Melatonin for Insomnia:
how, when, and why
One of the most common questions I am asked regarding natural sleep aids is about melatonin for insomnia. When patients are looking for a holistic medicine approach to sleep problems, they often think of melatonin first. It is widely available in grocery stores, chain pharmacies and internet shopping sites, and has a general reputation as safe and effective. So while I often recommend melatonin for insomnia, I do have some reservations and cautions about its use.
Melatonin is a natural hormone which our bodies make in response to brain signals that it is dark in the immediate environment. The pineal gland, a tiny structure in the brain, is in charge of its production. This makes perfect sense as a way the human organism adapted to life on earth: when it gets dark, our very chemistry changes to promote rest and sleep. Ingenious eh? Except since the widespread electrification of homes and businesses, we humans no longer pay very careful attention to the environmental cues of cyclic dark and light, living in homes that may be bright as daylight round the clock. This in fact is one of the causes of sleep problems: failure to pay attention to the rhythms of nature and turn the lights off when it’s time to think about getting some rest. Continued flashing of bright lights and images into the brain from television screens, computer monitors and video games right up until bedtime is almost guaranteed to cause trouble falling asleep.
In that context, when patients ask me about melatonin for insomnia, I first am inclined to ask a few questions about lifestyle, schedules, and the home environment (this set of data refers to the topic of sleep hygiene ). I’d much rather have my patients boost their own natural production of melatonin by turning down the lights before bedtime and assuring that the bedroom is completely dark.
But sometimes even a peaceful dark bedroom is not enough and a natural sleep aid is needed. This is where melatonin can be useful. As an occasional short term sleep aid, it works well and can help with a better night’s sleep in just one dose. A 1 mg dose is often sufficient for adults or kids over 12. It is effective in younger children, and has been shown to benefit children with severe developmental disorders such as autism which interfere with sleep. Higher doses can be used, but with the caution that higher doses may result in bizarre dreams or nightmares.
My caution regarding melatonin for insomnia is that we do not have any research data on the safety of its use at high doses for a long period of time. It is after all a hormone with effects on multiple body systems. So I prefer to see melatonin used short term (several weeks at most) or just intermittently as needed.
To your health,
Robert Pendergrast, MD
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