From the Guidelines
The recommended melatonin dose 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 dosage 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 binds to the M1 and M2 receptors, suppressing REM sleep motor tone and renormalizing other circadian features of REM sleep.
Some key points to consider when prescribing melatonin for isolated REM sleep behavior disorder include:
- The starting dose of immediate-release melatonin is usually 3 mg taken at bedtime
- The dose may be titrated up to address dream enactment in 3-mg increments to 15 mg
- Data on higher dosing are not available
- Melatonin is considered a dietary supplement and is available over the counter in the United States and Canada, but its bioavailability and content may be less consistent across formulations
- Combination therapy using clonazepam and melatonin is common in clinical practice if response to monotherapy is inadequate, but there is a paucity of data examining combination therapies 1.
It's essential to note that melatonin requires a prescription in the European Union and the United Kingdom, and its use should be monitored by a healthcare provider, especially for long-term use or in patients with underlying medical conditions 1.
From the Research
Recommended Melatonin Dose
- The recommended melatonin dose is not explicitly stated in the provided studies, but various doses have been investigated for their effects on sleep.
- A study on ramelteon, a selective melatonin receptor agonist, found that an 8 mg tablet taken 30 minutes prior to bedtime was effective for the treatment of insomnia characterized by difficulty with sleep onset 2.
- A systematic review and meta-analysis on the safety of higher doses of melatonin in adults found that doses of 10 mg or higher were generally well-tolerated, but may increase the risk of adverse events such as drowsiness, headache, and dizziness 3.
- A review of the sleep-promoting effects of melatonin found that the effects of melatonin may vary depending on the dose, category of subjects, and time of administration, and that melatonin may benefit sleep by correcting circadian phase abnormalities or by a modest direct soporific effect 4.
- A clinical review of the literature on optimal melatonin dose in older adults found that doses between 1 mg and 6 mg may be effective for improving sleep in older adults, but further studies are needed to determine the optimal minimum effective dose 5.
- A systematic review and meta-analysis on the efficacy and safety of ramelteon for the treatment of insomnia in adults found that ramelteon was associated with improved sleep quality and reduced subjective sleep latency, but its clinical impact was small 6.