From the Guidelines
Melatonin primarily helps with sleep initiation rather than sleep maintenance, with a mean reduction in sleep latency of 9 minutes compared to placebo, as reported in the 2017 American Academy of Sleep Medicine clinical practice guideline 1.
Key Points
- Melatonin works best for people who have difficulty falling asleep at the beginning of the night, with typical dosages ranging from 0.5-5mg taken 30-60 minutes before bedtime.
- Lower doses (0.5-1mg) are often recommended to start, as higher doses don't necessarily work better and may cause morning grogginess.
- For sleep maintenance issues (waking up during the night), extended-release formulations may be more helpful, though evidence for this is less robust.
- Melatonin works by reinforcing your body's natural sleep-wake cycle, binding to receptors in the brain that regulate circadian rhythms, as described in the 2015 American Academy of Sleep Medicine clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders 1.
Important Considerations
- Melatonin is particularly effective for certain conditions like delayed sleep phase syndrome or jet lag.
- Side effects are generally mild and may include headache, dizziness, or daytime sleepiness.
- While melatonin is available over-the-counter, it's best to discuss its use with a healthcare provider, especially if you have existing health conditions or take other medications, as recommended in the 2016 American College of Physicians clinical practice guideline for the management of chronic insomnia disorder in adults 1.
Recent Findings
- A 2022 study published in Sleep Medicine Reviews found that exogenous melatonin, which has soporific effects in some when administered 30–60 min prior to sleep, and circadian phase advancing or delaying effects when administered in the early evening or early morning hours, respectively, has also been investigated as an adjunctive treatment for adolescent sleep and circadian outcomes 1.
From the FDA Drug Label
Helps establish normal sleep patterns nighttime sleep aid for occassional sleeplessness
Melatonin helps with sleep initiation.
- It is used as a nighttime sleep aid for occasional sleeplessness, which suggests it aids in falling asleep.
- The label does not explicitly mention sleep maintenance, which is the ability to stay asleep throughout the night. 2
From the Research
Melatonin's Role in Sleep
- Melatonin is an endogenous hormone produced by the pineal gland and released exclusively at night, playing a major role in the regulation of the sleep-wake cycle 3, 4, 5.
- It has been shown to synchronize the circadian rhythms, and improve the onset, duration, and quality of sleep 3, 6.
- Melatonin is centrally involved in anti-oxidation, circadian rhythmicity maintenance, sleep regulation, and neuronal survival 3.
Sleep Initiation and Maintenance
- Melatonin helps regulate the sleep-wake cycle, and its secretion is coupled with the opening of the nocturnal sleep gate, suggesting a role in sleep initiation 5.
- Exogenously administered melatonin may be beneficial in certain types of insomnia related to disturbances in the normal secretion of the hormone, which can affect both sleep initiation and maintenance 5, 6.
- The prolonged release formulation of melatonin has been recommended for the treatment of insomnia in over 55 years old subjects, indicating its potential in improving sleep quality and maintenance 6.
Therapeutic Functions of Melatonin
- Melatonin offers an alternative treatment to currently available pharmaceutical therapies for sleep disorders with significantly less side effects 3, 7.
- It has been suggested that melatonin deficit is at least partly responsible for sleep disorders, and treating this age-related deficit may be a natural way of restoring sleep quality 7.