Having trouble sleeping? You may be thinking about taking melatonin, a popular over-the-counter supplement used to promote better sleep. But melatonin isn’t a cure-all, and it doesn’t work for everyone. “The potential for benefit depends largely on dose, timing and the type of insomnia it is being used to treat,” says Dr. Melanie Pogach, a sleep medicine and pulmonary critical care specialist at St. Elizabeth’s Medical Center in Boston.
What Is Melatonin?
Melatonin is a natural brain chemical that’s sometimes called a “darkness hormone.” It helps regulate your sleep-wake cycle or circadian rhythm.
Melatonin levels increase at night, before you crawl into bed. “The dim light melatonin onset, when the melatonin level starts to rise, occurs a few hours prior to an individual’s sleep onset time,” Pogach says.
And when you do go to sleep, melatonin levels rise and eventually fall. “Melatonin starts to increase progressively, peaks in the middle of the night, and begins to disappear gradually by morning or sunrise,” says Dr. Mara Cvejic, a sleep medicine specialist based in Tampa, Florida.
A synthetic version of melatonin is available as a supplement. You’ll find melatonin pills in varying doses — such as 1, 3, 5 or 10 milligrams. Melatonin supplements are also sold in the form of gummies, tinctures (drops) or patches. You can even find sleep “cocktails” or combinations of supplements that include melatonin and other herbs that may promote sleep (such as valerian root), either in pills or droplets.
But you won’t find melatonin supplements with FDA approval. This is because melatonin is considered a dietary supplement, so it falls under different regulations than prescription medications.
Dietary supplements are not tested for quality or safety before they land on store shelves. That means:
— You can’t be sure exactly how much melatonin a supplement contains — if any — despite marketing promises on packaging.
— You won’t know what other ingredients are in melatonin supplements. Manufacturers may or may not include that information on packaging.
Who Should Take Melatonin?
Melatonin supplements are typically recommended to help people who are struggling with a circadian rhythm that’s out of sync. For example, that person could be:
— Someone working the night shift who has trouble sleeping during the day (shift work disorder).
— Someone coping with jet lag after flying in from another time zone (jet lag disorder).
— A high school student who is going to sleep too late at night.
“The goal of using melatonin is to shift the patient’s sleep onset to a more acceptable time. For patients with jet lag, this may be very different than for a high school student who needs to fall asleep earlier,” says Dr. Melissa Bernbaum, director of epilepsy and ambulatory sleep medicine at Northwell Health’s Huntington Hospital in Huntington, New York.
Melatonin is also used for sleep challenges such as:
— Delayed sleep phase syndrome. In this condition, a person’s natural sleep time is delayed by a few hours. So instead of falling asleep at 11 p.m., the person typically falls asleep at 1 a.m., and then wakes up later as a result.
— Irregular sleep-wake rhythm disorder. “Irregular sleep-wake rhythm occurs in the chronically ill or immobile who are in bed during the day,” Cvejic says.
Talk to your pharmacist or doctor before taking melatonin supplements. While it’s considered generally safe for use, melatonin is not recommended for older adults with dementia, and it’s unclear if melatonin is safe for use in breastfeeding or pregnant women. Melatonin may also interact with some medications, such as those to treat high blood pressure or diabetes.
The dosing and timing of melatonin depends on your sleep condition.
— For delayed sleep phase syndrome: Pogach recommends low-dose melatonin — 0.3 to 0.5 milligrams. “Together with proper light and dark cuing, low-dose melatonin taken two to three hours before the goal bedtime can help to pull sleep earlier,” she says.
— For general difficulty falling asleep: “A higher dose of 3 to 5 milligrams taken closer to bedtime is more sedating and can sometimes assist with sleep initiation,” Pogach says.
Melatonin is usually recommended for short-term use, just long enough to shift your sleep schedule and get back in sync with your circadian rhythm. “But patients sometimes take it chronically or intermittently without negative consequences,” Pogach says.
She notes that melatonin is not habit-forming and has no withdrawal symptoms when you stop taking the supplement, even abruptly.
However, there may be some short-term side effects of melatonin such as:
— Vivid dreams.
Will It Work?
Studies about melatonin’s effectiveness are mixed.
“In my experience, many patients who present to sleep medicine for evaluation report that they have tried melatonin and found it ineffective,” Pogach says. “This is likely because the expectation is that melatonin will fix insomnia and strongly induce sleep. That is not what melatonin does, however.”
But your own melatonin levels may also determine how effective the supplement is.
“When melatonin is taken during a person’s biological day, when one’s own melatonin levels are low, melatonin has transient and rapid ability to promote sleep. Sleep-inducing effects are much less consistent when melatonin is taken after a person’s own melatonin rise,” Pogach says.
[See: Steps to Fall Asleep Fast.]
What Else Will Help?
When taking melatonin, it’s important to maintain good sleep hygiene habits, such as:
— Going to sleep and waking up at the same time each day.
— Limiting exposure to blue light from electronic devices such as smartphones and TVs.
— Avoiding food and alcohol intake late in the evening.
— Creating a comfortable sleep environment that is dark and not too warm.
— Avoiding long naps in the daytime.
— Limiting caffeine intake.
— Exercising earlier in the day instead of right before bedtime.
Other therapies, such as cognitive behavioral therapy for insomnia, may also be helpful.
And remember that no single therapy will fix your sleeping problem. “A pill is almost never the permanent answer for sleep. It is only, after all, a supplement to the real changes in behavior, diet, attitude and exercise that we can directly effect real change,” Cvejic says. “But understanding our bodies and how we can make them more harmonious to the environment around us is the real benefit. This is essentially how I see melatonin — as an interesting bridge of education from the daytime sleep-wake habits we have to the neuroscience that is still a deep mystery.”
More from U.S. News