From the Guidelines
Melatonin supplements are generally considered safe for short-term use to help with sleep problems, with a typical dose ranging from 1-5 mg taken 30-60 minutes before bedtime, as evidenced by a study published in the Journal of Clinical Sleep Medicine in 2017 1. For adults, it's best to start with the lowest effective dose (0.5-1 mg) to minimize potential side effects. Melatonin is a hormone naturally produced by your pineal gland that helps regulate your sleep-wake cycle, and supplements can be helpful for jet lag, shift work sleep disorder, or occasional insomnia. Some key points to consider when using melatonin supplements include:
- Side effects are usually mild and may include headache, dizziness, nausea, or daytime drowsiness, as reported in a study published in the Annals of Internal Medicine in 2016 1.
- Melatonin is not recommended for pregnant or breastfeeding women, and those with autoimmune disorders, seizure disorders, or depression should consult a doctor first, as advised in a clinical practice guideline from the American College of Physicians in 2016 1.
- It may interact with certain medications including blood thinners, immunosuppressants, and some diabetes medications.
- While melatonin is available over-the-counter in many countries, it's best used for short periods rather than as a long-term solution for chronic sleep problems, as recommended in a study published in the Journal of Clinical Sleep Medicine in 2017 1. If sleep issues persist beyond a few weeks, consult a healthcare provider to address underlying causes. Additionally, cognitive behavioral therapy for insomnia (CBT-I) and other non-pharmacological interventions, such as stimulus control and relaxation strategies, may be effective in managing chronic insomnia disorder, as suggested in a clinical practice guideline from the American College of Physicians in 2016 1.
From the Research
Safety of Melatonin Pills for Sleep
- Melatonin is considered to be well-tolerated and has no obvious short- or long-term adverse effects 2
- It has been shown to synchronize the circadian rhythms, and improve the onset, duration, and quality of sleep 2
- Melatonin slightly improves sleep onset and sleep duration, but product quality and efficacy may vary 3
- Valerian and melatonin are unregulated products that have a small impact on sleep latency and can produce residual sedation 4
Comparison with Other Sleep Medications
- Benzodiazepines are discouraged in the geriatric population, especially for long-term use, due to the risk of dependence and addiction 3, 4
- Non-benzodiazepine receptor agonists have improved safety profiles compared with benzodiazepines, but their side effects include dementia, serious injury, and fractures 4
- Ramelteon has a minimal adverse effect profile and is effective for sleep-onset latency and increased total sleep time, making it a valuable first-line option 4
- Melatonin offers an alternative treatment to the currently available pharmaceutical therapies for sleep disorders with significantly less side effects 2
Recommendations for Use
- Cognitive behavioral therapy should always be the first-line treatment for insomnia 4, 5
- Melatonin may be considered as a treatment option for insomnia, especially in patients who are unable to pursue cognitive behavioral therapies or have comorbid mental disorders 3, 2, 4
- The choice of a hypnotic agent, including melatonin, should be symptom-based and take into account the patient's individual needs and medical history 3