Missing The Mark With Melatonin: Finding The Best Treatment For Insomnia

Stressful days and sleepless nights leave many people searching for a quick solution to their sleep troubles – is melatonin the answer?

As the coronavirus pandemic enters its second year, stress and anxiety are leaving many American adults struggling to get sufficient, quality sleep. Some may be tempted to turn to supplements like melatonin, but the American Academy of Sleep Medicine advises caution.

Melatonin is a natural hormone that helps regulate the daily cycle of sleep and wakefulness, with melatonin production increasing at night and decreasing in the morning. Evidence-based recommendations published by the AASM indicate that strategically timed melatonin can be a treatment option for some problems related to sleep timing, such as jet lag disorder and shift work disorder. However, another clinical practice guideline published by the AASM suggests that clinicians should not use melatonin in adults to treat chronic insomnia, which is what many are experiencing during the pandemic.

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“Melatonin isn’t a ‘one-size-fits-all’ solution to nightly sleep trouble,” said Jennifer Martin, who is a clinical psychologist, professor of medicine at UCLA and member of the AASM board of directors. “People who have difficulty sleeping should try making changes to reduce anxiety and stress near bedtime, like improving their sleep environment and getting into a morning routine first. If that doesn’t help, or their insomnia continues for more than 3 months, they should reach out to their healthcare provider to access effective treatment for their sleep difficulties, such as cognitive-behavioral therapy for insomnia.”

Another limitation of melatonin is that over-the-counter supplements aren’t regulated by the U.S. Food and Drug Administration. Therefore, there’s no way to be sure how much melatonin is in the supplement, unless the product label has the “USP Verified” mark, which indicates that the formulation meets the requirements of the U.S. Pharmacopeial Convention.

A 2017 study in the Journal of Clinical Sleep Medicine suggests that the melatonin content of dietary supplements often varies widely from what is listed on the label. Results show that melatonin content was not within a 10% margin of the label claim in more than 71% of supplements, with the actual content ranging from 83% less to 478% more than the label stated. The study also found that lot-to-lot variability within a particular product varied by as much as 465%.

Insomnia involves difficulty falling asleep or staying asleep, or regularly waking up earlier than desired, despite allowing enough time in bed for sleep. Daytime symptoms include fatigue or sleepiness; feeling dissatisfied with sleep; having trouble concentrating; feeling depressed, anxious, or irritable; and having low motivation or energy.

Instead of trying melatonin for better sleep, Martin suggests adopting healthy sleep habits and following these tips to address a short-term problem with insomnia:

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.

• Set a bedtime that is early enough for you to get at least 7 hours of sleep.

• Don’t go to bed unless you are sleepy.

• If you don’t fall asleep after 20 minutes, get out of bed.

• Establish a relaxing bedtime routine.

• Use your bed only for sleep and sex.

• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.

• Limit exposure to bright light in the evenings.

• Turn off electronic devices at least 30 minutes before bedtime.

• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.

• Exercise regularly and maintain a healthy diet.

• Avoid consuming caffeine in the late afternoon or evening.

• Avoid consuming alcohol before bedtime.

• Reduce your fluid intake before bedtime.

“These behavioral changes can result in long-term solutions for better sleep, instead of the temporary fix someone might get from a sleep aid,” said Martin.

However, if you have chronic insomnia, then sleep tips alone are unlikely to be enough to help you solve the problem. Chronic insomnia disorder, which affects about 10% of the adult population, is distinguished by a sleep disturbance with associated daytime symptoms occurring at least three times per week for at least three months.

The AASM recommends that clinicians use cognitive behavioral therapy for insomnia (CBT-I) for the treatment of chronic insomnia disorder in adults. CBT-I combines one or more cognitive therapy strategies with education about sleep regulation plus behavioral strategies such as stimulus control instructions. Medications for chronic insomnia should be considered mainly in patients who are unable to participate in CBT-I, patients who still have symptoms after this therapy, or those who require a temporary adjunct to CBT-I.

Bottom line? Talk to your medical provider before taking melatonin. Your provider can determine if you have a sleep disorder such as chronic insomnia and may refer you to an accredited sleep center for help.

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