What is melatonin?
Melatonin is a hormone that is produced by the pineal gland in the brain. Normally, your body makes more melatonin at night. Levels usually start to go up in the evening once the sun sets. They drop in the morning when the sun goes up. The amount of light you get each day, plus your own body clock, set how much your body makes.
What does it do?
Melatonin helps regulate the internal body clock’s cycle of sleep and wakefulness. Other claims are made for it: it has anti-oxidant and free radical scavenging properties and some say it has anticancer and anti-ageing effects, but there is no proof for this in humans. In regards to sleep, your blood melatonin level starts to go up about two hours before you go to sleep. It helps establish the conditions for sleep and your core body temperature to go down slightly at this time.
What can you use it for?
Melatonin in tablet form is used to treat insomnia and there are two ways that you can use it. The first is to make you feel sleepy. This is the most common use. The second is to help reset your internal body clock to a different time in conditions where it is out of synchrony with time of day, such as with jet lag or advanced or delayed sleep phase syndrome. In these cases melatonin therapy at night is often combined with Bright Light Therapy, applied in the morning (usually using outdoor light). Recently a synthetic form of melatonin has also been developed to treat depression.
Can I buy it or do I need a prescription?
In some countries you can buy melatonin supplements. In New Zealand melatonin is usually prescribed by a doctor.
Melatonin 2 mg modified release can be supplied without a prescription to adults aged 55 years or over with primary insomnia, for up to 13 weeks by a New Zealand registered pharmacist. This is the only approved use for melatonin in New Zealand and all other uses of melatonin, including the treatment of primary insomnia in younger adults, continues to require a prescription. In the future this change may apply to other currently unapproved formulations of melatonin, i.e. melatonin tablets up to 3 mg and melatonin modified release tablets up to 2 mg. Further information about this change is available from: www.medsafe.govt.nz/profs/class/ReclassificationOfMelatonin.asp
When should I take it?
If you take melatonin to go to sleep, the best time (for the slow release type particularly) is about an hour before you go to bed. However, some people feel a “wave” of sleepiness some 20 minutes after taking it and make the most of this by being in bed ready to sleep at this time. You may have to experiment a bit with when you take it. Discuss this with your prescribing doctor. You can also take it to adjust the body clock, for example when you are crossing time zones to minimise jet lag. You should take it close to target bedtime at your destination. The benefits are greater where more time zones are crossed and for eastward flights more than westward flights.
Can it cause problems?
Melatonin can cause sleepiness and so should not be taken before driving or operating machinery. Melatonin’s main benefit is in reinforcing external cues for sleep or as a tool to help shift sleep-wake rhythms. Long term use of melatonin is only appropriate if prescribed because of a significant underlying sleep disorder. Side effects are uncommon. These and its compatibility with your other medicines should be discussed with your prescribing doctor.
Are there side effects?
Melatonin is generally safe for short-term use. Unlike with many sleep medications, with melatonin you are unlikely to become dependent, have a diminished response after repeated use (habituation), or experience a hangover effect.
The most common melatonin side effects include:
Other, less common melatonin side effects include short-lasting feelings of depression, mild tremor, mild anxiety, abdominal cramps, irritability, reduced alertness, confusion or disorientation, and abnormally low blood pressure (hypotension). Because melatonin can cause daytime drowsiness, don’t drive or use machinery within five hours of taking the supplement.
In addition, melatonin supplements can interact with various medications, including:
- Anticoagulants and anti-platelet drugs
- Contraceptive drugs
- Diabetes medications
- Medications that suppress the immune system (immunosuppressants)
If you’re considering taking melatonin supplements, check with your doctor first — especially if you have any health conditions. He or she can help you determine if melatonin is right for you.
What about shiftwork?
Some shiftworkers take melatonin to help to “reset” their internal clock. If you’re considering taking melatonin, discuss it with your doctor and make sure you use it properly—in the correct dose and at the proper time. Inappropriate use of melatonin can backfire and increase sleep problems.
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