Starting Melatonin at 1 mg: Clinical Recommendation
Yes, you can start melatonin at 1 mg, but this is below the evidence-based starting dose of 3 mg recommended by the American Academy of Sleep Medicine for most adult sleep disorders. 1, 2
Guideline-Based Starting Doses
The American Academy of Sleep Medicine explicitly recommends starting with 3 mg of immediate-release melatonin for sleep disorders in adults, with dose titration in 3 mg increments only if needed, up to a maximum of 15 mg. 2, 3 This recommendation is based on clinical trial data demonstrating efficacy at this dose range.
Why 3 mg is the Standard Starting Dose
- Clinical efficacy data supports 3 mg as the threshold for meaningful sleep improvement in most adults with delayed sleep-wake phase disorder and insomnia. 3, 4
- Lower doses (<1 mg) are specifically reserved for circadian rhythm disorders in neuropsychiatric conditions, not primary insomnia or typical sleep disturbances. 5
- The 2017 American Academy of Sleep Medicine guideline found only weak evidence against clinically significant efficacy for melatonin in sleep-onset insomnia, but mixed evidence suggests possible improvement in sleep latency in elderly populations. 1
When 1 mg May Be Appropriate
For specific pediatric populations, 1 mg can be an appropriate starting dose:
- Children with typical development: 1-3 mg initial dose, 30-60 minutes before bedtime. 2
- Children with autism spectrum disorder or neurological conditions: 1 mg initial dose, 30-40 minutes before bedtime. 2
- Weight-based dosing for children without comorbidities: 0.15 mg/kg (which may approximate 1-2 mg in smaller children). 2, 3
The "Lower is Better" Misconception
While some evidence suggests receptor desensitization at very high doses (≥10 mg), there is no evidence that 1 mg is superior to 3 mg. 2 The American Academy of Sleep Medicine's recommendation to start at 3 mg reflects the dose at which clinical trials demonstrated meaningful benefit. 2, 3
- Higher doses (10 mg) may cause receptor saturation and more frequent adverse effects like morning headache and sleepiness. 2
- However, 3-5 mg represents the therapeutic sweet spot for most adults, balancing efficacy with minimal adverse effects. 2, 3
Practical Algorithm for Adults
Step 1: Start with 3 mg immediate-release melatonin taken 1.5-2 hours before desired bedtime. 2, 3
Step 2: Assess response after 1-2 weeks using sleep diaries tracking sleep latency and total sleep time. 2
Step 3: If ineffective and no adverse effects occur, increase by 3 mg increments up to maximum 15 mg. 2
Step 4: If 3 mg causes morning grogginess (uncommon but possible), you could trial reducing to 1-2 mg, though this is off-guideline. 2
Special Populations Requiring Lower Doses
- Elderly patients (>55 years): Prolonged-release melatonin 2 mg has shown some benefit, though evidence quality is low. 1, 3
- Patients with hepatic impairment or taking CYP1A2 inhibitors: May require dose reduction due to altered metabolism. 2
- Patients on warfarin or with epilepsy: Use with caution at any dose due to potential interactions. 2, 3
Important Caveats
- Melatonin is regulated as a dietary supplement in the US, raising concerns about purity and reliability of stated doses—choose United States Pharmacopeial Convention Verified formulations when possible. 2, 3
- Long-term safety data beyond 3-4 months is limited for chronic insomnia, though available evidence suggests good tolerability. 2
- Timing matters more than dose for circadian rhythm disorders—administration 1.5-2 hours before desired bedtime is critical for efficacy. 2, 3
- Morning or afternoon administration will worsen circadian misalignment. 2
Bottom Line
If you're treating an adult with typical sleep disturbances, start with 3 mg, not 1 mg, as this is the evidence-based dose with demonstrated clinical benefit. 1, 2, 3 Starting at 1 mg may result in inadequate treatment and delayed symptom relief. For children or specific circadian rhythm disorders, 1 mg may be appropriate based on weight and clinical context. 2, 6