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Enter Sandman: The Truth About Melatonin

Posted 3/12/2018 by UHBlog

Popping a pill isn’t a direct route to Dream Land. Ask us about proven methods for getting a restorative night’s sleep.

Sleeping tablets

It’s been a rough day and you must wake up early tomorrow for a breakfast meeting, so you take a melatonin pill, brush your teeth and crawl into bed. Then you stare at the ceiling. And stare. And stare.

Neurologist and sleep medicine specialist John Andrefsky, MD isn’t surprised.

“Melatonin decreases sleep latency by about six minutes, which is not a lot of time considering people sometimes can’t fall asleep for 45 minutes, an hour or two hours,” he says. “Melatonin affects when you fall asleep, not how quickly.”

Dr. Andrefsky says melatonin is more useful in mitigating jetlag than in curing chronic insomnia, so it can be an effective tool for people who travel leisurely or for business. It works this way: People's bodies naturally “correct” one hour every 24 hours. For instance, if you attend a conference on the West Coast and return to Cleveland, you'll shift back to your normal bedtime and awaken more normally in three days, which corresponds with the three-hour time difference. Melatonin can help speed that process.

Although billed as a cure-all for insomnia, melatonin is not a perfect antidote for sleeplessness. A synthesized form of the naturally occurring hormone, which is secreted by the pineal gland in the brain, was patented by MIT in 1995 and is widely available as a pill or chewable gummy candy. Many people turn to it for chronic or occasional insomnia, but with mixed results, because they use it too frequently, take higher-than-necessary doses or don’t time it properly.

Dr. Andrefsky offers these tips for using melatonin:

  • Timing is key. Don’t take melatonin right before bed because it takes several hours for it to become effective. If you are a night owl who normally stays up past midnight (delayed sleep phase syndrome), but would like to nod off around 11 p.m. instead, take melatonin at 6 p.m. Conversely, if you go to bed at 8 p.m. and rise at 4 a.m. (either because you have advanced sleep phase syndrome or because of your work schedule), it’s better to take melatonin in the late morning or early afternoon.
  • Don’t overdo it. More isn’t better. Just 0.3 mg to 1 mg is sufficient, although many over-the-counter preparations may be upwards of 5 mg each. Overusing melatonin has consequences including:
    • Losing its effectiveness over time because brain receptors get desensitized to it
    • Worsening insomnia
    • Headaches
    • Nausea
    • Next-day drowsiness, which can affect work performance
    • Decreasing body temperature in the elderly
    • Interacting with other medications
    “Think of melatonin like a Tylenol for sleep,” Dr. Andrefsky says. “When you have a headache or joint pain, you take Tylenol for a few days and then you stop.”

Maintaining good sleep habits can decrease the need for melatonin, Dr. Andrefsky says. Good sleep habits include:

  • Developing a consistent sleep-wake cycle – going to bed and waking up around the same time every day, including weekends
  • Turning on the light first thing in the morning, so your body understands it's time to be awake
  • Sleeping in a cool, dark room
  • Avoiding late-night exercise
  • Not drinking coffee in the afternoon or evening if you are affected by caffeine
  • Reserving your bed for sleep and sex only. That means don’t watch TV or read in bed.
  • Getting checked for sleep apnea if you are waking up tired on a regular basis

John Andrefsky, MD is a neurologist and sleep medicine specialist at University Hospitals Parma Medical Arts Center and University Hospitals Medina Health Center. You can request an appointment with Dr. Andrefsky or any other doctor online.

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