Allows us to better understand your problem
Sleep through the nightFall asleep fasterSleep without pills
Melatonin has emerged as one of the most widely utilized natural sleep supplements available today, with millions of Americans using this hormone supplement as a sleep quality enhancer. However, it is important to understand how melatonin acts, when to take melatonin, and what the side effects can be. This article intends to provide clinical evidence for you to help make your own decision on how to supplement melatonin.
Melatonin is a naturally occurring hormone that your brain's pineal gland makes. Your pineal gland is a small, pinecone-shaped gland that produces melatonin based on darkness as your body's circadian rhythm body clock. The main purpose of melatonin is to signal your body to get ready for sleep.
Research shows that for most healthy adults, melatonin production starts around 9 PM, peaks between 2-4 AM, and then fades until morning. Natural melatonin production can be interrupted by artificial light, shift work, jet lag, and aging. These are a few of the reasons why people supplement with natural sleep remedies or nutritional supplements such as melatonin.
Melatonin is a different sleep aid than that of physician-based sleeping pills. In fact, the melatonin receptors only trigger a mechanism of action that promotes the sleep cycle as it binds to melatonin in the brain, notably that of the suprachiasmatic nucleus (SCN). When melatonin binds to your receptors, it promotes drowsiness and temperature regulation, signaling to the body it is time for sleep in your circadian rhythm.
Clinical trials support melatonin reducing sleep onset latency by about 7 minutes and improved overall sleep quality. Keep in mind, melatonin effects vary widely from individual to individual, and timing can also affect the effect.
There is an optimum timing to use melatonin to get the best effect. Most sleep specialists recommend melatonin for sleep be taken anywhere from 30 to 120 minutes before bed. Ultimately, this timing is determined by your sleep problem and circadian rhythm.
We talked to Dr. Michael Grandner, Sleep Expert and Professor of Neuroscience and Physiological Sciences, to find out what the research says about timing. He stated: "Taking melatonin too late significantly reduces the effectiveness." In other words, melatonin works best at promoting sleep when timed to align with the body versus as a last-minute sleep aid.
If you are challenged with sleep onset (having trouble getting to sleep), I suggest taking melatonin 1 to 2 hours before your sleep time so the hormone can start working as your body prepares for sleep in a natural way.
On the contrary, circadian rhythm disorders related to jet lag or shift work sleep disorder are quite different. Research indicates if you travel east, you should take melatonin at destination time for bedtime and continue for several days. If you travel westward, you will need very little other than just staying awake at bedtime.
For advanced sleep phase syndrome (the person goes to sleep too early and wakes up too early), a smaller dose of melatonin should be taken in the evening. Delayed sleep phase syndrome will most likely benefit from morning light therapy and melatonin use in the evening.
One of the most frequently encountered errors that people make when taking melatonin is the dosing amount. Numerous clinical studies and clinical trials have been conducted which demonstrate that lower doses are more effective compared to the mega doses that are most commonly sold in stores.
Adults: Take 0.5 to 1 mg melatonin 30 to 60 minutes prior to your desired bedtime. Most people find benefit from dosing in the 1 to 3 mg range, but in some cases, the dose can reach as high as 5 mg. Doses above 5 mg typically produce no additional benefits, and often produce only side effects.
Older Adults: Those over age 55 can benefit from 2 mg of controlled-release melatonin taken 1 to 2 hours prior to desired bedtime. This is related to a decrease in melatonin production with aging. For this population, supplementation is especially pertinent because of this decrease in melatonin production.
Children: Dosing for children will require medical supervision, but research supports the use of 0.5-1 mg for most sleep disorders in children. Higher doses may further inhibit the natural development of hormones.
Melatonin is a safe treatment for short-term use, but is not without side effects. Understanding what potential side effects can occur will allow an individual to make their own informed choices about supplements, if that is what they decide to do.
Morning drowsiness, headaches, and dizziness tend to be the three most frequently reported side effects. Some individuals will report more vivid dreams or nightmares when taking large doses or increased frequency of dosing. Studies indicate that around 10-15% of individuals report next-day grogginess, as a result of either taking too much melatonin or taking melatonin too late at night.
Other potential physical side effects include nausea, mild tremor, and brief drops in blood pressure. Side effects are dose-dependent and usually resolve once the supplement is stopped.
Melatonin can have interactions with several hormonal systems in your body. It can affect reproductive hormones and suppress ovulation in women when taken at higher doses on a long-term basis. For this reason, researchers have researched melatonin as a contraceptive due to its potential hormonal effects, but effective contraceptive doses would be significantly higher than sleep-induced doses.
Additionally, melatonin may also moderate insulin regulation, which affects blood glucose. Thus, people with diabetes will want to monitor their glucose levels closely when taking melatonin, since the hormone may enhance insulin sensitivity.
Melatonin may interact with several other medications, so it would be worth checking with a healthcare professional before starting a supplement. For example, blood thinners such as warfarin may provide an augmented effect with increased bleeding risk. Drug interactions are plausible because melatonin can affect both platelet aggregation and blood coagulation mechanisms.
Medications that are prescribed to immune-compromised people may also have interactions with melatonin, due to its immune-modulating properties. People on medicines for autoimmune disease may want to check with their doctor prior to using melatonin supplementation.
Individuals who are pregnant and nursing are advised to avoid melatonin supplementation unless prescribed specifically by their provider. Although not definitively proven as safe during pregnancy, melatonin crosses the placental barrier and may affect fetal development.
Individuals with autoimmune diseases, seizures, or depression should also avoid or use caution in using melatonin supplements. The hormone's effects on immune function and neurotransmitter systems might exacerbate certain conditions.
Before jumping to supplements, it is also possible to make lifestyle changes that promote your body's natural production of melatonin. This approach takes action on possible disruption in melatonin production at the source and overall promotes more sustainable sleep.
Light exposure, mainly, is what controls levels of melatonin that your body produces. Exposure to blue light in the evening from smartphones, LED lights, tablets, etc., can drop melatonin production levels by even 23%. Using blue blocking glasses or warm lighting about 2 or 3 hours before bed can help increase melatonin production levels.
It is also important to expose yourself to bright light in the morning. Receiving bright light exposure for 10-15 minutes about an hour after waking will help promote proper circadian timing and ensure you receive optimal levels of melatonin in the evening.
Some foods also naturally contain melatonin or contain items that are precursors to melatonin for a boost. As an example, tart cherries are naturally high in melatonin and have been shown in studies to improve the quality of sleep and length of sleep. Other food sources of melatonin include walnuts, almonds, and some types of rice and oats.
Foods that contain tryptophan (the amino acid that melatonin is synthesized from), such as turkey, dairy, and bananas, are also natural sleep-promoting foods. These foods help with sleep because they support the body's ability to synthesize melatonin. However, the effects of dietary melatonin are generally mild compared to melatonin taken as a supplement. Therefore, food will be the best source of melatonin for helping to support healthy sleep cycles as opposed to treating sleep disorders or insomnia.
Understanding comparisons between melatonin and other sleeping aids can help you make your best choice. Melatonin generally has less risk of dependence and has fewer serious side effects than prescription sleep medications, but melatonin is also typically less effective than prescription medication for severe insomnia.
We asked Dr. Suzanne Gorovoy, Sleep Expert, Clinical Psychologist, and Behavioral Sleep Medicine Specialist, how melatonin compares to other sleep aid treatments. She says: "Melatonin is more effective in resolving circadian rhythm issues as compared to severe insomnia." So, while melatonin is great at helping with the timing of sleep, it may not help someone who has severe sleep maintenance issues or insomnia due to anxiety.
Prescription medications, such as zolpidem (Ambien) or eszopiclone (Lunesta), work much better than melatonin for inducing sleep but have greater risk of dependence, tolerance, and other side effects. Research indicates that prescription sleep drugs reduce sleep onset by about 12-19 minutes compared to melatonin's average reduction of 7 minutes, but they also come with the potential for next-day drowsiness, impaired function, and potential for abuse.
When evaluating melatonin and prescription sleep aids, think about the level of sleep disturbance you are experiencing, your medical history, and your tolerance for side effects from medications. Furthermore, many sleep specialists recommend trying cognitive behavioral therapy for insomnia (CBT-I) as the first line of treatment prior to both melatonin and prescription sleep aids.
One advantage of melatonin, compared to many sleep medications, is the lesser risk of tolerance development. There are still not many long-term safety studies of daily melatonin use, especially with doses above 3 mg or for daily use over the course of months.
Some literature suggests that chronic melatonin use may suppress natural production; however, the effect appears to be temporary and reversible. We do not have complete knowledge of the clinical relevance of the suppression of natural melatonin production; nonetheless, it does suggest employing melatonin in a limited manner rather than persistently when medically appropriate.
Think of melatonin use, instead of solely relying on melatonin supplementation, as part of a comprehensive sleep hygiene program. This can include going to bed and waking at the same time, creating the most optimal environment for sleep, and addressing other possible contributing factors that impact sleep.
Many people find success employing melatonin as a short-term supplement as they make long-term behavioral modifications. For example, you might choose to use melatonin for a period of 2-4 weeks as you engage in a new bedtime routine, or as you adjust to a change in your schedule; afterwards, you would work to taper off the melatonin or stop it altogether, as your sleep will be better regulated.
Shift workers have uncommon circumstances when it comes to melatonin use due to the nature of unpredictable sleep schedules. There is some evidence suggesting that strategic melatonin timing assists rotating shift workers to adjust to new, changing schedules.
For workers on night shifts, taking melatonin before sleeping during the day, along with blackout curtains and white noise, will be able to improve your sleep quality substantially. It is critical for shift workers to be consistent during their shifts, and to be mindful of taking melatonin on schedule to align with your target sleep period rather than your natural circadian-based rhythm.
Older adults may find supplementation particularly relevant due to the waning of melatonin production during the aging process. After age 60, natural melatonin production decreases substantially, which is likely contributing to the sleep-related problems associated with this age group.
We asked Dr. Areti Vassilopoulos, Sleep Expert, Pediatric Health Psychologist, and Assistant Professor of Child Psychology, to comment on how melatonin might play a role across the life span. She says: "Older adults likely experience the greatest benefits from melatonin supplementation." In other words, older adults probably manufacture less natural hormone, so they will be more responsive to melatonin therapy, although responses vary considerably with every individual.
The research around melatonin has expanded our understanding of the benefit of melatonin beyond sleeping. Research suggests melatonin may have neuroprotective qualities and may even prevent cognitive decline related to aging. Other research also suggests melatonin has antioxidant qualities and may protect against cellular damage due to aging and neurodegenerative diseases in particular.
In addition, preliminary reports have suggested melatonin may be of interest for immune function and inflammatory processes. Some reports show that individuals with sufficient melatonin are expected to show better immune response and recovery times, although further research is needed to determine more therapeutic uses.
Preliminary research suggests melatonin may be relevant to cancer prevention and treatment. Studies are currently looking at the role of melatonin in cardiovascular health and metabolic processes. These are promising uses, but further research is needed before clinical recommendations can be made.
Melatonin can be a helpful strategy for dealing with some sleep issues (typically circadian rhythm-related) but is not going to be appropriate for everyone nor work for everyone.
Before trying any melatonin, consider whether the sleep issues you are having might respond better to one or several behavioral activities, stress management, or treating the contributing medical issues directly if applicable. Many individuals have had much better success treating sleep-related anxiety, sleep environment, or bedtime routine issues.
If you decide to try melatonin, try the lowest effective dose possible and time taking the dose related to your desired sleep time. Take careful notes of your observations. You can keep a sleep diary over the course of time to note improvement or side effects relative to sleep. If you're concerned, consider talking to your doctor if there's been no improvement in symptoms in 2-3 weeks, or if there are side effects.
Improvement in sleep-related issues can take a comprehensive approach over time, and melatonin is probably going to be most effective as part of an overall sleep health strategy.
Dr. Shiyan Yeo
Dr. Shiyan Yeo is a medical doctor with over a decade of experience treating patients with chronic conditions. She graduated from the University of Manchester with a Bachelor of Medicine and Surgery (MBChB UK) and spent several years working at the National Health Service (NHS) in the United Kingdom, several Singapore government hospitals, and private functional medicine hospitals. Dr. Yeo specializes in root cause analysis, addressing hormonal, gut health, and lifestyle factors to treat chronic conditions. Drawing from her own experiences, she is dedicated to empowering others to optimize their health. She loves traveling, exploring nature, and spending quality time with family and friends.
.jpg)
