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Should You Take Melatonin for Insomnia?

Insomnia is a very common medical condition in today's high-stress world.  Aside from prescription drugs, you may have been curious about over-the-counter melatonin supplements. But do they work?  Are they safe?  

By
Sanaz Majd, MD,
June 8, 2017
Episode #216

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Insomnia is such a prevalent medical condition in this day and age of our fast-paced world. Juggling the hustle and bustle of everyday life, whether it is school, work, parenting, or family, can really do a number on our stress levels. Add a tinge of anxiety and depression, and this can be a recipe for some major sleepless nights.

Medications should never be our first choice when tackling insomnia, however. Most insomnia can be treated well with some behavioral changes, albeit not always easy to accomplish but quite worth the effort. The goal should primarily be to allow your body and mind to learn to fall asleep on its own, chemical free.  And then to seek medication if all else fails.

But I know that the reality is that many seek over-the-counter sleep aids as a first step.  Aside from antihistamines, melatonin seems to be a popular first choice amongst many. 

But does it work?  Is it safe?  And what is the proper way to take it? 

What Is Melatonin?

Melatonin is a hormone released by the pineal gland, a structure that sits tucked well inside the brain. This hormone regulates sleep patterns, referred to as our “circadian rhythm.”  When night falls, melatonin levels rise almost ten-fold, commanding our bodies and mind to wind and eventually shut down in order to rejuvenate. In the daytime, when exposed to sunlight, melatonin levels are then suppressed. Hence, we then feel awake and most alert. 

With age, this nighttime melatonin naturally diminishes. This is why older adults require less sleep and/or have more trouble catching their Zs. In addition, travelers with jet leg whose circadian rhythms go haywire are also another group of patients who can potentially benefit from taking melatonin. So can shift-workers who work at night and sleep during the daytime.

How to Take Melatonin

Melatonin is categorized as a "dietary supplement" and is available over-the-counter in the United States, without a prescription.  It is therefore not regulated by the FDA, and its sale can include variable, non-recommended doses.  Supra-high doses and versions with additives may have other potentially unwanted side effects. 

The recommended dose of Melatonin should ideally mimic physiologic levels. This includes a dose anywhere from 0.1 to 0.5 mg one hour prior to bedtime.  Anything more can be potentially unsafe.  But market doses can range anywhere up to 10mg, increasing melatonin levels in the body up to 60-fold, so please beware.

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