Melatonin for Insomnia

Did you sleep well last night?

Most of us have insomnia every now and then, and about 60 million Americans have trouble sleeping frequently or for extended amounts of time, according to the National Institute of Neurological Disorders and Stroke.

Drug cures are plentiful—and they’re also mostly short lived and sometimes a little too good to be true—but there may be an alternative.

Sleeping pills and side effects

For short-term sleep problems, doctors often prescribe benzodiazepines (such as Ativan, Valium, and Xanax) and other similar medications. While these do help people sleep, they’re not a cure for insomnia. Many (along with over-the-counter products) tend to lose their effectiveness after a couple of weeks. Worse, they can be habit forming and actually interfere with a good night’s sleep by reducing the time you spend in deep sleep.

For people who want to try an alternative, the answer may be the supplement melatonin.

How melatonin is thought to work

Melatonin is a hormone produced in the pineal gland, a structure deep within the brain. While there’s still a lot to learn about it, researchers have shown that it’s intimately connected with sleep. In fact, Rozerem—one of the newer sleeping pills—is a melatonin agonist, meaning it binds to the same receptors that melatonin does.

During the day, melatonin levels are low; when darkness falls, they increase significantly. Since we know that melatonin is part of the sleep/wake cycle, many integrative-medicine physicians recommend it as a sleep aid, touting it as a more “natural” way to help people beat insomnia.

Melatonin studies

Melatonin does have a few studies backing its effectiveness, though they’re not particularly large or conclusive.

In 2005, researchers analyzed data from 17 small studies. Their findings, published in Sleep Medicine Reviews, concluded that melatonin can make you fall asleep about four minutes faster, increase your sleep efficiency by about 2% to 3%, and add around 13 minutes to your sleep duration.

Melatonin safety and interaction information

Here's some melatonin safety and interaction information from the National Institutes of Health and National Library of Medicine. The site advises, among other things:

Do not take melatonin if either of the following apply:

• You’re pregnant, trying to get pregnant, or breastfeeding.
• You’re taking Coumadin or possibly other blood thinners.

Be cautious (you may require extra monitoring) if any of the following apply:

• You’re taking diabetes, heart, or blood pressure medicine.
• You’re taking herbs or supplements that may increase your blood sugar or risk of bleeding.
• You have a seizure disorder, major depression, or a psychiatric disorder.

Melatonin use may be especially relevant for the elderly. As people grow older, sleep problems become more common. Since melatonin levels decline as we age, it makes sense to think that supplements could help senior citizens get a good night’s sleep.

Melatonin effects and dosage

Melatonin doesn’t appear to be habit forming, lose its effectiveness, or interfere with normal sleep. It’s apparently safe for most people in the short term but hasn’t been studied in the long term. Dosages vary widely. A good starting point seems to be 0.3 milligrams. (You can cut a 1-mg tablet into thirds.)

As a physician specializing in holistic medicine, I try to educate my patients on which supplements are safe and effective, as well as those that are worthless and possibly dangerous. For people looking for a natural alternative for insomnia, melatonin appears to be a good choice to help them get a good night’s rest.


By Edward R. Rosick, DO, MPH
Contributing Writer
My Family Doctor Blog

[Last updated and/or approved March 2008, James Hubbard’s My Family Doctor Web site.]