Melatonin

More than three million Americans take melatonin to get to sleep. That’s twice the number that used this supplement in 2007 (National Center for Complementary and Integrative Health). This makes melatonin one of the most popular natural products on pharmacy and health food store shelves. How effective is it for promoting sleep? Are there melatonin side effects people should be aware of. This reader wants to know:

Melatonin Is Helpful but Not Perfect:

Q. I have taken zolpidem (Ambien) for years. You have written about the dangers of such sleep aids, so I decided to cut back. I spent several weeks hardly sleeping at all.

Melatonin has been helpful, though not perfect. Are there melatonin side effects I should know about?

Where Does Melatonin Come From?

A. Your body makes melatonin. When it gets dark, specialized cells in the eye send messages to the brain. Eventually the pineal gland responds by secreting melatonin. Some experts have called melatonin a hormone of darkness rather than a sleep hormone.

Our ancestors did not have computers, tablets or smart phones stimulating their retinas. Go back further and humans did not have electric lights. They went to sleep earlier because candlelight was not that powerful.

These days we are surrounded by bright lights. And we stare at our screens, often right up till bedtime. Researchers have discovered that light exposure has a profound impact on melatonin production (Journal of Clinical Endocrinology & Metabolism, March, 2011):

Results:

“Compared with dim light, exposure to room light before bedtime suppressed melatonin, resulting in a later melatonin onset in 99.0% of individuals and shortening melatonin duration by about 90 min. Also, exposure to room light during the usual hours of sleep suppressed melatonin by greater than 50% in most (85%) trials.

Conclusions:

“These findings indicate that room light exerts a profound suppressive effect on melatonin levels and shortens the body’s internal representation of night duration. Hence, chronically exposing oneself to electrical lighting in the late evening disrupts melatonin signaling and could therefore potentially impact sleep, thermoregulation, blood pressure, and glucose homeostasis.”

When Do Melatonin Levels Peak in the Body?

The later it gets at night, the more melatonin the body makes. Peak levels of melatonin normally occur between 2 and 4 am (Scoliosis, April 4, 2007). Any student who has pulled an all-nighter to work on a paper or prepare for an exam knows that fighting off sleepiness gets hardest between 2 and 4 in the morning.

Does Melatonin Work to Help People Sleep?

Melatonin has been used to help people like you reduce their reliance on benzodiazepine or z-type sleeping pills such as zolpidem (European Journal of Pharmacology, Sep. 5, 2015).  A randomized double-blind placebo-controlled trial showed that melatonin could improve sleep quality in people who have suffered traumatic brain injury (BMC Medicine, Jan. 19, 2018).

A meta-analysis of randomized, double-blind, placebo-controlled trials concluded that “Melatonin appears to be effective and safe in improving sleep quality in patients with AD” (International Journal of Geriatric Psychiatry, Jan. 2017).

It has also been used to help cancer patients sleep (Aging Clinical and Experimental Research, Oct. 2013).  A Cochrane Collaboration review suggests that night shift workers may sleep longer after taking melatonin (Cochrane Database of Systematic Reviews, Aug. 12, 2014). Another independent Cochrane analysis of melatonin for coping with jet lag concluded (Cochrane Database of Systematic Reviews, 2002):

“Melatonin is remarkably effective in preventing or reducing jet-lag, and occasional short-term use appears to be safe. It should be recommended to adult travelers flying across five or more time zones, particularly in an easterly direction, and especially if they have experienced jet-lag on previous journeys. Travellers crossing 2-4 time zones can also use it if need be. The pharmacology and toxicology of melatonin needs systematic study, and routine pharmaceutical quality control of melatonin products must be established. The effects of melatonin in people with epilepsy, and a possible interaction with warfarin, need investigation.”

Drugs That Deplete the Body of Melatonin:

Many health professionals are unaware that medications can reduce melatonin levels in the body. The University of Maryland Medical Center has gathered a list of “Drugs that Deplete: Melatonin.”

Here are just a few examples:

Corticosteroids (oral, inhaled and topical):

Budesonide (found in Rhinocort Aqua, Symbicort)

Fluticasone (found in Advair, Flonase and Flovent)

Hydrocortisone

Prednisone

Triamcinolone (in Azmacort)

NSAIDs (nonsteroidal anti-inflammatory drugs):

Diclofenac (found in Cataflam, Voltaren)

Ibuprofen (Advil, Motrin IB, etc)

Naproxen (Aleve, Naprosyn)

Meloxicam (Mobic)

Beta Blocker Heart Meds:

Atenolol

Metoprolol

Propranolol

Should people taking drugs that deplete melatonin from the body take extra melatonin? As far as we can tell, that question has not been answered with good research. Many people would like to have an answer!

Are Melatonin Side Effects Serious?

As far as we can tell, melatonin side effects are rarely, if ever, serious. Some people report nausea, dizziness or headaches. We were intrigued to learn that in Europe, melatonin is generally not sold over the counter in most pharmacies or health food stores. It is usually found as a prescription drug (Circadin).

We were surprised to discover that there have not been a lot of large, long-term, well-controlled melatonin trials to assess safety. That said, a review of most of the small, published trials to date concluded that (Clinical Drug Investigation, March, 2016):

“melatonin is safe for short-term use, even when given in extreme doses. Mild adverse effects, such as dizziness, headache, nausea and sleepiness have been reported in levels corresponding to placebo treatments. Final conclusions concerning long-term safety of melatonin are limited by a general lack of randomized, double blind, placebo-controlled studies, and methodical weaknesses in the reporting of possible adverse effects. However, the sparse data available suggest no serious adverse effects, even with long-term use.”

Some experts have raised concerns about drug interactions. For example: would people taking blood thinners be at greater risk of hemorrhage if they also take melatonin? Sleeping pills like zolpidem (Ambien) may be more dangerous when combined with melatonin. People should always ask the pharmacist and physician to check for such interactions.

What About Dependence as a Melatonin Side Effect?

Unlike many prescription sleeping pills or anti-anxiety agents, melatonin does not appear to cause withdrawal symptoms when stopped. The authors of the review of melatonin state:

“melatonin is neither physiologically nor psychologically addictive.”

A study of melatonin PR (prolonged release 2 mg) was published in the journal Drugs & Aging (Nov. 2012). It concluded:

“In 3-week and 6-month, randomized, double-blind clinical trials in patients with primary insomnia aged ≥55 years, melatonin PR 2 mg 1-2 h before bedtime was associated with significant improvements relative to placebo in many sleep and daytime parameters, including sleep quality and latency, morning alertness and health-related quality of life. Melatonin PR 2 mg was very well tolerated in clinical trials in older patients, with a tolerability profile that was similar to that of placebo. Short- or longer-term treatment with melatonin PR 2 mg was not associated with dependence, tolerance, rebound insomnia or withdrawal symptoms.”

An Unresolved Melatonin Side Effect Issue:

All this is quite comforting. One issue that remains unresolved, however, does concern us. When people take hormone pills, the body may cut back on its own production of that hormone. Will taking so-called exogenous melatonin interfere with the body’s own production of melatonin? One short-term study (seven days) suggested that was not a problem (Journal of Pineal Research, Jan. 1997). We would like to see much longer-term investigations to verify that this is not a problem.

Other Benefits of Melatonin:

There is some suggestion that melatonin may reduce “the severity of essential hypertension” and “should be more widely considered.” This was reported in the Annals of Medicine (May 6, 2010). The authors also suggest it may be helpful for patients suffering from heart failure.

There has been some research to suggest that women with low melatonin levels may be at increased risk for breast cancer. Ditto for men and prostate cancer. Whether supplementing with external (exogenous) melatonin will lower the risk for these tumors is yet to be proven.

Also up for consideration are claims that melatonin might help moderate tinnitus symptoms (ringing in the ears). There have also been claims that this hormone could help ease symptoms of overactive bladder. We would like to see better research before recommending melatonin for such purposes.

Increase Melatonin Levels Naturally:

Did you know that Montmorency cherries are rich in melatonin? Studies have shown that drinking tart cherry juice in the afternoon or evening can improve sleep quality and duration (European Journal of Nutrition, Dec., 2012; Journal of Nutrition, Health & Aging, vol. 17 No. 6, 2013).

Learn more at this link:

Overcoming Insomnia with Tart Cherry Juice

Stories from Readers:

Lou Ann is a runner in Raleigh. She says beware unexpected melatonin side effects:

“I would not recommend taking Melatonin on a daily basis if you are an athlete. I have trained for and have run 9 marathons. I started taking Melatonin to help me sleep in the fall 2017.

“During an 18 mile run, my body essentially shut down and my pulse dropped to 32. I had to call 911 and be taken to the emergency room where I was told I had a vagal response and was about to faint. I stopped the Melatonin and was able to complete a 20 mile training run and successfully run my marathon. I am convinced it was the Melatonin. I had been taking it every night for a couple weeks.”

Sarah in Charleston, SC, loves melatonin and raisins:

“3 mg Melatonin work beautifully for me! I got a big-box store brand of tablets and chew one about an hour before bedtime. It doesn’t help to take it immediately before bedtime.

“Also tried your suggestion of some raisins before bed to keep from getting up in the nite. Why they work I don’t know, and don’t care, but it’s miraculous! I get up only once, if at all!”

Joy in Florida reports good results with sublingual melatonin:

“I went almost three weeks of barely sleeping trying to quit Ambien cold turkey. Melatonin (1mg) dissolved under my tongue worked well or a product called Midnight which contains 1.5 mg Melatonin with lemon balm, chamomile, and lavender. Midnight also can be purchased as a CVS store brand for a few dollars less and is the exact same formulation as Midnight. You can also take it again in the middle of the night if you wake up, as long as you have 3 hours left to sleep.”

Ruby in NC got no benefit from a whopping dose of melatonin:

“Don’t waste your money! I tried the 10mg Melatonin tab and could have gotten better results with an aspirin. Didn’t even make me yawn. Total ripoff.”

Dagny in Philadelphia, PA, had good results with sublingual melatonin and cherry juice:

“I use Source Naturals spray melatonin and find it quite effective. The ‘sublingual’ part of the dosing seems to be key. I tried taking the pill form that’s supposed to be taken a few hours before bedtime some years back and it was unpredictable. It failed more often than it worked.

“I also recommend tart cherry juice, an ounce (a standard jigger or two tablespoons) sipped about half an hour before bedtime. I think I read about that remedy here, as a matter of fact.”

You can learn more about melatonin and other approaches to overcoming insomnia in our online resource, Getting a Good Night’s Sleep. It is available at www.PeoplesPharmacy.com.

Share your own melatonin story in the comment section below.

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  1. Bev
    Reply

    A small handful of walnuts does the trick for me. I heard that eating a little protein like walnuts will lull you to sleep. One night I was out of walnuts and ate pine nuts instead, and they made me restless and hyper. Needless to say, I never ate them at night again. So not all protein or nuts are created equal for sleeping purposes.

  2. Fran
    Mass.
    Reply

    I have had insomnia for too many years to count. Tried prescription drugs only to get addicted. I now take 5 mg. of melatonin about one hour before bedtime and find I fall asleep faster and stay asleep longer. If I wake up during the night I fall back to sleep faster. Gone are the nights where I’d be up and awake until 4 or 5:00 a.m. Sure works for me.

  3. Laura
    Chicago
    Reply

    Look at studies on Consumer Labs, they talk about the studied dose and other truths/myths of melatonin. Overall I find melatonin hit or miss, have tried 3mg and varoius smaller amounts. Often it makes me wired-tired and still can’t sleep. Look at studies on eating kiwi and sleep. It seems kiwi have melatonin like cherry juice. I’ve actually had better luck eating kiwi than w/cherry juice. Sadly if I really get desperate to sleep nothing still beats a small dose of alprazolam.

  4. Penelope
    Seattle WA
    Reply

    I find that Source Naturals 3 mg. Timed-Release tablets are very effective at keeping me asleep up to 8 hours at this low dose!

  5. Jims3D
    Reply

    Splitting the smallest tablet/dose and dissolving under tongue works great for me. Too much leaves me groggy in the morning. Wearing blue light blocking glasses in the evening when using an iPad really helps also.

  6. Brian
    Princeton NJ
    Reply

    I tried melatonin once. The next day they cancelled my favorite TV show. I’m absolutely sure it was the melatonin. I’ll never do that again.

    • Eileen
      UT
      Reply

      Thank you for the smile :-) :-)

      Seriously, you make a really good point. It is easy to attach blame for a problem in a knee-jerk way to something new with a suspicious timeline … however truly getting to the root cause of a problem (medical or otherwise) in reality is often much more complex. It is good to consider many things from many different angles before jumping to conclusions.

  7. Cindy Black
    Seattle, WA
    Reply

    This question has been vexing me for some time now, and I can’t find the answer. ALL THE TIME, you hear that darkness is what helps the body create melatonin. Along those same lines, say a person works the nightshift and sleeps in the daytime when it’s less dark. That person would produce less melatonin and be at higher risk for certain medical problems. Understood!

    But my question concerns the definition of “darkness.” Of course it’s dark on your body, because you’re under the covers. Say you also have a sleep mask, so it’s just as dark on your eyes as it would be at night. If a little light hits your chin, nose and forehead, is that a factor — or is it just the light coming into your eyes? (which of course are shut, so they’re mainly in the dark too!) In other words, what’s the main mechanism of action in this dark-vs-light thing????

    This is important to me because I’m a lifelong night-owl… I very rarely make it to bed before 5:00 or 6:00 a.m., and if I’m working the nightshift, it’s well after sun-up. But I keep my bedroom VERY DARK, even covering the clock radio with a little cloth. I have to keep the door cracked for the cats, but otherwise I should hope I’m in the clear — right?

    Anyway, the answer is kind of moot because I rarely take melatonin anymore, as the adaptogens I’m now taking work so well that I don’t need it! However I’ve also heard that a melatonin deficit could have bad health effects, so it’s still important to know if I’m making enough. THANKS.

  8. Barbara Battibulli
    Albany, NY
    Reply

    I’ve been taking 20 mg. Melatonin for well over ten years. I have horrible sleep without it. I have found Melatonin gives me a deep, restful sleep and my body seems to need this. Because Melatonin lets me have a peaceful deep sleep, I feel my body makes the repairs it needs and I generally just feel better. Have you ever functioned the next on little sleep? It used to just tear me up. Little or bad sleep leads to heart problems and a host of other ills. I have had NO ill effects from Melatonin at all. If I forget to take it at night, then I will wake up in the middle of the night. I make sure my body gets all the rest it needs. Sleep is blessed, what dreams may come.

  9. Ron
    Newport News, VA
    Reply

    I used low dose (1mg) melatonin for a year or so. Periodically, at night, I developed dizziness severe enough to cause nausea. After two episodes, which I would characterize as “extreme”, i.e. absolute vertigo, unable to stand up and two hours of toilet hugging nausea.

    I asked Doc if it could be Melatonin, he replied that since the body makes it, seems unlikely.

    Regardless, I stopped taking Melatonin and have not experienced a single episode of vertigo/dizziness since — 18 months ago.

    It did help with sleep, but at an unacceptable price to pay. Beware.

    • Carmen
      PR
      Reply

      I was taking 10mg of Melatonin to minimize cluster headaches. After 3 weeks of taking it I had a vertigo episode. It was the worst experience I have had. But I did not associate the vertigo to the Melatonin. Then, after 2 weeks of the vertigo episode I started again with the 10mg of Melatonin and, after 3 weeks of taking it, I had another episode of vertigo. Therefore, I assume that taking the 10mgs of Melatonin was causing the vertigo since I have never had vertigo before.
      Therefore, I will not take it anymore.

  10. Beth
    Reply

    I’ve never known anyone else with this issue, but melatonin makes me have to pee more often, which interrupts sleep sometimes.

  11. Janine
    WI
    Reply

    I find that .5 mg is the right dose for me. I don’t need it every night, but when I do it puts me to sleep quickly and wears off before I have to get up, without any after effects that I’ve noticed.

  12. Edward
    Reply

    Have tinnitus, ringing in the ear. Have been taking melatonin for approx. 10 years, 5mg just before bedtime. So far it’s been keeping my tinnitus at bay!!!!!!

  13. JUNEBUG14
    Houston, TX
    Reply

    My son has ADHD and is 250 lbs, and he must take 15mg to get the required results. I am 66, and I take only 5 mg being a smaller woman. I read where you can take up to 20 mg without any side effects. It works for us, and we buy it on sale whenever we can. BTW, my son’s pediatrician recommended it for his sleep disorder. It is common for ADD and ADHD children to have a lack of melatonin in their brains. It also helps to calm them down and promote a sense of well being.

  14. O.G.
    South Carolina
    Reply

    I use melatonin periodically, and at bedtime, and it works like a charm for me. My only problem is splitting the pill into small enough pieces: I cut a 3mg pill into quarters, and take one or two of them. Any more, and I get nightmares.

    Is there a “Princess and the Pea” syndrome? 😹😹😹

  15. oliver
    34996
    Reply

    My experience with melatonin is that I must take the sublingual type. Swallowed melatonin gives me unpleasant dreams. Other people I know had the same experience.
    I use it to prevent waking up at 4am. 1mg/hr is my formula. Taking 3mg at bedtime, I wake up at 7am.
    (1mg/time zone seems to work while traveling east too)
    I have recommended melatonin to others who have the same 4am problem. It worked for some, did not for others.
    I also proved the need for a dark bedroom. Makes a big difference.

    • JAM
      Bflo, ny
      Reply

      4 CVS sells chewable melatonin. One gummy is 2.5 mg. Maybe this will help you.

      • Carol
        Maryland
        Reply

        That’s what I’ve been taking, but chewing two 2.5mg gummy chews and would fall asleep so easily, I didn’t need ambien. However, I just came on here because after a couple of weeks of this, I’m wondering why I seem to need 4x as much coffee to get through the day, I’m so groggy and dizzy and can hardly keep my eyes open! I’ve always taken melatonin at night in tablet form, and it’s never affected me like this. Could it be this melatonin in gummy form and I’m now taking too much??

  16. Mary
    Raleigh NC
    Reply

    Someone told me to eat a small amount of mixed nuts daily and this would help me sleep.. It works beautifully for me!

  17. Teresa
    Texas
    Reply

    Some scientists theorize that humans naturally produce 300 mcg of Melatonin daily, and that as we age, we struggle to produce that amount. I have found that taking Melatonin at bedtime at a dosage of 300 mcg can be quite helpful. Melatonin in a dosage of 300 mcg can usually only be obtained online, not in stores, which seem to feature it at megadosages.

    • Joe Graedon
      Reply

      Thanks for this Teresa. We want to point out that 300 mcg is micrograms or 0.3 milligrams. WAY less than the 3-5 mg pills normally sold in pharmacies or health food stores.

  18. Ann
    Reply

    Melatonin makes my A-fib worse. I noticed when I take it the night before I have an episode of A-fib the following day. After I stopped taking Melatonin, I hardly ever have an episode unless I get extremely tired. I will never take it again.

  19. Debbie
    Brandon, FL
    Reply

    Tried taking melatonin, but always developed a headache. Also noted some irritation. Be careful! It can affect mood. Scary.

  20. Rick
    Virginia
    Reply

    http://news.mit.edu/2001/melatonin-1017

    MIT study says .3 mg good dose. I found out when I jumped from 1mg to 3 mg and I thought I build a tolerance but found out I was taking too much!

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