Today I rant about melatonin. Surprised? You should be! I normally drone on and on about the trendy, flash-in-the-pan type supplement that’s only popular because of social media.
Why rant about something considered to be low risk and widely used? Something reliable… something dependable?
It’s not like it’s outlawed over-the-counter in the UK, European Union, Japan, Australia, or Canada…
::Checks notes:: Oh wait, it is? It’s a prescription-only drug there? Yikes…
Well, I guess besides that, I’ve only got a few minor gripes about it. Specifically, our basis for using it is wrong, we use it incorrectly, we use too much, and generally, it’s a powerful tool at our disposal that we don’t respect.
And, me being me, I add another dimension to the conversation beyond therapeutics: melatonin products are a hot mess.
Let’s go on a ride here. Maybe across a few time zones. Let me lay out my 5 point case for why you also should take pause when it comes to melatonin.
I’m No Longer Pro Melato-nin.
A few months back I had the pleasure of interviewing lifelong sleep researcher and awesome first-named Dr. Neil Stanley’s How to Sleep Well is one of our most downloaded podcasts
Stanley’s reaction – avoiding it like the Black Plague – gave me pause. He quickly deferred to a real expert, whom I’ve had the pleasure of speaking with AND reading about 60 pages of her works, Dr. Jo Arendt.
While she’s been very helpful pointing me in the right direction, she doesn’t feel podcasts are her jam. Someday, I’ll get her on ????
Anyway, both of these respected experts come to the same conclusion: we’re messed up about melatonin.
Both agree with me that it CAN be a powerful tool, it is far too widely used and the use is mostly improper. I bring to you today the results of the conversations and research, and hopefully, it will help you take pause as I now do.
1 – Our Basis For Using Melatonin Is COMPLETELY Wrong
If you’re a regular follower of my work, you know I believe solving the problem of poor sleep is MUCH simpler than we believe.
You see, the complexity is created by the media which has fed an unhealthy obsession with sleep, which leads to even poorer sleep.
Most of us suffer from rather ‘simple’ insomnia. Meaning, we don’t have some neurological condition or sleep disorder that requires intense treatment. Melatonin CAN be an answer, then, but only if advised by a pro.
Many of us have difficulty falling asleep. Many more still have a hard time staying asleep. Some of us wake up earlier than we’d like.
Solving sleep problems requires understanding this triad, examining your circumstances, and learning the slightly nuanced approach to resolving the issues. It takes someone committed to fixing medical problems that may wake you up, and understanding a gentle approach to falling asleep is required.
That’s not us though.
From my years as a practitioner, I believe people want their sleep supplements to be taken just moments before getting into bed and then render them dead to the world for exactly 8 hours. They then would wake up refreshed and ready for the day, sans-cappuccino.
In less sarcastic words, our expectations around sleep are highly skewed.
We should not expect nor do we want our sleep medicine to knock us out like that. All sleep products provide a calm mind or calm body for you so you can fall asleep easier. They vary in intensity, side effects and other liabilities, and how long they last.
From a pharmacy nerd perspective, the doses and potencies required to have our perceived ideal effect are much too high, the agents that can provide that usually have active metabolites that can wreak havoc, and the effects can last well into the morning.
Melatonin, especially at the high-as-heck doses Americans use, CAN provide a solution for those looking for the quick, yet lazy fix. It will zonk you out for a LONG time. Melatonin, as we will discuss, is especially problematic when used this way.
This approach, with melatonin or otherwise, is penny wise (not the clown) and pound foolish. We’ll have short term success while building long term risks.
1.5 – Melatonin Isn’t A Sleep Hormone
We expect our sleep medicines to work in a manner in which is basically unhealthy, but highly convenient for us. Along the lines of incorrect expectations, we expect melatonin to be a sleep hormone and it, in fact is not.
Melatonin is a darkness hormone. Read it again. Etch it into your mind. You’ve been brainwashed by the media. Time to reprogram.
Melatonin’s role in the body is to respond to decreasing light. This has a role on us tracking the length of night as well as seasonal stuff, like growing your hair to keep warm or when mating season is coming up and you need to dust off those dancing shoes.
We don’t even NEED melatonin to sleep. People who have had their melatonin-producing pineal gland removed will still sleep to the norm. We sleep better when the normal rhythms are maintained AND in sync with our melatonin production, but it’s not needed.
Doses higher than our body produces that are taken as a medicine or supplement will have 2 major effects. First, it will induce sleep. Great, right? Well, it can be.
Melatonin taken as a medicine or supplement can shift our circadian rhythm, or night and day cycle. And that’s not great at all for most of us.
2 – We Use Melatonin Incorrectly
Here’s what you should know that I hope I’ve made clear so far: Melatonin isn’t a sedative. Or at least, it shouldn’t be considered a sedative by us.
Melatonin is best used to reinforce our natural circadian rhythm. It also has great potential to help with jet lag, where the visual cues of night and day are shifted dramatically from what our internal clocks are telling us.
Here’s a big asterisk to this conversation: there’s no such thing as a “normal” circadian rhythm. We don’t know what your peak melatonin levels will be. We don’t know how long melatonin will secrete, or when it will start. Studying melatonin use is difficult because of this highly individualized system. Therefore, before we even begin, we’re probably using melatonin wrong because we have no idea what your exact optimal schedule will be at any given time.
Melatonin begins secreting once the sun begins to set, then peaks at about midnight, then decreases until the morning.
Taking melatonin, then, at 11pm or 12am, will just shift our clocks out by 3-4 hours.
The other way we use melatonin incorrectly is by sending our body mixed messages. Melatonin is the darkness hormone, remember? Why would we take it and then watch bright TVs, keep on artificial blue house lights, and our use wonderful devices 2 inches from our eyes?
The amount of light we are exposed to will suppress or modify the amount of melatonin released, messing up our cycles more.
Light control is probably more effective than using melatonin if you believe you need a better night/day rhythm.
This is where camping for a week without electronics is the best mechanism to reset your cycles, as I referenced in our sleep article. The good news is you can do it in a weekend by just cutting all artificial lights after dusk and using just candles.
You don’t need to do the camping thing if you’re dramatically out of sync. If you’re staying up past your bed time with no tiredness in site, staring at the ceiling, I’d recommend getting your light cues in order. No artificial light after sundown for 3-7 days. No devices, either. Keep those curtains open so the sun shines in bright and early.
The Proper Use of Melatonin
To help you fall asleep earlier in the night, you would use melatonin in the early afternoon as or right before the sun sets. You would then dramatically decrease the artificial light at work and home, and even going as far as using sunglasses and black out blinds for the natural light. Just make sure that light shines in early in the morning.
To shift your sleep later, you would take melatonin in the early evening and keep your light cues higher than normal. Artificial light is good here, and hiding early morning light is ideal.
Melatonin For Jet Lag
This probably requires its own infographic or article, but there’s a science to properly using melatonin to help adjust to rapid time zone changes via travel.
First, if we’re going for less than 4 days, you should probably just suck it up. Don’t bother with melatonin, but adjust your light cues to best match the destination. If you’re in New York and going to Hawaii, keep those bright lights on late by 3-4 hours. Keep your curtains drawn in the morning. When you get there, short acting sedatives (again, CBD!) and caffeine are your friends.
If you’re going for 4-5 days, there’s a method where you slowly adjust by 1-2 hours each day starting about 5 days in advance. The same process has to happen, in reverse, for the flight home. Or, you can just toughen it out, adjust your light cues, and build in 1 day of rest to get caught back up.
In other words, you’re trying to adjust your body where you are to the time it is in your destination before you go.
Here’s a great image for those interested written by Jo:
3 – We Take Too Much Melatonin
Doses used for jet lag are 0.5mg-1.5mg typically. Low dose melatonin is normally way less than 5mg.
Many Americans use 5-10mg a night.
The larger the dose, the larger the sedation, but the larger the impact on the cycles.
There isn’t much to say beyond that, here, without spoiling the next section. I’ll leave you with this little pearl of wisdom:
“A recent meta-analysis of 17 studies (mostly healthy subjects) showed melatonin shortened sleep latency by a mean of 4 min, increased sleep efficiency by 2.2% and lengthened sleep duration by 12.8 min; all values are modest at best.”
We’re taking melatonin for sleep as a hypnotic even though it is generally ineffective. We take it incorrectly timed, then overdose ourselves. All because I believe we don’t respect it or the danger it could pose.
4 – We Don’t Respect Melatonin
Putting all of this together will hopefully help some of you out there go, “Oh, ay, wait a stinkin’ minute here…” Or however you talk.
There’s more reasons, though, why I believe that melatonin needs to be respected.
Melatonin belongs to a category of compounds called chronobiotics. No, this doesn’t have to do with your gut.
These compounds affect the clocks of your body. Not just today/tonight, but over a larger scale.
Melatonin can delay menstrual cycles. So much so that it was, about 25-30 years ago, studied as a contraceptive.
On top of this, melatonin has general anti-sex gland effects:
“Few know that melatonin in the early 1960s was known as an anti-gonadal hormone. Doses as little as 1 μg (20 μg/kg) reduced gonadal size and fertility in various rats, mice, and hamsters.
Doses well below those used in children had physiological effects on gonadal function in rodents and primates.
For children a 3-mg tablet of melatonin equals 200 μg/kg for a 15-kg child, and equals 60 μg/kg for a child weighing 50 kg. Melatonin implants in cats inhibit estrus and advanced the onset of puberty in primates by 5 mo… to assume melatonin would not have some sexual effects would be incorrect.”
Melatonin isn’t some benign agent. It’s a powerful weapon that can and should be used when the situation is right. I just dont think many of us respect the blade.
For those with clock issues, diagnosed by a medical professional, the continued use of melatonin may be advised. It’s fine to continue, but try lowering the dose to its lowest effective point, or even take a holiday.
5 – Melatonin Products Stink
Melatonin supplements used to come from piggie brains, but most of the supply now is synthetically made. A melatonin study done in Canada before the OTC ban was quite troubling.
A random sampling of products you can buy at stores came up with a harsh truth: your vitamins are lying to you. They found that 76% of products didn’t meet labelled claims. They weren’t off by a little bit, no. The products ranged from having 83% LESS melatonin than labelled all the way up to 478% MORE.
Melatonin degrades quickly, so the authors believed we end up with extra melatonin because they’re trying to account for that degradation, as is the case with probiotics like Probiotic Complete.
Five times the amount seems like a bit much.
And, to boot, the authors found traces of serotonin, the precursor to melatonin in a number of products. Serotonin is a neurotransmitter than can interact with other medications and induce serious complications like serotonin syndrome.
If we go back to The 3 Types of Dietary Supplements, remember I said that about ⅓ of supplements are potentially dangerous. Well, 26% had a potentially dangerous contaminant, and many products could have given significantly higher levels of melatonin. Maybe I should change my numbers around?
Why We’re Messed Up About Melatonin – A Summary
There’s a lot of info in this article. Actually everyone gets the firehose of information. Here’s a simplified version of it all:
- We use melatonin as a sedative. There are better options.
- We use melatonin at the wrong time. It’s best to use it as the sun is setting or at dusk. Taking it late will shift our clocks out, leaving us tired during the morning and unable to fall asleep earlier
- We take melatonin but then send our body mixed messages. Bright lights. TVs. Devices. All these will shift your rhythms. Melatonin must be combined with light controls to optimize the effect on your sleep cycle.
- Using melatonin for jet lag works best when you’re going for at least 4-5 days, but it requires a lot of work in advance
- Melatonin has some serious potential effects on puberty, menopause, and other system-wide clocks. There hasn’t been any demonstrated link, but we must respect melatonin more.
- Melatonin products are probably a mess. It’s important that your product meets labeled claims.
Practice Safe Sleep
I want ya’ll to get a melatonin you can trust if you’re looking for one. I personally prefer slower release forms like our Sleep Ease. It delivers a lower dose of 2.5mg immediately, then releases the balance of 2.5mg over some time, closer mimicking our natural release.
For those looking for lower doses, check out our 1mg lozenge. Split it in half and dissolve it in your mouth – it will get absorbed easier.
As I stated a few times here, I’m loving CBD for sleep. A small dose is enough to calm your mind or body. It works quickly. It doesn’t hang around forever, reducing your chance for drowsiness. If you get 4 hours in but wake up, you can redose without worrying about hangover the next morning.
Alternatively, schedule a consult with yours truly to address your sleep issues. The bottom of the Wellness Pyramid specifically states we need to get sleep in order to live our best lives. We don’t want to upset the geometry, do we?
Melatonin? More Like Mela-NO-nin! Right?
Just because it’s natural, doesn’t mean it’s better. Melatonin is excellent. When used correctly it can be a quite powerful tool. Not as a hypnotic or sedative, but as an agent that will help you restore a normal sleep/wake cycle – especially if traveling across time zones for days at a time.
Many of us should rethink our melatonin usage and sleep strategies. I believe America should follow suit with other countries and restrict the usage of melatonin, either by lowering the doses and types that are available or making it prescription only. Until then, let’s show melatonin the respect it deserves.
Just trying to keep it real…
Neal Smoller, PharmD
Owner, Pharmacist, Big Mouth
