3 minute read
SUPPLEMENT SPOTLIGHT
from CCC-0322
by ensembleiq
Melatonin Misconceptions
Before you recommend melatonin for sleepless patients, consider how it works
Most people who have struggled with
insomnia have had at least one health-care provider recommend melatonin. But this overthe-counter supplement isn’t a miracle med for all kinds of sleeplessness. Before you recommend it to your patients, consider what this hormone can—and can’t—do.
Our bodies already make melatonin. Nestled in the center of the brain, the pineal gland communicates with receptors in the retina to let us know when it’s light or dark. When it senses darkness, it releases high levels of melatonin to prepare us for sleep. When it senses light, it shuts melatonin production down.
Around age 40, the body begins to produce less melatonin, which can lead to age-related sleep problems. By age 90, melatonin levels are a mere 20% of what they were in the young adult years, notes Cinthya Pena-Orbea, MD, a sleep specialist at the Cleveland Clinic, Ohio.
Melatonin Affects Sleep Onset Time
Melatonin supplementation is far from a cure-all for insomnia. In fact, studies show that it may shave a mere seven or eight minutes off of the wait to fall asleep and lengthen sleep time by about the same amount. The American College of Physicians’ guidelines strongly recommend the use of cognitive behavioral therapy for insomnia (CBT-I) instead for simple insomnia. But sleep disorders other than simple insomnia are different. Because melatonin
affects the body’s circadian rhythm, it can help with issues such as delayed sleep phase syndrome, which is when people consistently fall asleep very late and wake up late the next day. It may help shift workers, who often struggle to work at night, when melatonin levels naturally rise, and to sleep during the day, when they fall. Studies suggest, however, that light therapy is more effective for this condition than melatonin supplements (See the article “Seasonal Affective Disorder” at
www.ConvenientCareClinician.com to see which light boxes are recommended by Yale Professor Paul Desan, MD.)
The strongest case for supplemental melatonin comes from studies on jet lag. Multiple studies show that taking melatonin close to bedtime when you arrive in a different time zone can help reduce jet-lag symptoms.
Dosage
There is no general consensus regarding dosage. Melatonin supplements often come in doses of 3 to 5 milligrams (mg), but studies suggest that as little as 0.3 to 0.5 mg per day might be more effective than higher doses in many people. Taking too much of the hormone can cause morning grogginess, headaches, reduced focus, and dizziness, so it’s best to start small and take it about an hour or two before bedtime.
Safety
Short-term use of melatonin supplements appears to be safe, but there isn’t enough data to assess long-term safety. Check your patient’s medication list before recommending melatonin: It can interact with other drugs, such as blood thinners, anticonvulsants, some blood pressure medications, and diabetes medications. Melatonin may stay active for a longer time in older people, and it can cause dizziness and drowsiness that can increase the risk of falls.
Sleep Recommendations
Patients can help their natural—and supplemental—melatonin do its job better with a few simple strategies: • Keep the lights low before bed. Even dim light can interfere with a person’s circadian rhythm and melatonin secretion. • Avoid blue light from computers, smartphones, and tablets for two to three hours before bed. If your patient can’t avoid such devices, they can try using a blue-light filter or an app like F. Lux or Night Shift to adjust the screen to nighttime mode. Compact fluorescent light bulbs and LED bulbs produce more blue light than incandescent bulbs. • Dim red light is the best choice for night lights. • Get exposure to daylight during the morning. Sunlight helps the body produce serotonin, which is the precursor to melatonin. C
