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Is There a Problem Taking Melatonin to Sleep?

Is taking melatonin a reasonable way to manage chronic insomnia? Be aware that there may be hazards like a higher risk of fracture.

Chronic insomnia wears you down. It also contributes to a range of health problems, from high blood pressure to diabetes. But many of the medications people take to get to sleep are not intended for long-term use. Others are not safe for seniors. What about taking melatonin? Some readers wonder if it is better than prescription sleeping pills.

Does Melatonin Work as Well as Alprazolam?

Q. Is there any problem taking alprazolam to get to sleep? I’ve been doing this for years. Would melatonin work as well?

A. Alprazolam (Xanax) is a benzodiazepine approved for anxiety but not insomnia. Benzos are considered inappropriate for older people. Stopping alprazolam may make it much harder to get to sleep, though. Discontinuing the drug requires medical supervision.

Melatonin won’t substitute for alprazolam, but it may help you readjust your sleep-wake cycle (Neuropsychopharmacology, July, 2022). You can learn more about alprazolam, melatonin and many other strategies for overcoming insomnia in our eGuide to Getting a Good Night’s Sleep.

Is Taking Melatonin a Safe Way to Get to Sleep?

Q. I have been taking melatonin for years to help me sleep. As I understand it, as your body ages it makes less of this natural sleep substance.

I try to avoid sleeping pills. The TV commercials for such medications scare me when they describe horrible side effects.

I recently read the fine print on my melatonin bottle. It said to take it for two months, then wait a week before taking it again. I can do this, but I don’t want to take sleeping pills while I am off melatonin.

I do not need anything that makes my memory worse, which is what I fear from the help-you-sleep stuff advertised on TV. At age 85, I’d like to stay safe. Is there a problem taking melatonin?

Risks of Sleeping Pills:

A. We appreciate your concerns about the dangers of OTC sleeping pills. Many contain DPH or other sedating antihistamines. A study in JAMA Internal Medicine (March 2015) linked the regular use of first-generation antihistamines like diphenhydramine (DPH) and other anticholinergic drugs to dementia.  Some prescription sleeping pills have also been associated with a higher risk of cognitive decline (Expert Opinion on Drug Safety, May 2015).

What About Melatonin?

Although melatonin is usually considered safe (Clinical Drug Investigations, March 2016), a British study recently found that older people taking melatonin are at a greater risk for fracture (Age and Ageing, Nov. 2016). That may be because of dizziness or a morning “hangover” effect.

You might consider a non-drug approach to overcoming insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is effective and does not provoke unwanted side effects (Journal of Cancer Survivorship, online Jan. 19, 2017). Not everyone can consult a therapist trained in cognitive behavioral therapy, but anyone with internet access could benefit from a computerized version of this therapy (PLOS One, Feb. 11, 2016).

Watch Out for Unexpected Stimulants:

Taking melatonin is not the only approach insomniacs may try. Some adopt the habit of drinking a non-caffeinated beverage in the evening. One reader discovered, to her surprise, that this tactic backfired.

Q. For years I had the same sleep problem: I’d fall asleep fine and then wake up three hours later. My mind would be racing and I’d be sweating, stressed and unable to fall back asleep for hours.

I tried everything I could think of: switched to decaf coffee, gave up all alcohol, started meditating, even found a lullaby playlist to condition my body into sleep-mode. (My husband hated it!)

Nighttime wakings turned into panic attacks; I was fighting with my husband, cranky with my kid and bad at my job. I tried to drug myself with over-the-counter stuff like Nyquil and Benadryl to sleep, but that was no good.

In the end, the culprit was so mundane I missed it for years: ginger tea. I love the strong flavor, and drank at least one cup every night, even on vacation or work trips. Because it’s not caffeinated, I overlooked its potential as a stimulant.

Once I stopped drinking ginger tea, all those problems disappeared, literally overnight. Now I can drink good coffee, have wine with dinner, ditch the lullabies and sleep fantastically. No more anxiety, night sweats, stress, sleep loss or fights. I offer this as a reminder that–for better or worse–herbs have powerful effects!

A. Thank you for sharing your fascinating story. Something as seemingly innocuous as an herbal tea could have unexpected consequences.

We could find no human studies demonstrating that ginger affects sleep. However, scientists studying mice found that ginger extract made the animals take longer to fall asleep and sleep less (Indian Journal of Experimental Biology, Oct. 2016).

Learn More:

You will find more information about sleeping pills and alternative ways to overcome insomnia in our online resource Guide to Getting a Good Night’s Sleep. In addition, you may wish to listen to our interview with sleep expert Rafael Pelayo. It is Show 1268: Learning How to Sleep.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies..
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Citations
  • Moon E et al, "Melatonergic agents influence the sleep-wake and circadian rhythms in healthy and psychiatric participants: a systematic review and meta-analysis of randomized controlled trials." Neuropsychopharmacology, July, 2022. doi: 10.1038/s41386-022-01278-5
  • Gray SL et al, "Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study." JAMA Internal Medicine, March 2015. DOI: 10.1001/jamainternmed.2014.7663
  • Billioti de Gage S et al, "Is there really a link between benzodiazepine use and the risk of dementia?" Expert Opinion on Drug Safety, May 2015. DOI: 10.1517/14740338.2015.1014796
  • Andersen LPH et al, "The safety of melatonin in humans." Clinical Drug Investigations, March 2016. DOI: 10.1007/s40261-015-0368-5
  • Frisher M et al, " Melatonin, hypnotics and their association with fracture: a matched cohort study." Age and Ageing, Nov. 2016. DOI: 10.1093/ageing/afw123
  • Peoples AR et al, "Effects of cognitive behavioral therapy for insomnia and armodafinil on quality of life in cancer survivors: a randomized placebo-controlled trial." Journal of Cancer Survivorship, online Jan. 19, 2017. DOI: 10.1007/s11764-017-0597-0
  • Seyffert M et al, "Internet-delivered cognitive behavioral therapy to treat insomnia: A systematic review and meta-analysis." PLOS One, Feb. 11, 2016. DOI: 10.1371/journal.pone.0149139
  • Sharma PK et al, "Effect of ethanolic extract of Zingiber officinale Roscoe on central nervous system activity in mice." Indian Journal of Experimental Biology, Oct. 2016.
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