From the Guidelines
The recommended dose of immediate-release melatonin for isolated REM sleep behavior disorder is 3 mg taken at bedtime, which can be titrated up to 15 mg in 3-mg increments if needed. This recommendation is based on the most recent and highest quality study available, which was published in the Journal of Clinical Sleep Medicine in 2023 1. The study suggests that melatonin is effective in suppressing REM sleep motor tone and renormalizing other circadian features of REM sleep, and that the starting dose of 3 mg can be adjusted as needed to address dream enactment.
Key Points to Consider
- Melatonin binds to the M1 and M2 receptors, which helps to regulate REM sleep and improve symptoms of RBD.
- The dose of melatonin may need to be adjusted over time, as the effectiveness of the medication can wear off after several weeks.
- Melatonin is considered a dietary supplement in the United States and Canada, but its bioavailability and content may vary across formulations.
- Combination therapy using clonazepam and melatonin is common in clinical practice, but there is limited data available on the effectiveness of this approach.
Important Considerations for Treatment
- Patients with isolated RBD can be expected to require treatment for years to decades, and the natural history of the condition is typically relentless and lifelong.
- The choice of treatment should be based on the individual patient's comorbidities and the unique mechanism of action and therapeutic profile of each agent.
- Clonazepam, pramipexole, and rivastigmine are also options for the treatment of isolated RBD, but the choice of medication should be individualized based on the patient's specific needs and circumstances.
From the FDA Drug Label
PRINCIPAL DISPLAY PANEL - Vitamin Bottle Label Safrel Melatonin 3mg Tablets: The recommended dose of melatonin is 3mg [ 2 ].
From the Research
Recommended Dose of Melatonin
The recommended dose of melatonin varies depending on the condition being treated and the age of the individual.
- For insomnia symptoms or comorbid insomnia in mood disorders, schizophrenia, and autism spectrum disorders, the administration of prolonged release melatonin at 2-10 mg, 1-2 h before bedtime, is recommended 3.
- For circadian sleep disturbances in neuropsychiatric disorders, immediate release melatonin at <1 mg may be useful 3.
- For jet lag, daily doses of melatonin between 0.5 and 5mg are similarly effective, with 5mg being more effective in terms of falling asleep faster and sleeping better 4.
- For sleep disorders in different age groups, the effective melatonin doses varied from 0.5 to 3 mg in children, 3 to 5 mg in adolescents, 1 to 5 mg in adults, and 1 to 6 mg in elderly people 5.
- There is limited evidence on the safety of higher doses of melatonin, but some studies suggest that doses above 10mg may increase the risk of adverse events such as drowsiness, headache, and dizziness 6.
Considerations for Melatonin Use
When using melatonin, it is essential to consider the timing of administration, as taking it at the wrong time can cause sleepiness and delay adaptation to local time 4.
- Melatonin may be effective in reducing jet lag, particularly in adult travelers flying across five or more time zones 4.
- In elderly patients with poor sleep and documented low melatonin production, melatonin may be helpful 7.
- Melatonin has few immediate side-effects except drowsiness, but the effects of chronic administration are unclear 7.