Melatonin and Sleep

Feb 16, 2021

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

``I`m done with adulting. I quit.`` I have to agree with Emily. Adulting sucks. One day last week when Eric came home from school, he managed to open the deadbolt on the door, but also break his key off in the lock. That led to several hours of trying to remove the dead bolt, stripping the Phillip's head, and Doris, the handyman of our house, going to McMunn and Yates and getting a new one. My 75-year-old dad was having trouble getting his printer to talk to his router. Despite his age, he is very computer savy. However, he couldn`t convince the tech on the phone that he had already rebooted his router and his 75-year-old knees didn`t want to get down there and do that again. We've all got the joys of adulting stories. But Emily might have us all beat how annoying adulting can be.

In the pharmacy last week, I got called to talk to someone in the melatonin aisle three times in a row. Sometimes the topics for this article are easier to find than others. Insomnia or trouble sleeping is a common problem. Sometimes people have trouble falling asleep. Sometimes people have trouble staying asleep. Insomnia can affect your work, school, social life and health. Other conditions people have can also make insomnia worse. Conditions like depression, anxiety, allergies, and pain.

Before reaching for any medication, we need to talk about good sleep habits. Good sleep habits are important. Try to go to bed and get up at the same time every day, even on weekends. Get regular exercise everyday and try to avoid exercise too late in the day. Before going to bed, imagine locking your worries into a box and putting that magical box away on a high shelf until morning. Do something relaxing and enjoyable before bed. Make your bedroom quiet, dark and comfortable. Avoid large meals just before bed. Don`t check Facebook, read emails, watch TV or anything else with a screen in your bed just before bedtime. Use your bedroom for sleep and sexual activity only. If you don`t fall asleep within 15-20 minutes, get up and go to another room. Only return to your bedroom when you feel drowsy. Don`t nap during the day. Avoid alcohol, nicotine and caffeine. Spend some time outside each day.

Even if you are on sleeping medication, good sleep habits are still important. In fact, it seems that more evidence is accumulating all the time that sleep medications might do more harm than good. There is currently a push to get older people off sleep medications. Medications called benzodiazepines with names like diazepam and temazepam and Z-drugs with names like zopiclone can cause serious harm like impaired driving, falls and broken bones after a fall.

Because of the push to get people, especially older people, off prescription sleep medication, melatonin has been getting more attention lately. Melatonin is a hormone produced by the pineal gland in your brain. Melatonin is produced when you are in the dark. The pineal gland is suppressed by light, so it only produces melatonin at night. Melatonin helps set your internal clock. For example, if a commercial pilot flies to Australia, her internal clock will be 15 hours off from local time. If she takes melatonin at 10 pm local Australian time, that will help convince her body it is dark out and it is time to sleep now. This will help reset her internal clock to local time. Interestingly, melatonin might be more effective for sleep in older people than in younger people. The theory is older people are more likely to have low levels of melatonin in their bodies, so melatonin supplementation might help older people more.

There have been lots of claims about all the good things melatonin might do. Various papers have looked at melatonin benefits in cancer, diabetes, high blood pressure, intestinal diseases, neurodegenerative diseases and even aging. The chances of bad things happening if you take melatonin is very low. Healthy volunteers have taken very large doses of melatonin, in the range of 20-100 mg per day, without showing any bad effects. But not everyone is so jazzed about melatonin and sleep. The American Sleep Association says melatonin's evidence is conflicting, but it might help some people sleep. The American Academy of Sleep Medicine advises clinicians not to recommend melatonin for sleep because it says the evidence is weakly against melatonin helping with sleep.

If you are going to try melatonin for sleep, usually a person would start with 3 mg of melatonin about 30 to 60 minutes before bedtime. Most people won`t need to go over 5 mg. If the melatonin doesn`t help within 2 weeks, stop. It isn`t harming you, but probably isn`t helping either. Melatonin may reduce the time to fall asleep by about 10 minutes, which is similar in effect most prescription sleep medications. Melatonin doesn`t usually cause hangover drowsiness the next day like some prescription sleeping medications. However, you can get extra sedation that you might not want if you mix melatonin with other sedatives.

A couple weeks ago, Emily called from Saskatoon. Her ice cubes had melted. Much Googling and phone calls and days later a repair person came to look at her fridge. A new part and several more phone calls and days later and the fridge was repaired. And the fridge repair lasted about a day. Then the fridge stopped working again. More Googling and more phone calls and we tried to order a new fridge to be delivered. The first store said it would take a month as that brand was on back order. More Googling and more phone calls and store number two said it would take the same month long wait for a fridge. So, Emily's fridge is on order. Emily and her roommate are keeping their frozen stuff on the patio and their fridge stuff in a cooler. And that is how Emily won the complaining about the adulting game.

As always if you have any questions or concerns about these products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.


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