this temperature high occurs 2 to 6 hours later.

The lowest core body temperature in normal sleepers—when people are sleepiest— occurs around 5 a.m. Research has shown that the body temperature low occurs on average over 2 hours later in people with DSPD. No wonder they can sleep right through buzzing alarm clocks.

A Longer Circadian Period

Studies have also shown that people with DSPD have longer-than-normal circadian periods. The average circadian period in humans—the time it takes to complete a full cycle—is 24 hours 12 minutes. Exposure to sunlight corrects for the 12-minute delay and keeps most of us running on 24-hour days.

The body clock in people with DSPD tends to run slow, cycling once every 25 or even 26 hours. The 1- or 2-hour advance needed to bring them into sync with the 24-hour day is harder to accomplish, say sleep experts, and likely another cause of DSPD.

Treatments

The gold standard in treatment for people with DSPD is early morning bright light therapy combined with a melatonin supplement taken around dinnertime:

  • Bright light: The light source can be the sun or a light box that disseminates light at 10,000 lux. Light exposure should occur immediately upon waking up. Two-hour sessions are most effective.
  • Melatonin supplement: Phase advances are also larger when morning bright light therapy is combined with a melatonin supplement taken late in the afternoon or early in the evening. In a recent study, 0.5 mg of melatonin taken late in the afternoon and 30 minutes of bright light therapy in the morning produced 75% of the phase shift that occurred with the 2-hour light exposure.

Still More Gifts for the Sleepless

It’s Cyber Monday, and maybe you’re looking for just the right gift for someone with insomnia. Not to worry.

Here are some suggestions for holiday gifts this year. (And if none of these suggestions appeal, check out my 2013 and 2014 holiday gift blogs.)

insomnia sufferers may enjoy several inexpensive holiday giftsIt’s Cyber Monday, and maybe you’re looking for just the right gift for someone with insomnia. Not to worry.

Here are some suggestions for holiday gifts this year. (And if none of these suggestions appeal, check out my 2013 and 2014 holiday gift blogs.)

Shiatsu Massage Pillow

Shiatsu massage pillows mimic the way it feels to have someone massaging your body, and kneading the tension out of tight muscles is helpful for people with sleep problems due to stress. But Lesley, a woman who shares comments on this website from time to time, found another use for hers. She was undergoing sleep restriction therapy for insomnia and having a tough time staying awake until her prescribed bedtime. To keep herself from nodding off too early, she sat up reading with a shiatsu massage pillow. It provided just enough stimulation to keep her from falling asleep. All the major department stores sell them from $30 to $60.

Cashmere Wrist Warmers

Do you love reading in bed but hate the way your hands and wrists get cold in the the wintertime? Knitted wrist warmers will solve that problem, and cashmere’s soft and warm. Even for those who avoid reading in bed (as insomniacs are advised to do), wrist warmers are a great wintertime gift. They’re good for sitting up late at night after you’ve had your shower and your body’s beginning to chill down. Many companies that make them are in the UK. Celtic & Co. sells them for $53 a pair. Order early: they take 7 to 10 business days to ship.

Wake-Up Light Alarm Clock

Night owls and light-sensitive sleepers are in trouble when they have to rise ‘n’ shine in the dark. Getting out of bed is a trial, never mind finding the energy to get out the door and the alertness to actually think or work. An alarm clock equipped to simulate the sunrise may alleviate the problem. These devices start to brighten gradually half an hour before a person’s normal rise time, so night owls will feel more aroused and alert when the alarm goes off. Philips makes two—the HF3510 and the HF3520—that sell for $111 and $115 on Amazon. The HF3471, a larger wake-up light endorsed by the National Sleep Foundation, sells for $201.

Escape Sleep Mask

Sleep masks are useful for anyone who’s sensitive to light at night, but this sleep mask is a twofer. Not only does it protect the light-sensitive from being awakened by moonlight streaming in the window or lights on a plane. With small cut-outs on the eye side, the mask avoids applying pressure to the eyelids, which can be very helpful for people with dry eye and other painful eye conditions common among short sleepers. The Dry Eye Company sells this mask for $22.

Euromild Low Acid Coffee

Any coffee lovers with sensitive stomachs out there? Finding a low-acid coffee that gives you a boost in the morning without hurting your stomach can be a real challenge—take it from one who knows! After sampling a few, I’ve found only one I like and can tolerate: Euromild. Made from 100 percent Arabica coffee, it’s smoother and less bitter than any other coffee I know. Just take care to drink it in moderation early in the day. Coffee Specialties sells a 14-oz. bag for $13.95.

The Savvy Insomniac

Give your friend or family member this A-to-Z guide to improving sleep and stamina. There’s no more comprehensive book about insomnia on the market today. Print and Kindle versions available from Amazon. Epub format available through other online booksellers, including Barnes & Noble, Kobo, and iBookstore.

Shift Work and Sleep: Always Incompatible?

The worst insomnia I ever had came when I was living in Mexico. I worked a split shift then, teaching English classes from 7 to 10 in the morning and then from 7 to 9 at night. This schedule might not sound difficult: a few hours’ work at both ends of the day, with the rest of the day free for sightseeing, napping, or doing whatever I pleased.

It was tough for me.

Insomnia and a poorer quality of life may result from working irregular hoursThe worst insomnia I ever had came when I was living in Mexico. I worked a split shift then, teaching English classes from 7 to 10 in the morning and then from 7 to 9 at night. This schedule might not sound difficult: a few hours’ work at both ends of the day, with the rest of the day free for sightseeing, napping, or doing whatever I pleased.

It was tough for me.

I’m a morning person, so getting up at 5:30 or 6 is normal. But gearing up for the evening classes took effort. Then I was wired after class. I had to spend at least a few hours winding down, and by then it was after midnight. The thought of having to throw my clothes on again at 6 made me anxious: what if I couldn’t sleep?

Working this split shift was a set-up for insomnia. I tossed and turned in bed, and on too many days I woke up to the sound of the alarm clock feeling achy and spent. It was all I could do to show up for my early class on time.

Shift Work and Chronotype

I put up with this schedule for one semester, but for millions of Americans, shift work is an ongoing part of life. Whether it’s a job in a hospital or in IT, in manufacturing or in the transportation industry, it probably involves working nights, evenings, or early mornings; or on rotating shifts or shifts other than the standard 8 to 5.

Shift work may keep you solvent, but it can also have negative effects on sleep and health. It disrupts the functioning of the body clock, altering physiologic processes and the activity of genes.

A new study in Current Biology suggests that adjusting work time to correspond more closely with an employee’s natural cycle of activity and rest may alleviate some of the harms associated with shift work. To conduct their research, investigators took a group of factory workers and divided them by chronotype—their preferred hours of sleep and activity:

  • Early birds (who preferred to go to bed and get up early)
  • Intermediate types
  • Night owls (who preferred to go to bed and get up late)

Then, to promote better sleep and reduce the mismatch between preferred wake and work times, they exempted the early birds from working their most challenging shift: the night shift (10 p.m. to 6 a.m.). Likewise, the night owls were exempted from working their most challenging shift: the morning shift (6 a.m. to 2 p.m.). The intermediate group served as control subjects, continuing to work morning, evening, and night shifts.

More Sleep and Satisfaction

The results confirmed many of the researchers’ predictions. Exempted from working their most challenging shifts,

  • Both early birds and night owls slept up to 30 minutes longer on workdays.
  • Both early birds and owls reported better sleep quality and a greater sense of well-being on workdays.
  • Early birds’ and owls’ sleep time on weekends more closely matched their sleep time on workdays (a consistent sleep schedule on weekends helps keep the body’s circadian system in sync).
  • Early birds reported increased satisfaction with their leisure time.

The researchers conclude by stating what many shift workers must already suspect: working more in accordance with natural circadian preferences might improve shift workers’ sleep, quality of life, health, and even productivity.

Whether many industries would or could take chronotype into account when making work assignments is an open question. My solution to the shift work problem in Mexico was to take a job with more regular hours.

If you’ve had experience working irregular hours, how has it affected your sleep and quality of life?

 

Will Melatonin Work for You?

Last week I gave a talk about insomnia and insomnia remedies, and I asked people in the audience to share what they knew. “Melatonin!” a man shouted out. “It doesn’t work!” Others laughed in agreement.

But there is at least one type of insomnia sufferer who stands to gain a lot by taking melatonin supplements regularly at the appropriate time of day. Watch this 3-minute book trailer to find out more.

Last week I gave a talk about insomnia and insomnia remedies, and I asked people in the audience to share what they knew. “Melatonin!” a man shouted out. “It doesn’t work!” Others laughed in agreement.

For many years I thought the same thing. Melatonin supplements are unregulated by the US government. What little information we do get about melatonin—from labels and from the Internet—is often misleading, prompting some of us to buy it and try it when we may as well have bought a pair of lottery tickets instead.

But there is at least one type of insomnia sufferer who stands to gain a lot by taking melatonin supplements regularly at the appropriate time of day. This is the topic of my second book trailer. Watch this three-minute video clip and tell me what you think!

Does Melatonin Work for Insomnia?