Does Melatonin usage promote sleep and are you taking it right?
Melatonin, the hormone of darkness as it’s called, is produced by the small pineal gland in the brain and typically produces about 0.1 to 0.9 mg per day, with production reducing with advancing age. Its production is triggered by the onset of dusk, increasing during the evening, reaching a peak between 2AM and 4AM and tapering off thereafter. Its half-life is between 10-60 mins after administration and metabolism is rapid.
Amongst its various uses, the one that has caught the public attention recently, is that of a safe sleep aid, more so after the COVID-19 pandemic. John Hopkins medicine states that taking melatonin supplements can aid in falling asleep slightly faster and might work for those with delayed sleeping and waking up times (technically known as delayed sleep phase syndrome). Melatonin did not have an effect on sleep quality, wakefulness after sleep onset (WASO), total sleep time, or percent time spent in REM sleep (Buscemi et al, 2004).
While the mechanism of melatonin inducing sleep is not well known, it might do so by influencing the circadian rhythm (24-hour body clock) or by reducing the core body temperature thus preparing the body for sleep (Buscemi et al, 2004). Taking the supplement 4 to 5 hours before bedtime works well for most and the more delayed the dose (closer to bedtime), the more the sleep-wake cycle gets delayed which means you wake up late and feel sleepy during the day (risescience.com, 2023). Melatonin is most effective in adjusting the circadian rhythm and hence could be useful when you have jet lag, or work night shifts. It is not a sleeping pill that you can pop and fall asleep.
Whatever be the mechanism of action and the efficacy, it’s an unfolding trend and possibly herd mentality along with the promotion of some new e-commerce platforms in this space. India is seeing a booming nutraceutical market which is slated to grow to US$18B by 2025 from US$4 Billion in 2020 growing at a CAGR of 20% (Finshots, 2024). Nutraceuticals are products isolated or purified from foods that are generally sold in medicinal forms not usually associated with food, demonstrated to have a physiological benefit or provide protection against chronic disease (Aronson, 2017). Melatonin supplements are one such nutraceutical that is available over the counter in various forms, pills, tablets, gummies etc. A survey found that about 70% Indians consume these nutraceuticals without consulting a doctor (Local Circles, 2024). Moreover, melatonin supplements are not approved by Food and Drug Administration (FDA) and hence are sold as dietary supplements over the counter. This boom in nutraceuticals post the pandemic could be dangerous due to 2 primary reasons:
- The danger of overdose – iron (overdose could lead to liver cirrhosis), vitamin D (vit D toxicity could kill), melatonin in kids (530% increase in emergency department visits for kids between 3 and 5 years of age between 2019-2021 in the US (CDC))
- The lack of regulation of nutraceuticals including melatonin. In India, nutraceuticals are classified as foods and not drugs and hence come under the purview of the Food Safety and Standards Authority of India (FSSAI) and not the Central Drugs Standard Control Organization (CDSCO), the apex drug regulator in India. Hence, they are exempt from rigorous product testing and trials before being approved.
In fact, the FSSAI, conducted a survey from 2019 to 2022 and found that 4,890 samples of dietary supplements were unsafe, 16,582 were substandard, and 11,482 had labeling defects or misleading information. In another study, OTC melatonin supplements were found to have a variation of -83% to +478% of the labeled content, which means that either you got close to a non-existent dose of melatonin or more than 4 times the labeled dose and about 26% of those samples also contained Serotonin, a neurochemical messenger which was not expected (Erland et al, 2017). Some melatonin gummies were found to have Cannabidiol, which is a banned substance.
Melatonin has been linked to headaches, dizziness, nausea, stomach cramps, drowsiness, confusion or disorientation, irritability and mild anxiety, depression and tremors as well as abnormally low blood pressure. It can also interact with common medications and trigger allergies.
Last but not least, it’s important to know that melatonin also has a protective effect on the immune and endocrine systems while also exhibiting differences between the sexes when it comes to melatonin secretion. One reason often cited is due to the use of oral contraceptive pills used by women for birth control which increases the secretion of melatonin among women at night. Possibly, reproductive hormones also affect melatonin secretion at night, and other studies suggest that there is bi-directional communication between melatonin and sex hormones (Cipolla-Neto et al, 2022)
The point being that we need to be careful while popping over the counter melatonin supplements. While it might give us a sense of satisfaction of having dodged the sleeping pill bullet, do risks of taking it without supervision outweigh the benefit of going off to sleep 5 minutes earlier?
Here are a few things that you can do to keep yourself safe-
- Talk to a Sleep specialist about taking melatonin supplements
- Mention any pre-existing conditions that you might have
- Take up-to 3 mgs of the drug (the exact amount to be directed by the physician)
- Do not pick up any over-the-counter melatonin supplement
- Get sunlight exposure in the morning, and l light exposure in the evening as bright lights might suppress the effects of natural and supplemental melatonin
- If you feel you have accidently overdosed on the supplement, seek medical help immediately.
Wish you a happy sleep!
References:
Buscemi N., Vandermeer B., Pandya R., et al. Melatonin for Treatment of Sleep Disorders. Summary, Evidence Report/Technology Assessment: Number 108. AHRQ Publication Number 05‐E002‐1, November 2004. Agency for Healthcare Research and Quality, Rockville, MD
Erland LA, Saxena PK. Melatonin natural health products and supplements: presence of serotonin and significant variability of melatonin content.
J Clin Sleep Med. 2017;13(2):275–281.
https://www.risescience.com/blog/how-long-before-bed-should-you-take-melatonin
Cipolla-Neto J, Amaral FG, Soares JM Jr, Gallo CC, Furtado A, Cavaco JE, Gonçalves I, Santos CRA, Quintela T. The Crosstalk between Melatonin and Sex Steroid Hormones. Neuroendocrinology. 2022;112(2):115-129. doi: 10.1159/000516148. Epub 2021 Mar 26. PMID: 33774638.