Melatonin

Should I Take Melatonin to Help Me Sleep Better?

Australia’s National Prescribing Service (NPS) has some great information about the efficacy of Melatonin in relation to sleep.

Firstly, lets have a look at their general RADAR page on melatonin, specifically the TGA approved drug called Circadin:

http://www.nps.org.au/health_professionals/publications/nps_radar/2010/may_2010/melatonin

Circadin has been approved by the TGA for short term use (up to 3 weeks) for primary insomnia, in people equal to, or greater than the age of 55.

“In clinical trials, people aged 55 years who received prolonged-release melatonin gained modest improvements in quality of sleep and morning alertness over those seen with placebo. Clinically meaningful improvements in both outcomes occurred in one-third of patients.”

Please note that it says that “there is insufficient evidence at present to support treatment beyond 3 weeks or repeated use after an initial course”, and the safety of long term use is yet to be established.

What we do see from this webpage is that this particular trialed melatonin does not appear to be addictive (or be associated with rebound insomnia), or impair daytime alertness.

However – the NPS still prefers other methods of dealing with insomnia apart from medications and melatonin use.

“Non-drug therapies are first line for treating primary insomnia.”

In fact, only one-third of the people responded with ‘clinically important improvements’ – which means that the majority did not.

“Some people gain clinically important improvements in quality of sleep and morning alertness with prolonged-release melatonin. However, many patients did not respond to treatment in clinical trials, and the magnitude of effect over placebo was modest. If insomnia persists or recurs on stopping melatonin, reconsider underlying causes and use non-drug therapies, if not already implemented.”

I would recommend you read the full page to draw your own conclusions after reading all the information provided.

And please note the figures for improvements attributed to the placebo, that’s interesting too.

Melatonin Dosage

Please read the full page referred to above before taking melatonin.

Here is a direct quote from that page on dosage (which relates specifically to the Circadin brand):

“The recommended dosage of prolonged-release melatonin is a 2 mg tablet taken once daily, 1–2 hours before bedtime.  Tablets must be swallowed whole after food, and not be crushed, chewed or divided.  Food delays the absorption of melatonin but does not affect peak concentrations or the total amount absorbed.”

Do not take it with alcohol or other sleep medications, including non-prescription and/or herbal remedies.

You can download the full report from here:

http://www.nps.org.au/__data/assets/pdf_file/0009/87867/OKA7754_NPS_RADAR_Melatonin_V3.pdf

Circadin Information on the Therapeutic Goods Administration (TGA) Site

For the keen, here is more information about Circadin from TGA Website in Australia:

http://www.tga.gov.au/pdf/auspar/auspar-circadin.pdf

This page also shows the results of co-administering Zolpidem with Circadin.

Melatonin and the US National Sleep Foundation

Here is the relevant page on melatonin from the National Sleep Foundation:

http://www.sleepfoundation.org/article/sleep-topics/melatonin-and-sleep

In the RESEARCH section of that page I found very little information that might convince me to take melatonin, and certainly some disagreement with other research results (e.g. an open ended finding on whether melatonin might be suitable for children).

There is also discussion there as to how melatonin might improve sleep onset, but there appears to be lack of evidence that it will help you stay asleep, or sleep for longer.

And even though there’s talk about melatonin possibly being helpful with jet lag I haven’t been able to source a study that addresses that adequately.

If you find one, or more, please tell me and I’ll have a look at them.

It’s a pretty mixed bag on melatonin!!

Melatonin and the Mayo Clinic

Here’s what the Mayo Clinic has to say.  Quite different dosages too.

http://www.mayoclinic.com/health/melatonin-side-effects/AN01717

It gets difficult when experts disagree doesn’t it?

Conclusions about Melatonin

The experts appear to disagree on efficacy and dosages.  And there appears to be a lack of proper research on melatonin, and the long term use and effects of it.

No information disagrees with trying all non-drug solutions first.

Daily exercise, good diet, taking out or reducing junk additives and colourings in your food, reducing light levels at night time before you go to bed (bright light inhibits the production of melatonin), hydration, reviewing the side-effects of all your existing medications and drugs (prescribed and otherwise), watching your alcohol intake, stress reduction, good sleep hygiene, cognitive behavioral therapy, consistent sleeping times and habits, daytime napping (keep it around 20 minutes unless you have a good reason to go longer), meditation, relaxing time out, making important life changes if that is the underlying problem beneath your insomnia, etc, etc.

None of this information persuades me that medicating – with prescription, non-prescription or over-the-counter sleep aids is going to help you sleep better than good old fashioned life skills, seeking expert advice to help you with psychological problems or existing medical conditions and pain.

If you are seriously exhausted unfortunately your brain’s executive functions, which include good decision making and the ability to sort through lots of information are significantly impaired – so there is part of the challenge!

Of course, if you are very depressed or anxious do not delay in getting expert help.