From the Guidelines
Melatonin can be safe for a 90-year-old woman with sleep difficulties, but should be used cautiously and preferably under medical supervision. For elderly individuals, it's best to start with a low dose of 0.5-1 mg taken 1-2 hours before bedtime, as recommended by studies such as 1 and 1. This is lower than typical adult dosing because older adults may be more sensitive to medications and supplements. Short-term use is generally considered safer than long-term use. Before starting melatonin, the elderly woman should discuss it with her healthcare provider, especially if she takes other medications, as melatonin may interact with blood thinners, diabetes medications, and immunosuppressants, as noted in 1 and 1.
Some key points to consider when using melatonin in elderly individuals include:
- Starting with a low dose to minimize side effects
- Using it for short-term periods, as the safety of long-term use is not well established, as mentioned in 1 and 1
- Monitoring for potential interactions with other medications
- Being aware of potential side effects, such as morning drowsiness, dizziness, headaches, and nausea, as reported in 1
Non-medication approaches should be tried first, including:
- Maintaining a regular sleep schedule
- Avoiding caffeine and alcohol before bedtime
- Limiting daytime napping
- Creating a comfortable sleep environment These approaches can help regulate the sleep-wake cycle and improve sleep quality, as suggested by 1 and 1. Melatonin works by supplementing the body's natural sleep hormone, which often decreases with age, helping to regulate the sleep-wake cycle that becomes less efficient in elderly individuals, as explained in 1 and 1.
From the Research
Safety of Melatonin for a 90-year-old Elderly Woman with Insomnia
- Melatonin is considered a relatively safe option for elderly patients with insomnia, as it has a low risk of dependence and adverse effects compared to other sleep medications 2, 3, 4, 5.
- A systematic review of melatonin in elderly patients with insomnia found that low doses of melatonin improved initial sleep quality in selected elderly insomniacs, with no significant adverse effects 4.
- However, the quality and efficacy of melatonin products may vary, and larger randomized controlled trials are needed to confirm its effectiveness in geriatric patients with insomnia 4.
- Other studies suggest that melatonin may be most effective in elderly insomniacs who chronically use benzodiazepines and/or have documented low melatonin levels during sleep 4.
- In comparison to other sleep medications, melatonin has a more favorable safety profile, especially when compared to benzodiazepines, which are not recommended for long-term use in the geriatric population due to their high risk of dependence and adverse effects 2, 3, 5.
Comparison to Other Sleep Medications
- Zolpidem, a nonbenzodiazepine hypnotic, has been shown to be effective in restoring normal sleep patterns in elderly patients with dementia and nighttime wandering, but it may have adverse effects such as dementia, serious injury, and fractures 6, 5.
- Ramelteon, a melatonin receptor agonist, 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 for insomnia in older adults 5.
- Suvorexant, an orexin receptor antagonist, improves sleep maintenance and has mild adverse effects, but its use is limited by residual daytime sedation 5.
- Benzodiazepines, sedating antidepressants, antipsychotic agents, and other medications have significant adverse effects and are not recommended as first-line treatments for insomnia in older adults 2, 3, 5.