Melatonin as a supplement
As a supplement, melatonin can serve as a sleep aid in older age, when we naturally produce less. It can assist in treatment of disorders of biological rhythms. It is sometimes recommended for migraines, irritable bowel syndrome and other conditions. It can also have positive effects on inflammation and immunity.
But consult a physician about use, dosing, timing, controlled-release vs. immediate-release formulations, safe brands, and melatonin vs. a prescription agonist — which binds to a common receptor and produces a similar effect — such as ramelteon.
Some people inadvertently misuse melatonin:
As a hypnotic. While there are exceptions, melatonin is not that efficacious for sleep onset and maintenance. It works better as a “chronobiotic” to manipulate biological rhythm for conditions such as jet lag, delayed sleep phase (night-owlishness) and impaired sleep timing in people who are blind.
At concerningly high doses. We produce melatonin in minute quantities in response to exquisitely orchestrated instructions from the hypothalamus. Doctors often recommend between 0.3 and 5 mg. Doses greater than or equal to 10 mg are not often associated with serious adverse events, but may have unintended consequences and exacerbate side effects such as headaches, dizziness, daytime sleepiness and nightmares. High doses may also desensitize the brain to its effects.
For too long. We don’t know enough about long-term — greater than six months — safety.
From the wrong source. Studies have exposed inconsistent and sometimes vastly higher doses than labels indicate. Purity is another concern. Look for the USP or NSF mark for pharmaceutical-grade melatonin.
Without a doctor’s input. Melatonin should not be used by people with certain conditions (for instance, autoimmune diseases) or on certain medications (such as anticoagulants, seizure medications and immunosuppressants). Risks in older adults must be weighed.
Coaxing your own melatonin to work for you and using supplements thoughtfully can be of great benefit to sleep. And don’t hesitate to seek insomnia treatment if you need further help.
Lisa Strauss, PhD, is a clinical psychologist in private practice in the Boston area. She specializes in sleep disorders.
At the wrong time. Phase response curves help guide what time to take melatonin to shift or maintain the timing of sleep. Two to three hours before sleep mimics sunset. Melatonin won’t help sleep much when your natural levels are already high, but it might throw off your rhythm if it’s (still) in your system at the wrong time (more likely at high doses).