Age Wise

Suzanne Bertisch used to take melatonin supplements now and then to help her get to sleep when transitioning from night-shift to day-shift work or to combat jet lag. For anyone considering melatonin as a remedy for sleeping problems, she advises such “strategic” use of the hormone, and cautions that it is not a cure-all for sleep issues.

Bertisch should know. She’s a medical doctor, assistant professor of medicine at Harvard Medical School, and director of behavioral sleep medicine at Brigham and Women’s Hospital.

Melatonin can be helpful in certain cases, such as time-zone transitions, for people who stay up late on weekends but need to get back on track for Monday morning, or for individuals whose internal clocks are otherwise out of sync with the demands of modern society, Bertisch explains. It is not recommended for chronic insomnia, however.

How melatonin works

Melatonin is produced naturally by the brain’s pineal gland and also, in lesser amounts, in the retina. The hormone helps regulate your internal clock, a daily cycle known as circadian rhythm. The sun serves as the primary on/off switch for this body clock: Darkness triggers the production of melatonin to start the process of making you sleepy; daylight throttles the production to keep you awake and alert.

If you disrupt this cycle — say, by working the night shift or sequestering yourself inside all day amid typical home or office lighting — your brain and body get royally confused. Some people, namely night owls, are naturally off-cycle.

Melatonin supplements can help fix a “body clock issue” by acting as a signal to the brain that it is indeed night. “It’s like a little push,” Bertisch says.

In a phone interview, I asked Bertisch about my wife, who typically sleeps well but is a total night owl, often coming to bed hours after I’m well zonked. “She’s the perfect candidate,” Bertisch says. “If she wanted to go to bed earlier, she’s someone who I could see would benefit from it.”

On the other hand, I usually start yearning for my pillow by 9 p.m. and have no trouble falling asleep by 11 p.m., yet I often wake around 5 a.m. and wish I could get another hour in. Melatonin supplements are not for me, Bertisch says. Rather, if I wanted to stay up later and try to align my bedtime with my wife’s — which seems like a silly way to manage one’s body clock — “we would actually use evening light to move you the other way,” she points out.

On the bright side, melatonin is not a sedative, so it doesn’t cause extreme drowsiness which, with many sleeping pills, can ironically linger into the next day. (For the record, studies have shown that over-the-counter sleeping pills generally do not work as marketed and have serious potential side effects — like diarrhea and, um, death.) Many experts see melatonin, then, as a safer and more natural alternative.

“Short-term use of melatonin supplements appears to be safe for most people,” according to the National Institutes of Health.

The problems with melatonin supplements

Melatonin is available over-the-counter in the United States, and consumption has increased the past decade, a recent study found. In Canada, Australia, Japan, and Europe, melatonin is sold by prescription only, acknowledging the hormone’s potency and the need for caution.

There are three reasons to be cautious about melatonin supplements:

1. Lack of evidence for effectiveness on insomnia: Research on whether melatonin supplements help people with chronic insomnia points to a lack of effectiveness. A 2017 review of studies on melatonin, often cited by experts in the field, concluded that it should not be prescribed for chronic insomnia.

2. Mystery ingredients: Because melatonin and other dietary supplements are not regulated in the United States the way medicine is, you often can’t be sure what you’re actually swallowing. A review of 30 melatonin supplement brands found the actual amount of the hormone ranged from 83% less than what the label said to 478% more. Similar variation was found even within separate lots of the same brand. Moreover, eight of the brands contained serotonin, a hormone used to treat neurological disorders, even though there was no mention of it on the labels.

3. Side effects: Immediate side effects of proper dosing tend to be mild, including drowsiness, headache, dizziness, and agitation. But there hasn’t been sufficient research to say whether continual use might be detrimental. “Information on the long-term safety of supplementing with melatonin is lacking,” according to the NIH.

Do this: When choosing a melatonin supplement, or any dietary supplement for that matter, look for a USP verification mark (or search verified products here). This label indicates the product has been tested, on a voluntary basis by the manufacturer but with oversight from a nonprofit, to contain what it says it does and nothing else.

Dose, timing, and experimenting

There are no formal guidelines for use or dosage of melatonin supplements in the United States. Night owls or frequent flyers wishing to shift to an earlier bedtime could try low doses, no more than three to five milligrams, Bertisch advises. Try splitting a pill in half to get the lowest dose possible.

If that doesn’t help, experiment with higher doses up to five milligrams, but not more.

There’s no established perfect timing. Bertisch suggests trying about one hour before the time you hope to fall asleep. If you’re using it to fight jet lag on a trip from west to east, for example, then take it the night before the outbound leg, about an hour before your hoped-for future East Coast bedtime.

It’s not advised to take melatonin during the night, after you’ve already slept some.

Melatonin is also notadvised for people who fall asleep reasonably well at a reasonable hour, but find sleep fitful later in the night or the early morning hours. (By the way, it’s totally normal and natural to awaken multiple times during the night, especially later in life.)

Older people should consider melatonin supplements with the same strategic eye as younger adults. If you get sleepy earlier as you age, and you fall asleep fine but wake up during the night, melatonin supplements are more likely to add to your problems than help, Bertisch says.

Most children should avoid melatonin — even though many pediatricians recommend it — in part because its effects on developing brains and bodies are not fully understood. “Melatonin is a hormone, and it may have effects on reproductive hormones, particularly at certain critical developmental windows,” Bertisch says.

Instead of supplements

Companies selling sleep aids would love you to think we’re a nation of sleep-deprived zombies. In reality, most adults can do just fine on seven or eight hours of nightly sleep, and the latest research finds about two-thirds of U.S. adults achieve this threshold.

If you think you need melatonin, you can get plenty of it for free. Simply get outside more. While very bright and targeted artificial lighting, such as from light boxes aimed at treating depression, can affect the circadian cycle, the effect from most home and office lights is somewhat negligible. Natural outdoor light, even on a cloudy day, is vital to properly suppress melatonin production, setting your body up to produce it at night, when you need it.

Experts advise at least two hours of outdoor time daily to keep your circadian rhythm in sync, and ideally get some of it first thing in the morning.

There are of course many other remedies for poor sleep. Among the most important, all of which combined help create a virtuous cycle of good health:

• Eat healthy foods and avoid alcohol.
• Avoid long naps, especially late in the day.
• In the evening, shun stressful activities like work email or scary movies.
• Pick a bedtime and stick to it.

If none of these remedies work, and your primary problem is with falling asleep at a decent hour, then melatonin supplements might offer some short-term help — not a long-term crutch, but a catalyst for change. If melatonin is going to work for you, the effect should become evident in a day or two.

“If you find you’re using it over a longer course, you should discuss it with your doctor,” Bertisch advises. “That may be a sign that you may have an underlying sleep disorder and there may be better and safer options.”

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